Jennifer L. Walsh

Sexual Hookups and Adverse Health Outcomes: A Longitudinal Study of First-Year College Women

“Hookups” are sexual encounters between partners who are not in a romantic relationship and do not expect commitment. We examined the associations between sexual hookup behavior and depression, sexual victimization (SV), and sexually transmitted infections (STIs) among first-year college women. In this longitudinal study, 483 women completed 13 monthly surveys assessing oral and vaginal sex with hookup and romantic partners, depression, SV, and self-reported STIs. Participants also provided biological specimens that were tested for STIs. During the study, 50% of participants reported hookup sex and 62% reported romantic sex. Covariates included previous levels of the outcome, alcohol use, impulsivity, sensation seeking, and romantic sex. Autoregressive cross-lagged models showed that, controlling for covariates, hookup behavior during college was correlated with depression, Bs = .21, ps < .05, and SV, Bs = .19, ps < .05. In addition, precollege hookup behavior predicted SV early in college, B = .62, p < .05. Hookup sex, OR 1.32, p < .05, and romantic sex, OR 1.19, p < .05, were associated with STIs. Overall, sexual hookup behavior among college women was positively correlated with experiencing depression, SV, and STIs, but the nature of these associations remains unclear, and hooking up did not predict future depression.

Changes in Women’s Condom Use over the First Year of College

Most college students are sexually active, engage in serially monogamous relationships, and use condoms inconsistently. Little is known about how condom use changes during college, and even less about variables predicting changes in use. Latent growth modeling (LGM) was used to examine changes in condom use during the first year of college among 279 women (mean age = 18.0; 74% White), who provided monthly reports on condom use frequency. At study entry, participants also reported on theoretically suggested risk and protective factors. Predictors of changes in use were examined after controlling for use of alternative contraception and partner type. LGM showed that women decreased their condom use during the first year of college. Levels of condom use were initially lower among women with strong alcohol–sexual risk expectancies, women with more previous sexual partners, women who did not smoke marijuana, and African American women. Decreases in condom use were greater among women with lower grade point averages, women from lower socioeconomic status families, and women who engaged in binge drinking. Reductions in condom use may place women at greater risk of unplanned pregnancy and sexually transmitted infections. Identification of factors associated with decreases in condom use will enable targeted educational and intervention efforts.

Female College Students’ Media Use and Academic Outcomes: Results from a Longitudinal Cohort Study

This longitudinal study describes women’s media use during their first year of college and examines associations between media use and academic outcomes. Female students (N = 483, M age = 18.1 years) reported on their use of 11 media forms and their grade point average (GPA), academic behaviors, academic confidence, and problems affecting schoolwork. Allowing for multitasking, women reported nearly 12 hr of media use per day; use of texting, music, the Internet, and social networking was heaviest. In general, media use was negatively associated with academic outcomes after controlling for prior academics and demographics. Exceptions were newspaper reading and music listening, which were positively associated with academic outcomes. There were significant indirect effects of magazine reading and social networking on GPA via academic behaviors, confidence, and problems. Results show that female college students are heavy users of new media, and that some forms of media use may adversely impact academic performance.

Do Alcohol and Marijuana Use Decrease the Probability of Condom Use for College Women

Alcohol and marijuana use are thought to increase sexual risk taking, but event-level studies conflict in their findings and often depend on reports from a limited number of people or on a limited number of sexual events per person. With event-level data from 1,856 sexual intercourse events provided by 297 college women (M age = 18 years; 71% White), we used multilevel modeling to examine associations between alcohol and marijuana use and condom use as well as interactions involving sexual partner type and alcohol-sexual risk expectancies. Controlling for alternative contraception use, partner type, regular levels of substance use, impulsivity and sensation seeking, and demographics, women were no more or less likely to use condoms during events involving drinking or heavy episodic drinking than during those without drinking. However, for drinking events, there was a negative association between number of drinks consumed and condom use; in addition, women with stronger alcohol-sexual risk expectancies were marginally less likely to use condoms when drinking. Although there was no main effect of marijuana use on condom use, these data suggest marijuana use with established romantic partners may increase risk of unprotected sex. Intervention efforts should target expectancies and emphasize the dose-response relationship of drinks to condom use.

