Young age at first intercourse and risk-taking behaviours—a study of nearly 65 000 women in four Nordic countries

European Journal of Public Health, Apr 2012

Background: Risk-taking behaviours such as early initiation of smoking, alcohol drinking and sexual activity often cluster within individuals and could be characteristics of adolescents who in general are risk takers. In the present study, using a large population-based sample of 64 659 women aged 18–45 years in four Nordic countries, we investigate whether young age at first sexual intercourse is associated with subsequent risk-taking behaviours. Methods: We examined the association between young age at first sexual intercourse (age ≤14 years) and subsequent risk-taking behaviours by using multivariate logistic regression by which odds ratios (ORs) and the corresponding 95% confidence intervals (95% CIs) were estimated. Results: The OR of reporting more than 10 lifetime sexual partners was almost four times higher among women who reported a young age at first intercourse (OR = 3.79; 95% CI: 3.60–4.00) in comparison with women >14 years at first intercourse. Furthermore, women who were young at first intercourse were more likely to report two or more recent partners (OR = 1.67; 95% CI: 1.54–1.82) and to have a history of STIs (OR = 2.03; 95% CI: 1.93–2.13). In addition, young age at first intercourse was associated with current smoking (OR = 2.31; 95% CI: 2.20–2.43) and binge drinking (OR = 1.36; 95% CI: 1.28–1.44). All ORs were adjusted for age, years of education and country of residence. Conclusion: Young age at first intercourse is associated with subsequent risk-taking behaviours. Our study emphasizes the importance of targeting prevention efforts towards the complexity of risk-taking behaviours.

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Young age at first intercourse and risk-taking behaviours—a study of nearly 65 000 women in four Nordic countries

European Journal of Public Health Young age at first intercourse and risk-taking behaviours-a study of nearly 65 000 women in four Nordic countries Tina Bech Olesen 2 3 Kirsten Egebjerg Jensen 2 3 Mari Nyga˚ rd 1 2 Laufey Tryggvadottir 0 2 7 Pa¨ r Spare´ n 2 6 Bo Terning Hansen 1 2 Kai-Li Liaw 2 5 Susanne K. Kjaer 2 3 4 0 Icelandic Cancer Society , Reykjavik , Iceland 1 Department of Screening-based Research, Cancer Registry of Norway , Oslo , Norway 2 Cancer Society , Strandboulevarden 49, DK-2100 Copenhagen, Denmark, tel: 3 Department of Viruses, Hormones and Cancer, Institute of Cancer Epidemiology, Danish Cancer Society , Copenhagen , Denmark 4 Department of Obstetrics and Gynaecology, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark 5 Merck Research Laboratories, Merck & Co., Inc. , Upper Gwynedd, Pennsylvania , USA 6 Department of Medical Epidemiology and Biostatistics, Karolinska Institute , Stockholm , Sweden 7 Department of Medicine, University of Iceland , Reykjavik , Iceland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . European Journal of Public Health, Vol. 22, No. 2, 220-224 The Author 2011. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. doi:10.1093/eurpub/ckr055 Advance Access published on 19 May 2011 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Background: Risk-taking behaviours such as early initiation of smoking, alcohol drinking and sexual activity often cluster within individuals and could be characteristics of adolescents who in general are risk takers. In the present study, using a large population-based sample of 64 659 women aged 18-45 years in four Nordic countries, we investigate whether young age at first sexual intercourse is associated with subsequent risk-taking behaviours. Methods: We examined the association between young age at first sexual intercourse (age 14 years) and subsequent risk-taking behaviours by using multivariate logistic regression by which odds ratios (ORs) and the corresponding 95% confidence intervals (95% CIs) were estimated. Results: The OR of reporting more than 10 lifetime sexual partners was almost four times higher among women who reported a young age at first intercourse (OR = 3.79; 95% CI: 3.60-4.00) in comparison with women >14 years at first intercourse. Furthermore, women who were young at first intercourse were more likely to report two or more recent partners (OR = 1.67; 95% CI: 1.54-1.82) and to have a history of STIs (OR = 2.03; 95% CI: 1.93-2.13). In addition, young age at first intercourse was associated with current smoking (OR = 2.31; 95% CI: 2.20-2.43) and binge drinking (OR = 1.36; 95% CI: 1.28-1.44). All ORs were adjusted for age, years of education and country of residence. Conclusion: Young age at first intercourse is associated with subsequent risk-taking behaviours. Our study emphasizes the importance of targeting prevention efforts towards the complexity of risk-taking behaviours. