Sexual Minority Women's Satisfaction with Health Care Providers and State-level Structural Support: Investigating the Impact of Lesbian,Gay, Bisexual,and Transgender Nondiscrimination Legislation

PurposeStructural discrimination is associated with negative health outcomes among sexual minority populations. Recent changes to state-level and national legislation provide both the opportunity and the need to further explore the impact of legislation on the health indicators of sexual minorities. Using an ecosocial theory lens, the present research addresses the relationship between structural support or discrimination and satisfaction with one's health care provider among sexual minority women.MethodsData were drawn from an online survey of sexual minority women's health care experiences. Using the Andersen Behavioral Model of Health Services Utilization to operationalize the variables in our model, we examined the relationship between state-level nondiscrimination legislation and satisfaction with provider—a widely used measure of health care quality—through regression analysis.FindingsParticipants in structurally supportive states (i.e., those with nondiscrimination legislation) were more likely to disclose their sexual identity to their providers and to report higher satisfaction with their providers. The absence of nondiscrimination legislation was associated negatively with satisfaction with providers.ConclusionsResults of our study show that the external environment in which sexual minority women seek health care, characterized by structural support or lack thereof, is related to perceived quality of health care.     

Sexting,Substance Use,and Sexual Risk Behavior in Young Adults

PurposeCell phone use has become more widespread over the past decade. Young adults are frequently early adopters of new technologies, including cell phones. Most previous research examining sexting, the act of sending sexually explicit or suggestive images via text message, has focused on the legal or social consequences of this behavior. The current study focused on the public health implications of sexting by examining associations between sexting, substance use, and sexual risk behavior in youth.MethodsYoung adults (N = 763) completed online questionnaires assessing demographics, cell phone use (e.g., texting, sexting), substance use, and sexual risk behaviors.ResultsSexting was reported by a substantial minority of participants (44%). Compared with their nonsexting counterparts, participants who engaged in sexting were more likely to report recent substance use and high-risk sexual behaviors, including unprotected sex and sex with multiple partners. Of those who engaged in sexting, a considerable percentage (31.8%) reported having sex with a new partner for the first time after sexting with that person. In multivariate analyses, sexting was associated with high-risk sexual behavior, after accounting for demographic factors, total texting behaviors, and substance use.ConclusionsResults suggest that sexting is robustly associated with high-risk sexual behavior. Many individuals exchange explicit or provocative photos with long-term sexual partners, but at least some participants in this study were incurring new sexual risks after sexting. Additional research is needed to understand the contexts in which sexting occurs, motivations for sexting, and relationship of sexting to risk behavior.     

Sexting Among Young Adults

PurposeSexting has stirred debate over its legality and safety, but few researchers have documented the relationship between sexting and health. We describe the sexting behavior of young adults in the United States, and examine its association with sexual behavior and psychological well-being.MethodsUsing an adapted Web version of respondent-driven sampling, we recruited a sample of U.S. young adults (aged 18–24 years, N = 3,447). We examined participant sexting behavior using four categories of sexting: (1) nonsexters, (2) receivers, (3) senders, and (4) two-way sexters. We then assessed the relationships between sexting categories and sociodemographic characteristics, sexual behavior, and psychological well-being.ResultsMore than half (57%) of the respondents were nonsexters, 28.2% were two-way sexters, 12.6% were receivers, and 2% were senders. Male respondents were more likely to be receivers than their female counterparts. Sexually active respondents were more likely to be two-way sexters than non–sexually active ones. Among participants who were sexually active in the past 30 days, we found no differences across sexting groups in the number of sexual partners or the number of unprotected sex partners in the past 30 days. We also found no relationship between sexting and psychological well-being.ConclusionsOur results suggest that sexting is not related to sexual risk behavior or psychological well-being. We discuss the findings of this study and propose directions for further research on sexting.     

