Qualitative analysis of Canadian blood and plasma donors' views on expanding donor screening eligibility for gay, bisexual, and other men who have sex with men.

BACKGROUND: In many countries, sexually active gay, bisexual and other men who have sex with men (gbMSM) continue to be screened based on their sex or gender and the sex or gender of their sexual partner. However, there is growing support that screening based on specific sexual behaviors that pose risk of transfusion transmissible infection is a better approach to donor screening. STUDY DESIGN AND METHODS: This paper reports results from Phase 1 (qualitative) of a mixed-methods study on Canadian blood and plasma donors' views on expanding eligibility for gbMSM by changing to sexual behavior-based screening. Semistructured interview data with 40 donors (whole blood = 20, plasma = 20; male = 21, female = 18, nonbinary = 1; mean age = 46.2; 10% participation rate) in Canada were analyzed using a thematic approach. RESULTS: All participants, except one, supported the change as they anticipated that at least one of three outcomes would be achieved: increasing blood supply, enhancing equity, and improving or maintaining the safety of blood supply. One donor who was more skeptical of the change questioned the scientific evidence for the change and indicated mistrust of state institutions. The discussion considers implications for blood operators' communication strategies that can be used to reduce donor discomfort with the changes to donor screening. CONCLUSION: In a nonrandom, purposive sample of 40 Canadian blood and plasma donors, most participants held favorable views regarding expanding the eligibility of gbMSM donors based on sexual risk behavior. Understanding donors' views on increasing eligibility may inform Canadian Blood Services and other blood operators as they develop their communications plans.

Alternatives to blood donor deferral of gay, bisexual, and other men who have sex with men: Acceptability of screening the sexual risk behavior of all blood donors.

BACKGROUND: Blood operators screen donors to reduce the risk of transfusion-transmitted infections (TTIs). Many are evolving screening procedures from those that defer all who have had a sexual interaction with gay, bisexual, or other men who have sex with men (gbMSM) to an approach that assesses individual donors' recent sexual risk behavior with any partner. STUDY DESIGN AND METHODS: A representative sample of current blood donors (N = 1194) was recruited online and randomized to complete either the existing (at the time of the study) Canadian Blood Services' donor questionnaire (DQ) that screens out those with recent gbMSM sexual experience, a modified donor questionnaire (MDQ) that assesses individuals' recent sexual behavior with any partner, or an MDQ that assesses individual sexual behavior with any partner and explains why these questions are asked. Respondents were asked for their perceptions concerning difficulty, comfort, and acceptability of these screening questionnaires. RESULTS: Across experimental conditions, current donors regarded screening questionnaire difficulty to be low; discomfort in responding was minimal; screening questionnaires were perceived to be relatively inoffensive and justified, and very few donors would cease donating if the screening questionnaire they responded to became the one in general use. Some minor sex differences were observed, and in some cases, perceptions of the MDQ with explanation were somewhat more positive than those of the DQ and MDQ without explanation. DISCUSSION: An individual risk behavior screening approach appears to be acceptable to current blood donors as an alternative to screening out all who have recently engaged in gbMSM sexual interactions.

Sexual risk behavior questions: Understanding and mitigating donor discomfort.

BACKGROUND: Blood operators are working to improve donor screening and eligibility for gay, bisexual and other men who have sex with men (gbMSM), and trans and nonbinary donors. Many consider screening all donors for specific sexual risk behaviors to be a more equitable approach that maintains the safety of the blood supply. Feasibility considerations with this change include ensuring donor understanding of additional sexual behavior questions and minimizing donor loss due to discomfort. STUDY DESIGN AND METHODS: Qualitative one-on-one interviews were conducted with Canadian whole blood and plasma donors (N = 40). A thematic analysis was conducted to assess participants' understandings of the questions, examine their comfort/discomfort, and identify strategies to mitigate donor discomfort. RESULTS: All participants understood what the sexual behavior questions were asking and thought the questions were appropriate. Themes related to comfort/discomfort include: their expectations of donor screening, social norms that they bring to donation, whether their answer felt like personal disclosure, knowing the reasons for the question, trusting confidentiality, confidence in knowing their sexual partner's behavior, and potential for the question to be discriminatory. Strategies to mitigate discomfort include: providing an explanation for the questions, forewarning donors of these questions, reducing ambiguity, and using a self-administered questionnaire. CONCLUSION: While many blood operators and regulators view the move to sexual behavior-based screening for all donors as a significant paradigmatic shift, donors may not perceive additional sexual behavior questions as a significant change to their donation experience. Further research is needed to evaluate the effectiveness of strategies to mitigate donor discomfort.

