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Abstract
Purpose: This paper examines the extent to which men who use the Internet to find other ... more Abstract Purpose: This paper examines the extent to which men who use the Internet to find other men for unprotected sex are aroused by semen. It also looks at the relationship between semen arousal and involvement in HIV risk practices, and the factors associated with higher levels of semen arousal. Methods: 332 men who used any of 16 websites targeting unprotected sex completed 90-minute telephone interviews. Both quantitative and qualitative data were collected. A random sampling strategy was used. Semen arousal was assessed by four questions asking men how much they were turned on by the way that semen smelled, tasted, looked, and felt. Results: 65.1% of the men found at least one sensory aspect of semen to be “fairly” or “very” arousing, compared to 10.2% being “not very” or “not at all” aroused by all four sensory aspects of semen. Multivariate analysis revealed that semen arousal was related to greater involvement in HIV risk practices, even when the impact of other salient factors such as demographic characteristics, HIV serostatus, and psychological functioning was taken into account. Five factors were found to underlie greater levels of semen arousal: not being African American, self-identification as a sexual “bottom,” being better educated, being HIV-positive, and being more depressed. Conclusions: Being aroused by the sensory aspects of giving or receiving semen is commonplace amongst men in this high-risk population. Semen arousal was related closely to involvement in risk practices, indicating a need for HIV intervention programs to address this phenomenon in this population.
Journal of Gay and Lesbian Mental Health, Apr 2014
PURPOSE: This study examines the prevalence of depression in a sample of MSM who are at high ris... more PURPOSE: This study examines the prevalence of depression in a sample of MSM who are at high risk for HIV. It examines the relationship between depressive symptomatology and involvement in HIV risk behaviors, and the factors associated with greater depressive symptomatology. METHODS: The data come from a national random sample of 332 MSM who used any of 16 websites to identify men with whom they could engage in unprotected sex. Data were collected via telephone interviews. RESULTS: Depression was more prevalent in this population (26.7%) than among men in the general population. Depression was not related directly to any of the HIV risk behaviors examined, but it was related to men’s attitudes toward condom use, which was the strongest predictor of their involvement in risky behaviors. Five factors were identified as being associated with greater depression: lower educational attainment, greater discrimination based on sexual orientation, greater eroticizing of ejaculatory fluids, experiencing more substance abuse problems, and greater childhood maltreatment. CONCLUSIONS: Depression is a consequential problem in this population. Although depression does not appear to be related directly to HIV risk practices in this population, its influence cannot be discounted because of its effects on other key predictors of risk involvement.
Purpose: Using a Syndemics Theory conceptual model, this study examines the relationship between ... more Purpose: Using a Syndemics Theory conceptual model, this study examines the relationship between emotional neglect experiences during childhood and/or adolescence and involvement in HIV risk taking in a sample of adult men who actively seek partners for unprotected sex via the Internet. Methods: The study was based on a national random sample of 332 MSM who use the Internet to seek men with whom they can engage in unprotected sex. Data
collection was conducted via telephone interviews between January 2008 and May 2009. Structural equation analysis was undertaken to examine the specific nature of the relationships
involved in understanding HIV risk practices. Results: Emotional neglect was highly prevalent among the men participating in this study. Emotional neglect experiences were not found to be related directly to involvement in HIV risk taking in adulthood. Emotional
neglect, was found to be an important variable in the overall structural equation. Its effect on HIV risk taking was indirect, operating principally by having a negative impact upon self-esteem, which in turn had a negative effect on attitudes toward condom use, which in turn were related strongly and directly to risk taking. Conclusions: Childhood experiences with emotional neglect are relevant to understanding HIV risk practices among MSM in adulthood, but the relationship is not as simple as usually conceptualized. Rather, emotional neglect appears to impact risk taking indirectly, through its effects on mental health functioning, which in turn affects risk-related attitudes.
Gift giving is the process by which an HIVpositive
person purposely infects an HIV-negative
perso... more Gift giving is the process by which an HIVpositive person purposely infects an HIV-negative person with HIV, usually with that person’s knowledge and consent. Little has been written about this HIV transmission practice. In this paper, two specific types of gift giving – generationing and stealthing – are explained and introduced to the scientific literature. Generationing is a type of gift giving in which one gift giver successfully infects a previouslyuninfected man with HIV, and then the two men collaborate in an effort to seroconvert another man, and so forth. Stealthing is another type of gift giving in which an HIV-positive man actively tries to infect an HIV-negative man with HIV, without the latter’s knowledge or consent. The present study reports on the prevalence of gift giving (4.6%) in a population of men who use the Internet specifically to identify partners for unprotected sex. The research is based on a national random sample of 332 men who have sex with men, identified from 16 websites. Data were collected via telephone interviews conducted between January 2008 and May 2009. The paper concludes with a discussion of the implications of these findings for HIV prevention and intervention efforts. Most notably, to the extent that generationing, stealthing, and gift giving occur among MSM, they represent a very high risk of HIV transmission. More work needs to be done to understand these behaviors, the factors that underlie them, and to determine how prevalent they are in the bare-backing population of MSM.
Abstract
Purpose: This paper examines the extent to which men who use the Internet to find other ... more Abstract Purpose: This paper examines the extent to which men who use the Internet to find other men for unprotected sex are aroused by semen. It also looks at the relationship between semen arousal and involvement in HIV risk practices, and the factors associated with higher levels of semen arousal. Methods: 332 men who used any of 16 websites targeting unprotected sex completed 90-minute telephone interviews. Both quantitative and qualitative data were collected. A random sampling strategy was used. Semen arousal was assessed by four questions asking men how much they were turned on by the way that semen smelled, tasted, looked, and felt. Results: 65.1% of the men found at least one sensory aspect of semen to be “fairly” or “very” arousing, compared to 10.2% being “not very” or “not at all” aroused by all four sensory aspects of semen. Multivariate analysis revealed that semen arousal was related to greater involvement in HIV risk practices, even when the impact of other salient factors such as demographic characteristics, HIV serostatus, and psychological functioning was taken into account. Five factors were found to underlie greater levels of semen arousal: not being African American, self-identification as a sexual “bottom,” being better educated, being HIV-positive, and being more depressed. Conclusions: Being aroused by the sensory aspects of giving or receiving semen is commonplace amongst men in this high-risk population. Semen arousal was related closely to involvement in risk practices, indicating a need for HIV intervention programs to address this phenomenon in this population.
