"Fulfilling His Needs, Not Mine": Reasons for Not Talking About Painful Sex and Associations with Lack of Pleasure in a Nationally Representative Sample of Women in the United States.

INTRODUCTION: Although much research has examined correlates of pain during sex, far less research has examined why women have sex despite having pain and why they avoid telling their partner. AIM: The purpose of our study was to examine women's reports of painful sex, including location of pain, whether they told their partner, factors associated with not disclosing their pain, and their reasons for not disclosing. METHODS: We used data from the 2018 National Survey of Sexual Health and Behavior, a probability-based online survey of 2,007 individuals ages 14 to 49 years. We limited our sample to adult women who reported a sexual experience that was painful in the past year (n = 382; 23.2%). The primary outcome in quantitative analyses was whether women told their partner they experienced pain during sex. Associations with social identities and sexual health were explored via logistic regression. Those who did not tell their partner about painful sex were asked why; their accounts were coded and analyzed qualitatively. MAIN OUTCOME MEASURE: Women were asked, "To what extent was this sexual experience physically painful for you?" Those who reported any pain were asked, "Did you tell your partner that you were in pain during sex?" and, if applicable, "Why didn't you tell your partner that you were in pain during sex?" RESULTS: Of those reporting pain during sex, most said it was "a little painful" (81.6%) and occurred at the vaginal entrance (31.5%), inside the vagina (34.4%), or at or around the cervix (17.4%). Overall, 51.0% (n = 193/382) told their partner about their pain. Adjusting for age and wantedness, women who reported little or no event-level sexual pleasure had nearly 3-fold greater odds of not telling a partner about painful sex (adjusted odds ratio = 3.24; 95% CI, 1.43-7.37). Normalizing painful sex, considering pain to be inconsequential, prioritizing the partner's enjoyment, and gendered interactional pressures were the predominant themes in women's narratives. CLINICAL IMPLICATIONS: Providers should ask about painful sex, if the woman continues intercourse despite pain, and how she feels about this as a means of assessing any sexual and social pressures. STRENGTHS & LIMITATIONS: Strengths include the use of social theory in nationally representative survey research to examine how contextual factors influence sexual health, but experiences were largely limited to heterosexual interactions. CONCLUSION: Many women do not discuss painful sex with their partners, lack of pleasure is significantly more likely among this group, and gender norms and cultural scripts are critical to understanding why. Carter A, Ford JV, Luetke M, et al. "Fulfilling His Needs, Not Mine": Reasons for Not Talking About Painful Sex and Associations with Lack of Pleasure in a Nationally Representative Sample of Women in the United States. J Sex Med 2019; 16:1953-1965.

Feeling Scared During Sex: Findings From a U.S. Probability Sample of Women and Men Ages 14 to 60.

Using data from a U.S. probability survey of individuals aged 14 to 60, we aimed (1) to assess the proportion of respondents who ever reported scary sexual situations and (2) to examine descriptions of sexual experiences reported as scary. Data were cross-sectional and collected via the GfK KnowledgePanel®. Scary sexual situations were reported by 23.9% of adult women, 10.3% of adult men, 12.5% of adolescent women, and 3.8% of adolescent men who had ever engaged in oral, vaginal, or anal sex. Themes included sexual assault/rape, incest, being held down, anal sex, choking, threats, multiple people, novelty/learning, among others.

Characteristics of Adolescent Sexting: Results from the 2015 National Survey of Sexual Health and Behavior.

Using data from 78 sexting-experienced adolescents from the 2015 National Survey of Sexual Health and Behavior, we describe sexting frequency, sexting partners, sexual relationships with such partners, and characteristics associated with sexting. Most (59.2%) respondents sexted at most monthly, usually with romantic partners (62.0%). About 41% of sexting-experienced adolescents did not usually have sexual relationships with sexting partners, 36.6% usually sexted after starting a sexual relationship, and 16.8% reported that their sexting typically preceded sexual relationships. Younger adolescents sexted more frequently. Those without vaginal sex/anal sex experience, or prior romantic experience, were more likely to have sexted a non-romantic/sexual partner.

