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.

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.

Clinicians Are Not Able to Infer Parental Intentions to Vaccinate Infants with a Seasonal Influenza Vaccine, and Perhaps They Should Not Try: Findings from the Pediatric Influenza Vaccination Optimization Trial (PIVOT)-IV.

This prospective cohort survey evaluated the concordance of clinicians' perceptions of parental intentions and parents' actual intentions to vaccinate their infants against influenza. During a routine healthy baby visit, clinicians provided parents with information about influenza, children's vulnerability to influenza, and nonadjuvanted and adjuvanted trivalent influenza vaccines (TIV and aTIV, respectively). Before and after the clinician−parent interaction, parents were surveyed about their attitudes, their perceptions of support from significant others, and the intention to vaccinate their infant with aTIV. Clinicians were asked about their perception of parents' intentions to choose aTIV for their children. These assessments included 24 clinicians at 15 community practices and nine public health clinics, and 207 parents. The correlation coefficients of the clinicians' assessment of parents' intention to vaccinate were 0.483 (p < 0.001) if the vaccine was presented as free of cost, 0.266 (p < 0.001) if the cost was $25, and 0.146 (p = 0.036) if the cost was $50, accounting for 23%, 7%, and 2% of the variance in parental intentions, respectively. The clinicians were poor at predicting parental intentions to immunize, particularly when cost was involved. Information on vaccine options and influenza infection should be provided for every eligible patient to allow parents to determine if the vaccine is appropriate for their child.

Parental Attitudes and Perceptions of Support after Brief Clinician Intervention Predict Intentions to Accept the Adjuvanted Seasonal Influenza Vaccination: Findings from the Pediatric Influenza Vaccination Optimization Trial (PIVOT)-I.

Adjuvanted trivalent influenza vaccine (aTIV) provides enhanced protection against seasonal influenza in children compared with nonadjuvanted trivalent influenza vaccine (TIV). This prospective cohort study assessed parental attitudes, beliefs, and intentions to vaccinate their infants aged 6-23 months with aTIV. Parents were surveyed before and after routine healthy baby visits, and post clinician interaction results were analyzed using multivariable logistic regression. Physicians at 15 community practice clinics and nurses at 3 public health clinics participated; 207 parents were surveyed. After clinician consultation, most parents considered immunization with aTIV to be safe (72.9%), effective (69.6%), and important (69.0%); most perceived support for vaccination from significant others (62.8%) and clinicians (81.6%); and 66.6% intended to vaccinate their infant with aTIV. Parental attitudes toward vaccinating their infant with aTIV were strongly correlated with perceptions of vaccine safety, efficacy, and importance, and these represented the strongest influence on intentions to vaccinate (odds ratio (OR) 79.25; 95% confidence interval (CI) 6.05-1037.50). Parental intentions were further influenced by perceived strength of clinician recommendation (OR 4.55, 95% CI 1.38-15.06) and social support for vaccination (OR 3.46, 95% CI 0.50-24.13). These findings may inform clinician approaches to parental education to ensure optimal seasonal pediatric influenza vaccination.

Understanding the Impact of Approved but Unfunded Vaccine Status on Parental Acceptance of an Adjuvanted Seasonal Influenza Vaccine for Infants: Results from the Pediatric Influenza Vaccination Optimization Trial (PIVOT)-III.

The adjuvanted trivalent influenza vaccine (aTIV) provides enhanced protection against influenza for infants but is not publicly funded (NPF). The objective of this prospective cohort study of parents with children 6 through 23 months of age was to understand how NPF status influences parental perceptions of approved but unfunded vaccines and their intentions to vaccinate. At healthy baby visits, clinicians provided parents with information about influenza and vaccination. Before and after these interactions, a research nurse assessed parents' intentions to vaccinate their children and their beliefs about the safety, efficacy, and necessity of vaccinating their children with aTIV in both publicly funded (PF) and NPF settings. Overall, 15 community practice clinics (n = 15 physicians) and nine public health clinics (n = 9 nurses) recruited 207 parents. The percentage of parents intending to immunize their children with aTIV decreased from 72% (vaccine PF, free of charge), to 42% (NPF, $25 per dose), to 27% (NPF, $50 per dose). Funding status strongly influenced whether parents perceived immunization with aTIV to be necessary, safe, and effective. Information on influenza and influenza vaccines should be provided to parents routinely to allow for well-informed decisions on the suitability of specific influenza vaccines for their child.

