Brian Dodge

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• McGray, T. L., Peterson, Z. D., Bedrick, E., Dodge, B., & Koss, M. P. (2026). Where does risk emerge? A comparative look at sexual exploitation across queer, trans and cisgender heterosexual populations in the US. Journal of Sexual Aggression. doi:10.1080/13552600.2026.2653767
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  Revisions to the Sexual Experiences Survey (SES-V) allow for assessment of sexual exploitation without heterosexual norms or gendered language. SES-V estimates show alarmingly high prevalence in queer and trans (QT) individuals. However, little evidence compares sexual exploitation characteristics across intersecting sexual orientation and gender identity (SOGI). Using SES-V data from two adult samples (N = 850), we compared sexual exploitation prevalence and characteristics of across SOGI. Sexual exploitation prevalence was higher in QT individuals. Further disaggregation illuminated nuance, including significantly higher prevalence in bisexual and heterosexual cis women compared to lesbians. Sexual orientation played a role in sexual exploitation risk across genders and perpetrators were mostly cis men. Findings indicate the need for attention to nuance within the LGBTQ+ umbrella. Similarities in characteristics across SOGI suggest the role of socioecological factors. Future research should focally sample to produce diverse samples. Services should expand to support diverse sexual exploitation scenarios and provide community-level prevention. PRACTICE IMPACT STATEMENT: Prevention and programming materials should be expanded to include diverse sexual exploitation scenarios and survivor-victims. Incorporating community-based practices and network-oriented approaches in sexual exploitation services can additionally help reach survivor-victims and perpetrators who would otherwise not seek out those services and influence the larger socioecological norms and beliefs that lead individuals to perpetrate sexual exploitation.
• Ferrand, J., Dodge, B., Eastman-Mueller, H., Carter, G., Green, H. D., & Walsh-Buhi, E. (2025). Correlates of pre-exposure prophylaxis (PrEP) use among college students in the United States. Journal of HIV/AIDS and Social Services, 23(Issue 2). doi:10.1080/15381501.2024.2425654
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  Introduction: HIV rates in the US continue to be high despite the availability of effective prevention medication such as pre-exposure prophylaxis (PrEP). Little is known about how undergraduate college students engaging with campus healthcare services use PrEP. This study of a national sample of undergraduate college students explored the sociodemographic and behavioral factors associated with PrEP use. Methods: Data were collected as part of the National College Health Assessment (NCHA). Logistic regression models were used to estimate the likelihood of PrEP use. Results: PrEP use was low (3.0%) and was associated with recent anal sex and identifying as men or transwomen. Being unsure about one’s HIV testing history was associated with higher odds of PrEP use, a potential concern considering how crucial HIV testing is to PrEP adherence. Discussion: College students may benefit from more explicit discussions around HIV tests and the results of those tests as well as targeted messaging campaigns around PrEP.
• Ford, J. V., Shah, A. H., & Dodge, B. (2025). “No Man’s Land”: A Qualitative Exploration of Perceptions of Structural Stigma Among Bisexual Men Compared with Gay Men. LGBT Health, 12(Issue). doi:10.1177/23258292251361314
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  Purpose: Recent research suggests that the benefits of minimized structural stigma experienced by gay men are not matched in bisexual men. The purpose of this study was to explore how bisexual men perceive structural stigma compared with gay men in hopes of understanding why improvements in structural stigma among sexual minority individuals may not equally benefit bisexual people. Methods: In 2020-2021, we conducted in-depth interviews with 19 bisexual men and 40 gay men recruited from a larger longitudinal cohort study of 502 men. Interviews were conducted by phone or Zoom (camera off). The interview guides for gay and bisexual men were nearly identical, except that bisexual men were asked specifically about structural stigma related to bisexuality. All interviews were recorded digitally, transcribed verbatim, and analyzed using grounded theory as an analytic strategy. Results: Emergent findings show that three interrelated forces complicate the relationship between structural stigma and outcomes for bisexual men: assumed heterosexuality, invisibility and erasure of bisexuality, and the blurring of interpersonal and structural stigma. In particular, bisexual men had trouble identifying structural stigma, reflecting the difficulty of fully pinning down this type of stigma. Conclusion: To understand the disparate effects of structural stigma for bisexual and gay men, we encourage scholars to take these dynamics into account. We suggest new concrete ways to measure structural stigma against bisexual people and better incorporate perspectives from bisexual men into future structural stigma research and interventions.
• McGray, T. L., Dodge, B., Peterson, Z. D., Bedrick, E. J., & Koss, M. P. (2025). Examining Sexual Exploitation in a National US Sample of LGBTQ+ Individuals Using the Revised Sexual Experiences Survey-Victimization. Journal of Sex Research. doi:10.1080/00224499.2025.2507881
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  Sexual exploitation (SE) refers to sex acts imposed without freely given permission. Despite the elevated risks of SE experienced by LGBTQ+ individuals, limitations in many existing datasets and research reports preclude a comprehensive understanding by incorporating few LGBTQ+ individuals, not disaggregating by sexual orientation and gender identity (SOGI), and using non-inclusive measures of SE items. This paper presents the first use of the 2024 revised Sexual Experiences Survey-Victimization to quantify SE in a national adult LGBTQ+ sample (N = 474) using measurement beyond prototypical cisgender heterosexual scenarios. Prevalences of noncontact, technology-facilitated, illegal acts, and verbal pressure SE were stratified by SOGI. Logistic regression was used to assess associations between SOGI and SE. Findings suggest alarmingly high sample-wide prevalence, with 95.23% of participants reporting any experience of SE. Asexual and lesbian cisgender women had significantly lower odds of experiencing verbal pressure and illegal acts than bisexual cisgender women. High prevalence provides evidence for the urgent need to continue investigating LGBTQ+ SE, particularly illegal acts and technology-facilitated SE. Future research should oversample underrepresented SOGI subgroups to bolster cell sizes and increase reliability. Understanding LGBTQ+ SE is essential for informing targeted prevention and intervention.
• McGray, T. L., Dodge, B., Peterson, Z. D., Bedrick, E. J., & Koss, M. P. (2025). Examining Sexual Exploitation in a National US Sample of LGBTQ+ Individuals Using the Revised Sexual Experiences Survey-Victimization. Journal of sex research, 1-18.
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  Sexual exploitation (SE) refers to sex acts imposed without freely given permission. Despite the elevated risks of SE experienced by LGBTQ+ individuals, limitations in many existing datasets and research reports preclude a comprehensive understanding by incorporating few LGBTQ+ individuals, not disaggregating by sexual orientation and gender identity (SOGI), and using non-inclusive measures of SE items. This paper presents the first use of the 2024 revised Sexual Experiences Survey-Victimization to quantify SE in a national adult LGBTQ+ sample ( = 474) using measurement beyond prototypical cisgender heterosexual scenarios. Prevalences of noncontact, technology-facilitated, illegal acts, and verbal pressure SE were stratified by SOGI. Logistic regression was used to assess associations between SOGI and SE. Findings suggest alarmingly high sample-wide prevalence, with 95.23% of participants reporting any experience of SE. Asexual and lesbian cisgender women had significantly lower odds of experiencing verbal pressure and illegal acts than bisexual cisgender women. High prevalence provides evidence for the urgent need to continue investigating LGBTQ+ SE, particularly illegal acts and technology-facilitated SE. Future research should oversample underrepresented SOGI subgroups to bolster cell sizes and increase reliability. Understanding LGBTQ+ SE is essential for informing targeted prevention and intervention.
• Smith, A., Hainsworth, S., Chadwick, H., Dodge, B., & Bostwick, W. (2025). Perceptions of bisexual identity, outness, and mental health among racially diverse bisexual women and men. Self and Identity, 24(Issue 6). doi:10.1080/15298868.2025.2522431
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  This study, employing data from the Women’s and Men’s Daily Experiences Studies, examines relationships between outness, anticipated binegativity, internalized binegativity, bisexual meta-perceptions, and mental health among 235 racially diverse bisexual adults. Path analyses via MPLUS explored whether several measures of negative bisexual identity perceptions were associated with relationships between outness and mental health, while moderation analyses assessed if positive identity perceptions moderate this relationship. Outness showed no direct association with anxiety or depression. However, anticipated binegativity was related to increased anxiety and depression. The association between outness and the different measures of negative identity perceptions varied. Additionally, community connectedness was inversely related to depression. These findings emphasize the necessity for additional research addressing bisexual-specific stressors, fostering positive identity perceptions, and enhancing community support for improving the mental well-being of bisexual individuals, particularly those that are people of color.
• Ferrand, J., Dodge, B., Eastman-Mueller, H., Carter, G., Green, H., & Walsh-Buhi, E. (2024). Correlates of pre-exposure prophylaxis (PrEP) use among college students in the United States. Journal of HIV/AIDS & Social Services, 1-22.
• Ford, J. V., Dodge, B., Clark, K. A., Lattanner, M. R., Shah, A., & Hatzenbuehler, M. L. (2024). (Re)Conceptualizing Structural Stigma: Insights From a Qualitative Study of Sexual Minority Men in a Longitudinal, Population-Based Cohort. Stigma and Health. doi:10.1037/sah0000571
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  A growing body of evidence has documented the adverse health consequences of structural stigma across multiple marginalized groups, including sexual minority people. In light of these advancements, scholars have urged the field to refine conceptualizations of structural stigma to guide future empirical work. We heed this charge by analyzing two sets of qualitative data among gay and bisexual men obtained from a probability-based panel: (a) responses to an open-ended survey question about structural stigma (n = 385) and (b) in-depth interviews about their subjective experiences of structural stigma (n = 60). Our findings revealed three key dimensions underlying structural stigma. First, participants described structural stigma using metaphors conveying that their freedom had been severely constrained; structural stigma was variously portrayed as a “cage,” a “prison,” and a “net” where “there is no exit.” Second, structural stigma communicated a lack of recognition by others, whereby participants were treated as “sub-human” and “a second-class citizen.” Third, in contexts with high levels of structural stigma, participants reported a lack of social safety, including that their sense of belonging had been threatened; for one participant, structural stigma felt “like knocking on a door and being able to see people on the other side laughing at you for trying to get in.” Based on these themes, we offer a revised definition: Structural stigma is manifested when institutional policies, practices, and cultural norms produce societal conditions that create unfreedom, engender failures of recognition, or undermine social safety. Implications for structural stigma measurement and for research with other stigmatized groups are discussed.
• McGray, T., Hutton, B., Dodge, B., & Koss, M. (2024). Effects of social support interventions on LGBTQ+ survivor-victims of intimate partner violence: a systematic review. Sexual and Gender Diversity in Social Services, 1-33.
• Feinstein, B. A., Ford, J. V., Lattanner, M. R., Bo, N., Tu, W., & Dodge, B. (2023). The Role of Partner Gender in Bisexual Men's Stigma-Related Experiences and Mental Health: Results From a Probability-Based Sample in the United States. Stigma and health, 8(2), 179-186.
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  Bisexual men are disproportionately affected by negative mental health outcomes compared to heterosexual and gay men. These disparities are related to the unique stressors that they experience, and emerging evidence suggests that their experiences of these stressors can be different depending on the gender of their partner. However, previous studies have largely focused on bisexual women and little is known about the role of partner gender in bisexual men's experiences and mental health. We examined the associations between relationship type and outness, stigma-related experiences, and mental health using data from Wave 1 of the National Study of Stigma and Sexual Health, a probability-based sample of 502 gay and bisexual men in the U.S. Analyses focused on the subset of 128 men who identified as bisexual (44.53% in relationships with women, 14.84% in relationships with men, 40.63% not in relationships). Bisexual men in relationships with men reported being more out than those in relationships with women and those who were not in relationships; furthermore, bisexual men in relationships with men reported more discrimination and family stress than those in relationships with women. Bisexual men who were not in relationships reported more anticipated and internalized stigma than those in relationships with men; additionally, bisexual men who were not in relationships reported more anticipated stigma and depression than those in relationships with women. Partner gender plays a role in bisexual men's stigma-related experiences and mental health, and efforts to improve bisexual men's health should attend to sexual orientation, relationship status, and partner gender.
• Ferrand, J., Walsh-Buhi, E., Dodge, B., Svetina, D., & Herbenick, D. (2023). Variations in Pre-exposure Prophylaxis (PrEP) Awareness and Healthcare Provider Interactions in a Nationally Representative Sample of American Men Aged 15-49 Years: A Cross-Sectional Study. AIDS and behavior, 27(9), 2932-2943.
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  Awareness of and discussions with a healthcare provider (HCP) around pre-exposure prophylaxis (PrEP), an effective HIV prevention method, are associated with PrEP uptake, yet few studies utilize representative samples or report on these outcomes using distinct behavioral risk subgroups. This cross-sectional study utilized responses given by men on the 2017-2019 National Survey of Family Growth, a nationally representative survey of Americans aged 15-49 years. Multiple logistic regression models were used to determine how respondents' sociodemographic characteristics and HIV risk behaviors were related to PrEP awareness and HCP discussions. PrEP awareness was low (29.40%) as was the proportion who reported ever discussing PrEP with an HCP (4.48%). Odds of being PrEP aware and discussing PrEP with an HCP varied significantly within sexual behavior subgroups based on sociodemographic and behavioral characteristics highlighting the differential risks within distinct behavioral subgroupings of men. Sexual behavior subgroupings should be considered when promoting PrEP awareness and discussions as HIV risk behaviors vary considerably and sexual identity alone may not sufficiently capture one's HIV risk.
• Mata, D., Korpak, A. K., Macaulay, T., Dodge, B., Mustanski, B., & Feinstein, B. A. (2023). Substance Use Experiences Among Bisexual, Pansexual, and Queer (Bi+) Male Youth: A Qualitative Study of Motivations, Consequences, and Decision Making. Archives of Sexual Behavior, 52(Issue 3). doi:10.1007/s10508-022-02447-9
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  Sexual minority youth are at increased risk of substance use compared to their heterosexual peers, and bisexual youth appear to be at greatest risk. However, little is known about their motivations for and against using substances, how they make decisions, and what consequences they experience. We used qualitative data from a study of 54 cisgender and transgender male youth (ages 14–17 years) who reported attractions to more than one gender or regardless of gender (i.e., bisexual, pansexual, or queer; collectively referred to as bi+) to explore these aspects of substance use. Participants completed a survey and an interview, and interviews were thematically analyzed. Qualitative analyses revealed that participants described diverse motivations for using substances (e.g., to cope with stress, to experiment, to have fun) and for not using them (e.g., concern about consequences, not having access). The most common sources of stress were mental health problems, school, and family. They did not describe sexual orientation-related stress as a motivation for their use, but they acknowledged that it could influence others’ use. Participants also described thinking about when, where, and with whom they were going to use prior to doing so (e.g., only using in safe places and with people who they trusted). Finally, they described a range of consequences they experienced (e.g., getting sick, getting in trouble), and a subset of transgender participants described experiencing dependence symptoms. These findings suggest that substance use prevention and harm reduction interventions for bi+ male youth should address diverse motivations for use, including general stressors, which are often overlooked compared to minority-specific stressors. Further, interventions should approach youth as capable of making decisions. Findings also highlight the particular need to address substance use among transgender youth.
• Mata, D., Korpak, A. K., Macaulay, T., Dodge, B., Mustanski, B., & Feinstein, B. A. (2023). Substance Use Experiences Among Bisexual, Pansexual, and Queer (Bi+) Male Youth: A Qualitative Study of Motivations, Consequences, and Decision Making. Archives of sexual behavior, 52(3), 1169-1181.
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  Sexual minority youth are at increased risk of substance use compared to their heterosexual peers, and bisexual youth appear to be at greatest risk. However, little is known about their motivations for and against using substances, how they make decisions, and what consequences they experience. We used qualitative data from a study of 54 cisgender and transgender male youth (ages 14-17 years) who reported attractions to more than one gender or regardless of gender (i.e., bisexual, pansexual, or queer; collectively referred to as bi+) to explore these aspects of substance use. Participants completed a survey and an interview, and interviews were thematically analyzed. Qualitative analyses revealed that participants described diverse motivations for using substances (e.g., to cope with stress, to experiment, to have fun) and for not using them (e.g., concern about consequences, not having access). The most common sources of stress were mental health problems, school, and family. They did not describe sexual orientation-related stress as a motivation for their use, but they acknowledged that it could influence others' use. Participants also described thinking about when, where, and with whom they were going to use prior to doing so (e.g., only using in safe places and with people who they trusted). Finally, they described a range of consequences they experienced (e.g., getting sick, getting in trouble), and a subset of transgender participants described experiencing dependence symptoms. These findings suggest that substance use prevention and harm reduction interventions for bi+ male youth should address diverse motivations for use, including general stressors, which are often overlooked compared to minority-specific stressors. Further, interventions should approach youth as capable of making decisions. Findings also highlight the particular need to address substance use among transgender youth.
• Owens, C., Voorheis, E., Lester, J. N., Green, H. D., Herbenick, D., Dodge, B., & Hubach, R. D. (2023). The lived experiences of rural HIV social workers. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 35(Issue 1). doi:10.1080/09540121.2021.1981817
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  HIV service providers are the primary implementers of HIV care services, but rural HIV service providers are under researched. We used an interpretative phenomenological analysis to explore rural HIV service providers’ lived experiences of working in HIV care, who work in a rural region of a Midwestern state in the United States. From July to August 2019, 15 HIV service providers participated in a one-hour semi-structured telephone interview that elicited their experiences working in the rural HIV care continuum. Participants were tired of constantly educating and working to reduce HIV stigma; however, they received support from family and friends once they educated them about HIV. Participants felt they lacked control over systems and they developed emotional-based coping to address constant occupational stressors. Findings highlight the importance of resiliency and advocacy research and practice across ecological levels.
• Owens, C., Voorheis, E., Lester, J. N., Green, H. D., Herbenick, D., Dodge, B., & Hubach, R. D. (2023). The lived experiences of rural HIV social workers. AIDS care, 35(1), 48-52.
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  HIV service providers are the primary implementers of HIV care services, but rural HIV service providers are under researched. We used an interpretative phenomenological analysis to explore rural HIV service providers' lived experiences of working in HIV care, who work in a rural region of a Midwestern state in the United States. From July to August 2019, 15 HIV service providers participated in a one-hour semi-structured telephone interview that elicited their experiences working in the rural HIV care continuum. Participants were tired of constantly educating and working to reduce HIV stigma; however, they received support from family and friends once they educated them about HIV. Participants felt they lacked control over systems and they developed emotional-based coping to address constant occupational stressors. Findings highlight the importance of resiliency and advocacy research and practice across ecological levels.
• Beckmeyer, J. J., Patterson, C. L., Fu, T. C., Hensel, D. J., Dodge, B., & Herbenick, D. (2022). Do Adolescents and Young Adults Learn About Condoms from Healthcare Providers? Findings from a US Probability Sample. Sexuality Research and Social Policy, 19(Issue 2). doi:10.1007/s13178-021-00589-4
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  Introduction: Using data from the 2018 National Survey of Sexual Health and Behavior, we determined the prevalence and content of adolescents’ and young adults’ communication with healthcare providers about condom use. Methods: Adolescents (14–17 years old; n = 283) and young adults (18–24 years old, n = 225), who discussed sexual health with a healthcare provider in the past year, reported if they had discussed condom use with a healthcare provider, and among those who did, they also reported why healthcare providers recommended condoms, if they demonstrated correct condom use, and/or provided condoms. Data collection occurred in February and March 2018. Results: Most adolescents (71.0%) and young adults (66.7%) who discussed sexual health with a healthcare provider reported discussing condom use. Condoms were most often recommended for both pregnancy and STD prevention. Fewer adolescents and young adults were shown how to use condoms (11.4% of adolescents; 5.7% of young adults) or provided condoms (14.9% of adolescents; 14.7% of young adults). Only 3.2% of adolescents and 1.3% of young adults had healthcare providers who discussed, demonstrated, and provided condoms. Conclusions: Sexual health conversations with healthcare providers are likely to include condoms. But few adolescents and young adults were shown how to use condoms or provide condoms. Policy Implications: Providing healthcare providers with resources and trainings about how to talk about condoms with patients may lead to more adolescents and young adults learning medically accurate information about condoms. Healthcare offices and clinics could also provide condom use resources outside of provider-patient interactions.
• Eastman-Mueller, H., Fu, T. C., Dodge, B. M., & Herbenick, D. (2022). The relationship between college students' campus sexual health resource utilization and self-reported STI testing: Findings from an undergraduate probability survey. Journal of American college health : J of ACH, 70(3), 843-851.
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  To examine the prevalence of student utilization of campus sexual health resources and their association with sexually transmitted infection (STI) testing. Undergraduate students ( = 7020) at a large Midwestern university completed a confidential online survey in 2015. A probability-based sample of undergraduate students completed a cross-sectional online survey. Commonly accessed sexual health resources were student orientation activities about sexual assault or rape, sexuality/gender classes, gender and sexual orientation panels, class panels on sexual assault, birth control and STI presentations, and having joined a sexuality-related student organization. Campus sexual health resource utilization was significantly associated with greater STI testing since college. Gender, race, class level, enrollment status, sexual orientation, timing of last sexual event, and perceived STI risk were significantly associated with STI testing in college. Campus sexual health resources play an important role in student sexual health promotion.
• Eastman-Mueller, H., Fu, T. c., Dodge, B. M., & Herbenick, D. (2022). The relationship between college students’ campus sexual health resource utilization and self-reported STI testing: Findings from an undergraduate probability survey. Journal of American College Health, 70(Issue 3). doi:10.1080/07448481.2020.1775607
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  Objective To examine the prevalence of student utilization of campus sexual health resources and their association with sexually transmitted infection (STI) testing. Participants: Undergraduate students (n = 7020) at a large Midwestern university completed a confidential online survey in 2015. Methods: A probability-based sample of undergraduate students completed a cross-sectional online survey. Results: Commonly accessed sexual health resources were student orientation activities about sexual assault or rape, sexuality/gender classes, gender and sexual orientation panels, class panels on sexual assault, birth control and STI presentations, and having joined a sexuality-related student organization. Campus sexual health resource utilization was significantly associated with greater STI testing since college. Gender, race, class level, enrollment status, sexual orientation, timing of last sexual event, and perceived STI risk were significantly associated with STI testing in college. Conclusions: Campus sexual health resources play an important role in student sexual health promotion.
• Fritz, N., Malic, V., Fu, T. C., Paul, B., Zhou, Y., Dodge, B., Fortenberry, J. D., & Herbenick, D. (2022). Porn Sex versus Real Sex: Sexual Behaviors Reported by a U.S. Probability Survey Compared to Depictions of Sex in Mainstream Internet-Based Male-Female Pornography. Archives of sexual behavior, 51(2), 1187-1200.
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  Using data from a 2014 U.S. nationally representative probability survey and a 2014 content analysis of 2562 male-female videos from two popular pornographic websites, this study aimed to: (1) compare the prevalence of survey respondents' event-level sexual behaviors with those depicted in mainstream pornography online videos; (2) compare event-level condom use with condom use prevalence in pornographic videos; (3) compare event-level orgasm with prevalence of orgasms in pornographic videos; and (4) assess whether respondents' partnered use of pornography was associated with the sexual behaviors in which they report engaging. We found that kissing, male orgasm, female orgasm, and condom use were significantly less prevalent in the pornographic videos than in survey respondents' most recent sexual experiences. Conversely, penile-anal intercourse and fellatio were significantly more prevalent in the pornographic videos than in participants' reports of their most recent sexual experience. There were no significant differences between the prevalence of cunnilingus or sex toy use represented in the videos as compared to survey respondents' reports. Finally, we found that individuals who reported partnered pornography use during their most recent sexual experience were more likely to report having engaged in oral sex, penile-anal intercourse, and sex toy use and were also more likely to report female orgasm during their most recent sexual experience.
• Fritz, N., Malic, V., Fu, T. c., Paul, B., Zhou, Y., Dodge, B., Fortenberry, J. D., & Herbenick, D. (2022). Porn Sex versus Real Sex: Sexual Behaviors Reported by a U.S. Probability Survey Compared to Depictions of Sex in Mainstream Internet-Based Male–Female Pornography. Archives of Sexual Behavior, 51(Issue 2). doi:10.1007/s10508-021-02175-6
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  Using data from a 2014 U.S. nationally representative probability survey and a 2014 content analysis of 2562 male–female videos from two popular pornographic websites, this study aimed to: (1) compare the prevalence of survey respondents’ event-level sexual behaviors with those depicted in mainstream pornography online videos; (2) compare event-level condom use with condom use prevalence in pornographic videos; (3) compare event-level orgasm with prevalence of orgasms in pornographic videos; and (4) assess whether respondents’ partnered use of pornography was associated with the sexual behaviors in which they report engaging. We found that kissing, male orgasm, female orgasm, and condom use were significantly less prevalent in the pornographic videos than in survey respondents’ most recent sexual experiences. Conversely, penile–anal intercourse and fellatio were significantly more prevalent in the pornographic videos than in participants’ reports of their most recent sexual experience. There were no significant differences between the prevalence of cunnilingus or sex toy use represented in the videos as compared to survey respondents’ reports. Finally, we found that individuals who reported partnered pornography use during their most recent sexual experience were more likely to report having engaged in oral sex, penile–anal intercourse, and sex toy use and were also more likely to report female orgasm during their most recent sexual experience.
• Mata, D., Korpak, A. K., Sorensen, B. L., Dodge, B., Mustanski, B., & Feinstein, B. A. (2022). A Mixed Methods Study of Sexuality Education Experiences and Preferences Among Bisexual, Pansexual, and Queer (Bi+) Male Youth. Sexuality Research and Social Policy, 19(Issue 2). doi:10.1007/s13178-021-00593-8
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  Introduction: Bisexual male youth are more likely to engage in certain behaviors that contribute to HIV/STI transmission (e.g., substance use) than are heterosexual and gay male youth. However, sexuality education rarely addresses the unique needs of sexual minority youth, especially bisexual, pansexual, and queer (bi+) youth, and little is known about their sexuality education experiences and preferences. As such, the goal of this study was to examine bi+ male youth’s experiences learning about sex and their preferences for sexuality education. Methods: In 2019, 56 bi+ male youth ages 14–17 were surveyed and interviewed about their sexuality education experiences and preferences. Participants identified as bisexual (64%), pansexual (27%), and queer (9%), were racially/ethnically diverse (39% white, 32% Latinx, 20% Black, 9% other races), and included cisgender (79%) and transgender (21%) male youth. Results: Participants described varied experiences with school-based sexuality education (e.g., none, abstinence only, covered sexual health in some way), but it rarely addressed their unique needs. They typically learned about sex by searching for information online and from sexually explicit media. Participants identified several topics they wanted to learn more about (e.g., sex with same-gender partners, anal sex, consent), but they typically believed they were prepared to have sex. Finally, some participants described benefits of tailoring sexuality education to their unique needs, while others described benefits of more inclusive programs. Conclusions and Policy Implications: Findings suggest that bi+ male youth do not receive adequate sexuality education to make informed decisions about safer sex, highlighting the critical need for reform.
• Mata, D., Korpak, A. K., Sorensen, B. L., Dodge, B., Mustanski, B., & Feinstein, B. A. (2022). Correction to: A Mixed Methods Study of Sexuality Education Experiences and Preferences Among Bisexual, Pansexual, and Queer (Bi +) Male Youth (Sexuality Research and Social Policy, (2022), 19, 2, (806-821), 10.1007/s13178-021-00593-8). Sexuality Research and Social Policy, 19(Issue 3). doi:10.1007/s13178-022-00726-7
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  The original version of this article unfortunately had a missing reference. In Table 2, the list of topics related to sex and sexual health was adapted from Nelson et al. (2019). Nelson, K. M., Pantalone, D. W., and Carey, M. P. (2019). Sexual health education for adolescent males who are interested in sex with males: An investigation of experiences, preferences, and needs. Journal of Adolescent Health, 64, 36-42.
• Mata, D., Korpak, A. K., Sorensen, B., Dodge, B., Mustanski, B., & Feinstein, B. A. (2022). A mixed methods study of sexuality education experiences and preferences among bisexual, pansexual, and queer (bi+) male youth. Sexuality research & social policy : journal of NSRC : SR & SP, 19(2), 806-821.
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  Bisexual male youth are more likely to engage in certain behaviors that contribute to HIV/STI transmission (e.g., substance use) than are heterosexual and gay male youth. However, sexuality education rarely addresses the unique needs of sexual minority youth, especially bisexual, pansexual, and queer (bi+) youth, and little is known about their sexuality education experiences and preferences. As such, the goal of this study was to examine bi+ male youth's experiences learning about sex and their preferences for sexuality education.