Kissing, Cuddling, and Massage at Most Recent Sexual Event: Findings From a U.S. Nationally Representative Probability Sample.

Using data from the 2014 National Survey of Sexual Health and Behavior, a probability survey of Americans aged 14+, we assessed the prevalence and correlates of kissing, cuddling, and massage during 1,493 individuals' most recent sexual event from the past year. Most respondents reported kissing (87%) and cuddling (70%); fewer (23%) reported massage. Each was significantly associated with age, education, and relationship structure. Respondents younger than 30 were significantly more likely to indicate they did not kiss because kissing would have been too intimate with their partner. Only cuddling was significantly associated with event-level emotional intimacy and sexual pleasure.

Meta-Perceptions of Others' Attitudes Toward Bisexual Men and Women Among a Nationally Representative Probability Sample.

Researchers posit that negative attitudes, prejudice, and discrimination (i.e., binegativity) from heterosexual and gay/lesbian individuals may contribute to health disparities among bisexual individuals relative to heterosexual and gay/lesbian individuals. Recent studies have focused on gay, lesbian, and heterosexual people's (e.g., "others") attitudes toward bisexual people. No studies have investigated how bisexual individuals perceive others' attitudes toward bisexual people, which are generally known as "meta-perceptions." As part of the 2015 National Survey of Sexual Health and Behavior, we collected data from a nationally representative probability sample of 2999 adults, including from a subsample of 33 men and 61 women self-identified as bisexual. The Bisexualities: Indiana Attitudes Scale-bisexual (BIAS-b), a modified 5-item scale assessing bisexual people's perceptions of others' attitudes toward bisexual individuals, was included and was followed by an open-ended text box question. Quantitative scale data were analyzed using descriptive and gamma regression methods. Two coders thematically analyzed the open-ended text box data. The internal consistency of the BIAS-b was high (Cronbach's α = 0.85). An exploratory factor analysis supported a one-factor solution. Participants responded to statements regarding others' attitudes toward them as bisexual people, including the domains of confusion, HIV/STD risk, incapability of monogamy, promiscuity, and instability ("just a phase"). Participants' text box descriptions largely aligned with these five domains, with the exception of HIV/STD risk. Additionally, some participants reported others' positive perceptions of them as bisexual individuals. In sum, we observed a range of meta-perceptions, primarily neutral to negative, but also including some relatively positive. These results show the need for interventions to promote acceptance of bisexual individuals among heterosexual and gay/lesbian individuals.

Women's Experiences With Genital Touching, Sexual Pleasure, and Orgasm: Results From a U.S. Probability Sample of Women Ages 18 to 94.

The study purpose was to assess, in a U.S. probability sample of women, experiences related to orgasm, sexual pleasure, and genital touching. In June 2015, 1,055 women ages 18 to 94 from the nationally representative GfK KnowledgePanel® completed a confidential, Internet-based survey. While 18.4% of women reported that intercourse alone was sufficient for orgasm, 36.6% reported clitoral stimulation was necessary for orgasm during intercourse, and an additional 36% indicated that, while clitoral stimulation was not needed, their orgasms feel better if their clitoris is stimulated during intercourse. Women reported diverse preferences for genital touch location, pressure, shape, and pattern. Clinical, therapeutic, and educational implications are discussed.

Knowledge of Zika and perception of risk among sexually-active adults in the United States of America: results from a nationally representative sample.

