Objectives: This paper describes African American teenaged males' attitudes and perspectives on a... more Objectives: This paper describes African American teenaged males' attitudes and perspectives on abortion. Methods: Data were derived from a larger cross-sectional survey of African American males aged 14–19, living in the south side of Chicago. Results: Acceptability of abortion varied by partner type, such that 60% of teenagers felt abortion was acceptable with a casual partner while 37% found it acceptable with committed partners (p < .001). Acceptability also varied by sociocontextual factors, and with overarching uncertainty or inconsistency. Conclusions: Teenaged African American males have uniquely complex attitudes toward abortion.
This paper presents findings from a focus group study conducted to evaluate The Source, an altern... more This paper presents findings from a focus group study conducted to evaluate The Source, an alternate reality game (ARG). ARGs are a relatively new genre of interactive digital games that use a variety of media to engage game players. We developed modules on sexual health, sexual orientation, and homophobia in a game that was delivered to 133 predominantly African-American and Latino US youth. Ten focus groups were conducted with 43 young people aged 13–18 who played The Source to understand feasibility and acceptability issues and the impact of the game on young people’s attitudes, knowledge, and behaviours. Data were transcribed and analysed for common themes by two independent coders. Four primary themes were identified: (1) the feasibility and acceptability of using an ARG for sexual education; (2) the acceptability of The Source’s specific sexual health content; (3) the game’s influence on sexual health-related knowledge, attitudes, and behaviours; and (4) the impact of the game on young people’s thoughts and responses to sexual orientation and homophobia. Study findings indicate that an ARG is an exciting and interactive way to educate young people on sensitive topics in sexuality education, but that attention to narrative authenticity and effective messaging are important issues to address.
Data from 1,380 self-identified bisexual women and men age 18
to 70 living in the United States d... more Data from 1,380 self-identified bisexual women and men age 18 to 70 living in the United States document significant diversity across age and gender in attitudes regarding which behaviors constitute “sex” and behavioral histories. With the exceptions of deep kissing, penile-vaginal intercourse, and penile-anal intercourse, the 18 to 29 age groups of both genders were significantly less likely to count all other behaviors (manual and oral stimulation of breasts, genitals, and anus; and use of sex toys) as sex. Stronger age effects were found for men than women for manual and oral stimulation of genitals or anus, and sex toy use. Compared to older men and women, fewer 18- to 29-year-olds had experienced each behavior. Use of behaviorally nonspecific sexual history questions in research and clinical practice is problematic because (1) across age-group comparisons may be contaminated by differential interpretation of questions across age groups and (2) within age-group comparisons may be confounded by gender differences in interpretation.
American Journal of Obstetrics and Gynecology, 2014
Adoption of long-acting reversible contraception (LARC) (ie, the intrauterine device or the contr... more Adoption of long-acting reversible contraception (LARC) (ie, the intrauterine device or the contraceptive implant) immediately after abortion is associated with high contraceptive satisfaction and reduced rates of repeat abortion. Theory-based counseling interventions have been demonstrated to improve a variety of health behaviors; data on theory-based counseling interventions for postabortion contraception are lacking. Informed by the transtheoretical model of behavioral change, a video intervention was developed to increase awareness of, and dispel misconceptions about, LARC methods. The intervention was evaluated in a randomized controlled trial among women aged 18-29 years undergoing surgical abortion at a clinic in Chicago, IL. Participants were randomized 1:1 to watch the intervention video or to watch a stress management video (control), both 7 minutes in duration. Contraceptive methods were supplied to all participants free of charge. Rates of LARC initiation immediately after abortion were compared. Rates of LARC initiation immediately after abortion were not significantly different between the 2 study arms; 59.6% in the intervention and 51.6% in the control arm chose a LARC method (P = .27). This study resulted in an unexpectedly high rate of LARC initiation immediately after abortion. High rates of LARC initiation could not be attributed to a theory-based counseling intervention.
American Journal of Obstetrics and Gynecology, 2015
The objective of the study was to evaluate the impact of doula support on first-trimester abortio... more The objective of the study was to evaluate the impact of doula support on first-trimester abortion care. Women were randomized to receive doula support or routine care during first-trimester surgical abortion. We examined the effect of doula support on pain during abortion using a 100 mm visual analog scale. The study had the statistical power to detect a 20% difference in mean pain scores. Secondary measures included satisfaction, procedure duration, and patient recommendations regarding doula support. Two hundred fourteen women completed the study: 106 received doula support, and 108 received routine care. The groups did not differ regarding demographics, gestational age, or medical history. Pain scores in the doula and control groups did not differ at speculum insertion (38.6 [±26.3 mm] vs 43.6 mm [±25.9 mm], P = .18) or procedure completion (68.2 [±28.0 mm] vs 70.6 mm [±23.5 mm], P = .52). Procedure duration (3.39 [±2.83 min] vs 3.18 min [±2.36 min], P = .55) and patient satisfaction (75.2 [±28.6 mm] vs 74.6 mm [±27.4 mm], P = .89) did not differ between the doula and control groups. Among women who received doula support, 96.2% recommended routine doula support for abortion and 60.4% indicated interest in training as doulas. Among women who did not receive doula support, 71.6% of women would have wanted it. Additional clinical staff was needed to provide support for 2.9% of women in the doula group and 14.7% of controls (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01). Although doula support did not have a measurable effect on pain or satisfaction, women overwhelmingly recommended it for routine care. Women receiving doula support were less likely to require additional clinic support resources. Doula support therefore may address patient psychosocial needs.
Current Opinion in Obstetrics and Gynecology, 2014
Digital media, including the Internet, social networking sites, text messaging, and mobile applic... more Digital media, including the Internet, social networking sites, text messaging, and mobile applications, are ubiquitous among adolescents and young adults. These platforms enable users to obtain important information on a multitude of health topics, they may facilitate risk-taking behaviors, and they can be key components of health interventions. The purpose of this article is to review the recent literature on digital media and sexually transmitted infections, discussing their role in potentiating and reducing risk. This review demonstrates adolescents&amp;amp;amp;amp;amp;amp;#39; use of digital media to gather information on health topics and discusses significant privacy concerns regarding using media to explore sexual health information. Although several studies demonstrate an association between social media and increased sexual risk-taking behaviors, this relationship is not fully understood. Digital media-based interventions are increasingly being developed to either reduce risk or improve management of sexually transmitted infections. As greater numbers of adolescents use digital media, the potential for these platforms to influence sexual risk-taking behaviors is significant. Additional research is needed to better understand the impact of digital media on sexually transmitted infection risk and to develop social media-based interventions to improve sexually transmitted infection outcomes.
Understanding the definition and meaning of the word &quot;sex&quot; has implications for... more Understanding the definition and meaning of the word &quot;sex&quot; has implications for sexual medicine, HIV/AIDS research, and clinical practices. Previous studies have reported variations in the definition of having &quot;had sex&quot; and the necessity of using behaviorally specific terminology when taking sexual histories and assessing sexual risk. The purpose of the current study is to assess gay men&#39;s definitions of what constitutes having &quot;had sex.&quot; Two international convenience samples are compared: a UK sample of 180 self-identified gay men ranging from 18 to 56 years of age (M=36 years; SD=8.29) and a US sample of 190 self-identified gay men ranging 18-74 years of age (M=33.9 years; SD=12.49). Both groups were asked to indicate whether each of a list of sexual behaviors was considered having &quot;had sex.&quot; Almost all participants (~95%) believed that penile-anal intercourse constituted having &quot;had sex.&quot; US and UK gay men differed in defining the following as having &quot;had sex&quot;: giving oral-genital stimulation (US 71.6%, UK 84.9%, P=0.002); giving (G) and receiving (R) manual-anal stimulation (G: US 53.4%, UK 70.9%, P=0.001; R: US 53.7%, UK 71.2%, P=0.001); giving and receiving oral-anal stimulation (G: US 61.2%, UK 78.4%, P&lt;0.001; R: US 59.3%, UK 78.1, P&lt;0.001); and giving and receiving sex-toy stimulation (G: US 55%, UK 77.1%, P&lt;0.001; R: US 56.1%, UK 77.7%, P&lt;0.001). It is important to note that regardless of country there was not overall consensus on which behaviors constituted having &quot;had sex.&quot; These findings reinforce the need for behavioral specificity in documenting sexual histories and assessing sexual risk. Further, researchers and clinicians should exercise caution by not assuming that their own definitions of the term &quot;sex&quot; is shared by their gay male participants or patients.