• Williams, D., Bartelt, E., Thomas, B., Guerra-Reyes, L., Carspecken, L., Rosenstock Gonzalez, Y. R., Klimek, S., & Dodge, B. (2022). Beyond the Boundaries: Exploring the Identity-Related Experiences of Biracial/Multiracial and Bisexual Adults. Archives of Sexual Behavior, 51(Issue 4). doi:10.1007/s10508-021-02236-w
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  Most prior bisexual research takes a monolithic approach to racial identity, and existing racial/ethnic minority research often overlooks bisexuality. Consequently, previous studies have rarely examined the experiences and unique health needs of biracial/multiracial and bisexual individuals. This exploratory qualitative study investigated the identity-related experiences of biracial/multiracial and bisexual adults within the context of health and well-being. Data were collected through 90-min semi-structured telephone interviews. Participants were recruited through online social network sites and included 24 adults between ages 18 and 59 years. We aimed to explore how identity-related experiences shape biracial/multiracial and bisexual individuals’ identity development processes; how biracial/multiracial and bisexual individuals negotiate their identities; how the blending of multiple identities may contribute to perceptions of inclusion, exclusion, and social connectedness; and how biracial/multiracial and bisexual individuals may attribute positive and negative experiences to their identities. Interview transcripts were analyzed using an inductive thematic approach. Analysis highlighted four major themes: passing and invisible identities, not measuring up and erasing complexity, cultural binegativity/queerphobia and intersectional oppressions, and navigating beyond boundaries. Our findings imply promoting affirmative visibility and developing intentional support networks may help biracial/multiracial and bisexual individuals cultivate resiliency and navigate sources of identity stress. We encourage future research to explore mental health and chronic stress among this community.
• Williams, D., Bartelt, E., Thomas, B., Guerra-Reyes, L., Carspecken, L., Rosenstock Gonzalez, Y. R., Klimek, S., & Dodge, B. (2022). Beyond the Boundaries: Exploring the Identity-Related Experiences of Biracial/Multiracial and Bisexual Adults. Archives of sexual behavior, 51(4), 2241-2259.
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  Most prior bisexual research takes a monolithic approach to racial identity, and existing racial/ethnic minority research often overlooks bisexuality. Consequently, previous studies have rarely examined the experiences and unique health needs of biracial/multiracial and bisexual individuals. This exploratory qualitative study investigated the identity-related experiences of biracial/multiracial and bisexual adults within the context of health and well-being. Data were collected through 90-min semi-structured telephone interviews. Participants were recruited through online social network sites and included 24 adults between ages 18 and 59 years. We aimed to explore how identity-related experiences shape biracial/multiracial and bisexual individuals' identity development processes; how biracial/multiracial and bisexual individuals negotiate their identities; how the blending of multiple identities may contribute to perceptions of inclusion, exclusion, and social connectedness; and how biracial/multiracial and bisexual individuals may attribute positive and negative experiences to their identities. Interview transcripts were analyzed using an inductive thematic approach. Analysis highlighted four major themes: passing and invisible identities, not measuring up and erasing complexity, cultural binegativity/queerphobia and intersectional oppressions, and navigating beyond boundaries. Our findings imply promoting affirmative visibility and developing intentional support networks may help biracial/multiracial and bisexual individuals cultivate resiliency and navigate sources of identity stress. We encourage future research to explore mental health and chronic stress among this community.
• Willis, M., Fu, T. C., Jozkowski, K. N., Dodge, B., & Herbenick, D. (2022). Associations between sexual precedent and sexual compliance: An event-level examination. Journal of American College Health, 70(Issue 1). doi:10.1080/07448481.2020.1726928
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  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.
• Willis, M., Fu, T. J., Jozkowski, K. N., Dodge, B., & Herbenick, D. (2022). Associations between sexual precedent and sexual compliance: An event-level examination. Journal of American college health : J of ACH, 70(1), 107-113.
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  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. A probability sample of college students at a university in the Midwest United States ( = 7,112). Participants completed an online survey based on measures from the National Survey of Sexual Health and Behavior. Only 2.5% ( = 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. 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.
• Barnhart, K. J., Dodge, B., Sayegh, M. A., Herbenick, D., & Reece, M. (2021). Shared injection experiences: Interpersonal involvement in injection drug practices among women. Substance Abuse, 42(Issue 4). doi:10.1080/08897077.2021.1903650
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  Background: Many women who inject drugs are aware of the associated risks, however social influences play a part in their behavioral decisions. Incorporation of others in drug use behaviors may be common practice among women who use drugs. The aim of this study was to gain an in-depth understanding of women’s injection drug use experiences with a focus on interpersonal involvement. Methods: Venue-based recruitment was conducted in collaboration with a harm reduction program. A group of 30 women, ages 18 and older, who reported injecting drugs within the past 30 days took part in a demographic survey and semi-structured interview to gain an understanding of their injection practices. In vivo coding and thematic analysis were conducted. Results: Three main themes that relate to incorporating others into injection drug behaviors surfaced, including: (1) injection practices described as we and not I, (2) partnered purchase and drug preparation, and (3) assisted injection. This group of women most often incorporated sexual and/or romantic partners (same and other-gender), friends, or family members into their injection drug use behaviors. Some women described a lack of ability to inject themselves and require assistance every time they use. Women also reported helping other women during drug use behaviors. Conclusions: Our primary themes indicate that a variety of relationship partners are important conceptual links in theoretical frameworks explaining drug use behaviors among women. Findings suggest same gender assistance during drug use behaviors, including injection, that may reduce harm. The interpersonal nature of injection drug use among women may indicate the expansion of treatment options designed for couples or other relationship partners, such as family, together.
• Barnhart, K. J., Dodge, B., Sayegh, M. A., Herbenick, D., & Reece, M. (2021). Shared injection experiences: Interpersonal involvement in injection drug practices among women. Substance abuse, 42(4), 912-918.
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  Many women who inject drugs are aware of the associated risks, however social influences play a part in their behavioral decisions. Incorporation of others in drug use behaviors may be common practice among women who use drugs. The aim of this study was to gain an in-depth understanding of women's injection drug use experiences with a focus on interpersonal involvement. : Venue-based recruitment was conducted in collaboration with a harm reduction program. A group of 30 women, ages 18 and older, who reported injecting drugs within the past 30 days took part in a demographic survey and semi-structured interview to gain an understanding of their injection practices. In vivo coding and thematic analysis were conducted. Three main themes that relate to incorporating others into injection drug behaviors surfaced, including: (1) injection practices described as we and not I, (2) partnered purchase and drug preparation, and (3) assisted injection. This group of women most often incorporated sexual and/or romantic partners (same and other-gender), friends, or family members into their injection drug use behaviors. Some women described a lack of ability to inject themselves and require assistance every time they use. Women also reported helping other women during drug use behaviors. Our primary themes indicate that a variety of relationship partners are important conceptual links in theoretical frameworks explaining drug use behaviors among women. Findings suggest same gender assistance during drug use behaviors, including injection, that may reduce harm. The interpersonal nature of injection drug use among women may indicate the expansion of treatment options designed for couples or other relationship partners, such as family, together.
• Beckmeyer, J. J., Herbenick, D., Fu, T. C., Dodge, B., & Fortenberry, J. D. (2021). Pleasure During Adolescents' Most Recent Partnered Sexual Experience: Findings from a U.S. Probability Survey. Archives of sexual behavior, 50(6), 2423-2434.
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  Compared to studies on sexually transmitted infections and pregnancy prevention, sexual pleasure has received limited attention in the adolescent sexual development literature. In the present study, we used data from 157 adolescents (66 females; 14 to 17 years old), with a partnered sexual experience in the past 12 months to explore adolescents' sexual pleasure. First, we examined adolescents' perceptions of pleasure during their most recent partnered sexual experience. We then used information about those sexual experiences to identify correlates of sexual pleasure. Adolescents' reports of sexual pleasure were mixed. Although 17.8% reported their sexual experience was extremely pleasurable and 36.5% reported it was quite pleasurable, 26.6% indicated moderate pleasure, 13.1% a little pleasure, and 3.3% reported no pleasure. Sexual pleasure was primarily associated with aspects of sexual experiences that reflected socioemotional intimacy and desire. Specifically, cuddling with partners, emotional intimacy, and wantedness were all associated with greater sexual pleasure. Additionally, adolescents found sex more pleasurable when it occurred with a friend, but less pleasurable when it involved genital rubbing. Most sexual behaviors, having experienced orgasm, and the situational context of sexual experiences were not associated with sexual pleasure. Thus, specific sexual behaviors and orgasm may have less impact on sexual pleasure than feelings of emotional intimacy and desire. The diversity of perceived sexual pleasure and its associations with intimacy and desire suggest that, during adolescence, partnered sexual experiences are not primarily motivated by anticipated physical pleasure.
• Beckmeyer, J. J., Herbenick, D., Fu, T. C., Dodge, B., & Fortenberry, J. D. (2021). Pleasure During Adolescents’ Most Recent Partnered Sexual Experience: Findings from a U.S. Probability Survey. Archives of Sexual Behavior, 50(Issue 6). doi:10.1007/s10508-021-02026-4
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  Compared to studies on sexually transmitted infections and pregnancy prevention, sexual pleasure has received limited attention in the adolescent sexual development literature. In the present study, we used data from 157 adolescents (66 females; 14 to 17 years old), with a partnered sexual experience in the past 12 months to explore adolescents’ sexual pleasure. First, we examined adolescents’ perceptions of pleasure during their most recent partnered sexual experience. We then used information about those sexual experiences to identify correlates of sexual pleasure. Adolescents’ reports of sexual pleasure were mixed. Although 17.8% reported their sexual experience was extremely pleasurable and 36.5% reported it was quite pleasurable, 26.6% indicated moderate pleasure, 13.1% a little pleasure, and 3.3% reported no pleasure. Sexual pleasure was primarily associated with aspects of sexual experiences that reflected socioemotional intimacy and desire. Specifically, cuddling with partners, emotional intimacy, and wantedness were all associated with greater sexual pleasure. Additionally, adolescents found sex more pleasurable when it occurred with a friend, but less pleasurable when it involved genital rubbing. Most sexual behaviors, having experienced orgasm, and the situational context of sexual experiences were not associated with sexual pleasure. Thus, specific sexual behaviors and orgasm may have less impact on sexual pleasure than feelings of emotional intimacy and desire. The diversity of perceived sexual pleasure and its associations with intimacy and desire suggest that, during adolescence, partnered sexual experiences are not primarily motivated by anticipated physical pleasure.
• Bowling, J., Bowling, J., Simmons, M., Simmons, M., Blekfeld-Sztraky, D., Blekfeld-Sztraky, D., Bartelt, E., Bartelt, E., Dodge, B., Dodge, B., Sundarraman, V., Sundarraman, V., Lakshmi, B., Lakshmi, B., Herbenick, D., & Herbenick, D. (2021). "It's a walk of shame": Experiences of unintended pregnancy and abortion among sexual- and gender-minoritized females in urban India. Medicine access @ point of care, 5, 23992026211027698.
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  Unintended pregnancy and safe abortion access in India remain critical public health concerns. The health of sexual- and gender-minoritized females (SGMF; those assigned female at birth and identify as other than heterosexual and/or as other than cisgender women) in India is understudied.
• Feinstein, B. A., Ford, J. V., Lattanner, M. R., Bo, N., Tu, W., & Dodge, B. (2021). The Role of Partner Gender in Bisexual Men’s Stigma-Related Experiences and Mental Health: Results From a Probability-Based Sample in the United States. Stigma and Health, 8(Issue 2). doi:10.1037/sah0000297
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  Bisexual men are disproportionately affected by negative mental health outcomes compared to heterosexual and gay men. These disparities are related to the unique stressors that they experience, and emerging evidence suggests that their experiences of these stressors can be different depending on the gender of their partner. However, previous studies have largely focused on bisexual women and little is known about the role of partner gender in bisexual men’s experiences and mental health. We examined the associations between relationship type and outness, stigma-related experiences, and mental health using data from Wave 1 of the National Study of Stigma and Sexual Health, a probability-based sample of 502 gay and bisexual men in the U.S. Analyses focused on the subset of 128 men who identified as bisexual (44.53% in relationships with women, 14.84% in relationships with men, 40.63% not in relationships). Bisexual men in relationships with men reported being more out than those in relationships with women and those who were not in relationships; furthermore, bisexual men in relationships with men reported more discrimination and family stress than those in relationships with women. Bisexual men who were not in relationships reported more anticipated and internalized stigma than those in relationships with men; additionally, bisexual men who were not in relationships reported more anticipated stigma and depression than those in relationships with women. Partner gender plays a role in bisexual men’s stigma-related experiences and mental health, and efforts to improve bisexual men’s health should attend to sexual orientation, relationship status, and partner gender.
• Fu, T. C., Herbenick, D., Dodge, B. M., Beckmeyer, J. J., & Hensel, D. J. (2021). Long-Acting Reversible Contraceptive Users' Knowledge, Conversations with Healthcare Providers, and Condom Use: Findings from a U.S. Nationally Representative Probability Survey. International journal of sexual health : official journal of the World Association for Sexual Health, 33(2), 163-174.
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  Objectives To describe long-acting reversible contraceptive (LARC) users' knowledge, patient-provider interactions, and condom use associated with LARC use. : Data are from the 2018 National Survey of Sexual Health and Behavior, a probability survey of Americans aged 14-49. : Of 1,451 sexually active women, 11.2% used intrauterine devices, and 3.1% used implants. Approximately 19-26% of LARC users reported inaccurately on LARC longevity, and 30% reported relying on their provider to indicate the timing of intrauterine device removal. Consistent condom use among LARC users was rare (6.1%). : Our findings have implications for how clinicians educate patients on LARC and condom use.
• Hensel, D. J., Herbenick, D., Beckmeyer, J. J., Fu, T. C., & Dodge, B. (2021). Adolescents' Discussion of Sexual and Reproductive Health Care Topics With Providers: Findings From a Nationally Representative Probability Sample of U.S. Adolescents. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 68(3), 626-628.
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  National practice guidelines encourage providers address sexual and reproductive health (SRH) as part of all clinical encounters with adolescents. Yet, no studies provide nationally representative estimates of how frequently adolescents are screened.
• Hensel, D. J., Herbenick, D., Beckmeyer, J. J., Fu, T. c., & Dodge, B. (2021). Adolescents' Discussion of Sexual and Reproductive Health Care Topics With Providers: Findings From a Nationally Representative Probability Sample of U.S. Adolescents. Journal of Adolescent Health, 68(Issue 3). doi:10.1016/j.jadohealth.2020.06.037
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  Purpose: National practice guidelines encourage providers address sexual and reproductive health (SRH) as part of all clinical encounters with adolescents. Yet, no studies provide nationally representative estimates of how frequently adolescents are screened. Methods: Data were adolescent participants (aged 14–17 years; N = 826) in the 2018 National Survey of Sexual Health and Behavior, an online, nationally representative study of sexual health experiences of people in the U.S. SRH variables were: (all no/yes) pregnancy prevention, sexual identity, STD/HIV prevention, sexual difficulties, sexually transmitted infections testing, and sexual activity. We used descriptive statistics and weighted logistic regression (Stata 16.0; all p < .05) to examine differences in the odds of SRH discussion with provider by sexual identity, age, gender, and race/ethnicity. Results: The coverage of SRH topics was poor. The most common topic was asking about sexual activity (52.9%), and the least common was being offered a sexually transmitted infection test (21.7%). An adolescent's sexual identity, race/ethnicity, and age affected the odds of topic screening. Conclusions: Health care providers appear to both infrequently and inconsistently address key SRH topics during encounters with young people. Targeted interventions should focus on strengthening the regularity and depth of clinicians’ SRH conversations regardless of adolescent demographic or history.
• Lattanner, M. R., Ford, J., Bo, N., Tu, W., Pachankis, J. E., Dodge, B., & Hatzenbuehler, M. L. (2021). A Contextual Approach to the Psychological Study of Identity Concealment: Examining Direct, Interactive, and Indirect Effects of Structural Stigma on Concealment Motivation Across Proximal and Distal Geographic Levels. Psychological Science, 32(Issue 10). doi:10.1177/09567976211018624
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  Psychological theories of identity concealment locate the ultimate source of concealment decisions within the social environment, yet most studies have not explicitly assessed stigmatizing environments beyond the immediate situation. We advanced the identity-concealment literature by objectively measuring structural forms of stigma related to sexual orientation (e.g., social policies) at proximal and distal geographic levels. We linked these measures to a new, population-based data set of 502 gay and bisexual men (residing in 44 states and Washington, DC; 269 counties; and 354 cities) who completed survey items about stigma, including identity-concealment motivation. Among gay men, the association between structural stigma and concealment motivation was (a) observed across three levels (city, county, and state), (b) conditional on one’s exposure at another geographic level (participants reported the least motivations to conceal their identity if they resided in both cities and states that were lowest in structural stigma), and (c) mediated by subjective perceptions of greater structural stigma.
• Lattanner, M. R., Ford, J., Bo, N., Tu, W., Pachankis, J. E., Dodge, B., & Hatzenbuehler, M. L. (2021). A Contextual Approach to the Psychological Study of Identity Concealment: Examining Direct, Interactive, and Indirect Effects of Structural Stigma on Concealment Motivation Across Proximal and Distal Geographic Levels. Psychological science, 32(10), 1684-1696.
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  Psychological theories of identity concealment locate the ultimate source of concealment decisions within the social environment, yet most studies have not explicitly assessed stigmatizing environments beyond the immediate situation. We advanced the identity-concealment literature by objectively measuring structural forms of stigma related to sexual orientation (e.g., social policies) at proximal and distal geographic levels. We linked these measures to a new, population-based data set of 502 gay and bisexual men (residing in 44 states and Washington, DC; 269 counties; and 354 cities) who completed survey items about stigma, including identity-concealment motivation. Among gay men, the association between structural stigma and concealment motivation was (a) observed across three levels (city, county, and state), (b) conditional on one's exposure at another geographic level (participants reported the least motivations to conceal their identity if they resided in both cities and states that were lowest in structural stigma), and (c) mediated by subjective perceptions of greater structural stigma.
• Owens, C., Voorheis, E., Struble, N., Lester, J. N., Green, H. D., Herbenick, D., Hubach, R. D., & Dodge, B. (2021). A community-based study of clients’ lived experiences of going through the rural HIV care continuum. Journal of HIV/AIDS and Social Services, 20(Issue 1). doi:10.1080/15381501.2021.1906819
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  This community-based study explored the lived experiences of being in and going through the rural HIV care continuum among 15 gay and bisexual men (GBM) with HIV who live in a rural area of a Midwestern state. Our analysis adapted a six-step interpretative phenomenological analysis. Five themes emerged that reflected the five continuum stages: 1) Diagnosis means death, 2) Linkage to care means uncertainty, 3) HIV care improves the quality of life lost pre- or peri-diagnosis, 4) ART implies life, and 5) Undetectable addresses the medical but not social aspects of HIV. Participants recalled they faced and continue to face social determinants, stigma, and chronic and mental health conditions. Findings provide future research directions and practical implications to address social determinants of health, promote chronic and mental health, and reduce interpersonal stigma throughout all HIV care continuum stages.
• Rothman, E. F., Beckmeyer, J. J., Herbenick, D., Fu, T. C., Dodge, B., & Fortenberry, J. D. (2021). The Prevalence of Using Pornography for Information About How to Have Sex: Findings from a Nationally Representative Survey of U.S. Adolescents and Young Adults. Archives of Sexual Behavior, 50(Issue 2). doi:10.1007/s10508-020-01877-7
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  We analyzed cross-sectional data collected from a U.S. nationally representative survey of individuals ages 14–24 years old on what sources of information from the past year they considered to be the most helpful about how to have sex (n = 600 adolescents ages 14–17 years old, and n = 666 young adults ages 18–24 years old). Among the 324 adolescents who indicated that they had been helped by at least one source of information, helpful information was most likely to have come from parents (31.0%) and friends (21.6%). Only 8.4% of adolescents said pornography was helpful. However, for those in the 18–24-year-old age group, pornography was the most commonly endorsed helpful source (24.5%), as compared to other possible options such as sexual partners, friends, media, and health care professionals. Multivariable regression analyses revealed that indicating that pornography was the most helpful source of information about how to have sex, compared to the other sources, was inversely associated with being female (OR = 0.32, p =.001), inversely associated with identifying as bisexual compared to heterosexual (OR = 0.15, p =.038), positively associated with being Black compared to being white non-Hispanic (OR = 4.26, p =.021), inversely associated with reporting a household income of either $25 K to $49,999 (OR = 0.31, p =.010) or $50 K to $74,999 (OR = 0.36, p =.019) compared to more than $75 K, and positively associated with having masturbated (OR = 13.20, p =.005). Subsequent research should investigate the role of pornography in both adolescent and adult sexual development, including why one-quarter of U.S. young adults say that pornography is a helpful source of information about how to have sex and what they think that they are learning from it.
• Rothman, E. F., Beckmeyer, J. J., Herbenick, D., Fu, T. C., Dodge, B., & Fortenberry, J. D. (2021). The Prevalence of Using Pornography for Information About How to Have Sex: Findings from a Nationally Representative Survey of U.S. Adolescents and Young Adults. Archives of sexual behavior, 50(2), 629-646.
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  We analyzed cross-sectional data collected from a U.S. nationally representative survey of individuals ages 14-24 years old on what sources of information from the past year they considered to be the most helpful about how to have sex (n = 600 adolescents ages 14-17 years old, and n = 666 young adults ages 18-24 years old). Among the 324 adolescents who indicated that they had been helped by at least one source of information, helpful information was most likely to have come from parents (31.0%) and friends (21.6%). Only 8.4% of adolescents said pornography was helpful. However, for those in the 18-24-year-old age group, pornography was the most commonly endorsed helpful source (24.5%), as compared to other possible options such as sexual partners, friends, media, and health care professionals. Multivariable regression analyses revealed that indicating that pornography was the most helpful source of information about how to have sex, compared to the other sources, was inversely associated with being female (OR = 0.32, p = .001), inversely associated with identifying as bisexual compared to heterosexual (OR = 0.15, p = .038), positively associated with being Black compared to being white non-Hispanic (OR = 4.26, p = .021), inversely associated with reporting a household income of either $25 K to $49,999 (OR = 0.31, p = .010) or $50 K to $74,999 (OR = 0.36, p = .019) compared to more than $75 K, and positively associated with having masturbated (OR = 13.20, p = .005). Subsequent research should investigate the role of pornography in both adolescent and adult sexual development, including why one-quarter of U.S. young adults say that pornography is a helpful source of information about how to have sex and what they think that they are learning from it.
• Sandfort, T. G., Bos, H. M., Fu, T. C., Herbenick, D., & Dodge, B. (2021). 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. Journal of Sex Research, 58(Issue 1). doi:10.1080/00224499.2020.1818178
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  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.
• Sandfort, T. G., Bos, H. M., Fu, T. J., Herbenick, D., & Dodge, B. (2021). 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. Journal of sex research, 58(1), 51-63.
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  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.
• Beckmeyer, J. J., Herbenick, D., Fu, T. C., Dodge, B., & Fortenberry, J. D. (2020). Prevalence of Romantic Experiences and Competencies Among 14 to 17 Year Olds: Implications for the Primary Care Setting. Clinical Pediatrics, 59(Issue 2). doi:10.1177/0009922819885659
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  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.
• Beckmeyer, J. J., Herbenick, D., Fu, T. J., Dodge, B., & Fortenberry, J. D. (2020). Prevalence of Romantic Experiences and Competencies Among 14 to 17 Year Olds: Implications for the Primary Care Setting. Clinical pediatrics, 59(2), 116-126.
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  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.
• Bowling, J., Blekfeld-Sztraky, D., Simmons, M., Dodge, B., Sundarraman, V., Lakshmi, B., Dharuman, S. D., & Herbenick, D. (2020). Definitions of sex and intimacy among gender and sexual minoritised groups in urban India. Culture, Health and Sexuality, 22(Issue 5). doi:10.1080/13691058.2019.1614670
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  Understandings of sex and intimacy carry important implications for individuals’ behaviours and health. In many research studies, sex is narrowly defined as penile-vaginal intercourse, which may exclude the experiences of sexual and gender minoritised individuals. Likewise, sexual intimacy, or intimacy related to sexual experience between two or more people, is under-researched. Even less is known about how sexual and gender minoritised individuals in countries such as India understand these concepts. This qualitative study included focus group discussions and interviews conducted in three urban areas in India–Chennai, Bangalore and Kolkata. Data were analysed thematically. Participants described sex as a context-dependent experience, acknowledging that their definitions might not capture others’ characterisations. Participants reported numerous barriers to intimacy, especially for transgender and other gender minority individuals. We discuss the implications of simplistic definitions related to gender and sexuality for future sexuality research and public health in settings such as those discussed here.
• Bowling, J., Bowling, J., Blekfeld-Sztraky, D., Blekfeld-Sztraky, D., Simmons, M., Simmons, M., Dodge, B., Dodge, B., Sundarraman, V., Sundarraman, V., Lakshmi, B., Lakshmi, B., Dharuman, S. D., Dharuman, S. D., Herbenick, D., & Herbenick, D. (2020). Definitions of sex and intimacy among gender and sexual minoritised groups in urban India. Culture, health & sexuality, 22(5), 520-534.
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  Understandings of sex and intimacy carry important implications for individuals' behaviours and health. In many research studies, sex is narrowly defined as penile-vaginal intercourse, which may exclude the experiences of sexual and gender minoritised individuals. Likewise, sexual intimacy, or intimacy related to sexual experience between two or more people, is under-researched. Even less is known about how sexual and gender minoritised individuals in countries such as India understand these concepts. This qualitative study included focus group discussions and interviews conducted in three urban areas in India - Chennai, Bangalore and Kolkata. Data were analysed thematically. Participants described sex as a context-dependent experience, acknowledging that their definitions might not capture others' characterisations. Participants reported numerous barriers to intimacy, especially for transgender and other gender minority individuals. We discuss the implications of simplistic definitions related to gender and sexuality for future sexuality research and public health in settings such as those discussed here.
• Feinstein, B. A., & Dodge, B. (2020). Meeting the Sexual Health Needs of Bisexual Men in the Age of Biomedical HIV Prevention: Gaps and Priorities. Archives of Sexual Behavior, 49(Issue 1). doi:10.1007/s10508-019-01468-1
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  The field of HIV/STI prevention has primarily focused on gay men (or “men who have sex with men” [MSM] as a broad category) with limited attention to bisexual men in particular. Although bisexual men are also at increased risk for HIV and other STI, they are less likely to utilize HIV/STI prevention services than gay men, and very few interventions have been developed to address their unique needs. Further, while biomedical advances are changing the field of HIV prevention, bisexual men are also less likely to use biomedical HIV prevention strategies (e.g., pre-exposure prophylaxis [PrEP]) than gay men. In an effort to advance research on bisexual men and their sexual health needs, the goals of this commentary are: (1) to review the empirical literature on the prevalence of HIV/STI among bisexual men, the few existing HIV/STI prevention interventions developed for bisexual men, and the use of biomedical HIV prevention among bisexual men; (2) to describe the ways in which the field of HIV/STI prevention has largely overlooked bisexual men as a population in need of targeted services; and (3) to discuss how researchers can better address the sexual health needs of bisexual men in the age of biomedical HIV prevention.
• Feinstein, B. A., & Dodge, B. (2020). Meeting the Sexual Health Needs of Bisexual Men in the Age of Biomedical HIV Prevention: Gaps and Priorities. Archives of sexual behavior, 49(1), 217-232.
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  The field of HIV/STI prevention has primarily focused on gay men (or "men who have sex with men" [MSM] as a broad category) with limited attention to bisexual men in particular. Although bisexual men are also at increased risk for HIV and other STI, they are less likely to utilize HIV/STI prevention services than gay men, and very few interventions have been developed to address their unique needs. Further, while biomedical advances are changing the field of HIV prevention, bisexual men are also less likely to use biomedical HIV prevention strategies (e.g., pre-exposure prophylaxis [PrEP]) than gay men. In an effort to advance research on bisexual men and their sexual health needs, the goals of this commentary are: (1) to review the empirical literature on the prevalence of HIV/STI among bisexual men, the few existing HIV/STI prevention interventions developed for bisexual men, and the use of biomedical HIV prevention among bisexual men; (2) to describe the ways in which the field of HIV/STI prevention has largely overlooked bisexual men as a population in need of targeted services; and (3) to discuss how researchers can better address the sexual health needs of bisexual men in the age of biomedical HIV prevention.