OBJECTIVE: To examine knowledge of Zika transmission and risk perception and to assess variability by condom use in a probability sample of sexually-active adults in the United States. METHODS: Data for this study came from the 2016 wave of the National Survey of Sexual Health and Behavior, a nationally representative probability sample of adults in the United States. Data were collected in November 2016 via a cross-sectional Internet-based survey administered to members of a Knowledge Panel, an address-based random sample service managed by GfK. A weighted subsample (n = 1 713) of sexually active adults, 18 - 50 years of age, was included in analyses. RESULTS: More than 90% of men and women reported low or no perceived risk of Zika. Most participants identified mosquito bite as a route of transmission, while significantly fewer identified sexual intercourse (≈ 40%) and vertical (29% men, 41% women) transmission routes. CONCLUSION: Sexually-active adults in the United States, especially young men, lack awareness of sexual and vertical transmission of Zika Virus. Given the likely endemic nature of Zika, this low-risk perception is an important prevention challenge. Zika prevention messaging should address lesser known transmission routes, emphasize male education, and promote correct and consistent condom use.

Re-detection vs. new acquisition of high-risk human papillomavirus in mid-adult women.

To understand high-risk (hr) human papillomavirus (HPV) epidemiology in mid-adulthood, we assessed whether associations between incident detection of hrHPV DNA and recent sexual behavior differed according to whether or not there was serologic evidence of prior infection. From 2011 to 2012, we enrolled 409 women aged 30-50 years into a 6-month longitudinal study. We collected health and sexual behavior histories, enrollment sera for HPV antibody testing, and monthly self-collected vaginal swabs for HPV DNA genotyping. Generalized estimating equations logistic regression identified risk factors for type-specific incident hrHPV DNA, stratified by type-specific hrHPV serostatus at enrollment. Population attributable risks of hrHPV due to prior and recent exposure were estimated. When type-specific hrHPV serology was negative, recent sexual risk behavior was positively associated with incident hrHPV DNA (odds ratio in women reporting ≥3 recent sexual risk behaviors [e.g., new or multiple partners] vs. no recent sexual activity = 9.8, 95% CI: 2.4-40.6). No associations with recent sexual behavior were observed with positive type-specific hrHPV serology. Thirty percent of incident hrHPV DNA detection was attributable to prior infection (with positive serology) and 40% was attributable to recent sexual risk behavior (with negative serology). The proportion of incident hrHPV DNA detection attributable to recent sexual risk behavior decreased with increasing age. Among women with serologic evidence of prior infection, re-detection of the same hrHPV type is likely due to reactivation or intermittent detection of persistent infection. Without serologic evidence of prior infection, new detection is likely due to new acquisition or to intermittent detection of persisting infection.

Determinants of High-Risk Human Papillomavirus Seroprevalence and DNA Prevalence in Mid-Adult Women.

BACKGROUND: The epidemiology of high-risk human papillomavirus (hrHPV) infections in mid-adult women is not well understood. METHODS: We conducted a cross-sectional analysis of 379 women 30 to 50 years of age. Vaginal samples were tested for type-specific HPV DNA by polymerase chain reaction. Sera were tested for type-specific HPV antibodies by Luminex-based assay. Assays included 13 hrHPV types (16/18/31/33/35/39/45/51/52/56/58/59/68). Self-reported health and sexual history were ascertained. Risk factors for seropositivity and DNA positivity to hrHPV were assessed in separate Poisson regression models. RESULTS: The mean (SD) age of participants was 38.7 (6.1) years, and the median lifetime number of male sex partners was 7. Approximately two-thirds (68.1%) were seropositive for any hrHPV, 15.0% were DNA positive, and 70.7% were seropositive or DNA positive. In multivariate analyses, women who were married/living with a partner were less likely to be seropositive than single/separated women (adjusted prevalence ratio [aPR], 0.86; 95% confidence interval [CI], 0.75-0.98). Compared with never hormonal contraceptive users, current (aPR, 1.53; 95% CI, 1.01-2.29) or former (aPR, 1.64; 95% CI, 1.10-2.45) users were more likely to be seropositive. Women with a lifetime number of sex partners of 12 or more were more likely to be seropositive compared with those with 0 to 4 partners (aPR, 1.29; 95% CI, 1.06-1.56). Similar associations were seen with DNA positivity. In addition, there was a positive association between current smoking and hrHPV DNA (aPR vs. never smokers, 2.51; 95% CI, 1.40-4.49). CONCLUSIONS: Seventy-one percent of mid-adult women had evidence of current or prior hrHPV infection. Measures of probable increased exposure to HPV infection were associated with both seropositivity and DNA positivity to hrHPV, whereas current smoking was positively associated with hrHPV DNA only.