This paper presents findings from a focus group study conducted to evaluate The Source, an Altern... more This paper presents findings from a focus group study conducted to evaluate The Source, an Alternate Reality Game (ARG). ARGs are a relatively new genre of interactive digital games that utilise a variety of media to engage game players. We developed modules on sexual health, sexual orientation, and homophobia a game that was delivered to 133 predominantly African American and Latino youth. Ten focus groups were conducted with 43 young people ages 13–18 years old who played The Source to understand feasibility and acceptability issues and the impact of the game on youth’s attitudes, knowledge, and behaviours. Data were transcribed and analysed for common themes by two independent coders. Four primary themes were identified: (1) the feasibility and acceptability of using an ARG for sexual education; (2) the acceptability of The Source’s specific sexual health content; (3) the game’s influence on sexual health-related knowledge, attitudes, and behaviours; and (4) the impact of the game on young people’s thoughts and responses to sexual orientation and homophobia. Study findings indicate that an ARG is an exciting and interactive way to educate young people on sensitive topics in sexuality education, but that attention to narrative authenticity and effective messaging are important issues to address.
Purpose. The purposes of this study were to document the HIV testing behaviors and serostatus of ... more Purpose. The purposes of this study were to document the HIV testing behaviors and serostatus of younger men of color who have sex with men (YMSM) and to explore sociodemographic, behavioral, and maternal correlates of HIV testing in the past 6 months.
Methods. A total of 135 YMSM aged 16–19 years completed a close-ended survey on HIV testing and risk behaviors, mother–son communication, and sociodemographic characteristics. Youth were offered point-of-care HIV testing, with results provided at survey end. Multivariate logistic regression analyzed the sociodemographic, behavioral, and maternal factors associated with routine HIV testing.
Results. A total of 90.3% of YMSM had previously tested for HIV, and 70.9% had tested in the past 6 months. In total, 11.7% of youth reported being HIV positive, and 3.3% reported unknown serostatus. When offered an HIV test, 97.8% accepted. Of these, 14.7% had a positive oral test result, and 31.58% of HIV-positive YMSM (n = 6) were seropositive unaware. Logistic regression results indicated that maternal communication about sex with males was positively associated with routine testing (odds ratio = 2.36; 95% confidence interval = 1.13–4.94). Conversely, communication about puberty and general human sexuality was negatively associated (odds ratio = .45; 95% confidence interval = .24–.86). Condomless anal intercourse and positive sexually transmitted infection history were negatively associated with routine testing; however, frequency of alcohol use was positively associated.
Conclusions. Despite high rates of testing, we found high rates of HIV infection, with 31.58% of HIV-positive YMSM being seropositive unaware. Mother–son communication about sex needs to address same-sex behavior as this appears to be more important than other topics. YMSM with known risk factors for HIV are not testing at the recommended time intervals.
Background: Previous studies have associated men who experience condom-associated erection proble... more Background: Previous studies have associated men who experience condom-associated erection problems (CAEP) with incomplete condom use and/or foregoing using condoms altogether. However, how men respond to CAEP and what they attribute CAEP to, remains unclear. Understanding young men’s CAEP responses and attributions could help improve sexually transmissible infections (STI)/HIV prevention programs and interventions. Methods: Behavioural responses to, and attributions for, CAEP during application (CAEP-Application) and/or during penile-vaginal intercourse (CAEP-PVI) were reported using an online questionnaire by 295 young, heterosexual men (aged 18–24 years) who were recruited via social media websites and university Listservs across major cities in the Midwestern USA. Results: Behavioural responses to CAEP-Application included receiving oral or manual stimulation, stimulating a partner, self-stimulation, foregoing condom use and applying the condom after starting intercourse. Attributions for CAEP-Application included: distraction, fit and feel problems, application taking too long and having consumed too much alcohol. Behavioural responses to CAEP-PVI included increasing the intensity of intercourse, removing the condom to receive oral or manual stimulation and removing condom and continuing intercourse. Attributions for CAEP-PVI included: lack of sensation, taking too long to orgasm, not being ‘turned on’ enough, fit and feel problems and partner-related factors. Conclusions: Men who report CAEP respond with both STI/HIV risk-reducing and potentially risk-increasing behaviours (e.g. forgoing condom use). Men attribute their experiences to a wide range of individual- and partner-level factors. Addressing men’s CAEP behavioural responses and attributions may increase the efficacious value of condom programs and STI/HIV prevention interventions – particularly among men who experience CAEP.
Introduction. Condom-associated erection problems (CAEP) are an underestimated factor related to ... more Introduction. Condom-associated erection problems (CAEP) are an underestimated factor related to inconsistent or incomplete male condom use. The underlying mechanisms of CAEP are not understood, and whether men who report these difficulties are also likely to experience erectile problems in situations when condoms are not used has not been studied. Aim. The aim of the study was to investigate, in a sample of condom-using young, heterosexual men (aged 18–24 years), whether men who report CAEP are more likely to (i) have erection problems when not using condoms and (ii) meet criteria for erectile dysfunction. Methods. A total of 479 men recruited online completed the International Index of Erectile Function (IIEF-5) and answered questions about erection problems experienced when using and not using condoms during the last 90 days. Demographic, sexual experience, and health status variables were investigated as correlates. Main Outcome Measures. Self-reported frequency of erection loss during condom application or during penile– vaginal intercourse (PVI) in the past 90 days and IIEF-5 scores. Results. Of the men, 38.4% were classified in the no CAEP group, 13.8% as having CAEP during condom application, 15.7% as having CAEP during PVI, and 32.2% as having CAEP during both condom application and PVI. Men reporting any form of CAEP were significantly more likely than men reporting no CAEP to also report erection difficulties during sexual activity when not using condoms. Men who reported CAEP during PVI only or during both application and PVI scored significantly lower on the IIEF-5 than men without CAEP. Conclusion. The findings suggest that men who report CAEP are also more likely to experience more generalized erection difficulties. Clinicians should assess whether men using condoms experience CAEP and where appropriate, refer for psychosexual therapy or provide condom skills education. S
Questionnaire data from 479 heterosexual men 18-24 years old were analyzed for correlates of CAEP... more Questionnaire data from 479 heterosexual men 18-24 years old were analyzed for correlates of CAEP during application (CAEP-Application) and CAEP during penile-vaginal intercourse (CAEP-PVI). Potential correlates were self-efficacy (condom application, product selection, and maintaining arousal), condom perceptions (condom worry/distraction, negative condom perceptions, concerns about application speed), condom fit, and motivation to use condoms. We conclude that (1) experiencing CAEP may become a repeating cycle, both affecting and being affected by, worry and distraction related to losing erections and maintaining arousal while using a condom (2) poorly fitting condoms may contribute to CAEP, and (3) CAEP may decrease motivation to use condoms.
