Risk and Protective Factors Associated with Personal Mastery Among Sexual Minority African-American Female Sex Workers

Research among sexual minorities has traditionally examined problems such as substance use, HIV risk, mental health problems, and victimization. Among sexual minority street-based female sex workers, these vulnerabilities can be magnified. Grounded in theories of resilience, this study examines risk and protective factors associated with a high level of personal mastery among a vulnerable population of women. Data are drawn from baseline interviews from street-based African-American female sex workers enrolled in a randomized intervention trial in Miami, Florida. We compare sexual minority (N = 197) and heterosexual (N = 365) women on measures of risk and protective factors; among sexual minority women we present logistic regression analyses which reveal that severe mental distress and HIV transmission risk are associated with low levels of personal mastery, while protective factors of transportation access and social support are associated with high levels of personal mastery. These findings suggest that these protective factors may potentially facilitate the development of personal mastery and represent beneficial avenues for intervention efforts.     

Prevalence and Risk Factors for Dyspareunia and Unsatisfying Sexual Relationships in a Cohort of Primiparous and Secondiparous Women After 12 Months Postpartum

ABSTRACT

Dyspareunia is a common short-term pregnancy complication, rarely lasting longer than 1 year after delivery. Our study aims to determine postpartum dyspareunia prevalence and its impact on women's sexual health. In this retrospective study, we asked 602 women about dyspareunia and the quality of sexual intercourse through telephone interviews. The influence of dyspareunia on the quality of sexual intercourse and couple relationship is scored on a 4-point verbal scale according to its severity. Data were analyzed by R (version 2.8.0), considering significant p < .05. Nearly 100% of women (99.9%) resumed their sexual activity; 16.2% of them reported dyspareunia significantly compromising their sexual intercourse and couple relationships. In univariate analysis, severe perineal tears are associated with persistent dyspareunia (p < .05). By multivariate analysis, postpartum dyspareunia results independently influenced by operative delivery, previous dyspareunia, recurrent urogenital infections and urge incontinence (p < .05), as well as by the Kristeller maneuver and partoanalgesia (p = .084) in the case of women who had a vaginal delivery. Dyspareunia significantly compromises women's sexual health postpartum, mostly caused by perineal trauma by means of delivery management and recurrent urogenital infections.     

Identifying Demographic and Attitudinal Correlates of Young Adults’ Safer-Sex Self-Efficacy

Objectives: Using data from young-adult college students (N = 207), we identified demographic and attitudinal correlates of safer-sex self-efficacy. Female respondents reported higher levels of safer-sex self-efficacy than males. Methods: Participants completed a self-report survey about their sexual attitudes, values, and experiences. Results: In regression analyses only, the importance of safer-sex practices was related to safer sex self-efficacy in both men and women. Women's safersex self-efficacy was associated with additional demographic factors and sexual beliefs. Conclusions: The factors identified in this study may serve as intervention targets for young-adult sexual health programs. Reinforcing the importance of safer-sex practices may be particularly effective in increasing young adults’ safer-sex self-efficacy.     

Assessing symptoms of hypogonadism by self-administered questionnaire: qualitative findings in patients and controls

Background. Current screening instruments for hypogonadism lack adequate specificity and diagnostic accuracy. A new self-administered questionnaire of hypogonadism symptoms is being developed to address this need. The process for questionnaire development and results from the first (qualitative) phase are presented.

Methods. Qualitative interviews were conducted based on a new conceptual model of hypogonadism and according to standards for questionnaire development. An item pool was generated from focus groups and in-depth interviews with two groups of hypogonadal patients, treated (N = 26) and untreated (N = 26), and age-equivalent controls (N = 28). Standardized scoring of the qualitative interviews was used to confirm conceptual domains in the model and to generate questionnaire items for further validation.

Results. Key domains identified in both patients and controls included: (a) physical function; (b) bodily signs and symptoms; (c) sexual function and libido; (d) sleep function; (e) mood and affective function; (f) memory and cognitive function. The final domain is distress or bother associated with hypogonadism symptoms. This domain was only relevant to the patient groups.

Conclusions. The first stage in the design of a new hypogonadism screener has been completed. Seven domains were identified and draft items were developed in each domain according to current standards of patient-reported outcomes.     