Sexual Behaviors of U.S. Men by Self-Identified Sexual Orientation: Results From the 2012 National Survey of Sexual Health and Behavior.

INTRODUCTION: Although a large body of previous research has examined sexual behavior and its relation to risk in men of diverse sexual identities, most studies have relied on convenience sampling. As such, the vast majority of research on the sexual behaviors of gay and bisexual men, in particular, might not be generalizable to the general population of these men in the United States. This is of particular concern because many studies are based on samples of men recruited from relatively "high-risk" venues and environments. AIMS: To provide nationally representative baseline rates for sexual behavior in heterosexual, gay, and bisexual men in the United States and compare findings on sexual behaviors, relationships, and other variables across subgroups. METHODS: Data were obtained from the 2012 National Survey of Sexual Health and Behavior, which involved the administration of an online questionnaire to a nationally representative probability sample of women and men at least 18 years old in the United States, with oversampling of self-identified gay and bisexual men and women. Results from the male participants are included in this article. MAIN OUTCOME MEASURES: Measurements include demographic characteristics, particularly sexual identity, and their relations to diverse sexual behaviors, including masturbation, mutual masturbation, oral sex, vaginal sex, and anal sex. Behaviors with male and female partners were examined. RESULTS: Men of all self-identified sexual identities reported engaging in a range of sexual behaviors (solo and partnered). As in previous studies, sexual identity was not always congruent for gender of lifetime and recent sexual partners. CONCLUSION: Patterns of sexual behaviors and relationships vary among heterosexual, gay, and bisexual men. Several demographic characteristics, including age, were related to men's sexual behaviors. The results from this probability study highlight the diversity in men's sexual behaviors across sexual identities, and these data allow generalizability to the broader population of gay and bisexual men, in particular, in the United States, which is a major advancement in research focused on individuals in a sexual minority.

Short-term natural history of high-risk human papillomavirus infection in mid-adult women sampled monthly.

Characterizing short-term HPV detection patterns and viral load may inform HPV natural history in mid-adult women. From 2011-2012, we recruited women aged 30-50 years. Women submitted monthly self-collected vaginal samples for high-risk HPV DNA testing for 6 months. Positive samples were tested for type-specific HPV DNA load by real-time PCR. HPV type-adjusted linear and Poisson regression assessed factors associated with (i) viral load at initial HPV detection and (ii) repeat type-specific HPV detection. One-hundred thirty-nine women (36% of 387 women with ≥4 samples) contributed 243 type-specific HR HPV infections during the study; 54% of infections were prevalent and 46% were incident. Incident (vs. prevalent) detection and past pregnancy were associated with lower viral load, whereas current smoking was associated with higher viral load. In multivariate analysis, current smoking was associated with a 40% (95% CI: 5-87%) increase in the proportion of samples that were repeatedly positive for the same HPV type, whereas incident (vs. prevalent) detection status and past pregnancy were each associated with a reduction in the proportion of samples repeatedly positive (55%, 95% CI: 38-67% and 26%, 95% CI: 10-39%, respectively). In a separate multivariate model, each log10 increase in viral load was associated with a 10% (95% CI: 4-16%) increase in the proportion of samples repeatedly positive. Factors associated with repeat HPV detection were similar to those observed in longer-term studies, suggesting that short-term repeat detection may relate to long-term persistence. The negative associations between incident HPV detection and both viral load and repeat detection suggest that reactivation or intermittent persistence was more common than new acquisition.

