Sexual Behaviors and Violence in Pornography: Systematic Review and Narrative Synthesis of Video Content Analyses.

BACKGROUND: Owing to increasing access to Web-based pornography and concerns about its impact on viewers, many researchers have attempted to systematically analyze the content of pornography. OBJECTIVE: We aimed to systematically review the results of quantitative content analyses of video-based pornography and identify the degree to which the following behaviors are depicted: (1) sexual behaviors and themes, (2) condom use during sexual behaviors, and (3) aggression and violence. METHODS: Inclusion criteria for article eligibility were (1) peer-reviewed publications, (2) articles in the English language, (3) articles describing a quantitative content analysis of video pornography, and (4) articles quantitatively examining at least one variable of interest. RESULTS: A total of 23 studies met the eligibility criteria. Studies varied in scope and definitions of behavioral variables. Condom use was rare, although more commonly depicted in gay male pornography (36%-64% videos) compared with heterosexual pornography (2%-3% videos). Normative sexual behaviors were most frequently depicted in pornography samples (eg, vaginal intercourse in 48%-90% and fellatio in 52%-90% of heterosexual videos; fellatio in 66%-100% and anal intercourse in 70%-80% of gay male videos). Extreme acts of violence (1%-3% videos) and rape (0%-6% videos) were relatively rare. However, more subtle forms of aggression, such as spanking (5%-75% videos), were more common, and unequal sexual relations (eg, domination) were also common. Although estimates varied by study, dominating and violent behaviors were nearly always directed toward women. CONCLUSIONS: Condom nonuse and gender inequalities are common in pornography, which has implications for the development of healthy sexual relationships among pornography viewers. Higher quality research, including study replication and consistent methodological choices, is needed.

Personal and reported partner pornography viewing by Australian women, and association with mental health and body image.

Background Personal and partner pornography viewing may affect health and wellbeing. This study aimed to improve understanding of the effects of pornography on mental health and body image, given emerging evidence of increasing use, particularly among young people. METHODS: A cross-sectional survey was implemented, targeting people who had accessed health and fitness content via social media. Convenience sampling was used and participants were recruited via advertising on social media. RESULTS: Overall, 76% (75/99) of women reported having ever viewed pornography, and 21% had viewed pornography frequently (monthly/weekly/daily) in the prior 12 months. The association between frequent viewing and higher-risk Kessler 10 Psychological Distress Scale scores lost significance once controlled for age (adjusted OR 2.30, 95%CI 0.82-6.49, P=0.11). There was an association with frequent reported partner pornography use (monthly/weekly/daily) and increased Drive for Muscularity scores (adjusted OR 2.20, 95%CI 1.01-4.80, P=0.048). There were no other associations found with pornography use (personal or partner) and body image or mental health, although this was limited by the small sample size. Most women (85%, 41/48) reported being happy with their partner's pornography use, and in qualitative responses, indicated that pornography had minimal effect on their lives. Nevertheless, multiple qualitative responses indicated a multiplicity of perceived effects of pornography, including negative effects on body image. CONCLUSIONS: Pornography had a minor effect on mental health and body image in this study. Additional research is required to improve understanding of the effects of pornography on body image and mental health, particularly among vulnerable individuals.

"I am yet to encounter any survey that actually reflects my life": a qualitative study of inclusivity in sexual health research.

BACKGROUND: Heteronormativity describes a set of norms and assumptions pertaining to heterosexual identities and binary gender. In 2015, we conducted our annual Sex, Drugs and Rock'n'Roll study, an online health survey of over 1000 Victorians aged 15-29 years. Feedback from participants suggested that our survey contained heteronormative language. In response to this, we aimed to make inclusive changes to our survey via consultation with young gender and sexually diverse (GSD) people. METHODS: We conducted two semi-structured focus groups in Melbourne with a total of 16 participants (age range: 21-28 years). Participants were mostly cisgender women, and there were two transgender participants and one non-binary participant. Participants also had a range of sexual identities including lesbian, queer, bisexual, pansexual, and asexual. Focus group discussions were transcribed verbatim and analysed thematically. RESULTS: Most participants indicated heteronormativity affects their lives in multiple ways, noting its impacts on access to sexual healthcare, invalidating sexual experiences and miscommunication in forms and surveys. Overall, participants emphasised the need for sexual health research to avoid assumptions about behaviour, to be clear and eliminate question ambiguity and avoiding treating gender as binary. Participants also discussed how the Sex, Drugs and Rock'n'Roll survey could address a range of sexual behaviours and experiences, rather than focusing on penetrative sex, which many participants found invalidating. CONCLUSIONS: Our findings have important implications for future health surveys aimed at general populations. We present recommendations that encourage research to be more inclusive to ensure data collection from GSD participants is respectful and rigorous.

