Michael Reece

Sexual Behavior in the United States: Results from a National Probability Sample of Men and Women Ages 14–94

INTRODUCTION Despite a demonstrated relationship between sexual behaviors and health, including clinical risks, little is known about contemporary sexual behavior. AIMS To assess the rates of sexual behavior among adolescents and adults in the United States. METHODS We report the recent (past month, past year) and lifetime prevalence of sexual behaviors in a nationally representative probability sample of 5,865 men and women ages 14 to 94 in the United States (2,936 men, 2,929 women). MAIN OUTCOME MEASURES Behaviors assessed included solo masturbation, partnered masturbation, giving and receiving oral sex, vaginal intercourse, and anal intercourse. RESULTS Masturbation was common throughout the lifespan and more common than partnered sexual activities during adolescence and older age (70+). Although uncommon among 14- to 15-year olds, in the past year 18.3% of 16- to 17-year-old males and 22.4% of 16- to 17-year-old females performed oral sex with an other-sex partner. Also in the past year, more than half of women and men ages 18 to 49 engaged in oral sex. The proportion of adults who reported vaginal sex in the past year was highest among men ages 25-39 and for women ages 20-29, then progressively declined among older age groups. More than 20% of men ages 25-49 and women ages 20-39 reported anal sex in the past year. Same-sex sexual behaviors occurring in the past year were uncommonly reported. CONCLUSIONS Men and women engage in a diverse range of solo and partnered sexual behaviors throughout the life course. The rates of contemporary sexual behavior provided in this report will be valuable to those who develop, implement, and evaluate programs that seek to improve societal knowledge related to the prevalence of sexual behaviors and to sexual health clinicians whose work to improve sexual health among the population often requires such rates of behavior.

Validity/Reliability of PHQ-9 and PHQ-2 Depression Scales Among Adults Living with HIV/AIDS in Western Kenya

BackgroundDepression greatly burdens sub-Saharan Africa, especially populations living with HIV/AIDS, for whom few validated depression scales exist. Patient Health Questionnaire-9 (PHQ-9), a brief dual-purpose instrument yielding DSM-IV diagnoses and severity, and PHQ-2, an ultra-brief screening tool, offer advantages in resource-constrained settings.ObjectiveTo assess the validity/reliability of PHQ-9 and PHQ-2.DesignObservational, two occasions 7 days apart.ParticipantsA total of 347 patients attending psychosocial support groups.MeasurementsDemographics, PHQ-9, PHQ-2, general health perception rating and CD4 count.ResultsRates for PHQ-9 DSM-IV major depressive disorder (MDD), other depressive disorder (ODD) and any depressive disorder were 13%, 21% and 34%. Depression was associated with female gender, but not CD4. Construct validity was supported by: (1) a strong association between PHQ-9 and general health rating, (2) a single major factor with loadings exceeding 0.50, (3) item-total correlations exceeding 0.37 and (4) a pattern of item means similar to US validation studies. Four focus groups indicated culturally relevant content validity and minor modifications to the PHQ-9 instructions. Coefficient alpha was 0.78. Test-retest reliability was acceptable: (1) intraclass correlation 0.59 for PHQ-9 total score, (2) kappas 0.24, 0.25 and 0.38 for PHQ-9 MDD, ODD and any depressive disorder and (3) weighted kappa 0.53 for PHQ-9 depression severity categories. PHQ-2 ≥3 demonstrated high sensitivity (85%) and specificity (95%) for diagnosing any PHQ-9 depressive disorder (AUC, 0.97), and 91% and 77%, respectively, for diagnosing PHQ-9 MDD (AUC, 0.91). Psychometrics were also good within four gender/age (18–35, 36–61) subgroups.ConclusionsPHQ-9 and PHQ-2 appear valid/reliable for assessing DSM-IV depressive disorders and depression severity among adults living with HIV/AIDS in western Kenya.