• Jennings Mayo-Wilson, L., Coleman, J., Timbo, F., Ssewamala, F. M., Linnemayr, S., Yi, G. T., Kang, B. A., Johnson, M. W., Yenokyan, G., Dodge, B., & Glass, N. E. (2020). Microenterprise Intervention to Reduce Sexual Risk Behaviors and Increase Employment and HIV Preventive Practices Among Economically-Vulnerable African-American Young Adults (EMERGE): A Feasibility Randomized Clinical Trial. AIDS and Behavior, 24(Issue 12). doi:10.1007/s10461-020-02931-0
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  Economic vulnerability, such as homelessness and unemployment, contributes to HIV risk among U.S. racial minorities. Yet, few economic-strengthening interventions have been adapted for HIV prevention in this population. This study assessed the feasibility of conducting a randomized clinical trial of a 20-week microenterprise intervention for economically-vulnerable African-American young adults. Engaging MicroenterprisE for Resource Generation and Health Empowerment (EMERGE) aimed to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors. The experimental group received text messages on job openings plus educational sessions, mentoring, a start-up grant, and business and HIV prevention text messages. The comparison group received text messages on job openings only. Primary feasibility objectives assessed recruitment, randomization, participation, and retention. Secondary objectives examined employment, sexual risk behaviors, and HIV preventive behaviors. Outcome assessments used an in-person pre- and post-intervention interview and a weekly text message survey. Several progression criteria for a definitive trial were met. Thirty-eight participants were randomized to experimental (n = 19) or comparison group (n = 19) of which 95% were retained. The comparison intervention enhanced willingness to be randomized and reduced non-participation. Mean age of participants was 21.0 years; 35% were male; 81% were unemployed. Fifty-eight percent (58%) of experimental participants completed ≥ 70% of intervention activities, and 74% completed ≥ 50% of intervention activities. Participation in intervention activities and outcome assessments was highest in the first half (~ 10 weeks) of the study. Seventy-one percent (71%) of weekly text message surveys received a response through week 14, but responsiveness declined to 37% of participants responding to ≥ 70% of weekly text message surveys at the end of the study. The experimental group reported higher employment (from 32% at baseline to 83% at week 26) and lower unprotected sex (79% to 58%) over time compared to reported changes in employment (37% to 47%) and unprotected sex (63% to 53%) over time in the comparison group. Conducting this feasibility trial was a critical step in the process of designing and testing a behavioral intervention. Development of a fully-powered effectiveness trial should take into account lessons learned regarding intervention duration, screening, and measurement. Trial Registration ClinicalTrials.gov. NCT03766165. Registered 04 December 2018. https://clinicaltrials.gov/ct2/show/NCT03766165
• Jennings Mayo-Wilson, L., Coleman, J., Timbo, F., Ssewamala, F. M., Linnemayr, S., Yi, G. T., Kang, B. A., Johnson, M. W., Yenokyan, G., Dodge, B., & Glass, N. E. (2020). Microenterprise Intervention to Reduce Sexual Risk Behaviors and Increase Employment and HIV Preventive Practices Among Economically-Vulnerable African-American Young Adults (EMERGE): A Feasibility Randomized Clinical Trial. AIDS and behavior, 24(12), 3545-3561.
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  Economic vulnerability, such as homelessness and unemployment, contributes to HIV risk among U.S. racial minorities. Yet, few economic-strengthening interventions have been adapted for HIV prevention in this population. This study assessed the feasibility of conducting a randomized clinical trial of a 20-week microenterprise intervention for economically-vulnerable African-American young adults. Engaging MicroenterprisE for Resource Generation and Health Empowerment (EMERGE) aimed to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors. The experimental group received text messages on job openings plus educational sessions, mentoring, a start-up grant, and business and HIV prevention text messages. The comparison group received text messages on job openings only. Primary feasibility objectives assessed recruitment, randomization, participation, and retention. Secondary objectives examined employment, sexual risk behaviors, and HIV preventive behaviors. Outcome assessments used an in-person pre- and post-intervention interview and a weekly text message survey. Several progression criteria for a definitive trial were met. Thirty-eight participants were randomized to experimental (n = 19) or comparison group (n = 19) of which 95% were retained. The comparison intervention enhanced willingness to be randomized and reduced non-participation. Mean age of participants was 21.0 years; 35% were male; 81% were unemployed. Fifty-eight percent (58%) of experimental participants completed ≥ 70% of intervention activities, and 74% completed ≥ 50% of intervention activities. Participation in intervention activities and outcome assessments was highest in the first half (~ 10 weeks) of the study. Seventy-one percent (71%) of weekly text message surveys received a response through week 14, but responsiveness declined to 37% of participants responding to ≥ 70% of weekly text message surveys at the end of the study. The experimental group reported higher employment (from 32% at baseline to 83% at week 26) and lower unprotected sex (79% to 58%) over time compared to reported changes in employment (37% to 47%) and unprotected sex (63% to 53%) over time in the comparison group. Conducting this feasibility trial was a critical step in the process of designing and testing a behavioral intervention. Development of a fully-powered effectiveness trial should take into account lessons learned regarding intervention duration, screening, and measurement.Trial Registration ClinicalTrials.gov. NCT03766165. Registered 04 December 2018. https://clinicaltrials.gov/ct2/show/NCT03766165.
• Owens, C., Hubach, R. D., Lester, J. N., Williams, D., Voorheis, E., Reece, M., & Dodge, B. (2020). Assessing determinants of pre-exposure prophylaxis (PrEP) adherence among a sample of rural Midwestern men who have sex with men (MSM). AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 32(Issue 12). doi:10.1080/09540121.2020.1757021
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  Pre-exposure prophylaxis (PrEP) efficacy in preventing HIV among gay, bisexual, and other men who have sex with men (MSM) is dependent upon adherence. Little is known about the PrEP adherence experiences among MSM who live in rural areas of the US. This qualitative study was informed by a modified version of Straussian Grounded Theory. Thirty-four 34 rural Midwestern MSM participated in telephone interviews that assessed their PrEP adherence factors. Overall, participants adhered to the PrEP regimen, ranging from missing none to a couple of doses per month. Participants had high self-efficacy (competence) and self-reliance (autonomy) in taking PrEP daily. Participants incorporated PrEP into their already existing routines. Participants were motivated to adhere to prevent HIV acquisition and be financially responsible. All participants mentioned their PrEP provider discussed the importance of adherence with PrEP’s effectiveness, but future patient-provider PrEP adherence communication varied among participants. Future PrEP adherence interventions should address counseling strategies that leverage these constructs to support pill taking. Future research should explore patient-provider conversations surrounding PrEP adherence to inform provider- and patient-level interventions.
• Owens, C., Hubach, R. D., Lester, J. N., Williams, D., Voorheis, E., Reece, M., & Dodge, B. (2020). Assessing determinants of pre-exposure prophylaxis (PrEP) adherence among a sample of rural Midwestern men who have sex with men (MSM). AIDS care, 32(12), 1581-1588.
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  Pre-exposure prophylaxis (PrEP) efficacy in preventing HIV among gay, bisexual, and other men who have sex with men (MSM) is dependent upon adherence. Little is known about the PrEP adherence experiences among MSM who live in rural areas of the US. This qualitative study was informed by a modified version of Straussian Grounded Theory. Thirty-four 34 rural Midwestern MSM participated in telephone interviews that assessed their PrEP adherence factors. Overall, participants adhered to the PrEP regimen, ranging from missing none to a couple of doses per month. Participants had high self-efficacy (competence) and self-reliance (autonomy) in taking PrEP daily. Participants incorporated PrEP into their already existing routines. Participants were motivated to adhere to prevent HIV acquisition and be financially responsible. All participants mentioned their PrEP provider discussed the importance of adherence with PrEP's effectiveness, but future patient-provider PrEP adherence communication varied among participants. Future PrEP adherence interventions should address counseling strategies that leverage these constructs to support pill taking. Future research should explore patient-provider conversations surrounding PrEP adherence to inform provider- and patient-level interventions.
• Owens, C., Hubach, R. D., Williams, D., Lester, J., Reece, M., & Dodge, B. (2020). Exploring the Pre-exposure Prophylaxis (PrEP) Health Care Experiences Among Men Who Have Sex With Men (MSM) Who Live in Rural Areas of the Midwest. AIDS education and prevention : official publication of the International Society for AIDS Education, 32(1), 51-66.
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  Most pre-exposure prophylaxis (PrEP) research samples men who have sex with men (MSM) who live in metropolitan cities. There is a limited understanding of the PrEP experiences among rural MSM. Thirty-four semi-structured interviews were conducted to explore the PrEP health care experiences among 34 rural Midwestern MSM. Of the 34 participants, 23 obtained PrEP from their non-primary care provider (PCP). Three themes were present: (1) PrEP is unavailable in rural areas, (2) PrEP is inaccessible in rural areas due to PCPs being unwilling to prescribe PrEP, and (3) PrEP services are unamicable in rural areas due to stigmatizing attitudes and behaviors of PCPs. It is important to address PrEP care continuum factors in all settings; however, these factors are often exacerbated in rural areas due to social determinants. Without further research and programming, organizational and social determinants may contribute to lower rates of PrEP outcomes in rural areas.
• Owens, C., Hubach, R. D., Williams, D., Lester, J., Reece, M., & Dodge, B. (2020). Exploring the pre-exposure prophylaxis (Prep) health care experiences among men who have sex with men (msm) who live in rural areas of the midwest. AIDS Education and Prevention, 32(Issue 1). doi:10.1521/aeap.2020.32.1.51
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  Most pre-exposure prophylaxis (PrEP) research samples men who have sex with men (MSM) who live in metropolitan cities. There is a limited understanding of the PrEP experiences among rural MSM. Thirty-four semi-structured interviews were conducted to explore the PrEP health care experiences among 34 rural Midwestern MSM. Of the 34 participants, 23 obtained PrEP from their non–primary care provider (PCP). Three themes were present: (1) PrEP is unavailable in rural areas, (2) PrEP is inaccessible in rural areas due to PCPs being unwilling to prescribe PrEP, and (3) PrEP services are unamicable in rural areas due to stigmatizing attitudes and behaviors of PCPs. It is important to address PrEP care continuum factors in all settings; however, these factors are often exacerbated in rural areas due to social determinants. Without further research and programming, organizational and social determinants may contribute to lower rates of PrEP outcomes in rural areas.
• Owens, C., Hubach, R. D., Williams, D., Voorheis, E., Lester, J., Reece, M., & Dodge, B. (2020). Facilitators and Barriers of Pre-exposure Prophylaxis (PrEP) Uptake Among Rural Men who have Sex with Men Living in the Midwestern U.S. Archives of sexual behavior, 49(6), 2179-2191.
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  Facilitators and barriers of Pre-exposure Prophylaxis (PrEP) uptake have been established in prior studies; however, most of these studies comprise samples of MSM from metropolitan cities and hypothetical PrEP use. There is a dearth of literature on the uptake factors among rural U.S. MSM who are prescribed PrEP. Thirty-four rural Midwestern MSM who currently take PrEP participated in semi-structured telephone interviews about their barriers and facilitators to their PrEP use. Interviews were analyzed using an inductive thematic analysis approach. There were four barriers: (1) lack of rural dissemination of PrEP information, (2) concern about side and adverse effects of using PrEP, (3) cost of PrEP uptake and engagement, and (4) lack of access to PrEP care and PrEP care quality. Individual and social facilitators that participants utilized to overcome these barriers are discussed. Findings elevate the importance of multilevel interventions that address PrEP adoption from a patient, provider, and healthcare system perspective.
• Owens, C., Hubach, R. D., Williams, D., Voorheis, E., Lester, J., Reece, M., & Dodge, B. (2020). Facilitators and Barriers of Pre-exposure Prophylaxis (PrEP) Uptake Among Rural Men who have Sex with Men Living in the Midwestern U.S.. Archives of Sexual Behavior, 49(Issue 6). doi:10.1007/s10508-020-01654-6
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  Facilitators and barriers of Pre-exposure Prophylaxis (PrEP) uptake have been established in prior studies; however, most of these studies comprise samples of MSM from metropolitan cities and hypothetical PrEP use. There is a dearth of literature on the uptake factors among rural U.S. MSM who are prescribed PrEP. Thirty-four rural Midwestern MSM who currently take PrEP participated in semi-structured telephone interviews about their barriers and facilitators to their PrEP use. Interviews were analyzed using an inductive thematic analysis approach. There were four barriers: (1) lack of rural dissemination of PrEP information, (2) concern about side and adverse effects of using PrEP, (3) cost of PrEP uptake and engagement, and (4) lack of access to PrEP care and PrEP care quality. Individual and social facilitators that participants utilized to overcome these barriers are discussed. Findings elevate the importance of multilevel interventions that address PrEP adoption from a patient, provider, and healthcare system perspective.
• Simmons, M., Bowling, J., Dodge, B., Sundarraman, V., Lakshmi, B., & Herbenick, D. (2020). Contraceptive and Barrier Use by Sexual- and Gender-Minoritized Individuals Assigned Female at Birth in Urban India. Women's Reproductive Health, 7(Issue 1). doi:10.1080/23293691.2019.1690308
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  Consistent and correct use of contraceptives and barrier methods are effective ways to prevent sexually transmitted infections (STIs) and unintended pregnancy. We examined contraceptive and barrier use among a sample of 27 sexual- and gender-minoritized individuals assigned female at birth (SGMF) in three cities in India. Contraceptive and barrier use was prevalent among SGMF with male sex partners but was perceived as unnecessary for many who solely engaged with female partners. Perceived lack of risk, cultural and partner-related issues, and concerns about side effects served as barriers to use. Inclusive sexuality education would better address the needs of SGMF.
• Williams, D., Dodge, B., Berger, B., Kimbrough, A., & Bostwick, W. B. (2020). Self-Reported Health Concerns and Healthcare Experiences among Diverse Bisexual Men: An Exploratory Qualitative Study. Journal of Bisexuality, 20(Issue 3). doi:10.1080/15299716.2020.1822256
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  Bisexual individuals have disproportionately higher rates of physical and mental health concerns compared to both heterosexual and gay/lesbian individuals. Few studies have examined diverse bisexual-identified men’s perceived health concerns for themselves and other bisexual men or their experiences in healthcare settings. This qualitative study explored health and healthcare experiences among cisgender and transgender bisexual men, most of whom were also men of color. Data were collected through semi-structured interviews. Participants included 31 self-identified bisexual men from the Chicago area. Participants were asked questions surrounding bisexual men’s health and healthcare experiences in general and their personal experiences, drawing connections between intersecting bisexual and racial/ethnic identities. Interview transcripts were analyzed using thematic analysis. Participants reported sexual health and mental health as the top health concerns for bisexual men. Participants viewed their bisexual identity as a motivator for seeking healthcare services and adopting safer sex practices. Mental health challenges faced by respondents were connected to bisexual stereotypes and fear of disclosing bisexual and transgender identities. Furthermore, perceptions of masculinity amongst bisexual men of color were particularly salient in connecting to their mental health experiences. The intersection of participants’ transgender and bisexual identities impacted their healthcare experiences in general healthcare settings, with many participants reporting a lack of cultural competence and provider knowledge concerning their identities. LGBTQ Federally Qualified Health Centers, however, were described as providing compassionate care. Our findings suggest the need for more interventions that account for bisexual men’s intersecting identities. Furthermore, increased provider training is necessary for providing affirmative care to bisexual men.
• Baldwin, A., Fu, T. C., Reece, M., Herbenick, D., Dodge, B., Sanders, S. A., Schick, V., & Fortenberry, J. D. (2019). Condom Use Completeness, Perceptions, and Sexual Quality at Most Recent Sexual Event: Results from a U.S. Nationally Representative Probability Sample. International Journal of Sexual Health, 31(Issue 4). doi:10.1080/19317611.2019.1670316
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  Objectives: To explore perceptions of condoms associated with complete use and evaluate relationships between condom perceptions, condom use, and sexual quality. Methods: Using data from a U. S. nationally representative probability sample, we assessed individuals’ condom use perceptions and related characteristics of their most recent sexual event through bivariate and regression analyses (n = 234). Results: Most participants reported complete condom use and neutral or positive perceptions of condoms. Though incomplete use was associated with orgasm among women, arousal and pleasure did not differ by gender or duration of condom use. Conclusions: We found no evidence that delayed application or early condom removal increased sexual arousal or pleasure, which may help sexual health promotion interventions address negative cultural ideas about condoms.
• Baldwin, A., Herbenick, D., Schick, V. R., Light, B., Dodge, B., Jackson, C. A., & Fortenberry, J. D. (2019). Sexual Satisfaction in Monogamous, Nonmonogamous, and Unpartnered Sexual Minority Women in the US. Journal of Bisexuality, 19(Issue 1). doi:10.1080/15299716.2019.1598529
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  Research on sexual satisfaction tends to focus mostly on heterosexual women and women in monogamous relationships. Sexual satisfaction among sexual minority women and women who are nonmonogamous or not partnered is under-researched. Through an online survey, we gathered data from 334 cisgender sexual minority women in various relationship configurations and assessed sexual satisfaction in relation to individual and interpersonal factors. Sexual satisfaction was not related to sexual identity or gender of relationship, dating, or sexual partners. Although women without a partner reported lower sexual satisfaction compared to those with one partner and those with more than one partner (p
• Baldwin, A., Schick, V. R., Smith, N. K., Dodge, B. M., Uriarte, J., & Dennis Fortenberry, J. (2019). Factors Associated with Contraceptive Use in Women Who Have Sex with Women and Men: An Exploratory Analysis. Journal of Bisexuality, 19(Issue 1). doi:10.1080/15299716.2018.1552903
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  Women who have sex with women and men (WSWM) are less likely to use effective contraception and more likely to experience unintended pregnancies than their exclusively heterosexual peers. The authors examined contraception use among a community sample of 80 WSWM (defined as genital contact with at least one cisgender man and woman during the past 12 months) of reproductive age living in the Midwest. Authors determined if contraceptive use differed by sociodemographic characteristics, or sexuality and relationship characteristics, and used a modified timeline follow-back calendar to explore contraception use during most recent penile-vaginal intercourse (PVI). Overall, use of highly effective contraception was low (38.8%) with combined hormonal contraceptive pills reported most frequently (54.8%). Of participants who engaged in PVI during their most recent sexual event with a male, nearly one half (46.1%) reported using at least one form of contraception. WSWM with a primary sexual attraction to men were more likely to use contraception (p
• Banik, S., Dodge, B., Schmidt-Sane, M., Sivasubramanian, M., Bowling, J., Rawat, S. M., Dange, A., & Anand, V. (2019). Humanizing an Invisible Population in India: Voices from Bisexual Men Concerning Identity, Life Experiences, and Sexual Health. Archives of Sexual Behavior, 48(Issue 1). doi:10.1007/s10508-018-1361-x
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  Research examining the sexual identities, behaviors, and experiences of bisexual men outside of Western contexts (including in India) is limited. Individuals who self-identify as bisexual due to their orientation toward partners of more than one gender face distinct psychosocial challenges relative to exclusively heterosexual, gay/lesbian, or other individuals. We conducted four focus group discussions (n = 22) and in-depth interviews (n = 50) with self-identified bisexual men (age 18 years and older) who were recruited from the metropolitan area of Mumbai, India, between June and August 2013. We triangulated and analyzed focus group and interview data using standard qualitative research techniques. Findings from our study suggest that multiple factors influence the sexual experiences of self-identified bisexual men in Mumbai, including contexts of sexual interactions, sexual positioning, and the gender of sexual partners. Participants described cultural meaning systems and psychosocial dynamics that regulate bisexual identity development, disclosure, and sexual decision making with male, female, and other partners. Secrecy, discretion, and sexual pleasure also influenced sexual behaviors and relationships. Although Western sexual identity categories are not necessarily equivalent in the Indian context, it is interesting and important to note that a number of individuals in India continue to use the identity label of “bisexual.” Before developing interventions to meet unique sexual health needs of bisexual men, it is crucial to understand how these men perceive themselves, reconcile the ordinary aspects of their lives with their sexuality, and structure their relationships with partners.
• Banik, S., Dodge, B., Schmidt-Sane, M., Sivasubramanian, M., Bowling, J., Rawat, S. M., Dange, A., & Anand, V. (2019). Humanizing an Invisible Population in India: Voices from Bisexual Men Concerning Identity, Life Experiences, and Sexual Health. Archives of sexual behavior, 48(1), 305-316.
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  Research examining the sexual identities, behaviors, and experiences of bisexual men outside of Western contexts (including in India) is limited. Individuals who self-identify as bisexual due to their orientation toward partners of more than one gender face distinct psychosocial challenges relative to exclusively heterosexual, gay/lesbian, or other individuals. We conducted four focus group discussions (n = 22) and in-depth interviews (n = 50) with self-identified bisexual men (age 18 years and older) who were recruited from the metropolitan area of Mumbai, India, between June and August 2013. We triangulated and analyzed focus group and interview data using standard qualitative research techniques. Findings from our study suggest that multiple factors influence the sexual experiences of self-identified bisexual men in Mumbai, including contexts of sexual interactions, sexual positioning, and the gender of sexual partners. Participants described cultural meaning systems and psychosocial dynamics that regulate bisexual identity development, disclosure, and sexual decision making with male, female, and other partners. Secrecy, discretion, and sexual pleasure also influenced sexual behaviors and relationships. Although Western sexual identity categories are not necessarily equivalent in the Indian context, it is interesting and important to note that a number of individuals in India continue to use the identity label of "bisexual." Before developing interventions to meet unique sexual health needs of bisexual men, it is crucial to understand how these men perceive themselves, reconcile the ordinary aspects of their lives with their sexuality, and structure their relationships with partners.
• Batteiger, T. A., Jordan, S. J., Toh, E., Fortenberry, L., Williams, J. A., LaPradd, M., Katz, B., Fortenberry, J. D., Dodge, B., Arno, J., Batteiger, B. E., & Nelson, D. E. (2019). Detection of Rectal Chlamydia trachomatis in Heterosexual Men Who Report Cunnilingus. Sexually transmitted diseases, 46(7), 440-445.
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  Rectal infection with Chlamydia trachomatis (CT) is frequent in women who deny receptive anal sex and is thought to arise from autoinoculation of the rectum from vaginal secretions. An alternate hypothesis is that oral sex inoculates and establishes gastrointestinal tract infection. Distinguishing these hypotheses is difficult in women. In men, autoinoculation is unlikely and heterosexual men frequently perform oral sex, but rarely participate in receptive anal exposure behaviors.
• Batteiger, T. A., Jordan, S. J., Toh, E., Fortenberry, L., Williams, J. A., Lapradd, M., Katz, B., Fortenberry, J. D., Dodge, B., Arno, J., Batteiger, B. E., & Nelson, D. E. (2019). Detection of rectal chlamydia trachomatis in heterosexual men who report cunnilingus. Sexually Transmitted Diseases, 46(Issue 7). doi:10.1097/olq.0000000000000998
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  Background Rectal infection with Chlamydia trachomatis (CT) is frequent in women who deny receptive anal sex and is thought to arise from autoinoculation of the rectum from vaginal secretions. An alternate hypothesis is that oral sex inoculates and establishes gastrointestinal tract infection. Distinguishing these hypotheses is difficult in women. In men, autoinoculation is unlikely and heterosexual men frequently perform oral sex, but rarely participate in receptive anal exposure behaviors. Methods We enrolled high-risk men with and without nongonococcal urethritis who presented to a sexually transmitted infection clinic in Indianapolis, Indiana. Urine and rectal swabs were collected and tested for urogenital and rectal CT, Neisseria gonorrhoeae (NG), and Mycoplasma genitalium (MG). Men completed surveys concerning symptoms, sexual orientation, and detailed recent and lifetime oral and anal sexual behaviors. Results Rectal CT was detected in 2/84 (2.4%) heterosexual men who reported cunnilingus, but no lifetime receptive anal behaviors. All of the men who denied receptive anal behaviors were negative for rectal NG and MG. In homosexual and bisexual men, rectal CT prevalence was high (9.7%), and rectal NG (4.8%) and MG (4.8%) were also detected. Conclusions We detected rectal CT infections in heterosexual men who reported cunnilingus but denied receptive anal behaviors. Oral sex may be a risk factor for rectal CT infection via oral inoculation of the gastrointestinal tract.
• Beach, L., Bartelt, E., Dodge, B., Bostwick, W., Schick, V., Fu, T. J., Friedman, M. R., & Herbenick, D. (2019). Meta-Perceptions of Others' Attitudes Toward Bisexual Men and Women Among a Nationally Representative Probability Sample. Archives of sexual behavior, 48(1), 191-197.
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  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.
• Beckmeyer, J. J., Beckmeyer, J. J., Herbenick, D., Herbenick, D., Fu, T. J., Fu, T. J., Dodge, B., Dodge, B., Reece, M., Reece, M., Fortenberry, J. D., & Fortenberry, J. D. (2019). Characteristics of Adolescent Sexting: Results from the 2015 National Survey of Sexual Health and Behavior. Journal of sex & marital therapy, 45(8), 767-780.
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  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.
• Beckmeyer, J. J., Herbenick, D., Fu, T. C., Dodge, B., Reece, M., & Fortenberry, J. D. (2019). Characteristics of Adolescent Sexting: Results from the 2015 National Survey of Sexual Health and Behavior. Journal of Sex and Marital Therapy, 45(Issue 8). doi:10.1080/0092623x.2019.1613463
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  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.
• Bostwick, W. B., & Dodge, B. (2019). Introduction to the Special Section on Bisexual Health: Can You See Us Now?. Archives of Sexual Behavior, 48(Issue 1). doi:10.1007/s10508-018-1370-9
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  Despite comprising the largest proportion of the “lesbian, gay, and bisexual” population, research focusing on the unique health concerns and needs of bisexual individuals is relatively scarce. While health disparities are increasingly well documented among lesbian, gay, bisexual, and transgender individuals relative to their heterosexual and cisgender counterparts, gaps remain in our basic understanding of how health status, behaviors, and outcomes vary within these groups, especially bisexual individuals. The lack of specified research on bisexual health is even more curious given that, when separated from both heterosexual and gay/lesbian individuals, bisexual individuals consistently report higher rates of a wide range of negative health outcomes, including mood and anxiety disorders, substance use, suicidality, as well as disparities related to healthcare access and utilization. Indeed, in scientific research, mass media, and in public health interventions, bisexual individuals remain relatively invisible. This Special Section represents an effort to shed light on a new generation of quantitative, qualitative, and mixed methods research studies that examine health-related concerns, outcomes, and intervention opportunities specifically among diverse samples of bisexual individuals from a variety of social and cultural contexts. The research herein focuses on intersections of multiple identities, the development of new measures, the use of large national data sets, and diverse groups of self-identified bisexual men (who tend to be least visible in health research). Findings from these studies will significantly advance our knowledge of factors associated with health disparities, as well as health and well-being more generally, among bisexual individuals and will help to inform directions for future health promotion research and intervention efforts.
• Bostwick, W. B., & Dodge, B. (2019). Introduction to the Special Section on Bisexual Health: Can You See Us Now?. Archives of sexual behavior, 48(1), 79-87.
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  Despite comprising the largest proportion of the "lesbian, gay, and bisexual" population, research focusing on the unique health concerns and needs of bisexual individuals is relatively scarce. While health disparities are increasingly well documented among lesbian, gay, bisexual, and transgender individuals relative to their heterosexual and cisgender counterparts, gaps remain in our basic understanding of how health status, behaviors, and outcomes vary within these groups, especially bisexual individuals. The lack of specified research on bisexual health is even more curious given that, when separated from both heterosexual and gay/lesbian individuals, bisexual individuals consistently report higher rates of a wide range of negative health outcomes, including mood and anxiety disorders, substance use, suicidality, as well as disparities related to healthcare access and utilization. Indeed, in scientific research, mass media, and in public health interventions, bisexual individuals remain relatively invisible. This Special Section represents an effort to shed light on a new generation of quantitative, qualitative, and mixed methods research studies that examine health-related concerns, outcomes, and intervention opportunities specifically among diverse samples of bisexual individuals from a variety of social and cultural contexts. The research herein focuses on intersections of multiple identities, the development of new measures, the use of large national data sets, and diverse groups of self-identified bisexual men (who tend to be least visible in health research). Findings from these studies will significantly advance our knowledge of factors associated with health disparities, as well as health and well-being more generally, among bisexual individuals and will help to inform directions for future health promotion research and intervention efforts.
• Bowling, J., Dodge, B., Bartelt, E., Simmons, M., & Fortenberry, J. D. (2019). Paths to Parenthood Among Self-Identified Bisexual Individuals in the United States. Archives of Sexual Behavior, 48(Issue 1). doi:10.1007/s10508-017-1090-6
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  Bisexual parents have been notably absent from prior research on parenting, despite comprising the largest proportion of parents among “lesbian, gay, and bisexual” (LGB) individuals. Indeed, recent national probability data indicate that young bisexual women are more likely than their heterosexual counterparts to report having at least one child. Intentions to have children, patterns of family planning and contraception use, and related issues have important implications for health and healthcare-related decisions and priorities among bisexual parents. We conducted in-depth interviews with a sample of 33 bisexual parents from across the U.S. who reported having at least one child (genetic, adopted, step or foster child, guardian, and/or warden of the state). In cases of intentional pregnancies, participants considered relationship and financial stability, job security and their ideal family size. Unintentional pregnancies, as well as pregnancy terminations, were often reframed as positive experiences. After deciding not to have more children, participants reported using contraceptive methods, including sterilization or long-acting reversible contraceptive methods (e.g., intrauterine devices). Instances of deception, in which partners deceived participants with false beliefs regarding their contraceptive use, were recalled negatively for the relatively small number of participants who reported such experiences. Overall, our findings point to a diversity in the intentions and ways bisexual individuals become parents, similar to parents of other sexual identities. Acknowledgements of the diverse experiences and concerns faced by bisexual parents may be beneficial in improving efforts related to providing appropriate and relevant health- and healthcare-related services.
• Bowling, J., Dodge, B., Bartelt, E., Simmons, M., & Fortenberry, J. D. (2019). Paths to Parenthood Among Self-Identified Bisexual Individuals in the United States. Archives of sexual behavior, 48(1), 277-289.