Epidemiology of Human Papillomavirus Detected in the Oral Cavity and Fingernails of Mid-Adult Women.

BACKGROUND: Oral and fingernail human papillomavirus (HPV) detection may be associated with HPV-related carcinoma risk at these nongenital sites and foster transmission to the genitals. We describe the epidemiology of oral and fingernail HPV among mid-adult women. METHODS: Between 2011 and 2012, 409 women aged 30 to 50 years were followed up for 6 months. Women completed health and behavior surveys and provided self-collected oral, fingernail, and vaginal specimens at enrollment and exit for type-specific HPV DNA testing. Concordance of type-specific HPV detection across anatomical sites was described with κ statistics. Using generalized estimating equations or exact logistic regression, we measured the univariate associations of various risk factors with type-specific oral and fingernail HPV detection. RESULTS: Prevalence of detecting HPV in the oral cavity (2.4%) and fingernails (3.8%) was low compared with the vagina (33.1%). Concordance across anatomical sites was poor (κ < 0.20 for all comparisons). However, concurrent vaginal infection with the same HPV type (odds ratio [OR], 101.0; 95% confidence interval [CI], 31.4-748.6) and vaginal HPV viral load (OR per 1 log10 viral load increase, 2.2; 95% CI, 1.5-5.5) were each associated with fingernail HPV detection. Abnormal Papanicolaou history (OR, 11.1; 95% CI, 2.8-infinity), lifetime number of male vaginal sex partners at least 10 (OR vs. 0-3 partners, 5.0; 95% CI, 1.2-infinity), and lifetime number of open-mouth kissing partners at least 16 (OR vs. 0-15 partners, infinity; 95% CI, 2.6-infinity, by exact logistic regression) were each associated with oral HPV detection. CONCLUSIONS: Although our findings support HPV DNA deposition or autoinoculation between anatomical sites in mid-adult women, the rarity of HPV in the oral cavity and fingernails suggests that oral/fingernail HPV does not account for a significant fraction of HPV in genital sites.

Asexual or not sure: Findings from a probability sample of undergraduate students.

OBJECTIVE: Present study aims to: 1) examine demographic correlates of LGB, asexual, or not sure participants 2) describe the prevalence of diverse sexual behaviors, 3) assess the prevalence of event-level sexual behaviors and 4) examine predictors of sexual pleasure. PARTICIPANTS: 761 non-heterosexual undergraduates at a large, public U.S. university. METHODS: Randomly sampled undergraduate students completed a confidential, cross-sectional online survey. RESULTS: Of 761 non-heterosexual respondents; 567 identified as LGB, 47 asexual, and 147 not sure. Asexual students, those not sure were less likely to report having engaged in solo and partnered sexual activities and report sexual activities being less pleasurable at most recent sexual event, compared with LGB students. This difference (relative to LGB) became nonsignificant when accounting for reported sexual activities. CONCLUSIONS: Our findings inform how college students define and experience their sexual identities and assist college health professionals in training on sexuality and prevention of risk factors.

Associations between sexual precedent and sexual compliance: An event-level examination.

Objective Most studies on agreeing to unwanted sex have assessed sexual encounters between people who have had sex before. Thus, we examined instances of sexual compliance with a novel sexual partner. Participants: A probability sample of college students at a university in the Midwest United States (N = 7,112). Methods: Participants completed an online survey based on measures from the National Survey of Sexual Health and Behavior. Results: Only 2.5% (n = 179) agreed to unwanted sexual activity at their most recent sexual encounter. People who were sexually compliant with a novel sexual partner frequently did so due to their own alcohol intoxication. Further, sexual compliance with novel sexual partners was less frequently associated with affectionate sexual behaviors or orgasm. Conclusions: Our initial findings regarding the effect of sexual precedent on sexual compliance warrant further research on instances when people agree to sex they don't want with novel partners.