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction isk-taking behaviours such as early initiation of smoking, alcohol Rdrinking and sexual activity often cluster within individuals and could be characteristics of adolescents who in general are risk takers.1–3 A population-based study concerning risk-taking behaviours in women in four Nordic countries has shown early smoking initiation to be associated with more lifetime and recent sexual partners and a history of STIs.4 Sexual behaviour, such as young age at first sexual intercourse and a high lifetime number of sexual partners influences women’s reproductive health.5 Sexual behaviour is associated with sexually transmitted infections (STIs) and recent population-based studies on the prevalence of self-reported STIs in Nordic women aged 18–45 years have shown that 17.0% of the women reported to have been diagnosed with genital Chlamydia, 4.8% with genital herpes6 and 10.6% with genital warts.7 STIs can have adverse consequences for women’s reproductive health, such as pelvic inflammatory disease, infertility and ectopic pregnancy and can hence have a great impact on public health.8 In addition, an STI diagnosis could at the individual level be associated with anxiety, psychological stress and stigmatization.9–11 A previous study has shown that >80% of women who had their first sexual intercourse at ages 13–14 years wished that they had waited longer before getting sexually active.12 This may be due to a gap between age at puberty onset and age at psychological and social maturity;13,14 puberty onset may promote interest in sexual activity, whereas psychological immaturity may result in inability to foresee the consequences of engaging in sexual intercourse.14,15 Furthermore, young women may have an increased risk of contracting an STI because of the biological predisposition of the immature cervix to infection if exposed.8,16 Downloaded from https://academic.oup.com/eurpub/article-abstract/22/2/220/512777 by guest on 06 July 2018 A young age at first sexual intercourse may, therefore, have negative influences both on women’s psychological well-being and on their reproductive health. In the present study, we wish to examine whether young age at first sexual intercourse is associated with subsequent risk-taking behaviours. In order to cover a broad spectrum of risk-taking behaviours, we focus on aspects of women’s reproductive health, i.e. number of sexual partners and history of STIs and on aspects of women’s lifestyle, i.e. smoking and binge drinking. Most studies on the association between young age at first sexual intercourse and subsequent risk-taking behaviours have focused solely on adolescents and young adults, comprise small study samples and relatively few studies were population based.3,14,17–20 In the present study, comprising a large population-based sample of 64 659 women aged 18–45 years in four Nordic countries, we aim to investigate whether young age at first sexual intercourse is associated with subsequent risk-taking behaviours. Methods Subjects In Denmark, Iceland, Norway and Sweden, all permanent residents are assigned a unique personal identification number and are registered in a computerized population registry in the respective country. The population registries contain complete information on date of birth, gender, citizenship, place of residence and vital status of all permanent residents and these data enable researchers to carry out representative population-based studies.7,21 The data collection for this study is described in detail elsewhere.7 Briefly, we used data from a large population-based cross-sectional questionnaire study on women’s health and sexual behaviour carried out in Denmark, Iceland, Norway and Sweden in 2004–05. The women included in the study were aged 18– 45 years at the time of enrolment and were randomly sampled from the population registry in each country using the unique personal identification number as the key identifier. Altogether 69 486 women participated in our study by responding to a self-administered questionnaire (22 173 from Denmark, 15 025 from Iceland, 16 575 from Norway and 15 713 from Sweden). The response rates varied between 54.6% (in Iceland) and 81.4% (in Denmark) and the overall response rate was 66.9%. The study was approved by the data protection agencies and ethical committees in each of the four countries. Statistical analysis For this study, we excluded 2281 women due to missing values in relation to experience of sexual intercourse or age at first sexual intercourse. In addition, we excluded 11 women who reported a higher age at first sexual intercourse than their age at enrolment in the study. The analyses were performed only among women who were sexually active; we excluded 2535 women who had not yet had sexual intercourse. A total of 64 659 women were included in the analyses for this study. ‘Young age at first intercourse’ was defined as ages equal to or lower than the 10th percentile of the reported age at first sexual intercourse. This corresponded to participants who had their first intercourse at ages 14 years. As previously reported the proportions of