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  Bisexual parents have been notably absent from prior research on parenting, despite comprising the largest proportion of parents among "lesbian, gay, and bisexual" (LGB) individuals. Indeed, recent national probability data indicate that young bisexual women are more likely than their heterosexual counterparts to report having at least one child. Intentions to have children, patterns of family planning and contraception use, and related issues have important implications for health and healthcare-related decisions and priorities among bisexual parents. We conducted in-depth interviews with a sample of 33 bisexual parents from across the U.S. who reported having at least one child (genetic, adopted, step or foster child, guardian, and/or warden of the state). In cases of intentional pregnancies, participants considered relationship and financial stability, job security and their ideal family size. Unintentional pregnancies, as well as pregnancy terminations, were often reframed as positive experiences. After deciding not to have more children, participants reported using contraceptive methods, including sterilization or long-acting reversible contraceptive methods (e.g., intrauterine devices). Instances of deception, in which partners deceived participants with false beliefs regarding their contraceptive use, were recalled negatively for the relatively small number of participants who reported such experiences. Overall, our findings point to a diversity in the intentions and ways bisexual individuals become parents, similar to parents of other sexual identities. Acknowledgements of the diverse experiences and concerns faced by bisexual parents may be beneficial in improving efforts related to providing appropriate and relevant health- and healthcare-related services.
• Bowling, J., Mennicke, A., Blekfeld-Sztraky, D., Simmons, M., Dodge, B., Sundarraman, V., Lakshmi, B., Dharuman, S. T., & Herbenick, D. (2019). The Influences of Stigma on Sexuality among Sexual and Gender Minoritized Individuals in Urban India. International Journal of Sexual Health, 31(Issue 3). doi:10.1080/19317611.2019.1625994
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  Indian sexual and gender minoritized (SGM) individuals face marginalization and discrimination. Objectives: This study examines stigma’s effects on sexuality among SGM individuals in urban India. Methods: We conducted 5 focus group discussions and 27 interviews with SGM-identified adults connected to SGM-advocacy organizations in 3 cities (Chennai, Bangalore, Kolkata). Results: Stigma affected sexuality in the following ways: gender-specific stigma and behavioral norms, sexual identity-specific stigma, partners’ stigma and buffering effects of partner, heterosexual marriage pressure, and limited sexual healthcare. Conclusions: Although there were similarities with stigma’s effects in Western environments, the unique Indian context necessitates further research for more targeted interventions.
• Bowling, J., Simmons, M., Dodge, B., Sundarraman, V., Lakshmi, B., Dharuman, S. T., & Herbenick, D. (2019). Family Formation Goals Among Sexual and Gender Minority Individuals in Urban India. Studies in Family Planning, 50(Issue 4). doi:10.1111/sifp.12102
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  Sexual and Gender Minority (SGM) individuals’ (nonheterosexual or noncisgender) desires and intentions to form families have been under-researched. Further, research on family formation among SGM individuals is even more scant in India. Family formation, a significant milestone for many individuals, has important implications for overall health. Using data from interviews (n=25) and focus group discussions (8 participants) with SGM individuals in Bangalore, Chennai, and Kolkata, we explore desires and intentions related to parenting. Pressure to have children was ubiquitous, though participants’ parenting-related desires varied. Participants considering parenting noted many priorities including their financial stability, relationships with partners, and the legality and legitimacy of their partnerships. Adoption and assisted biological reproduction (e.g., IVF) were the preferred methods of family formation. Experiences and expectations of stigma for themselves and their children shaped participants’ limited control over parenting-related decisions. However, they exerted agency as they navigated achieving their ideals for family formation.
• Bowling, J., Simmons, M., Dodge, B., Sundarraman, V., Lakshmi, B., Dharuman, S. T., & Herbenick, D. (2019). Family Formation Goals Among Sexual and Gender Minority Individuals in Urban India. Studies in family planning, 50(4), 357-373.
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  Sexual and Gender Minority (SGM) individuals' (nonheterosexual or noncisgender) desires and intentions to form families have been under-researched. Further, research on family formation among SGM individuals is even more scant in India. Family formation, a significant milestone for many individuals, has important implications for overall health. Using data from interviews (n=25) and focus group discussions (8 participants) with SGM individuals in Bangalore, Chennai, and Kolkata, we explore desires and intentions related to parenting. Pressure to have children was ubiquitous, though participants' parenting-related desires varied. Participants considering parenting noted many priorities including their financial stability, relationships with partners, and the legality and legitimacy of their partnerships. Adoption and assisted biological reproduction (e.g., IVF) were the preferred methods of family formation. Experiences and expectations of stigma for themselves and their children shaped participants' limited control over parenting-related decisions. However, they exerted agency as they navigated achieving their ideals for family formation.
• Carter, A., Carter, A., Ford, J. V., Ford, J. V., Luetke, M., Luetke, M., Fu, T. J., Fu, T. J., Townes, A., Townes, A., Hensel, D. J., Hensel, D. J., Dodge, B., Dodge, B., Herbenick, D., & Herbenick, D. (2019). "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. The journal of sexual medicine, 16(12), 1953-1965.
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  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.
• Carter, A., Ford, J. V., Luetke, M., Fu, T. c., Townes, A., Hensel, D. J., Dodge, B., & Herbenick, D. (2019). “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. Journal of Sexual Medicine, 16(Issue 12). doi:10.1016/j.jsxm.2019.08.016
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  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.
• Dodge, B., Ford, J. V., Bo, N., Tu, W., Pachankis, J., Herbenick, D., Mayer, K., & Hatzenbuehler, M. L. (2019). HIV Risk and Prevention Outcomes in a Probability-Based Sample of Gay and Bisexual Men in the United States. Journal of Acquired Immune Deficiency Syndromes, 82(Issue 4). doi:10.1097/qai.0000000000002151
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  Background: Although gay and bisexual men (GBM) represent the largest group of HIV-infected individuals in the United States, nearly all evidence on their HIV risk and prevention outcomes derive from nonprobability samples. Setting: A probability-based cohort of GBM (N = 502) from 45 states and Washington, DC. Methods: Cross-sectional survey. Results: Among HIV-negative/unknown/untested GBM, only 6.7% reported using pre-exposure prophylaxis (PrEP) in the past 6 months. Two-thirds (63.3%) of PrEP users reported daily adherence in the past week. Over half (54.2%) of GBM reported not using a condom during anal sex with their most recent male partner; of these men, 93.8% were not on PrEP. Most GBM had been tested for HIV (80.7%) and other sexually transmitted infections (67.1%) in their lifetime, with 45.2% having tested for HIV during the past year. Among those ever tested, 14.1% reported being HIV infected, whereas an additional 8.9% reported testing positive for at least one other sexually transmitted infection after their most recent test. All HIV-positive GBM reported being currently on antiretroviral treatment, and 94.7% reported an undetectable viral load, but nearly one-third (30.4%) reported not taking their medication every day during the past month. A majority of HIV-negative/unknown/ untested GBM (64.3%) reported that they had never discussed HIV prevention with their primary health care provider. Conclusions: Our findings present a decidedly mixed picture regarding the success of the US National HIV/AIDS Strategy in meeting its stated goals of addressing HIV risk among the general population of GBM.
• Dodge, B., Ford, J. V., Bo, N., Tu, W., Pachankis, J., Herbenick, D., Mayer, K., & Hatzenbuehler, M. L. (2019). HIV Risk and Prevention Outcomes in a Probability-Based Sample of Gay and Bisexual Men in the United States. Journal of acquired immune deficiency syndromes (1999), 82(4), 355-361.
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  Although gay and bisexual men (GBM) represent the largest group of HIV-infected individuals in the United States, nearly all evidence on their HIV risk and prevention outcomes derive from nonprobability samples.
• Feinstein, B. A., Dodge, B., Korpak, A. K., Newcomb, M. E., & Mustanski, B. (2019). Improving the Health of Cisgender Men Who Identify as Bisexual: What Do They Want from Interventions?. Sexuality Research and Social Policy, 16(Issue 3). doi:10.1007/s13178-019-0380-2
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  Self-identified bisexual men are at increased risk for negative health outcomes, but there are no interventions tailored to their unique needs. In order to develop interventions for this population, it is first necessary to understand their preferences. As part of a larger study, 128 cisgender men who identified as bisexual reported on their preferences for different intervention components. Large proportions of participants prioritized addressing both health (e.g., mental health, HIV/STI) and psychosocial experiences (e.g., dating/relationships, discrimination/victimization). A slightly larger proportion of participants preferred an intervention for gay and bisexual men together compared to an intervention for bisexual men only. However, those who reported more discrimination and recent female sexual partners were more likely to prefer an intervention for bisexual men only. Larger proportions of participants preferred a group intervention compared to an individual intervention and an in-person intervention compared to an online intervention. These findings highlight the importance of addressing both health and psychosocial experiences in tailored interventions for self-identified bisexual men. Further, while in-person and group interventions may appeal to larger proportions of self-identified bisexual men, the appeal of an intervention for gay and bisexual men together compared to an intervention for bisexual men only may depend on individual and social/contextual factors.
• Feinstein, B. A., Feinstein, B. A., Dodge, B., Dodge, B., Korpak, A. K., Korpak, A. K., Newcomb, M. E., Newcomb, M. E., Mustanski, B., & Mustanski, B. (2019). Improving the health of cisgender men who identify as bisexual: What do they want from interventions?. Sexuality research & social policy : journal of NSRC : SR & SP, 16(3), 385-391.
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  Self-identified bisexual men are at increased risk for negative health outcomes, but there are no interventions tailored to their unique needs. In order to develop interventions for this population, it is first necessary to understand their preferences. As part of a larger study, 128 cisgender men who identified as bisexual reported on their preferences for different intervention components. Large proportions of participants prioritized addressing both health (e.g., mental health, HIV/STI) and psychosocial experiences (e.g., dating/relationships, discrimination/victimization). A slightly larger proportion of participants preferred an intervention for gay and bisexual men together compared to an intervention for bisexual men only. However, those who reported more discrimination and recent female sexual partners were more likely to prefer an intervention for bisexual men only. Larger proportions of participants preferred a group intervention compared to an individual intervention and an in-person intervention compared to an online intervention. These findings highlight the importance of addressing both health and psychosocial experiences in tailored interventions for self-identified bisexual men. Further, while in-person and group interventions may appeal to larger proportions of self-identified bisexual men, the appeal of an intervention for gay and bisexual men together compared to an intervention for bisexual men only may depend on individual and social/contextual factors.
• Fu, T. C., Hensel, D. J., Beckmeyer, J. J., Dodge, B., & Herbenick, D. (2019). Considerations in the Measurement and Reporting of Withdrawal: Findings from the 2018 National Survey of Sexual Health and Behavior. The journal of sexual medicine, 16(8), 1170-1177.
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  Although withdrawal use is routinely measured as part of contraceptive surveillance in the United States, its assessment may be prone to underreporting and measurement errors. Additionally, at the population level, little is known about subjective experiences of withdrawal.
• Fu, T. C., Herbenick, D., Dodge, B., Owens, C., Sanders, S. A., Reece, M., & Fortenberry, J. D. (2019). Relationships Among Sexual Identity, Sexual Attraction, and Sexual Behavior: Results from a Nationally Representative Probability Sample of Adults in the United States. Archives of sexual behavior, 48(5), 1483-1493.
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  Sexual orientation is a multi-dimensional concept, at a minimum comprised of sexual identity, sexual attraction, and sexual behavior. Our study aimed to assess relationships among self-identified sexual identity, sexual attraction, and sexual behaviors in a probability sample of adults in the U.S. and to identify associated factors with diverse patterns. We collected data from adults in the 2015 National Survey of Sexual Health and Behavior, an Internet-based nationally representative probability survey of the general U.S. population. Concordance between sexual identity versus sexual attraction and sexual behaviors was assessed using percent agreement. We identified correlates of discordance using logistic regression. Concordance between sexual identity versus sexual attraction and past-year sexual behaviors was 94% and 96%, respectively, though our sample was predominately composed of heterosexual individuals. Women and sexual minority individuals reported greater discordance across sexuality-related measures than men and heterosexual individuals. Younger adults (aged 18-24 years) were more likely to report sexual behaviors discordant with sexual identity compared with older adults (including those ages 25-34 years). Higher levels of educational attainment were significantly associated with less discordance of reported recent sexual activity and sexual identity. Measures of sexual identity, attraction, and behaviors are not interchangeable. Future research should consider multiple sexuality-related measures in order to capture the complexity and variability of sexualities.
• Fu, T. c., Hensel, D. J., Beckmeyer, J. J., Dodge, B., & Herbenick, D. (2019). Considerations in the Measurement and Reporting of Withdrawal: Findings from the 2018 National Survey of Sexual Health and Behavior. Journal of Sexual Medicine, 16(Issue 8). doi:10.1016/j.jsxm.2019.05.022
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  Introduction: Although withdrawal use is routinely measured as part of contraceptive surveillance in the United States, its assessment may be prone to underreporting and measurement errors. Additionally, at the population level, little is known about subjective experiences of withdrawal. Aim: To measure respondents’ frequency of and reasons for engaging in extra-vaginal ejaculation in the past year, and to compare contraceptive withdrawal vs extra-vaginal/anal ejaculation during the most recent sexual event. Methods: The 2018 National Survey of Sexual Health and Behavior is a U.S. nationally representative probability survey of adolescents and adults. This study was administered in February–March 2018 via GfK Research's KnowledgePanel. Respondents who reported consensual penile-vaginal intercourse in the past year were included in the analysis. Logistic regression was used to assess factors associated with finding extra-vaginal ejaculation sexy/arousing. Main Outcome Measures: Main outcomes were the frequency of and reasons for extra-vaginal ejaculation in the past year, as well as reported contraceptive withdrawal use and the location of ejaculation at the most recent penile-vaginal intercourse. Results: In the past year, approximately 60% of respondents reported engaging in any extra-vaginal ejaculation; pregnancy prevention and sexual pleasure were given as common reasons. Those who were men, white, or aged 25–29 were more likely to find extra-vaginal ejaculation sexy or arousing; no gender differences were observed in their partner's perception of this act. Prevalence of selecting withdrawal on the contraceptive inventory was 12.2% (95% CI 10.6–14.0) at last sexual event, whereas extra-vaginal/anal ejaculation was reported by 20.8% (95% CI 18.7–23.0). This lack of concordance in differing measures was observed consistently across all age groups, and approximately 12% to 14% of individuals reported an ejaculation location that did not correspond to their withdrawal use. Clinical Implications: The results of this study have implications for how healthcare providers discuss withdrawal with their patients and counsel them on using extra-vaginal ejaculation as part of their contraceptive use or part of their sexual repertoire. Strengths & Limitations: This is the first nationally representative study to directly compare contraceptive withdrawal to extra-vaginal ejaculation. Limited data were collected at event level regarding motivations for extra-vaginal ejaculation, pregnancy attitudes, perceptions of condoms and sexually transmitted infection prevention, or exposure to erotic media, thus limiting further assessment of relationships between various factors and extra-vaginal/anal ejaculation. Conclusion: We found that reporting of withdrawal as a contraceptive method vs extra-vaginal/anal ejaculation was inconsistent and that extra-vaginal/anal ejaculation was commonly used for reasons other than pregnancy prevention; future research should use more precise measures of “withdrawal.” Fu TC, Hensel DJ, Beckmeyer JJ, et al. Considerations in the Measurement and Reporting of Withdrawal: Findings from the 2018 National Survey of Sexual Health and Behavior. J Sex Med 2019;16:1170–1177.
• Fu, T. c., Herbenick, D., Dodge, B., Owens, C., Sanders, S. A., Reece, M., & Fortenberry, J. D. (2019). Relationships Among Sexual Identity, Sexual Attraction, and Sexual Behavior: Results from a Nationally Representative Probability Sample of Adults in the United States. Archives of Sexual Behavior, 48(Issue 5). doi:10.1007/s10508-018-1319-z
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  Sexual orientation is a multi-dimensional concept, at a minimum comprised of sexual identity, sexual attraction, and sexual behavior. Our study aimed to assess relationships among self-identified sexual identity, sexual attraction, and sexual behaviors in a probability sample of adults in the U.S. and to identify associated factors with diverse patterns. We collected data from adults in the 2015 National Survey of Sexual Health and Behavior, an Internet-based nationally representative probability survey of the general U.S. population. Concordance between sexual identity versus sexual attraction and sexual behaviors was assessed using percent agreement. We identified correlates of discordance using logistic regression. Concordance between sexual identity versus sexual attraction and past-year sexual behaviors was 94% and 96%, respectively, though our sample was predominately composed of heterosexual individuals. Women and sexual minority individuals reported greater discordance across sexuality-related measures than men and heterosexual individuals. Younger adults (aged 18–24 years) were more likely to report sexual behaviors discordant with sexual identity compared with older adults (including those ages 25–34 years). Higher levels of educational attainment were significantly associated with less discordance of reported recent sexual activity and sexual identity. Measures of sexual identity, attraction, and behaviors are not interchangeable. Future research should consider multiple sexuality-related measures in order to capture the complexity and variability of sexualities.
• Herbenick, D., Eastman-Mueller, H., Fu, T. C., Dodge, B., Ponander, K., & Sanders, S. A. (2019). Women's Sexual Satisfaction, Communication, and Reasons for (No Longer) Faking Orgasm: Findings from a U.S. Probability Sample. Archives of sexual behavior, 48(8), 2461-2472.
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  We aimed to assess, among a U.S. probability sample of adult women: (1) the prevalence of, and reasons given for, faking and no longer faking orgasm, (2) women's histories of sexual non-communication and reasons for non-communication, (3) associations between sexual non-communication and sexual satisfaction and faking orgasm, (4) associations between specific sexual communication and recent sexual satisfaction, and (5) associations between specific sexual communication and faking orgasm. Respondents were 1008 adult women ages 18-94 from the GfK KnowledgePanel (a nationally representative probability sample of non-institutionalized and English-speaking adults), who completed a confidential Internet-based survey. Although 58.8% of female respondents reported having ever faked/pretended orgasm, 67.3% of those who had ever faked orgasm no longer did. Women who continued to fake orgasms were more likely to indicate embarrassment talking about sex with their partner in explicit ways and were less likely to agree that they and their partner are able to talk specifically about what makes sex more pleasurable for them. More than half (55.4%) of women reported they had wanted to communicate with a partner regarding sex but decided not to; the most common reasons were not wanting to hurt a partner's feelings (42.4%), not feeling comfortable going into detail (40.2%), and embarrassment (37.7%). Greater self-reported sexual satisfaction was associated with more comfortable sexual communication. Study findings and implications for professionals are discussed in the context of adult sexual development and learning. This includes growing more comfortable talking with a partner about sexual preferences and sexual pleasure.
• Herbenick, D., Eastman-Mueller, H., Fu, T. c., Dodge, B., Ponander, K., & Sanders, S. A. (2019). Women’s Sexual Satisfaction, Communication, and Reasons for (No Longer) Faking Orgasm: Findings from a U.S. Probability Sample. Archives of Sexual Behavior, 48(Issue 8). doi:10.1007/s10508-019-01493-0
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  We aimed to assess, among a U.S. probability sample of adult women: (1) the prevalence of, and reasons given for, faking and no longer faking orgasm, (2) women’s histories of sexual non-communication and reasons for non-communication, (3) associations between sexual non-communication and sexual satisfaction and faking orgasm, (4) associations between specific sexual communication and recent sexual satisfaction, and (5) associations between specific sexual communication and faking orgasm. Respondents were 1008 adult women ages 18–94 from the GfK KnowledgePanel (a nationally representative probability sample of non-institutionalized and English-speaking adults), who completed a confidential Internet-based survey. Although 58.8% of female respondents reported having ever faked/pretended orgasm, 67.3% of those who had ever faked orgasm no longer did. Women who continued to fake orgasms were more likely to indicate embarrassment talking about sex with their partner in explicit ways and were less likely to agree that they and their partner are able to talk specifically about what makes sex more pleasurable for them. More than half (55.4%) of women reported they had wanted to communicate with a partner regarding sex but decided not to; the most common reasons were not wanting to hurt a partner’s feelings (42.4%), not feeling comfortable going into detail (40.2%), and embarrassment (37.7%). Greater self-reported sexual satisfaction was associated with more comfortable sexual communication. Study findings and implications for professionals are discussed in the context of adult sexual development and learning. This includes growing more comfortable talking with a partner about sexual preferences and sexual pleasure.
• Herbenick, D., Fu, T. C., Dodge, B., & Fortenberry, J. D. (2019). The alcohol contexts of consent, wanted sex, sexual pleasure, and sexual assault: Results from a probability survey of undergraduate students. Journal of American College Health, 67(Issue 2). doi:10.1080/07448481.2018.1462827
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  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.
• Herbenick, D., Fu, T. C., Owens, C., Bartelt, E., Dodge, B., Reece, M., & Fortenberry, J. D. (2019). Kissing, Cuddling, and Massage at Most Recent Sexual Event: Findings From a U.S. Nationally Representative Probability Sample. Journal of Sex and Marital Therapy, 45(Issue 2). doi:10.1080/0092623x.2018.1494648
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  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.
• Herbenick, D., Fu, T. J., Dodge, B., & Fortenberry, J. D. (2019). The alcohol contexts of consent, wanted sex, sexual pleasure, and sexual assault: Results from a probability survey of undergraduate students. Journal of American college health : J of ACH, 67(2), 144-152.
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  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.
• Herbenick, D., Herbenick, D., Fu, T. J., Fu, T. J., Owens, C., Owens, C., Bartelt, E., Bartelt, E., Dodge, B., Dodge, B., Reece, M., Reece, M., Fortenberry, J. D., & Fortenberry, J. D. (2019). Kissing, Cuddling, and Massage at Most Recent Sexual Event: Findings From a U.S. Nationally Representative Probability Sample. Journal of sex & marital therapy, 45(2), 159-172.
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  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.
• Mayo-Wilson, L. J., Glass, N. E., Ssewamala, F. M., Linnemayr, S., Coleman, J., Timbo, F., Johnson, M. W., Davoust, M., Labrique, A., Yenokyan, G., Dodge, B., & Latkin, C. (2019). Microenterprise intervention to reduce sexual risk behaviors and increase employment and HIV preventive practices in economically-vulnerable African-American young adults (EMERGE): Protocol for a feasibility randomized clinical trial. Trials, 20(Issue 1). doi:10.1186/s13063-019-3529-7
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  Background: Economic vulnerability, such as homelessness and unemployment, contributes to the HIV risk among racial minorities in the U.S., who are disproportionately infected. Yet, few economic-strengthening interventions have been adapted for HIV prevention in economically-vulnerable African-American young adults. Engaging Microenterprise for Resource Generation and Health Empowerment (EMERGE) is a feasibility randomized clinical trial of an HIV prevention microenterprise intervention with integrated text messages ("nudges") that are informed by behavioral economic principles. The trial aims to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors. Methods/design: In total, 40 young adults who are African-American, aged 18-24, live in Baltimore City, have experienced at least one episode of homelessness in the last 12 months, are unemployed or underemployed (fewer than 10 h per week), are not enrolled in school, own a cell phone with text messaging, and report at least one episode of unprotected or unsafe sex in the prior 12 months will be recruited from two community-based organizations providing residential supportive services to urban youth. Participants will undergo a 3-week run-in period and thereafter be randomly assigned to one of two groups with active interventions for 20 weeks. The first group ("comparison") will receive text messages with information on job openings. The second group ("experimental") will receive text messages with information on job openings plus information on HIV prevention and business educational sessions, a mentored apprenticeship, and a start-up grant, and business and HIV prevention text messages based on principles from behavioral economics. The two primary outcomes relate to the feasibility of conducting a larger trial. Secondary outcomes relate to employment, sexual risk behaviors, and HIV preventive practices. All participants will be assessed using an in-person questionnaire at pre-intervention (prior to randomization) and at 3 weeks post-intervention. To obtain repeated, longitudinal measures, participants will be assessed weekly using text message surveys from pre-intervention up to 3 weeks post-intervention. Discussion: This study will be one of the first U.S.-based feasibility randomized clinical trials of an HIV prevention microenterprise intervention for economically-vulnerable African-American young adults. The findings will inform whether and how to conduct a larger efficacy trial for HIV risk reduction in this population. Trial registration: ClinicalTrials.gov, NCT03766165. Registered on 4 December 2018.
• Mayo-Wilson, L. J., Glass, N. E., Ssewamala, F. M., Linnemayr, S., Coleman, J., Timbo, F., Johnson, M. W., Davoust, M., Labrique, A., Yenokyan, G., Dodge, B., & Latkin, C. (2019). Microenterprise intervention to reduce sexual risk behaviors and increase employment and HIV preventive practices in economically-vulnerable African-American young adults (EMERGE): protocol for a feasibility randomized clinical trial. Trials, 20(1), 439.
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  Economic vulnerability, such as homelessness and unemployment, contributes to the HIV risk among racial minorities in the U.S., who are disproportionately infected. Yet, few economic-strengthening interventions have been adapted for HIV prevention in economically-vulnerable African-American young adults. Engaging Microenterprise for Resource Generation and Health Empowerment (EMERGE) is a feasibility randomized clinical trial of an HIV prevention microenterprise intervention with integrated text messages ("nudges") that are informed by behavioral economic principles. The trial aims to reduce sexual risk behaviors and increase employment and uptake of HIV preventive behaviors.
• Baldwin, A., Dodge, B., Schick, V. R., Light, B., Scharrs, P. W., Herbenick, D., & Dennis Fortenberry, J. (2018). Transgender and genderqueer individuals’ experiences with health care providers: What’s working, what’s not, and where do we go from here?. Journal of Health Care for the Poor and Underserved, 29(Issue 4). doi:10.1353/hpu.2018.0097
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  Research demonstrates health disparities between gender-minority individuals and cisgender individuals. These disparities arise from multiple sources, including negative health care experiences. This study examines interactions between transgender and gender non-binary (TGGNB) individuals and their health care providers. We analyzed 119 participants’ descriptions of positive and negative health care experiences, and what they wish providers knew about caring for TGGNB patients. Health care experiences went well when providers and staff used inclusive language, demonstrated their experience and education, and treated identity disclosure as routine. Negative interactions were characterized by misgendering, unfamiliarity with TGGNB people and health issues, and transphobic practices. Participants wished providers understood their health concerns, did not expect their patients to educate them, and created a welcoming clinical environment. Medical educators, administrators, and providers share responsibility for improving TGGNB patient experiences. Through a framework of cultural safety, we recommend several changes to ensure more equitable treatment in health care.
• Baldwin, A., Dodge, B., Schick, V. R., Light, B., Scharrs, P. W., Herbenick, D., & Fortenberry, J. D. (2018). Transgender and Genderqueer Individuals' Experiences with Health Care Providers: What's Working, What's Not, and Where Do We Go from Here?. Journal of health care for the poor and underserved, 29(4), 1300-1318.
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  Research demonstrates health disparities between gender-minority individuals and cisgender individuals. These disparities arise from multiple sources, including negative health care experiences. This study examines interactions between transgender and gender non-binary (TGGNB) individuals and their health care providers. We analyzed 119 participants' descriptions of positive and negative health care experiences, and what they wish providers knew about caring for TGGNB patients. Health care experiences went well when providers and staff used inclusive language, demonstrated their experience and education, and treated identity disclosure as routine. Negative interactions were characterized by misgendering, unfamiliarity with TGGNB people and health issues, and transphobic practices. Participants wished providers understood their health concerns, did not expect their patients to educate them, and created a welcoming clinical environment. Medical educators, administrators, and providers share responsibility for improving TGGNB patient experiences. Through a framework of cultural safety, we recommend several changes to ensure more equitable treatment in health care.
• Bowling, J., Bowling, J., Dodge, B., Dodge, B., Banik, S., Banik, S., Bartelt, E., Bartelt, E., Mengle, S., Mengle, S., Guerra-Reyes, L., Guerra-Reyes, L., Hensel, D., Hensel, D., Herbenick, D., Herbenick, D., Anand, V., & Anand, V. (2018). Social support relationships for sexual minority women in Mumbai, India: a photo elicitation interview study. Culture, health & sexuality, 20(2), 183-200.
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  Little research exists on women who do not identify as heterosexual in India. Social support for sexual minority women may protect against the effects of discrimination. An examination of significant social relationships may point to both strengths and weaknesses in this support. We aimed to understand relationship prioritisation and communication patterns associated with the social support of sexual minority women in Mumbai. In partnership with the Humsafar Trust, India's oldest and largest sexual and gender minority-advocacy organisation, we conducted photo-elicitation interviews with 18 sexual minority women, using participants' photographs to prompt dialogue about their social support. Intimate partners were a source of dependable support and many of those without relationships were seeking them. Participants' extended networks included friends and family as well as less formal relationships of social support. Participants mediated their communication with particular social network members, which involved filtering information sexual identity, romantic interests, and personal aspirations, among others. The diverse relationships that sexual minority women have in their social support networks may be used to guide programmes to improve health outcomes.
• Bowling, J., Dodge, B., & Bartelt, E. (2018). Diversity and commonalities in relationship experiences among self-identified bisexual parents in the United States. Sexual and Relationship Therapy, 33(Issue 1-2). doi:10.1080/14681994.2017.1419565
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  Although bisexual parents represent the largest proportion of lesbian, gay, and bisexual (LGB) parents, their lived experiences are rarely included in prior research. The intimate relationships of bisexual parents may be similar to or distinct from monosexual (i.e. sexually oriented to one sex/gender) individuals, and such relationships impact individuals’ health and well-being, as well as family dynamics. We conducted phone interviews with 33 self-identified bisexual parents who were at least 18 years old, with at least one child (genetic, adopted, foster, stepchildren, partners’ children) living in the United States. As with individuals of all sexual identities, participants’ relationship structures (e.g. monogamy, commitment, co-parenting with former partners, single, dating) were diverse. Most participants’ partners were supportive of their bisexuality. Former relationships were often significant in positive ways, including beneficial coparenting, or in negative ways, including poor co-parenting and experiences of biphobia. Open communication, boundary negotiation, and counseling were all strategies that reportedly strengthened relationships. Many participants viewed relationships differently based on the gender of their partner(s), and biphobia impacted these perceptions. Participants expressed the desire for targeted resources and therapeutic approaches for bisexual parents, since their role as a parent was often a primary factor in how they organized their relationships.