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.

Continuing Medical Education Improves Physician Communication Skills and Increases Likelihood of Pediatric Vaccination: Findings from the Pediatric Influenza Vaccination Optimization Trial (PIVOT)-II.

This study evaluated the impact of a continuing medical education (CME) program that emphasized actionable information, motivation to act, and skills to strengthen physician recommendations for seasonal influenza vaccination in children 6 through 23 months of age for whom influenza immunization rates are suboptimal. Physicians were randomly assigned to an accredited CME program or to no CME. Participants completed pre- and post-study questionnaires. Influenza immunization rates were compared between groups. A total of 33 physicians in the CME group and 35 in the control group documented 292 and 322 healthy baby visits, respectively. Significantly more parents immunized their children against influenza after interacting with CME-trained physicians than those with no CME training (52.9% vs. 40.7%; p = 0.007). The odds ratio for vaccination after visits with CME-trained physicians was 1.52 (95% confidence interval 1.09 to 2.12; p = 0.014), which was unaffected by the socioeconomic status of parents. Parents who discussed influenza vaccination with CME-trained physicians were 20% more likely to choose an approved but publicly unfunded adjuvanted pediatric influenza vaccine. The percentages of physicians reporting the highest levels of knowledge, ability, and confidence doubled or tripled after the CME intervention. Significantly more parents immunized very young children after interacting with physicians who had undergone CME training.

No Gender Differences in Enrollment for Replicated, Minimally-Different 'Pornographic' Versus 'Photographic' Studies.

Objective: Since women tend to use pornography less, they may enroll less in studies concerning it and/or those who do may be gender-atypical. Methods: One study plus replication, assessed proportion of participants reporting being women, responding to each of two, minimally different (one including the word "pornographic") study advertisement versions, and their pornography use frequency, Erotophilia-Erotophobia, and Openness to Experience. Results: Proportion responding to each version did not differ. In one sample only, women responding to one version differed in Openness to Experience. Conclusions: Advertising to North American convenience samples using the word "pornographic", may produce neither self-selection out by, nor over-sampling of gender-atypical, women.

But What's Your Partner Up to? Associations Between Relationship Quality and Pornography Use Depend on Contextual Patterns of Use Within the Couple.

It is commonly assumed that exposure to pornography harms relationships because pornography changes the way that individuals think, feel, and behave in problematic ways. In the current research, we contribute to a small but growing body of work that challenges this assumption by carefully scrutinizing the relational context of pornography use. In contrast to dominant theoretical explanations in this field, we argue that at least some of the apparent negative "impacts" of pornography use on relationship quality may reflect partner dissimilarity in pornography use behavior rather than the consequences of exposure to such materials. Moreover, we further examine a particular type of pornography use - shared use with a partner - which previous evidence suggests may be positively associated with relationship quality. To this end, we sought to test whether dyadic patterns of pornography use, and related attributes, were associated with sexual and relationship satisfaction in two cross-sectional (N 1 = 200; N 3 = 207) and two longitudinal (N 2 = 77; N 4 = 277) samples of heterosexual couples. Across these samples, we found consistent evidence that partners who watch pornography together report higher relationship and sexual satisfaction than partners who do not, and notably, this association was not moderated by gender. Independent of this association, we also found evidence of a similarity-dissimilarity effect, such that the solitary pornography use of one partner was negatively associated with their own relationship and sexual satisfaction, but only in cases where their romantic partners used little or no pornography alone. Further consideration of several correlates of pornography use established comparable patterns of results for dissimilarity in attitudes toward pornography, erotophobia-erotophilia, sexual preferences, and sex drive. Importantly, only dissimilarity in sex drive statistically accounted for dissimilarity in solitary pornography use, suggesting that differences in sex drive may be implicated in the associations between pornography use and relationship quality. These findings demonstrate that links between pornography use and relationship health are partially a function of different dyadic patterns of pornography use within couples and do not always suggest relational harm.

