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Item Adolescent Sexual Behavior Research: Perspectives of Investigators, IRB Members, and IRB Staff about Risk Categorization and IRB Approval(The Hastings Center, 2017) McGregor, Kyle A.; Hensel, Devon J.; Waltz, Amy C.; Molnar, Elizabeth; Ott, Mary A.; Pediatrics, School of MedicineItem A Daily Diary Analysis of Condom Breakage and Slippage during Vaginal Sex or Anal Sex among Adolescent Women(Wolters Kluwer, 2016-09) Hensel, Devon J.; Selby, Sarah; Tanner, Amanda E.; Fortenberry, J. Dennis; Pediatrics, School of MedicineBackground Adolescent women Adolescent women are disproportionately impacted by the adverse outcomes associated with sexual activity, including sexually transmitted infections (STI). Condoms as a means of prevention relies upon use that is free of usage failure, including breakage and/or slippage. This study examined the daily prevalence of and predictors of condom breakage and/or slippage during vaginal sex and during anal sex among adolescent women. Methods Adolescent women (N=387; 14 to 17 years) were recruited from primary care clinics for a longitudinal cohort study of STIs and sexual behavior. Data were daily partner-specific sexual diaries. Random intercept mixed effects logistic regression was used to estimate the fixed effect of each predictor on condom breakage/slippage during vaginal or during anal sex (Stata, 13.0), adjusting model coefficients for the correlation between repeated within-participant diary entries. Results Condom slippage and/or breakage varied across sexual behaviors and was associated with individual-specific (e.g., age and sexual interest) and partner-specific factors (e.g., negativity). Recent behavioral factors (e.g., experiencing slippage and/or breakage in the past week) were the strongest predictors of current condom slippage and/or breakage during vaginal or anal sex Conclusion Factors associated with young women’s condom breakage/slippage during vaginal or during anal sex should be integrated as part of STI prevention efforts, and should be assessed as part of ongoing routine clinical care.Item Daily diary study of adult men’s and women’s event-level sexual motivations and sexual behaviour(Csiro, 2017) Hensel, Devon J.; He, Fei; Harezlak, Jarek; Fortenberry, J. Dennis; Pediatrics, School of MedicineBackground: Understanding people’s sexual motivations has long been of public health and health promotion interest. We used daily diaries to examine how adult men’s and women’s event-specific affective sexual motivations were linked to the types and combinations of sexual behaviours chosen in a given sexual event. Methods: Adult men (n = 156) and women (n = 192) completed thrice-daily electronic diaries assessing individual- and partner-specific attributes and non-coital or coital sexual behaviours. Sexual motivations were: interest in sex, feeling in love with partner, wanted to have sex and partner wanted to have sex. The outcome variable was: sexual behaviour type (no sex, one vaginal sex event, one vaginal sex event + any other sex types, multiple vaginal sex events, any other sex types). Mixed-effect multinomial logistic regression modelled the influence of each sexual motivation on sexual behaviour type (Stata; all p < 0.05). ‘No sex’ was the referent in all models; all models controlled for gender. Results: Participants contributed 14 856 total partner-associated diary entries. Most (54%; women: 56.5%, men: 51.2%) were associated with no sex; when sex occurred, the most common behaviour type was one vaginal sex event (13.1%) for women and other sex types (16.4%) for men. Wanting to have sex or perceiving a partner wanted to have sex were the strongest predictors of sexual behaviour type, and were associated with a greater number of reported sexual behaviours. Conclusions: Event-specific sexual motivations are associated with the choice to have sex, and with variation in the chosen sexual behaviours.Item Developmental Trajectories of Religiosity, Sexual Conservatism and Sexual Behavior among Female Adolescents(Elsevier B.V., 2013-12) Aalsma, Matthew C.; Woodrome, Stacy E.; Downs, Sarah M.; Hensel, Devon J.; Zimet, Gregory D.; Orr, Don P.; Fortenberry, J. Dennis; Department of Pediatrics, IU School of MedicineUnderstanding the role of socio-sexual cognitions and religiosity on adolescent sexual behavior could guide adolescent sexual health efforts. The present study utilized longitudinal data from 328 young women to assess the role of religion and socio-sexual cognitions on sexual behavior accrual (measuring both coital and non-coital sexual behavior). In the final triple conditional trajectory structural equation model, religiosity declined over time and then increased to baseline levels. Additionally, religiosity predicted decreased sexual conservatism