Sexual Atonement аnd tһе Іmportance of Sexual Wellness tօ Calibre οf Living Ƭhroughout tһｅ Liveliness Trend ߋf UႽ Adults
Kathryn Ꭼ. Flynn, PhD,1 Li Lin, ᎷS,2 Deborah Watkins Bruner, PhD,3 Jill M. Cyranowski, PhD,4 Elizabeth Ꭺ. Hahn, ΜА,5,6 Diana Ꭰ. Jeffery, PhD,7 Jennifer Barsky Reese, Ngintip Ngewe 2021 PhD,8,9 Bryce В. Reeve, PhD,10 Rebecca Ꭺ. Shelby, PhD,11 and Kevin P. Weinfurt, Rekaman Pribadi Hot Donlod PhD2,11
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Initiation
Discussions some sexual health аre rare in clinical encounters, Ԁespite tһе intimate disfunction connected ᴡith mаny park wellness conditions. Reason оf tһe importance ᧐f sexual wellness and Pidio Sex Cecy Hongkong Ganas sexual atonement аmong UᏚ adults is limited.

Purport
Τ᧐ ply epidemiological іnformation оn tһe grandness οf sexual wellness fⲟr timber οf life ɑnd people’ѕ gratification with tһeir gender lives ɑnd tⲟ canvas һow from ｅach ߋne is connected ѡith demographic ɑnd wellness factors.

Methods
Data aгｅ from а cross-sectional, ѕelf-account questionnaire fгom а taste ߋf 3515 English-speech production UᏚ adults recruited from аn online instrument panel tһat ᥙsеs

address-based probability sample distribution.

Independent Termination Measures
Ꮃе reputation ratings of grandness ߋf intimate health tο choice of life (unity ⅾetail with 5-head response) аnd tһе PROMIS® Atonement ԝith Sexuality Sprightliness mark (5 items, [empty] apiece ԝith 5-pointedness responses, tons centered on tһｅ UЅ mｅan).

Ꮢesults
High school grandness ᧐f sexual wellness to character ⲟf aliveness ѡаs ｒeported Ьу 62.2% of manpower (95% СΙ, 59.4%–65.0%) and 42.8% օf women (95% ϹІ, Download Whitney Wright Sex Video 39.6%–46.1%; P < .001). Importance of sexual health varied by sex, age, sexual activity status, and general self-rated health. For the 55% of men and 45% of women who reported sexual activity in the previous 30 days, satisfaction with sex life differed by sex, age, race/ethnicity (among men only), and health. Men and women in excellent health had significantly higher satisfaction than participants in fair or poor health. Women with hypertension reported significantly lower satisfaction (especially younger women), as did men with depression or anxiety (especially younger men).

Conclusion
In this large study of US adults’ ratings of the importance of sexual health

and satisfaction with sex life, sexual health was a highly important aspect of quality of life for many participants, including participants in poor health. Moreover, participants in poorer health reported lower sexual satisfaction. Accordingly, sexual health should be a routine part of clinicians’ assessments of their patients. Health care systems that state a commitment to improving patients’ overall health must have resources in place to address sexual concerns. These resources should be available for all patients across the life span.

Keywords: Quality of Life, Self-Report, Sexual Behavior, Cross-Sectional Studies, Male, Female
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Introduction
It has been over 15 years since Laumann et al1 identified sexual dysfunction as an "important public health concern" in the pages of JAMA. Many common health conditions and their treatments are associated with sexual dysfunction, including diabetes, hypertension, coronary artery disease, cancer, anxiety, and depression.2 Despite the high prevalence of these conditions, discussions about sexual health are uncommon in clinical encounters, perhaps in part due to underlying assumptions that sexual health is not a priority.3–8 Patients may assume their clinicians will tell them if sexual side effects are associated with a disease or its treatments; clinicians may assume patients will initiate discussions about sexual health if it is important to them. In a study of older adults (ages 57–85), Lindau et al9 found that relatively few rated sex as unimportant. Yet, our understanding of the importance of sexual health for people of all ages and in various health states remains limited.

Moreover, while many studies have examined risk factors for specific sexual problems10 less is known about individuals’ global evaluations of sexual satisfaction and whether satisfaction differs by demographic and health characteristics. Multiple factors interact to determine sexual satisfaction, including but not limited to culturally influenced expectations about sex and sexuality,11 sexual communication and sexual practices within couples,12,13 and, in a study limited to older women, age, race/ethnicity, and mental

health.14 Conceptually related to satisfaction (though not equivalent), bother or distress about sexual dysfunction appears to increase both men’s and women’s willingness to discuss a sexual problem with a physician, and in women also drives decisions to seek treatment.15

A better understanding of the importance of sexual health to quality of life and global evaluations of sexual satisfaction in diverse populations is needed to help guide future research efforts, including the development of interventions to enhance patient-provider communication about sexual concerns associated with common conditions and their treatments.. To this end, this study sought to provide epidemiologic data on the importance of sexual health to quality of life and

sexual satisfaction among a large sample of diverse US adults and to examine how each is associated with sex, age, race/ethnicity, and health factors.

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Methods
Study Population
Data for this study were collected during testing of version 2.0 of the Patient-Reported Outcomes Measurement Information System® (PROMIS®) Sexual Function and Satisfaction (SexFS) measure in a large, cross-sectional, population-based sample of US adults in KnowledgePanel® (GfK). The panel is an address-based probability sample drawn from the US Postal Service Computerized Delivery Sequence File, which includes 97% of households in the United States. Selected panel members who do not have a computer with Internet access are provided with one.

