The purpose of this study is to assess attitudes toward premarital dating and sexual encounters in individuals aged 15—49 years in Tehran. Descriptive, bivariate and multivariate analyses were conducted using statistical software. The results indicated that the majority of the participants were supportive of dating.
Also, males held significantly more liberal attitudes than females in their acceptance of premarital sex. This study showed that, being a male, of a younger age, single, and being less religious or being secular were important determinants of a liberal sexual attitude.
These results might reflect a socio-cultural transition in the sexual attitudes of different age groups of participants - a phenomenon that will need empirical studies to unpack in the Iranian socio-cultural context.
Sexual attitude, Premarital sex, Virginity, Sexual health, Sexual encounters Background According to the World Health Organization WHO individual sexuality is, to a large extent, determined and influenced by social norms and family values . Hence, sexual attitudes and permissiveness are conceptualized and understood differently according to societal contexts [38, 41].
In fact, social construction of sexuality in any given culture defines sexual behaviours of men and women [22, 38]. Sexual permissiveness entails accepting a wide range of sexual attitudes and associated behaviours, and is influenced by various cultural factors including religious beliefs and the importance of economic exchange at marriage, as well as increased exposure to external influences due to the expansion of worldwide communi- cations and economic changes .
There have been significant transformations in sexual- ity and sexual behaviours in special cultural contexts . Attitudes toward sexuality and its ethical aspects have been altered over the past few decades in many parts of the world [54, 63, 65, 69].
Reproductive Health Iran as a conservative and religious society is no exception. Similar to other countries in Asia India, China, Philippines; Thailand; Malaysia, Viet Nam and others , Iran has experienced significant social and attitudinal changes over the past decades [7, 8, 24, 25, 49, 55, 58]. Factors such as westernization, modernization, educa- tion, social networks and worldwide communications, information technology; and a rapidly widening gener- ational gap have created grounds for changes in value systems and norms within this country [37, 51, 56, 62].
What perhaps makes Iran, interesting as a case is that since , religion is the core cement of the Iranian value system and norms due to Islamic Law. Despite the aforementioned emerging changes, sexual intimacy and sex is only acceptable within the institution of marriage within Iranian society.
Premarital sex is con- sidered sinful according to the Islamic religious perspec- tive [5, 30, 61]. It is also legally prohibited and culturally forbidden in this society . Despite the socio-cultural pressure in Iran stressing on marriage as the fundamen- tal core for family formation, the younger generation of Iranian females in particular over the last three decades postpone their marriage .
They cite socio-economic reasons for the delay in marriage, or their wish to pursue education . The increasing trend of delayed mar- riages possibly explains attitude changes toward pre- marital sexual encounters in the Iranian context. Postponing marriage has widened the gap between pu- berty and marriage and this has led to the higher likeli- hood of people living in metropolitan contexts to be more open, accepting and engaging in premarital hetero- sexual interactions including sex [29, 32, 33].
However, despite this, in certain settings where only marital sex is documented, this may give the mistaken impression that the age of first sexual intercourse has increased . Sexual behaviours are influenced by a range of factors such as personal attitudes and beliefs, knowledge about sex and its consequences, situational factors, feelings and desires [9, 57]. In social psychology, it is widely accepted that attitudes are socially learned .
Increasing premarital heterosexual friendships and dating with the opposite sex among young Iranians has been documented. Since friendship with the opposite sex is not accept- able in Iranian families, in many cases, particularly for females, families are mostly unaware of any such interac- tions or relationships.
Most parents do not play a key role in informing, educating or supporting their young people on how to manage their friendships and the po- tential risks posed . Similar to other Islamic states such as Pakistan, in Iran, religiosity is considered to be protective for premarital sex, but it seems that due to the gap between marriage and puberty, and changes in social networks, media and communication technology as well as socio-economic development, the protective role of religiosity is diminishing [11, 27, 56, 62, 64].
Fur- thermore, there is no comprehensive sexuality education for singles; hence individuals in intimate relationships including sex are unprepared to deal with potential risks for both physical and mental health such as non- consensual sex, sexual coercion and unwanted preg- nancy. Yet, another issue is that reportedly Iran has entered into its third wave of an HIV epidemic, which is one of the most serious health risk issues in the country.