Condom Use Rates in a National Probability Sample of Males and Females Ages 14 to 94 in the United States

INTRODUCTION Given the efficacy of latex condoms for preventing pregnancy, HIV, and most STI, their promotion remains central to global sexual health efforts. To inform the development of accurate and appropriately-targeted interventions, there is a need for contemporary condom use rates among specific populations. AIMS The purpose of this study was to establish rates of condom use among sexually active individuals in the U.S. population. METHODS Data were collected via a national probability sample of 5,865 U.S. adolescents and adults aged 14 to 94 years. MAIN OUTCOME MEASURES Condom use was assessed during the most recent partnered vaginal or anal sexual event and over the past 10 vaginal and anal intercourse events. RESULTS Condom use by men during past 10 vaginal intercourse events was slightly higher (21.5%) than that reported by women (18.4%), and consistent with rates of condom use reported during most recent vaginal intercourse by men (24.7%) and women (21.8%). Adolescent men reported condom use during 79.1% of the past 10 vaginal intercourse events, adolescent women reported use during 58.1% of the same. Condom use during past 10 anal intercourse events was higher among men (25.8%) than women (13.2%); the same was observed for most recent anal intercourse event (26.5% for insertive men, 44.1% for receptive men, and 10.8% for receptive women). Generally, condom use was highest among unmarried adults, higher among adolescents than adults, and higher among black and Hispanic individuals when compared with other racial groups. CONCLUSION These data indicate clear trends in condom use across age, gender, relationship status, and race/ethnicity. These contemporary rates of condom use will be helpful to those who lead efforts to increase condom use among individuals who may be at risk for sexually transmitted infections or who desire to prevent pregnancy.

Sexual compulsivity among heterosexual college students

A growing body of literature suggests that an association exists between sexual compulsivity and participation in sexual behaviors that are high risk in terms of HIV/STD infection. In most of these studies, sexual compulsivity has been measured using the Sexual Compulsivity Scale (SCS; Kalichman & Rompa, 1995). As yet, sexual compulsivity has only been assessed with this scale among individuals who are members of “high risk” groups for HIV infection or who are HIV‐positive. In this study, we found support for reliability and construct validity of the SCS in a sample of 876 heterosexual college students, a group not yet examined in the sexual addiction and compulsivity literature. Construct validity was substantiated by the presence of significant relationships of sexual compulsivity with frequencies of sexual behaviors and numbers of sexual partners. The scale was also related to gender and age. Sexual compulsivity scores were associated with frequency of risky sexual behaviors. The relationships between sexual compulsivity and solo, partner, public, and risky sexual behaviors remained significant when we controlled for demographic variables. Although we found support for construct validity of the SCS in our sample, it is not clear whether the scale distinctly measures sexual compulsivity or taps into other constructs, such as sexual desire and sexual exploration.

Sexual Behaviors, Condom Use, and Sexual Health of Americans Over 50: Implications for Sexual Health Promotion for Older Adults

INTRODUCTION In the contemporary U.S., men and women are living longer and healthier lives. As such, many people spend greater portions of their lives as sexually active individuals. Yet, little is known about the myriad of ways that older adults experience their sexual lives. AIM This study sought to assess the context and frequency of sexual behaviors, condom use, sexual pleasure, and sexual experience of men and women over age 50. METHODS Information regarding the sexual experiences of a nationally representative sample of men and women over age 50 within the past year was examined. MAIN OUTCOME MEASURES Sexual behavior over the past year was assessed in relation to several situational and contextual characteristics (e.g., event location, type of partner, health status, condom use). Participants were also asked about their experience (i.e., pleasure, arousal, pain, lubrication/erectile difficulties, and orgasm) during their most recent partnered sexual event. Bivariate or ordinal logistic regression models were used to investigate the relationship of age, health and partner status to sexual frequency and experience. RESULTS Although sizable proportions (20-30%) of both men and women remained sexually active well into their 80s age was related to a lower likelihood of solo and most partnered sexual behaviors. When controlling for age, relationship status, and health remained significant predictors of select sexual behaviors. The participants evaluation of their most recent sexual experience in terms of arousal, erectile difficulty, and orgasm all declined with age. Health status was related to mens evaluation of the experience. Relationship status was the most consistent predictor of womens evaluation of the experience. Condom use rates remained low for participants across age groups. CONCLUSION Many older adults continue be sexually active well into advanced age (80+). Thus, providers need to be attentive to the diverse sexual health needs of older adults.