Sexting Among Young Men Who Have Sex With Men: Results From a National Survey

PurposeWe know little about the prevalence of sexting behavior among young men who have sex with men (YMSM) or its association with their sexual behaviors.MethodsTo address these gaps, we used data from an online study examining the partner-seeking behaviors of single YMSM (N = 1,502; ages 18–24 years) in the United States. Most participants (87.5%) reported sexting, with 75.7% of the sample reporting having sent and received a sext.ResultsSexting was more frequent among sexually active YMSM, with YMSM who had sent and received a sext being more likely to report insertive anal intercourse, with and without condoms, than those who had not sexted. We found no association between sexting and receptive anal intercourse.ConclusionsOur findings suggest that sexting may vary by YMSM's sexual roles. We discuss our findings with attention to their implications for sexual health promotion.     

Support for Texting-Based Condom Negotiation Among Forcibly Displaced Adolescents in the Slums of Kampala,Uganda: Cross-sectional Validation of the Condom Use Negotiated Experiences Through Technology Scale

BackgroundPromoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg, sexting) may increase adolescents’ confidence in discussing sexual health issues and negotiating condom use. However, limited evidence exists describing validated measures for text-based condom negotiation in the literature.ObjectiveThis study helps fill this gap by adapting and examining the psychometric properties of a condom use experience through technology (condom use negotiated experiences through technology [CuNET]) scale.MethodsUsing peer network sampling, 242 forcibly displaced adolescents (aged 16-19 years) living in Kampala’s slums were recruited for participation between January and March 2018. A subscale (embarrassment to negotiate condom use) of the Multidimensional Condom Attitudes Scale was adapted to incorporate sexting, yielding CuNET. Participants were randomly assigned to calibration and validation subsamples to conduct exploratory and confirmatory factor analyses to establish and validate the scale. CuNET measured participants’ support levels for texting-based condom negotiation via sexting based on gender, and multivariable logistic regression was used to explore its associations with sexual health outcomes (recent consistent condom use, access to sexual and reproductive health services, and lifetime sexually transmitted infection testing).ResultsThe one-factor CuNET with the validation sample was valid (χ²₄=5.3; P=.26; root mean square error of approximation=0.05, 90% CI 0.00-0.16; comparative fit index=0.99; Tucker-Lewis index=0.99; standardized root mean square residual=0.006), and reliability (Cronbach α=.98). Adolescent girls showed significantly lower levels of support for using sexting to negotiate condom use (mean 13.60, SE 0.70 vs mean 21.48, SE 1.23; P=.001). In multivariable analyses, a 1-point increase in the CuNET score was associated with increased odds of recent consistent condom use (adjusted odds ratio [aOR] 1.73, 95% CI 1.24-2.41) but not with access to sexual and reproductive health services (aOR 1.51, 95% CI 0.99-2.30) or lifetime sexually transmitted infection testing (aOR 0.90, 95% CI 0.64-1.26).ConclusionsThe unidimensional CuNET scale is valid and reliable for forcibly displaced adolescents living in slums in Kampala, gender-sensitive, and relevant for predicting consistent condom use among urban displaced and refugee adolescents. Further development of this scale will enable a better understanding of how adolescents use digital tools for condom negotiation.     

Sexting in the public domain: competing discourses in online news article comments in the USA and the UK involving teenage sexting

The current study examined the phenomenon of teenage sexting through an analysis of 1030 comments from 15 online stories in the US and the UK. Four competing messages emerged: (1) Innocuity: Is sexting a harmless or harmful activity?; (2) Comparability: Were teenagers in the past the same or different than current teenagers?; (3) Criminality: Is teenage sexting a criminal offense or a legal activity?; and (4) Sexuality: Is teenage sexting sexual exploration or sexual exploitation? The online comments indicated an overall struggle between two different discursive constructions of sexting: A discourse of normal connection and a discourse of aberrant exposure. Implications of these findings are discussed.     