PrEP Awareness, Familiarity, Comfort, and Prescribing Experience among US Primary Care Providers and HIV Specialists.

HIV pre-exposure prophylaxis (PrEP) was FDA approved in 2012, but uptake remains low. To characterize what would facilitate health care providers’ increased PrEP prescribing, we conducted a 10-city, online survey of 525 primary care providers (PCPs) and HIV providers (HIVPs) to assess awareness, knowledge, and experience with prescribing PrEP; and, comfort with and barriers to PrEP-related activities. Fewer PCPs than HIVPs had heard of PrEP (76 vs 98%), felt familiar with prescribing PrEP (28 vs. 76%), or had prescribed it (17 vs. 64%). PCPs were less comfortable than HIVPs with PrEP-related activities such as discussing sexual activities (75 vs. 94%), testing for acute HIV (83 vs. 98%), or delivering a new HIV diagnosis (80 vs. 95%). PCPs most frequently identified limited knowledge about PrEP and concerns about insurance coverage as prescribing barriers. PCPs and HIVPs differ in needs that will facilitate their PrEP prescribing. Efforts to increase PrEP uptake will require interventions to increase the knowledge, comfort, and skills of providers to prescribe PrEP.ResumenProfilaxis pre-exposición por VIH (PrEP) fue aprobado por la FDA en 2012, pero su utilización ha sido lento. Para caracterizar lo que facilataría un aumento de la prescripción de profilaxis pre-exposición entre los proveedores de salud, se realizó una encuesta en línea con 525 proveedores de atención primaria (PAP) y los proveedores de VIH (PVIH) en diez ciudades, para evaluar la conciencia, conocimiento y la experiencia con la prescripción de profilaxis pre-exposición; y comodidad con y barreras a las actividades relacionadas con la prescripción de PrEP. Menos PAPs que PVIHs habían oído hablar de profilaxis pre-exposición (76 vs 98%), se sentía familiarizado con prescripción de profilaxis pre-exposición (28 vs. 76%), o habían prescrito (17 vs. 64%). Los PAPs eran menos cómodo que PVIHs con actividades relacionadas con la PrEP como hablar sobre las actividades sexuales (75 vs. 94%), las pruebas de VIH aguda (83 vs. 98%), o la entrega de un nuevo diagnóstico de VIH (80 vs. 95%). Los PAPs frecuentemente identificaron un conocimiento limitado sobre PrEP y preocupaciones acerca de la cobertura de seguro como barreras de prescripción. PAPs y PVIHs difieren en las necesidades que van a facilitar su prescripción de PrEP. Los esfuerzos para aumentar la absorción de la PrEP requerirán intervenciones para aumentar el conocimiento, la comodidad, y las habilidades de los proveedores para prescribir PrEP.

Magazine reading and involvement and young adults' sexual health knowledge, efficacy, and behaviors

These studies investigate connections between magazine reading and involvement and young peoples sexual health knowledge, self-efficacy, intentions, and contraception use. Study 1 assessed sexual health behaviors and magazine reading among 579 undergraduate students (69% were female; 68% were White; Mage = 19.73). As expected, more frequent reading of mainstream magazines was associated with greater sexual health knowledge, safe-sex self-efficacy, and consistency of using contraception, although results varied across sex and magazine genre. Study 2 replicated and expanded on these findings with a survey of 422 undergraduate students (51% were female; 71% were White; 49% were age 18 or younger), incorporating a more extensive knowledge scale, questions about safe-sex intentions, and measures of magazine involvement. Results suggest that magazine use is associated with positive sexual health outcomes among young people.