Sexual Behaviors, Relationships, and Perceived Health Among Adult Men in the United States: Results from a National Probability Sample

INTRODUCTION To provide a foundation for those who provide sexual health services and programs to men in the United States, the need for population-based data that describes mens sexual behaviors and their correlates remains. AIMS The purpose of this study was to, in a national probability survey of men ages 18-94 years, assess the occurrence and frequency of sexual behaviors and their associations with relationship status and health status. METHODS A national probability sample of 2,522 men aged 18 to 94 completed a cross-sectional survey about their sexual behaviors, relationship status, and health. MAIN OUTCOME MEASURES Relationship status; health status; experience of solo masturbation, partnered masturbation, giving oral sex, receiving oral sex, vaginal intercourse and anal intercourse, in the past 90 days; frequency of solo masturbation, vaginal intercourse and anal intercourse in the past year. RESULTS Masturbation, oral intercourse, and vaginal intercourse are prevalent among men throughout most of their adult life, with both occurrence and frequency varying with age and as functions of relationship type and physical health status. Masturbation is prevalent and frequent across various stages of life and for both those with and without a relational partner, with fewer men with fair to poor health reporting recent masturbation. Patterns of giving oral sex to a female partner were similar to those for receiving oral sex. Vaginal intercourse in the past 90 days was more prevalent among men in their late 20s and 30s than in the other age groups, although being reported by approximately 50% of men in the sixth and seventh decades of life. Anal intercourse and sexual interactions with other men were less common than all other sexual behaviors. CONCLUSION Contemporary men in the United States engage in diverse solo and partnered sexual activities; however, sexual behavior is less common and more infrequent among older age cohorts.

A CBPR Partnership Increases HIV Testing Among Men Who Have Sex With Men (MSM): Outcome Findings From a Pilot Test of the CyBER/testing Internet Intervention

The Internet has emerged as an important tool for the delivery of health promotion and disease prevention interventions. Our community-based participatory research (CBPR) partnership developed and piloted CyBER/testing, a culturally congruent intervention designed to promote HIV testing among men who have sex with men (MSM) within existing Internet chat rooms. Using a quasi-experimental, single-group study design, cross-sectional data were collected from chat room participants, known as “chatters,” at pretest (n = 346) and posttest (n = 315). Extant profile data also were collected to describe the demographics of the online population. The intervention significantly increased self-reported HIV testing among chatters overall, increasing rates from 44.5% at pretest to nearly 60% at posttest (p < .001). Furthermore, chatters who reported having both male and female sexual partners had nearly 6 times the odds of reporting HIV testing at posttest. Findings suggest that chat room—based HIV testing intervention may increase testing among MSM who may be difficult to reach in traditional physical spaces.

ORIGINAL RESEARCH—OUTCOMES ASSESSMENT: Development and Validation of the Female Genital Self‐Image Scale

INTRODUCTION Womens sexual function may be influenced by various factors including medical conditions, trauma or abuse, medications, relationship dynamics, relaxation, mood, and body image. However, few studies have explored the influence of a womans genital self-image on her sexual function or behaviors. AIMS The purpose of this study was to establish a reliable and valid measure of female genital self-image, the Female Genital Self-Image Scale (FGSIS), and to assess the relationship between scores on the FGSIS and womens sexual function. METHODS The FGSIS was developed in two stages. Phase One involved an analysis of cross-sectional paper-based survey data and a review of the literature. Phase Two involved a cross-sectional internet-based administration of the scale items to a total of 1,937 women. MAIN OUTCOME MEASURES Psychometric properties of the scale were evaluated through the use of reliability analysis, factor analysis, and score differences based on womens experience of orgasm from receiving cunnilingus or from self-masturbation with a vibrator. Correlation analysis was used to explore the relationship between female genital self-image and scores on the Female Sexual Function Index (FSFI). RESULTS The scale was found to have sufficient reliability (Cronbachs alpha = 0.88) and one factor that explained 59.23% of the variance. Women who had ever experienced orgasm as a result of cunnilingus or self-masturbation with a vibrator and women who reported having had a gynecological exam in the previous 12 months had significantly higher FGSIS scores than those who had not (P < 0.001). Scores on the FGSIS were positively and significantly correlated with scores on all FSFI domains (P < 0.001), including the Total score, with the exception of the Desire domain. CONCLUSION The FGSIS was initially found to be a reliable and valid measure though further research is needed to understand its properties in diverse populations. In addition, female genital self-image was found to be positively related to womens sexual function.