Assessing unintentional creation of bias against men who have sex with men as a function of exposure to blood donor screening questionnaire: A national randomized controlled trial.

BACKGROUND: Canadian Blood Services (CBS) screens donors based on group status (e.g., men who have sex with men, MSM) instead of specific, high-risk sexual practices (e.g., occurrence of condomless sex). The MSM screening question is embedded in a cluster of questions about stigmatized attributes such as history of imprisonment and illicit substance use. This juxtaposition of the "MSM question" and stigmatized attributes may unintentionally cause blood donors to perceive MSM more negatively. The aim of this research is to determine whether the CBS donor eligibility questionnaire generates negative bias against MSM. STUDY DESIGN AND METHODS: A national, randomized online study of 903 CBS donors was conducted. Participants completed either the existing blood donor eligibility questionnaire or a modified donor questionnaire that repositioned the MSM question among neutral questions. After completing the existing or modified questionnaire, bias against MSM was measured using the sexuality implicit association test (IAT) and Modern Homonegativity Scale - Gay Men (MHS-G). Lastly, participants estimated prevalence rates among MSM of certain stigmatized behaviors. RESULTS: Participants who completed the existing donor eligibility questionnaire more strongly associated gay men with negative attributes on the IAT (pone-tailed  = .045), suggesting question position generated implicit negative bias toward MSM. Responses to the MHS-G (pone-tailed  = .506) and prevalence estimation task (p = .443) indicated that question order had no significant impact on explicit bias. DISCUSSION: Positioning the MSM screening question among stigmatizing questions creates implicit negative bias against MSM. Policy makers should be mindful of question positioning when designing donor questionnaires.

Testing the Confluence Model of the Association Between Pornography Use and Male Sexual Aggression: A Longitudinal Assessment in Two Independent Adolescent Samples from Croatia.

According to confluence model theorizing, pornography use contributes to sexual violence, but only among men who are predisposed to sexual aggression. Support for this assertion is limited to cross-sectional research, which cannot speak to the temporal ordering of assumed causes and consequences. To address this issue, we employed generalized linear mixed modeling to determine whether hostile masculinity, impersonal sexuality, and pornography use, and their interactions, predicted change in the odds of subsequently reported sexual aggression in two independent panel samples of male Croatian adolescents (N1 = 936 with 2808 observations; N2 = 743 with 2972 observations). While we observed the link between hostile masculinity and self-reported sexual aggression in both panels, we found no evidence that impersonal sexuality and pornography use increased the odds of subsequently reporting sexual aggression-regardless of participants' predisposed risk. This study's findings are difficult to reconcile with the view that pornography use plays a causal role in male sexual violence.

Are We Losing the Most Relevant Cases First? Selective Dropout in Two Longitudinal Studies of Adolescent Pornography Use.

In longitudinal studies of pornography use, selective loss of participants who may be more vulnerable to the effects of pornography than their peers is a serious concern. To explore the potential for such selective dropout, we used data from two independent large-scale panel studies of adolescents' pornography use. Of the three types of attrition-early attrition, later attrition, and gaps in participation-only the first was substantially higher among more vulnerable adolescents, compared with other participants. Panel type (online vs. classroom-based) moderated only the association between vulnerability and participation gaps, which was significant in the classroom-based but not the online panel. Overall, this study's findings point to the importance of delaying selective dropout by developing a comprehensive plan of action, for which we offer some guidelines.

Compersion: When Jealousy-Inducing Situations Don't (Just) Induce Jealousy.

