Szociológia | Felsőoktatás » Murray-Swartzendurber-Sales - The Influence of Sexual Arousability on Partner Communication Mediators of Condom Use Among African American Female Adolescents

Source: http://www.doksinet 1 The Influence of Sexual Arousability on Partner Communication Mediators of Condom Use Among African American Female Adolescents Sarah H. Murray, MSc1, Andrea Swartzendurber, PhD, 2,3 Jessica M Sales, PhD,2,3 Robin R Milhausen, PhD1, Stephanie A. Sanders, PhD,4-6 Cynthia A Graham, PhD, 4,5,7 Ralph J DiClemente, PhD,2,3,8 & Gina M. Wingood, PhD2,3 1 Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario Canada 2 Rollins School of Public Health at Emory University, Atlanta, Georgia 3 Emory Center for AIDS Research, Atlanta, Georgia 4 The Kinsey Institute for Research in Sex, Gender, and Reproduction, Morrison Hall 313, Indiana University, Bloomington, IN 47405 USA 5 Rural Center for AIDS/STD Prevention, Indiana University, Bloomington, IN 47405 USA 6 Department of Gender Studies, Memorial Hall E130, Indiana University, Bloomington, IN 47405 USA 7 Oxford Doctoral Course in Clinical Psychology, University

of Oxford, Oxford, OX3 7JX UK 8 Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Epidemiology, and Immunology, Atlanta, Georgia Source: http://www.doksinet 2 ACKNOWLEDGMENTS This research was supported by a grant, number K01 MH085506-01A1, from the National Institute of Mental Health to the first author, and grant number 5 R01 MH070537-07, from the National Institute of Mental Health to the third author. Word count: 2,685; Abstract word count: 244 Correspondance: Sarah H. Murray, BA Department of Family Relations and Applied Nutrition, Room 217 Macdonald Institute, University of Guelph, Guelph, Ontario, Canada, N1G 2W1 Email: murrays@uoguelph.ca; Phone: (519) 824-4120 ext 56987 Key Words: African American; female adolescents; arousability; condom use Source: http://www.doksinet 3 Abstract Background: Ample evidence shows that partner sexual communication is related to condom use. Although communication about safer sex may often

occur when sexual arousal is high, no studies have examined arousability, one’s propensity for sexual arousal, and partner sexual communication. The purpose of this study was to examine associations between sexual arousabilty and partner-related mediators of condom use among African American female adolescents, who have disproportionate risk for HIV and sexually transmitted infections (STIs). Methods: The study analyzed baseline data from 701 African American females aged 14-20 years participating in an HIV/STI trial. Prior to randomization, participants provided selfreported data via audio computer-assisted self-interviews Linear regression models examined associations between arousability and partner-related mediators of condom use while controlling for age, impulsivity and relationship power. Partner communication variables included partner sexual communication self-efficacy, partner sexual communication frequency, and sex refusal self-efficacy. Associations between arousability

and condom use self-efficacy were also assessed. Results: Greater arousability was significantly associated with reduced levels of each partner communication outcome assessed but was not associated with condom use self-efficacy. The findings suggest that arousability is associated with sexual partner communication but not all partner-related mediators of condom use. Conclusions: Arousal and other positive aspects of sex have largely been ignored by current HIV/STI prevention efforts, which primarily focus on individual behavior. A population-level sexual health approach which focuses on sexual well-being may reduce stigma, facilitate partner Source: http://www.doksinet 4 sexual communication, and be more effective at reducing HIV/STI rates than traditional approaches. Source: http://www.doksinet 5 The Influence of Sexual Arousability on Partner Communication Mediators of Condom Use Among African American Female Adolescents Young people represent only one-quarter of the American

sexually active population yet acquire almost half of all new sexually transmitted infections (STIs) reported annually (Weinstock, Berman, & Cates, 2004). African Americans are disproportionately affected by sexually transmitted infections, including HIV (Centers for Disease Control and Prevention [CDC], 2012; CDC, 2013). In 2010, the rate of new HIV infections among African American women was 20 times that of white women and almost 5 times that of Hispanic/Latino women (CDC, 2012). That same year, African Americans represented more than half (57%) of new HIV infections among adolescents aged 13-24 years (CDC, 2012). Furthermore, nationally, rates of Chlamydia and gonorrhea, are highest among African American female adolescents aged 15-24 years (CDC, 2013). Improved HIV/STI prevention interventions are needed to decrease sexual risk behaviors, increase condom use and reduce HIV/STI rates among African American female adolescents. Although sexual arousal has been shown to be related