Marital Aspirations,Sexual Behaviors,and HIV/AIDS in Rural Malawi

We explore how marital aspirations are related to the sexual behaviors of adolescents and young adults in Malawi, where HIV/AIDS prevalence among adults exceeds 10%. We also consider whether the specter of AIDS is shaping ideals about marriage. By combining survey data (N = 1,087) and in‐depth interviews (N = 133) with young Malawians from the Malawi Diffusion and Ideational Change Project, we show that looking for and finding a suitable spouse are linked to sexual behaviors and, thus, HIV risks. Moreover, concerns about contracting HIV are closely tied to the ideal characteristics of a future spouse. Our findings draw long‐overdue attention to the importance of marital aspirations in understanding adolescent sexual behaviors and risks in the era of AIDS.     

Mental health and substance use of sexual minority college athletes

ABSTRACT

Objective: Assess the mental health and substance use of sexual minority collegiate student-athletes in the United States, as compared with heterosexual college students and heterosexual student-athletes. Participants: Undergraduate students (N = 196,872) who completed the American College Health Association's National College Health Assessment (Fall 2008–Fall 2012 administrations). Methods: Written cross-sectional survey. Results: Sexual minority student-athletes had a higher risk of experiencing mental health difficulties than their heterosexual athlete peers. There were no significant differences in mental health between sexual minority male athletes and nonathletes. Sexual minority female athletes appeared to fare better than nonathlete peers. Substance use was greater among sexual minority students (athlete and nonathlete) and was mediated by mental health. Conclusions: Participation in athletics does not appear to be associated with an elevated risk of negative mental health outcomes for sexual minority participants; however, there are disparities in mental health outcomes by sexual orientation regardless of athletics participation.     

Associations Between Sexual Abuse and Negative Health Consequences Among High-Risk Men Who Have Sex with Men

This study evaluated whether a history of sexual abuse could differentiate negative health consequences among men who have sex with men (MSM; N = 148) enrolled in a risk counseling program. More than half (51.4%) reported an experience of sexual abuse. A history of sexual abuse was associated with increased psychological distress, increased rates of alcohol (AOR = 2.91; p <.01) and/or drug abuse (AOR = 2; p <.01) treatment, increased risk of housing instability (AOR = 2.13; p <.05), and increased risk for suicidality (AOR = 4.3; p <.001). Findings demonstrate that screening for sexual abuse may be useful in determining the service needs of high-risk MSM.     

Effect of a Web-Based Sexual Health Enhancement Program for Women with Gynecologic Cancer and Their Husbands

Objectives: This study examined the effects of a web-based sexual health enhancement program on of women with gynecologic cancer and their husbands. Methods: Twenty-one couples attended the program for 4 weeks and 22 couples were assigned to a control group. Results: The experimental group reported significant improvements in the sexual function of the women with gynecologic cancer (effect size [ES] = .75; p?p?=?.015). Conclusions: Therefore, our results can help provide interventions for patients and their husbands to identify and resolve sexual problems after gynecologic cancer treatment.     

Psychometric Confirmation of the Sexual Health Survey as a Useful Tool for College Health Professionals

Abstract

Objective: To conduct a confirmatory factor analysis on the 17-item Sexual Health Survey (SHS), a comprehensive instrument designed to be used with college students. Participants: College students (N = 515) aged 18 to 26 years enrolled at a Midwest public university October 2009. Methods: Confirmatory factor analysis with maximum likelihood estimation was performed to test the stability of the constructs. Results: All factor loadings were significant (p < .001), ranging from .55 to .99 (standardized). The range of squared multiple correlations of items was .31 to .98, and the intercorrelations among the 5 factors were from ?.03 to .52. These small to moderate levels of intercorrelation support discriminant validity of 5 constructs. Conclusions: This study supports the 5-factor version of the 17-item SHS as a viable scale that can measure sexual health overall and 5 distinct areas. College health professionals should consider use of this scale for assessment purposes and evaluation of programmatic efforts.     