Emotional reactions to a partner's extradyadic romantic interests are assumed to be negative and characterized by jealousy, an emotional state that arises over a perceived threat to one's relationship. Yet, reactions may also be positive, and involve compersion, or taking joy in one's partner's pleasure in other sexual and relational encounters. Although some have argued that compersion is the opposite of jealousy, research suggests that compersion and jealousy may not be opposing constructs, despite being treated this way in both theoretical and empirical research. Using a convenience sample of polyamorous (N = 3530) and monogamous (N = 1358) individuals, we draw on theories of jealousy, emotional ambivalence, and emotional forecasting to examine people's anticipated affective responses to hypothetical situations involving a partner's extradyadic relations and assess whether experience with having a partner engage in extradyadic relations was associated with anticipating less jealousy and more compersion. Results suggest that people in polyamorous relationships report less jealousy and more compersion with their partners, and that personal experience involving a partner's extradyadic romantic interests predicted more compersion and less jealousy, with experience predicting greater increases in compersion among monogamous than polyamorous participants. Finally, while anticipated compersion was associated with greater relationship satisfaction, neither jealousy nor ambivalence was associated with relationship satisfaction. These results further demonstrate that individuals can experience both positive and negative reactions to a partner's extradyadic relations, both based on actual experience and projection of responses to future events, and that real-life experiences are important in anticipating these emotions.

Reading Pornography: Methodological Considerations in Evaluating Pornography Research.

INTRODUCTION: With the emergence of rapidly expanding access to sexually explicit materials, research concerning pornography prevalence, pornography content, pornography users, and pornography effects has increased steadily among scientists and clinicians. Findings in this research area are often inconsistent and controversial. AIM: The current discussion aims to assist scientists and clinicians to "read pornography-that is, pornography research-" from an appropriately rigorous scientific perspective, so that we may approach work in this area with a clearer understanding of the often contested evidence base and a clearer understanding of what science can, and cannot, tell us, at present, about pornography prevalence, content, users, and effects. METHODS: Discussion focuses on the critical implications, for scientific validity and clinical application, of variations in research design, participant sampling, conceptual and operational definitions of "pornography" and "use," measurement of sexually violent content, and measurement of pornography use effects. RESULTS: Failure to acknowledge the implications of research design limitations and heterogeneity of conceptual and operational definitions of pornography have resulted in an inconsistent and contested evidence base in this area. CLINICAL IMPLICATIONS: Clinicians must rigorously evaluate the published literature concerning pornography, according to classical principles of scientific research, before clinical application of diverse and inconsistent research claims. STRENGTH & LIMITATIONS: This analysis brings to bear classic scientific considerations in attempting to strengthen critical reading and research contributions in the area of pornography prevalence, content, users, correlates, and effects. Many of the assertions and suggestions contained in this discussion await empirical verification. CONCLUSION: Rigorous application of basic scientific research principles should guide the evaluation and conduct of research concerning pornography prevalence, content, users, covariates, and effects. Fisher WA, Kohut T. Reading Pornography: Methodological Considerations in Evaluating Pornography Research. J Sex Med 2020;17:195-209.

Comparing Relationship Quality Across Different Types of Romantic Partners in Polyamorous and Monogamous Relationships.

Polyamory is the practice of having multiple emotionally close relationships that may or may not be sexual. Research concerning polyamory has just begun to determine how relationships among partners in polyamorous arrangements may vary. Most of the research assessing perceptions of polyamorous partners has focused on primary-secondary configurations; however, non-hierarchical configurations exist and can involve having multiple primary partners or having only non-primary partners. The current research is the first to examine perceptions of partners and relationship quality in various polyamorous configurations and compares results for each configuration to monogamous partners. Results from online convenience samples suggest that co-primary and non-primary configurations are common among polyamorous participants, with approximately 38% identifying with one of these configurations in 2013 and 55% in 2017. Furthermore, our results suggest that while relationships with partners in co-primary and non-primary structures still differ in some ways (e.g., investment, acceptance, secrecy, time spent having sex), they are closer to their ideals on several psychologically meaningful indicators of relationship quality (e.g., commitment and satisfaction). In other words, despite rejecting hierarchical primary-secondary labels, many of the same relationship qualities differ systematically among partners in non-hierarchical relationships. Furthermore, pseudo-primary partners and primary partners in these relationships are more comparable to monogamous partners than they are to secondary partners. We discuss how these results inform our understanding of polyamorous and monogamous relationships and suggest future directions based on these findings.

The dynamics of adolescents' pornography use and psychological well-being: a six-wave latent growth and latent class modeling approach.