Journal of Gay and Lesbian Mental Health, Apr 2014
PURPOSE: This study examines the prevalence of depression in a sample of MSM who are at high ris... more PURPOSE: This study examines the prevalence of depression in a sample of MSM who are at high risk for HIV. It examines the relationship between depressive symptomatology and involvement in HIV risk behaviors, and the factors associated with greater depressive symptomatology. METHODS: The data come from a national random sample of 332 MSM who used any of 16 websites to identify men with whom they could engage in unprotected sex. Data were collected via telephone interviews. RESULTS: Depression was more prevalent in this population (26.7%) than among men in the general population. Depression was not related directly to any of the HIV risk behaviors examined, but it was related to men’s attitudes toward condom use, which was the strongest predictor of their involvement in risky behaviors. Five factors were identified as being associated with greater depression: lower educational attainment, greater discrimination based on sexual orientation, greater eroticizing of ejaculatory fluids, experiencing more substance abuse problems, and greater childhood maltreatment. CONCLUSIONS: Depression is a consequential problem in this population. Although depression does not appear to be related directly to HIV risk practices in this population, its influence cannot be discounted because of its effects on other key predictors of risk involvement.
Purpose: Using a Syndemics Theory conceptual model, this study examines the relationship between ... more Purpose: Using a Syndemics Theory conceptual model, this study examines the relationship between emotional neglect experiences during childhood and/or adolescence and involvement in HIV risk taking in a sample of adult men who actively seek partners for unprotected sex via the Internet. Methods: The study was based on a national random sample of 332 MSM who use the Internet to seek men with whom they can engage in unprotected sex. Data
collection was conducted via telephone interviews between January 2008 and May 2009. Structural equation analysis was undertaken to examine the specific nature of the relationships
involved in understanding HIV risk practices. Results: Emotional neglect was highly prevalent among the men participating in this study. Emotional neglect experiences were not found to be related directly to involvement in HIV risk taking in adulthood. Emotional
neglect, was found to be an important variable in the overall structural equation. Its effect on HIV risk taking was indirect, operating principally by having a negative impact upon self-esteem, which in turn had a negative effect on attitudes toward condom use, which in turn were related strongly and directly to risk taking. Conclusions: Childhood experiences with emotional neglect are relevant to understanding HIV risk practices among MSM in adulthood, but the relationship is not as simple as usually conceptualized. Rather, emotional neglect appears to impact risk taking indirectly, through its effects on mental health functioning, which in turn affects risk-related attitudes.
Gift giving is the process by which an HIVpositive
person purposely infects an HIV-negative
perso... more Gift giving is the process by which an HIVpositive person purposely infects an HIV-negative person with HIV, usually with that person’s knowledge and consent. Little has been written about this HIV transmission practice. In this paper, two specific types of gift giving – generationing and stealthing – are explained and introduced to the scientific literature. Generationing is a type of gift giving in which one gift giver successfully infects a previouslyuninfected man with HIV, and then the two men collaborate in an effort to seroconvert another man, and so forth. Stealthing is another type of gift giving in which an HIV-positive man actively tries to infect an HIV-negative man with HIV, without the latter’s knowledge or consent. The present study reports on the prevalence of gift giving (4.6%) in a population of men who use the Internet specifically to identify partners for unprotected sex. The research is based on a national random sample of 332 men who have sex with men, identified from 16 websites. Data were collected via telephone interviews conducted between January 2008 and May 2009. The paper concludes with a discussion of the implications of these findings for HIV prevention and intervention efforts. Most notably, to the extent that generationing, stealthing, and gift giving occur among MSM, they represent a very high risk of HIV transmission. More work needs to be done to understand these behaviors, the factors that underlie them, and to determine how prevalent they are in the bare-backing population of MSM.
REPRINTED IN: Child and Adolescent Health Yearbook 2011 (Editor: Joav Merrick), 2012
Relying upon a content analysis of animated cartoons, this study examines the messages provided... more Relying upon a content analysis of animated cartoons, this study examines the messages provided about gun violence, focusing on the following questions: (1) How prevalent is gun violence in animated cartoons? (2) Has this prevalence changed over time? (3) What characteristics are associated with being a perpetrator of gun violence? (4) What types of effects are shown to result from the perpetration of gun violence? (5) What reasons are given for why cartoon characters use guns? (6) What “types” of characters are victimized by firearms?
Results indicate that gun violence is prevalent in cartoons and the prevalence has not diminished over time. Cartoons provide inaccurate information about the characteristics associated with perpetrating or being a victim of gun violence. Oftentimes, the use of firearms is shown to result in no negative consequences to the perpetrator or the victim, and this is true even when victims are shown to be shot. When effects are shown, they tend to be minor in nature. Anger, revenge, and inherent meanspiritedness are the most common reasons implied for why characters commit acts of gun violence.
REPRINTED IN: Child and Adolescent Health Yearbook: 2012 (Editor: Joav Merrick), 2012
Relying upon a content analysis of one specific type of medium to which young people are expose... more Relying upon a content analysis of one specific type of medium to which young people are exposed beginning at an early age, on a regular basis, and for many years (i.e., animated cartoons), the present study examines what types of messages are provided about verbal aggression. This research examines the following issues: (1) How prevalent is verbal aggression in animated cartoons? (2) Has this prevalence changed over time? (3) What characteristics tend to be associated with being a perpetrator of verbal aggression? (4) What reasons are given for why cartoon characters engage in verbal aggression? (6) What “types” of characters are yelled at, threatened, insulted, and so forth?
Results indicate that verbal aggression is fairly prevalent in cartoons (it is the second most common type of antisocial behavior shown, ranking second only to violence) and that this prevalence has increased greatly over time. Cartoons tend to normalize verbal aggression, both by virtue of its frequency of occurrence and by the lack of patterning of characteristics associated with perpetrating this behavior. Although many (nearly half) of the reasons implied for being verbally aggressive are negative in nature, a substantial proportion of the time, this behavior is undertaken for positive reasons or for no reason at all. Characters of all types are equally likely to be verbally aggressive for negative reasons, although only certain types of characters (e.g., female, intelligent, “good guys,” physically attractive) are shown to engage in this behavior for positive reasons.
Purpose. This study examines the prevalence of alcohol-related problems, the factors underlying t... more Purpose. This study examines the prevalence of alcohol-related problems, the factors underlying these problems, and whether or not there is evidence of syndemic effects in a community population of southern, urban African American women. Methods. Questionnaire-based interviews were conducted with 817 women, all African American, from 80 targeted census block groups in Atlanta, Georgia. Results. Most of the alcohol users (67.8%) experienced at least one problem as a result of their alcohol (ab)use, with most women experiencing two or more such problems. Eight factors were found to be associated with experiencing more alcohol problems: being aged 30 or older, having had no recent health insurance, lower levels of educational attainment, self-identifying as lesbian or bisexual, experiencing greater amounts of childhood maltreatment, greater impulsivity, perceiving one's local community or neighborhood to be unsafe, and having a larger number of criminally involved friends. Conclusions. Drinking-related problems were prevalent in this population. Numerous factors underlie the extent to which African American women experienced problems resulting from their alcohol use. There is strong evidence of syndemic-type effects influencing drinking problems in this population, and future efforts to reduce the negative impact of alcohol (ab)use ought to consider the adoption of programs using a syndemics' theory approach.
