Predicting the Condom Assertiveness of Collegiate Females in the United States From the Expanded Health Belief Model

ABSTRACT. Collegiate females in the United States are susceptible to sexually transmitted infections (STIs) due to their propensity for sexual exploration, multiple sexual partnerships, and inconsistent safe-sex practices. Despite the potential for safe-sex communication to contribute to safer sex, little is known about the predictors of this form of sexual communication. Research on condom assertiveness—the unambiguous messaging that sex without a condom is unacceptable—is especially rare. This study employed the Expanded Health Belief Model (EHBM) in an attempt to understand why some collegiate females are more condom assertive than others. Compared with less condom-assertive females, more condom-assertive females have more faith in the effectiveness of condoms, believe more in their own condom communication skills, perceive that they are more susceptible to STIs, believe there are more relational benefits to being condom assertive, believe their peers are more condom assertive, and intend to be more condom assertive. Overall, EHBM variables accounted for nearly 70% of the variability in condom assertiveness. Several of these associations, however, were moderated by sexual compulsivity and general assertiveness. Implications of these findings for sexual health practitioners are discussed, and directions for future research are suggested.     

Femininity Ideology and Sexual Health in Young Women: A focus on Sexual Knowledge,Embodiment, and Agency

ABSTRACT

Traditional femininity ideology is associated with diminished sexual agency in women; yet we know little about its connection to sexual knowledge or experiences of one's body during sex. This study examined how femininity ideology related to sexual health knowledge, body comfort during sex, condom self-efficacy, and sexual assertiveness in college-age women. Femininity ideologies were related to decreased sexual-risk knowledge and lowered body esteem during sex. Femininity ideologies were also related to decreased sexual assertiveness and condom use self-efficacy. Results highlight the importance of understanding the association between femininity ideologies and sexual knowledge acquisition as an aspect of sexual agency, as well as sexual embodiment, in addition to the more commonly studied sexual self-efficacy and assertiveness.     

Women's Unprotected Sex Intentions: Roles of Sexual Victimization,Intoxication, and Partner Perception

Sexually victimized women may make sexual decisions differently than nonvictimized women. This study used an eroticized scenario and laboratory alcohol administration to investigate the roles of victimization history, intoxication, and relationship context in women's perceptions of a male partner and their subsequent intentions for unprotected sex. A community sample of 436 women completed childhood sexual abuse (CSA) and adolescent/adult sexual assault (ASA) measures. After random assignment to an alcohol or control condition, participants read and projected themselves into a sexual scenario that depicted the male partner as having high or low potential for a lasting relationship. Participants rated their perceptions of his intoxication, sexually transmitted infection (STI) risk level, and anticipated reactions to insistence on condom use. They then indicated their likelihood of allowing the partner to decide how far to go sexually (abdication) and of engaging in unprotected sex. Structural equation modeling (SEM) analyses revealed that intoxication predicted greater unprotected sex likelihood indirectly via abdication. CSA and ASA predicted partner perceptions, which in turn predicted unprotected sex likelihood. These findings indicate that, compared to their nonvictimized counterparts, sexually victimized women may respond differently in sexual encounters partly as a function of their perceptions of partners' STI risk and anticipated reactions to condom insistence.     

Attachment Insecurities and Women's Sexual Function and Satisfaction: The Mediating Roles of Sexual Self-Esteem,Sexual Anxiety,and Sexual Assertiveness

We examined the potential role of three mediators—sexual self-esteem, sexual anxiety, and sexual assertiveness—of the association between romantic attachment insecurities (anxiety and avoidance) and two aspects of women's sexual functioning: sexual function and sexual satisfaction. A sample of 556 women aged 18 to 30 agreed to complete an online series of validated questionnaires assessing attachment insecurities and several aspects of sexual functioning. Lower sexual self-esteem and higher sexual anxiety mediated the associations between attachment anxiety and lower sexual function and satisfaction. Lower sexual self-esteem and higher sexual anxiety also partially mediated the links between attachment-related avoidance and the two sexual functioning variables. Sexual assertiveness, however, did not mediate these associations. A significant interaction between attachment anxiety and avoidance was also found to predict sexual satisfaction, with women high in avoidance and low in anxiety being the least satisfied. Results are discussed in terms of theoretical and clinical implications.     