• Bowling, J., Dodge, B., Banik, S., Bartelt, E., Mengle, S., Guerra-Reyes, L., Hensel, D., Herbenick, D., & Anand, V. (2018). Social support relationships for sexual minority women in Mumbai, India: a photo elicitation interview study. Culture, Health and Sexuality, 20(Issue 2). doi:10.1080/13691058.2017.1337928
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  Little research exists on women who do not identify as heterosexual in India. Social support for sexual minority women may protect against the effects of discrimination. An examination of significant social relationships may point to both strengths and weaknesses in this support. We aimed to understand relationship prioritisation and communication patterns associated with the social support of sexual minority women in Mumbai. In partnership with the Humsafar Trust, India’s oldest and largest sexual and gender minority-advocacy organisation, we conducted photo-elicitation interviews with 18 sexual minority women, using participants’ photographs to prompt dialogue about their social support. Intimate partners were a source of dependable support and many of those without relationships were seeking them. Participants’ extended networks included friends and family as well as less formal relationships of social support. Participants mediated their communication with particular social network members, which involved filtering information sexual identity, romantic interests, and personal aspirations, among others. The diverse relationships that sexual minority women have in their social support networks may be used to guide programmes to improve health outcomes.
• Bowling, J., Dodge, B., Banik, S., Bartelt, E., Rawat, S., Guerra-Reyes, L., Hensel, D., Herbenick, D., & Anand, V. (2018). A multi-method study of health behaviours and perceived concerns of sexual minority females in Mumbai, India. Sexual Health, 15(Issue 1). doi:10.1071/sh17042
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  Background: This multi-method study explores the perceived health status and health behaviours of sexual minority (i.e. self-identifying with a sexual identity label other than heterosexual) females (i.e. those assigned female at birth who may or may not identify as women) in Mumbai, India, a population whose health has been generally absent in scientific literature. Methods: Using community-based participatory research approaches, this study is a partnership with The Humsafar Trust (HST). HST is India's oldest and largest LGBT-advocacy organisation. An online survey targeted towards sexual minority females was conducted (n≤49), with questions about sexual identity, perceived health and wellbeing, physical and mental healthcare access and experiences, and health behaviours (including substance use). Additionally, photo-elicitation interviews in which participants' photos prompt interview discussion were conducted with 18 sexual minority females. Results: Sexual minority females face obstacles in health care, mostly related to acceptability and quality of care. Their use of preventative health screenings is low. Perceived mental health and experiences with care were less positive than that for physical health. Participants in photo-elicitation interviews described bodyweight issues and caretaking of family members in relation to physical health. Substance use functioned as both a protective and a risk factor for their health. Conclusion: Our findings point to a need for more resources for sexual minority females. Education on screening guidelines and screening access for sexual minority females would also assist these individuals in increasing their rates of preventative health.
• Bowling, J., Dodge, B., Banik, S., Bartelt, E., Rawat, S., Guerra-Reyes, L., Hensel, D., Herbenick, D., & Anand, V. (2018). A multi-method study of health behaviours and perceived concerns of sexual minority females in Mumbai, India. Sexual health, 15(1), 29-38.
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  This multi-method study explores the perceived health status and health behaviours of sexual minority (i.e. self-identifying with a sexual identity label other than heterosexual) females (i.e. those assigned female at birth who may or may not identify as women) in Mumbai, India, a population whose health has been generally absent in scientific literature.
• Bowling, J., Dodge, B., Bindra, N., Dave, B., Sharma, R., Sundarraman, V., Thirupathur Dharuman, S., & Herbenick, D. (2018). Female condom acceptability in urban India: Examining the role of sexual pleasure. Journal of Health Psychology, 23(Issue 2). doi:10.1177/1359105317745963
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  This qualitative study examined the acceptability of female condoms in urban India, with a focus on sexual pleasure. We conducted focus group discussions with 50 women and 19 men, as well as a small number of individual interviews with women (n = 3), in Chennai and New Delhi. Perceived benefits of female condoms included protection against unintended pregnancy and sexually transmitted infections, increased sense of empowerment for women, and simple clean up. The most common drawback was reduced sensation. Participants suggested structural changes to the female condom to ease insertion and use. Consent and privacy were discussed as increasing sexual pleasure. Pleasure should be acknowledged in design and education efforts to increase female condom use.
• Bowling, J., Dodge, B., Bindra, N., Dave, B., Sharma, R., Sundarraman, V., Thirupathur Dharuman, S., & Herbenick, D. (2018). Female condom acceptability in urban India: Examining the role of sexual pleasure. Journal of health psychology, 23(2), 218-228.
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  This qualitative study examined the acceptability of female condoms in urban India, with a focus on sexual pleasure. We conducted focus group discussions with 50 women and 19 men, as well as a small number of individual interviews with women ( n = 3), in Chennai and New Delhi. Perceived benefits of female condoms included protection against unintended pregnancy and sexually transmitted infections, increased sense of empowerment for women, and simple clean up. The most common drawback was reduced sensation. Participants suggested structural changes to the female condom to ease insertion and use. Consent and privacy were discussed as increasing sexual pleasure. Pleasure should be acknowledged in design and education efforts to increase female condom use.
• Collazo-Vargas, E. M., Dodge, B., Herbenick, D., Guerra-Reyes, L., Mowatt, R., Otero-Cruz, I. M., & Rodríguez-Díaz, C. (2018). Sexual Behaviors, Experiences of Sexual Violence, and Substance Use among Women Who inject Drugs: Accessing Health and Prevention Services in Puerto Rico. Puerto Rico health sciences journal, 37(2), 88-97.
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  People who inject drugs (PWID) face numerous gender-specific health risks, which increase their susceptibility to adverse outcomes, including violence. There is a need for research on female PWID to capture their unique experiences and understand behavioral and gender-based differences. This study aimed to understand which drug use and sexual behaviors are the most prevalent among female PWID accessing health services in Puerto Rico and to gather preliminary information on those individuals' experiences of sexual violence.
• Collazo-Vargas, E. M., Dodge, B., Herbenick, D., Guerra-Reyes, L., Mowatt, R., Otero-Cruz, I. M., & Rodríguez-Díaz, C. E. (2018). Sexual behaviors, experiences of sexual violence, and substance use among women who inject drugs: Accessing health and prevention services in Puerto Rico. Puerto Rico Health Sciences Journal, 37(Issue 2).
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  Objective: People who inject drugs (PWID) face numerous gender-specific health risks, which increase their susceptibility to adverse outcomes, including violence. There is a need for research on female PWID to capture their unique experiences and understand behavioral and gender-based differences. This study aimed to understand which drug use and sexual behaviors are the most prevalent among female PWID accessing health services in Puerto Rico and to gather preliminary information on those individuals’ experiences of sexual violence. Methods: Utilizing a transformative theoretical perspective, a mixed-methods study was conducted with a sample of 90 Puerto Rican women who reported recent (past 12 months) injection drug use (IDU) This manuscript focused on Phase 1, in which participants completed an interviewer-administered survey eliciting information about sexual behaviors, drug use, experiences of sexual violence, and access to healthcare services. Phase 2 involved an in-depth interview focused on sexual health and access to healthcare services. Results: Female PWID were found to engage in a variety of sexual behaviors throughout their lifespans and at their most recent sexual events. There were significant differences across age groups for participants, those being time of most recent sexual event (p = 0.007), partner’s sex (p = 0.039), relationship with partner (p = 0.023), contraception method used (p = 0.057), and reports of partner orgasm (p = 0.055). Over half of all participants reported having experienced sexual violence in their lifetime. Conclusion: This study extends the literature on PWID in Puerto Rico by underscoring the diversity of female PWID sexual experiences and needs while illustrating how those experiences are often mediated by drug use. The findings highlight the need for further research on female PWID in Puerto Rico to better develop programs that include sexual violence prevention as part of future interventions for this population.
• Ensign, K. A., Dodge, B. M., Herbenick, D., & Docherty, C. L. (2018). Development of an Instrument to Assess Athletic Trainers' Attitudes Toward Transgender Patients. Journal of athletic training, 53(4), 431-436.
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    The unique contexts in which athletic trainers (ATs) work require specific tools in order to understand their attitudes toward diverse patient populations, including sexual and gender minorities.
• Ensign, K. A., Dodge, B. M., Herbenick, D., & Docherty, C. L. (2018). Development of an instrument to assess athletic trainers' attitudes toward transgender patients. Journal of Athletic Training, 53(Issue 4). doi:10.4085/1062-6050-496-16
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  Context: The unique contexts in which athletic trainers (ATs) work require specific tools in order to understand their attitudes toward diverse patient populations, including sexual and gender minorities. Objective: To develop and validate the Attitudes Toward Transgender Patients (ATTP) instrument for ATs. Design: Cross-sectional study. Setting: Semistructured interviews, paper-based questionnaire, and electronic questionnaire. Patients or Other Participants: Six ATs completed semistructured interviews to develop themes regarding transgender patients. Additionally, 39 students in professional and postprofessional athletic training programs answered questionnaires designed to elicit statements regarding transgender patients. For item reduction, a sample of 3000 ATs were e-mailed (response rate ¼ 17%), and for validation, another sample of 3000 ATs were e-mailed (response rate ¼ 13%). Athletic trainers' e-mail addresses were obtained from the National Athletic Trainers' Association. Data Collection and Analysis: The 3 phases were (1) exploratory interviews, (2) construct validity and item reduction, and (3) criterion validity. Items were created based on interviews and questionnaires. Principal axis factoring was used for item reduction, and Pearson correlations were used for validation. Results: Thirty-six statements pertaining to transgender patients were developed from the interview and questionnaire data. After item reduction, 10 items remained to form the ATTP (a ¼ .834). For validation, the ATTP and Transphobia Scale were significantly correlated (r ¼ .723; P, .001). Conclusions: The ability to assess attitudes toward transgender patients will allow clinicians to identify needed areas of focus for training and education. The ATTP assesses affective and cognitive attitudes and behavioral intentions toward transgender patients in common clinical settings.
• Guerra-Reyes, L., Fu, T. J., Williams, D., Herbenick, D., Dodge, B., Reece, M., & Fortenberry, J. D. (2018). Knowledge of Zika and perception of risk among sexually-active adults in the United States of America: results from a nationally representative sample. Revista panamericana de salud publica = Pan American journal of public health, 42, e43.
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  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.
• Guerra-Reyes, L., Fu, T. c., Williams, D., Herbenick, D., Dodge, B., Reece, M., & Fortenberry, J. D. (2018). Knowledge of Zika and perception of risk among sexually-active adults in the United States of America: results from a nationally representative sample. Revista Panamericana de Salud Publica/Pan American Journal of Public Health, 42(Issue). doi:10.26633/rpsp.2018.43
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  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.
• Herbenick, D., Fu, T. C., Arter, J., Sanders, S. A., & Dodge, B. (2018). Women's Experiences With Genital Touching, Sexual Pleasure, and Orgasm: Results From a U.S. Probability Sample of Women Ages 18 to 94. Journal of Sex and Marital Therapy, 44(Issue 2). doi:10.1080/0092623x.2017.1346530
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  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.
• Herbenick, D., Herbenick, D., Fu, T. J., Fu, T. J., Arter, J., Arter, J., Sanders, S. A., Sanders, S. A., Dodge, B., & Dodge, B. (2018). Women's Experiences With Genital Touching, Sexual Pleasure, and Orgasm: Results From a U.S. Probability Sample of Women Ages 18 to 94. Journal of sex & marital therapy, 44(2), 201-212.
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  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.
• Levine, E. C., Herbenick, D., Martinez, O., Fu, T. C., & Dodge, B. (2018). Open Relationships, Nonconsensual Nonmonogamy, and Monogamy Among U.S. Adults: Findings from the 2012 National Survey of Sexual Health and Behavior. Archives of Sexual Behavior, 47(Issue 5). doi:10.1007/s10508-018-1178-7
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  People in open and other consensually nonmonogamous partnerships have been historically underserved by researchers and providers. Many studies group such partnerships together with nonconsensual nonmonogamy (NCNM) under the banner of “concurrent sexual partnerships.” Discrimination from service providers poses a substantial barrier to care. Responding to such concerns, this investigation explored sociodemographic correlates with open relationships and associations between relationship structure and sexual risk, HIV/STI testing, and relationship satisfaction in a nationally representative probability sample. Data were drawn from the 2012 National Survey of Sexual Health and Behavior (n = 2270). We used multinomial logistic regression to identify correlates with relationship structure, and linear and logistic regression to investigate associations between relationship structure and testing, condom use, and relationship satisfaction. Eighty-nine percent of participants reported monogamy, 4% reported open relationships, and 8% reported NCNM. Males, gay/lesbian individuals, bisexual individuals, and those who identified as “Other, Non-Hispanic” were more likely to report open relationships. Bisexual individuals and Black, Non-Hispanic participants were more likely to report NCNM; older participants were less likely to do so. Participants in open relationships reported more frequent condom use for anal intercourse and lower relationship satisfaction than monogamous participants. NCNM participants reported more HIV testing and lower satisfaction. Identities, experiences, and behaviors within open and other consensually nonmonogamous populations should be regarded as unique and diverse, rather than conflated with those common to other relationship structures. There is a need for greater awareness of diverse relationship structures among researchers and providers, and incorporation of related content into educational programming.
• Levine, E. C., Herbenick, D., Martinez, O., Fu, T. C., & Dodge, B. (2018). Open Relationships, Nonconsensual Nonmonogamy, and Monogamy Among U.S. Adults: Findings from the 2012 National Survey of Sexual Health and Behavior. Archives of sexual behavior, 47(5), 1439-1450.
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  People in open and other consensually nonmonogamous partnerships have been historically underserved by researchers and providers. Many studies group such partnerships together with nonconsensual nonmonogamy (NCNM) under the banner of "concurrent sexual partnerships." Discrimination from service providers poses a substantial barrier to care. Responding to such concerns, this investigation explored sociodemographic correlates with open relationships and associations between relationship structure and sexual risk, HIV/STI testing, and relationship satisfaction in a nationally representative probability sample. Data were drawn from the 2012 National Survey of Sexual Health and Behavior (n = 2270). We used multinomial logistic regression to identify correlates with relationship structure, and linear and logistic regression to investigate associations between relationship structure and testing, condom use, and relationship satisfaction. Eighty-nine percent of participants reported monogamy, 4% reported open relationships, and 8% reported NCNM. Males, gay/lesbian individuals, bisexual individuals, and those who identified as "Other, Non-Hispanic" were more likely to report open relationships. Bisexual individuals and Black, Non-Hispanic participants were more likely to report NCNM; older participants were less likely to do so. Participants in open relationships reported more frequent condom use for anal intercourse and lower relationship satisfaction than monogamous participants. NCNM participants reported more HIV testing and lower satisfaction. Identities, experiences, and behaviors within open and other consensually nonmonogamous populations should be regarded as unique and diverse, rather than conflated with those common to other relationship structures. There is a need for greater awareness of diverse relationship structures among researchers and providers, and incorporation of related content into educational programming.
• Levine, E. C., Martinez, O., Mattera, B., Wu, E., Arreola, S., Rutledge, S. E., Newman, B., Icard, L., Muñoz-Laboy, M., Hausmann-Stabile, C., Welles, S., Rhodes, S. D., Dodge, B. M., Alfonso, S., Fernandez, M. I., & Carballo-Diéguez, A. (2018). Child Sexual Abuse and Adult Mental Health, Sexual Risk Behaviors, and Drinking Patterns Among Latino Men Who Have Sex With Men. Journal of Child Sexual Abuse, 27(Issue 3). doi:10.1080/10538712.2017.1343885
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  One in five Latino men who have sex with men has experienced child sexual abuse. Although concerning in itself, child sexual abuse may increase an individuals’ likelihood of depression and risk-taking in adult life, including engagement in HIV risk behaviors and alcohol and substance use. It is therefore urgent that researchers and practitioners better understand the long-term effects of child sexual abuse. We utilized logistic and linear regression to assess associations between child sexual abuse (operationalized as forced or coerced sexual activity before age 17) and depression, sexual behaviors, and drinking patterns in a sample of 176 adult Latino men who have sex with men from New York City. Over one-fifth (22%) of participants reported child sexual abuse. In multivariable models, participants with histories of child sexual abuse were significantly more likely than participants without such histories to screen for clinically significant depressive symptoms and heavy drinking and reported more anal sex acts, male sexual partners, and incidents of condomless anal intercourse in the previous three months. These findings confirm a high prevalence of child sexual abuse among Latino men who have sex with men and associations between child sexual abuse and adulthood depressive symptoms, high-risk alcohol consumption, and sexual risk behaviors. We recommend that providers who serve Latino men who have sex with men incorporate child sexual abuse screenings into mental health, HIV prevention, and substance use treatment programs, utilizing approaches that are inclusive of resilience.
• Levine, E. C., Martinez, O., Mattera, B., Wu, E., Arreola, S., Rutledge, S. E., Newman, B., Icard, L., Muñoz-Laboy, M., Hausmann-Stabile, C., Welles, S., Rhodes, S. D., Dodge, B. M., Alfonso, S., Fernandez, M. I., & Carballo-Diéguez, A. (2018). Child Sexual Abuse and Adult Mental Health, Sexual Risk Behaviors, and Drinking Patterns Among Latino Men Who Have Sex With Men. Journal of child sexual abuse, 27(3), 237-253.
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  One in five Latino men who have sex with men has experienced child sexual abuse. Although concerning in itself, child sexual abuse may increase an individuals' likelihood of depression and risk-taking in adult life, including engagement in HIV risk behaviors and alcohol and substance use. It is therefore urgent that researchers and practitioners better understand the long-term effects of child sexual abuse. We utilized logistic and linear regression to assess associations between child sexual abuse (operationalized as forced or coerced sexual activity before age 17) and depression, sexual behaviors, and drinking patterns in a sample of 176 adult Latino men who have sex with men from New York City. Over one-fifth (22%) of participants reported child sexual abuse. In multivariable models, participants with histories of child sexual abuse were significantly more likely than participants without such histories to screen for clinically significant depressive symptoms and heavy drinking and reported more anal sex acts, male sexual partners, and incidents of condomless anal intercourse in the previous three months. These findings confirm a high prevalence of child sexual abuse among Latino men who have sex with men and associations between child sexual abuse and adulthood depressive symptoms, high-risk alcohol consumption, and sexual risk behaviors. We recommend that providers who serve Latino men who have sex with men incorporate child sexual abuse screenings into mental health, HIV prevention, and substance use treatment programs, utilizing approaches that are inclusive of resilience.
• Morgan, A., Saunders, B., Dodge, B., Harper, G., & Arrington Sanders, R. (2018). Exploring the Sexual Development Experiences of Black Bisexual Male Adolescents Over Time. Archives of Sexual Behavior, 47(Issue 6). doi:10.1007/s10508-017-1084-4
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  Scant research has sought to explore the development of dimensions of sexual orientation among Black bisexual male adolescents (BBMA). Understanding how sexual attractions, behaviors, and identities evolve among BBMA over time is crucial to understanding the most appropriate support strategies to provide during this developmental period. We sought to understand and describe the sexual orientation development experiences in a sample of BBMA over the course of 1 year. We further sought to understand the sociocontextual factors that may play a role during this development process. Fifteen BBMA, aged 15–19 years, were interviewed about sexual debut experiences (baseline) and were re-interviewed three times over a 1-year period about sexual attractions, behaviors, and identity at each follow-up point. A three-person team used inductive open coding to analyze each participant’s data set. The mean Kinsey scale score for the sample was 2.93 (SD = 1.2) most closely translating to “heterosexual/gay-equally.” A case study analysis was used to identify themes related to sexual attractions, behavior, and identity over time, within and across participants. Among the sample of young men, two unique groups were identified based on self-reported sexual identity and experiences of same- and other-sex sexual attractions and behaviors over time. The first group consisted of seven young men who consistently described their sexual identity as bisexual from baseline to the final follow-up. These young men also described similar experiences related to same- and other-sex sexual and romantic attractions and more consistently described same- and other-sex sexual behaviors. The second group consisted of eight young men that described changing sexual identity and same- and other-sex sexual romantic attractions over time. Participants described sociocontextual factors such as religion, masculinity, and homophobia played during their development. Findings from this study underscore the complexity of sexual orientation development and sociocultural factors and expectations that may influence sexual identity and behavior among BBMA.
• Morgan, A., Saunders, B., Dodge, B., Harper, G., & Arrington Sanders, R. (2018). Exploring the Sexual Development Experiences of Black Bisexual Male Adolescents Over Time. Archives of sexual behavior, 47(6), 1839-1851.
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  Scant research has sought to explore the development of dimensions of sexual orientation among Black bisexual male adolescents (BBMA). Understanding how sexual attractions, behaviors, and identities evolve among BBMA over time is crucial to understanding the most appropriate support strategies to provide during this developmental period. We sought to understand and describe the sexual orientation development experiences in a sample of BBMA over the course of 1 year. We further sought to understand the sociocontextual factors that may play a role during this development process. Fifteen BBMA, aged 15-19 years, were interviewed about sexual debut experiences (baseline) and were re-interviewed three times over a 1-year period about sexual attractions, behaviors, and identity at each follow-up point. A three-person team used inductive open coding to analyze each participant's data set. The mean Kinsey scale score for the sample was 2.93 (SD = 1.2) most closely translating to "heterosexual/gay-equally." A case study analysis was used to identify themes related to sexual attractions, behavior, and identity over time, within and across participants. Among the sample of young men, two unique groups were identified based on self-reported sexual identity and experiences of same- and other-sex sexual attractions and behaviors over time. The first group consisted of seven young men who consistently described their sexual identity as bisexual from baseline to the final follow-up. These young men also described similar experiences related to same- and other-sex sexual and romantic attractions and more consistently described same- and other-sex sexual behaviors. The second group consisted of eight young men that described changing sexual identity and same- and other-sex sexual romantic attractions over time. Participants described sociocontextual factors such as religion, masculinity, and homophobia played during their development. Findings from this study underscore the complexity of sexual orientation development and sociocultural factors and expectations that may influence sexual identity and behavior among BBMA.
• Baldwin, A. M., Dodge, B., Schick, V., Sanders, S. A., & Fortenberry, J. D. (2017). Sexual Minority Women's Satisfaction with Health Care Providers and State-level Structural Support: Investigating the Impact of Lesbian, Gay, Bisexual, and Transgender Nondiscrimination Legislation. Women's Health Issues, 27(Issue 3). doi:10.1016/j.whi.2017.01.004
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  Purpose Structural discrimination is associated with negative health outcomes among sexual minority populations. Recent changes to state-level and national legislation provide both the opportunity and the need to further explore the impact of legislation on the health indicators of sexual minorities. Using an ecosocial theory lens, the present research addresses the relationship between structural support or discrimination and satisfaction with one's health care provider among sexual minority women. Methods Data were drawn from an online survey of sexual minority women's health care experiences. Using the Andersen Behavioral Model of Health Services Utilization to operationalize the variables in our model, we examined the relationship between state-level nondiscrimination legislation and satisfaction with provider—a widely used measure of health care quality—through regression analysis. Findings Participants in structurally supportive states (i.e., those with nondiscrimination legislation) were more likely to disclose their sexual identity to their providers and to report higher satisfaction with their providers. The absence of nondiscrimination legislation was associated negatively with satisfaction with providers. Conclusions Results of our study show that the external environment in which sexual minority women seek health care, characterized by structural support or lack thereof, is related to perceived quality of health care.
• Baldwin, A. M., Dodge, B., Schick, V., Sanders, S. A., & Fortenberry, J. D. (2017). Sexual Minority Women's Satisfaction with Health Care Providers and State-level Structural Support: Investigating the Impact of Lesbian, Gay, Bisexual, and Transgender Nondiscrimination Legislation. Women's health issues : official publication of the Jacobs Institute of Women's Health, 27(3), 271-278.
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  Structural discrimination is associated with negative health outcomes among sexual minority populations. Recent changes to state-level and national legislation provide both the opportunity and the need to further explore the impact of legislation on the health indicators of sexual minorities. Using an ecosocial theory lens, the present research addresses the relationship between structural support or discrimination and satisfaction with one's health care provider among sexual minority women.
• Baldwin, A., Baldwin, A., Dodge, B., Dodge, B., Schick, V., Schick, V., Herbenick, D., Herbenick, D., Sanders, S. A., Sanders, S. A., Dhoot, R., Dhoot, R., Fortenberry, J. D., & Fortenberry, J. D. (2017). Health and identity-related interactions between lesbian, bisexual, queer and pansexual women and their healthcare providers. Culture, health & sexuality, 19(11), 1181-1196.
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  Disclosure of sexual identity among sexual minority women is related to better outcomes and improved quality of care. The existing literature on sexual minority women's experiences of identity disclosure and related interactions with healthcare providers draws little distinction between different groups of sexual minority women, despite the different barriers, stigma and health outcomes that exist between them. This paper presents factors influencing identity disclosure and describes the characteristics of interactions that sexual minority women have with their healthcare providers around sexual identity and health. Using a mixed-methods approach, both qualitative and quantitative data were gathered using an online survey. The sample included lesbian, bisexual, queer and pansexual women from across the USA. Qualitative and quantitative data were analysed concurrently, and qualitative themes were quantified and integrated into quantitative analyses. Identity disclosure, reasons for disclosing identity and characteristics of interactions with providers varied by identity, but often overlapped. Bisexual and pansexual participants were significantly less likely to disclose identity than lesbian participants. There were no significant differences related to age or ethnicity. Findings from this study have the potential to inform ethical medical practices and improve healthcare quality among sexual minority women.
• Baldwin, A., Dodge, B., Schick, V., Herbenick, D., Sanders, S. A., Dhoot, R., & Fortenberry, J. D. (2017). Health and identity-related interactions between lesbian, bisexual, queer and pansexual women and their healthcare providers. Culture, Health and Sexuality, 19(Issue 11). doi:10.1080/13691058.2017.1298844
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  Disclosure of sexual identity among sexual minority women is related to better outcomes and improved quality of care. The existing literature on sexual minority women’s experiences of identity disclosure and related interactions with healthcare providers draws little distinction between different groups of sexual minority women, despite the different barriers, stigma and health outcomes that exist between them. This paper presents factors influencing identity disclosure and describes the characteristics of interactions that sexual minority women have with their healthcare providers around sexual identity and health. Using a mixed-methods approach, both qualitative and quantitative data were gathered using an online survey. The sample included lesbian, bisexual, queer and pansexual women from across the USA. Qualitative and quantitative data were analysed concurrently, and qualitative themes were quantified and integrated into quantitative analyses. Identity disclosure, reasons for disclosing identity and characteristics of interactions with providers varied by identity, but often overlapped. Bisexual and pansexual participants were significantly less likely to disclose identity than lesbian participants. There were no significant differences related to age or ethnicity. Findings from this study have the potential to inform ethical medical practices and improve healthcare quality among sexual minority women.
• Baldwin, A., Schick, V. R., Dodge, B., van Der Pol, B., Herbenick, D., Sanders, S. A., & Fortenberry, J. D. (2017). Variation in Sexual Identification Among Behaviorally Bisexual Women in the Midwestern United States: Challenging the Established Methods for Collecting Data on Sexual Identity and Orientation. Archives of Sexual Behavior, 46(Issue 5). doi:10.1007/s10508-016-0817-0
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  Collecting information on sexual identity is critical to ensuring the visibility of minority populations who face stigmatization and discrimination related to sexual identities. However, it is challenging to capture the nuances of sexual identity with traditional survey research methods. Using a mixed-methods approach, we gathered data on the sexual identities of 80 behaviorally bisexual women in the Midwestern United States through an online survey. When provided different types of measures (e.g., open ended and fixed response) and different contexts in which to identify (e.g., private and public), participants varied in how they reported their sexual identities. Qualitative analysis of participant narratives around identity change finds partitioning and ranking of attraction is a key component in understanding behaviorally bisexual women’s identities. We further identify a division regarding the desired outcomes of identity development processes. Given the multiple ways in which participants identified depending upon the type of measure and the context specified, and the variation in identification over time, results support reconsidering the capability of typical measures and methods used in survey research to capture sexual identity information. Additionally, findings highlight the utility of including multiple, context-specific measures of sexual identities in future research.
• Bartelt, E., Bowling, J., Dodge, B., & Bostwick, W. (2017). Bisexual Identity in the Context of Parenthood: An Exploratory Qualitative Study of Self-Identified Bisexual Parents in the United States. Journal of Bisexuality, 17(Issue 4). doi:10.1080/15299716.2017.1384947
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  Bisexual parents constitute the largest proportion of “lesbian, gay and bisexual (LGB) parents” yet are largely absent from previous research. As parenting and sexual identity may be significant pieces of one's self-concept, examining bisexual parents’ experiences and sexual identity formation is important. This qualitative study used phone interviews with 33 self-identified bisexual parents in the United States with at least one child (including genetic, adopted, step, or foster). Participants were between ages 22 and 65 years, and the majority were non-Hispanic White. The authors thematically analyzed interview data using Dedoose. Participants described experiencing biphobia as a barrier to understanding their identity or coming out to others, including their children. Despite misconceptions about bisexuality, parents reported pride in their identity and more openness to and understanding of their children. Developing resources to navigate biphobia and identity disclosure in the context of parenting may build community and reduce stress.