For this study, a syndemics theory approach was used to examine the factors associated with adult... more For this study, a syndemics theory approach was used to examine the factors associated with adulthood obesity in a community-based sample of African-American adults. Interviews were conducted with 1,274 African-American adults residing in Atlanta, Georgia in 80 strategically chosen census tracts, selected on the basis of factors such as low household income, low levels of educational attainment among heads of household, and low levels of labor force participation. Comparisons were made between normal-weight persons (body mass index [BMI] = 18.5 –24.9; n = 800) and obese persons (BMI = 30.0 or greater; n = 474). Structural equation analysis was used to examine the interrelationships among variables. One quarter (25.6%) of the study participants were classified as obese. Five factors were related directly to obesity. These were gender, age, relationship status, frequency of eating 3 meals per day, and frequency of alcohol consumption. The frequency of alcohol consumption was an endogenous measure and 7 factors were identified as underlying this measure. The 7 factors were gender, age, sexual orientation, self-esteem, impulsivity, criminality of friends, and neighborhood violence. The structural model developed for this study proved to be useful for conceptualizing the factors underlying obesity and there was considerable evidence of syndemic effects among key predic-tors. The myriad factors underlying obesity in this population interacted with one another in such a manner as to support the use of syndemics theory-based models in future research. In particular, obesity researchers might wish to consider the interplay of demographic factors such as age and gender, psychosocial characteristics such as self-esteem and impulsivity, alcohol use/abuse, and community factors such as neighborhood violence and criminality influences.
Purpose: Previous research has demonstrated that HIV risk practices often differ based on gender... more Purpose: Previous research has demonstrated that HIV risk practices often differ based on gender and on whether or not people experienced sexual abuse during their formative (i.e., childhood and adolescence) years. The interaction of these two factors, which is the focus of this paper, has received limited attention. Methods: Based on a model derived from Social Disorganization Theory and Syndemics Theory, interviews were conducted between 2009 and 2011 with 1,864 African American adults residing in Atlanta, Georgia in 80 strategically-chosen census block groups. Results: Based on multiple regression and structural equation analyses, the interaction of sexual abuse and gender was found to be a significant predictor of involvement in (un)protected sex. The interaction of sexual abuse and gender also was related to condom use self-efficacy, which was one of the strongest factors underlying (un)protected sex. Conclusions: The relationship of sexual abuse history and gender is relevant in the understanding of HIV risk practices. The interaction of these factors with one another and with other relevant influences to shape people’s HIV risk profiles is complex. The Syndemics Theory approach used to conceptualize the relationships among relevant variables in this study is an effective way of trying to understand and address HIV risk practices.
Purpose: We examine early-onset cigarette smoking and how, if at all, it is related to subsequen... more Purpose: We examine early-onset cigarette smoking and how, if at all, it is related to subsequent smoking practices.
Methods: From 2004 to 2007, face-to-face interviews were conducted with 485 adult cigarette smokers residing in the Atlanta metropolitan area. Data analysis involved a multivariate analysis to determine whether age of smoking onset was related to current smoking practices when the effects of gender, age, race, marital/relationship status, income, and educational attainment were taken into account.
Results: The mean age for smoking onset was 14.8, and more than one-half of all smokers had their first cigarette between the ages
of 12 and 16. Most people reported an interval of less than one month between their first and second time using tobacco. Earlier
onset cigarette smoking was related to more cigarette use and worse tobacco-related health outcomes in adulthood.
Conclusions: Early prevention and intervention are needed to avoid early-onset smoking behaviors. Intervening after initial experimentation but before patterned smoking practices are established will be challenging, as the interval between initial and subsequent use tends to be short.
Purpose: Barebacking is a term that is used to refer to intentional involvement in unprotected an... more Purpose: Barebacking is a term that is used to refer to intentional involvement in unprotected anal sex. This paper examines the relationship between masculinity and self-identification as a barebacker, and how these factors related to HIV risk practices in a sample of men who have sex with other men (MSM).
Method: As part of the Men4Men Study, a brief Internet-based survey was completed in 2007 with English-speaking MSM aged 18+ who were not involved in a marital/romantic relationship at the time of interview. 886 participants were recruited by placing electronic postings and banner advertisements on Weblogs, social and sexual networking sites, and listservs frequented by MSM.
Results: A number of factors differentiated men who self-identified as barebackers from those who did not, and barebacking identity was linked with greater involvement in HIV risk practices. Multivariate analysis revealed that having a high level of masculinity was associated with a greater likelihood of self-identifying as a barebacker.
Conclusions: HIV prevention and intervention efforts targeting MSM ought to address issues of self-identification as a barebacker as well as the extent to which men adhere to a masculine ideology.
The focus of this paper is on HIV sexual risk taking among a community-based sample of disadvanta... more The focus of this paper is on HIV sexual risk taking among a community-based sample of disadvantaged African American adults. The objective is to examine multiple factors associated with sexual HIV risk behaviors within a syndemic conceptual framework. Face-to-face, computer-assisted, structured interviews were conducted with 1535 individuals in Atlanta, Georgia. Bivariate analyses indicated a high level of relationships among the HIV sexual risks and other factors. Results from multivariate models indicated that gender, sexual orientation, relationship status, self-esteem, condom use self-efficacy, sex while the respondent was high, and sex while the partner was high were significant predictors of condomless sex. Additionally, a multivariate additive model of risk behaviors indicated that the number of health risks significantly increased the risk of condomless sex. This intersection of HIV sexual risk behaviors and their associations with various other behavioral, socio-demographic, and psychological functioning factors help explain HIV risk-taking among this sample of African American adults and highlights the need for research and practice that accounts for multiple health behaviors and problems.
Despite 50+ years of public health efforts to reduce smoking rates in the United States, approxim... more Despite 50+ years of public health efforts to reduce smoking rates in the United States, approximately one-fifth of the adults living in this country continue to smoke cigarettes. Previous studies have examined smokers’ risk perceptions of cigarette smoking, as well as the perceived benefits of quitting smoking. Less research has focused on the perceived benefits of smoking among current cigarette smokers. The latter is the main focus of the present paper. Questionnaire-based interviews were conducted with a community-based sample of 485 adult current cigarette smokers recruited from the Atlanta, Georgia, metropolitan area between 2004 and 2007. Active and passive recruiting approaches were used, along with a targeted sampling strategy. Results revealed that most current cigarette smokers perceive themselves to experience benefits as a result of their cigarette use, including (among others) increased relaxation, cigarette smoking was associated with a variety of tobacco use measures, such as smoking more cigarettes, an increased likelihood of chain smoking, and overall negative attitude toward quitting smoking, among others. Several factors were associated with the extent to which smokers perceived themselves to benefit from their tobacco use, including education attainment, the age of first purchasing cigarettes, the proportion of friends who smoked, hiding smoking from others, being internally-oriented regarding locus of control, and self-esteem.