Background: The purpose of this study was to develop an abbreviated reliable tool for assessing t... more Background: The purpose of this study was to develop an abbreviated reliable tool for assessing the attitudes US college-aged men and women have about condoms and condom use. Method: An online questionnaire was constructed and completed by 674 participants incorporating modified items from the Attitudes Towards Condom Scale (1984) and the Multidimensional Condom Attitude Scale (1994), with the addition of gender-neutral worded and condom positive or erotic items. Results: The original 40 items were reduced to 18 Likert-type items comprising the Brief Condom Attitude Scale (BCAS). Gender comparisons on a subset of 584 self-identified heterosexual participants indicated that women were significantly more likely to consider condoms as less protective, while men were significantly more likely to consider condoms as more interruptive. Additional analyses examining partnership indicated that monogamous participants were significantly more likely to view condoms as less interruptive, more erotic and less negative than non-monogamous participants. Conclusions: The BCAS appears to be a reliable measure for assessing US college-aged individuals' attitudes about condoms.
Condom-associated erection problems (CAEPs) are reported by a substantial number of young men and... more Condom-associated erection problems (CAEPs) are reported by a substantial number of young men and are associated with inconsistent and/or incomplete condom use. The underlying mechanisms of CAEP are not well understood, and research examining the possibility that men who report CAEP differ from other men in their sexual responsivity is lacking. Aim. This study used psychophysiological methods to examine whether men who report CAEP have a higher threshold for sexual arousal, a stronger need for tactile stimulation, and/or more easily lose their sexual arousal due to neutral distractors or performance-related demands. Methods. A total of 142 young, heterosexual men (53% reporting CAEP) were presented with four 3-minute erotic film clips. Three film clips were combined with one of the following manipulations: (i) distraction; (ii) performance demand; or (iii) vibrotactile stimulation. One erotic film clip was presented with no further instructions or manipulations. Main Outcome Measures. Average penile circumference changes during the first, second, and third minute (time) of the erotic film stimuli (condition) were submitted to a mixed-model analysis of variance with condition and time as within-subjects factors and group (CAEP/no-CAEP) as between-subjects factor. Results. Significant main effects of condition and time and a significant interaction of group × time were found. No significant interactions involving condition were found. Men who reported CAEP had smaller erectile responses during the first minute, regardless of film condition, than men who reported no CAEP (F(1,141) = 8.64, P < 0.005). Conclusion. The findings suggest that men with and without CAEP differ in the ease with which they become sexually aroused. Men reporting CAEP needed more time and/or more intense stimulation to become aroused. To our knowledge, this study is the first to use psychophysiological methods to assess sexual responsivity in men who report CAEP. Janssen E, Sanders SA, Hill BJ, Amick E, Oversen D, Kvam P, and Ingelhart K. Patterns of sexual arousal in young, heterosexual men who experience condom-associated erection problems (CAEP).
Investigating the ways in which barrier methods such as condoms may affect penile sensory thresho... more Investigating the ways in which barrier methods such as condoms may affect penile sensory thresholds has potential relevance to the development of interventions in men who experience negative effects of condoms on sexual response and sensation. A quantitative, psychophysiological investigation examining the degree to which sensations are altered by condoms has, to date, not been conducted. Aim. The objective of this study was to examine penile vibrotactile sensitivity thresholds in both flaccid and erect penises with and without a condom while comparing men who do and those who do not report condom-associated erection problems (CAEP). Methods. Penile vibrotactile sensitivity thresholds were assessed among a total of 141 young, heterosexual men using biothesiometry. An incremental two-step staircase method was used and repeated three times for each of four conditions. Intra-class correlation coefficients (ICCs) were calculated for all vibratory assessments. Penile vibratory thresholds were compared using a mixed-model analysis of variance. Main Outcome Measures. Penile vibrotactile sensitivity thresholds with and without a condom, erectile function measured by International Index of Erectile Function Questionnaire, and self-reported degree of erection. Results. Significant main effects of condoms (yes/no) and erection (yes/no) were found. No main or interaction effects of CAEP were found. Condoms were associated with higher penile vibrotactile sensitivity thresholds (F[1,124] = 17.11, P < 0.001). Penile vibrotactile thresholds were higher with an erect penis than with a flaccid penis (F[1,124] = 4.21, P = 0.042). Conclusion. The current study demonstrates the feasibility of measuring penile vibratory thresholds with and without a condom in both erect and flaccid experimental conditions. As might be expected, condoms increased penile vibrotactile sensitivity thresholds. Interestingly, erections were associated with the highest thresholds. Thus, this study was the first to document that erect penises are less sensitive to vibrotactile stimulation than flaccid penises. Hill BJ, Janssen E, Kvam P, Amick EE, and Sanders SA. The effect of condoms on penile vibrotactile sensitivity thresholds in young, heterosexual men. J Sex Med 2014;11:102-106.
The goal of this study was to improve our understanding of men's sexual response and its componen... more The goal of this study was to improve our understanding of men's sexual response and its components as well as the factors or types of situations that men describe as facilitating or interfering with sexual arousal. Six focus groups, involving 50 mostly white, heterosexual men (M age = 35.2 years; range, 18-70), were conducted. As it was previously found in women (Graham, Sanders, Milhausen, & McBride, Archives of Sexual Behavior, 33, 527-538, 2004), men described a wide range of physical (genital as well as nongenital) and cognitive/affective cues for sexual arousal. Also, men described the relationship between sexual desire and arousal as being variable and complex, presented a wide range of factors that increased or decreased sexual arousal, and showed substantial variability in both the importance and direction of their effects. The findings may help further development of models of sexual response and inform discussions about gender differences in sexual desire and arousal.
The goal of this study was to improve our understanding of men's sexual response and its componen... more The goal of this study was to improve our understanding of men's sexual response and its components as well as the factors or types of situations that men describe as facilitating or interfering with sexual arousal. Six focus groups, involving 50 mostly white, heterosexual men (M age = 35.2 years; range, 18-70), were conducted. As it was previously found in women (Graham, Sanders, Milhausen, & McBride, Archives of Sexual Behavior, 33, 527-538, 2004), men described a wide range of physical (genital as well as nongenital) and cognitive/affective cues for sexual arousal. Also, men described the relationship between sexual desire and arousal as being variable and complex, presented a wide range of factors that increased or decreased sexual arousal, and showed substantial variability in both the importance and direction of their effects. The findings may help further development of models of sexual response and inform discussions about gender differences in sexual desire and arousal.
Objectives: This paper describes African American teenaged males' attitudes and perspectives on a... more Objectives: This paper describes African American teenaged males' attitudes and perspectives on abortion. Methods: Data were derived from a larger cross-sectional survey of African American males aged 14–19, living in the south side of Chicago. Results: Acceptability of abortion varied by partner type, such that 60% of teenagers felt abortion was acceptable with a casual partner while 37% found it acceptable with committed partners (p < .001). Acceptability also varied by sociocontextual factors, and with overarching uncertainty or inconsistency. Conclusions: Teenaged African American males have uniquely complex attitudes toward abortion.
This paper presents findings from a focus group study conducted to evaluate The Source, an altern... more This paper presents findings from a focus group study conducted to evaluate The Source, an alternate reality game (ARG). ARGs are a relatively new genre of interactive digital games that use a variety of media to engage game players. We developed modules on sexual health, sexual orientation, and homophobia in a game that was delivered to 133 predominantly African-American and Latino US youth. Ten focus groups were conducted with 43 young people aged 13–18 who played The Source to understand feasibility and acceptability issues and the impact of the game on young people’s attitudes, knowledge, and behaviours. Data were transcribed and analysed for common themes by two independent coders. Four primary themes were identified: (1) the feasibility and acceptability of using an ARG for sexual education; (2) the acceptability of The Source’s specific sexual health content; (3) the game’s influence on sexual health-related knowledge, attitudes, and behaviours; and (4) the impact of the game on young people’s thoughts and responses to sexual orientation and homophobia. Study findings indicate that an ARG is an exciting and interactive way to educate young people on sensitive topics in sexuality education, but that attention to narrative authenticity and effective messaging are important issues to address.