to HIV/STI risk in a variety of populations (Bancroft et al., 2003; Bancroft, Janssen, Strong, & Vukadinovic, 2003; Graham, Crosby, Milhausen, Sanders, & Yarber, 2011; Wood et al., 2013), scant research has investigated sexual arousal and HIV/STI risk among African American female adolescents. Such research may be useful for improving or targeting HIV/STI prevention interventions for this vulnerable population and is consistent with a sexual health approach, which researchers and advocates suggest may be more effective than traditional approaches in reducing HIV/STI rates (Douglas & Fenton, 2013; Swartzendruber & Zenilman, 2010). Sexual health is a framework which recognizes sexual expression as normative and emphasizes well-being in relation to sexuality Source: http://www.doksinet 6 across the lifespan (Douglas & Fenton, 2013; Swartzendruber & Zenilman, 2010; World Health Organization [WHO] ). Sexual health concerns far more than preventing disease; it is a

holistic, positive, rights-based approach to sexuality and encompasses both preventive and treatment services to ensure the possibility of safe and pleasurable sexual experiences (Douglas & Fenton, 2013; Swartzendruber & Zenilman, 2010; WHO ). Greater understanding about the pathways through which sexual arousal may influence sexual risk behavior may be useful for increasing the acceptance and impact of HIV/STI prevention efforts and improving poor sexual health indicators. The Dual Control Model of Sexual Response proposes that sexual responding occurs as a result of an interaction between sexual excitatory and sexual inhibitory processes (Bancroft, Graham, Janssen, & Sanders, 2009). The model suggests that individuals differ in their levels of arousability/ sexual excitation (SE) and sexual inhibition (SI), and that propensity for SE and SI has implications for sexual behaviors (Bancroft et al., 2009) A model assumption, supported by empirical evidence, is that

individuals with higher levels of arousability (i.e, greater propensity for sexual arousal) are more likely to engage in sexual risk behavior (Bancroft et al., 2009) For example, among men, greater arousability has been shown to be significantly associated with a greater number of casual partners and incomplete condom use, specifically, putting on a condom after sex began (Bancroft et al., 2003; Graham et al, 2011) Research on SE and SI among women is limited. However, studies among women have also reported greater arousability is associated with greater levels of sexual risk behavior (Turchik, Garske, Probst, & Irvin, 2010; Wood et al., 2013) For example, an analysis of the data used in the current study found that greater arousability among African American female adolescents was associated with Source: http://www.doksinet 7 inconsistent condom use and a greater number of sexual partners in unadjusted models and models controlling for age and impulsivity (Wood et al., 2013)

Although HIV/STI prevention efforts typically focus on individual behavior (DiClemente, Salazar, & Crosby, 2007), partner and relationship influences on sexual risk behavior are widely recognized. Sexual communication and negotiation with partners are key skills for protecting individual sexual health (Noar & Edgar, 2008) and often the focus of HIV/STI interventions. Partner sexual communication self-efficacy, partner sexual communication frequency, and sex refusal self-efficacy are well-established mediators of condom use among adolescents and African American female adolescents, specifically (Crosby et al., 2002; DiClemente et al, 1996; Noar & Edgar, 2008; Sales et al., 2008) Although interactions with partners enhance sexual arousal and the influence of sexual arousal on HIV/STI risk is dependent on partner interactions, to date, research has not investigated the extent to which sexual arousability influence partnerrelated mediators of condom use. Particularly in a