Mediators of Sexual Revictimization Risk in Adult Sexual Assault Victims

This study examined sexual risk behaviors and sexual refusal assertiveness in relationship to child sexual abuse, emotion dysregulation, and adult sexual revictimization. Path analyses of 1,094 survivors who had sex in the past year were done to examine sexual risk behavior and sexual refusal assertiveness mediational pathways by which child sexual abuse severity and emotion dysregulation may affect revictimization over one year in adult female sexual assault survivors. Exchanging sex for money and sexual refusal assertiveness were significantly associated with emotion dysregulation, whereas exchanging sex for money, and not sexual refusal assertiveness, was only significantly related to child sexual abuse severity. Both exchanging sex for money and sex refusal assertiveness mediated the relationship between emotion dysregulation and adult sexual revictimization. Exchanging sex for money mediated the child sexual abuse severity-revictimization relationship. These findings demonstrate the importance of considering both risky and protective sexual behaviors in research and prevention programming that address sexual revictimization in women.     

Will It Help? Identifying Socialization Discourses That Promote Sexual Risk and Sexual Health Among African American Youth

Because much of the existing research examining sexual communication to African American youth focuses on demographic and parental factors predicting sexual risk behaviors, less is known about factors predicting sexual health, and little is understood about the contributions of peer communications. The current study aimed to expand existing approaches by assessing which socialization discourses communicated by parents and peers contribute to sexual risk and health outcomes (sexual assertiveness, positive sexual affect, and condom self-efficacy). Participants were 631 African American undergraduates (73% female) who indicated the extent to which they had received from their parents and peers each of 28 messages representing four cultural discourses: abstinence, relational sex, sex positive, and gendered sexual roles. As expected, parents were perceived to emphasize relational sex and abstinence messages more than peers, and peers were perceived to communicate sex-positive and gendered sex role messages more than parents. Greater exposure to abstinence messages predicted lower levels of sexual experimentation, whereas exposure to sex-positive messages predicted higher levels. In addition, exposure to relational sex and sex-positive messages predicted higher levels of sexual assertiveness and positive sexual affect. Implications are discussed concerning sexual communications that could help Black youth develop healthy sexual perspectives.     

Differences and Similarities in Men's and Women's Sexual Self-Schemas

In the last 10 years, researchers have developed separate rating scales for men and women that purport to measure a person's thoughts about their sexual self or sexual self-schema. While these scales are promising, there are some problems intrinsic to these measures. This study addresses these concerns and tests a combined measure for use among both men and women, while retaining internal consistency and a factor structure similar to the women's scale. Having both men and women complete the same scale permitted a comparison of how men and women think about their sexual selves. In this study, gender differences netted a small effect, with men scoring lower on both the loving/warmth and reserved/conservative factors compared to women. Results are discussed in terms of future research with this new scale and the meaning of gender differences along these dimensions.     

Motivations for Sexual Intimacy: Development of a Needs-Based Sexual Intimacy Scale

ABSTRACT

To assess motivations associated with sexual intimacy, a need for sexual intimacy scale (NSIS) was developed within a needs-based framework, focusing on needs for sex, affiliation, and dominance. Participants were 347 individuals associated with two large Southern California universities. Both exploratory and confirmatory factor analyses (EFA and CFA) were utilized, as were multiple attitudinal and behavioral measures for validation purposes. EFA found 22 items to be associated with the three need sets, with good internal consistency reliability. CFA confirmed these findings, and promising construct and criterion validities were also noted for the factors. Those reporting a greater need for sex noted more lifetime sex partners and one-night stands, but were less likely to use condoms. Individuals with affiliation needs were more likely to be truthful with their partners and more likely to practice safe-sex. Those reporting dominance needs want to control their partners sexually, but were less likely to use condoms. Men were found to exhibit greater needs for sex, while women reported higher levels of affiliation need. Sexual health and primary prevention concerns are discussed.     

Relations Among Religiousness,Spirituality, and Sexual Practices

Although religiousness is commonly associated with limited sexual activity, little is known about spirituality's unique effect. Study aims involved measuring spirituality's unique affect on young adults' sexual practices (frequency of sex, number of sexual partners, and condom use) and determining whether spirituality adds significant increment over well-established predictors. Three hundred fifty-three (61% female) heterosexual young adults aged 17 to 29 completed this cross-sectional, self-report questionnaire study. Hierarchical regression analyses demonstrated spirituality is positively associated with participants' number of sexual partners and frequency of sex without a condom. Spirituality contributed to the prediction of participants' number of partners and condom use above and beyond the variance accounted for by religiousness, alcohol use, and impulsivity. A moderating effect for gender was found. Spirituality appears to have a unique and strong association with the sexual practices of young adults, particularly women, and should be assessed in future studies of young adults' sexual practices.     