In June 2013, after a pilot test in a convenience sample of 30 participants, 10,129 English-speaking panel members 18 years or older were invited to participate in our survey. Of those, 4443 (43.9%) viewed the informed consent form, which included the

description, "The study will help researchers understand how illness affects different areas of people’s lives, particularly their sex lives." Of those who viewed the consent form, 3667 (82.5%) consented to participate and 3515 (95.9%) completed the survey. A target sample size of 3500 participants was based on previously planned psychometric analyses for measure development. However, this sample size also provided sufficient statistical power for the multivariable modeling presented here. With a sample size of 3500 equally allocated in 2 groups, we had greater than 90% statistical power to detect a difference in 2 proportions of 0.06 or less and greater than 90% statistical power to detect a less than 1.1 point difference in T-scores between 2 means.

The self-administered online questionnaire included approximately 177 items. Skip patterns determined the particular set of items participants received

depending on their sex and sexual activity status. Content included all candidate items for the SexFS version 2.0 and items capturing sociodemographic and health characteristics. For a survey of this length, KnowledgePanel participants receive an incentive equivalent to $6. The institutional review board of the XXXXX approved the study, and all participants provided informed consent.

Variables
Importance of sexual health

was measured with an item we developed that asked, "How important is sexual health to your quality of life?" Response options include "not at all," "a little bit," "somewhat," "quite a bit," and "very." We considered modeling importance as ordinal using ordinal logistic regression or even as continuous using simple linear regression, but a chi-square score test showed significant violation of the proportional odds assumption (P < .0001) within an ordinal logistic regression model, signaling that the response increments are not linear with respect to the covariates. Thus, for use in the models and presentation in the tables, we dichotomized responses into high importance (ie, "quite a bit" or "very") and low importance (ie, "not at all," "a little bit," or "somewhat").

Sexual satisfaction was measured using the PROMIS

SexFS version 2.0 Satisfaction With Sex Life scale.16 The PROMIS SexFS is a state-of-the-art, patient-reported outcome measure developed using robust qualitative and quantitative methods.16–22 The satisfaction scale includes 5 items to assess how satisfying and pleasurable the person regards his or her sex life in the past 30 days, with no limitation on how the person defines "sex life." Internal consistency reliability is high in the US general population (Cronbach’s alpha = 0.94). The scale is scored on the T-metric, with a score of 50 centered on the mean for sexually active US adults and an SD of 10 points. Higher scores indicate greater satisfaction.

We modeled age as a continuous variable. Sexual activity status was based on an item that asked whether the respondent had any type of sexual activity (ie, masturbation, oral sex, or sexual intercourse) in the previous 30 days. Race and ethnicity data were captured by 2 questions (consistent with the reporting requirements of the National Institutes of Health) but combined into a single variable with 4 categories for the analysis due to small numbers in some categories. Data on health conditions were captured by questions asking whether a doctor or other health care provider had ever told the respondent they had the condition, except in the case of hypertension, for which the participant was asked whether they currently had high blood pressure. General self-rated health was measured with a single item (ie, "In general, would you say your health is excellent, very good, good, fair, or poor?"). This item is a predictor of mortality; in a meta-analysis of 22 studies, poor self-rated health was associated with a twofold higher risk of mortality than excellent health.23 We treated general self-rated health as a categorical variable in the models, combining "fair" and "poor" health because of small numbers.

Statistical Analysis
We weighted the data to approximate the English-speaking US adult population with respect to sex, age, race/ethnicity, education level, and geographic region. We report percentages of participants who indicated high importance of sexual health with 95% CIs by sex, sexual activity status, race/ethnicity, and health. We used local regression (LOESS) curves to describe relationships between importance and age separately by sex. We modeled relationships between importance of sexual health and age, sexual activity status, race/ethnicity, and health using logistic regression with adjustment for the complex survey design. We conducted an omnibus likelihood ratio test of all 2-way interactions between age and sexual activity status with each other and with the rest of the race/ethnicity and health variables. When the omnibus test was statistically significant, we used a likelihood ratio test for each individual interaction and added the significant interactions to the models. However, to ease interpretation of the results, we retained interactions in the final models only if they remained significant. Graphical diagnostics suggested that age was better modeled by adding a quadratic term (ie, age2), so we included both a linear term and a quadratic term in all analyses involving age.

The analysis of satisfaction with sex life followed the same approach as the analysis of importance, except that we analyzed satisfaction scores as continuous scores and restricted the analysis to respondents who reported engaging in sexual activity in the previous 30 days. We also tested a cubic term for age (ie, age3), but the model fit best with the quadratic term. We report means and corresponding 95% CIs for the satisfaction scores; relationships to other

variables are based on a multivariable general linear model.

We included specific health conditions in the models, as well as general self-rated health, to capture aspects of health not covered by the particular diagnoses and to serve as a broader indicator of health status. However, we were concerned that the general self-rated health variable might obscure the effects of the individual diagnoses, as an individual’s rating of overall health may be based in part on diagnosed conditions. Therefore, in a sensitivity analysis, we estimated the models after removing the general self-rated health variable. In the Results section, we indicate when results were different between the 2 models. For all analyses, we considered a 2-tailed α level of 0.05 to be significant.