Al- though the HIV epidemic is primarily concentrated among key populations such as injecting drug users, HIV transmission through unsafe sex is on rise among adolescent and young adults, with recent studies sug- gesting an increase in premarital sexual encounters in Iran [4, 11, 20, 33]. The main feature of this peak is the significant shift in new cases of HIV infection from intravenous drug use to unsafe sexual practices.
These rates show a significant rise in sexual transmission of HIV in Iran . It is within the interest of the current global health context that this empirical study, focusing on attitudes toward premarital dating and sexual encounters in Iran is both, socioculturally relevant in order to highlight shifting attitudes and perceptions as it is from the point of better elucidating gaps in current public health Motamedi et al. The purpose of this study is to assess attitudes toward premarital dating and sexual encounters among adults aged years in Iran.
Conceptual framework Studies among female college students have shown that young people believe that social norms are still against premarital sex in Iran [31, 40]. In contrast, evidence in- dicates a rise in premarital sex, particularly among young men and women aged 18—34 in metropolitan cities of Iran .
This contrast persuaded a team of re- searchers to hypothesize that changes in sexuality in the Iranian contexts might be related to changes in personal attitudes, rather than social norms which are more resistant to change. Social norms influence personal attitudes and behaviors, although the links are compli- cated and may be bi-directional . However, in this study, the associations between sexual attitudes and age, biological sex, educa- tion, religiosity and marital status have been sought out.
Methods This paper is based on the quantitative data of an ori- ginal mixed methods study. This cross sectional study was conducted from March to May Ques- tionnaires were administered to males and females aged 15—49 years residing in Tehran, the capital of Iran. These individuals were presented with a consent form to sign.
Seven hundred and fifty five individuals completed the questionnaire. Forty five people decided to withdraw from completing the study questionnaire. About 12 million people live in the city of Tehran , which is a large metropolis with different cultures and ethnic groups. Given this, the residents are more influ- enced by modern ideas and social changes than those in small towns and villages.
To obtain a representative sample of adults in Tehran, the city was divided into three regions based on the population density; region with large, medium- and small-population. Each region comprised of several dis- tricts. According to the proportion of population to the total population in each district, the required sample was calculated in each section. Then a district from each region was randomly selected.
These districts house a number of community health centers, public parks and public places such as venues for cultural activities. From each district, one community health center, one venue for the cultural activities, and one public park was ran- domly selected. Trained staff explained the objectives of the study to the individ- uals who agreed to complete the questionnaire. Female staff assisted female participants to complete the question- naires and male staff assisted the male participants.
Same sex interviewers were believed to enhance response rate because of cultural sensitivity of this topic which was strength of this study. Each participant spent 30—45 mins to complete the questionnaire.
Only eligible volunteers were recruited for this study. No incentives were provided for participation in this study.
The survey instrument was adapted from the World Health Organization WHO questionnaire for assessing sexual and reproductive health of young people . This questionnaire was designed in order to assess knowledge, attitudes, behaviors and sexual health out- comes. Back-translation from English version of question- naire to Persian was initially conducted blindly by two independent bilingual English and Persian experts and validated in a separate study by the research team .
Content and face validity and reliability of the question- naire was assessed and confirmed by both qualitative and quantitative methods for the age group 15—49 years and both single and married people.
The questionnaire was edited to be suitable as a self-administered questionnaire. This scale was constructed by sum of scores of nine aligned items or statements about the acceptability of a range of premarital intimacy situations and sex for unmarried men and women Table 3. Each items was measured by three-point Likert scale 1- agree, 2- not sure, 3-disagree.
The higher the score, the more liberal is the attitude towards premarital sex and vice versa. Independent variables included age, sex, education, marital status and religiosity. Firstly, socio-economic status and responses to attitu- dinal statements were described. To compare the attitu- dinal scale scores by independent variables such as age, educational level, biological sex, marital status and religi- osity, t-Test and ANOVA were applied.
Finally, those factors significantly associated with personal attitudes and were not highly correlated, were entered into Motamedi et al. In this study P-values less than 0.