Amy Bleakley

Relationships of Stigma and Shame to Gonorrhea and HIV Screening

OBJECTIVES The purpose of this study was to assess the relationships between stigma and shame associated with seeking treatment for sexually transmitted diseases (STDs) and undergoing testing for gonorrhea and HIV. METHODS Participants were 847 males and 1126 females (mean age: 24.9 years) in 7 cities. Two scales assessed STD-related stigma and STD-related shame. RESULTS Rates of stigma and shame were higher among participants without a gonorrhea test in the past year and among those without an HIV test. Sex, age, health service use, previous suspicion of gonorrhea, and low levels of stigma were independently associated with gonorrhea testing. Age, enrollment site, use of health services, gonorrhea testing, and low levels of stigma were independently associated with HIV testing. CONCLUSIONS Shame is part of the experience of seeking STD-related care, but stigma may be a more powerful barrier to obtaining such care.

It Works Both Ways: The Relationship between Exposure to Sexual Content in the Media and Adolescent Sexual Behavior

Using a longitudinal Web-based survey of adolescents 14–16 years of age, we estimate regression models where self-reported sexual behavior and content analytic-based exposure to sex in the media are related cross-sectionally and longitudinally. We find evidence for both cross-sectional nonrecursive and prospective longitudinal relationships even after adjusting for both established predictors of sexual behavior (e.g., physical development, having a romantic partner, parental monitoring, peer and parental norms, respondents age) and of exposure to sexual media content (e.g., time the respondent goes to bed, extracurricular activities, television in the bedroom, total time spent with television, music, video games, and magazines). Sexually active adolescents are more likely to expose themselves to sex in the media and those exposed to sex in the media are more likely to progress in their sexual activity. These findings are consistent with others in the literature that demonstrate a causal effect of exposure to sexual content on sexual behavior but extend established results by also looking at the causal effect of sexual behavior on exposure both cross-sectionally and over time.

Estimating the Longitudinal Association Between Adolescent Sexual Behavior and Exposure to Sexual Media Content

The purpose of this study is to estimate the association between adolescent sexual behavior and exposure to sexual media content. A three-wave, longitudinal survey sample (N = 506) of 14- to 16-year-olds at baseline is analyzed using growth curves. Growth trajectories are linear for sexual behavior but not for exposure to sexual media content. The signs of the exposure slopes are not uniformly positive: Hispanic and African American respondents show declines of exposure to sexual media content over the age range investigated here. Although changes in exposure to sex content are highly associated with changes in sexual behavior among Whites, there is little or no association between changes in these variables among Blacks.

A Model of Adolescents' Seeking of Sexual Content in Their Media Choices

This article reports on the extent to which adolescents report actively seeking sexual content in media, identifies from which media they report seeking, estimates the association between seeking sexual information and romantic and sexual behavior, and shows that active seeking of sexual content in media sources is explained by an intention to seek such content using the Integrative Model of Behavioral Prediction, a reasoned action approach. The data are a national sample of 810 adolescents aged 13 to 18 years. Results show that 50% of adolescents reported actively seeking sexual content in their media choices, which included movies, television, music, Internet pornography sites, and magazines. Males sought sex content more than females, and gender differences were greatest for seeking from Internet pornography sites, movies, and television. Path analysis demonstrate that seeking sexual content is well-predicted by intentions to seek, and intentions are primarily driven by perceived normative pressure to seek sexual content.

Using the Integrative Model to Explain How Exposure to Sexual Media Content Influences Adolescent Sexual Behavior

Published research demonstrates an association between exposure to media sexual content and a variety of sex-related outcomes for adolescents. What is not known is the mechanism through which sexual content produces this “media effect” on adolescent beliefs, attitudes, and behavior. Using the Integrative Model of Behavioral Prediction, this article uses data from a longitudinal study of adolescents ages 16 to 18 (N = 460) to determine how exposure to sexual media content influences sexual behavior. Path analysis and structural equation modeling demonstrated that intention to engage in sexual intercourse is determined by a combination of attitudes, normative pressure, and self-efficacy but that exposure to sexual media content only affects normative pressure beliefs. By applying the Integrative Model, we are able to identify which beliefs are influenced by exposure to media sex and improve the ability of health educators, researchers, and others to design effective messages for health communication campaigns and messages pertaining to adolescents’ engaging in sexual intercourse.