women with young age at first sexual intercourse differed between the four Nordic countries,22 hence the analyses were also conducted separately for each country using the country-specific 10th percentile to define country-specific young age at first sexual intercourse (age 14 years in women in Denmark, Iceland and Sweden and age 15 years in women in Norway). For all analyses, employment of the country specific and the total population definitions gave very similar results (data not shown) and we hence only report analyses using the latter definition adjusting for country of residence in the final analyses. We considered aspects of women’s reproductive health, i.e. ‘lifetime number of sexual partners’, ‘recent partners’ (number of new sexual partners within the past 6 months) and ‘history of STIs’, and aspects of women’s lifestyle, i.e. ‘current smoking’ and ‘binge drinking’ as subsequent risk-taking behaviours, as described below. In our study population, the median lifetime number of sexual partners was 6 lifetime partners, while the 75th percentile was 10 lifetime partners. We defined a high lifetime number of sexual partners as higher than the 75th percentile corresponding to reporting more than 10 lifetime number of sexual partners. We defined a high number of recent sexual partners as equal to or higher than the 95th percentile corresponding to two or more recent partners. Women who reported to have been diagnosed with genital Chlamydia, herpes, trichomoniasis, gonorrhoea or genital warts were considered as having a ‘history of STIs’. Women who reported to be either smoking every day, smoking at least once a week or smoking, but less than once a week were considered to be ‘current smokers’ as opposed to women who reported to be former smokers or to never have been smoking. Women who reported to be drinking more than six units of alcohol at the same occasion one or more times per month were defined as ‘current binge-drinkers’. We examined the association between young age at first sexual intercourse (age 14 years) and subsequent risk-taking behaviours by using multivariate logistic regression by which odds ratios (ORs) and the corresponding 95% confidence intervals (95% CIs) were estimated (SAS statistical package version 9.1). Furthermore, we performed 2-tests to test for differences between groups. Based on the current literature, we considered ‘age at study entry’ and ‘years of education’ to be possible confounding factors on the association between age at first sexual intercourse and subsequent risk-taking behaviours and hence adjusted the analyses for these possible confounders. The variable ‘years of education’ was constructed on the basis of women reporting to have had 12, 13–16 or 17 years of education, while ‘age at study entry’ was used as a continuous variable in the multivariate logistic regression analyses. Downloaded from https://academic.oup.com/eurpub/article-abstract/22/2/220/512777 by guest on 06 July 2018 Results In the present study, we found that 7467 women (11.6%; 95% CI: 11.3– 11.8) of the 64 659 participating women reported a young age at first sexual intercourse (age 14 years). A significantly (P < 0.0001) larger proportion of the women aged 18–25 years old were age 14 years at their first intercourse (14.9%; 95% CI: 14.3–15.4) than the women in the older age groups (10.1–10.4%) (figure 1a). There was also a significant difference (P < 0.0001) in young age at first intercourse in relation to years of education: 16.0% (95% CI: 15.5–16.5) of the women with 12 years of education reported a young age at first sexual intercourse, 10.6% (95% CI: 10.2–10.9) of the women with 13–16 years of education and 7.0% (95% CI: 6.6–7.5) of the women with 17 years of education reported a young age at first intercourse (figure 1b). Among women who reported a young age at first intercourse we found that 37.4% (95% CI: 36.3–38.5) reported 15 or more lifetime sexual partners whereas 14.0% (95% CI: 13.2–14.8) reported 1–4 lifetime partners (table 1). Among women who were >14 years at first intercourse, 13.8% (95% CI: 13.5–14.1) reported 15 or more lifetime partners, whereas 43.3% (95% CI: 42.9–43.7) reported 1–4 lifetime partners. A significantly (P < 0.0001) larger proportion of the women who reported a young age at first intercourse also reported a history of STIs (42.0%; 95% CI: 40.8–43.1) in comparison with women who were >14 years at first intercourse (27.2%; 95% CI: 26.8–27.5). Furthermore, a larger proportion of women who were aged 14 years at first intercourse reported current smoking (48.0%; 95% CI: 46.9–49.1) in comparison with women who were >14 years at first intercourse (27.7%; 95% CI: 27.3–28.0). A less pronounced difference was seen with respect to recent partners (two or more partners: 11.1%; 95% CI: 10.4–11.8 vs. 6.1%; 95% CI: 5.9–6.3) and binge drinking (once or more times per month: 27.0%; 95% CI: 26.0–28.1 vs. 20.3%; 95% CI: 20.0–20.7). In the multivariate logistic regression analyses, adjusting for age at enrolment in the