Data from 1,380 self-identified bisexual women and men age 18
to 70 living in the United States d... more Data from 1,380 self-identified bisexual women and men age 18 to 70 living in the United States document significant diversity across age and gender in attitudes regarding which behaviors constitute “sex” and behavioral histories. With the exceptions of deep kissing, penile-vaginal intercourse, and penile-anal intercourse, the 18 to 29 age groups of both genders were significantly less likely to count all other behaviors (manual and oral stimulation of breasts, genitals, and anus; and use of sex toys) as sex. Stronger age effects were found for men than women for manual and oral stimulation of genitals or anus, and sex toy use. Compared to older men and women, fewer 18- to 29-year-olds had experienced each behavior. Use of behaviorally nonspecific sexual history questions in research and clinical practice is problematic because (1) across age-group comparisons may be contaminated by differential interpretation of questions across age groups and (2) within age-group comparisons may be confounded by gender differences in interpretation.
American Journal of Obstetrics and Gynecology, 2014
Adoption of long-acting reversible contraception (LARC) (ie, the intrauterine device or the contr... more Adoption of long-acting reversible contraception (LARC) (ie, the intrauterine device or the contraceptive implant) immediately after abortion is associated with high contraceptive satisfaction and reduced rates of repeat abortion. Theory-based counseling interventions have been demonstrated to improve a variety of health behaviors; data on theory-based counseling interventions for postabortion contraception are lacking. Informed by the transtheoretical model of behavioral change, a video intervention was developed to increase awareness of, and dispel misconceptions about, LARC methods. The intervention was evaluated in a randomized controlled trial among women aged 18-29 years undergoing surgical abortion at a clinic in Chicago, IL. Participants were randomized 1:1 to watch the intervention video or to watch a stress management video (control), both 7 minutes in duration. Contraceptive methods were supplied to all participants free of charge. Rates of LARC initiation immediately after abortion were compared. Rates of LARC initiation immediately after abortion were not significantly different between the 2 study arms; 59.6% in the intervention and 51.6% in the control arm chose a LARC method (P = .27). This study resulted in an unexpectedly high rate of LARC initiation immediately after abortion. High rates of LARC initiation could not be attributed to a theory-based counseling intervention.
American Journal of Obstetrics and Gynecology, 2015
The objective of the study was to evaluate the impact of doula support on first-trimester abortio... more The objective of the study was to evaluate the impact of doula support on first-trimester abortion care. Women were randomized to receive doula support or routine care during first-trimester surgical abortion. We examined the effect of doula support on pain during abortion using a 100 mm visual analog scale. The study had the statistical power to detect a 20% difference in mean pain scores. Secondary measures included satisfaction, procedure duration, and patient recommendations regarding doula support. Two hundred fourteen women completed the study: 106 received doula support, and 108 received routine care. The groups did not differ regarding demographics, gestational age, or medical history. Pain scores in the doula and control groups did not differ at speculum insertion (38.6 [±26.3 mm] vs 43.6 mm [±25.9 mm], P = .18) or procedure completion (68.2 [±28.0 mm] vs 70.6 mm [±23.5 mm], P = .52). Procedure duration (3.39 [±2.83 min] vs 3.18 min [±2.36 min], P = .55) and patient satisfaction (75.2 [±28.6 mm] vs 74.6 mm [±27.4 mm], P = .89) did not differ between the doula and control groups. Among women who received doula support, 96.2% recommended routine doula support for abortion and 60.4% indicated interest in training as doulas. Among women who did not receive doula support, 71.6% of women would have wanted it. Additional clinical staff was needed to provide support for 2.9% of women in the doula group and 14.7% of controls (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01). Although doula support did not have a measurable effect on pain or satisfaction, women overwhelmingly recommended it for routine care. Women receiving doula support were less likely to require additional clinic support resources. Doula support therefore may address patient psychosocial needs.
Current Opinion in Obstetrics and Gynecology, 2014
Digital media, including the Internet, social networking sites, text messaging, and mobile applic... more Digital media, including the Internet, social networking sites, text messaging, and mobile applications, are ubiquitous among adolescents and young adults. These platforms enable users to obtain important information on a multitude of health topics, they may facilitate risk-taking behaviors, and they can be key components of health interventions. The purpose of this article is to review the recent literature on digital media and sexually transmitted infections, discussing their role in potentiating and reducing risk. This review demonstrates adolescents&amp;amp;amp;amp;amp;amp;#39; use of digital media to gather information on health topics and discusses significant privacy concerns regarding using media to explore sexual health information. Although several studies demonstrate an association between social media and increased sexual risk-taking behaviors, this relationship is not fully understood. Digital media-based interventions are increasingly being developed to either reduce risk or improve management of sexually transmitted infections. As greater numbers of adolescents use digital media, the potential for these platforms to influence sexual risk-taking behaviors is significant. Additional research is needed to better understand the impact of digital media on sexually transmitted infection risk and to develop social media-based interventions to improve sexually transmitted infection outcomes.
Understanding the definition and meaning of the word &quot;sex&quot; has implications for... more Understanding the definition and meaning of the word &quot;sex&quot; has implications for sexual medicine, HIV/AIDS research, and clinical practices. Previous studies have reported variations in the definition of having &quot;had sex&quot; and the necessity of using behaviorally specific terminology when taking sexual histories and assessing sexual risk. The purpose of the current study is to assess gay men&#39;s definitions of what constitutes having &quot;had sex.&quot; Two international convenience samples are compared: a UK sample of 180 self-identified gay men ranging from 18 to 56 years of age (M=36 years; SD=8.29) and a US sample of 190 self-identified gay men ranging 18-74 years of age (M=33.9 years; SD=12.49). Both groups were asked to indicate whether each of a list of sexual behaviors was considered having &quot;had sex.&quot; Almost all participants (~95%) believed that penile-anal intercourse constituted having &quot;had sex.&quot; US and UK gay men differed in defining the following as having &quot;had sex&quot;: giving oral-genital stimulation (US 71.6%, UK 84.9%, P=0.002); giving (G) and receiving (R) manual-anal stimulation (G: US 53.4%, UK 70.9%, P=0.001; R: US 53.7%, UK 71.2%, P=0.001); giving and receiving oral-anal stimulation (G: US 61.2%, UK 78.4%, P&lt;0.001; R: US 59.3%, UK 78.1, P&lt;0.001); and giving and receiving sex-toy stimulation (G: US 55%, UK 77.1%, P&lt;0.001; R: US 56.1%, UK 77.7%, P&lt;0.001). It is important to note that regardless of country there was not overall consensus on which behaviors constituted having &quot;had sex.&quot; These findings reinforce the need for behavioral specificity in documenting sexual histories and assessing sexual risk. Further, researchers and clinicians should exercise caution by not assuming that their own definitions of the term &quot;sex&quot; is shared by their gay male participants or patients.