Gender Expression and Its Correlates in a Nationally Representative Sample of the U.S. Adult Population: Findings from the National Survey of Sexual Health and Behavior.

We explored the associations of gender expression with childhood gender expression, sexual identity, and demographic characteristics in a representative sample of the U.S. population aged 18 to 65 years (N = 1277), using data from the 2015 National Survey of Sexual Health and Behavior. As expected, gay men were less gender conforming than heterosexual men. However, among women, persons with a bisexual identity were less gender conforming compared to heterosexual and lesbian persons. In multivariate analyses, childhood gender expression trumped the role of sexual identity. In terms of demographic characteristics, gender conformity seemed to be more present among persons with positions with less social status in terms of age, race/ethnicity, education, income, and relationship status. Finally, we found among both men and women, that a large proportion saw themselves as more masculine or feminine than men and women on average, respectively, suggesting that accentuating one's gender conformity has a psychological function.

Prevalence of Romantic Experiences and Competencies Among 14 to 17 Year Olds: Implications for the Primary Care Setting.

Using data from 600 adolescents (14-17 years old) from the 2015 National Survey of Sexual Health and Behavior, we examined the prevalence and demographic correlates of adolescents' romantic activities (ie, group dating, dyadic dating, and relationship involvement) and their confidence in avoiding unwanted romantic experiences. Overall, 55.8% of adolescents had engaged in at least one romantic activity. More adolescents reported having gone on dyadic (42.1%) and group (37.3%) dates than had been involved in romantic relationships (32.9%). Age and gender were the most consistent correlates of each romantic activity. Each type of romantic activity becomes more common as adolescents mature. Female adolescents were less likely to report romantic activities. Approximately 25.7% of adolescents were not confident that they could turn down unwanted dates, and 34.3% were not confident that they could end a relationship they no longer wanted to be in. Clinicians can draw on our results when discussing romantic development with their adolescent patients.

The alcohol contexts of consent, wanted sex, sexual pleasure, and sexual assault: Results from a probability survey of undergraduate students.

OBJECTIVE: To examine, in a probability sample of undergraduate students, characteristics of students' most recent sexual experiences (including alcohol use) as well as their experiences with nonconsensual sex. PARTICIPANTS: In January and February 2015, 22,046 students were invited to participate in an anonymous, cross-sectional, Internet-based survey; 7,032 surveys were completed (31.9%). METHODS: Measures included background characteristics (age, gender, sexual orientation), most recent sexual event items (sexual pleasure, wantedness, alcohol use), and experiences with nonconsensual sex (since college and lifetime). RESULTS: Respondents reporting sober consensual sex were more likely to report higher levels of sexual pleasure and wantedness. Nonconsensual oral, vaginal, or anal penetration occurring during college were reported by 15.8% of women and 7.7% of men. Students more often told friends, partners, or family members and rarely disclosed to university faculty or police. CONCLUSIONS: Implications for campus policy and health education are addressed.

Sexual diversity in the United States: Results from a nationally representative probability sample of adult women and men.

In 2015, we conducted a cross-sectional, Internet-based, U.S. nationally representative probability survey of 2,021 adults (975 men, 1,046 women) focused on a broad range of sexual behaviors. Individuals invited to participate were from the GfK KnowledgePanel®. The survey was titled the 2015 Sexual Exploration in America Study and survey completion took about 12 to 15 minutes. The survey was confidential and the researchers never had access to respondents' identifiers. Respondents reported on demographic items, lifetime and recent sexual behaviors, and the appeal of 50+ sexual behaviors. Most (>80%) reported lifetime masturbation, vaginal sex, and oral sex. Lifetime anal sex was reported by 43% of men (insertive) and 37% of women (receptive). Common lifetime sexual behaviors included wearing sexy lingerie/underwear (75% women, 26% men), sending/receiving digital nude/semi-nude photos (54% women, 65% men), reading erotic stories (57% of participants), public sex (≥43%), role-playing (≥22%), tying/being tied up (≥20%), spanking (≥30%), and watching sexually explicit videos/DVDs (60% women, 82% men). Having engaged in threesomes (10% women, 18% men) and playful whipping (≥13%) were less common. Lifetime group sex, sex parties, taking a sexuality class/workshop, and going to BDSM parties were uncommon (each <8%). More Americans identified behaviors as "appealing" than had engaged in them. Romantic/affectionate behaviors were among those most commonly identified as appealing for both men and women. The appeal of particular behaviors was associated with greater odds that the individual had ever engaged in the behavior. This study contributes to our understanding of more diverse adult sexual behaviors than has previously been captured in U.S. nationally representative probability surveys. Implications for sexuality educators, clinicians, and individuals in the general population are discussed.

