Familial Aggregation of Sexual Risky Behaviors in the Northwestern Iran: A Cross Sectional Study

Extended Abstract
Background
Risky behaviors are regarded as the most significant issues threatening the mental, physical, and social health of individuals and society. At present, high-risk sexual behaviors constitute an important concern that requires focused attention. Risky sexual behavior encompasses any sexual activity that places an individual at risk of negative health outcomes. These adverse health outcomes may include unwanted pregnancies or the transmission of sexually transmitted diseases, such as human immunodeficiency virus (HIV).
Understanding the factors that influence high-risk sexual behaviors is essential for designing preventive measures and interventions to reduce them. Genetic epidemiology is an emerging scientific field that provides a new perspective on the etiology of diseases and health-related conditions; in other words, it highlights that risk factors associated with diseases can aggregate among family members. Familial aggregation can arise from environmental factors, genetic influences, or interactions. Confirming familial aggregation can significantly impact health systems and intervention strategies. In addressing familial aggregation, health systems may implement targeted interventions specifically designed for high-risk families and the preventive and therapeutic measures presently available for the general population.
Additionally, screening family members of an affected individual and early identification of risk factors can help prevent the severity or occurrence of the disease. Although numerous studies have been conducted to identify factors associated with high-risk sexual behaviors globally, no research has been done on the familial aggregation of these behaviors, at least in Iran. Therefore, the present study aims to estimate the prevalence of high-risk sexual behaviors as well as to assess their familial aggregation among first-degree relatives.
Methods
The present correctional study was conducted in Tabriz, Iran, in 2022. The source population consisted of clients from the family medicine clinic at Tabriz Asadabadi Hospital. In this study, the heads of households were considered as probands. A proband is defined as a person whose family relationship is determined by their role in the family. Considering a 95% confidence level, 0.2 d, p: 0.118, and a 20% non-response rate, the sample size was estimated to be 861 individuals. Data was collected using two standard self-reported questionnaires: a Persian version of the Risky Behavior Questionnaire and a very short version of the Socioeconomic Status Questionnaire (SES). In the Risky Behavior Questionnaire, high-risk sexual behaviors are assessed using five questions. The answers to the questions are on a 5-point Likert scale. Higher scores on the questionnaire indicate higher-risk sexual behaviors. The SES Iran is a self-report tool comprising six items, which include participants’ occupations, education level, housing cost, automobile expenses, and health-related expenditures. Responses for the first three items were recorded on a 7-point Likert scale, while items 4 and 5 were assessed using 6-point Likert scales. It is important to note that for item 1, a lower score corresponds to a higher socioeconomic status. Consequently, we inverted the score for the first item to compute the total SES score. Additionally, we applied a weighting factor of 0.25 to items 3 through 6.
Mean and standard deviation were employed to describe quantitative variables, while frequency and percentage were used for qualitative variables. Initially, bivariate tests, including the chi-square test and Fisher's exact test, were performed to examine the association between high-risk sexual behaviors and the underlying variables. The interaction of SES, household size, age, and gender concerning high-risk sexual behaviors was also examined. The K-means clustering method was used to assign individuals to groups with high-risk sexual behaviors or without high-risk sexual behaviors. Finally, generalized estimating equations (GEE2) were used with the exchangeable approach to assess family aggregation between mothers and offspring, fathers and offspring, between spouses, and among siblings. To calculate the exact size of the family aggregation effect, variables with a significance level of 0.2 or less in bivariate tests were adjusted in GEE2. Statistical analyses were performed using the STATA software package version 16.
Results
In the current study, the response rate was reported as 95.47%. The prevalence of risky sexual behavior among participants was reported to be 18.61%, with 22.9% occurring among fathers and 33.3% and 43.8% among mothers and offspring, respectively. Risky sexual behavior was reported by 39.9% of individuals from the middle level of SES, while 29.4% were from the high level of SES. Almost 35% of individuals exhibiting risky sexual behaviors were married, and 23.3% were widowed. Findings showed a familial aggregation in terms of the presence of risky sexual behavior between spouses; however, this association was not statistically significant (OR: 1.34, 0.95% CI: 0.4-4.45). A statistically significant familial aggregation was observed in terms of risky sexual behavior between fathers and offspring (OR: 2.34, 0.95% CI: 1.4-4.45). In other words, if either the fathers or offspring exhibited risky sexual behavior, the likelihood of the other also engaging in such behavior was 2.34 times. A significant familial aggregation was also observed in risky sexual behavior between mothers and offspring (OR: 1.88, 95% CI: 1.3-3.9).
Conclusion
Based on the results of the current study, there was a significant familial aggregation, particularly between fathers and their offspring, regarding risky sexual behaviors. This study demonstrated that family members play a crucial role in the occurrence of risky sexual behaviors among one another, regardless of the environmental or genetic causes.

Practical Implications of Research
The findings of this study assist in implementing preventive interventions irrespective of the underlying causes of family gatherings. Intervention programs designed to prevent or modify high-risk behaviors within the community are more effective when executed on a family basis. The outcomes of this study can also be utilized in harm reduction centers and behavioral counseling facilities.