study, years of education and country of residence, we confirmed that young age at first sexual intercourse was associated with subsequent risk-taking behaviours (table 2): The adjusted OR of reporting more than 10 lifetime sexual partners was almost 4 times higher among women who reported a young age at first intercourse (OR = 3.79; 95% CI: 3.60–4.00) in comparison with women > 14 years at first intercourse. Furthermore, women who were young at first intercourse were more likely to report two or more recent sexual partners (OR = 1.67; 95% CI: 1.54–1.82) and to report a history of STIs (OR = 2.03; 95% CI: 1.93–2.13). The logistic regression analysis also showed young age at first sexual intercourse to be associated with current smoking (OR = 2.31; 95% CI: 2.20–2.43) and binge drinking one or more times per month (OR = 1.36; 95% CI: 1.28–1.44). Many of the variables in the statistical models may be correlated with age, nevertheless when stratifying the analyses by age at enrolment in the study the estimates did not differ substantially from the estimates presented above (data not shown). Discussion The present study carried out among nearly 65 000 women in four Nordic countries illustrates that young age at first sexual intercourse is highly associated with reporting risk-taking behaviours. We found young age at first intercourse to be associated with both a high number of lifetime Table 1 Prevalence of risk-taking behaviours in relation to age at first sexual intercourse among sexually active women 18–45 years of age in four Nordic countriesa Total population Age at first sexual intercourse % (95% CI) Lifetime no. of sex partners 1–4 partners 39.9 (39.6–40.3) 5–9 partners 28.6 (28.3–29.0) 10–14 partners 15.0 (14.7–15.3) 15 partners 16.5 (16.2–16.8) Recent partnersb 0 partners 80.1 (79.8–80.4) 1 partner 13.2 (13.0–13.5) 2 partners 6.7 (6.5–6.9) History of STIsc Ever 28.9 (28.5–29.2) Never 71.1 (70.8–71.5) Smoking pattern Never 49.3 (48.9–49.7) Former 20.7 (20.4–21.0) Current 30.0 (29.7–30.4) Binge drinking Never 36.6 (36.2–37.0) <1/month 42.3 (41.9–42.7) 1/month 21.1 (20.8–21.4) 14 years old % (95% CI) 14.0 (13.2–14.8) 27.6 (26.6–28.7) 21.0 (20.1–21.9) 37.4 (36.3–38.5) 74.7 (73.8–75.7) 14.1 (13.3–14.9) 11.1 (10.4–11.8) 42.0 (40.8–43.1) 58.0 (56.9–59.2) 24.0 (23.0–24.9) 28.0 (27.0–29.1) 48.0 (46.9–49.1) 30.2 (29.2–31.3) 42.7 (41.6–43.9) 27.0 (26.0–28.1) >14 years old % (95% CI) 43.3 (42.9–43.7) 28.8 (28.4–29.3) 14.2 (13.9–14.5) 13.8 (13.5–14.1) 80.8 (80.5–81.1) 13.1 (12.8–13.4) 6.1 (5.9–6.3) 27.2 (26.8–27.5) 72.9 (72.5–73.2) 52.6 (52.2–53.0) 19.7 (19.4–20.1) 27.7 (27.3–28.0) 37.5 (37.1–37.9) 42.2 (41.8–42.7) 20.3 (20.0–20.7) a: The numbers may not add up to 100% due to missing values. b: Number of new partners during the past 6 months. c: STIs include genital Chlamydia, herpes, trichomoniasis, gonorrhoea and genital warts. sexual partners and a high number of recent partners. Other studies have found similar results, even though the type of study population varied and the definition of young age at first sexual intercourse and high number of sexual partners differed.3,14,17–20 One reason why women with a young age at first sexual intercourse accumulate many sexual partners could be that they are sexually active during a period of time in adolescence and young adulthood in which relationships of short duration and changing sexual partners are common.9 In addition, these women have a longer sexual career altogether and hence more time to accumulate sexual partners. Furthermore, women who become sexually active at such a young age as in our study ( 14 years old) may be more likely to engage in more risk-taking sexual behaviours and therefore have new sexual partners more frequently also later in life. The latter explanation is supported by our finding that women who initiated intercourse at a young age had more recent partners than women who had initiated intercourse later in life. We found young age at first sexual intercourse to be associated with a self-reported history of STIs. Results from previous studies are equivocal; most studies report that women with a young age at sexual debut are more likely to report STIs,3,14,19,20,23 whereas some studies found no or only a weak association.8,12,24 It could be hypothesized that the higher likelihood of STIs may be explained by a higher lifetime number of sexual partners. When we adjusted for this variable the OR was reduced, but the association remained statistically significant (data not shown) so the association was not completely explained by this factor. In addition, it should be noted that we consider lifetime number of sexual partners to be an intermediate variable rather than a confounder in the association between young age at first intercourse and STIs. An explanation for the association between young age at first sexual intercourse and STIs could be that women who have sex at such a young age engage in more risky sexual behaviour such as having sex without a condom. In addition, women who engage in