Attitudes toward Bisexual Men and Women among a Nationally Representative Probability Sample of Adults in the United States.

As bisexual individuals in the United States (U.S.) face significant health disparities, researchers have posited that these differences may be fueled, at least in part, by negative attitudes, prejudice, stigma, and discrimination toward bisexual individuals from heterosexual and gay/lesbian individuals. Previous studies of individual and social attitudes toward bisexual men and women have been conducted almost exclusively with convenience samples, with limited generalizability to the broader U.S. POPULATION: Our study provides an assessment of attitudes toward bisexual men and women among a nationally representative probability sample of heterosexual, gay, lesbian, and other-identified adults in the U.S. Data were collected from the 2015 National Survey of Sexual Health and Behavior (NSSHB), via an online questionnaire with a probability sample of adults (18 years and over) from throughout the U.S. We included two modified 5-item versions of the Bisexualities: Indiana Attitudes Scale (BIAS), validated sub-scales that were developed to measure attitudes toward bisexual men and women. Data were analyzed using descriptive statistics, gamma regression, and paired t-tests. Gender, sexual identity, age, race/ethnicity, income, and educational attainment were all significantly associated with participants' attitudes toward bisexual individuals. In terms of responses to individual scale items, participants were most likely to "neither agree nor disagree" with all attitudinal statements. Across sexual identities, self-identified other participants reported the most positive attitudes, while heterosexual male participants reported the least positive attitudes. As in previous research on convenience samples, we found a wide range of demographic characteristics were related with attitudes toward bisexual individuals in our nationally-representative study of heterosexual, gay/lesbian, and other-identified adults in the U.S. In particular, gender emerged as a significant characteristic; female participants' attitudes were more positive than male participants' attitudes, and all participants' attitudes were generally more positive toward bisexual women than bisexual men. While recent population data suggest a marked shift in more positive attitudes toward gay men and lesbian women in the general population of the U.S., the largest proportions of participants in our study reported a relative lack of agreement or disagreement with all affective-evaluative statements in the BIAS scales. Findings document the relative lack of positive attitudes toward bisexual individuals among the general population of adults in the U.S. and highlight the need for developing intervention approaches to promote more positive attitudes toward bisexual individuals, targeted toward not only heterosexual but also gay/lesbian individuals and communities.

Knowledge of Zika and perception of risk among sexually-active adults in the United States of America: results from a nationally representative sample

[ABSTRACT]. Objective. To examine knowledge of Zika transmission and risk perception and to assess variability by condom use in a probability sample of sexually-active adults in the United States. Methods. Data for this study came from the 2016 wave of the National Survey of Sexual Health and Behavior, a nationally representative probability sample of adults in the United States. Data were collected in November 2016 via a cross-sectional Internet-based survey administered to members of a Knowledge Panel, an address-based random sample service managed by GfK. A weighted subsample (n = 1 713) of sexually active adults, 18 – 50 years of age, was included in analyses. Results. More than 90% of men and women reported low or no perceived risk of Zika. Most participants identified mosquito bite as a route of transmission, while significantly fewer identified sexual intercourse (≈ 40%) and vertical (29% men, 41% women) transmission routes. Conclusion. Sexually-active adults in the United States, especially young men, lack awareness of sexual and vertical transmission of Zika Virus. Given the likely endemic nature of Zika, this low-risk perception is an important prevention challenge. Zika prevention messaging should address lesser known transmission routes, emphasize male education, and promote correct and consistent condom use.