• Bowling, J., Dodge, B., & Bartelt, E. (2017). Sexuality-related communication within the family context: experiences of bisexual parents with their children in the United States of America. Sex Education, 17(Issue 1). doi:10.1080/14681811.2016.1238821
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  Although many self-identified bisexual individuals report having at least one child, bisexual parents’ unique experiences, including sexuality-related communication with their children, have been largely absent from the parenting literature. We conducted in-depth interviews via telephone (or digital telephony such as voice over Internet protocol) with 33 individuals who self-identified as bisexual were at least 18 years old, had at least one child (genetic, adopted, step, foster, guardian or partner’s child) and currently living in the USA. Nearly all participants encouraged their children to be tolerant of sexual and gender diversity. Sexual behaviours were primarily discussed in terms of protection from sexually transmitted infections and unintended pregnancy. Participants’ approaches to communication included non-verbal methods (e.g. role modelling) and pragmatic verbal discussion. Participants employed numerous strategies, including age-appropriate, child-driven and opportunistic discussions. Some parents did not discuss sexuality at all with their children. Many had not received training in childhood development or sexuality education. The participants’ experiences were often similar to previous research on parents of other sexual identities. However, due to the unique stigma associated with bisexuality, findings point to a need for developing and providing targeted resources for bisexual parents to assist in discussions about sexuality within the family context.
• Chatterji, S., Bay-Cheng, L. Y., Schick, V., Dodge, B., Baldwin, A., Van Der Pol, B., & Fortenberry, J. D. (2017). The Year’s Best: Interpersonal Elements of Bisexual Women’s Most Satisfying Sexual Experiences in the Past Year. Journal of Sex Research, 54(Issue 7). doi:10.1080/00224499.2016.1207056
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  Sexual satisfaction is commonly defined and discussed in physiological terms of arousal and orgasm. Yet this narrow discourse does not accommodate the complex, multidimensional, and interpersonal aspects of sexual experience. To broaden and deepen our understanding of sexual satisfaction, we employed McClelland’s (2014) holistic four-factor framework of sexual satisfaction in a theoretical thematic analysis of 39 behaviorally bisexual women’s descriptions of their “best” partnered sexual experiences from the past year. We found women’s accounts mapped on to four elements: emotional attunement, emotional gratification, partner gratification, and sensory gratification. Relational and emotional dynamics, including emotional security, quality of interpersonal interaction during and after a sexual encounter, mutuality, intimacy, partner skill, novelty, and communication, were key to participants’ best sex experiences. Our findings support a multifaceted model of women’s sexual satisfaction that accounts for emotional, relational, and embodied experiences and the diverse relationships and behaviors these might involve.
• Guerra-Reyes, L., Rush, B., Herbenick, D., Dodge, B., Reece, M., Schick, V., Sanders, S. A., & Fortenberry, J. D. (2017). Sexual Health and Language Dominance Among Hispanic/Latino Women and Men: Analysis of a Nationally Representative Sample. Journal of Immigrant and Minority Health, 19(Issue 5). doi:10.1007/s10903-016-0446-7
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  This study assessed the prevalence of sexual behaviors among a nationally representative sample of Latino men and women in the United States (US) (N = 432) including Spanish language data collection. Prior studies of sexual health among US Latinos have consisted of convenience samples, and focused mainly on assessing risk behaviors. We consider a broader range of sexual behaviors, subjective sexual experiences (e.g. pleasure and arousal), and STI testing behaviors. Analyses by language dominance and gender indicate a higher variability in sexual behaviors for English-dominant participants and a link between overall STI testing to regular medical examinations, especially women. Higher rates of pleasure, orgasms and arousal was reported by Spanish-dominant men and women, relative to the English-dominant group. Results represent a nuanced examination of internal differentiation among US Latinos and provides applicable data for reducing sexual health disparities in this population.
• Herbenick, D., Bowling, J., Fu, T. C., Dodge, B., Guerra-Reyes, L., & Sanders, S. (2017). Sexual diversity in the United States: Results from a nationally representative probability sample of adult women and men. PLoS ONE, 12(Issue 7). doi:10.1371/journal.pone.0181198
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  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
• Herbenick, D., Bowling, J., Fu, T. J., Dodge, B., Guerra-Reyes, L., & Sanders, S. (2017). Sexual diversity in the United States: Results from a nationally representative probability sample of adult women and men. PloS one, 12(7), e0181198.
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  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
• Martinez, O., Muñoz-Laboy, M., Levine, E. C., Starks, T., Dolezal, C., Dodge, B., Icard, L., Moya, E., Chavez-Baray, S., Rhodes, S. D., & Fernandez, M. I. (2017). Relationship Factors Associated with Sexual Risk Behavior and High-Risk Alcohol Consumption Among Latino Men Who Have Sex with Men: Challenges and Opportunities to Intervene on HIV Risk. Archives of Sexual Behavior, 46(Issue 4). doi:10.1007/s10508-016-0835-y
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  The HIV epidemic continues to be a major public health concern, affecting communities with varying prevention and treatment needs. In the U.S., Latino men who have sex with men (MSM) bear a disproportionate burden of HIV incidence. While recent studies have highlighted the relevance of relationship factors for HIV transmission among MSM generally, the unique needs and experiences of Latino MSM have received relatively little attention. Consequently, associations between relationship factors and HIV risk among Latino MSM remain unknown. This mixed-method study examined relationship status and dynamics and potential HIV-related risk behaviors among Latino MSM. Quantitative analyses with 240 Latino MSM investigated associations between relationship status and engagement in condomless anal intercourse (CAI). Focus groups with 20 Latino male couples and 10 health service providers explored the impact of relationship dynamics on sexual behaviors, as well as opportunities to intervene on HIV risk. The majority of participants were predominantly Spanish speaking, most screened positive for high-risk alcohol consumption in the past month, more than half engaged in CAI in the past 3 months, and a majority reported multiple sexual partners in this period. Among participants in same-sex relationships (n = 175), approximately half reported multiple partners in the previous 3 months and more than two-thirds reported CAI in this time period. Being in a same-sex relationship was positively associated with high-risk alcohol consumption and being age 30 or older and negatively associated with having multiple partners. Moreover, being in a same-sex relationship significantly increased the likelihood that participants would report engaging in CAI. Qualitative analyses identified themes related to relationship dynamics and sexual behavior, as well as opportunities to intervene on HIV risk. Despite the challenges encountered by Latino male couples, most participants expressed commitment to and support for their partners. As such, prevention efforts involving Latino male couples must address relationship dynamics and the role they play in sexual health, including safer sex practices.
• Schnarrs, P. W., Rosenberger, J. G., Schick, V., Delgado, A., Briggs, L., Dodge, B., & Reece, M. (2017). Difference in Condom Use Between Bear Concordant and Discordant Dyads During the Last Anal Sex Event. Journal of Homosexuality, 64(Issue 2). doi:10.1080/00918369.2016.1174024
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  The purpose of this study was to understand how bear identity influenced condom use during the last anal sex event. Participants were recruited to complete an online, anonymous self-report survey through bear-related sexual and social networking websites. A total of 1,080 men who identified as gay or bisexual and as a member of the bear community and were 18 years or older completed the survey. Overall, fewer than a third of men reported condom use during the most recent receptive (28%) and insertive (30%) anal sex event. Men in bear concordant pairings were less likely to use a condom during receptive and insertive anal sex compared to those is discordant pairings (p
• Bowling, J., Dodge, B., Banik, S., Rodriguez, I., Mengele, S. R., Herbenick, D., Guerra-Reyes, L., Sanders, S., Dange, A., & Anand, V. (2016). Perceived health concerns among sexual minority women in Mumbai, India: an exploratory qualitative study. Culture, Health and Sexuality, 18(Issue 7). doi:10.1080/13691058.2015.1134812
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  The experiences of sexual minority women (i.e., women who do not identify as ‘heterosexual’) in India have largely been absent in scientific literature. In partnership with India’s oldest and largest sexual and gender minority-advocacy organisation, the Humsafar Trust, our study used community-based participatory research principles to explore the lived experiences and health concerns of sexual minority women in Mumbai. Study methodologies included interviews with key informants, a focus group comprised of six women, and an additional 12 in-person interviews with sexual minority women to identify important physical, mental, social and other health priorities from these women’s perspectives. Thematic data are organised within the framework offered by the social ecological model, including individual, interpersonal, micro and macro levels. Findings from this study are important in providing the groundwork for future research and intervention involving sexual minority women in India, a dramatically underserved population.
• Davis, A., Best, J., Luo, J., Van Der Pol, B., Dodge, B., Meyerson, B., Aalsma, M., Wei, C., Tucker, J. D., Zhang, Y., Tang, W., Yang, B., Liu, F., Han, L., & Yang, L. (2016). Differences in risk behaviours, HIV/STI testing and HIV/STI prevalence between men who have sex with men and men who have sex with both men and women in China. International Journal of STD and AIDS, 27(Issue 10). doi:10.1177/0956462415596302
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  Differences in risk behaviours between men who have sex with men (MSM) and men who have sex with both men and women (MSMW) have important implications for HIV and sexually transmitted infection (STI) transmission. We examined differences in risk behaviours, HIV/STI testing, self-reported HIV/STI diagnoses, and linkage to HIV care between MSM and MSMW across China. Participants were recruited through three MSM-focused websites in China. An online survey containing items on socio-demographics, risk behaviours, testing history, self-reported HIV/STI diagnosis, and linkage to and retention in HIV care was completed from September to October 2014. Chi square tests and logistic regression analyses were conducted. MSMW were less likely to use a condom during last anal sex (p ≤ 0.01) and more likely to engage in group sex (p ≤ 0.01) and transactional sex (p ≤ 0.01) compared to MSM. Self-reported HIV/STI testing and positivity rates between MSM and MSMW were similar. Among HIV-infected MSM, there was no difference in rates of linkage to or retention in antiretroviral therapy when comparing MSM and MSMW. Chinese MSM and MSMW may benefit from different HIV and STI intervention and prevention strategies. Achieving a successful decrease in HIV/STI epidemics among Chinese MSM and MSMW will depend on the ability of targeted and culturally congruent HIV/STI control programmes to facilitate a reduction in risk behaviours.
• Dodge, B., Banik, S., Bowling, J., Sivasubramanian, M., Mengle, S., Schick, V., Herbenick, D., Row Kavi, A., & Anand, V. (2016). Sexual Relationships, Behaviors, and Experiences Among Bisexual Men in Mumbai, India. International Journal of Sexual Health, 28(Issue 1). doi:10.1080/19317611.2015.1116482
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  Objectives: This exploratory study attempted to assess a range of sexual behaviors, relationships, and related factors among a sample of bisexual men in Mumbai, India. Methods: Data collection occurred in two separate phases. First, focus group discussions were facilitated with local community members in order to finalize an interviewer-administered questionnaire. Afterward, structured interviews were conducted with a sample of 50 bisexual men using this questionnaire. Results: Participants reported a wide range of sexual behaviors and relationships with male and female partners. Conclusions: Findings have implications for future research and practice focusing on bisexual men in India,as well as their partners of all genders.
• Dodge, B., Herbenick, D., Friedman, M. R., Schick, V., Fu, T. C., Bostwick, W., Bartelt, E., Muñoz-Laboy, M., Pletta, D., Reece, M., & Sandfort, T. G. (2016). Attitudes toward bisexual men and women among a nationally representative probability sample of adults in the United States. PLoS ONE, 11(Issue 10). doi:10.1371/journal.pone.0164430
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  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.
• Dodge, B., Herbenick, D., Friedman, M. R., Schick, V., Fu, T. J., Bostwick, W., Bartelt, E., Muñoz-Laboy, M., Pletta, D., Reece, M., & Sandfort, T. G. (2016). Attitudes toward Bisexual Men and Women among a Nationally Representative Probability Sample of Adults in the United States. PloS one, 11(10), e0164430.
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  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.
• Dodge, B., Herbenick, D., Fu, T. C., Schick, V., Reece, M., Sanders, S., & Fortenberry, J. D. (2016). Sexual Behaviors of U.S. Men by Self-Identified Sexual Orientation: Results From the 2012 National Survey of Sexual Health and Behavior. Journal of Sexual Medicine, 13(Issue 4). doi:10.1016/j.jsxm.2016.01.015
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  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.
• Martinez, O., Martinez, O., Wu, E., Wu, E., Levine, E. C., Levine, E. C., Muñoz-Laboy, M., Muñoz-Laboy, M., Spadafino, J., Spadafino, J., Dodge, B., Dodge, B., Rhodes, S. D., Rhodes, S. D., Rios, J. L., Rios, J. L., Ovejero, H., Ovejero, H., Moya, E. M., , Moya, E. M., et al. (2016). Syndemic factors associated with drinking patterns among Latino men and Latina transgender women who have sex with men in New York City. Addiction research & theory, 24(6), 466-476.
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  Alcohol consumption is a significant public health concern among Latino men and Latina transgender women who have sex with men. However, characteristics and behaviors associated with alcohol consumption in this population, particularly in regard to the complex influence of syndemic factors, remain understudied. The purpose of this study was to examine predictors of high-risk alcohol consumption (i.e. binge or heavy drinking). Between January and March of 2014, 176 Latino men and Latina transgender women in New York City completed an interviewer-administered questionnaire. We developed a syndemics scale to reflect the total number of syndemic factors - clinically significant depression, childhood sexual abuse, intimate partner violence, and discrimination - reported by each participant. We also carried out a multinomial logistic regression model predicting binge and heavy drinking. Forty-seven percent of participants reported high-risk alcohol consumption in the past 30 days (21% binge and 26% heavy). Approximately 16% of participants reported no syndemic factors, 27% reported one factor, 39% reported two factors, and 18% reported three or four. In the multinomial logistic regression model, our syndemic factors scale was not significantly associated with binge drinking. However, participants who reported three or four factors were significantly more likely to report heavy drinking. In addition, having multiple sexual partners was associated with an increased risk of binge and heavy drinking; involvement in a same-sex relationship was associated with binge drinking. Further work is needed to develop effective prevention intervention approaches for high-risk alcohol consumption within this population.
• Martinez, O., Wu, E., Levine, E. C., Muñoz-Laboy, M., Spadafino, J., Dodge, B., Rhodes, S. D., López Rios, J., Ovejero, H., Moya, E. M., Baray, S. C., Carballo-Diéguez, A., & Fernandez, M. I. (2016). Syndemic factors associated with drinking patterns among Latino men and Latina transgender women who have sex with men in New York City. Addiction Research and Theory, 24(Issue 6). doi:10.3109/16066359.2016.1167191
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  Alcohol consumption is a significant public health concern among Latino men and Latina transgender women who have sex with men. However, characteristics and behaviors associated with alcohol consumption in this population, particularly in regard to the complex influence of syndemic factors, remain understudied. The purpose of this study was to examine predictors of high-risk alcohol consumption (i.e. binge or heavy drinking). Between January and March of 2014, 176 Latino men and Latina transgender women in New York City completed an interviewer-administered questionnaire. We developed a syndemics scale to reflect the total number of syndemic factors – clinically significant depression, childhood sexual abuse, intimate partner violence, and discrimination – reported by each participant. We also carried out a multinomial logistic regression model predicting binge and heavy drinking. Forty-seven percent of participants reported high-risk alcohol consumption in the past 30 days (21% binge and 26% heavy). Approximately 16% of participants reported no syndemic factors, 27% reported one factor, 39% reported two factors, and 18% reported three or four. In the multinomial logistic regression model, our syndemic factors scale was not significantly associated with binge drinking. However, participants who reported three or four factors were significantly more likely to report heavy drinking. In addition, having multiple sexual partners was associated with an increased risk of binge and heavy drinking; involvement in a same-sex relationship was associated with binge drinking. Further work is needed to develop effective prevention intervention approaches for high-risk alcohol consumption within this population.
• Martinez, O., Wu, E., Sandfort, T., Dodge, B., Carballo-Dieguez, A., Pinto, R., Rhodes, S. D., Moya, E., & Chavez-Baray, S. (2016). Erratum to: Evaluating the Impact of Immigration Policies on Health Status Among Undocumented Immigrants: A Systematic Review (Journal of Immigrant and Minority Health, 10.1007/s10903-013-9968-4). Journal of Immigrant and Minority Health, 18(Issue 1). doi:10.1007/s10903-014-9976-z
• Schick, V. R., Baldwin, A., Bay-Cheng, L. Y., Dodge, B., Van Der Pol, B., & Fortenberry, J. D. (2016). "First, I... then, we...": exploring the sequence of sexual acts and safety strategies reported during a sexual encounter using a modified timeline followback method. Sexually Transmitted Infections, 92(Issue 4). doi:10.1136/sextrans-2015-052207
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  Objectives Assessments of sexual safety often rely on questions about the occurrence of condom use within a designated timeline, assuming that penile-vaginal intercourse (PVI) occurred once at the conclusion of the event. An investigation of all sexual acts and safety strategies that occur during a single event may present a more nuanced picture of sexual risk. Methods Behaviourally, bisexual women (N=45) were recruited due to the potential diversity of their sexual behaviour and safety strategies. A modified timeline follow-back method, the SEQUENCE Calendar, was designed to capture information about the participants' most recent sexual event with a male partner, including the order of each sexual act during the sexual event. Interviews took between 1 and 3h. These acts were compiled into narratives and the behavioural sequences were reviewed and coded. Results Participants reported an average of 7.9 (SD=4.3) sexual acts. Over a third (35.9%, N=14) of the participants who reported PVI indicated engaging in genital contact after PVI and over 15% (N=6) of these participants reporting PVI at two different time points, separated by sexual behaviour. Additional potential for infection outside of condom use and PVI was also identified. Conclusions Sexual interactions are comprised of multiple acts that occur in a variety of permutations. Understanding the complexity of people's sexual encounters has potential to inform the ways we measure condom use and consider sexual safety.
• Spadafino, J. T., Martinez, O., Levine, E. C., Dodge, B., Munõz-Laboy, M., & Fernandez, M. I. (2016). Correlates of HIV and STI testing among Latino men who have sex with men in New York City. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 28(Issue 6). doi:10.1080/09540121.2016.1147017
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  We assessed the extent to which sociodemographic, personal, and behavioral factors are associated with human immunodeciency virus/sexually transmitted infection (HIV/STI) testing among a diverse group of Latino men who have sex with men (MSM) in New York City. The triangulation approach was used to synthesize data from 176 MSM who completed an in-person or phone questionnaire about substance use, alcohol consumption, sexual behaviors, and HIV/STI testing history and 40 participants who participated in focus groups. Correlates of testing significant in univariable analyses (p < .05) were entered into multivariable logistic regression models. Over half (57.9%) of study subjects tested for HIV in the previous 12 months and 60.2% tested for STIs in the previous 12 months. Age and education were positively correlated with HIV testing in multivariable analysis. No significant correlates of STI testing were identified. Spanish-speaking only subjects were less likely to get tested for HIV and STI; however, this association was not significant. Our study demonstrates the need for further study of predictors of STI testing as well as the potential role of language barriers and education in routine testing for HIV. Social and behavioral factors may intensify these obstacles. Future research and interventions should address the role of language barriers and perceived issues of immigration status in the decision to get tested.
• Baldwin, A., Dodge, B., Schick, V., Hubach, R. D., Bowling, J., Malebranche, D., Goncalves, G., Schnarrs, P. W., Reece, M., Fortenberry, J. D., Baldwin, A., Dodge, B., Schick, V., Hubach, R. D., Bowling, J., Malebranche, D., Goncalves, G., Schnarrs, P. W., Reece, M., & Fortenberry, J. D. (2015). Sexual Self-Identification Among Behaviorally Bisexual Men in the Midwestern United States. Archives of Sexual Behavior, 44(Issue 7). doi:10.1007/s10508-014-0376-1
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  Previous social and behavioral research on identity among bisexual men, when not subsumed within the category of men who have sex with men (MSM), has primarily focused on samples of self-identified bisexual men. Little is known about sexual self-identification among men who are behaviorally bisexual, regardless of sexual identity. Using qualitative data from 77 in-depth interviews with a diverse sample of behaviorally bisexual men (i.e., men who have had sex with at least one woman and at least one man in the past six months) from a large city in the Midwestern United States, we analyzed responses from a domain focusing on sexual self-identity and related issues. Overall, participants’ sexual self-identification was exceptionally diverse. Three primary themes emerged: (1) a resistance to, or rejection of, using sexual self-identity labels; (2) concurrent use of multiple identity categories and the strategic deployment of multiple sexual identity labels; and (3) a variety of trajectories to current sexual self-identification. Based on our findings, we offer insights into the unique lived experiences of behaviorally bisexual men, as well as broader considerations for the study of men’s sexuality. We also explore identity-related information useful for the design of HIV/STI prevention and other sexual health programs directed toward behaviorally bisexual men, which will ideally be variable and flexible in accordance with the wide range of diversity found in this population.
• Briggs, L. M., Gilbert, K. R., Reece, M. D., Dodge, B. M., & Obeng, S. G. (2015). To god be the glory: Discussing sex in evangelical communities in Southern Nigeria. African Journal of Reproductive Health, 19(Issue 4).
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  Many people hold stereotypes and assumptions about religious communities in regards to their feelings and beliefs about sex and the impact it has on the lived experiences of religious people. However, stereotypes and assumptions are not often grounded in reality, and many people are hesitant to address the issue head on. This qualitative ethnographically informed preliminary grounded theory study aimed to engage an Evangelical Pentecostal community in Southern Nigeria with the ultimate goal of understanding how communities conceptualize and discuss sexuality topics, the factors influencing sexual decision making amongst youth and young adults, and to identify research needs that will better inform innovative and efficacious research utilizing religious communities in sexuality research. Results showed that this population was highly interested in discussing sexuality in their community including major threats to their ideal sexual behavior path, reasons why people stray from this ideal and how to keep people on this ideal path. This research demonstrates that religious communities are interested in conducting sexuality research so long as the research takes their values and beliefs into account and respects their limitations when it comes to research intent and methods.
• Davis, A., Best, J., Wei, C., Luo, J., Van Der Pol, B., Meyerson, B., Dodge, B., Aalsma, M., & Tucker, J. (2015). Intimate partner violence and correlates with risk behaviors and HIV/STI diagnoses among men who have sex with men and men who have sex with men and women in China: A hidden epidemic. Sexually Transmitted Diseases, 42(Issue 7). doi:10.1097/olq.0000000000000302
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  Background: Intimate partner violence (IPV) research has primarily focused on heterosexual couples but has largely ignored IPVamongmen who have sex with men (MSM). We examined IPV prevalence among MSM and men who have sex with men and women (MSMW) in China. Methods: Men who have sex withmen older than 16 years were recruited through 3 MSM-focused Web sites in China. An online survey containing items on sociodemographics, risk behaviors, IPV, and self-reported HIV or sexually transmitted infection diagnosis was completed. Multivariate regression was used to examine associations between IPVand risk behaviors and an HIVor sexually transmitted infection diagnosis. Results: Among 610 participants, 182 (29.8%) reported experiencing at least 1 type of IPV. Men who have sex with both men and women were at significantly greater risk for IPV (adjusted odds ratio [AOR], 1.65; 95% confidence interval [CI], 1.08-2.53) compared with MSM. Men who had experienced IPV were more likely to have participated in group sex (AOR, 1.86; 95% CI, 1.08-3.21), to have had sex in exchange for gifts or money (AOR, 5.06; 95% CI, 2.47-10.35), and to report a positive HIV diagnosis (AOR, 2.59; 95% CI, 1.22-5.51). Conclusions: There is a hidden epidemic of IPVamong MSM in China, especially among MSMW. The hidden nature of MSM and MSMW suggests the need for a clinical environment more conducive to disclosure. Research is needed to understand the pathways linking IPV and HIV risk among MSM to optimize the design of effective interventions.
• Dodge, B., Hubach, R. D., Schick, V., Herbenick, D., Reece, M., Sanders, S. A., & Fortenberry, J. D. (2015). Lubricant use at last sexual encounter with a male partner: Findings from a nationally representative sample of self-identified gay and bisexual men in the United States. Sexual Health, 12(Issue 4). doi:10.1071/sh14186
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  Background There is a lack of research that examines event-level lubricant use and outcomes among gay and bisexual men, with the majority of current research addressing lubricant use within the context of sexual risk. Most studies examining sexual health among gay and bisexual men have relied on convenience sampling strategies for participant recruitment. Methods: Data were collected from the 2012 wave of the National Survey of Sexual Health and Behaviour (NSSHB), which involved the administration of an online questionnaire to a nationally representative probability sample of women and men in the United States aged 18 years and older, including an oversampling of self-identified gay and bisexual men and women. The findings from gay (n≤307) and bisexual (n≤25) participants who reported sexual behaviours with other male partners during their last sexual encounter are included in this paper. Post-stratification data weights were applied to the data to maximise the generalisability of the findings. Results: Men who reported lubricant use during their last sexual event with a male partner (n≤163) were significantly more likely to be non-White, Hispanic and between 30 and 39 years old. Bisexual men had lower odds of using lubricant than gay-identified men. The majority of men reported using lubricant during anal intercourse, along with lower numbers with a range of other sexual behaviours. Conclusion: Public health promotion specialists should consider recommending continued lubricant use as a part of comprehensive sexual health promotion efforts for gay and bisexual men, including that it reduces pain and maximises pleasure.
• Hensel, D. J., Schick, V., Herbenick, D., Dodge, B., Reece, M., Sanders, S. A., & Fortenberry, J. D. (2015). Lifetime Lubricant Use among a Nationally Representative Sample of Lesbian- and Bisexual-Identified Women in the United States. Journal of Sexual Medicine, 12(Issue 5). doi:10.1111/jsm.12873
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  Introduction: The diversity in self-identified lesbian and bisexual women's sexual interactions necessitates better understanding of how and when they integrate personal lubricant into different experiences. However, little is known about lesbian and bisexual women's lifetime lubricant use, particularly at the population level. Aims: The aim of this study was to examine the prevalence and characteristics of lubricant use among adult lesbian and bisexual women in the United States. Methods: Data were drawn from a subset of lesbian and bisexual participants who participated in the 2012 National Survey of Sexual Health and Behavior, an online questionnaire administered to a nationally representative probability sample of U.S. adults ages 18 and older. Main Outcome Measures: We examined socio-demographic characteristics, recent and lifetime lubricant use, lubricant use in associated with specific sexual behaviors and condom use, frequency of use, motivations for use, as well as perception of lubricant when used. Results: A majority of lesbian- (60.1%) and bisexual-identified (77.1%) women reported ever using lubricant; 25.7% of lesbian women and 32.7% of bisexual women used it in the last 30 days. Across most age groups, lubricant was commonly used during partnered sexual play, partnered sexual intercourse, or when a vibrator/dildo was used. Lesbian and bisexual women reported using lubricants to increase arousal/sexual pleasure/desire, to make sex more fun, or to increase physical comfort during sex. Conclusions: Lubricant use is identified as a part of lesbian and bisexual women's sexual experience across the life span, as a part of both solo and partnered experiences. As part of evolving sexual health assessments, clinicians and health educators may find value in integrating lubricant-focused conversation with their lesbian and bisexual patients and clients, particularly.
• Hubach, R. D., Dodge, B., Li, M. J., Schick, V., Herbenick, D., Ramos, W. D., Cola, T., & Reece, M. (2015). Loneliness, HIV-related stigma, and condom use among a predominantly rural sample of HIV-positive men who have sex with men (MSM). AIDS Education and Prevention, 27(Issue 1). doi:10.1521/aeap.2015.27.1.72
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  Most previous studies of the sexual behaviors of men who have sex with men (MSM) living with HIV are based on samples recruited within relatively urban and suburban areas of rhe United States. Using an internet-based questionnaire, we assessed HIV-related stigma, loneliness, and event-level sexual behaviors in a sample of HIV positive MSM (n = 100) residing within a largely rural area in the Midwestern United States. HIV-related stigma was correlated with loneliness (r = 0.619, p < 0.01). Loneliness was negatively associated with condom usage with the most recent partner of unknown status (p < 0.05). Namely, a 1-unit increase in the UCLA loneliness score was met with a 10% decrease in odds of condom usage. Further studies are warranted that explore loneliness, within the context of HIV-related stigma, among HIV-positive MSM residing in rural areas. More refined data will inform clinical and social service practice, as they provide much-needed information on sexual health outcomes and experiences of an often underserved and under studied population.