Mental Health and Associated Sexual Health Behaviours in a Sample of Young People Attending a Music Festival in Melbourne, Victoria.

Poor mental health has previously been associated with risky sexual health behaviours among young people internationally and in clinical samples, but little is known about this relationship in non-clinical settings. We conducted a cross-sectional survey with a convenience sample of 1345 Australians aged 15-29. Multivariable logistic regression was used to identify sexual health behaviours independently associated with recent poor mental health including contraception use, STI testing, sexting and age at first sexual intercourse. Recent poor mental health was reported by 29.7 % of participants and independently associated with female gender (OR 1.8; 95 % CI 1.4-2.4), not identifying as heterosexual (OR 3.0; 95 % CI 2.1-4.4) and young age at first sexual intercourse among female participants (OR 1.4; 95 % CI 1.0-2.0). Results suggest mental health is largely driven by variables other than sexual health behaviours, although youth mental health services should consider inclusion of sexual health promotion within the scope of their services.

Reach, engagement, and effectiveness: a systematic review of evaluation methodologies used in health promotion via social networking sites.

Issue addressed Social networking sites (SNS) are increasingly popular platforms for health promotion. Advancements in SNS health promotion require quality evidence; however, interventions are often not formally evaluated. This study aims to describe evaluation practices used in SNS health promotion. Methods A systematic review was undertaken of Medline, PsycINFO, Scopus, EMBASE, CINAHL Plus, Communication and Mass Media Complete, and Cochrane Library databases. Articles published between 2006 and 2013 describing any health promotion intervention delivered using SNS were included. Results Forty-seven studies were included. There were two main evaluation approaches: closed designs (n=23), which used traditional research designs and formal recruitment procedures; and open designs (n=19), which evaluated the intervention in a real-world setting, allowing unknown SNS users to interact with the content without enrolling in research. Closed designs were unable to assess reach and engagement beyond their research sample. Open designs often relied on weaker study designs with no use of objective outcome measures and yielded low response rates. Conclusions Barriers to evaluation included low participation rates, high attrition, unknown representativeness and lack of comparison groups. Acceptability was typically assessed among those engaged with the intervention, with limited population data available to accurately assess intervention reach. Few studies were able to assess uptake of the intervention in a real-life setting while simultaneously assessing effectiveness of interventions with research rigour. So what? Through use of quasi-experimental or well designed before-after evaluations, in combination with detailed engagement metrics, it is possible to balance assessment of effectiveness and reach to evaluate SNS health promotion.

Predictors of "Liking" Three Types of Health and Fitness-Related Content on Social Media: A Cross-Sectional Study.

BACKGROUND: Adolescence and young adulthood are key periods for developing norms related to health behaviors and body image, and social media can influence these norms. Social media is saturated with content related to dieting, fitness, and health. Health and fitness-related social media content has received significant media attention for often containing objectifying and inaccurate health messages. Limited research has identified problematic features of such content, including stigmatizing language around weight, portraying guilt-related messages regarding food, and praising thinness. However, no research has identified who is "liking" or "following" (ie, consuming) such content. OBJECTIVE: This exploratory study aimed to identify demographics, mental health, and substance use-related behaviors that predicted consuming 3 types of health and fitness-related social media content-weight loss/fitness motivation pages (ie, "fitspiration"), detox/cleanse pages, and diet/fitness plan pages-among young social media users. METHODS: Participants (N=1001; age: median 21.06, IQR 17.64-24.64; female: 723/1001, 72.23%) completed a cross-sectional 112-question online survey aimed at social media users aged between 15-29 years residing in Victoria, Australia. Logistic regression was used to determine which characteristics predicted consuming the 3 types of health and fitness-related social media content. RESULTS: A total of 378 (37.76%) participants reported consuming at least 1 of the 3 types of health and fitness-related social media content: 308 (30.77%) fitspiration pages, 145 (14.49%) detox pages, and 235 (23.48%) diet/fitness plan pages. Of the health and fitness-related social media content consumers, 85.7% (324/378) identified as female and 44.8% (324/723) of all female participants consumed at least 1 type of health and fitness-related social media content. Predictors of consuming at least one type of health and fitness-related social media content in univariable analysis included female gender (OR 3.5, 95% CI 2.5-4.9, P<.001), being aged 15-17 years (OR 3.0, 95% CI 2.2-4.0, P<.001), residing outside a major city (OR 2.0, 95% CI 1.4-2.9, P<.001), having no post-high school education (OR 2.2, 95% CI 1.7-2.9, P<.001), being born in Australia (OR 2.0, 95% CI 1.2-3.2, P=.006), having a self-reported eating disorder (OR 2.4, 95% CI 1.5-3.9, P<.001), being a victim of bullying (OR 1.7, CI 1.3-2.3, P<.001), misusing detox/laxative teas or diet pills (OR 4.6, 95% CI 2.8-7.6, P<.001), never using illegal drugs (OR 1.6, 95% CI 1.2-2.0, P=.001), and not engaging in risky single occasion drinking on a weekly basis (OR 2.0, 95% CI 1.3-3.0, P=.003). CONCLUSIONS: Consumers of health and fitness-related social media content were predominantly teenaged girls. There is a need to ensure that this social media content portrays responsible health messages and to research further the role of fitspiration pages, detox pages, and diet/fitness plan pages in influencing body image and health behaviors.