Purpose: The focus of this paper is to examine the extent to
which a community-based sample of cu... more Purpose: The focus of this paper is to examine the extent to which a community-based sample of current cigarette smokers believes it to be the responsibility of outside persons and agencies to inform the public about the dangers of smoking and/or to regulate smoking behaviors (herein termed REGULATE). Also investigated is how REGULATE relates to smokers’ attitudes toward cigarette smoking and actual smoking practices, and whether REGULATE matters when the influence of other key variables is taken into account. Method: Questionnairebased interviews were conducted with a community-based sample of 485 adult current cigarette smokers recruited from the Atlanta, Georgia metropolitan area. Active and passive recruiting approaches were used, along with a targeted sampling strategy. Results: Participants were divided in their beliefs pertaining to REGULATE. Their beliefs were related consistently to smoking-related attitudes but much less to actual smoking behaviors. Four factors (greater religiosity, older age of first purchasing a cigarette, lower levels of depression, and sexual abuse history) were found to underlie REGULATE. Structural equation analysis revealed that REGULATE is an influential measure to consider when trying to understand overall attitudes toward smoking and actual smoking behaviors. Conclusion: REGULATE is an important variable to consider when aiming to understand the factors associated with how people feel about their smoking practices, including actual cigarette use. It may be construed as a proxy measure for locus of control; and the implications of this are discussed.
Based on a national probability sample of 2,401 Americans aged 21 and over (1,069 of whom were de... more Based on a national probability sample of 2,401 Americans aged 21 and over (1,069 of whom were deemed "drinkers" on the basis of having drunk at least one alcoholic beverage in the past 7 days), this study examines which of six specific problems people associate with the use of beer, distilled spirits, wine, and wine coolers. It was found that people are most likely to associate alcoholism, birth defects, drunk driving, and fighting and rowdy behavior equally with these four types of alcohol. But when beverage associations are made, distilled spirits and beer are blamed most frequently for these problems, whereas wine and wine coolers are virtually never thought of as being closely related to any of the problems under study. It was also determined that nearly 1 out of every 7 drinkers surveyed stated that birth defects are unrelated to alcohol use of any kind.
... Problems that result from drinking (eg, inability to work because of the effects of a hangove... more ... Problems that result from drinking (eg, inability to work because of the effects of a hangover; experiencing poorer work ... over time) social phenomena such as college students' drinking behaviors and college students' attitudes toward drinking should not be of great concern. ...
The American Journal of Drug and Alcohol Abuse, 1993
Based on a November 1986 national probability sample of American adults aged 21 and over (1,069 o... more Based on a November 1986 national probability sample of American adults aged 21 and over (1,069 of whom were deemed "drinkers" on the basis of having consumed at least one alcoholic beverage in the 7 days prior to interview), this study examines whether region of residence influences drinkers' alcohol consumption and/or their perceptions of alcohol use. In addition to examining the main effects of the relationship between geographic region of residence and alcohol use, four measures of urbanization are also investigated for their influence on drinking. Results indicate that geographic region of residence makes little to no difference in people's alcohol use and has only a small impact on their drinking-related attitudes. By and large, urbanization and gender are not influential variables in these relationships.
Purpose: Despite being at the cornerstone of current initiatives to curtail the spread of HIV, Pr... more Purpose: Despite being at the cornerstone of current initiatives to curtail the spread of HIV, Pre-Exposure Prophylaxis (PrEP) medication has been slow to proliferate among many “at risk” populations. This is true for men who have sex with other men (MSM), who account for the largest number of new HIV diagnoses in the United States. The present paper examines the role that lack of awareness of PrEP and lack of exposure to other PrEP users play regarding why more MSM are not using PrEP.
Methods: Purposive sampling was used to derive a sample of 273 diverse MSM. Men completed a brief questionnaire inquiring about their awareness of PrEP, willingness to avail themselves of various sources of information about PrEP, perceptions about PrEP-related stigma, and perceptions about obstacles to PrEP use. Odds ratios were computed to compare demographic subgroups of men with respect to their familiarity with PrEP and other PrEP users.
Results: 70% of the participants had never heard about PrEP prior to taking part in this study, and many of the men who had heard of it did not have an accurate understanding of what PrEP is. PrEP awareness was significantly lower among: men of color, those who were not married or “involved” with someone, HIV-negative men, those under the age of 40, and those with a lower level of education.
Conclusions: Lack of awareness about PrEP is one of the main reasons why more MSM are not using PrEP, as is lack of exposure to known PrEP users. The subgroups of men who need to know about PrEP the most (based on known HIV risk behavior profiles) are the ones who, in actuality, are the least familiar with PrEP.
Purpose: This paper compares younger (aged 18-39; n=197) and older (ages 50+; n=53) MSM to determ... more Purpose: This paper compares younger (aged 18-39; n=197) and older (ages 50+; n=53) MSM to determine their familiarity with PrEP, willingness to learn more about PrEP, perceptions of stigma relating to PrEP use, and perceptions of barriers to PrEP adoption. Methods: A purposive sample of diverse MSM completed 15-minute questionnaires. Younger and older MSM were compared using Student's t-tests and odds ratios for bivariate analyses, and multivariate logistic regression and multiple regressions for analyses controlling for key demographic characteristics. Results: Compared to younger MSM, older MSM were more aware of PrEP, more likely to know another PrEP user, less interested in learning more about PrEP, and more averse to using existing resources to learn more about PrEP. Older men perceived less stigma relating to PrEP and fewer obstacles needing to be overcome in order to give serious consideration to PrEP adoption. These differences remained when race, educational attainment, sexual orientation, and HIV serostatus were controlled. Conclusions: There is a "good news/bad news" situation with respect to older MSM and PrEP. They were more aware of PrEP, less likely to associate stigma with PrEP use or PrEP users, and anticipated fewer barriers to PrEP adoption. They were also less interested than their younger counterparts in learning more about PrEP and expressed less comfort using existing sources of information to learn more about PrEP. Age-appropriate PrEP educational campaigns are advisable in order to reach older MSM and encourage more of them to consider PrEP adoption.
Purpose: This paper examines lack of interest in pre-exposure prophylaxis (PrEP) and lack of will... more Purpose: This paper examines lack of interest in pre-exposure prophylaxis (PrEP) and lack of willingness to use PrEP information sources among men who have sex with men (MSM). Methods: Demographic subgroups were compared via odds ratios in this purposive sample of 273 MSM. Results: 29% were uninterested in learning more about PrEP. Lack of interest was most common among: already PrEP-aware, Caucasian, HIV-positive, aged 40+, well-educated men. Most sources of information about PrEP were deemed unacceptable. Conclusions: Fueling the lack of PrEP use among MSM are a lack of interest in PrEP and an unwillingness to utilize existing information resources.