Knowledge,Attitudes, and Informational Behaviors of College Students in Regard to the Human Papillomavirus

Abstract

Objective: To assess students’ human papillomavirus (HPV) knowledge, attitudes, and behaviors. Participants/ Methods: Students (N = 1,282) at a large, public university in the Northeast United States completed a questionnaire during February 2008 assessing HPV knowledge, prevalence, transmission, cervical cancer risk and stigma; sexual behavior, vaccination status, as well as past and preferred sources of information about HPV and sexual health. Results: A majority of respondents know of HPV. However, understanding was insufficient in several important areas. Overwhelmingly, respondents heard about HPV via television commercials yet preferred to obtain sexual health information from physicians. Hearing about HPV on a TV commercial was associated with increased knowledge. More knowledge of HPV was associated with less stigma. Men exhibit a higher level of stigma and less knowledge than women. Conclusions: Publicly funded health campaigns aimed at increasing knowledge about HPV are overdue and necessary. This is especially true for efforts targeting young adults about this extremely common sexually transmitted infection (STI).     

I've Got You Under My Skin: Marital Biography and Biological Risk

Social relationships shape adult health in profound ways. This study informs our understanding of this association by investigating how the transitions, timing, and exposures to marriage are associated with types of biological risk presumed to serve as pathways to disease and disability. Drawing on the 2005–2006 National Social Health and Aging Project (N = 1,062), the authors evaluated how marital biography was associated with cardiovascular, metabolic, and chronic inflammation risk. The results showed that the effects of marital biography were highly sensitive to gender, the dimension of marital biography, and type of biological risk. For example, marital exposure was protective of cardiovascular risk for women, but not men, whereas an earlier age at first marriage had a pernicious effect on chronic inflammation among men, but not women. Health behaviors did not explain these associations. The implications of these findings are discussed as they pertain to under‐the‐skin risk processes and chronic morbidity.     

Intimate partner violence,health, sexuality,and academic performance among a national sample of undergraduates

ABSTRACT

Objective: To determine the association between intimate partner violence (IPV) and academic performance among heterosexual and sexual minority undergraduates, including whether health mediates this relationship. Participants: A national sample of undergraduate students aged 18–24 years old who completed the 2011–2014 National College Health Assessment IIb (N = 85,071). Methods: We used structural equation modeling to create a latent variable of IPV victimization (stalking, physical, sexual, and emotional violence) in order to test its relationship with health (physical and mental) and two indicators of academic performance (GPA and perceived academic difficulties), according to participants’ sexual identity (heterosexual, lesbian, gay, bisexual, and unsure). Results: Regardless of sexual identity, undergraduates who reported IPV were more likely to have lower GPA and increased academic difficulties. Health mediates this relationship, such that IPV reduces health, which negatively affects performance. Conclusions: IPV poses a serious threat to undergraduates’ health and educational success. Findings warrant universal prevention and intervention.     

The sexual inhibition (SIS) and sexual excitation (SES) scales: I. Measuring sexual inhibition and excitation proneness in men

This study involves the development and initial validation of a questionnaire measuring the propensity for sexual inhibition and excitation in men: the Sexual Inhibition & Sexual Excitation Scales (SIS/SES). The underlying theoretical model postulates that sexual response and associated behavior depend on dual control mechanisms, involving excitatory and inhibitory neurophysiological systems. The scales and their discriminant and convergent validity and test‐retest reliability are described. In a sample of 408 sexually functional men (mean age = 22.8 years), factor analyses identified three higher‐level factors: two related to sexual inhibition and one to sexual excitation. Multigroup Confirmatory Factor Analyses revealed that the factor structure provided an acceptable fit to the data obtained in a second (N = 459; mean age = 20.9 years) and third (N = 313; mean age = 46.2 years) sample of men, with similar distributions and relationships with other measures. Theoretical issues and areas for further research, including male sexual dysfunction and risk taking, are discussed.     

Prevalence of Human Immunodeficiency Virus Testing and Associated Risk Factors in College Students

Abstract

Objective: This study documents the prevalence of human immunodeficiency virus (HIV) testing in a sample of college students and examines associated demographic and behavioral characteristics. Participants: College students aged 18 or older were randomly selected to participate in a health behavior survey at a southeastern university in September 2011. Methods: Only sexually active students were included (N = 905). Relationships between demographic and sexual behavior characteristics were explored using logistic regression and classification regression tree (p ≤.05). Results: Only 36.2% reported having been tested for HIV. Age was the most significant factor associated with testing. Factors associated with those least likely to be tested were race and anal sexual activity. Unsafe sexual behaviors were also associated with lower rates of HIV testing. Conclusions: Findings support the need for targeted HIV interventions on college campuses. Such interventions need to be tailored for at-risk students and take into consideration factors likely to contribute to HIV testing.     