Maintaining the privacy of a minor's sexual orientation and gender identity in the medical environment

Dealing with self‐identity, sexual orientation, and gender identity is often a struggle for minors. The potential negative outcomes minors face when their sexual orientation or gender identity is disclosed to others before they have an opportunity to address it in their own time has become more evident in the media. Because of the intimate nature of the provider–patient relationship, the healthcare provider may be the first person in whom they confide. If a minor receives a positive, nonjudgmental experience from his or her provider, it will often lead to a more positive self‐image, whereas a negative, judgmental experience will often result in the opposite. Critical components of their experience are a sense of trust that the provider will keep the information confidential and the healthcare setting being organized in a manner that promotes privacy. Healthcare providers play a key role in developing and projecting a safe, comfortable environment where the minor can discretely discuss issues of sexual orientation and gender identity. Establishing this environment will usually facilitate a positive therapeutic relationship between the minor and the provider. Steps healthcare providers can take to achieve trust from minor patients and ensure confidentiality of sensitive information are understanding privacy laws, making privacy a priority, getting consent, training staff, and demonstrating privacy in the environment.     

Sexting among high school students in a metropolis in Ghana: an exploratory and descriptive study

ABSTRACT

The sharing of sexually explicit materials using internet-enabled devices by adolescents (sexting) is an issue of global concern. Very little is known about it in sub-Saharan Africa. We conducted a self-administered survey among a randomly selected group of high school students in Tema, Ghana. Students’ self-esteem was assessed using the Rosenberg Self-Esteem Scale. Analysis including logistic regression explored prevalence and determinants of sexting, as well as its effect on sexual behavior. Five hundred and seventy-six (53% females) students participated. About 24.7% had shared sext materials using mobile phones. The predictors of sexting were being male (adjusted OR = 6.01, 95% CI 3.49–10.35), being in a “serious” (5.91, 2.77–12.64) or “casual” (2.82, 1.67–4.75) relationship and owning a mobile phone (1.82, 1.10–3.02). Students aged >16years (1.48, 0.94-2-34) and students with low self-esteem (1.24, 0.74–2.05) were more likely to be involved in sexting. Sexters were more likely to be sexually active (3.79, 2.33–6.14). Self-gratification and social pressures were the reasons for sexting. Fear that materials could go viral, religiosity and possible reprimand were the reasons students did not engage in sexting. Sexting among adolescents in this population is high and similar to levels in developed countries. Given the possible adverse short and long-term impact, school-based interventions are needed.     

The role of peer networks in adolescent pornography use and sexting in Croatia

ABSTRACT

Although communication about sexuality is a significant pathway through which peers influence adolescent sexual development, little research has examined the role of peer networks in the use of sexualized media. We applied a social network approach to assess the role of close peers in adolescent pornography use and sexting in a sample of Croatian high school students. Sexual conversation networks’ characteristics did not correlate with pornography use. In contrast, sexting was associated with the proportion of same gender peers, the proportion of older peers and the proportion of sexually experienced peers in the network – pointing to the role of peer influence. Participants’ gender did not moderate these associations. Specific mechanisms underlying the observed associations and the role of peer selection remain important tasks for future research.     

Race,Trust in Doctors,Privacy Concerns,and Consent Preferences for Biobanks

ABSTRACT

This study investigates how patients’ privacy concerns about research uses of biospecimen and trust in doctors are associated with their preferences for informed consent and need for control over biospecimens in a biobank. Particularly, this study focuses on the perspectives of Communication Privacy Management theory, precision medicine, and racial health disparities. We recruited 358 women aged 40 and older stratified by race (56% African American and 44% European American). Multivariable linear regression models examined hypothesis and research questions. Individuals’ privacy concerns and trust in doctors were significantly associated with their need for control. Although participants’ privacy concerns were positively associated with their preference for study-specific model, trust in doctors had no effect on the preference. African American participants needed more control over their sample and were more likely to prefer study-specific model compared to European American participants. Significant interactions by race on the associations between trust and need for control and between privacy concerns and preference for study-specific model were found. These findings suggest that when developing large diverse biobanks for future studies it is important to consider privacy concerns, trust, and need for control with an understanding that there are differences in preferences by race.     