The Female Genital Self‐Image Scale (FGSIS): Results from a Nationally Representative Probability Sample of Women in the United States

INTRODUCTION Over the past two decades, an expanding body of research has examined womens and mens genital self-image. Support for the reliability and validity of the 7-item Female Genital Self-Image Scale (FGSIS) has been found in a convenience sample of women. AIMS The purpose of this study was to assess the reliability and validity of the FGSIS, its model of fit, and its association with womens scores on the Female Sexual Function Index (FSFI) in a nationally representative probability sample of women in the United States ages 18 to 60. A second purpose was to assess the temporal stability of the scale in a subset of this sample. METHODS A nationally representative sample of 3,800 women ages 18 to 60 were invited to participate in a cross-sectional Internet-based survey; 2,056 (54.1%) participated. MAIN OUTCOME MEASURES Demographic items (e.g., age, race/ethnicity, marital status, sexual orientation, geographic region), having had a gynecological examination in the past year, having performed a genital self-examination in the past month, frequency of masturbation in the past month, vibrator use in the past month, the FGSIS, and the FSFI. RESULTS An abbreviated 4-item version of the scale, the FGSIS-4, was a better fit to the data than the original 7-item scale. Womens scores on the FGSIS-4 were significantly related to vibrator use, frequency of masturbation, having had a gynecological exam in the past year, having performed genital self examination in the past month, and all FSFI subscales. CONCLUSION Most of the participants felt generally positively about their genitals and female genital self-image was significantly related to female sexual function, womens sexual behavior and their sexual and genital healthcare behaviors. In addition, the FGSIS-4 has evidence of reliability, validity, and temporal stability in a nationally representative probability sample of women in the United States.

Condom Use During Most Recent Vaginal Intercourse Event Among a Probability Sample of Adults in the United States

INTRODUCTION Correct and consistent condom use remains the most effective way to reduce sexually transmissible infection/HIV transmission during sex and is a highly effective contraceptive method. Understanding correlates of condom use is vital to public health programs. AIM To explore sociodemographic, event characteristics, and experiential correlates of condom use at last penile-vaginal intercourse (PVI). METHODS Survey data were collected from a nationally representative probability sample of adults in the United States as part of the National Survey of Sexual Health and Behavior. MAIN OUTCOME MEASURES Condom use/non-use at most recent PVI was the main outcome. Logistic regression analyses predicted condom use from sociodemographic variables (i.e., age, education, race/ethnicity, sexual orientation, health status, type of relationship with sexual partner) and event characteristics (i.e., location of sexual encounter, prior intercourse experience with partner, whether partner had other sex partners in the 6 months prior to sex with the participant; other contraceptive use, alcohol use, marijuana use, and for men, erection medication use). Logistic regression analyses examined evaluations of the sexual aspects of the experience (pleasure, arousal, erection/lubrication difficulty, participant orgasm, partner orgasm) in light of condom use. RESULTS Condom-protected PVI was significantly greater among younger people, blacks and Hispanics, and those having PVI with a nonrelationship partner. Statistically adjusting for these differences, condom use was significantly associated with fewer previous intercourse experiences with the partner and not using other forms of contraception. The sexual aspects of experience were evaluated similarly regardless of whether or not a condom was used. CONCLUSION Public health programs among youths and minorities may underlie higher condom use rates among these groups. Condom use may be further improved by continuing such programs and also expanding outreach to older persons and whites, suggesting prolonging use as relationships develop, and highlighting that condom use does not necessarily interfere with the sexual experience.