and decreased sexual conservatism predicted increased sexual behavior. The final models are indicative of young women's increasing accrual of sexual experience, decreasing sexual conservatism and initial decreasing religiosity. The results of this study suggest that decreased religiosity affects the accrual of sexual experience through decreased sexual conservatism. Effective strategies of sexual health promotion should include an understanding of the complex role of socio-sexual attitudes with religiosity.Item Parent-Child Sexual Communication Among Middle School Youth(Elsevier, 2018-08) Edwards, Laura L.; Hunt, Abby; Cope-Barnes, Doug; Hensel, Devon J.; Ott, Mary A.; Pediatrics, School of MedicineMiddle school youth (N=1472) in Central Indiana completed a survey about parent-adolescent sexual communi-cation. Being older, female, mixed race, ever had sex, ever arrested, and higher HIV knowledge were associatedwith more frequent sexual communication.Item The Person That Asks the Question Controls the Conversation: College Students' Privacy Management with Physicians about Sexual Behavior(2019-09) Hernandez, Rachael; Petronio, Sandra; Bute, Jennifer; Hoffman-Longtin, Krista; Schwartz, PeterCollege students demonstrate a persistent lack of knowledge about safe sexual practices and engage in sexual behavior that puts them at risk for preventable health issues, specifically, sexually transmitted infections and unplanned pregnancy. Fortunately, physicians have an opportunity to provide accurate and timely information about safe sexual behavior to individuals in their care. However, many young people, and in particular young women, are reticent to talk to their physicians about sexual behavior because they typically consider the information to be private. They draw thick privacy boundaries around this information, leading to a missed opportunity to communicate about sexual behavior with their healthcare provider. Exacerbating this issue is the fact that many physicians are also uncomfortable discussing sexual topics with their patients. In this dissertation, Communication Privacy Management (CPM) theory is used to investigate the criteria that female college students employ to negotiate the disclosure and concealment of information about sexual behavior to physicians. Qualitative analysis of open-ended interviews with female college students were used to describe and explain the way college students perceive issues concerning disclosure of sexual behaviors to their physician. These findings have the potential to improve communication interventions both for female college students and healthcare professionals.Item Reasons People Give for Using (or not Using) Condoms(Springer, 2016) Farrington, Elizabeth M.; Bell, David C.; DiBacco, Aron E.; Department of Sociology, School of Liberal ArtsStudy participants (N = 348) were asked about 46 reasons that have been suggested for why people use or do not use condoms. Participants were asked which of these reasons motivated them when they were deciding whether to use condoms in 503 sexual relationships. Participants were classified into one of three roles based on their HIV status and the status of each sexual partner: HIV+ people with HIV− partners; HIV− people with HIV+ partners; and HIV− people with HIV− partners. Motivations were looked at in the context of each of these roles. Of the 46 reasons, only 15 were selected by at least 1/3 of the participants, and only seven were selected by at least half. Frequently reported reasons primarily concern protecting self and partner from STDs including HIV. Less frequently reported reasons involved social norms, effects of condoms on sex, and concern for the relationship. These findings have implications for clinical interventions.Item Risk perceptions after human papillomavirus vaccination are not subsequently associated with riskier behaviors or sexually transmitted infections in HIV-infected young women(Taylor & Francis, 2019-06-03) Thomas, Rachel; Dillard, Mary; Xu, Jiahong; Zimet, Gregory D.; Kahn, Jessica A.; Pediatrics, School of MedicineConcerns have been raised that risk perceptions after human papillomavirus (HPV) vaccination may lead to riskier sexual behaviors or sexually transmitted infection (STI) diagnosis. The aims of this study were to determine whether risk perceptions immediately after HPV vaccination (perceived risk of HPV, perceived risk of STIs other than HPV, and perceived need for safer sexual behaviors, measured using 5-item scales) were associated with number of sexual partners, condom use at last sexual intercourse, or STI diagnosis over the subsequent 48 weeks in HIV-infected young women (N = 99, 17–24 years of age) participating in an HPV vaccine clinical trial. Generalized estimating equation models demonstrated that lower perceived need for safer sexual