Sociodemographic Patterns in Retrospective Sexual Orientation Identity and Attraction Change in the Sexual Orientation Fluidity in Youth Study

PurposeThis study examined sociodemographic patterns of retrospective fluidity in sexual orientation identity (i.e., any change from one identity to another) and attractions (i.e., any change in attractions to one or more gender(s)) in a large sample of US youth.MethodsParticipants were 4,087 youth (58% cisgender girls/women, 38% cisgender boys/men, 5% transgender or nonbinary individuals), ages 14–25 years, from across the United States, who were recruited from an online survey panel. Sexual and gender minorities and people of color were oversampled. Participants completed the Wave 1 survey of the longitudinal Sexual Orientation Fluidity in Youth study, which assessed sociodemographic characteristics and retrospective fluidity in sexual orientation identity and attractions.ResultsAcross the sample, 17% reported a retrospective change in identity and 33% reported a change in attractions. Participants who were most likely to report identity change were in the younger age group (14–17 years), were transgender or nonbinary, had a plurisexual identity (pansexual, queer), and reported attractions to more than one gender. Participants who were most likely to report attraction change were nonbinary, had a plurisexual identity (pansexual, queer, bisexual), and reported attractions to more than one gender.DiscussionThis study found retrospective changes in sexual orientation identity and attractions were common in this sample of youth, with the prevalence of these changes differing by sociodemographic characteristics. Results from this study inform future research on adolescent health and have implications for supporting and caring for this age group, for whom sexual fluidity is common.     

Social networking for medical information: A digital divide or a trust inquiry?

ObjectiveTo profile social networkers and those who use social networks for medical purposes and investigate the role of three behavioural triggers related to control, trust and privacy.Data sourcesWe use data from Europe (Eurobarometer 74.3, 2010) containing information about reported behaviour and perceptions on social issues such as media, privacy and social networking.Study designProbit models showing associations between individual socio-economic variables and reported social networking, and social networking for health. Extra variables proxying for control, trust in health care providers and privacy of personal information are then added. Following this, two part models accounting for zero observations are utilised.FindingsThe age profile of social networkers using it for medical care differs from that of social networkers per se. Privacy perceptions appear to be a deterrent of social networking whilst trust in the health care providers is not a significant driver of social network use.ConclusionsThere is some evidence of a digital divide owing to age, while income is not significantly associated with social networking for health. Social networking does not perfectly substitute for conventional health care.     

Risks and Benefits of Adolescent Girls’ Participation in Online Sexting Survey Research

The increasingly ubiquitous use of sexting among adolescent girls underscores the importance of empirical data on their sexting behaviors, motivations, and outcomes. To date, the majority of sexting studies have been conducted online; however, little is known about the extent to which responding to such socially sensitive questions may cause participant discomfort or distress. Research on this question is critical since in the absence of empirical data, institutional review boards (IRBs) may permit or place restrictions on online sexting studies based on an under- or overestimation of adolescent participation risk. The current online study asked 210 girls (aged 14–18 years, 55% non-Hispanic White, with sexting experience in the past 12 months) who previously registered to take online surveys on (1) their anticipated comfort in responding to a sexting survey include items on sexting motivations, positive and negative sexting consequences, and related sexual behaviors; (2) their perceptions of sexting research benefits/harms; and (3) comfort discussing similar topics in everyday life and with health professionals. Overall, participants were comfortable responding to sexting survey questions, rated sexting research as high benefits and low risks, and felt about the same as or more comfortable completing a sexting survey than discussing similar topics with peers, parents, or healthcare professionals. Findings suggest that anonymous online sexting studies can be classified as minimal risk research for adolescent girls and provide empirical support for IRB decisions to waive guardian permission for participation in such studies.

