Measurement of Adverse Health Burden Related to Sexual Behavior

  • S. H. Ebrahim
  • M. McKenna
Reference work entry


As part of an analysis of the burden of disease and injury in the United States, we established a method to identify and quantify the incidence of adverse health events, deaths, and disability adjusted life years (DALY) attributed to unprotected sexual behavior (USB). Estimates for the incidence, morbidity and mortality from sexually transmitted diseases (STD) were derived from vital statistics, notifiable disease surveillance system, national surveys, outpatient and hospital discharge summaries, prevalence data from individuals attending health care services, the published literature, and expert opinion. Because many conditions for which USB is implicated as a cause have multifactorial causes, a major challenge is developing estimates for the attributable fraction of disease that is exclusively related to USB. For conditions with risk factors other than sexual behavior (e.g., HIV), or etiology (e.g., liver disease), sexual behavior-attributable fraction was estimated based on the literature or through expert consultations. Maternal and infant conditions related to unintended pregnancy and all voluntary abortions were considered as adverse outcomes of sexual behavior. A comprehensive estimation including morbidity, mortality, and summary measures such as DALYs can identify a larger burden related to sexual behavior and more profound disparities by gender than that can be captured by traditional measurement of mortality or morbidity alone. However, because epidemiology of health events related to sexual behavior varies by countries or regions, statistics such as attributable fractions should be developed based on these geographic units. Further, summary measures involve the synthesis of parameters considered objective and science-driven with culture-specific and value oriented inputs. Many countries have limited information regarding either of these topics and must develop estimates in this context. This chapter provides only a roadmap for such estimation.


Cervical Cancer Sexual Behavior Reproductive Health Bacterial Vaginosis Chlamydia Trachomatis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations:


disability adjusted life years


human immunodeficiency virus;


international classification of diseases


sexually transmitted diseases


unprotected sexual behavior

Further Reading

  1. AbouZahr C, Vaughan JP. (2000). Bull World Health Org. 78: 655–665.PubMedGoogle Scholar
  2. Barendregt JJ, Bonneux L, Maas PJ Van der. (1996). Bull World Health Organ. 74(4): 439–443.PubMedGoogle Scholar
  3. Cates W Jr. (1999). Sex Transm Dis. 26(4): S2–S7.PubMedGoogle Scholar
  4. Centers for Disease Control and Prevention. (2001). Pregnancy-related deaths among Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native women-United States, 1991–1997. MMWR. 50: 361–364.Google Scholar
  5. Centers for Disease Control and Prevention. (1998). Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR. 47: 1–39.Google Scholar
  6. Ebrahim SH, Peterman TA, Zaidi AA, Kamb ML. (1997). Am J Public Health. 87: 938–944.PubMedCrossRefGoogle Scholar
  7. Ebrahim SH, MCkenna MT, Marks JS. (2005). Sex Transm Infect. 81: 38–40.Google Scholar
  8. Field M, Gold MR. (1998). Summarizing Population Health: Directions for the Development and Application of Population Metrics. National Academy, Washington DC.Google Scholar
  9. Grimes DA. (1986). JAMA. 255: 1727–1729.Google Scholar
  10. Gold MR, Siegel J, Russell L, Weinstein MC (ed.). (1996). Cost-effectiveness in Health and Medicine. Oxford University Press, New York.Google Scholar
  11. Henshaw SK. (1998). Fam Plann Perspect. 30: 24–29.PubMedCrossRefGoogle Scholar
  12. Koran JM, Fleming PL, Steketee RW, De Cock KM. (2001). Am J Public Health. 91: 1060–1068.CrossRefGoogle Scholar
  13. McGinnis J, Foege WH. (1993). JAMA 270: 2207–2217.PubMedCrossRefGoogle Scholar
  14. Michaud CM, Murray CJL, Bloom BR. (2001). JAMA. 285: 535–539.PubMedCrossRefGoogle Scholar
  15. Murray CJ, Kulkarni SC, Ezzati M. (2006). Circulation. 113(17): 2071–2081.PubMedCrossRefGoogle Scholar
  16. Murry CJL, Lopez AD (ed.). (1998). Health dimensions of sex and reproduction: the global burden of sexually transmitted diseases, HIV, maternal conditions, perinatal disorders, and congenital anomalies. World Health Organization, Geneva.Google Scholar
  17. Murray CJL, Salomon JA, Mathers CD, Lopez AD (ed.). (2002). Summary Measures of Population Health: Concepts, Ethics, Measurement and Applications. World Health Organization, Geneva.Google Scholar
  18. Rein DB, Kassler WJ, Irwin KL, Rabiee L. (2000). Obstet Gynecol. 95: 397–402.PubMedCrossRefGoogle Scholar
  19. Torres A, Forrest JD. (1988). Fam Plann Perspect. 20: 169–176.PubMedCrossRefGoogle Scholar
  20. Williams A. (1999). Health Economics. 8: 1–8.PubMedCrossRefGoogle Scholar
  21. Wilcox LS, Mosher WD. (1993). Obstet Gynecol. 82: 122–127.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • S. H. Ebrahim
    • 1
  • M. McKenna
  1. 1.Centers for Disease Control and PreventionUS Department of Health and Human ServicesAtlantaUSA

Personalised recommendations