Despite increasing concerns that pornography decreases adolescents' well-being, existing empirical support for this position is largely limited to cross-sectional studies. To explore possible links between adolescent pornography use and psychological well-being more systematically, this study focused on parallel dynamics in pornography use, self-esteem and symptoms of depression and anxiety. A sample of 775 female and 514 male Croatian high school students (Mage at baseline 15.9 years, SD 0.52) from 14 larger secondary schools, who were surveyed 6 times at approximately 5-month intervals, was used for the analyses. The longitudinal data were analyzed using latent growth curve and latent class growth modeling. We observed no significant correspondence between growth in pornography use and changes in the two indicators of psychological well-being over time in either female or male participants. However, a significant negative association was found between female adolescents' pornography use and psychological well-being at baseline. Controlling for group-specific trajectories of pornography use (i.e., latent classes) confirmed the robustness of findings in the both female and male samples. This study's findings do not corroborate the notion that pornography use in middle to late adolescence contributes to adverse psychological well-being, but do not rule out such a link during an earlier developmental phase-particularly in female adolescents. The findings have ramifications for educational and adolescent health specialists, but also for concerned parents.

The Role of Religiosity in Adolescents' Compulsive Pornography Use: A Longitudinal Assessment.

Despite increasing concerns that adolescent men are vulnerable to developing compulsive pornography use, little research has been done in this area. Given recent theorizing and research concerning moral incongruence, we hypothesized that symptoms of compulsive pornography use should generally be associated with higher levels of pornography use and increased growth in male adolescent pornography use over time, but that this pattern would be attenuated among very religious participants. These hypotheses were tested with mixed effects growth models using two independent panel samples of male Croatian adolescents. As expected, adolescent men who reported features of compulsive pornography use tended to exhibited higher levels of pornography use. However, contrary to expectations, increased growth in pornography use was limited to more religious compulsive users. Compared to nonreligious compulsive users, these adolescents started with lower initial levels of pornography use and their use increased over time at a greater rate of change. This study's results are the first to suggest that some adolescent men who report high levels of pornography use tend to exhibit symptoms of compulsive use, which highlights a need for counseling and therapeutic attention. Our findings also have implications for the emerging theory of moral incongruence.

HPV Unvaccinated Status and HPV Sexual Risk Behaviour are Common among Canadian Young Adult Women and Men.

OBJECTIVE: The current research focuses on sexual risk behaviour among young adult Canadians who have not been vaccinated against HPV. METHODS: Six hundred and forty-six Canadian university undergraduates completed a self-administered survey assessing HPV vaccination status and sexual risk behaviour. RESULTS: Five hundred and thirty-seven participants (154 men and 383 women aged 17-23) who met eligibility criteria were analyzed. 48.5% (n = 185) of female and 89.6% (n = 138) of male participants had not been vaccinated against HPV. In the unvaccinated cohort, 51.4% (n = 95) of women were coitally experienced, 49.2% (n = 91) reported experience with oral sex, and 6.5% (n = 12) reported experience with receptive anal intercourse. 55.1% (n = 76) of men were coitally experienced, 22.5% (n = 31) of men reported receptive oral sex, and 2.9% (n = 4) of men reported receptive anal intercourse. Using validated sexual risk behaviour cut-offs, we determined that in the female unvaccinated population, the proportion at significantly increased risk for genital warts, cervical, anal, and oropharyngeal cancer was 11.0%, 30.0%, 6.5%, and 49.2% respectively. In the male unvaccinated population, the proportion at significantly elevated risk for genital warts and anal cancer was 27.2% and 2.9% respectively. CONCLUSION: Unvaccinated young Canadian women and men commonly engaged in sexual risk behaviours for HPV infection, engaged in sexual risk behaviours at a similar level as their vaccinated counterparts, and a substantial number were at elevated risk of HPV related morbidities at a young age. Findings contribute to an evidence-based case for redoubling efforts to encourage HPV vaccination among unvaccinated young Canadians who are at risk of HPV infection.

Perceived Effects of Pornography on the Couple Relationship: Initial Findings of Open-Ended, Participant-Informed, "Bottom-Up" Research.