     

Sexual Identity and Sexual Well-Being in Female Heterosexual University Students

Sexual identity has generally been studied with a focus on sexual orientation and has not incorporated a general identity framework. Low levels of identity exploration and commitment have been shown to predict poor well-being in adolescents, but the relationship between sexual identity and sexual well-being has not been examined. The current cross-sectional survey was administered to 293 heterosexual female undergraduate students from a mid-sized university in Ontario, Canada. Participants completed the Measure of Sexual Identity Exploration and Commitment (Worthington, Navarro, Savoy, & Hampton, 2008), as well as several measures to assess sexual well-being. These included the Sexuality Scale (Snell & Papini, 1989), the Sexual Awareness Questionnaire (Snell, Fisher, & Miller, 1991), the Body Esteem Scale for Adolescents and Adults (Mendelson, Mendelson, & White, 2001; Mendelson, White, & Mendelson, 1997), and four individual items assessing sexual satisfaction (Laumann et al., 2006). Confirmatory factor analysis was used to test the measurement models of sexual identity and sexual well-being, and structural equation modeling was used to examine the relationship between sexual identity and sexual well-being. Results indicated that higher levels of sexual identity exploration and commitment predicted sexual well-being. However, other aspects of sexual identity, such as synthesis and sexual orientation identity, were not predictive of sexual well-being. The implications of using an identity framework for measuring sexual identity are discussed.     

Trust,control, and privacy in children’s digitalized lives: introduction to the special symposium

ABSTRACT

The contribution discusses the interrelated role of privacy, control, and trust in children's experience as they are living and growing up in today's digitalized world. It has a form of guest editorial, acting as an introduction to the symposium of five articles exploring the theme from international and interdisciplinary perspectives. The overall aim of this introduction and the symposium is to offer insight into the multifaceted nature of trust, control, and privacy in digitalized environments, in which diverse children and adolescents live, learn, and develop.     

Lines of Action for Sexting Prevention and Intervention: A Systematic Review

Sexting has become a new form of intimate interaction in line with contemporary communication methods. This phenomenon often leads to positive outcomes, but it can also have negative repercussions depending on the situation, such as the context of the relationship, and whether it is consensual or coercive. Despite this, the main types of sexting behaviors (sending, receiving, and third-party forwarding) must be addressed in order to promote safe and healthy practices. However, the approach to tackling this phenomenon remains unclear. This systematic review sought to summarize the lines of action proposed or conducted in the scientific literature to address sexting, to help researchers and educators create and evaluate effective programs. A systematic search of 21 databases was conducted; only articles relating to sexting education, prevention, and intervention among child and adolescent populations were considered. In total, 456 articles were identified, 91 of which were included for the purposes of this research. The results highlighted a need to respond to the aforementioned sexting behaviors and to tackle the resulting conflict situations. Although interventions across different areas are recommended (e.g., health, family, policies, legal advice, law enforcement, technology experts, and even society as a whole), most studies agree that school is the most practical setting for intervention. Thus, the 15 lines of action identified in this systematic review must all be considered to effectively address sexting in childhood and adolescence.

     

“Football is pure enjoyment”: An exploration of the behaviour change processes which facilitate engagement in football for people with mental health problems

IntroductionPhysical activity is known to be beneficial for people with mental health problems, although engagement is low. Football, provided by professional football club community trusts could aid engagement in physical activity, however little is known about the behaviour change processes which engage individuals in this type of PA. One factor which is often overlooked is affect and exploring this could help identify the behaviour change processes, which engage individuals in a professional football club-led mental health intervention. The aim of this study was to explore the experiences of individuals attending football provided by a professional club community trust to further our understanding of the behaviour change processes involved in facilitating engagement in this provision.MethodSemi-structured interviews were conducted with twelve men who played football provided by a professional football club trust. A range of mental health problems were reported and the participants were aged between 19 and 46. Template analysis was conducted, implementing some of the concepts from the Affective – Reflective Theory (ART).ResultsThe results highlighted that both affective and reflective processes of ART were evident in engaging individuals in football. Pleasurable experiences were enabled through the physical and social characteristics of football. Self-control strategies emerged which help to action engagement. The professional football club trust provided coaching knowledge and skills, team organisation and resources and feelings of belonging and responsibility.ConclusionApplication of ART to the understanding of football experiences has provided a novel exploration of the processes involved in engaging individuals in football. This has important implications for intervention design; the focus should be on providing pleasurable experiences and fostering appropriate self-control strategies.