This paper presents findings from a focus group study conducted to evaluate The Source, an Altern... more This paper presents findings from a focus group study conducted to evaluate The Source, an Alternate Reality Game (ARG). ARGs are a relatively new genre of interactive digital games that utilise a variety of media to engage game players. We developed modules on sexual health, sexual orientation, and homophobia a game that was delivered to 133 predominantly African American and Latino youth. Ten focus groups were conducted with 43 young people ages 13–18 years old who played The Source to understand feasibility and acceptability issues and the impact of the game on youth’s attitudes, knowledge, and behaviours. Data were transcribed and analysed for common themes by two independent coders. Four primary themes were identified: (1) the feasibility and acceptability of using an ARG for sexual education; (2) the acceptability of The Source’s specific sexual health content; (3) the game’s influence on sexual health-related knowledge, attitudes, and behaviours; and (4) the impact of the game on young people’s thoughts and responses to sexual orientation and homophobia. Study findings indicate that an ARG is an exciting and interactive way to educate young people on sensitive topics in sexuality education, but that attention to narrative authenticity and effective messaging are important issues to address.
Purpose. The purposes of this study were to document the HIV testing behaviors and serostatus of ... more Purpose. The purposes of this study were to document the HIV testing behaviors and serostatus of younger men of color who have sex with men (YMSM) and to explore sociodemographic, behavioral, and maternal correlates of HIV testing in the past 6 months.
Methods. A total of 135 YMSM aged 16–19 years completed a close-ended survey on HIV testing and risk behaviors, mother–son communication, and sociodemographic characteristics. Youth were offered point-of-care HIV testing, with results provided at survey end. Multivariate logistic regression analyzed the sociodemographic, behavioral, and maternal factors associated with routine HIV testing.
Results. A total of 90.3% of YMSM had previously tested for HIV, and 70.9% had tested in the past 6 months. In total, 11.7% of youth reported being HIV positive, and 3.3% reported unknown serostatus. When offered an HIV test, 97.8% accepted. Of these, 14.7% had a positive oral test result, and 31.58% of HIV-positive YMSM (n = 6) were seropositive unaware. Logistic regression results indicated that maternal communication about sex with males was positively associated with routine testing (odds ratio = 2.36; 95% confidence interval = 1.13–4.94). Conversely, communication about puberty and general human sexuality was negatively associated (odds ratio = .45; 95% confidence interval = .24–.86). Condomless anal intercourse and positive sexually transmitted infection history were negatively associated with routine testing; however, frequency of alcohol use was positively associated.
Conclusions. Despite high rates of testing, we found high rates of HIV infection, with 31.58% of HIV-positive YMSM being seropositive unaware. Mother–son communication about sex needs to address same-sex behavior as this appears to be more important than other topics. YMSM with known risk factors for HIV are not testing at the recommended time intervals.
Background: Previous studies have associated men who experience condom-associated erection proble... more Background: Previous studies have associated men who experience condom-associated erection problems (CAEP) with incomplete condom use and/or foregoing using condoms altogether. However, how men respond to CAEP and what they attribute CAEP to, remains unclear. Understanding young men’s CAEP responses and attributions could help improve sexually transmissible infections (STI)/HIV prevention programs and interventions. Methods: Behavioural responses to, and attributions for, CAEP during application (CAEP-Application) and/or during penile-vaginal intercourse (CAEP-PVI) were reported using an online questionnaire by 295 young, heterosexual men (aged 18–24 years) who were recruited via social media websites and university Listservs across major cities in the Midwestern USA. Results: Behavioural responses to CAEP-Application included receiving oral or manual stimulation, stimulating a partner, self-stimulation, foregoing condom use and applying the condom after starting intercourse. Attributions for CAEP-Application included: distraction, fit and feel problems, application taking too long and having consumed too much alcohol. Behavioural responses to CAEP-PVI included increasing the intensity of intercourse, removing the condom to receive oral or manual stimulation and removing condom and continuing intercourse. Attributions for CAEP-PVI included: lack of sensation, taking too long to orgasm, not being ‘turned on’ enough, fit and feel problems and partner-related factors. Conclusions: Men who report CAEP respond with both STI/HIV risk-reducing and potentially risk-increasing behaviours (e.g. forgoing condom use). Men attribute their experiences to a wide range of individual- and partner-level factors. Addressing men’s CAEP behavioural responses and attributions may increase the efficacious value of condom programs and STI/HIV prevention interventions – particularly among men who experience CAEP.
Introduction. Condom-associated erection problems (CAEP) are an underestimated factor related to ... more Introduction. Condom-associated erection problems (CAEP) are an underestimated factor related to inconsistent or incomplete male condom use. The underlying mechanisms of CAEP are not understood, and whether men who report these difficulties are also likely to experience erectile problems in situations when condoms are not used has not been studied. Aim. The aim of the study was to investigate, in a sample of condom-using young, heterosexual men (aged 18–24 years), whether men who report CAEP are more likely to (i) have erection problems when not using condoms and (ii) meet criteria for erectile dysfunction. Methods. A total of 479 men recruited online completed the International Index of Erectile Function (IIEF-5) and answered questions about erection problems experienced when using and not using condoms during the last 90 days. Demographic, sexual experience, and health status variables were investigated as correlates. Main Outcome Measures. Self-reported frequency of erection loss during condom application or during penile– vaginal intercourse (PVI) in the past 90 days and IIEF-5 scores. Results. Of the men, 38.4% were classified in the no CAEP group, 13.8% as having CAEP during condom application, 15.7% as having CAEP during PVI, and 32.2% as having CAEP during both condom application and PVI. Men reporting any form of CAEP were significantly more likely than men reporting no CAEP to also report erection difficulties during sexual activity when not using condoms. Men who reported CAEP during PVI only or during both application and PVI scored significantly lower on the IIEF-5 than men without CAEP. Conclusion. The findings suggest that men who report CAEP are also more likely to experience more generalized erection difficulties. Clinicians should assess whether men using condoms experience CAEP and where appropriate, refer for psychosexual therapy or provide condom skills education. S
Questionnaire data from 479 heterosexual men 18-24 years old were analyzed for correlates of CAEP... more Questionnaire data from 479 heterosexual men 18-24 years old were analyzed for correlates of CAEP during application (CAEP-Application) and CAEP during penile-vaginal intercourse (CAEP-PVI). Potential correlates were self-efficacy (condom application, product selection, and maintaining arousal), condom perceptions (condom worry/distraction, negative condom perceptions, concerns about application speed), condom fit, and motivation to use condoms. We conclude that (1) experiencing CAEP may become a repeating cycle, both affecting and being affected by, worry and distraction related to losing erections and maintaining arousal while using a condom (2) poorly fitting condoms may contribute to CAEP, and (3) CAEP may decrease motivation to use condoms.
Background: The purpose of this study was to develop an abbreviated reliable tool for assessing t... more Background: The purpose of this study was to develop an abbreviated reliable tool for assessing the attitudes US college-aged men and women have about condoms and condom use. Method: An online questionnaire was constructed and completed by 674 participants incorporating modified items from the Attitudes Towards Condom Scale (1984) and the Multidimensional Condom Attitude Scale (1994), with the addition of gender-neutral worded and condom positive or erotic items. Results: The original 40 items were reduced to 18 Likert-type items comprising the Brief Condom Attitude Scale (BCAS). Gender comparisons on a subset of 584 self-identified heterosexual participants indicated that women were significantly more likely to consider condoms as less protective, while men were significantly more likely to consider condoms as more interruptive. Additional analyses examining partnership indicated that monogamous participants were significantly more likely to view condoms as less interruptive, more erotic and less negative than non-monogamous participants. Conclusions: The BCAS appears to be a reliable measure for assessing US college-aged individuals' attitudes about condoms.