Safety, Acceptability, and Initial Effectiveness of a Novel Digital Suicide Prevention Campaign Challenging Perceived Burdensomeness.

Background: Better Off With You is a peer-to-peer, digital suicide prevention campaign pilot designed to challenge the idea of perceived burdensomeness; the schema experienced by many people contemplating suicide that they are a burden on others. Aims: To investigate the safety, acceptability, and initial effectiveness of the campaign. Method: This mixed methods pilot involved a general community sample (N = 157), from targeted sites within two Australian communities. Data were collected at baseline and after 1-week exposure to the campaign videos and website. Qualitative interviews were conducted with a subset of participants (N = 15). Results: Participants rated the campaign as highly engaging and relevant to local communities. In interviews, participants identified the campaign as being unique, safe, and impactful. Overall, exposure to Better Off With You did not result in any notable changes in perceived burdensomeness, psychological distress, or help-seeking. Limitations: The pilot involved a community sample. As such, outcome measurement scores were low at baseline. Conclusion: This pilot provides new insights about the safety, engagement and initial effectiveness of the Better Off With You campaign. Future research is needed to explore its impact on people experiencing suicidal ideation.

What Behaviors Do Young Heterosexual Australians See in Pornography? A Cross-Sectional Study.

This study investigated how frequently a group of young heterosexual Australians (ages 15 to 29) saw a range of behaviors represented in pornography over the previous 12 months. Participants were recruited to an anonymous online survey. Those who reported having viewed pornography in the past 12 months (n = 517) indicated how frequently they saw each of a list of 17 behaviors when they watched pornography in the past 12 months. Men's pleasure (83%) was seen frequently by the highest proportion of young people surveyed, followed by a man being portrayed as dominant (70%). Women were more likely to report frequently seeing violence toward a woman (p < 0.01). Men were more likely to report frequently seeing heterosexual anal sex (p < 0.01), ejaculation onto a woman's face (p < 0.01), women portrayed as dominant (p < 0.01), a man being called names or slurs (p < 0.01), and violence toward a man that appears consensual (p < 0.01). Younger age was significantly associated with frequently seeing women's pleasure (p < 0.05), violence toward women which appeared consensual, and all types of violence (p < 0.01). Older age was associated with frequently seeing men's pleasure (p < 0.01) and heterosexual anal sex (p < 0.05). Our findings draw attention to the gendered ways that behaviors in pornography are seen and identified by young heterosexual audiences.

Longitudinal changes in personal wellbeing in a cohort of people who inject drugs.

AIMS: To determine whether the self-reported personal wellbeing of a cohort of people who inject drugs (PWID) changes over time, and to identify longitudinal correlates of change. METHODS: We used Personal Wellbeing Index (PWI) scores reported between April 2008 and February 2015 by 757 PWID (66% male) enrolled in the Melbourne Injecting Drug Use Cohort Study (2,862 interviews; up to seven follow-up waves). A mixed-effects model was used to identify correlations between changes in temporal variables and changes in individual PWI scores while controlling for demographic variables. RESULTS: The cohort's mean PWI score did not significantly differ over time (between 54.4/100 and 56.7/100 across the first four interview waves), and was 25-28% lower than general Australian population scores (76.0/100). However, there were large variations in individuals' PWI scores between interviews. Increased psychological distress, moving into unstable accommodation, reporting intentional overdose in the past 12 months and being the victim of assault in the past six months were associated with declines in PWI scores. CONCLUSIONS: Participants experienced substantially lower levels of personal wellbeing than the general Australian population, influenced by experiences of psychological distress, assault, overdose and harms related to low socioeconomic status. The results of this study suggest a need to ensure referral to appropriate housing and health support services for PWID.

Young Australians' use of pornography and associations with sexual risk behaviours.