Development and Assessment of Measures of Adolescents' Attitudes about Sexual Relationship Rights

Objective: Develop and validate measures of adolescents' attitudes about sexual relationship rights. Methods: Items were completed by students in a large U.S. city (N = 655). The authors conducted an exploratory factor analysis, evaluated internal consistency, and assessed construct validity, including ability to predict sexual behavior at 1-year follow-up. Results: Factor analysis identified 2 distinct factors, comprising attitudes about rights to refuse unwanted sexual activity (5 items) and express sexual engagement needs (5 items) in a sexual relationship. The measures showed sound evidence of reliability and construct validity. Conclusions: The psychometric evidence supports the use of these measures in adolescent sexual health research.     

Sexual Life of Women with Multiple Sclerosis: A Qualitative Study

Objectives: To define the thoughts, emotions, experiences and perceptions of women with multiple sclerosis (MS) and to determine sexual, physical, and emotional effects of MS on patients. Methods: Twenty-one women were included into this qualitatively designed study. Results: Three baseline themes were defined as “uncertainty” arising from complaints due to numbness in extremities and loss of sense, balance or vision, “alterations in sexual life,” and “inability” as a result of deformities in marital status and gender role. Conclusion: Healthcare providers should evaluate MS patients meticulously as to sexual life and refer such patients to appropriate health centers.     

Tanning benefits,seasonal effects,and concerns about sunscreen: Measuring health beliefs about UV among college students

Abstract

Objective: To develop and validate a scale measuring health beliefs about UV in cloudy climates that may impact UV exposure behaviors. Participants: Students at a large university in Oregon completed pilot (N?=?115) and final (N?=?335) scales online March–July, 2016. Five participants underwent cognitive interviews. Methods: Expert feedback, cognitive interviews, and pilot data guided item development and refinement. We conducted factor analysis and invariance testing. Results: The final four-factor model fit well (χ²?=?37.97, df?=?37, RMSEA?=?0.000, CFI?=?1.000). HBAU subscales are Sunscreen Toxicity, Seasonal Effects, Health Benefits of Tanning, and Tanning Through the Winter. Invariance testing supported strong invariance across sex and tanning status. Conclusion: The HBAU measures beliefs that encourage UV exposure and discourage protection (eg, the belief that sunscreen ingredients are toxic). This scale will enable more comprehensive measurement of cognitive predictors of UV exposure for student health, clinical, and research purposes.     

Associations Between Social Support Network Characteristics and Receipt of Emotional and Material Support Among a Sample of Male Sexual Minority Youths

Few studies have examined how social support network characteristics are related to perceived receipt of social support among male sexual minority youths. Using egocentric network data collected from a study of male sexual minority youths (N = 592), multivariable logistic regression analyses examined distinct associations between individual and social network characteristics with receipt of (1) emotional and (2) material support. In multivariable models, frequent communication and having friends in one's network yielded a twofold increase in the likelihood of receiving emotional support whereas frequent communication was associated with an almost threefold higher likelihood of perceived material support. Finally, greater internalized homophobia and personal experiences of gay-related stigma were inversely associated with perceived receipt of emotional and material support, respectively. Understanding the evolving social context and social interactions of this new generation of male sexual minority youths is warranted in order to understand the broader, contextual factors associated with their overall health and well-being.     

An examination of sexual risk behaviors in adolescent substance users

ABSTRACT. Objectives: This study examined the risk for engaging in high-risk sexual behavior associated with substance use in a sample of U.S. adolescents. Methods: The sample (N = 15,425) was obtained via the Youth Risk Behavior Surveillance System, a survey of public high school students. Results: Substance use was associated with sexual risk behaviors, with odds ratios being greatest for adolescents who used cigarettes and illicit substances, as well as those who engaged in injection drug use. Conclusions: Results highlight the need for prevention and intervention programs targeting sexual risk behaviors in substance-using adolescents as a means to decrease the spread of sexually transmitted infections.