Condom-associated erection problems (CAEPs) are reported by a substantial number of young men and... more Condom-associated erection problems (CAEPs) are reported by a substantial number of young men and are associated with inconsistent and/or incomplete condom use. The underlying mechanisms of CAEP are not well understood, and research examining the possibility that men who report CAEP differ from other men in their sexual responsivity is lacking. Aim. This study used psychophysiological methods to examine whether men who report CAEP have a higher threshold for sexual arousal, a stronger need for tactile stimulation, and/or more easily lose their sexual arousal due to neutral distractors or performance-related demands. Methods. A total of 142 young, heterosexual men (53% reporting CAEP) were presented with four 3-minute erotic film clips. Three film clips were combined with one of the following manipulations: (i) distraction; (ii) performance demand; or (iii) vibrotactile stimulation. One erotic film clip was presented with no further instructions or manipulations. Main Outcome Measures. Average penile circumference changes during the first, second, and third minute (time) of the erotic film stimuli (condition) were submitted to a mixed-model analysis of variance with condition and time as within-subjects factors and group (CAEP/no-CAEP) as between-subjects factor. Results. Significant main effects of condition and time and a significant interaction of group × time were found. No significant interactions involving condition were found. Men who reported CAEP had smaller erectile responses during the first minute, regardless of film condition, than men who reported no CAEP (F(1,141) = 8.64, P < 0.005). Conclusion. The findings suggest that men with and without CAEP differ in the ease with which they become sexually aroused. Men reporting CAEP needed more time and/or more intense stimulation to become aroused. To our knowledge, this study is the first to use psychophysiological methods to assess sexual responsivity in men who report CAEP. Janssen E, Sanders SA, Hill BJ, Amick E, Oversen D, Kvam P, and Ingelhart K. Patterns of sexual arousal in young, heterosexual men who experience condom-associated erection problems (CAEP).
Investigating the ways in which barrier methods such as condoms may affect penile sensory thresho... more Investigating the ways in which barrier methods such as condoms may affect penile sensory thresholds has potential relevance to the development of interventions in men who experience negative effects of condoms on sexual response and sensation. A quantitative, psychophysiological investigation examining the degree to which sensations are altered by condoms has, to date, not been conducted. Aim. The objective of this study was to examine penile vibrotactile sensitivity thresholds in both flaccid and erect penises with and without a condom while comparing men who do and those who do not report condom-associated erection problems (CAEP). Methods. Penile vibrotactile sensitivity thresholds were assessed among a total of 141 young, heterosexual men using biothesiometry. An incremental two-step staircase method was used and repeated three times for each of four conditions. Intra-class correlation coefficients (ICCs) were calculated for all vibratory assessments. Penile vibratory thresholds were compared using a mixed-model analysis of variance. Main Outcome Measures. Penile vibrotactile sensitivity thresholds with and without a condom, erectile function measured by International Index of Erectile Function Questionnaire, and self-reported degree of erection. Results. Significant main effects of condoms (yes/no) and erection (yes/no) were found. No main or interaction effects of CAEP were found. Condoms were associated with higher penile vibrotactile sensitivity thresholds (F[1,124] = 17.11, P < 0.001). Penile vibrotactile thresholds were higher with an erect penis than with a flaccid penis (F[1,124] = 4.21, P = 0.042). Conclusion. The current study demonstrates the feasibility of measuring penile vibratory thresholds with and without a condom in both erect and flaccid experimental conditions. As might be expected, condoms increased penile vibrotactile sensitivity thresholds. Interestingly, erections were associated with the highest thresholds. Thus, this study was the first to document that erect penises are less sensitive to vibrotactile stimulation than flaccid penises. Hill BJ, Janssen E, Kvam P, Amick EE, and Sanders SA. The effect of condoms on penile vibrotactile sensitivity thresholds in young, heterosexual men. J Sex Med 2014;11:102-106.
The goal of this study was to improve our understanding of men's sexual response and its componen... more The goal of this study was to improve our understanding of men's sexual response and its components as well as the factors or types of situations that men describe as facilitating or interfering with sexual arousal. Six focus groups, involving 50 mostly white, heterosexual men (M age = 35.2 years; range, 18-70), were conducted. As it was previously found in women (Graham, Sanders, Milhausen, & McBride, Archives of Sexual Behavior, 33, 527-538, 2004), men described a wide range of physical (genital as well as nongenital) and cognitive/affective cues for sexual arousal. Also, men described the relationship between sexual desire and arousal as being variable and complex, presented a wide range of factors that increased or decreased sexual arousal, and showed substantial variability in both the importance and direction of their effects. The findings may help further development of models of sexual response and inform discussions about gender differences in sexual desire and arousal.
The goal of this study was to improve our understanding of men's sexual response and its componen... more The goal of this study was to improve our understanding of men's sexual response and its components as well as the factors or types of situations that men describe as facilitating or interfering with sexual arousal. Six focus groups, involving 50 mostly white, heterosexual men (M age = 35.2 years; range, 18-70), were conducted. As it was previously found in women (Graham, Sanders, Milhausen, & McBride, Archives of Sexual Behavior, 33, 527-538, 2004), men described a wide range of physical (genital as well as nongenital) and cognitive/affective cues for sexual arousal. Also, men described the relationship between sexual desire and arousal as being variable and complex, presented a wide range of factors that increased or decreased sexual arousal, and showed substantial variability in both the importance and direction of their effects. The findings may help further development of models of sexual response and inform discussions about gender differences in sexual desire and arousal.
A B S T R A C T Purpose: To describe the extent to which African-American male adolescents percei... more A B S T R A C T Purpose: To describe the extent to which African-American male adolescents perceive responsibility for contraception and condom use and to understand the perceived importance of dual method use for respondents in casual versus committed relationships. Methods: Data were collected using surveys informed by formative focus group sessions. Participants included African-American male high-school students aged 14e19 years from the Chicago's South Side. Respondents were surveyed regarding contraceptive behavioral intentions and perceived importance of dual method use. Responses were compared by relationship type. Logistic regression modeling was used to determine the association between contraception responsibility and perceiving dual method protection as important for each sexual relationship type. Results: Sample included 348 young men (mean age: 16.1 years; mean age at first sex: 13.8 years). Among those who had heard of condoms (99.4%) and withdrawal (90.4%), most reported liking these methods (83.7% and 53.9%). Participants were more likely to report greater responsibility within a committed relationship for all perceived contraceptive responsibilities (e.g., going with partner to get contraception). Participants were more likely to engage in conversation about pregnancy prevention with a committed partner. Among sexually active respondents, perceived contraceptive responsibility was associated with perceiving dual protection as very important (odds ratio ¼ 1.58; 95% confidence interval ¼ 1.05e2.38). Conclusions: Respondents felt partially responsible for pregnancy prevention, particularly within committed relationships, and were open to using dual protection. However, many respondents had low levels of contraception knowledge. These findings indicate that male African-American adolescents might benefit from increased education and support around contraception methods and condom use.
Purpose: The Veterans Health Administration (VHA) has provided transgender transition-related car... more Purpose: The Veterans Health Administration (VHA) has provided transgender transition-related care to veterans since 2011. However, little is known about the experiences of transgender veteran patients accessing transgen-der transition-related healthcare at Veterans Affairs (VA) clinics since the establishment of this care. The purpose of this study was to explore transgender veterans' experiences accessing and utilizing transition-related health-care through the VA healthcare system. Methods: Eleven transgender veterans were recruited using in-person recruitment at the 2013 Southern Comfort Conference (Atlanta, GA). In-depth semistructured interviews were conducted with participants using a qualitative inquiry methodological perspective and experience-centered approach. Interviews were digitally recorded and transcribed verbatim. The transcripts were coded by two independent researchers using ATLAS.ti.ª Results: Five interrelated themes were identified as key factors impacting the accessibility and quality of care trans-gender veterans receive through the VA: (1) long delays in receiving care; (2) needing to travel to receive care; (3) lack of patient knowledge regarding the coverage of transition-related care; (4) insensitivity, harassment, and violence among providers; and (5) a general lack of knowledge about transgender patients and care among providers. Conclusion: To our knowledge, this study is one of the first to explore the experiences of transgender veterans in accessing and utilizing transgender transition-related care at the VA after the 2011 VHA directive. Our findings suggest that although transgender healthcare coverage is available, additional patient-centered and healthcare system-level interventions are needed to improve the uptake and implementation of the VHA transgender pro-tections and care coverage.