OBJECTIVES: Amid public health concern that rising pornography use may have a negative impact on young people's health and wellbeing, we report prevalence of pornography viewing and explore factors associated with viewing frequency and age at first viewing. METHODS: Cross-sectional online survey in a convenience sample of Victorians aged 15 to 29 years recruited via social media. RESULTS: Ever viewing pornography was reported by 815 of 941 (87%) participants. The median age at first pornography viewing was 13 years for men and 16 years for women. More frequent pornography viewing was associated with male gender, younger age, higher education, non-heterosexual identity, ever having anal intercourse and recent mental health problems. Younger age at first pornography viewing was associated with male gender, younger current age, higher education, non-heterosexual identity, younger age at first sexual contact and recent mental health problems. CONCLUSIONS: Pornography use is common and associated with some health and behavioural outcomes. Longitudinal research is needed to determine the causal impact of pornography on these factors. Implications for public health: Viewing pornography is common and frequent among young people from a young age and this needs to be considered in sexuality education.

An investigation of strategies used in alcohol brand marketing and alcohol-related health promotion on Facebook.

OBJECTIVE: Alcohol brands are incorporating social networking sites (SNS) into their marketing programmes. SNS are also being used to reduce alcohol consumption and harms by health promotion organisations. Marketing via SNS can attempt to influence consumers using a range of strategies from traditional marketing, social media, and behaviour change theory. This study systematically quantifies marketing strategies used by alcohol brands and health promoters on Facebook. METHODS: We identified the 10 most popular alcohol brands and health promotion organisations in Australia on Facebook and extracted all posts from April 2014. A framework was developed, listing 33 SNS marketing strategies. The frequency of use of each strategy in posts was counted for all profiles. RESULTS: The median number of fans of alcohol brands was 189,290 compared with 7562 for health promotion pages. A total of 210 Facebook posts were analysed. Popular marketing strategies included visual attraction, connecting with other organisations, and links to culture and events. Time-specific and day-specific posts and tweets were used more regularly by alcohol brands than health promotion agencies. CONCLUSIONS: Alcohol brands remain substantially more popular than health promotion organisations, and this difference is likely driven by offline factors rather than specific use of marketing strategies. However, health promotion organisations can learn from the strategies used by popular brands, particularly in the use of time and day-specific content.

Who 'likes' alcohol? Young Australians' engagement with alcohol marketing via social media and related alcohol consumption patterns.

OBJECTIVE: To describe patterns of 'liking' alcohol marketing social media pages, and determine related alcohol consumption patterns among young Australians. METHODS: Participants were 1,001 Australians aged 15-29 years who completed a cross-sectional online survey. Logistic regression and ordinal logistic regression were used. RESULTS: A quarter (249/1001, 24.9%) liked at least one of the alcohol marketing social media pages, most commonly brands of spirits, cider and alcohol retailers. Underage participants were as likely as older participants to report liking these pages. Alcohol marketing social media use was significantly and independently associated with male gender, living outside a major city, ever using illegal drugs and early age of first alcohol consumption (all p<0.05). Alcohol marketing social media use (OR 2.1, 95% CI 1.5-2.8, p=<0.001) was independently associated with higher categories on the AUDIT-C, indicating riskier alcohol consumption. CONCLUSIONS: Liking or following alcohol marketing pages is common regardless of age, and associated with riskier alcohol consumption, among young Australians. IMPLICATIONS: There is a need to develop strategies to reduce the exposure to, and potential impact of, alcohol marketing social media pages on young Australians, and ensure these pages are neither accessible to nor targeting underage social media users.

Longitudinal changes in psychological distress in a cohort of people who inject drugs in Melbourne, Australia.

BACKGROUND: Previous research into psychological distress among people who inject drugs (PWID) is predominantly cross-sectional; we determined longitudinal predictors of change in psychological distress among a cohort of PWID. METHOD: We examined Kessler Psychological Distress Scale (K10) scores from 564 PWID (66% male) enrolled in the Melbourne Injecting Drug User Cohort Study. Gender-stratified linear models with fixed effects for each participant were used to examine correlates of change in individual K10 scores. Further linear regressions of adjusted K10 scores were used to measure correlations between demographic variables. RESULTS: Participants reported higher K10 scores (higher psychological distress) than the general Australian population (mean K10 scores 23.4 (95%CI 22.6-24.2) and 14.5 (95%CI 14.3-14.7) respectively). The cohort's mean K10 score did not significantly differ over time, but individual variations were common. Women reported higher K10 scores than men (mean baseline K10 scores 25.2 (95%CI 23.9-26.6) and 22.4 (95%CI 21.5-23.3) respectively), however no significant differences remained after controlling for temporal factors. Key predictors of increases in K10 scores were being the victim of an assault in the past six months (P<0.001 for women and men) and intentionally overdosing in the past 12 months (P=.010 for women and P<0.001 for men). CONCLUSIONS: PWID experience higher levels of psychological distress than the general population. Temporal rather than individual factors may account for the higher levels of psychological distress reported among women. Interventions to reduce rates of assault and/or intentional overdose should be explored to reduce high levels of psychological distress among PWID.