sexual intercourse at a young age may be more susceptible to STIs because the tissue of the female genital tract is immature.8,16 This study has several strengths. To our knowledge, it is the largest study to date to investigate the association between young age at first sexual intercourse and subsequent risk-taking behaviours. Furthermore, the invited women were randomly drawn from the general female population in each of the four participating Nordic countries and together with a relatively high response rate this produces more generalizable results and more precise estimates. The population registries are continuously updated and has a 100% coverage of all residents and, therefore, prove an important tool in epidemiological research.21 The study also has some limitations that should be taken into account. First of all, the study has a cross-sectional design and, therefore, the possibility to address causal relationships or time-dependent relationships is limited. However, the sexual behaviours, we investigate i.e. lifetime number of sexual partners, number of recent partners and history of STIs obviously succeed first sexual intercourse. Furthermore, we investigate current smoking and current binge drinking among women who reported already to have had sexual intercourse and thus these behaviours also succeed sexual debut. Second, even though we obtained a relatively high participation rate, selection bias due to non-participation cannot be excluded. We found that the age distribution among non-participants was very similar to that among the participants in our study (data not shown),7 but as we do not have more information about the non-participants, it is unknown whether non-participants differ significantly from the participating women in relation to other variables. It has been suggested that respondents might reply in a manner that will be viewed favourably by others,25 and this may influence participant’s responses to the questionnaire, for example, underreporting of alcohol consumption and STIs. Nevertheless, in a Danish study on the validity of self-reported alcohol consumption the self-reported data were found to be a valid measure of the actual alcohol intake,26 and a study from the UK demonstrated a high consistency between self-reported data on STIs and population rates.5 In addition, underreport of socially undesirable behaviours is less likely in self-administered questionnaires compared to face-to-face interviews.25 Questionnaire surveys and registration of different types of information is well-accepted in the Nordic countries. This is mainly due to the fact that national registration of all residents is required by law, thus people in the Nordic countries are accustomed to being registered. Moreover, there is no history of misuse of information recorded in the population registries.21 Furthermore, potentially sensitive topics such as sexual behaviour are nowadays not very tabooed in the Nordic countries, and this may also be reflected by the relatively low number of women who did not want to respond to these questions (data not shown). This may enhance the validity of the information obtained via our self-administered questionnaire survey. We found that young age at first intercourse is associated with several risk-taking behaviours. Other studies have shown that both parents’ and peers’ norms and behaviour may have a great influence on teenagers sexual behaviour, in particular in terms of age at first sexual intercourse and the number of sexual partners acquired.27,28 This implies that prevention efforts, in particular sexuality education should also focus on norms about sexual behaviour. Furthermore, sexuality education should focus on enabling adolescents to make informed choices about when to engage in sexual activity in order to take better care of their sexual health and to avoid that first intercourse takes place while the adolescents are still psychologically immature. Together with previous studies,1–4 our study indicates that risk-taking behaviours often cluster within individuals. Moreover, we found young age at first intercourse to be associated with both binge drinking and current smoking. This suggests that prevention efforts should be targeted at the complexity of risk-taking behaviours and not focus solely on young age at first intercourse.2 In conclusion, the present population-based study of nearly 65 000 women aged 18–45 years in four Nordic countries illustrates that young age at first sexual intercourse is associated with subsequent sexual risk-taking behaviours, in particular, a high lifetime number of sexual partners, a high number of recent sexual partners, and a history of STIs. In addition, young age at first sexual intercourse is associated with women’s lifestyle, i.e. current smoking and binge drinking. Our study emphasizes that prevention efforts, should target the complexity of the clustering of risk-taking behaviours. Acknowledgements The study was initiated and analysed by the investigators. Funding