Purpose: Among black transgender women (transwomen) at high risk of HIV acquisition or already li... more Purpose: Among black transgender women (transwomen) at high risk of HIV acquisition or already living with HIV/AIDS, the study examined whether medical or socially based gender affirming factors may contribute differentially to selected measures of resiliency, perceived stress, and a scale measure of mental health outcomes. This question has implications for clinical care and counseling of this population. Methods: Seventy-seven black transwomen were recruited to participate in a private, face-to-face structured interview. Two index measures of gender affirmation (GA) were constructed from the data. One comprised medical aspects only and the other comprised social aspects of GA. Assessed outcomes were personal competence and acceptance of self and life (resiliency), perceived stress and recent anxiety, depression, and suicide ideation (mental health). Associations between GA variables and outcomes were first assessed using bivariate level correlations. Significant bivariate associations were then tested in multivariable regression models adjusting for age and HIV status. Results: Mean age of the sample was 34.5 years. More than one-half of the sample (62.3%) indicated being HIV-infected. None of the bivariate or multivariable associations pertaining to GA medical factors were significant. Conversely, the social GA factors were significant and protective with all four outcomes. In the presence of age and HIV status, greater social GA was significantly associated with greater personal competence, acceptance of self and life, and positive mental health outcome. HIV status had an independent effect on personal competence , acceptance of self and life, with HIV-positive transwomen scoring higher on both measures. Conclusion: Among black transwomen at high risk of HIV acquisition or already HIV-infected, study findings suggest the possibility that socially based GA may play a prominent role in strengthening the resiliency and mental health of black transwomen. This same protective effect may not occur as a consequence of gender affirming body modification practices.
This project developed and studied The Source, an
alternate reality game (ARG) designed to foster... more This project developed and studied The Source, an alternate reality game (ARG) designed to foster interest and knowledge related to science, technology, engineering, and math (STEM) among youth from populations underrepresented in STEM fields. ARGs are multiplayer games that engage participants across several media such as shared websites, social media, personal communications, and real-world settings to complete activities and collaborate with team members. The Source was a five-week summer program with 144 participants from Chicago aged 13 to 18 years. The Source incorporated six socio-contextual factors derived from three frameworks: Chang’s (ERIC Digest, 2002) recommendations for engaging underrepresented populations in STEM careers, Lave and Wenger’s (Cambridge University Press, 1991) situated learning model, and Barron’s (Human Development, 49(4); 193-224, 2006) learning ecology perspective. These factors aligned with the program’s aims of promoting (1) social community and peer support, (2) collaboration and teamwork, (3) real-world relevance and investigative learning, (4) mentoring and exposure to STEM professionals, (5) hands-on activities to foster transferable skill building, and (6) interface with technology. This paper presents results from 10 focus groups and 10 individual interviews conducted with a subset of the 144 youth participants who completed the game. It describes how these six factors were realized through The Source and uses them as a lens for considering how The Source functioned pedagogically. Qualitative findings describe youth’s perception of The Source’s potential influence on STEM interest, engagement, and identity formation. Despite limitations, study results indicate that underrepresented youth can engage in an immersive, narrative, and gamebased experience as a potential mechanism for piquing and developing STEM interest and skills, particularly among underrepresented youth.
Purpose: Although transgender people are currently excluded from enlistment and discharged from s... more Purpose: Although transgender people are currently excluded from enlistment and discharged from service based on medical and psychological fitness policies, the current mental and physical health of transgender active-duty U.S. military personnel and veterans is poorly understood. The purpose of the current study was to investigate the military histories, lifetime mental and physical health diagnoses, and transgender transitionrelated health of transgender active-duty service members (ADSM) and veterans. Methods: Participants were recruited through private LGBT military and veteran organizational listservs, snowball sampling, and in-person recruitment to complete an anonymous and confidential self-administered online questionnaire. Results: A total of 106 transgender ADSM (n = 55) and veterans (n = 51) completed the questionnaire. Transgender veterans were significantly older (44 mean years vs. 29.5 mean years, t = À6.23, p < 0.001). A greater percentage of veterans than ADSM reported depression (64.6% vs. 30.9%, v 2 = 11.68, p = 0.001) and anxiety (41.3% vs. 18.2%, v 2 = 6.54, p = 0.011). In addition, 15.9% of veterans versus 1.8% of ADSM (v 2 = 6.53, p = 0.011) had been diagnosed with a substance abuse disorder. There were no significant differences in lifetime physical health conditions; however, veterans reported a higher body-mass index than ADSM (28.4 vs. 24.9, t = À3.85, p < 0.001). For both groups, mental and physical health problems were positively correlated with age and years of military service (r = 0.37-0.84, p < 0.01). There were no significant differences between groups in transgender transition-related health. Conclusion: Our data represent the first descriptive statistics of lifetime mental and physical health issues among transgender ADSM and veterans. Data indicate that transgender ADSM report fewer lifetime mental and physical health problems than transgender veterans. Taken together, our findings suggest that more research, specifically among transgender ADSM, is needed to challenge the exclusion of transgender persons from U.S. military service based on the presumption of poor mental or physical health.
In this essay, the authors pose and respond to three questions about their process of generating ... more In this essay, the authors pose and respond to three questions about their process of generating and contributing to an archive of transgender military experiences: First, why create an archive of transgender military experiences? Second, what constitutes such an archive? And, third, what are the political stakes of doing this work? By tracing their experiences, the authors offer insights, chart challenges, and lay bare their hopes for an archive of transgender military experiences. Along the way, the authors reflect on the political, legal, and ethical dimensions of this project as a way to demonstrate its broader theoretical and practical implications for the field of transgender studies.
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Papers by Brandon Hill
to sexual orientation and homophobia. Study findings indicate that an ARG is an exciting and interactive way to educate young people on sensitive topics in sexuality education, but that attention to narrative authenticity and effective messaging are important issues to address.
to 70 living in the United States document significant diversity
across age and gender in attitudes regarding which behaviors
constitute “sex” and behavioral histories. With the exceptions of
deep kissing, penile-vaginal intercourse, and penile-anal
intercourse, the 18 to 29 age groups of both genders were
significantly less likely to count all other behaviors (manual and
oral stimulation of breasts, genitals, and anus; and use of sex
toys) as sex. Stronger age effects were found for men than
women for manual and oral stimulation of genitals or anus, and
sex toy use. Compared to older men and women, fewer 18- to
29-year-olds had experienced each behavior. Use of behaviorally nonspecific sexual history questions in research and clinical practice is problematic because (1) across age-group
comparisons may be contaminated by differential interpretation of questions across age groups and (2) within age-group comparisons may be confounded by gender differences in interpretation.
Methods. A total of 135 YMSM aged 16–19 years completed a close-ended survey on HIV testing and risk behaviors, mother–son communication, and sociodemographic characteristics. Youth were offered point-of-care HIV testing, with results provided at survey end. Multivariate logistic regression analyzed the sociodemographic, behavioral, and maternal factors associated with routine HIV testing.
