Examining the Problematic Pornography Use Model: A Quantitative Exploration of Dysregulated Pornography Use.

BACKGROUND: Questions concerning problematic pornography consumption have been widely discussed, but longitudinal data examining the relationships implicated by problematic pornography use models are rare. To date, two models have been proposed that have sought to elucidate the causal mechanisms involved in a problematic pornography use model, the I-PACE model and the Pornography Problems Due to Moral Incongruence Model. AIM: We sought to clarify this issue by investigating the prospective association between variables integral to previously proposed addiction models. METHODS: Using a longitudinal TurkPrime.com sample (N = 317), and a newly developed measure of pornography consumption, we asked participants to answer questions related to their pornography usage, their distress levels, and individual differences over a six-month time frame during 2017. MAIN OUTCOME: Pornography consumption only led to distress when an individual possessed certain individual differences. Moreover, there was no evidence that pornography use mediated or suppressed the relationship between pornography consumption and distress. RESULTS: Using a series of mediation/suppression models, we found evidence to support the structure of existing theoretical models; specifically, pornography consumption amplifies the relationship between individual differences (ie, sexual compulsivity and sexual sensation seeking) and distress (ie, depression and sexual esteem) over a six-month time period. However, we failed to observe an association between pornography consumption and distress when sexual compulsivity and sexual sensation seeking were left unaccounted for within the model, suggesting pornography use likely only results in distress in those with certain individual differences. Moreover, there was no evidence that perceptions of problematic pornography use suppressed or mediated the relationship between pornography consumption and distress. CLINICAL IMPLICATIONS: These findings suggest that targeting specific individual differences -a la Acceptance and Commitment Therapy-rather than pornography consumption attitudes may be a more effective strategy to reduce problematic pornography use. STRENGTHS & LIMITATIONS: One strength of the current study was that we were able to corroborate previously hypothesized models of problematic pornography consumption. Furthermore, this was done using a newly designed measurement of pornography consumption. However, the study was not without some shortcoming. We were unable to test the pornography problems due to moral incongruence arm of the study, something that previous research has indicated may lead to distress. CONCLUSION: This paper sought to empirically examine models investigating problematic pornography use. Our findings indicate that pornography consumption will only lead to certain sorts of distress in the presence of specific individual differences ie, sexual compulsivity and sexual sensation seeking. Hatch HD, Hatch SG, Henderson E, et al. Examining the Problematic Pornography Use Model: A Quantitative Exploration of Dysregulated Pornography Use. J Sex Med 2022;19:132-143.

Risk Factors Associated With the Prescription of Opioids Among Service Members Following a First Mild Traumatic Brain Injury.

OBJECTIVE: To evaluate factors impacting opioid receipt among active-duty service members (SMs) following a first mild traumatic brain injury (mTBI). SETTING: Active-duty SMs receiving care within the Military Health System. PARTICIPANTS: In total, 14 757 SMs who have sustained an initial mTBI, as documented within electronic health records (EHRs), between 2016 and 2017. DESIGN: A retrospective analysis of EHR metadata. MAIN MEASURES: Multivariable logistic regression assessed factors impacting opioid receipt and initiation. Factors include demographics, military characteristics, and preexisting clinical conditions, including prior opioid prescription. RESULTS: Of the sample population, 33.4% (n = 4927) were prescribed opioids after their initial mTBI, of which, 60.6% (n = 2985) received opioids for the first time following injury. Significant risk factors associated with the increased probability of opioid receipt included age, gender, and preexisting behavioral health and musculoskeletal conditions. Military characteristics also exhibited changes in the probability of opioid receipt, both among initiation and new prescription. No changes were observed among race, nor among those with preexisting headaches or migraines. CONCLUSION: Despite concerns about the negative impact on recovery, the prescribing of opioids is common in this population of active-duty SMs first diagnosed with an mTBI. As several demographic and preexisting health conditions are factors in the receipt of opioids post-mTBI, the entire medical history of these patients should be considered prior to prescription. Understanding these factors may further inform policy for opioid use in the Military Health System.