• Hubach, R. D., Dodge, B., Schick, V., Ramos, W. D., Herbenick, D., Li, M. J., Cola, T., & Reece, M. (2015). Experiences of HIV-positive gay, bisexual and other men who have sex with men residing in relatively rural areas. Culture, Health and Sexuality, 17(Issue 7). doi:10.1080/13691058.2014.994231
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  Most previous studies of the sexual behaviour of gay, bisexual and other men who have sex with men living with HIV are based on samples of men recruited within relatively urban and suburban areas of the USA. The aim of the present study was to explore the potential challenges associated with HIV-related stigma and residing in a relatively rural area. We conducted a qualitative study based in south-central Indiana, a relatively rural area of the USA. Twenty-three HIV-positive gay, bisexual and other men who have sex with men, aged 21–48 years, were interviewed on topics regarding community engagement, perceived HIV-related stigma, relationship formation, sexual behaviour and HIV status disclosure. Findings indicate HIV-related stigma is commonly reported at the interpersonal and community levels. Because of this, men face complex situations on how and when to disclose their HIV status to members of their social and sexual networks. Although many participants reported many challenges associated with relationship formation, all expressed a desire for romantic and/or sexual connections with other men and/or women. Results suggest that new programmatic approaches are necessary to inform the work of social service and medical providers on mechanisms to intervene and combat stigma and discrimination inherent in communities, programmes and policies.
• Li, M. J., Hubach, R. D., & Dodge, B. (2015). Social Milieu and Mediators of Loneliness Among Gay and Bisexual Men in Rural Indiana. Journal of Gay and Lesbian Mental Health, 19(Issue 4). doi:10.1080/19359705.2015.1033798
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  Extant research on quality of life in gay, bisexual, and other men who have sex with men (MSM) primarily capture the social milieu and psychosocial outcomes of those living in urban rather than rural settings. Much of this can be attributed to the high demand for services in areas with greater concentrations of sexual minorities. As MSM in rural communities are both underrepresented in research and susceptible to social estrangement from each other, our study assessed the impacts of several aspects of their social milieu—recency of access to community resources for gay/bisexual men and time socializing with other gay/bisexual men—on loneliness, as well as the mediating role of perceived connectedness to the local gay/bisexual community on this association. Using purposive sampling and Internet-based direct marketing, we recruited 225 MSM aged 18 or older in rural and mixed rural areas in south-central Indiana. We performed a path analysis to test our hypothesized model. Recency of access to community resources was positively associated with perceived connectedness to the gay/bisexual community, which in turn was protective against loneliness. Findings indicate that improving accessibility to venues or activities for rural MSM could serve to facilitate community-building and benefit their psychosocial well-being.
• Martinez, O., Wu, E., Sandfort, T., Dodge, B., Carballo-Dieguez, A., Pinto, R., Rhodes, S., Moya, E., & Chavez-Baray, S. (2015). Evaluating the Impact of Immigration Policies on Health Status Among Undocumented Immigrants: A Systematic Review. Journal of Immigrant and Minority Health, 17(Issue 3). doi:10.1007/s10903-013-9968-4
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  Over the past two decades, new anti-immigration policies and laws have emerged to address the migration of undocumented immigrants. A systematic review of the literature was conducted to assess and understand how these immigration policies and laws may affect both access to health services and health outcomes among undocumented immigrants. Eight databases were used to conduct this review, which returned 325 papers that were assessed for validity based on specified inclusion criteria. Forty critically appraised articles were selected for analysis; thirty articles related to access to health services, and ten related to health outcomes. The articles showed a direct relationship between anti-immigration policies and their effects on access to health services. In addition, as a result of these policies, undocumented immigrants were impacted by mental health outcomes, including depression, anxiety, and post-traumatic stress disorder. Action items were presented, including the promotion of cultural diversity training and the development of innovative strategies to support safety-net health care facilities serving vulnerable populations.
• Roth, A. M., Van Der Pol, B., Fortenberry, J. D., Dodge, B., Reece, M., Certo, D., & Zimet, G. D. (2015). The impact of brief messages on HSV-2 screening uptake among female defendants in a court setting: A randomized controlled trial utilizing prospect theory. Journal of Health Communication, 20(Issue 2). doi:10.1080/10810730.2014.920062
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  Epidemiologic data demonstrate that women involved with the criminal justice system in the United States are at high risk for sexually transmitted infections, including herpes simplex virus type 2 (HSV-2). Female defendants were recruited from a misdemeanor court to assess whether brief framed messages utilizing prospect theory could encourage testing for HSV-2. Participants were randomly assigned to a message condition (gain, loss, or control), completed an interviewer-administered survey assessing factors associated with antibody test uptake/refusal and were offered free point-of-care HSV-2 serologic testing. Although individuals in the loss-frame group accepted testing at the highest rate, an overall statistical difference in HSV-2 testing behavior by group (p ≤.43) was not detected. The majority of the sample (74.6%) characterized receiving a serological test for HSV-2 as health affirming. However, this did not moderate the effect of the intervention nor was it significantly associated with test acceptance (p ≤.82). Although the effects of message framing are subtle, the findings have important theoretical implications given the participants' characterization of HSV-2 screening as health affirming despite being a detection behavior. Implications of study results for health care providers interested in brief, low cost interventions are also explored.
• Schick, V. R., Hensel, D., Herbenick, D., Dodge, B., Reece, M., Sanders, S., & Fortenberry, J. D. (2015). Lesbian- and bisexually-identified women's use of lubricant during their most recent sexual event with a female partner: Findings from a nationally representative study in the United States. LGBT Health, 2(Issue 2). doi:10.1089/lgbt.2014.0058
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  Purpose: While previous research suggests that lubricant use may be common among lesbian- and bisexually-identified women, it remains unclear from this research whether lubricant was being used with a male or female partner. The present study explores the behavioral, emotional, situational, and relational aspects of lesbian- and bisexually-identified women's lubricant use during their most recent female-partnered sexual event. Methods: Nationally representative data was collected as part of the 2012 National Survey of Sexual Health and Behavior (NSSHB). The 2012 NSSHB had an oversample of lesbian, gay, and bisexual (LGB) individuals. Participants were included in the present study if they identified as a lesbian or bisexual women and indicated that their most recent sexual partner was a female. Participants were asked a variety of questions about the context and experience of lubricant use during this event. Results: Nearly a quarter (21.9%, n=32) of the participants reported that they used a lubricant during their most recent female-partnered sexual event. The likelihood of lubricant use significantly differed based upon age, race/ethnicity and sexual identity. The most commonly reported reason for lubricant use was to "make sex more comfortable," with half reporting use for clitoral stimulation (50.6%, n=16). Overall, participants indicated that lubricant use enhanced their sexual experience. Conclusion: Lubricant use may improve comfort and increase pleasure during certain sexual acts between women. The use of lubrication should be considered as a means of reducing pain and enhancing sexual pleasure during sexual behavior between women.
• Schick, V., Dodge, B., Van Der Pol, B., Baldwin, A., & Fortenberry, J. D. (2015). Sexual behaviours, sex toy and sexual safety methods reported by women who have sex with women and men. Sexual Health, 12(Issue 4). doi:10.1071/sh14045
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  A ubset of participants (n≤53) provided detailed sexual behaviour data for each sexual partner over the previous 12 months. Results: Almost three-quarters of the sample reported at least one concurrent multi-person sexual activity. Nearly two-thirds of participants reported engaging in sexual behaviour that involved their own (66.7%) or their partner's (49.4%) anus in the past year. Barrier use for sexual behaviours other than penile-vaginal intercourse was uncommon. Behaviours and safety strategies were similar with men and women regardless of partner gender. Conclusions: The sexual repertoires reported by participants in this study were diverse. Understanding the range of diverse sexual behaviours of the participants may enable the construction of tailored recommendations for sexual health maintenance among WSWM. Background Relative to women who engage in sex with exclusively men or women, women who have sex with women and men (WSWM) are more likely to report a history of sexually transmissible infections. Knowledge of the diversity and specificity of the sexual behaviours in which they engage may provide insight into the behavioural modes of infection. The present study sought to document a range of behaviours including concurrent multi-person sexual activity (e.g. orgy, threesome), anal sexual activity and sex toy use. Barrier use methods during specific behaviours were also assessed. Methods: Eighty women who reported recent genital contact with at least one man and one woman were recruited via targeted Internet, venue-based and snowball sampling methods. Consenting participants were directed to an online survey. During an in-person timeline follow-back interview (the SEQUENCE
• Schick, V., Van Der Pol, B., Dodge, B., Baldwin, A., & Dennis Fortenberry, J. (2015). A mixed methods approach to assess the likelihood of testing for STI using self-collected samples among behaviourally bisexual women. Sexually Transmitted Infections, 91(Issue 5). doi:10.1136/sextrans-2014-051842
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  Objectives Behaviourally bisexual women (women who have sex with women and men (WSWM)) are more likely to report a history of sexually transmitted infections (STI) than women who have sex exclusively with men or exclusively with women. Barriers to care may prohibit WSWM from seeking STI testing. The present study investigated participant willingness to self-collect oral, vaginal and anal samples for STI testing. Methods Eighty WSWM were recruited from two midwestern locations. After completing an online questionnaire, a subset of the participants were interviewed (n=54) and provided the option to selfcollect oral, vaginal and/or anal samples to screen for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis. Results Over two-thirds (67.5%, n=54) of the participants completed the baseline scheduled and attended the interview. The majority of these participants provided vaginal (87.0%, n=47), oral (85.2%, n=46) and/or anal (61.1%, n=33) samples. Participants with a history of anal play were significantly more likely to provide an anal sample. C. trachomatis infection was identified in the samples of 6.8% (n=3) of the participants including 4.5% (n=2) of the vaginal samples and 3.3% (n=1) of the anal samples. None of the samples were positive for N. gonorrhoeae or T. vaginalis. Participants who reported a recent history of anal sexual behaviour with a male partner were significantly more likely to self-collect an anal sample. Conclusions Given the comparatively high STI rates among WSWM, self-sampling in non-traditional settings may present a unique opportunity to provide needed care to this underserved population of women.
• Anderson, T. A., Schick, V., Herbenick, D., Dodge, B., & Fortenberry, J. D. (2014). A study of human papillomavirus on vaginally inserted sex toys, before and after cleaning, among women who have sex with women and men. Sexually Transmitted Infections, 90(Issue 7). doi:10.1136/sextrans-2014-051558
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  Objectives: The objective of the study was to determine the potential of human papillomavirus (HPV) transmission via shared sex toys, and determine whether cleaning practices implemented by the study participants were effective. Methods: Vibrator 1 was composed of thermoplastic elastomer. Vibrator 2 was composed of silicone. Twelve women, recruited from a university, used each vibrator on separate occasions and provided self-collected vaginal and vibrator samples (obtained from the vibrator shaft and handle), collected immediately after use, immediately after cleaning with a commercially available cleaner, and 24 h after cleaning. Vaginal and vibrator samples were assessed for HPV DNA by the Roche Linear Array HPV Genotyping Test. Results: HPV was detected in the vaginal samples of 9/12 (75%) women. Vibrator 1 shaft swabs were HPV positive before cleaning in 89% (8/9), immediately after cleaning in 56% (5/9), and 24 h after cleaning in 40% (2/5) of those that were HPV positive immediately after cleaning. Vibrator 2 shaft swabs were HPV positive before cleaning in 67% (6/9), immediately after cleaning in 44% (4/9), and 24 h after cleaning in none. Conclusions: HPV was detected on at least one vibrator immediately after use in the women with vaginal HPV. This supports the potential for HPV transmission via shared sex toy use, and is additionally supported by continued detection of HPV up to 24 h after standard cleaning. The data add to understanding of the range of sexual behaviours associated with HPV transmission, and the need for evidence-based recommendations for sex toy cleaning.
• Dodge, B., Schick, V., Herbenick, D., Reece, M., Sanders, S. A., & Fortenberry, J. D. (2014). Frequency, reasons for, and perceptions of lubricant use among a nationally representative sample of self-identified gay and bisexual men in the United States. Journal of Sexual Medicine, 11(Issue 10). doi:10.1111/jsm.12640
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  Introduction: Few previous studies have examined lubricant use among gay and bisexual men outside the context of human immunodeficiency virus risk reduction associated with condom use during penile-anal intercourse and the potential use of lubricants to deliver rectal microbicides. The vast majority of studies examining lubricant use among gay and bisexual men have employed convenience sampling strategies for participant recruitment. Additionally, most studies have collapsed gay men and bisexual men into one category of "gay and bisexual men." Aims: This study aimed to provide overall rates of lubricant use and related factors among a nationally representative sample of self-identified gay and bisexual men. Frequencies of lubricant use, reasons for using lubricant, and perceptions of lubricant use were examined separately for subsamples of both gay and bisexual men. Methods: Data were 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 in the United States aged 18 and older, and we oversampled self-identified gay and bisexual men and women; the results from male participants are included in this article. Main Outcome Measures: Measure included demographic characteristics, recent and lifetime commercial lubricant use, lubricant use during specific sexual behaviors, frequency of lubricant use, and reasons for lubricant use during sexual activity. Results: Over 90% of both gay and bisexual male participants reported lifetime lubricant use. Use was most common during partnered sexual activities, particularly among men aged 25-29years old. The most commonly reported reasons for lubricant use included to increase comfort during anal intercourse, curiosity, and to make sex more comfortable. Conclusions: Most gay and bisexual men in the United States have used lubricant to enhance a wide range of sexual activities, including but not limited to anal intercourse. Findings from this study will be of utility to clinicians and other health practitioners who seek to understand and promote sexual health among gay and bisexual men and other traditionally underserved public health populations.
• Friedman, M. R., Dodge, B., Schick, V., Herbenick, D., Hubach, R. D., Bowling, J., Goncalves, G., Krier, S., & Reece, M. (2014). From bias to bisexual health disparities: Attitudes toward bisexual men and women in the united states. LGBT Health, 1(Issue 4). doi:10.1089/lgbt.2014.0005
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  Purpose: A newly emergent literature suggests that bisexual men and women face profound health disparities in comparison to both heterosexual and homosexual individuals. Additionally, bisexual individuals often experience prejudice, stigma, and discrimination from both gay/lesbian and straight communities, termed biphobia. However, only limited research exists that empirically tests the extent and predictors of this double discrimination. The Bisexualities: Indiana Attitudes Scale (BIAS) was developed to test associations between biphobia and sexual identity. Methods: Using standard techniques, we developed and administered a scale to a purposive online sample of adults from a wide range of social networking websites. We conducted exploratory factor analysis to refine scales assessing attitudes toward bisexual men and bisexual women, respectively. Using generalized linear modeling, we assessed relationships between BIAS scores and sexual identity, adjusting for covariates. Results: Two separately gendered scales were developed, administered, and refined: BIAS-m (n=645), focusing on attitudes toward bisexual men, and BIAS-f (n=631), focusing on attitudes toward bisexual women. Across scales, sexual identity significantly predicted response variance. Lesbian/gay respondents had lower levels of bi-negative attitudes than their heterosexual counterparts (all p-values .05); bisexual respondents had lower levels of bi-negative attitudes than their straight counterparts (all p-values .001); and bisexual respondents had lower levels of bi-negative attitudes than their lesbian/gay counterparts (all p-values .05). Within racial/ethnic minority respondents, biracial/multiracial status was associated with lower bi-negativity scores (all p-values.05). Conclusions: This study provides important quantitative support for theories related to biphobia and double discrimination. Our findings provide strong evidence for understanding how stereotypes and stigma may lead to dramatic disparities in depression, anxiety, stress, and other health outcomes among bisexual individuals in comparison to their heterosexual and homosexual counterparts. Our results yield valuable data for informing social awareness and intervention efforts that aim to decrease bi-negative attitudes within both straight and gay/lesbian communities, with the ultimate goal of alleviating health disparities among bisexual men and women.
• Higgins, J. A., Smith, N. K., Sanders, S. A., Schick, V., Herbenick, D., Reece, M., Dodge, B., & Fortenberry, J. D. (2014). Dual method use at last sexual encounter: A nationally representative, episode-level analysis of US men and women: Prepared for resubmission to Contraception. Contraception, 90(Issue 4). doi:10.1016/j.contraception.2014.06.003
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  Objectives Male condom use in conjunction with other contraceptives increases protection against pregnancy and sexually transmitted infections. However, few analyses contextualize dual method use within the sexual episode, include reports from men or explore gendered patterns in reporting. Study design We analyzed dual method use patterns using a nationally representative dataset of 18-44 years old in the US (N=404 men, 416 women). Respondents indicated contraceptive methods used at last penile-vaginal intercourse, condom practices and relationship and sexual information about that particular partner. Results More than one-in-three penile-vaginal intercourse episodes (40%) involved male condom use: 28% condom only and 12% condom plus a highly effective method. Dual method reporting did not differ significantly by gender. Among dual method users, only 59% reported condom use during the entire intercourse episode, while 35% began intercourse without one and 6% removed the condom during intercourse. A greater proportion of men than women reported incorrect use of condoms (49% versus 35%), though this difference was not statistically significant. Only 50% of dual method users reported condom use in all of their last 10 intercourse episodes. Conclusions Many people classified as "dual users" in previous studies may not be using dual methods consistently or correctly. Researchers and practitioners should inquire how and how often condoms are used when assessing and addressing dual method use. Furthermore, though men have rarely been surveyed about dual method use, they can provide consistent contraceptive estimates and may be more likely to report condom practices such as late application or early removal. Implications statement Many US women and men reporting dual method use also reported late application and early removal of condoms, as well as multiple condom-less prior sexual acts with that partner. Clinicians may wish to inquire how and how often clients use condoms; they may also wish to provide condom instruction and/or tips on better integrating condoms into the sexual experience with one's partner. © 2014 Elsevier Inc. All rights reserved.
• Hubach, R. D., Dodge, B., Davis, A., Smith, A. D., Zimet, G. D., & Van Der Pol, B. (2014). Preferred methods of sexually transmitted infection service delivery among an urban sample of underserved midwestern men. Sexually Transmitted Diseases, 41(Issue 2). doi:10.1097/olq.0000000000000082
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  Semistructured interviews were completed with a sample of 25 men residing in an urban area of the Midwestern United States to elicit preferred methods of sexually transmitted infection service delivery. Results highlight the influence of stigma, social support, and perceived risk on sexually transmitted infection screening uptake and preferred methods of screening. Copyright © 2014 American Sexually Transmitted Diseases Association All rights reserved.
• Hubach, R. D., Dodge, B., Goncalves, G., Malebranche, D., Reece, M., Van Der Pol, B., Martinez, O., Schnarrs, P. W., Nix, R., & Dennis Fortenberry, J. (2014). Gender matters: Condom use and nonuse among behaviorally bisexual men. Archives of Sexual Behavior, 43(Issue 4). doi:10.1007/s10508-013-0147-4
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  Although frequently cited as being at high risk for HIV/STI transmission, little is known about behaviorally bisexual men's patterns and experiences of condom use and nonuse with male and female sexual partners. Using a variety of recruitment techniques informed by a Community Advisory Committee, a total of 77 behaviorally bisexual men were recruited from Indianapolis, Indiana to participate in semi-structured interviews focused on sexual health. Qualitative data were collected containing detailed information on their patterns and experiences of condom use and nonuse with both male and female partners. Participants described numerous commonly reported barriers for consistent condom use, as well as distinct bisexual-specific barriers. The majority reported consistent condom use with male and female casual partners, but many who did not use condoms described doing so in the context of ongoing relationships. In addition, participants provided reasons for condom use and nonuse that varied based on the gender of the partner and the type of relationship with the partner. Future interventions focused on increasing condom use among behaviorally bisexual men should take into account the unique complexities of gender and relationship configurations in this distinct population. © 2013 Springer Science+Business Media New York.
• Rodriguez-Diaz, C. E., Collazo, E., Dodge, B., Roman-Rivera, A., Candelaria-Rosa, E., Colon-Colon, M., & Herbenick, D. (2014). "Sexplorando": Sexual practices and condom use among an internet-based sample of men and women in Puerto Rico. Journal of Sexual Medicine, 11(Issue 10). doi:10.1111/jsm.12642
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  Introduction: Despite the wealth of literature addressing sexual practices and condom use among men and women, very little data are available among Hispanic/Latino populations and in the Caribbean Region. This study adds to the existing literature on sexual practices and condom use in Puerto Rico (PR) and provides comparisons based on sex given the need for more current information on the sexual characteristics and condom use rates among understudied populations. Aim: The aim of this study was to assess the rates of sexual practices and condom use among adults, aged 21-49, in PR. Methods: We report the prevalence of lifetime and recent (past 3 months) sexual practices by sex, as event-level condom use rates, and condom familiarity and accessibility in an online-based sample of adult men and women in PR. Main Outcome Measures: The main variables assessed include sociodemographic characteristics, solo and partnered sexual practices, and condom use frequencies, as well as familiarity and accessibility to male and female condoms. Results: Overall, 93% of the sample reported having been sexually active (engaged in oral, vaginal, and/or anal sex) in their lifetime and 78% reported sexual practices in the past 3 months. As in other studies Hispanic/Latino populations, reported rates of anal intercourse (AI) among both men and women were relatively high. Overall, a greater proportion of men reported condom use during all sexual practices (41% vaginal intercourse (VI); 65% receptive AI; 46% insertive AI) than women (22% VI; 18% AI). Conclusions: These findings provide current sexual practice and condom use frequency rates that can aid in the understanding of the particular sexual health needs of Hispanic/Latino populations as well as of other groups in the Caribbean. It also serves for the development of future studies and sexual health promotion programs, including comprehensive sexual health care.
• Dodge, B., Schnarrs, P. W., Reece, M., Martinez, O., Goncalves, G., Malebranche, D., Van Der Pol, B., Nix, R., & Fortenberry, J. D. (2013). Sexual behaviors and experiences among behaviorally bisexual men in the Midwestern United States. Archives of Sexual Behavior, 42(Issue 2). doi:10.1007/s10508-011-9878-2
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  Research examining the sexual behaviors and experiences of behaviorally bisexual men is limited. Most studies focus primarily on highlighting sexual risk behaviors among groups of "men who have sex with men (MSM)" or "gay and bisexual men," which may not be appropriate in terms of behaviorally bisexual men's sexual repertoires with both men and women. This study aimed to assess a broad range of sexual behaviors and associated experiences among bisexual men living in the midwestern United States. An interviewer-administered questionnaire containing items from the National Survey of Sexual Health and Behavior assessed lifetime and recent (i.e., past 6 months and last event) sexual behaviors and experiences with both male and female partners among a diverse sample of 75 behaviorally bisexual men. Responses were quantified and analyzed using descriptive and multivariate statistics. A wide range of sexual behaviors with partners of both genders was found. Vaginal intercourse and oral sex with both men and women were the most commonly reported behaviors. Subjective reports of pleasure, arousal, and sexual function during sexual activity were similar with both male and female sexual partners. Many participants reported using condoms during insertive sexual behaviors with male and female partners, but less during oral sex. Unprotected receptive anal sex was less commonly reported. Overall, participants reported a variety of sexual behaviors and experiences; however, unlike other populations, they shared these with partners of both genders. Results have implications for interventions targeting the sexual behaviors and associated issues among behaviorally bisexual men. ©2011 Springer Science+Business Media, LLC.
• Herbenick, D., Schick, V., Reece, M., Sanders, S. A., Smith, N., Dodge, B., & Fortenberry, J. D. (2013). Characteristics of Condom and Lubricant Use among a Nationally Representative Probability Sample of Adults Ages 18-59 in the United States. Journal of Sexual Medicine, 10(Issue 2). doi:10.1111/jsm.12021
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  Introduction. Although most Americans have used condoms and/or lubricant during sex, little is known about the context of sexual events that involve the use of such products outside of experimentally manipulated studies. Aims. To assess, in a nationally representative study of men and women in the United States ages 18-59, the characteristics of condom and lubricant use during participants' most recent sexual event and the relationship of their condom and lubricant use to event-level ratings of sexual quality. Methods. Data are from the National Survey of Sexual Health and Behavior, which involved the administration of an online questionnaire to a nationally representative probability sample of the U.S. adults. Main Outcome Measures. Sociodemographic items: event-level items related to sexual behavior, condom use, lubricant use, and participants' perceptions of their arousal, pleasure, ease of erection or lubrication, and pain associated with sex. Results. During their most recent sexual experience, 27.5% of men (N=237) and 22.3% of women (N=175) reported using a condom. More than twice as many women as men were unsure whether the condom was lubricated (26.6% vs. 11.4%) and the material it was made of (23.6% vs. 8.9%). Participants consistently rated sex to be arousing and pleasurable whether or not they used condoms or lubricant. No significant differences were found in regard to men's ratings of the ease of their erections based on condom and lubricant use. Conclusions. Although some have concerns about how condoms or lubricants may impact their enjoyment of sex, in a nationally representative sample of men and women ages 18-59, ratings of sex were largely quite high, with few differences based on condom and lubricant use. Women, more often than men, reported being unsure about the type of condom and lubricant used, which has implications for patient education. Herbenick D, Schick V, Reece M, Sanders SA, Smith N, Dodge B, and Fortenberry JD. Characteristics of condom and lubricant use among a nationally representative probability sample of adults ages 18-59 in the United States. © 2013 International Society for Sexual Medicine.
• Kingori, C., Reece, M., Obeng, S., Murray, M., Shacham, E., Dodge, B., Akach, E., Ngatia, P., & Ojakaa, D. (2013). Psychometric evaluation of a cross-culturally adapted felt stigma questionnaire among people living with HIV in Kenya. AIDS Patient Care and STDs, 27(Issue 8). doi:10.1089/apc.2012.0403
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  Psychometric properties of an 18-item HIV felt stigma questionnaire were evaluated utilizing data collected from a diverse ethnic and socioeconomic group of 370 people living with HIV/AIDS and receiving HIV/AIDS-related health services at an HIV clinic in Kenya. Factor analyses revealed a four factor solution (public attitudes, ostracize, discrimination, personal life disrupted) based on the Scree plot with explained variance of 44% that had Eigen values greater than 1.00. The retained felt stigma items revealed a Cronbach's alpha coefficient of 0.828, while the four factors had coefficient alphas ranging from 0.675 to 0.799. The adapted retained questionnaire was deemed a practical guide for measuring felt stigma in a Kenyan cultural context to necessitate provision of the most effective HIV-related mental health services to individuals living with HIV in Kenya. © 2013, Mary Ann Liebert, Inc.
• Roth, A. M., Van Der Pol, B., Fortenberry, J. D., Reece, M., Dodge, B., Certo, D., & Zimet, G. D. (2013). Herpes simplex virus type 2 serological testing at a community court: Predictors of test acceptance and seropositivity among female defendants. International Journal of STD and AIDS, 24(Issue 3). doi:10.1177/0956462412472442
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  Despite the high prevalence of herpes simplex virus type 2 (HSV-2), testing for asymptomatic infections is uncommon. One population for whom targeted interventions may be prioritized include individuals involved with the correctional system. Here we describe the acceptability of a novel HSV-2 screening program, implemented in a court setting, as a possible intervention for corrections-involved women. Female defendants completed an interviewer administered survey assessing factors associated with uptake/refusal of free point-of-care HSV-2 serologic testing and HSV-2 seropositivity. Participants included 143 women, 18-62 years old (mean 32.85) with diverse ethnicities. The majority (65.7%) accepted testing and 62.4% tested HSV-2 seropositive. Factors independently associated with test acceptance included higher perceived susceptibility to genital herpes infection and not receiving a preventative health screen. Women who were seropositive tended to be older, Black, report having previous STI, and be arrested on a prostitution charge. Findings suggest point-of-care testing in a court setting is acceptable to women and can be implemented to improve case finding of STI.
• Sanders, S. A., Herbenick, D., Reece, M., Schick, V., Mullinax, M., Dodge, B., & Fortenberry, J. D. (2013). The Development and validation of a brief quality of sexual experience (QSE) scale: Results from a nationally representative sample of men and women in the United States. Journal of Sexual Medicine, 10(Issue 10). doi:10.1111/jsm.12198
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  Introduction: Much scientific research focuses on assessing and understanding individuals' perceptions of sexual pleasure, enjoyment and satisfaction. Many existing measures of pleasure and satisfaction provide valuable information but are limited in their ability to assess event-level quality. Aims: To develop a scale for measuring the event-level quality of a sexual experience that could be used regardless of the age, gender, sexual orientation, and relationship status of the individual and across sexual activity types. Methods: Interviews about the measurement of sexual quality and pleasure were conducted with 15 experts in the field of sexual health and informed the development of an event-level scale to measure the quality of sexual experiences. Scale items were administered to a cross-sectional nationally representative probability survey of Americans ages 18 to 60. Main Outcome Measures: Socio-demographic items; Quality of Sexual Experience (QSE) scale items; event-level items related to overall sexual quality ("Quality item"), comparison to other sexual events ("Comparison item"), and orgasm ("Orgasm item"). Results: QSE scores were significantly correlated with responses to the Quality Item (r=0.901, P
• Dodge, B., Dodge, B., Schnarrs, P. W., Schnarrs, P. W., Goncalves, G., Goncalves, G., Malebranche, D., Malebranche, D., Martinez, O., Martinez, O., Reece, M., Reece, M., Rhodes, S. D., Rhodes, S. D., van der Pol, B., van der Pol, B., Nix, R., Nix, R., Dennis Fortenberry, J., & Dennis Fortenberry, J. (2012). The significance of privacy and trust in providing health-related services to behaviorally bisexual men in the United States. AIDS Education and Prevention, 24(Issue 3). doi:10.1521/aeap.2012.24.3.242
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  Previous research suggests that bisexual men face unique health concerns in comparison to their exclusively homosexual and heterosexual counterparts. However, little is known about behaviorally bisexual men's experiences with health services, including ways of providing services that would be most appropriate to meet the health needs of this population. This study sought to understand preferences for health-related services among behaviorally bisexual men in the Midwestern United States. Using a communitybased research approach, a diverse sample of 75 behaviorally bisexual men was recruited for in-depth interviews. Qualitative data were analyzed utilizing inductive coding through established team-based protocols to ensure reliability. Themes emerged involving the importance of privacy and trust when reaching, recruiting, and engaging behaviorally bisexual men in health services. Findings suggest that multifaceted approaches are needed, including those that provide relevant and confidential services while allowing for the development and ongoing maintenance of trust. © 2012 The Guilford Press.