behaviors was associated subsequently with lower total number of sexual partners (adjusted odds ratio (AOR) = 1.05, 95% confidence interval (CI) = 1.01–1.09) and lower perceived risk of HPV was associated with subsequent report of having used condoms at last sex (AOR = 0.36, AOR = 0.14–0.92). Lower perceived risk of other STIs was not associated with subsequent sexual behaviors. None of the three risk perceptions was associated with subsequent risk of STIs. The findings suggest that inappropriate risk perceptions after HPV vaccination such as lower perceived need for safer sexual behaviors and lower perceived risk of HPV or other STIs were not subsequently associated with risky behaviors or STI diagnosis in HIV-infected young women.Item Risks, Risk Factors, and Outcomes Associated with Phone and Internet Sexting Among University Students in the United States(Springer, 2015-08) Dir, Ally L.; Cyders, Melissa A.; Department of Psychology, School of ScienceSexting, defined as the exchange of sexually suggestive pictures or messages via mobile phone or social networking sites (SNS), has received media attention for its prevalence and associated negative outcomes; however, research has not yet fully established risk factors for and resulting outcomes from sexting behaviors. The current study was the first empirical test of a causal path model in males and females, in which impulsivity-related traits and expectancies influence sexual behaviors through phone and SNS sexting. We also examined prevalence and perceived likelihood of common negative outcomes associated with sexting. Multiple regression and structural equation modeling (SEM) statistics were conducted on two independent undergraduate samples (n = 611 and 255). The best fitting SEM model (RMSEA = 0.04, CFI = 0.96, TLI = 0.94, and χ2 = 176.06, df = 75, p < .001) demonstrated a significant indirect effect of sensation seeking on phone sexting behaviors through sex-related sexting expectancies and a significant indirect effect of sensation seeking on sexual hookup behaviors through phone sexting behaviors (b = 0.06, p = .03), but only for females. Reverse mediations and mediation with SNS were not significant. Negative outcomes were rare: sexts being spread to others was the most common negative sexting experience (n = 21, 12 %). This study suggests the viability of personality and expectancies affecting sexual hookup behaviors through engagement in sexting behaviors. It also suggests that although direct negative outcomes associated with sexting are thought to be common, they were rare in the current sample.Item Using an FSDS-R Item to Screen for Sexually Related Distress: A MsFLASH Analysis(2015) Carpenter, Janet S.; Reed, Susan D.; Guthrie, Katherine A.; Larson, Joseph C.; Newton, Katherine M.; Lau, R. Jane; Learman, Lee A.; Shifren, Jan L.Introduction The Female Sexual Distress Scale-Revised (FSDS-R) was created and validated to assess distress associated with impaired sexual function, but it is lengthy for use in clinical practice and research when assessing sexual function is not a primary objective. Aim The study aims to evaluate whether a single item from the FSDS-R could be identified to use to screen midlife women for bothersome diminution in sexual function based on three criteria: (i) highly correlated with total scores; (ii) correlated with commonly assessed domains of female sexual functioning; and (iii) able to differentiate between women reporting high and low sexual concerns during the prior month. Methods Data from 93 midlife women were collected by the Menopause Strategies Finding Lasting Answers to Symptoms and Health (MsFLASH) research network. Main Outcome Measures Women completed the FSDS-R, Female Sexual Function Index (FSFI), and Menopausal Quality of Life Scale (MENQOL). Those who reported a change in the past month on the MENQOL sexual were categorized into a high sexual concerns group, while all others were categorized into a low sexual concerns group. Results Women were an average of 54.6 years old (SD 3.1) and mostly Caucasian (77.4%), college educated (60.2%), married/living as married (64.5%), and postmenopausal (79.6%). The FSDS-R item number 1 “Distressed about sex life” was: (i) highly correlated with FSDS-R total scores (r = 0.90); (ii) moderately correlated with FSFI total scores (r = −0.38) and FSFI desire (r = −0.37) and satisfaction domains (r = −0.40); and (iii) showed one of the largest mean differences between high and low sexual concerns groups (P < 0.001). Other FSDS-R items met one or two, but not all three of the prespecified criteria (i, ii, iii). Conclusions A single FSDS-R item may be a useful screening tool to quickly identify midlife women with sexually related distress when it is not feasible to administer the entire scale, though further validation is warranted.