Committee Opinion No. 419: Coercion Free Contraceptive Care.

OBJECTIVE: To provide guidance on culturally competent contraception counselling that is free of coercion and promotes shared decision-making and patient autonomy. TARGET POPULATION: Individuals of reproductive age who seek contraception or counselling for family planning. OPTIONS: Contraception counselling is provided within a rights-based family planning framework, where the individual's beliefs, culture, preferences, and ability to use the chosen method are respected. OUTCOMES: To promote patient autonomy in decision-making surrounding family planning, including the right to access and use their contraceptive method of choice, to decline contraception or use less effective methods of contraception, and to freely choose to discontinue a method of contraception, as well as the right to unbiased, non-coercive contraception counselling and evidence-based information from their health care provider BENEFITS, HARMS, AND COSTS: Implementation of these recommendations would reduce real or perceived coercive contraceptive care, particularly among vulnerable populations, resulting in improved patient autonomy and a better patient experience in health care settings. EVIDENCE: Databases searched: MEDLINE, Cochrane, PubMed, and CanLII. Medical terms used: contraception, family planning services, informed consent, coercion, decision making, sterilization, permanent contraception, counselling. Legal terms searched: forced sterilization, and aboriginal. Initial search conducted in 2020 and updated in 2021. INTENDED AUDIENCE: This committee opinion is intended for health care providers (obstetricians, gynaecologists, family physicians, general surgeons, nurse practitioners, nurses, midwives, undergraduate/postgraduate medical trainees, and other health care providers) who provide sexual and reproductive health services.

Achieving Influenza Vaccine Uptake Target in Canada via a Pharmacy-Led Telephone Discussion during the 2019-2020 Season.

Older adults (≥65 years) are at elevated risk of influenza-related morbidity and mortality. Many developed countries do not achieve the World Health Organization influenza immunization target of 75% in people ≥65 years. We aimed to determine whether a brief pharmacy phone call could increase vaccine uptake of standard and enhanced influenza. Twenty-eight community pharmacists across Canada performed a telephone consultation with 643 older adults whose primary care records indicated that they had not received their influenza vaccination from their usual practitioner. Of these 643 adults, 169 (26.3%) had been vaccinated in another setting. Of the remaining 474, 313 (66%) agreed to receive the vaccine. Of those who refused vaccination, 69 provided a rationale for not wanting it, including that the flu shot "causes the flu" (n = 25), "doesn't work" (n = 25), "is too painful" (n = 10), and other (n = 10). Overall, of the 643 individuals who had not received their vaccination from their usual health care provider in the first wave of vaccinations, 75.4% (n = 485) ultimately received their vaccination in the 2019-2020 season. This highlights the important role of the community pharmacist in achieving the World Health Organization (WHO) targets for vaccination.

Understanding Influenza Vaccination During Pregnancy in Canada: Attitudes, Norms, Intentions, and Vaccine Uptake.

To improve uptake of influenza vaccine in pregnancy, it is important to understand the factors that predict prenatal vaccination. The aim of this study was to test the capability of the theory of planned behavior, augmented with information constructs, to predict and explain influenza vaccination uptake in a sample of 600 pregnant individuals in Canada. A baseline survey at the start of influenza season assessed beliefs, norms, perceived control, and information-seeking behavior related to influenza vaccination in pregnancy, as well as respondent demographics. A follow-up survey at the conclusion of influenza season assessed self-reported influenza vaccine uptake as well as infant vaccination intentions. Multivariable analysis indicated that attitudes toward influenza vaccination in pregnancy, subjective norms, information seeking, and past vaccination behavior predicted intentions to be vaccinated, and intentions predicted vaccine uptake. Neither perceived control nor demographics were significant predictors of intentions or vaccine uptake. These findings suggest that presumptive offering of vaccination in pregnancy by health care providers, as well as patient and public health educational interventions, may be effective in communicating norms and strengthening positive attitudes and intentions concerning influenza vaccination in pregnancy, resulting in higher vaccine coverage.

A dyadic approach to understanding safer sex behavior in intimate heterosexual relationships.