social climate which does not fully embrace the concept of sexual health, there are many social and interpersonal barriers to open communication with sexual partners about safer sex. Evidence suggests that partner communication about safer sex may often occur, if it occurs at all, during a brief window of time just prior to sex (Edgar & Fitzpatrick, 1993; Noar & Edgar, 2008) when arousal is high. The purpose of the current study was to investigate relationships between arousability and key partner communication mediators of condom use, including partner sexual communication self-efficacy, partner sexual communication frequency, and refusal self-efficacy, while controlling for age, impulsivity and relationship power, factors shown to be associated with both arousability and sexual risk behavior among African American females adolescents (Graham, Sanders, & Milhausen, 2006; Sales et al., 2013; Wood et al, Source: http://www.doksinet 8 2013). In order to investigate whether

arousability is associated with all partner-related mediators of condom use or partner communication specifically, associations between arousability and condom use self-efficacy, belief about one’s ability to correctly apply a male condom, were also examined as a key contrast. The investigators hypothesized that greater arousability would be associated with reduced levels of each partner communication factor examined. The authors hypothesized no association between arousability and condom use self-efficacy. Method Participants This study used baseline data from 701 African American adolescent females participating in a randomized controlled trial of a behavioral HIV/STI prevention intervention. The study procedures methods have been described elsewhere (DiClemente et al., 2014) Briefly, between July, 2005, and June, 2007, potential participants attending three clinics in Atlanta, Georgia, that provide sexual and reproductive health services were approached by a female African

American recruiter who determined study eligibility. Eligibility criteria included a) selfidentifying as African American, b) being 14-20 years of age and c) having had vaginal intercourse without a condom at least once in the prior 6 months. Married individuals and those currently pregnant or trying to become pregnant were excluded from study participation. Of eligible women, 701 (94%) were enrolled. Mean age of participants was 176 years, and 52% (n=364) lived in a household receiving governmental assistance (DiClemente et al., 2014) Data Collection All participants provided written informed consent at a return clinic visit following the eligibility assessment. Parental consent for those under the age of 18 was waived to maintain confidentially regarding sexual and reproductive health services. After enrollment, participants Source: http://www.doksinet 9 completed baseline assessments and were randomized to the intervention (n=342) or comparison (n=359) conditions. The baseline

assessment included an audio computer-assisted self-interview (ACASI), which assessed sociodemographic characteristics, sexual risk behavior and psychosocial mediators of sexual risk behavior. The Emory University Institutional Review Board approved all study protocols. Measures Outcomes. Partner sexual communication self-efficacy. A 6-item scale was used to assess partner sexual communication self-efficacy (α = 0.82) (Milhausen et al, 2007) Sample items included “With a sex partner, how hard is it for you to ask how many sex partners he has had?” and “With a sex partner, how hard is it for you to ask if he would use a condom?” Response options ranged from 1 = Very hard to 4 = Very easy, with higher scores indicating greater partner sexual communication self-efficacy. Partner sexual communication frequency. Partner sexual communication frequency was measured using a five-item scale assessing adolescents’ frequency of communicating about sex with a male partner (α = 0.85)

(Milhausen et al, 2007) A sample item was “During the past 90 days, how many times have you and your boyfriend or sex partner(s) talked about his sexual history?” Response options ranged from 1 = Never to 4 = Seven or more times. Higher score indicate more frequent sexual communication. Sex refusal self-efficacy. Sex refusal self-efficacy was measured using seven items from the Sex Refusal Self-efficacy scale (Cecil & Pinkerton, 1998). This measure assesses an individual’s confidence in her ability to say ‘no’ to sex in various situations (α = 0.82) (Seth, Raiji, DiClemente, Wingood, & Rose, 2009). Sample items included “How sure are you that you Source: http://www.doksinet 10 would be able to say NO to having sex with someone you want to date again?” and “How sure are you that you would be able to say NO to having sex with someone who refuses to wear a condom?” Response options ranged from 1 = I definitely can’t say no to 4 = I definitely can say no,