Testing a New Measure of Sexual Health Knowledge and Its Connections to Students' Sex Education,Communication, Confidence,and Condom Use

ABSTRACT

This study investigates the nature of college students' sexual health knowledge, prior sex education coverage, and sexual communication and confidence. We created a new, comprehensive sexual health knowledge measure to assess 347 undergraduates' knowledge of reproductive health, contraception, condom use, sexually transmitted diseases (STDs), and HIV/AIDS. Overall, students demonstrated a fairly poor understanding of sexual health issues. Women were more knowledgeable than men, specifically on the topics of contraception and STDs. Prior exposure to sex education covering mainstream reproductive health issues or newer contraception methods was correlated with greater knowledge across all domains, particularly for men. Greater knowledge was also correlated with greater sexual assertiveness and confidence with condoms among women.     

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 Deception as a Social-Exchange Process: Development of a Behavior-Based Sexual Deception Scale

The use of deception in association with sexual encounters may take many forms, ranging from outright lies to more subtle, evasive manipulations. To address such deceptions, a behavior-based sexual deception scale was developed utilizing social exchange theory. Participants were 267 individuals associated with two large universities who were surveyed regarding different aspects of their sexual deceptive behaviors. In addition, items addressing sexually related behaviors and attitudes were assessed for validation purposes. Principal components analysis identified three components of sexual deception, labeled Blatant Lying, Self-Serving, and Avoiding Confrontation. Confirmatory factor analysis verified the resulting structure, and promising validity was noted. In general, those using any of these deceptions reported more sexual partners and one-night stands. Those telling blatant lies to have sex were more likely to report greater needs for sex, while those using self-serving lies or having sex to avoid confrontation experienced greater worry about partner loss. Men were more likely to use blatant lies to have sex, while women were more likely to have sex to avoid confrontation. Results support sexual deception as an exchange process, with sex for pleasure and positive relationship outcomes acting as rewards, and unwanted sex and deception consequences as costs. Implications for health interventions and primary prevention applications are discussed.     

Gender Differences in the Sexual Well-Being of Mexican Adolescents

Objective: This study examines the associations of gender roles and sexual power with the sexual wellbeing of Mexican adolescents. Particularly we look at the role played by adolescent’s attitudes toward gender roles and sexual power regarding three aspects of their sexual well-being: satisfaction with one’s sex life; consistent condom use; and the refusal of unwanted sexual contact with one’s partner. Methods: we used logistic regression models to analyze possible associations between attitudes toward gender roles, and sexual power, with the sexual well-being of adolescents, using a random and representative sample of 4,738 sexually active teenagers from three Mexican states. Results: egalitarian attitudes are positively associated to high sexual satisfaction for female adolescents, whereas for males they favor the refusal of unwanted sex. Sexual power shows significant associations with consistent condom use for both males and females, and it also significantly increases the likelihood of high sexual satisfaction and refusal of unwanted sex among females. Conclusions: the findings suggest the relevance of overcoming traditional sex roles to achieve adolescent sexual well-being. In this sense, health and population policies should direct more substantial efforts in the promotion of gender equality among the adolescents and in the development of critical attitudes towards traditional gender norms.     

Dual Measures of Sexual Consent: A Confirmatory Factor Analysis of the Internal Consent Scale and External Consent Scale

Sexual assault, often defined as nonconsensual sex, is a problem among college students. Universities have made efforts to increase student awareness about sexual consent, which varies along two dimensions: internal feelings of wantedness and external expressions of consent. However, interventions focus on increasing knowledge of the external expression of consent despite the importance of both dimensions for effective sexual communication. A validated research tool that captures students’ ecological experiences along both dimensions is critical. The current study aimed to replicate and validate the factor structure of the Internal Consent Scale (ICS) and External Consent Scale (ECS) in a sample of 610 undergraduate students and to expand on prior work by examining associations with relationship to partner and sexual orientation. Confirmatory factor analyses (CFA) provided support for the ICS in its current form (i.e., model fit and factor loadings for the ICS were good). Although model fit for the ECS was good, one subscale, no response signals, had poor factor loadings (.16, .38); thus, suggestions are offered to improve its psychometric properties. Despite limitations of the ECS, these dual measures fill a gap in the consent literature by providing a tool to quantify internal and external aspects of sexual consent.     