This study applied a dyadic approach to condom-use research. Partners from 124 heterosexual couples independently completed a questionnaire assessing condom-related attitudes, subjective norms, perceived behavioral control, and intentions to use condoms. Results demonstrate the superiority of a dyadic approach to understanding couples' condom-use intentions and behavior over traditional, individual-level approaches. The addition of partner effects to the model, via the actor-partner interdependence model, resulted in an increase in the variance accounted for in condom-use intentions and this dyadic model showed better fit compared to the individual-level model. The results suggest that consideration of relationship partners plays an important role in the prediction of safer sex intentions.

An Exploration of Factors That Influence Enactment of Affirmative Consent Behaviors.

Affirmative sexual consent, which is ongoing, continuous, and clearly communicated, appears to be highly inconsistent with the way in which individuals actually negotiate their sexual interactions. The current qualitative research proposes an Information-Motivation-Behavioral Skills (IMB) model of sexual consent behavior and elicits, from young, sexually active informants, elements of information, motivation, and behavioral skills that appear to be necessary for engaging in affirmative consent behaviors. Eleven focus groups were conducted (N = 48 participants), which were semi-structured and guided by questions to tap into information, motivation, and behavioral skills aspects of ascertaining and expressing affirmative sexual consent. Two themes related to Information emerged from the data: (1) consent should be verbal, clear, and ongoing, and (2) consent should be natural and free-flowing. Two themes related to motivation were discussed: (1) affirmative consent is awkward, and (2) explicitly asking for consent can be good, but ascertaining consent indirectly is more comfortable. One theme related to behavioral skills was discussed: (1) social and personal factors influence how easy or hard it is to explicitly discuss consent to sexual activity. Understanding factors that influence affirmative sexual consent is an essential step toward developing interventions to promote consensual sexual interactions and explicit sexual communication.

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.

Surveying Pornography Use: A Shaky Science Resting on Poor Measurement Foundations.

A great deal of pornography research relies on dubious measurements. Measurement of pornography use has been highly variable across studies and existing measurement approaches have not been developed using standard psychometric practices nor have they addressed construct validation or reliability. This state of affairs is problematic for the accumulation of knowledge about the nature of pornography use, its antecedents, correlates, and consequences, as it can contribute to inconsistent results across studies and undermine the generalizability of research findings. This article provides a summary of contemporary measurement practices in pornography research accompanied by an explication of the problems therein. It also offers suggestions on how best to move forward by adopting a more limited set of standardized and validated instruments. We recommend that the creation of such instruments be guided by the careful and thorough conceptualization of pornography use and systematic adherence to measurement development principles.

Human Papillomavirus Vaccines: Successes and Future Challenges.

Over a decade has passed since the first human papillomavirus (HPV) vaccine was introduced. These vaccines have received unequivocal backing from the scientific and medical communities, yet continue to be debated in the media and within the general public. The current review is an updated examination that the authors made five years ago on some of the key sociocultural and behavioral issues associated with HPV vaccine uptake and acceptability, given the changing HPV vaccine policies and beliefs worldwide. We explore current worldwide HPV vaccination rates, outline HPV vaccine policies, and revisit critical issues associated with HPV vaccine uptake including: risk compensation, perceptions of vaccine safety and efficacy, age of vaccination, and healthcare provider (HCP) recommendation and communication. While public scrutiny of the vaccine has not subsided, empirical evidence supporting its safety and efficacy beyond preventing cervical cancer has amassed. There are conclusive findings showing no link that vaccinated individuals engage in riskier sexual behaviors as a result of being immunized (risk compensation) both at the individual and at the policy level. Finally, HCP recommendation continues to be a central factor in HPV vaccine uptake. Studies have illuminated how HCP practices and communication enhance uptake and alleviate misperceptions about HPV vaccination. Strategies such as bundling vaccinations, allowing nurses to vaccinate via "standing orders," and diversifying vaccination settings (e.g., pharmacies) may be effective steps to increase rates. The successes of HPV vaccination outweigh the controversy, but as the incidence of HPV-related cancers rises, it is imperative that future research on HPV vaccine acceptability continues to identify effective and targeted strategies to inform HPV vaccination programs and improve HPV coverage rates worldwide.

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.