with higher scores indicating greater refusal self-efficacy. Condom Use Self-Efficacy. A 9-item scale was used to assess participants’ confidence in their ability to correctly use a condom properly (α = 0.87) (DiClemente et al, 2004) Sample items included “How much of a problem would it be for you to start over using a new condom if you placed it on the wrong way?” and “How much of a problem would it be for you to unroll a condom fully to the base of a penis?” Response options ranged from 1 = None to 5 =A lot, with higher scores indicating greater condom use self-efficacy. Independent variable of interest. Arousability. Sexual Excitation was assessed by the arousability subscale of the Sexual Excitation/Sexual Inhibition Inventory for Women and Men (SESII-W/M) (α = 0.73) (Graham et al., 2006) The subscale is comprised of 5 items assessing the tendency to become easily sexually aroused. Items were phrased as statements to which participants indicated their level of

agreement, from 1 = Strongly Disagree to 4 = Strongly Agree. A sample item was “Just talking about sex is enough to put me in a sexual mood.” Higher scores indicate a greater propensity for sexual arousal. Potential confounders. Age. Current age at baseline assessment was assessed with “How old are you (in years)?” Impulsivity. Impulsivity was assessed using Zimmerman’s (1996) 15-item impulsivity scale (α = 0.76) (Zimmerman & Donohew, 1996) Sample scale items include “I like to do Source: http://www.doksinet 11 things as soon as I think about them”, and “I act on the spur of the moment”. Response options range from 1 = Never to 5 = Always, with higher scores indicating higher levels of impulsivity. Relationship power. Power was assessed using modified version of Pulerwitz et al (2000)’s power in relationship scale (α = 0.75) (Pulerwitz, Gortmaker, & DeJong, 2000) Sample scale items include “If I asked my partner to use a condom, he would get

violent” and “My partner does what he wants even if I don’t want him to”. Response options ranged from 1 = Strongly disagree to 4 = Strongly agree, with higher scores indicating having less power in one’s relationship. Data analysis A series of linear regression models were used to examine associations between arousability and partner-related mediators of condom use. Covariates were entered in blocks The first block included factors assumed to confound relationships between arousbility and the outcomes of interest, including age, power in relationship and impulsivity. Arousbility score was entered in the second block. Results Table 1 presents the results of analyses examining associations between arousability and partner sexual communication self-efficacy. Controlling for age, impulsivity and relationship power, increasing arousability was significantly associated with reduced partner communication self-efficacy. Total variance explained by the full model was 144%;

arousability explained an additional 0.6% of the variance above that explained by the control variables Table 2 presents the results of analyses examining associations between arousability and partner sexual communication frequency. Increasing arousability was significantly associated with decreased partner communication frequency. Total variance in partner sexual Source: http://www.doksinet 12 communication frequency explained by the control variables was 3.4%Arousability and the control variables explained 4.0% of total variance in partner sexual communication frequency Table 3 presents the results of analyses examining associations between arousability and sex refusal self-efficacy. Increasing arousability was significantly associated with reduced selfefficacy to refuse sex The full model explained 134% of total variance in refusal self-efficacy, a .9% increase over the model which contained only the control variables Table 4 presents the results of analyses examining

associations between arousability and condom use self-efficacy. No significant association between arousability and condom use selfefficacy was observed Discussion The purpose of this study was to examine the influence of arousability on partner sexual communication self-efficacy, partner sexual communication frequency, sex refusal self-efficacy, and condom use self-efficacy, well-established mediators of condom use among African American female adolescents. Despite marked HIV/STI disparities and growing attention to sexual health as framework for improving national indicators of sexual risk, to the authors’ knowledge, this is the first study to investigate arousability and mediators of condom use exclusively among African American female adolescents. The current study identified small but significant associations between arousability and measures of partner sexual communication, partner communication self-efficacy, partner communication frequency, and refusal of sex self-efficacy.

Arousability was not observed to be correlated with condom use self-efficacy. Thus, the findings suggest that arousability is related to partner sexual communication but not all partner-related mediators of condom use. Furthermore, the findings suggest that African American female adolescents with a higher propensity to Source: http://www.doksinet 13 become aroused to a variety of sexual stimuli may particularly benefit from skills training to improve communication about safer sex with male partners. For example, HIV/STI preventions interventions might provide content on the role of sexual arousal on decision-making and encourage communication about safer sex in situations when individuals are not highly aroused. Prevention interventions may also benefit by framing condom use in relation to arousal (e.g, incorporating condoms in foreplay) (Tanner & Pollack, 1988). HIV/STI prevention interventions for adolescents have primarily relied on socialcognitive theory of behavior change