Merck & Co., Inc. (EPO 8014.016). Conflicts of interest: None declared. Key points The present population-based study of nearly 65 000 women aged 18–45 years in four Nordic countries illustrates that young age at Downloaded from https://academic.oup.com/eurpub/article-abstract/22/2/220/512777 by guest on 06 July 2018 first sexual intercourse is associated with subsequent sexual risk-taking behaviours and current smoking and binge drinking. Our study emphasizes the importance of prevention efforts, in particular sexuality education enabling adolescents to make informed choices about when to engage in sexual activity in order to take better care of their sexual health. This study indicates that risk-taking behaviours cluster within individuals; therefore prevention efforts should be targeted at the complexity of risk-taking behaviours and should identify adolescents at risk of engaging in risk-taking behaviours. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . European Journal of Public Health, Vol. 22, No. 2, 224–229 The Author 2010. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. doi:10.1093/eurpub/ckq137 Advance Access published on 30 September 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Changes in health-related quality of life with smoking cessation treatment J. Taylor Hays1, Ivana T. Croghan1, Christine L. Baker2, Joseph C. Cappelleri3, Andrew G. Bushmakin3 1 Mayo Clinic, Mayo Nicotine Dependence Center, Rochester, MN, USA 2 Global Outcomes Research, Pfizer Inc, New York, NY, USA 3 Global Research and Development, Pfizer Inc, New York, NY, USA Background: Cigarette smoking causes reduced health-related quality of life (QoL) and smoking abstinence improves health-related QoL. We assessed the effects of treatment for tobacco dependence on the health-related QoL in a 52-week randomized controlled trial of varenicline and bupropion sustained release (SR). Methods: Subjects who smoked 10 cigarettes per day for the past year were randomly assigned to receive varenicline 1 mg twice daily (n = 696), bupropion SR 150 mg twice daily (n = 671) or placebo (n = 685) for 12 weeks and followed post-therapy for an additional 40 weeks. Health-related QoL was assessed using the Smoking Cessation Quality of Life questionnaire at baseline and Weeks 12, 24 and 52. Results: Health transition (perceived health compared with baseline) and self-control were both significantly improved among subjects receiving varenicline and bupropion SR compared with placebo at Weeks 12, 24 and 52. Similarly, varenicline-treated subjects had significantly improved health transition and self-control compared with subjects who received bupropion SR at Weeks 12 and 24, and at Week 52 for health transition. A significant positive association existed between length of continuous abstinence and improved health transition, vitality, self-control, anxiety and overall mental profile. In most instances both a direct and an indirect effect (through continuous smoking abstinence) of each active treatment (vs. placebo) contributed to improved self-control and health transition. Conclusion: Treatment with varenicline and bupropion SR for smoking cessation resulted in improved self-control and health transition that was mediated in large part by continuous smoking abstinence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Introduction treatment. In two pivotal clinical trials varenicline had greater efficacy for smoking cessation than did sustained release (SR) bupropion and placebo.10,11 All participants had data collected at various time points regarding their perceptions on health-related QoL using validated self-administered instruments. The aim of this study was to analyse the effect of smoking cessation pharmacotherapies (12-week treatment with varenicline, bupropion SR or placebo) and smoking abstinence on perceived health-related QoL using data pooled from these two smoking cessation trials. Methods For the current analysis, we used data from two identically designed double-blind, randomized, placebo-controlled trials that consisted of 12 weeks of treatment with varenicline 1 mg twice daily (BID), bupropion SR 150 mg BID or placebo, with non-treatment follow-up for 40 weeks (to Week 52).10,11 Medication 1 2 3 4 6 7 8 9 Garriguet D. Early sexual intercourse . Health Rep 2005 ; 16 : 9 - 18 . Kuzman M , Simetin IP , Franelic IP . Early sexual intercourse and risk factors in Croatian adolescents . Coll Antropol 2007 ; 31 ( Suppl 2 ): 121 - 30 . Coker AL , Richter DL , Valois RF , et al. Correlates and consequences of early initiation of sexual intercourse . J Sch Health 1994 ; 64 : 372 - 7 . 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Olesen, Tina Bech, Jensen, Kirsten Egebjerg, Nygård, Mari, Tryggvadottir, Laufey, Sparén, Pär, Hansen, Bo Terning, Liaw, Kai-Li, Kjær, Susanne K.. Young age at first intercourse and risk-taking behaviours—a study of nearly 65 000 women in four Nordic countries, European Journal of Public Health, 2012, 220-224, DOI: 10.1093/eurpub/ckr055