Results. A total of 90.3% of YMSM had previously tested for HIV, and 70.9% had tested in the past 6 months. In total, 11.7% of youth reported being HIV positive, and 3.3% reported unknown serostatus. When offered an HIV test, 97.8% accepted. Of these, 14.7% had a positive oral test result, and 31.58% of HIV-positive YMSM (n = 6) were seropositive unaware. Logistic regression results indicated that maternal communication about sex with males was positively associated with routine testing (odds ratio = 2.36; 95% confidence interval = 1.13–4.94). Conversely, communication about puberty and general human sexuality was negatively associated (odds ratio = .45; 95% confidence interval = .24–.86). Condomless anal intercourse and positive sexually transmitted infection history were negatively associated with routine testing; however, frequency of alcohol use was positively associated.
Conclusions. Despite high rates of testing, we found high rates of HIV infection, with 31.58% of HIV-positive YMSM being seropositive unaware. Mother–son communication about sex needs to address same-sex behavior as this appears to be more important than other topics. YMSM with known risk factors for HIV are not testing at the recommended time intervals.
incomplete male condom use. The underlying mechanisms of CAEP are not understood, and whether men who report
these difficulties are also likely to experience erectile problems in situations when condoms are not used has not been
studied.
Aim. The aim of the study was to investigate, in a sample of condom-using young, heterosexual men (aged 18–24
years), whether men who report CAEP are more likely to (i) have erection problems when not using condoms and
(ii) meet criteria for erectile dysfunction.
Methods. A total of 479 men recruited online completed the International Index of Erectile Function (IIEF-5) and
answered questions about erection problems experienced when using and not using condoms during the last 90 days.
Demographic, sexual experience, and health status variables were investigated as correlates.
Main Outcome Measures. Self-reported frequency of erection loss during condom application or during penile–
vaginal intercourse (PVI) in the past 90 days and IIEF-5 scores.
Results. Of the men, 38.4% were classified in the no CAEP group, 13.8% as having CAEP during condom
application, 15.7% as having CAEP during PVI, and 32.2% as having CAEP during both condom application and
PVI. Men reporting any form of CAEP were significantly more likely than men reporting no CAEP to also report
erection difficulties during sexual activity when not using condoms. Men who reported CAEP during PVI only or
during both application and PVI scored significantly lower on the IIEF-5 than men without CAEP.
Conclusion. The findings suggest that men who report CAEP are also more likely to experience more generalized
erection difficulties. Clinicians should assess whether men using condoms experience CAEP and where appropriate,
refer for psychosexual therapy or provide condom skills education. S
to sexual orientation and homophobia. Study findings indicate that an ARG is an exciting and interactive way to educate young people on sensitive topics in sexuality education, but that attention to narrative authenticity and effective messaging are important issues to address.
to 70 living in the United States document significant diversity
across age and gender in attitudes regarding which behaviors
constitute “sex” and behavioral histories. With the exceptions of
deep kissing, penile-vaginal intercourse, and penile-anal
intercourse, the 18 to 29 age groups of both genders were
significantly less likely to count all other behaviors (manual and
oral stimulation of breasts, genitals, and anus; and use of sex
toys) as sex. Stronger age effects were found for men than
women for manual and oral stimulation of genitals or anus, and
sex toy use. Compared to older men and women, fewer 18- to
29-year-olds had experienced each behavior. Use of behaviorally nonspecific sexual history questions in research and clinical practice is problematic because (1) across age-group
comparisons may be contaminated by differential interpretation of questions across age groups and (2) within age-group comparisons may be confounded by gender differences in interpretation.
Methods. A total of 135 YMSM aged 16–19 years completed a close-ended survey on HIV testing and risk behaviors, mother–son communication, and sociodemographic characteristics. Youth were offered point-of-care HIV testing, with results provided at survey end. Multivariate logistic regression analyzed the sociodemographic, behavioral, and maternal factors associated with routine HIV testing.
Results. A total of 90.3% of YMSM had previously tested for HIV, and 70.9% had tested in the past 6 months. In total, 11.7% of youth reported being HIV positive, and 3.3% reported unknown serostatus. When offered an HIV test, 97.8% accepted. Of these, 14.7% had a positive oral test result, and 31.58% of HIV-positive YMSM (n = 6) were seropositive unaware. Logistic regression results indicated that maternal communication about sex with males was positively associated with routine testing (odds ratio = 2.36; 95% confidence interval = 1.13–4.94). Conversely, communication about puberty and general human sexuality was negatively associated (odds ratio = .45; 95% confidence interval = .24–.86). Condomless anal intercourse and positive sexually transmitted infection history were negatively associated with routine testing; however, frequency of alcohol use was positively associated.
Conclusions. Despite high rates of testing, we found high rates of HIV infection, with 31.58% of HIV-positive YMSM being seropositive unaware. Mother–son communication about sex needs to address same-sex behavior as this appears to be more important than other topics. YMSM with known risk factors for HIV are not testing at the recommended time intervals.
incomplete male condom use. The underlying mechanisms of CAEP are not understood, and whether men who report
these difficulties are also likely to experience erectile problems in situations when condoms are not used has not been
studied.
Aim. The aim of the study was to investigate, in a sample of condom-using young, heterosexual men (aged 18–24
years), whether men who report CAEP are more likely to (i) have erection problems when not using condoms and
(ii) meet criteria for erectile dysfunction.
Methods. A total of 479 men recruited online completed the International Index of Erectile Function (IIEF-5) and
answered questions about erection problems experienced when using and not using condoms during the last 90 days.
Demographic, sexual experience, and health status variables were investigated as correlates.
Main Outcome Measures. Self-reported frequency of erection loss during condom application or during penile–
vaginal intercourse (PVI) in the past 90 days and IIEF-5 scores.
Results. Of the men, 38.4% were classified in the no CAEP group, 13.8% as having CAEP during condom
application, 15.7% as having CAEP during PVI, and 32.2% as having CAEP during both condom application and
PVI. Men reporting any form of CAEP were significantly more likely than men reporting no CAEP to also report
erection difficulties during sexual activity when not using condoms. Men who reported CAEP during PVI only or
during both application and PVI scored significantly lower on the IIEF-5 than men without CAEP.
Conclusion. The findings suggest that men who report CAEP are also more likely to experience more generalized
erection difficulties. Clinicians should assess whether men using condoms experience CAEP and where appropriate,
refer for psychosexual therapy or provide condom skills education. S
alternate reality game (ARG) designed to foster interest and
knowledge related to science, technology, engineering, and
math (STEM) among youth from populations underrepresented
in STEM fields. ARGs are multiplayer games that engage
participants across several media such as shared websites,
social media, personal communications, and real-world settings
to complete activities and collaborate with team members.
The Source was a five-week summer program with 144
participants from Chicago aged 13 to 18 years. The Source
incorporated six socio-contextual factors derived from three
frameworks: Chang’s (ERIC Digest, 2002) recommendations
for engaging underrepresented populations in STEM careers,
Lave and Wenger’s (Cambridge University Press, 1991) situated
learning model, and Barron’s (Human Development,
49(4); 193-224, 2006) learning ecology perspective. These
factors aligned with the program’s aims of promoting (1) social
community and peer support, (2) collaboration and teamwork,
(3) real-world relevance and investigative learning, (4)
mentoring and exposure to STEM professionals, (5) hands-on
activities to foster transferable skill building, and (6) interface
with technology. This paper presents results from 10 focus groups and 10 individual interviews conducted with a subset
of the 144 youth participants who completed the game. It
describes how these six factors were realized through The
Source and uses them as a lens for considering how The
Source functioned pedagogically. Qualitative findings describe
youth’s perception of The Source’s potential influence
on STEM interest, engagement, and identity formation.
Despite limitations, study results indicate that underrepresented
youth can engage in an immersive, narrative, and gamebased
experience as a potential mechanism for piquing and
developing STEM interest and skills, particularly among underrepresented
youth.