[RESUMEN]. Objetivo. Examinar el conocimiento y la percepción del riesgo en cuanto a la transmisión del virus del Zika y evaluar la variabilidad en el uso de preservativos en una muestra probabilística de adultos sexualmente activos en los Estados Unidos. Métodos. Los datos usados en este estudio se tomaron de las respuestas que una muestra probabilística representativa a nivel nacional de adultos de los Estados Unidos dio en el 2016 como parte de la Encuesta nacional sobre salud y comportamiento sexual. La recopilación de datos se hizo en noviembre del 2016 mediante un cuestionario transversal en línea que respondieron los miembros de Knowledge Panel, un servicio de muestras aleatorias seleccionadas por la dirección de los usuarios que presta la empresa GfK. Para los análisis se usó una submuestra ponderada (n = 1 713) de adultos sexualmente activos de 18 a 50 años de edad. Resultados. Más de 90% de los hombres y mujeres encuestados informaron que su nivel de percepción sobre el riesgo del virus del Zika era bajo o nulo. La mayoría de los participantes sabía que la picadura de mosquitos es una vía de contagio, y un número significativamente menor de participantes sabía que el virus puede transmitirse por relaciones sexuales (≈ 40%) y de madre a hijo (29% de los hombres, 41% de las mujeres). Conclusiones. Los adultos sexualmente activos en los Estados Unidos —y en particular, los hombres jóvenes— tienen escaso conocimiento acerca de la transmisión sexual y vertical del virus del Zika. Dada la probable naturaleza endémica de este virus, esta percepción de que el riesgo es bajo constituye un reto importante para las iniciativas de prevención. Los mensajes sobre la prevención de la infección por el virus del Zika deben abordar las rutas de transmisión menos conocidas, hacer hincapié en educar a los hombres, y promover el uso correcto y sistemático de preservativos.

[RESUMO]. Objetivo. Examinar o conhecimento sobre a transmissão do vírus zika e a percepção de risco de infecção e avaliar a variabilidade no uso de preservativos em uma amostra probabilística de adultos sexualmente ativos nos Estados Unidos. Métodos. Os dados do estudo foram obtidos do ciclo de 2016 da Pesquisa Nacional de Saúde e Comportamento Sexual, uma amostra probabilística representativa nacional da população adulta dos Estados Unidos. A coleta foi realizada em novembro de 2016 em uma pesquisa transversal realizada pela internet administrada aos participantes de um painel de conhecimento, um serviço de amostragem aleatória por endereço gerido pela GfK. Uma submostra ponderada (n = 1.713), composta por adultos sexualmente ativos com idade de 18 a 50 anos, foi incluída nas análises. Resultados. Acima de 90% dos homens e mulheres informaram percepção de baixo ou nenhum risco de infecção pelo vírus zika. A maioria dos participantes identificou a picada de mosquito como uma via de transmissão e uma proporção significativamente menor identificou a relação sexual (≈40%) e a transmissão vertical (29% dos homens e 41% das mulheres) como vias de transmissão. Conclusões. Falta conhecimento sobre a transmissão sexual e a transmissão vertical do vírus zika aos adultos sexualmente ativos nos Estados Unidos, sobretudo aos jovens do sexo masculino. Diante da provável endemicidade do vírus, a percepção de baixo risco é um grande desafio à prevenção. As mensagens para prevenção de zika devem abordar as vias de transmissão menos conhecidas, concentrando-se em instruir indivíduos do sexo masculino e promover o uso correto e consistente de preservativos.