Despite being at the cornerstone of current initiatives to curtail the spread of HIV, Pre-Exposur... more Despite being at the cornerstone of current initiatives to curtail the spread of HIV, Pre-Exposure Prophylaxis (PrEP) medication has been slow to proliferate among many "at risk" populations. This is true for men who have sex with other men (MSM), who account for the largest number of new HIV diagnoses in the United States. To try to understand why MSM are not adopting PrEP in greater numbers, the present authors have created a 22-item PrEP Stigma Scale. This paper reports findings for that scale. Methods: Purposive sampling was used to derive a sample of 273 diverse MSM. Men completed a brief questionnaire inquiring about their awareness of PrEP, willingness to avail themselves of various sources of information about PrEP, perceptions about PrEP-related stigma, and perceptions about obstacles to PrEP use. Cronbach's alpha reliability coefficients were computed for the PrEP Stigma Scale, for the full sample and for key subgroups. Factor analysis was performed to determine whether or not subscales exist. Results: The PrEP Stigma Scale was found to be highly reliable, both in its full version (alpha=0.96) and in its shortened version (alpha=0.95). Reliability estimates were strong for all subgroups based on age, race, sexual orientation , educational attainment, relationship status, and HIV serostatus. Two subscales were identified, each with excellent reliability (alpha=0.95 and 0.94), again for the sample as a whole and for all key subgroups. Conclusions: The PrEP Stigma Scale shows great promise for aiding our understanding of why more MSM are not adopting PrEP. It was found to be reliable for all key subgroups under examination, and that is true both for the 22-item and the 11-item version of the scale.
Purpose: Despite being at the cornerstone of current initiatives to curtail the spread of HIV, Pr... more Purpose: Despite being at the cornerstone of current initiatives to curtail the spread of HIV, Pre-Exposure Prophylaxis (PrEP) medication has been slow to proliferate among many “at risk” populations. This is true for men who have sex with other men (MSM), who account for the largest number of new HIV diagnoses in the United States. The present paper examines several key factors underlying why more MSM are not using PrEP, inclduing (1) lack of awareness of PrEP, (2) lack of exposure to other PrEP users, (3) general lack of interest in learning more about PrEP, (4) lack of willingness to avail themselves of existing information sources and resources to learn more about PrEP, (5) perceived stigma associated with the use of PrEP, and (6) perceived obstacles needing to be overcome in order to give PrEP adoption more serious consideration.
Methods: Purposive sampling was used to derive a sample of 273 diverse MSM across the United States. Men completed a brief questionnaire inquiring about their awareness of PrEP, willingness to avail themselves of various sources of information about PrEP, perceptions about PrEP-related stigma, and perceptions about obstacles to PrEP use. Odds ratios were computed to compare demographic subgroups of men with respect to their familiarity with PrEP and other PrEP users.
Results: 70% of the participants had never heard about PrEP prior to taking part in this study, and many of the men who had heard of it did not have an accurate understanding of what PrEP is. PrEP awareness was significantly lower among: men of color, those who were not married or “involved” with someone, HIV-negative men, those under the age of 40, and those with a lower level of education. Additionally, 71% of the men who had never heard about PrEP prior to taking part in this study expressed an interest in learning more about PrEP, compared to 43% of the men who were already aware of PrEP. Approximately one-half of the men deemed their personal physicians or online resources such as podcasts to be viable sources of information about PrEP (52% and 57%, respectively), with far fewer expressing a willingness to seek additional information from men signed up on a dating or sex site (24%), from their friends (33%), or social media sites (32%). Substantial proportions of the study participants expressed stigma-related concerns surrounding the notion of adopting PrEP and/or perceived there to be numerous obstacles that would have to be overcome in order for them to give more serious consideration to using PrEP.
Conclusions: Lack of awareness about PrEP is one of the main reasons why more MSM are not using PrEP, as is lack of exposure to known PrEP users. The subgroups of men who need to know about PrEP the most are the ones who, in actuality, are the least familiar with PrEP. Additionally, interest in PrEP is moderately high among people who have never heard about it, but fairly low among those who are already familiar with it. There was a general lack of willingness to avail oneself of existing information sources to learn more about PrEP. Also, men perceive there to be numerous stigmata associated with the use of PrEP as well as the existence of many key hurdles needing to be overcome if they themselves are going to give PrEP use more serious consideration.
Purpose: This paper looks at rates of HIV testing and HIV seropositivity among transgender adults... more Purpose: This paper looks at rates of HIV testing and HIV seropositivity among transgender adults. It also explores the factors associated with greater odds of having been tested for HIV and greater odds of testing positive for HIV, and investigates the presence of syndemic effects. Methods: Data from the 2015 U.S. National Transgender Survey were used to examine the "triple whammy" relationship in a sample of 27,715 transgender Americans aged 18 or older. Odds ratios and multivariate logistic regression were used to examine the data. Results: 51.5% of the respondents had ever been tested for HIV, and only 24% of those individuals (12.4% of the sample) had been tested during the previous year. The HIV seropositivity rate was 1.3%. Older age, higher educational attainment, and reaching various transition milestones were among the strongest predictors of lifetime HIV testing. Risk factors for being HIV-positive included gender identity (female), race (African American), age (middle-aged), and educational attainment (lower). Conclusions: Rates of HIV testing are low among transgender adults, and among those tested, the likelihood of being HIV-positive is much greater than in the population-at-large. Certain subpopulations of transgender individuals are much more likely than others to report never having been tested for HIV and/or to say that they had tested positive for HIV. Substantial evidence was found for the presence of syndemic-type effects influencing both the likelihood of having been tested for HIV and the odds of testing HIV-positive.
Purpose: Using a minority stress paradigm, this paper examines the relationship between anti-tran... more Purpose: Using a minority stress paradigm, this paper examines the relationship between anti-transgender discrimination, harassment, and violence among transgender adults. Methods: Data from the 2015 U.S. National Transgender Survey were used to examine twenty types of anti-transgender experiences/problems (e.g., harassment at work, problems with police officials, verbal and physical assaults) in a sample of 27,715 transgender Americans aged 18 or older. Binge drinking during the previous month was the dependent variable, and eight control measures were examined in the multivariate analysis. Results: Experiencing any of the twenty types of anti-transgender discrimination, harassment, or violence increased the odds of binge drinking by 48%. Experiencing many such problems increased the odds of binge drinking by 104%. Multivariate analysis showed that anti-transgender discrimination, harassment, and violence remains a predictor of binge drinking even when other key measures are taken into account. Younger people, racial minority group members, and persons who were not married or "involved" were at particularly great risk. Conclusions: Consistent with the minority stress paradigm, the more different types of anti-transgender experiences people had, the more likely they were to engage in binge drinking. Targeted intervention needs to help transgender persons to avoid anti-transgender discrimination, harassment, and violence to the greatest extent possible, and to develop resiliency skills whenever they are victimized. This is particularly true for transgender persons who are younger, minority, and not "involved" in a relationship.