(Pedlow & Carey, 2003). Implicit in these intervention models is a rational approach to decision-making. As such, these models typically fail to account for factors such as sexual arousal, which has a strong impact on cognitive processing, judgment, and decision-making (Ariely & Loewenstein, 2006). In addition, HIV/STI prevention efforts have traditionally focused on individual behavior (DiClemente et al., 2007) and failed to recognize aspects of pleasure and enjoyment in sexual experiences. A population-level sexual health approach may be effective for addressing the influence of arousability on condom use and partner communication. Open public discussion, recognition that sexual experience is a normal, positive part of human development and public orientation towards sexual well-being may help diminish stigma related to sexual health issues and facilitate sexual communication between partners throughout their relationship (Swartzendruber & Zenilman, 2010). Given that

communication about safer sex occurs among couples, individual-level interventions by themselves may be limited to optimally reduce HIV/STI rates among adolescents. Indeed, high HIV/STI rates among African American female adolescents persist despite dissemination of effective individual-level HIV/STI prevention interventions for this population. Source: http://www.doksinet 14 Strengths and Limitations This study is subject to a number of limitations. First, participants were recruited from urban sexual health clinics in the Southern U.S and enrolled in an HIV/STI prevention trial The degree to which the findings may be generalized to other African American female adolescents or other adolescents is unknown. In addition, the study relied on self-reported data Therefore, the findings may underestimate true associations due to socially desirable responding. Further, limited information about sexual partnerships was available, including length and quality of relationships, which may

moderate relationships between arousability and outcomes such as partner sexual communication frequency. Strengths of this study include a large sample of African American female adolescents at high risk for HIV/STIs. To the authors’ knowledge, this study is the first to examine associations between arousability and mediators of condom use. In addition, the study used validated measures of arousability and the outcomes of interest. Implications The findings suggest that arousability is associated with partner sexual communication among African American female adolescents. Individual-level HIV/STI prevention interventions for this population may benefit by incorporating content and skills training related to arousability, decision-making and sexual partner communication. In addition, a public orientation toward sexual health may decrease stigma and facilitate sexual partner communication and may ultimately be more effective than traditional approaches in reducing high HIV/STI rates

among American adolescents (Douglas & Fenton, 2013; Swartzendruber & Zenilman, 2010). Source: http://www.doksinet 15 References Ariely, D., & Loewenstein, G (2006) The heat of the moment: The effect of sexual arousal on sexual decision making. Journal of Behavioral Decision Making, 19(2), 87-98 Bancroft, J., Graham, C A, Janssen, E, & Sanders, S A (2009) The dual control model: Current status and future directions. Journal of Sex Research, 46(2-3), 121-142 doi:10.1080/00224490902747222 Bancroft, J., Janssen, E, Strong, D, Carnes, L, Vukadinovic, Z, & Long, J S (2003) Sexual risk-taking in gay men: The relevance of sexual arousability, mood, and sensation seeking. Archives of Sexual Behavior, 32(6), 555-572. Bancroft, J., Janssen, E, Strong, D, & Vukadinovic, Z (2003) The relation between mood and sexuality in gay men. Archives of Sexual Behavior, 32(3), 231-242 Cecil, H., & Pinkerton, S D (1998) Reliability and validity of a self-efficacy instrument for

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Wingood, G M, Rose, E, & Sales, J M (2012) Prevalence and correlates of recent vaginal douching among African American adolescent females. Journal of Pediatric and Adolescent Gynecology, 25(1), 48-53 doi:10.1016/jjpag201107017 Douglas, J. M,Jr, & Fenton, K A (2013) Understanding sexual health and its role in more effective prevention programs. Public Health Reports, 128 Suppl 1, 1-4 Edgar, T., & Fitzpatrick, M A (1993) Expectations for sexual interaction: A cognitive test of the sequencing of sexual communication behaviors. Health Communication, 5(4), 239-261 Source: http://www.doksinet 17 Graham, C. A, Crosby, R A, Milhausen, R R, Sanders, S A, & Yarber, W L (2011) Incomplete use of condoms: The importance of sexual arousal. AIDS and Behavior, 15(7), 1328-1331. doi:101007/s10461-009-9638-7 Graham, C. A, Sanders, S A, & Milhausen, R R (2006) The sexual excitation/sexual inhibition inventory for women: Psychometric properties. Archives of Sexual Behavior, 35(4),