The current study adopted a participant-informed, "bottom-up," qualitative approach to identifying perceived effects of pornography on the couple relationship. A large sample (N = 430) of men and women in heterosexual relationships in which pornography was used by at least one partner was recruited through online (e.g., Facebook, Twitter, etc.) and offline (e.g., newspapers, radio, etc.) sources. Participants responded to open-ended questions regarding perceived consequences of pornography use for each couple member and for their relationship in the context of an online survey. In the current sample of respondents, "no negative effects" was the most commonly reported impact of pornography use. Among remaining responses, positive perceived effects of pornography use on couple members and their relationship (e.g., improved sexual communication, more sexual experimentation, enhanced sexual comfort) were reported frequently; negative perceived effects of pornography (e.g., unrealistic expectations, decreased sexual interest in partner, increased insecurity) were also reported, albeit with considerably less frequency. The results of this work suggest new research directions that require more systematic attention.

Revisiting the Role of Pornography Use in the Confluence Model Theory of Sexual Aggression.

This research tested Confluence Model reasoning that pornography use should be related to sexual aggression among men who are high but not low in the predisposing risk factors of hostile masculinity (HM) and impersonal sexuality (IS). This hypothesis was examined with three online surveys of young adult males, including an American Mechanical Turk sample (N1 = 1,528, Mage = 22.46 years); a national sample of Canadian students (N2 = 1,049, Mage = 20.89 years); and a national sample of Canadian non-students (N3 = 905, Mage = 21.66 years). As expected, synergistic interactions between HM and IS reliably predicted self-reported sexual aggression across samples. Results with respect to interactions with pornography use were more complex. The Confluence Model hypothesis was supported when pornography use was operationalized as the use of nine specific magazines but it was not supported when pornography use was operationalized with a contemporary inclusive approach that included use of internet materials. These discrepant findings are difficult to account for with Confluence Model theorizing and highlight the non-equivalence of pornography use measures in survey research.

Understanding human papillomavirus vaccination intentions: comparative utility of the theory of reasoned action and the theory of planned behavior in vaccine target age women and men.

INTRODUCTION: Human papillomavirus (HPV) is an exceedingly prevalent sexually transmitted infection with serious medical, sexual, and relationship consequences. HPV vaccine protection is available but vaccine uptake is very inconsistent. AIMS: This research applies two major theories of health behavior uptake, the Theory of Reasoned Action and the Theory of Planned Behavior, in an effort to understand intentions to receive HPV vaccine among vaccine target age women and men. The Theory of Reasoned Action asserts that attitudes toward HPV vaccination and perceptions of social support for HPV vaccination are the determinants of intentions to be vaccinated, whereas the Theory of Planned Behavior holds that attitudes toward vaccination, perceptions of social support for vaccination, and perceived ability to get vaccinated are the determinants of intentions to be vaccinated. METHODS: Canadian university men (N=118) and women (N=146) in the HPV vaccine target age range took part in this correlational study online. MAIN OUTCOME MEASURES: Participants completed standard measures of attitudes toward HPV vaccination, perceptions of social support for vaccination, perceived ability to get vaccinated, beliefs about vaccination, and intentions to be vaccinated in the coming semester. RESULTS: Findings confirmed the propositions of the Theory of Reasoned Action and indicated that attitudes toward undergoing HPV vaccination and perceptions of social support for undergoing HPV vaccination contributed uniquely to the prediction of women's (R2=0.53) and men's (R2=0.44) intentions to be vaccinated in the coming semester. CONCLUSION: Clinical and public health education should focus on strengthening attitudes and perceptions of social support for HPV vaccination, and on the basic beliefs that appear to underlie attitudes and perceptions of social support for HPV vaccination, in efforts to promote HPV vaccine uptake.

Pornography, sex crime, and paraphilia.

The current paper reviews research findings concerning the association of pornography with sexual violence and paraphilic interests. Little clarity concerning the causal impact of pornography on sexual aggression or child-oriented sexual behavior has been achieved in the scientific literature. Laboratory experimentation demonstrates that violent pornography may contribute to antiwoman aggression, but the artificiality and constraints of the experimental setting severely limit generalization of these findings to real-world situations, and observational studies in natural settings consistently find no association or an inverse association of pornography with sexual aggression. In addition, although pedophiles often use child pornography, the causal impact of child pornography on child sexual offending is not conclusive. The current analysis considers the confluence of predisposing factors and pornography use as issues requiring clinical judgment in the reduction of sexual aggression and management of paraphilic interest in children.