Purpose: Transition milestones (e.g., telling family members that one is transgender, beginning ... more Purpose: Transition milestones (e.g., telling family members that one is transgender, beginning hormone treatments) are specific transition-related events in transgender persons’ lives that demarcate what their life circumstances were before versus after the milestone was reached. This paper examines the relationship between transition milestones and psychological distress in a large sample of transgender adults. Methods: Data from the 2015 U.S. National Transgender Survey were used to examine 11 specific transition milestones in a sample of 27,715 transgender Americans aged 18 or older. The Kessler-6 scale was used to measure psychological distress. Covariates in the multivariate analysis included demographic measures, variables assessing support and discrimination, and 11 transition milestones. Results: 64.6% of respondents reported that psychological distress had affected them “some” or “a lot.” Along with nine of the demographic measures and thirteen of the support/discrimination measures, nine of the eleven transition milestones under study were found to be related to psychological distress levels. Multivariate analysis showed that three transition milestones–changing one’s name and/or gender on any legal document(s), receiving gender-conforming hormone treatment, and undergoing any gender-affirming surgical procedure–were related to reduced levels of psychological distress even when controlling for all other measures was taken into account. Conclusions: Reaching specific transition milestones plays an important role in many transgender adults’ lives, and may be highly beneficial in helping them to reduce psychological distress.
Objectives: Very little research has examined suicidal ideation or the factors associated with co... more Objectives: Very little research has examined suicidal ideation or the factors associated with contemplating suicide among older transgender adults. This paper examines whether or not there is evidence of syndemic effects influencing suicidal ideation among transgender persons aged 50 or older. Methods: Data from the 2015 U.S. National Transgender Survey were used to examine five domains of potentially-syndemic effects (workplace issues, interactions with professionals, using public services, personal safety, and socioeconomic disadvantages) in a sample of 3,724 transgender Americans aged 50 or older. A dichotomous measure of suicidal ideation during the past year was the main outcome measure. Results: The odds of contemplating suicide increased anywhere from 96% to 121% among people experiencing any of the problems under study, and anywhere from 258% to 1,552% (depending upon the syndemic effect domain in question) when they were faced by all of the experiences included in any particular domain. When all items were combined, exposure to any of the domains' problems elevated the risk of contemplating suicide by 276% and exposure to all of the problems examined increased the risk by 861%. The syndemic effects measure remained significant in multivariate analysis controlling for the influence of other potentially-relevant factors. Conclusions: Considerable evidence for the presence of syndemic effects was found, demonstrating that the more different types of adverse conditions that older transgender person's face, the more likely they are to experience to contemplate suicide. There is evidence that these effects diminish with advancing age.
Very little research has been undertaken to examine the prevalence of sex-trading behaviors among... more Very little research has been undertaken to examine the prevalence of sex-trading behaviors among transgender adults, and even less is known about how engaging in this behavior affects sex-trading individuals. This paper examines the nexus of sex trading and psychological distress and suicidal ideation. Data from the 2015 U.S. National Transgender Survey were used to examine the factors associated with sex trading in a sample of 27,715 transgender Americans aged 18 or older. The Kessler-6 scale was used to measure psychological distress and a dichotomous measure of suicidal ideation during the past year was the other main outcome measure. Covariates in the multivariate analysis included sociodemographic measures, numerous measures of anti-transgender harassment, discrimination, and violence, and several transition milestones. Approximately one person in six had engaged in sex-trading behaviors. Multivariate analysis revealed that sex trading was related to psychological distress and to an increased risk of suicidal ideation. Structural equation analysis showed that sex trading had both a direct impact upon suicidal ideation and an indirect effect through its influence on psychological distress, which was the strongest predictor of suicidal ideation. Although sex trading is relatively uncommon among transgender persons, it is much more common in this population than it is in the population-at-large. Among persons who engage in this practice, though, there is a greatly elevated risk for suffering from psychological distress and suicidal ideation.
This paper examines the conjoint effects of serious psychological distress, suicidal ideation, an... more This paper examines the conjoint effects of serious psychological distress, suicidal ideation, and substance abuse among transgender adults. The principal aims are to determine the prevalence of this "triple whammy," identify the factors underlying the co-occurrence of all three problems, and to determine if there is evidence of syndemic effects underlying the "triple whammy." Methods: Data from the 2015 U.S. National Transgender Survey were used to examine the "triple whammy" relationship in a sample of 27,715 transgender Americans aged 18 or older. Odds ratios and multivariate logistic regression were performed to examine the data. Results: 13.3 % of the study participants reported experiencing serious psychological distress, suicidal ideation, and substance abuse. The most potent predictors of the "triple whammy" were younger age, a greater number of anti-transgender experiences, and not reaching various transition milestones. Strong evidence emerged to indicate the presence of syndemic effects in operation. Conclusions: Experiencing the combination of adverse mental health and substance abuse was not uncommon in this population of transgender adults. Being young, experiencing a larger variety of types of anti-transgender discrimination, harassment, and violence, and not reaching specific transition milestones all had a significant impact on the odds that people would experience the "triple whammy." This was particularly true when these measures were examined in conjunction with one another, because of strong syndemic effects.
Purpose: This paper examines the relationships among transition milestones (i.e., transition-rela... more Purpose: This paper examines the relationships among transition milestones (i.e., transition-related events in transgender persons' lives that demarcate their life circumstances before vs. afte a milestone was reached), psychological distress, and suicidal ideation in a large sample of transgender adults. Methods: Data from the 2015 U.S. National Transgender Survey were used to examine 11 specific transition milestones in a sample of 27,715 transgender Americans aged 18 or older. The Kessler-6 scale was used to measure psychological distress and a dichotomous measure of suicidal ideation during the past year was the other main outcome measure. Covariates in the multivariate analysis included demographic measures, variables assessing support and discrimination, and 11 transition milestones. Results: Bivariate analyses revealed that, in almost all instances, reaching specific transition milestones led to reduced psychological distress and diminished odds of suicidal ideation. Multivariate analysis revealed that psychological distress was a strong predictor of suicidal ideation, but transition milestones were not retained in the final model. Structural equation analysis showed that three specific transition milestones (namely, changing one's name and/or gender on legal documents, taking gender-affirming hormones, having had any genderconforming surgical procedures) influenced suicidal ideation indirectly, through their
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Bareback Project Papers by hugh klein
Purpose: This paper examines the extent to which men who use the Internet to find other men for unprotected sex are aroused by semen. It also looks at the relationship between semen arousal and involvement in HIV risk practices, and the factors associated with higher levels of semen arousal.
Methods: 332 men who used any of 16 websites targeting unprotected sex completed 90-minute telephone interviews. Both quantitative and qualitative data were collected. A random sampling strategy was used. Semen arousal was assessed by four questions asking men how much they were turned on by the way that semen smelled, tasted, looked, and felt.