Gender,Generational Status,and Parent–Adolescent Sexual Communication: Implications for Latino/a Adolescent Sexual Behavior

There is little research on how specific parent–adolescent sexual communication topics influence Latino/a youth's sexual behaviors, and how gender and generational status may moderate effects. This study examined effects of three different messages on intercourse and condom use among 1,944 Latino/as from the National Longitudinal Study of Adolescent Health (T1 mean age = 15.46; SD = 1.50). Results indicated discussing health consequences predicted higher odds of intercourse 1 year later across gender and generation groups. Birth control recommendation effects on subsequent intercourse and condom use differed by generational status and gender. Results indicated that message content is important for understanding effects of parent–adolescent sex communication on adolescents' behavior and underscored the need to consider gender and generational status in Latino/a parent–adolescent sexual communication studies.     

What is Sexual Satisfaction? Thematic Analysis of Lay People's Definitions

Sexual satisfaction is an important indicator of sexual health and is strongly associated with relationship satisfaction. However, research exploring lay definitions of sexual satisfaction has been scarce. We present thematic analysis of written responses of 449 women and 311 men to the question “How would you define sexual satisfaction?” The participants were heterosexual individuals with a mean age of 36.05 years (SD = 8.34) involved in a committed exclusive relationship. In this exploratory study, two main themes were identified: personal sexual well-being and dyadic processes. The first theme focuses on the positive aspects of individual sexual experience, such as pleasure, positive feelings, arousal, sexual openness, and orgasm. The second theme emphasizes relational dimensions, such as mutuality, romance, expression of feelings, creativity, acting out desires, and frequency of sexual activity. Our results highlight that mutual pleasure is a crucial component of sexual satisfaction and that sexual satisfaction derives from positive sexual experiences and not from the absence of conflict or dysfunction. The findings support definitions and models of sexual satisfaction that focus on positive sexual outcomes and the use of measures that incorporate items linked to personal and dyadic sexual rewards for both men and women.     

Sexual deception as a social-exchange process: development of a behavior-based sexual deception scale

The use of deception in association with sexual encounters may take many forms, ranging from outright lies to more subtle, evasive manipulations. To address such deceptions, a behavior-based sexual deception scale was developed utilizing social exchange theory. Participants were 267 individuals associated with two large universities who were surveyed regarding different aspects of their sexual deceptive behaviors. In addition, items addressing sexually related behaviors and attitudes were assessed for validation purposes. Principal components analysis identified three components of sexual deception, labeled Blatant Lying, Self-Serving, and Avoiding Confrontation. Confirmatory factor analysis verified the resulting structure, and promising validity was noted. In general, those using any of these deceptions reported more sexual partners and one-night stands. Those telling blatant lies to have sex were more likely to report greater needs for sex, while those using self-serving lies or having sex to avoid confrontation experienced greater worry about partner loss. Men were more likely to use blatant lies to have sex, while women were more likely to have sex to avoid confrontation. Results support sexual deception as an exchange process, with sex for pleasure and positive relationship outcomes acting as rewards, and unwanted sex and deception consequences as costs. Implications for health interventions and primary prevention applications are discussed.     

Sexual Desire Inventory: Two or Three Dimensions?

The Sexual Desire Inventory (SDI), developed by Spector, Carey, and Steinberg in 1996, has been widely used to assess sexual desire in men and women throughout the world. This questionnaire categorizes sexual desire in two dimensions: dyadic sexual desire and solitary sexual desire. Our study addressed the factorial structure of the SDI, an aspect that until now has been largely neglected. We recruited two samples of Spanish men and women involved in stable heterosexual relationships. The first sample consisted of 3,417 subjects (1,600 males and 1,817 females), ages 18 to 84; the second sample consisted of 677 subjects (285 males and 392 females), ages 18 to 50. The results of an exploratory factor analysis (EFA) showed that instead of two dimensions the SDI should have three: (1) partner-focused dyadic sexual desire, (2) general dyadic sexual desire for an attractive person, and (3) solitary sexual desire. A confirmatory factor analysis (CFA) supported the robustness of this new three-factor structure. No gender differences were revealed, except for dyadic sexual desire for an attractive person, for which men reported higher scores. Good validity and reliability values were obtained. Moreover, standard scores for men and women by different age groups were developed.     

Bush's War on Sexual Health and Defensive Strategies Against It

Abstract

Since George W. Bush became President of the United States in 2001, his administration has presided over a far-reaching campaign attacking sexual and reproductive rights. This paper examines three facets of this campaign-the promotion of abstinence-only education; a general attack on condom use; and a campaign against sex workers-and offers strategies for advocates of sexual and reproductive rights to counter these measures.