The mediating roles of perceived stress and health behaviors in the relation between objective, subjective, and neighborhood socioeconomic status and perceived health.

BackgroundObjective, subjective, and neighborhood socioeconomic status (SES) are associated with perceived health, morbidity, and mortality.PurposeWe investigated whether perceived stress and health behaviors mediated the relation between the three types of SES and perceived health.MethodsParticipants (N = 508) attending a public clinic completed a computerized survey assessing objective SES (income, education, employment); health behaviors; perceived stress; and perceived health. They also indicated their social standing relative to others (subjective SES) and provided their current address to determine neighborhood SES.ResultsIn a structural equation model including all three SES types, lower objective and subjective SES were related to poorer perceived health. When mediators were included in the model, there were significant indirect effects of (a) SES on health through stress and (b) SES on health through stress and health-compromising behaviors.ConclusionsInterventions to reduce the impact of stressors could improve the health of socioeconomically disadvantaged individuals.

Awkward or Amazing: Gender and Age Trends in First Intercourse Experiences.

Although research continues to highlight significant gender differences in first coital experiences, developmental approaches suggest that some of these patterns may be age-related. Therefore, this study investigated both gender and age differences in first intercourse experiences. Open-ended responses regarding reasons for, and descriptions of, first vaginal intercourse were provided by 323 sexually active undergraduate students (65.3% female; 75.7% White; M age = 19.87) and coded into a range of categories. Several gender and age differences emerged, such that women’s descriptions were generally less positive than men’s, and women’s reasons were more likely than men’s to emphasize relationships and emotions. However, there were also a number of similarities in women’s and men’s experiences. Those who first experienced coitus during early adolescence were more likely to describe it as awkward, were less likely to describe it as positive, and differed in their reasons from those whose first coitus occurred later. Importantly, gender differences were less pronounced among older versus younger initiates, suggesting that commonly-identified gender differences may be developmentally specific. Future research focusing on subjective aspects of first intercourse experiences should carefully attend both to age or developmental stage and to gender similarities.

Dual method use among a sample of first-year college women.

CONTEXT Dual method use-using one protective method to reduce the risk of STDs and another to prevent pregnancy-is effective but understudied. No prior studies have employed an event-level approach to examining characteristics associated with dual method use among college women. METHODS In 12 consecutive monthly surveys conducted in 2009-2010, data on 1,843 vaginal intercourse events were collected from 296 first-year college women. Women reported on their use of condoms and hormonal contraceptives during all events. Multilevel regression analysis was used to assess associations between event-, month- and person-level characteristics and hormonal use and dual method use. RESULTS Women used hormonal contraceptives during 53% of events and condoms during 63%. Dual method use was reported 28% of the time, and only 14% of participants were consistent users of dual methods. The likelihood of dual method use was elevated when sex partners were friends as opposed to romantic partners or ex-boyfriends (odds ratios, 2.5-2.8), and among women who had received an STD diagnosis prior to college (coefficient, 2.9); it also increased with level of religiosity (0.8). Dual use was less likely when less reliable methods were used (odds ratio, 0.2) and when women reported more months of hormonal use (0.8), were older than 18 (coefficient, -4.7) and had had a greater number of partners before college (-0.3). CONCLUSIONS A better understanding of the characteristics associated with dual method use may help in the design of potential intervention efforts.

Benefits of Hooking Up: Self-Reports from First-Year College Women

ABSTRACT This study explored the benefits of hooking up among first-year college women. Two authors coded for the presence of 10 benefits (kappas: 0.76–0.97) in 262 womens responses to an open-response survey question regarding benefits of their most recent hookup. The most common benefits identified were sexual pleasure (23%), general positive emotions (21%), increased confidence (11%), and clarification of feelings (11%). Overall, 71% reported at least 1 benefit, but 29% reported no benefits. For some young women, hooking up has benefits that can include meeting their needs for social connection, sexual exploration and intimacy, and fun/enjoyment.