Results: 65.1% of the men found at least one sensory aspect of semen to be “fairly” or “very” arousing, compared to 10.2% being “not very” or “not at all” aroused by all four sensory aspects of semen. Multivariate analysis revealed that semen arousal was related to greater involvement in HIV risk practices, even when the impact of other salient factors such as demographic characteristics, HIV serostatus, and psychological functioning was taken into account. Five factors were found to underlie greater levels of semen arousal: not being African American, self-identification as a sexual “bottom,” being better educated, being HIV-positive, and being more depressed.
Conclusions: Being aroused by the sensory aspects of giving or receiving semen is commonplace amongst men in this high-risk population. Semen arousal was related closely to involvement in risk practices, indicating a need for HIV intervention programs to address this phenomenon in this population.
collection was conducted via telephone interviews between January 2008 and May 2009. Structural equation analysis was undertaken to examine the specific nature of the relationships
involved in understanding HIV risk practices. Results: Emotional neglect was highly prevalent among the men participating in this study. Emotional neglect experiences were not found to be related directly to involvement in HIV risk taking in adulthood. Emotional
neglect, was found to be an important variable in the overall structural equation. Its effect on HIV risk taking was indirect, operating principally by having a negative impact upon self-esteem, which in turn had a negative effect on attitudes toward condom use, which in turn were related strongly and directly to risk taking. Conclusions: Childhood experiences with emotional neglect are relevant to understanding HIV risk practices among MSM in adulthood, but the relationship is not as simple as usually conceptualized. Rather, emotional neglect appears to impact risk taking indirectly, through its effects on mental health functioning, which in turn affects risk-related attitudes.
person purposely infects an HIV-negative
person with HIV, usually with that person’s
knowledge and consent. Little has been written
about this HIV transmission practice. In this
paper, two specific types of gift giving – generationing
and stealthing – are explained and
introduced to the scientific literature.
Generationing is a type of gift giving in which
one gift giver successfully infects a previouslyuninfected
man with HIV, and then the two
men collaborate in an effort to seroconvert
another man, and so forth. Stealthing is another
type of gift giving in which an HIV-positive
man actively tries to infect an HIV-negative
man with HIV, without the latter’s knowledge
or consent. The present study reports on the
prevalence of gift giving (4.6%) in a population
of men who use the Internet specifically to
identify partners for unprotected sex. The
research is based on a national random sample
of 332 men who have sex with men, identified
from 16 websites. Data were collected via telephone
interviews conducted between January
2008 and May 2009. The paper concludes with
a discussion of the implications of these findings
for HIV prevention and intervention
efforts. Most notably, to the extent that generationing,
stealthing, and gift giving occur among
MSM, they represent a very high risk of HIV
transmission. More work needs to be done to
understand these behaviors, the factors that
underlie them, and to determine how prevalent
they are in the bare-backing population of
MSM.
Purpose: This paper examines the extent to which men who use the Internet to find other men for unprotected sex are aroused by semen. It also looks at the relationship between semen arousal and involvement in HIV risk practices, and the factors associated with higher levels of semen arousal.
Methods: 332 men who used any of 16 websites targeting unprotected sex completed 90-minute telephone interviews. Both quantitative and qualitative data were collected. A random sampling strategy was used. Semen arousal was assessed by four questions asking men how much they were turned on by the way that semen smelled, tasted, looked, and felt.
Results: 65.1% of the men found at least one sensory aspect of semen to be “fairly” or “very” arousing, compared to 10.2% being “not very” or “not at all” aroused by all four sensory aspects of semen. Multivariate analysis revealed that semen arousal was related to greater involvement in HIV risk practices, even when the impact of other salient factors such as demographic characteristics, HIV serostatus, and psychological functioning was taken into account. Five factors were found to underlie greater levels of semen arousal: not being African American, self-identification as a sexual “bottom,” being better educated, being HIV-positive, and being more depressed.
Conclusions: Being aroused by the sensory aspects of giving or receiving semen is commonplace amongst men in this high-risk population. Semen arousal was related closely to involvement in risk practices, indicating a need for HIV intervention programs to address this phenomenon in this population.
collection was conducted via telephone interviews between January 2008 and May 2009. Structural equation analysis was undertaken to examine the specific nature of the relationships
involved in understanding HIV risk practices. Results: Emotional neglect was highly prevalent among the men participating in this study. Emotional neglect experiences were not found to be related directly to involvement in HIV risk taking in adulthood. Emotional
neglect, was found to be an important variable in the overall structural equation. Its effect on HIV risk taking was indirect, operating principally by having a negative impact upon self-esteem, which in turn had a negative effect on attitudes toward condom use, which in turn were related strongly and directly to risk taking. Conclusions: Childhood experiences with emotional neglect are relevant to understanding HIV risk practices among MSM in adulthood, but the relationship is not as simple as usually conceptualized. Rather, emotional neglect appears to impact risk taking indirectly, through its effects on mental health functioning, which in turn affects risk-related attitudes.
person purposely infects an HIV-negative
person with HIV, usually with that person’s
knowledge and consent. Little has been written
about this HIV transmission practice. In this
paper, two specific types of gift giving – generationing
and stealthing – are explained and
introduced to the scientific literature.
Generationing is a type of gift giving in which
one gift giver successfully infects a previouslyuninfected
man with HIV, and then the two
men collaborate in an effort to seroconvert
another man, and so forth. Stealthing is another
type of gift giving in which an HIV-positive
man actively tries to infect an HIV-negative
man with HIV, without the latter’s knowledge
or consent. The present study reports on the
prevalence of gift giving (4.6%) in a population
of men who use the Internet specifically to
identify partners for unprotected sex. The
research is based on a national random sample
of 332 men who have sex with men, identified
from 16 websites. Data were collected via telephone
interviews conducted between January
2008 and May 2009. The paper concludes with
a discussion of the implications of these findings
for HIV prevention and intervention
efforts. Most notably, to the extent that generationing,
stealthing, and gift giving occur among
MSM, they represent a very high risk of HIV
transmission. More work needs to be done to
understand these behaviors, the factors that
underlie them, and to determine how prevalent
they are in the bare-backing population of
MSM.
Results indicate that gun violence is prevalent in cartoons and the prevalence has not diminished over time. Cartoons provide inaccurate information about the characteristics associated with perpetrating or being a victim of gun violence. Oftentimes, the use of firearms is shown to result in no negative consequences to the perpetrator or the victim, and this is true even when victims are shown to be shot. When effects are shown, they tend to be minor in nature. Anger, revenge, and inherent meanspiritedness are the most common reasons implied for why characters commit acts of gun violence.