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behaviors in young African American females with a history of sexual violence. Archives of Pediatrics & Adolescent Medicine, 162(5), 432-438. doi:101001/archpedi1625432 [doi] Sales, J. M, Smearman, E L, Brody, G H, Milhausen, R, Philibert, R A, & Diclemente, R J (2013). Factors associated with sexual arousal, sexual sensation seeking and sexual Source: http://www.doksinet 18 satisfaction among female African American adolescents. Sexual Health, 10(6), 512-521 doi:10.1071/SH13005 Seth, P., Raiji, P T, DiClemente, R J, Wingood, G M, & Rose, E (2009) Psychological distress as a correlate of a biologically confirmed STI, risky sexual practices, self-efficacy and communication with male sex partners in African-American female adolescents. Psychology, Health & Medicine, 14(3), 291-300. doi:101080/13548500902730119 Swartzendruber, A., & Zenilman, J M (2010) A national strategy to improve sexual health JAMA : The Journal of the American Medical Association, 304(9),

1005-1006. doi:10.1001/jama20101252 Tanner, W. M, & Pollack, R H (1988) The effect of condom use and erotic instructions on attitudes toward condoms. Turchik, J. A, Garske, J P, Probst, D R, & Irvin, C R (2010) Personality, sexuality, and substance use as predictors of sexual risk taking in college students. Journal of Sex Research, 47(5), 411-419. doi:101080/00224490903161621 Weinstock, H., Berman, S, & Cates, W,Jr (2004) Sexually transmitted diseases among American youth: Incidence and prevalence estimates, 2000. Perspectives on Sexual and Reproductive Health, 36(1), 6-10. doi:101363/psrh36604 World Health Organization. Gender and human rights Retrieved from http://www.whoint/reproductivehealth/topics/gender rights/sexual health/en/indexhtml Wood, J. R, Milhausen, R R, Sales, J M, Graham, C A, Sanders, S A, Diclemente, R J, & Wingood, G. M (2013) Arousability as a predictor of sexual risk behaviours in AfricanAmerican adolescent women Sexual Health, 10(2), 160-165

doi:101071/SH12055 Source: http://www.doksinet 19 Zimmerman, R. S, & Donohew, L (1996) Sensation seeking, impulsive decision-making, and adolescent sexual behaviors. Paper presented at the American Public Health Association Meeting; New York, 1996. Source: http://www.doksinet 20 Table 1. Partner Sexual Communication Self-Efficacy: Block Regression Models Predictor ∆R2 Total R2 B SE Block 1 .138* .138 Age .029 .076 Impulsivity -.095 .017 Power -.205 .289 Block 2 .006* .144 Arousability -.448 .204 *p < .05 β .013 -.204 -.259 -.079 Source: http://www.doksinet 21 Table 2. Partner Sexual Communication Frequency : Block Regression Models Predictor ∆R2 Total R2 B SE Block 1 .034* .034 Age -.230 .098 Impulsivity -.098 .022 Power -.190 .369 Block 2 .006* . 040 Arousability -.522 .261 *p < .05 β -.089 -.173 -.020 -.077 Source: http://www.doksinet 22 Table 3. Sex Refusal Self-Efficacy: Block Regression Models Predictor ∆R2 Total R2 B Block 1 .125* .125 Age .054

Impulsivity -.093 Power -1.731 Block 2 .010* .134 Arousability -.545 *p < .05 SE β .073 .017 .277 .027 -.208 -.230 .195 -.102 Source: http://www.doksinet 23 Table 4. Condom Use Self-Efficacy: Block Regression Models Predictor ∆R2 Total R2 B Block 1 .077* .077 Age -.700 Impulsivity .131 Power 1.598 Block 2 .000 .077 Arousability .126 *p < .05 SE β .155 .035 .584 -.167 .144 .103 .415 .011