Computer Access and Internet Use Among Urban Youths

This report presents data on computer access, Internet use, and factors associated with health information seeking on the Internet among a sample of youths aged 15 to 30 years in New York City. Findings from street intercept surveys indicate substantial computer access at home (62%) and frequent (everyday or a few times a week) Internet use (66%). Fifty-five percent of the sample reported seeking health information on the Internet, which was associated with positive beliefs about getting a health checkup and frequent Internet use.

The Role of Communication With Friends in Sexual Initiation

This study identifies a theoretical mechanism through which communication with friends about sex influences sexual initiation in a sample of adolescents. The integrative model was used to assess the effect of attitudes, normative pressure, and self-efficacy on intentions to have sex in a sample of virgin adolescents. Results show that the constructs of the theory partially mediated the effect of communication with friends on subsequent sexual initiation. The effect of communication with friends on sexual initiation was not different for male and female adolescents. Overall, the results suggest how conversations with friends about sex influence adolescents’ intentions to initiate sexual intercourse, which in turn influence subsequent sexual initiation.

The influence of substance use, social sexual environment, psychosocial factors, and partner characteristics on high-risk sexual behavior among young Black and Latino men who have sex with men living with HIV: A qualitative study.

Understanding the sexual risk behaviors of youths living with HIV/AIDS is critical to secondary prevention of HIV. As part of a larger qualitative study of youths living with HIV, in-depth interviews were conducted with 27 African American and Latino, HIV-infected young men who have sex with men, aged 16-24 years, living in New York City. The study explored the role of substance use, the social-sexual-environmental, and psychological contexts in which sexual risk behaviors occurred. Since learning of their HIV infection, the majority of participants had reduced their risky sexual behaviors; however, a subset (26%) of participants continued to have unprotected sex, in most cases with multiple partners. Substance use, the social environmental context of the sexual encounter, the psychological impact of HIV on sexual behavior, and partner characteristics were associated with high-risk sexual behaviors in this group. Among high-risk participants, factors associated with risky sexual behaviors clustered, with 57% reporting two or more factors. More intensive interventions are needed for this subset of youths living with HIV, including assessment and treatment for substance use and mental health issues, strategies for stress reduction, and partner interventions.

Identifying the Causal Pathways from Religiosity to Delayed Adolescent Sexual Behavior

This study used the Integrative Model as a framework to examine whether religiosity delays onset of coitus among a longitudinal sample of virgins, and investigated the causal pathways of this relationship. In addition, this study examined the behavioral beliefs about the consequences of engaging in sex, which distinguishes between youth who vary in level of religiosity. A further analysis was also conducted to examine whether religiosity offers protective effects in terms of progression toward sexual intercourse on a sexual behavior index. The sexual behavior index assumes a progressive nature of sexual behaviors, and includes the following seven behaviors: kissing, having breasts touched (touching for boys), genital touching, receiving oral sex, vaginal intercourse, giving oral sex, and receiving (or giving) anal sex. Religiosity at baseline was negatively associated with sexual debut one year later. This relationship was mediated through attitudes toward personally engaging in sexual intercourse. Religiosity at baseline was also negatively associated with scores on the sexual behavior index one year later. These results suggest that religiosity offers protective effects for both coital and noncoital sexual behaviors.

Differentiating Between Precursor and Control Variables When Analyzing Reasoned Action Theories

This paper highlights the distinction between precursor and control variables in the context of reasoned action theory. Here the theory is combined with structural equation modeling to demonstrate how age and past sexual behavior should be situated in a reasoned action analysis. A two wave longitudinal survey sample of African-American adolescents is analyzed where the target behavior is having vaginal sex. Results differ when age and past behavior are used as control variables and when they are correctly used as precursors. Because control variables do not appear in any form of reasoned action theory, this approach to including background variables is not correct when analyzing data sets based on the theoretical axioms of the Theory of Reasoned Action, the Theory of Planned Behavior, or the Integrative Model.