Results indicate that verbal aggression is fairly prevalent in cartoons (it is the second most common type of antisocial behavior shown, ranking second only to violence) and that this prevalence has increased greatly over time. Cartoons tend to normalize verbal aggression, both by virtue of its frequency of occurrence and by the lack of patterning of characteristics associated with perpetrating this behavior. Although many (nearly half) of the reasons implied for being verbally aggressive are negative in nature, a substantial proportion of the time, this behavior is undertaken for positive reasons or for no reason at all. Characters of all types are equally likely to be verbally aggressive for negative reasons, although only certain types of characters (e.g., female, intelligent, “good guys,” physically attractive) are shown to engage in this behavior for positive reasons.
Methods: From 2004 to 2007, face-to-face interviews were conducted with 485 adult cigarette smokers residing in the Atlanta metropolitan area. Data analysis involved a multivariate analysis to determine whether age of smoking onset was related to current smoking practices when the effects of gender, age, race, marital/relationship status, income, and educational attainment were taken into account.
Results: The mean age for smoking onset was 14.8, and more than one-half of all smokers had their first cigarette between the ages
of 12 and 16. Most people reported an interval of less than one month between their first and second time using tobacco. Earlier
onset cigarette smoking was related to more cigarette use and worse tobacco-related health outcomes in adulthood.
Conclusions: Early prevention and intervention are needed to avoid early-onset smoking behaviors. Intervening after initial experimentation but before patterned smoking practices are established will be challenging, as the interval between initial and subsequent use tends to be short.
Method: As part of the Men4Men Study, a brief Internet-based survey was completed in 2007 with English-speaking MSM aged 18+ who were not involved in a marital/romantic relationship at the time of interview. 886 participants were recruited by placing electronic postings and banner advertisements on Weblogs, social and sexual networking sites, and listservs frequented by MSM.
Results: A number of factors differentiated men who self-identified as barebackers from those who did not, and barebacking identity was linked with greater involvement in HIV risk practices. Multivariate analysis revealed that having a high level of masculinity was associated with a greater likelihood of self-identifying as a barebacker.
Conclusions: HIV prevention and intervention efforts targeting MSM ought to address issues of self-identification as a barebacker as well as the extent to which men adhere to a masculine ideology.
Additionally, a multivariate additive model of risk behaviors
indicated that the number of health risks significantly increased the risk of condomless sex. This intersection of HIV sexual risk behaviors and their associations with various other behavioral, socio-demographic, and psychological functioning factors help explain HIV risk-taking among this sample of African American adults and highlights the need for research and practice that accounts for multiple health behaviors and problems.
Several factors were associated with the extent to which smokers perceived themselves to benefit from their tobacco use, including education attainment, the age of first purchasing cigarettes, the proportion of friends who smoked, hiding smoking from others, being
internally-oriented regarding locus of control, and self-esteem.
which a community-based sample of current cigarette
smokers believes it to be the responsibility of outside
persons and agencies to inform the public about the dangers
of smoking and/or to regulate smoking behaviors (herein
termed REGULATE). Also investigated is how
REGULATE relates to smokers’ attitudes toward cigarette
smoking and actual smoking practices, and whether
REGULATE matters when the influence of other key
variables is taken into account. Method: Questionnairebased
interviews were conducted with a community-based
sample of 485 adult current cigarette smokers recruited
from the Atlanta, Georgia metropolitan area. Active and
passive recruiting approaches were used, along with a
targeted sampling strategy. Results: Participants were
divided in their beliefs pertaining to REGULATE. Their
beliefs were related consistently to smoking-related
attitudes but much less to actual smoking behaviors. Four
factors (greater religiosity, older age of first purchasing a
cigarette, lower levels of depression, and sexual abuse
history) were found to underlie REGULATE. Structural
equation analysis revealed that REGULATE is an
influential measure to consider when trying to understand
overall attitudes toward smoking and actual smoking
behaviors. Conclusion: REGULATE is an important
variable to consider when aiming to understand the factors
associated with how people feel about their smoking
practices, including actual cigarette use. It may be
construed as a proxy measure for locus of control; and the
implications of this are discussed.
examines the role that lack of awareness of PrEP and lack of exposure to other PrEP users play regarding why more MSM are not using PrEP.
Methods: Purposive sampling was used to derive a sample of 273 diverse MSM. Men completed a brief questionnaire inquiring about their awareness of PrEP, willingness to avail themselves of various sources of information about PrEP, perceptions about PrEP-related stigma, and perceptions about obstacles to PrEP use. Odds ratios were computed to
compare demographic subgroups of men with respect to their familiarity with PrEP and other PrEP users.
Results: 70% of the participants had never heard about PrEP prior to taking part in this study, and many of the men who had heard of it did not have an accurate understanding of what PrEP is. PrEP awareness was significantly lower among: men of color, those who were not married or “involved” with someone, HIV-negative men, those under the age of 40, and those with a lower level of education.
Conclusions: Lack of awareness about PrEP is one of the main reasons why more MSM are not using PrEP, as is lack of exposure to known PrEP users. The subgroups of men who need to know about PrEP the most (based on known HIV risk behavior profiles) are the ones who, in actuality, are the least familiar with PrEP.
Methods: Purposive sampling was used to derive a sample of 273 diverse MSM across the United States. Men completed a brief questionnaire inquiring about their awareness of PrEP, willingness to avail themselves of various sources of information about PrEP, perceptions about PrEP-related stigma, and perceptions about obstacles to PrEP use. Odds ratios were computed to compare demographic subgroups of men with respect to their familiarity with PrEP and other PrEP users.
Results: 70% of the participants had never heard about PrEP prior to taking part in this study, and many of the men who had heard of it did not have an accurate understanding of what PrEP is. PrEP awareness was significantly lower among: men of color, those who were not married or “involved” with someone, HIV-negative men, those under the age of 40, and those with a lower level of education. Additionally, 71% of the men who had never heard about PrEP prior to taking part in this study expressed an interest in learning more about PrEP, compared to 43% of the men who were already aware of PrEP. Approximately one-half of the men deemed their personal physicians or online resources such as podcasts to be viable sources of information about PrEP (52% and 57%, respectively), with far fewer expressing a willingness to seek additional information from men signed up on a dating or sex site (24%), from their friends (33%), or social media sites (32%). Substantial proportions of the study participants expressed stigma-related concerns surrounding the notion of adopting PrEP and/or perceived there to be numerous obstacles that would have to be overcome in order for them to give more serious consideration to using PrEP.
Conclusions: Lack of awareness about PrEP is one of the main reasons why more MSM are not using PrEP, as is lack of exposure to known PrEP users. The subgroups of men who need to know about PrEP the most are the ones who, in actuality, are the least familiar with PrEP. Additionally, interest in PrEP is moderately high among people who have never heard about it, but fairly low among those who are already familiar with it. There was a general lack of willingness to avail oneself of existing information sources to learn more about PrEP. Also, men perceive there to be numerous stigmata associated with the use of PrEP as well as the existence of many key hurdles needing to be overcome if they themselves are going to give PrEP use more serious consideration.