• Dodge, B., Rosenberger, J. G., Schick, V., Reece, M., Herbenick, D., & Novak, D. S. (2012). Beyond "Risk": Exploring Sexuality among Diverse Typologies of Bisexual Men in the United States. Journal of Bisexuality, 12(Issue 1). doi:10.1080/15299716.2012.645696
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  Little public health research has explored male bisexuality and the wide range of behaviors experienced by bisexual men beyond disease transmission and other negative consequences. There is a general lack of information on diverse expressions of sexuality among diverse groups of bisexual men in the United States. Researchers collected data on a wide range of variables related to sexual behavior from a sample of 26,042 participants, recruited via a large social and sexual networking Website. Four distinct typologies of male bisexuality were constructed: self-identified bisexual, bisexual dating, bisexual with current sexual partners and bisexual by behavior. These categories were examined individually as well as compared and contrasted with one another. Demographic characteristics varied among men depending on bisexual categorization. Although participants that identified as bisexual within each typology often met criteria for other categories for other typologies, there was no absolute overlap between categories. The recency and frequency of sexual behaviors significantly varied based upon the participant's bisexual typology. Findings suggest that previous research on bisexual men's sexual behaviors and sexual risk behaviors may be misleading if bisexuality is restricted to a single typology. Further research should examine the potential subjective meanings and health implications of diverse typologies of male bisexuality, beyond sexual risk. Comprehensive and insightful research on aspects of life other than disease infection and transmission among bisexual men will help to ensure a more accurate understanding of male bisexuality in a comprehensive sexual health framework. © 2012 Taylor and Francis Group, LLC.
• Dodge, B., Schnarrs, P. W., Reece, M., Goncalves, G., Martinez, O., Nix, R., Malebranche, D., van der Pol, B., Murray, M., & Fortenberry, J. D. (2012). Community involvement among behaviourally bisexual men in the Midwestern USA: Experiences and perceptions across communities. Culture, Health and Sexuality, 14(Issue 9). doi:10.1080/13691058.2012.721136
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  Limited research exists regarding community involvement and social support among behaviourally bisexual men. Previous studies suggest that bisexual men experience high levels of social stigma in both heterosexual and homosexual community settings. Research focusing on social support has demonstrated that individuals with limited access to similar individuals experience greater risk for negative health outcomes. Using a community-based research design, participants were recruited using multiple methods. Researchers conducted in-depth, semi-structured interviews with 75 men who reported having engaged in bisexual behaviour within the past six months. Interviews elucidated the experiences of behaviourally bisexual men in heterosexual and homosexual settings, as well as their perceptions of the existence of a bisexual community or bisexual spaces. All participants perceived a lack of a visible bisexual community and expressed difficulty with being comfortable, or a feeling of belonging, within a variety of heterosexual and homosexual community spaces. Findings suggest the need for interventions focused on community building among, as well as creating spaces specifically designed for, bisexual men in order to increase perceived social support and decrease isolation and possible negative health outcomes. © 2012 Copyright Taylor and Francis Group, LLC.
• Dodge, B., Schnarrs, P. W., Reece, M., Martinez, O., Goncalves, G., Malebranche, D., van der Pol, B., Nix, R., & Fortenberry, J. D. (2012). Individual and Social Factors Related to Mental Health Concerns Among Bisexual Men in the Midwestern United States. Journal of Bisexuality, 12(Issue 2). doi:10.1080/15299716.2012.674862
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  Research has not yet explored the potential impact of social stress, biphobia and other factors on the mental health of bisexual men. In-depth interviews were conducted with a diverse sample of 75 men who engaged in bisexual behavior within the past 6 months. Interviewers explored potential mental health stressors and supports. Many participants reported personal and social challenges associated with bisexuality, which in turn influenced their mental health. Reported instances of stigma toward bisexuality, from homosexual and heterosexual individuals, affected participants' feelings regarding their own sexualities. Isolation was also commonly reported. Programs are greatly needed that focus on the specific mental health and other concerns voiced by these men. Based on these findings, such programs should emphasize self-acceptance, social network and community building and ways to maximize available social support, similar to community-level empowerment interventions that have shown success among gay-identified men. © 2012 Copyright Taylor and Francis Group, LLC.
• Dodge, B., Van Der Pol, B., Reece, M., Malebranche, D., Martinez, O., Goncalves, G., Schnarrs, P., Nix, R., & Fortenberry, J. D. (2012). Rectal self-sampling in non-clinical venues for detection of sexually transmissible infections among behaviourally bisexual men. Sexual Health, 9(Issue 2). doi:10.1071/sh11068
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  Rectal sexually transmissible infections are a common health concern for men who have sex with men but little is known about these infections among men who have sex with both men and women. Self-obtained rectal specimens were collected from a diverse sample of behaviourally bisexual men. From a total sample of 75 bisexual men, 58 collected specimens. A relatively high prevalence of rectal Chlamydia trachomatis infection was found. Participants who collected specimens reported overall acceptability and comfort with self-sampling. Future efforts are needed focusing on increasing awareness of and options for rectal sexually transmissible infection testing among bisexual men. © 2012 CSIRO.
• Fisher, C. M., Reece, M., Wright, E., Dodge, B., Sherwood-Laughlin, C., & Baldwin, K. (2012). The Role of Community-Based Organizations in Adolescent Sexual Health Promotion. Health Promotion Practice, 13(Issue 4). doi:10.1177/1524839910390359
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  Many scholars and practitioners have advocated for a more ecological approach to sexual health promotion for adolescents, such as one that includes involvement from schools, parents, and community organizations. Although extensive research has been conducted with schools and parents, little is known about the roles community-based organizations (CBOs) may play in the education and promotion of sexual health to young people. This study aimed to (a) identify the types of sexual health and sexuality-related questions asked by youth and programming/services, resources, and referrals currently being provided by CBOs; (b) explore the approaches used by CBOs when developing and implementing sexual health promotion programs; and (c) compare these findings with those from a similar study on school teachers, counselors, and nurses within the same state. Data collected from 169 people working in CBOs indicate that a wide variety of topics were covered by CBOs through programming and services, resources, and/or referral protocols. Topics covered varied in frequency. Overall, participants indicated a relatively comprehensive and accessible approach to providing sexuality information to youth. The results of this study suggest that CBOs should be included in the range of sources to be used for comprehensive sexual health promotion. If such organizations are supported with information, training, and resources, they could play a valuable role in the promotion of sexual health for adolescents. © 2012 Society for Public Health Education.
• Hensel, D. J., Stupiansky, N. W., Herbenick, D., Dodge, B., & Reece, M. (2012). Sexual Pleasure during Condom-Protected Vaginal Sex among Heterosexual Men. Journal of Sexual Medicine, 9(Issue 5). doi:10.1111/j.1743-6109.2012.02700.x
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  Introduction. Public health condom promotion efforts increasingly focus on the importance of sexual pleasure; however, little is known about sexual event-specific factors that may increase or decrease perceptions of sexual pleasure when condoms are used. Aims. To examine event-level factors associated with ratings of sexual pleasure during condom-protected vaginal intercourse. Methods. Data were collected in 2008 from 1,875 men during a prospective daily diary study of sexual behavior and condom use. Sexual pleasure was assessed during condom-protected vaginal intercourse considering situational, relational, intrapersonal, and behavioral predictors. Analyses were generalized estimating equation ordinal regression. Main Outcome Measures. Event-specific perceptions of sexual pleasure (three categories: not at all enjoyable to extremely enjoyable). Results. Vaginal intercourse was reported on 29.8% (N=8,876/29,714) of diary days; complete condom use was reported for 59.1% (5,249/8,876) of all vaginal intercourse events. This was confusing by using the word "all sexual events." Higher sexual pleasure ratings during complete condom use were associated with older age, manual stimulation of one's genitals, receiving oral sex, and performing oral sex. Sexual pleasure ratings also increased in association with intercourse duration, intercourse intensity, ejaculation, erection perception, and condom comfort. Sexual pleasure ratings were lower with erection difficulty and partner discomfort during sex. Conclusions. These data advance understanding of sexual pleasure during condom use, suggesting that sexual pleasure increases in conjunction with specific relational, physiological, and condom perceptions. These findings offer points upon which clinicians and health educators can engage men in an ongoing dialogue about augmenting sexual pleasure in the context of condom use. © 2012 International Society for Sexual Medicine.
• Kingori, C., Reece, M., Obeng, S., Murray, M., Shacham, E., Dodge, B., Akach, E., Ngatia, P., & Ojakaa, D. (2012). Impact of internalized stigma on HIV prevention behaviors among HIV-infected individuals seeking HIV care in Kenya. AIDS Patient Care and STDs, 26(Issue 12). doi:10.1089/apc.2012.0258
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  In general, an initial diagnosis of HIV is likely to be correlated with the onset of HIV stigma. HIV-positive individuals are likely to internalize stigma, may suffer from psychosocial issues, or engage in maladaptive behaviors to cope with the diagnosis. Internalized stigma stems from fear of stigmatization also known as felt stigma. The current study examined the impact of HIV felt stigma on overall health and success of HIV prevention behaviors among 370 participants living with HIV and receiving care at an urban HIV clinic in Kenya. An 18-item instrument was cross culturally adapted to measure felt stigma. Descriptive and logistic regression analyses examined the data. Findings indicate that 25.9% (n=96) of participants who reported experiencing high levels of felt stigma related to other people's attitudes toward their condition, ostracizing, and a disruption of their personal life, were likely to not adhere to prescribed HIV medication and not disclose their HIV serostatus to one other person. Those who also experienced felt stigma related to a disruption of their personal lives while mediated by depression were likely to report poor overall health. Findings support having HIV clinics and interventions develop relevant HIV prevention strategies that focus on the emerging dimensions of felt stigma which can significantly impact disclosure of serostatus, medication adherence, and overall health. © 2012, Mary Ann Liebert, Inc.
• Reece, M., Mark, K., Herbenick, D., Hensel, D. J., Jawed-Wessel, S., & Dodge, B. (2012). An event-level analysis of adding exogenous lubricant to condoms in a sample of men who have vaginal sex with women. Journal of Sexual Medicine, 9(Issue 3). doi:10.1111/j.1743-6109.2011.02605.x
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  Introduction. Little is known about the characteristics of sexual events during which individuals choose to use lubricant with condoms. Aims. The aims of this article were to evaluate the determinants of adding lubricant to condoms during baseline and at the event level, to assess the event-level variables' influence on adding lubricants to condoms, and to assess the event-level influence of using condoms with lubricant on event-level condom attitudes. Methods. A total of 1,874 men completed a 30-day Internet-based prospective daily diary study of sexual behavior and condom use. Main Outcome Measures. Baseline data included demographic variables and information about condom education. Daily diary data included reports of penile-vaginal sex regarding intercourse duration, intercourse intensity, intoxication level, condom application method, partner contraceptive method, and partner and relationship characteristics. Results. Lubricant was added to 24.3% of the study-provided condoms and 26.2% of the condoms selected by study participants. Those with more education and those who were married were more likely to add lubrication to condoms. Adding lubricant to condoms, a female partner putting the condom on with her hands and using contraception, and the event occurring with a wife (vs. girlfriend) was significantly associated with longer intercourse. Event-level lubricant and condom use significantly predicted lower willingness to buy the condom it was used with, as well as to recommend the condom. Adding exogenous lubricant was not related to the participants' confidence in condoms as a method to prevent pregnancy and sexually transmitted infections. Conclusions. The event-level nature of this study provided for a more comprehensive assessment of the situational factors that are associated with applying lubricant to condoms. Findings from this study suggest that men are adding lubricant to condoms for reasons other than to increase condom efficacy. © 2012 International Society for Sexual Medicine.
• Schick, V., & Dodge, B. (2012). Introduction to the Special Issue: Bisexual Health: Unpacking the Paradox. Journal of Bisexuality, 12(Issue 2). doi:10.1080/15299716.2012.674849
• Schnarrs, P. W., Dodge, B., Reece, M., Goncalves, G., Martinez, O., van der Pol, B., Malebranche, D., Murray, M., Nix, R., & Fortenberry, J. D. (2012). Subjective Sexual Experiences of Behaviorally Bisexual Men in the Midwestern United States: Sexual Attraction, Sexual Behaviors and Condom Use. Journal of Bisexuality, 12(Issue 2). doi:10.1080/15299716.2012.674863
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  Studies concerning behaviorally bisexual men continue to focus on understanding sexual risk according to a narrow range of sexual behaviors. Few studies have explored the subjective meanings and experiences related to bisexual men's sexual behaviors with male and female partners. In-depth, semistructured interviews were conducted with 75 men who engaged in bisexual behavior within the past 6 months. Participants were asked about their subjective sexual experiences with male and female partners. Findings suggest adherence to normative gender roles, with attraction to men and women conforming to these stereotypes, as well as a segregation of sexual behaviors along gendered lines. Overall, condom use was influenced by perceptions of potential negative consequences. Based on these findings, it remains critical that public health and other social and behavioral sciences continue to study bisexual men's sexual health issues as separate and distinct from their exclusively homosexual and heterosexual counterparts. © 2012 Copyright Taylor and Francis Group, LLC.
• Hensel, D. J., Stupiansky, N. W., Herbenick, D., Dodge, B., & Reece, M. (2011). When Condom Use is Not Condom Use: An Event-Level Analysis of Condom Use Behaviors during Vaginal Intercourse. Journal of Sexual Medicine, 8(Issue 1). doi:10.1111/j.1743-6109.2010.02031.x
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  Introduction: Little is known about event-level condom use errors during vaginal sex.Aims. The aim of this article is to examine factors associated with complete condom use compared to forms of incomplete condom use, including delayed condom application and early condom removal, over a 30-day period. Methods: Data were collected in 2008 from 1,875 men during a prospective daily diary study of sexual behavior and condom use. Incomplete condom use was assessed during vaginal intercourse considering situational, relational, intrapersonal, and behavioral predictors. Analyses were generalized estimating equation multinomial logistic regression. Main Outcome Measures: Condom use during vaginal sex: complete use, delayed application, early removal, and both delayed application/early removal. Results: Of 29,714 diary reports, 30% (8,876) included vaginal intercourse. Analyses were conducted (in 2009) on 83.2% of these intercourse events (6,325), during which condoms were used and for which participants provided complete data. Incomplete condom use included penetration before applying condoms during 12% of events (749), removing condoms before intercourse ended during 3.1% (198), and both types of incomplete use during 2% (129) of events. Erection quality (less than typical erect penile length and circumference, less rigidity, and difficulty maintaining erection) was associated with greater odds of incomplete use, as was a participant's history of other recent incomplete use. Perceptions of condom comfort and recent previous complete use were protective factors against incomplete use. Conclusions: Men's incomplete condom use is associated with recent condom use patterns, as well as with their physiological characteristics and perceptions of condoms during sexual intercourse. Event-level analyses such as these help describe how incomplete condom use occurs among individuals incorporating condoms into their sexual activities. © 2010 International Society for Sexual Medicine.
• Herbenick, D., Reece, M., Schick, V., Jozkowski, K. N., Middelstadt, S. E., Sanders, S. A., Dodge, B. S., Ghassemi, A., & Fortenberry, J. D. (2011). Beliefs about women's vibrator use: Results from a nationally representative probability survey in the United States. Journal of Sex and Marital Therapy, 37(Issue 5). doi:10.1080/0092623x.2011.606745
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  Women's vibrator use is common in the United States, although little is known about beliefs about its use. Elicitation surveys and interviews informed the development of a 10-item scale, the Beliefs About Women's Vibrator Use Scale, which was administered to a nationally representative probability sample of adults ages 18 to 60 years. Most women and men held high positive and low negative beliefs about women's vibrator use. Women with positive beliefs reported higher Female Sexual Function Index scores related to arousal, lubrication, orgasm, satisfaction, and pain (indicating less pain). Copyright © Taylor & Francis Group, LLC.
• Herbenick, D., Schick, V., Reece, M., Sanders, S., Dodge, B., & Fortenberry, J. D. (2011). The Female Genital Self-Image Scale (FGSIS): Results from a Nationally Representative Probability Sample of Women in the United States. Journal of Sexual Medicine, 8(Issue 1). doi:10.1111/j.1743-6109.2010.02071.x
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  Over the past two decades, an expanding body of research has examined women's and men's genital self-image. Support for the reliability and validity of the 7-item Female Genital Self-Image Scale (FGSIS) has been found in a convenience sample of women.Aims. The purpose of this study was to assess the reliability and validity of the FGSIS, its model of fit, and its association with women's scores on the Female Sexual Function Index (FSFI) in a nationally representative probability sample of women in the United States ages 18 to 60. A second purpose was to assess the temporal stability of the scale in a subset of this sample. Methods: A nationally representative sample of 3,800 women ages 18 to 60 were invited to participate in a cross-sectional Internet-based survey; 2,056 (54.1%) participated. Main Outcome Measures: Demographic items (e.g., age, race/ethnicity, marital status, sexual orientation, geographic region), having had a gynecological examination in the past year, having performed a genital self-examination in the past month, frequency of masturbation in the past month, vibrator use in the past month, the FGSIS, and the FSFI. Results: An abbreviated 4-item version of the scale, the FGSIS-4, was a better fit to the data than the original 7-item scale. Women's scores on the FGSIS-4 were significantly related to vibrator use, frequency of masturbation, having had a gynecological exam in the past year, having performed genital self examination in the past month, and all FSFI subscales. Conclusion: Most of the participants felt generally positively about their genitals and female genital self-image was significantly related to female sexual function, women's sexual behavior and their sexual and genital healthcare behaviors. In addition, the FGSIS-4 has evidence of reliability, validity, and temporal stability in a nationally representative probability sample of women in the United States. © 2010 International Society for Sexual Medicine.
• Martinez, O., Dodge, B., Reece, M., Schnarrs, P. W., Rhodes, S. D., Goncalves, G., Muñoz-Laboy, M., Malebranche, D., van der Polf, B., Nix, R., Kelle, G., & Fortenberry, J. D. (2011). Sexual health and life experiences: Voices from behaviourally bisexual latino men in the Midwestern USA. Culture, Health and Sexuality, 13(Issue 9). doi:10.1080/13691058.2011.600461
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  Research on behaviourally bisexual Latino men in the USA has not yet examined sexual health issues among men living in diverse areas of the nation, including the Midwest. A community-based participatory research approach was used to engage a diverse sample of 75 behaviourally bisexual men (25 White, 25 Black and 25 Latino). Semi-structured interviews were conducted and standard qualitative analysis procedures were used to explore data from the 25 Latino participants. Men described their unique migration experiences as behaviourally bisexual men in this area of the USA, as well as related sexual risk behaviours and health concerns. Lack of culturally congruent public health and community resources for behaviourally bisexual men in the Midwestern USA were identified as significant barriers. As in other studies, familial and community relationships were significant for the participants, especially in terms of the decision to disclose or not disclose their bisexuality. Additionally, alcohol and other drugs were often used while engaging in sexual behaviours particularly with male and transgender, as well as female, partners. Behaviourally bisexual Latino men may benefit from receiving positive and affirmative individual- and structural-level support in regards to their unique experiences in this and other settings. © 2011 Taylor & Francis.
• Robbins, C. L., Schick, V., Reece, M., Herbenick, D., Sanders, S. A., Dodge, B., & Fortenberry, J. D. (2011). Prevalence, frequency, and associations of masturbation with partnered sexual behaviors among us adolescents. Archives of Pediatrics and Adolescent Medicine, 165(Issue 12). doi:10.1001/archpediatrics.2011.142
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  Objective: To assess masturbation prevalence, frequency, and associations with partnered sexual behaviors. Design: Cross-sectional survey. Setting: The United States of America. Participants: Nationally representative samples of adolescents aged 14 to 17 years. Main Outcome Measures: Solo masturbation, partnered sexual behaviors, and condom use. Results: Across age groups, more males (73.8%) reported masturbation than females (48.1%). Among males, masturbation occurrence increased with age: at age 14 years, 62.6% of males reported at least 1 prior occurrence, whereas 80% of 17-year-old males reported ever having masturbated. Recent masturbation also increased with age in males: 67.6% of 17-year-olds reported masturbation in the past month, compared with 42.9% of 14-year-olds. In females, prior masturbation increased with age (58% at age 17 years compared with 43.3% at age 14 years), but recent masturbation did not. Masturbation was associated with numerous partnered sexual behaviors in both males and females. In males, masturbation was associated with condom use, but in females it was not. Conclusions: Sexual development is a dynamic process during adolescence, and masturbation is an enduring component of sexuality. Fundamental differences appear to exist between male and female sexual expression. Health care providers should recognize that many teens masturbate and discuss masturbation with patients because masturbation is integral to normal sexual development. © 2011 American Medical Association. All rights reserved.
• Rosenberger, J. G., Dodge, B., Van Der Pol, B., Reece, M., Herbenick, D., & Fortenberry, J. D. (2011). Reactions to self-sampling for ano-rectal sexually transmitted infections among men who have sex with men: A qualitative study. Archives of Sexual Behavior, 40(Issue 2). doi:10.1007/s10508-009-9569-4
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  Little is known about men's potential motivations and barriers associated with specific sexually transmitted infections (STI) testing methods. In this study, we examined experiences of self-sampling for ano-rectal STI among men who have sex with men (MSM) in a midwestern community in the U.S. A total of 75 MSM were recruited from community venues throughout Indianapolis, Indiana. Participants completed semi-structured interviews, were asked to obtain ano-rectal self-sample in a private restroom, and were asked open-ended questions about their experiences with ano-rectal self-sampling for STI. Participants included 35 White, 27 Black, and 13 Latino MSM who ranged in age from 18 to 57 years. Regardless of sexual practices, most participants who obtained an ano-rectal self-sample (68/75) reported that the sampling procedure was relatively painless and physically easy. However, regardless of previous receptive anal sex, participants also expressed concerns about the nature of the test (i.e., inserting something into their rectum), which required increased levels of privacy and cleanliness compared to collection of urine samples. Self-sampling proved to be a feasible and acceptable method of collecting ano-rectal STI specimens among MSM. Increased testing for ano-rectal STI among MSM may require addressing the location of sampling and testing sites, existing negative perceptions of ano-rectal self-sampling, and the measures in place to promote privacy and cleanliness. © 2009 Springer Science+Business Media, LLC.
• Roth, A. M., Dodge, B. M., van der Pol, B., Reece, M., & Zimet, G. D. (2011). Low acceptance of HSV-2 testing among high-risk women. International Journal of STD and AIDS, 22(Issue 6). doi:10.1258/ijsa.2010.010399
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  We evaluated the acceptability of a community-based herpes simplex virus type 2 (HSV-2) screening programme for atrisk women and assessed factors related to uptake of point of care HSV-2 testing. One hundred recently arrested women (median age 34 years) were recruited from a community court handling lower-level misdemeanour cases in Indianapolis, Indiana. Individuals completed a survey assessing factors related to HSV-2 screening intentions and were offered point of care HSV-2 testing. Rates of HSV-2 infection in this population are high; 61.1% of women tested were positive. The majority (81%) accepted a prescription for suppressive therapy. Women in this sample indicated that HSV-2 screening is an important component of health care but were unwilling to pay the US$10 it cost to be tested. To encourage this and other high-risk populations to be screened for HSV-2, public health resources will be needed to help individuals overcome cost-related barriers to care.
• Roth, A., Van Der Pol, B., Dodge, B., Fortenberry, J. D., & Zimet, G. (2011). Future chlamydia screening preferences of men attending a sexually transmissible infection clinic. Sexual Health, 8(Issue 3). doi:10.1071/sh10017
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  Background: Despite years of public health efforts, Chlamydia trachomatis remains a highly prevalent disease suggesting that current control strategies are not sufficient. Asymptomatic men with chlamydial infections are under-identified and probably play an important role in sustaining the epidemic. Novel methods of actively screening asymptomatic men are needed to reduce the prevalence of chlamydia. This formative study explored the features of a sexually transmissible infection (STI) control program that would encourage annual testing among men. Methods: Using semi-structured interviews and focus group discussions, we explored issues related to health seeking behaviours and preferences for STI screening among men recruited from a public health STI clinic. Results: All 29 participants acknowledged the expertise of clinic staff and most men preferred speaking with a provider over using electronic informational resources. The clinic was the preferred venue for future screening, followed by self-collected home sampling with clinic drop-off. Men expressed a preference for receiving results via the telephone rather than electronic options, and preferred personalised reminders for future STI screening. Conclusions: In this sample, there was high interest in utilising the expertise of STI clinic personnel and less in non-clinical options. While this may be due to recruiting from an STI clinic, the data serves as a reminder that service provision must be responsive to the needs of potential users. Our findings suggest that future non-clinic based screening strategies may require an initial educational component to address concerns about confidentiality and sample quality in order to be acceptable. © CSIRO 2011.
• Dodge, B., Reece, M., Herbenick, D., & Schick, V. (2010). Experiences of condom fit and feel among men in five European nations. International Journal of Men's Health, 9(Issue 3). doi:10.3149/jmh.0903.175
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  Findings from recent studies in the United States indicate that some men report they perceive problems with the fit and feel of condoms and that these perceptions are associated with lack of consistent condom use. However, little research has explored how men outside the U.S. feel about the fit and feel of condoms. The research project was conducted by researchers in the U.S. in collaboration with a range of community partners in France, Germany, the Netherlands, Slovenia, and Spain. A total of 2,921 men completed The Condom Fit and Feel Scale and other items via Internet-based surveys available in six languages. Men from each nation were compared using descriptive and multivariate techniques to assess condom fit and feel. Although most men reported they generally perceived condoms to fit fine and feel comfortable, there were differences across men in different countries with regard to specific issues they experienced with condom fit and feel. In particular, men in the Netherlands were least likely to report that condoms fit fine and most likely to report that condoms felt too tight and/or too short. Men from Slovenia were most likely to report that condoms were too loose. The fit and feel issues that men identified may be among those that are associated with their likelihood of using, or not using, condoms consistently and correctly. A better understanding of fit and feel perceptions in this study will be beneficial to both condom manufacturers and health professionals. © 2010 by the Men's Studies Press, LLC. All rights reserved.
• Dodge, B., Van Der Pol, B., Rosenberger, J. G., Reece, M., Roth, A. M., Herbenick, D., & Fortenberry, J. D. (2010). Field collection of rectal samples for sexually transmitted infection diagnostics among men who have sex with men. International Journal of STD and AIDS, 21(Issue 4). doi:10.1258/ijsa.2009.009056
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  Rectal sexually transmitted infections (STIs) are common in men at risk for urethral infections with these pathogens, particularly men who have sex with men (MSM). However, for those individuals not regularly seen by a clinician, screening for rectal STI is not currently a widespread option. Qualitative data and samples (i.e. self-obtained rectal specimens) were collected from 75 MSM in a variety of venues. Upon completion of the rectal self-sampling, each participant completed a brief interview regarding their overall experience with the process. Participants reported an overall high level of acceptability and comfort-level involved with selfsampling for rectal STI. Of the majority of men who agreed to provide a rectal self-sample, all reported that they would provide a sample again in the future. However, many men also appreciated the interaction with a health-care provider that a clinical setting offered. In conclusion, self-sampling is a feasible and acceptable option when offered to MSM in a range of community-based venues. Further research is needed to determine which combinations of STI testing and treatment methods (including self-sampling) are most appropriate for diverse groups of men.
• Fisher, C. M., Reece, M., Dodge, B., Wright, E., Sherwood-Laughlin, C., & Baldwin, K. (2010). Expanding our reach: The potential for youth development professionals in community-based organizations to provide sexuality information. American Journal of Sexuality Education, 5(Issue 1). doi:10.1080/15546121003685297
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  Adolescents in the United States continue to face sexual health issues. While community-based organizations (CBOs) have a long history of addressing the sexual health needs of those they serve, little attention has been given to CBOs focused on adolescent populations and the role youth development professionals (YDPs) might play in the advancement of sexual health. The purpose of this study was to assess the potential of YDPs to provide sexuality information to youth by 1) determining the frequency and type of questions YDPs receive from youth on sexuality and 2) ascertaining the perceived comfort, confidence, skills, and knowledge of YDPs in answering questions from youth and characteristics that might be predictive of increased levels of perceived comfort, confidence, skills, and knowledge. Utilizing a community-based participatory research process that engaged the researchers with leaders, key stakeholders, and youth development professionals from community-based organizations throughout the state, data were collected from 169 YDP in Indiana. YDPs received questions from youth on a broad array of sexuality-related topics with personal skills and relationships being the most frequent topics. YDPs had high perceived levels of comfort, confidence, skills, and knowledge (CCSK) in addressing questions from youth about sexuality. Training, both formal classroom-type training and more informal practices such as advice-seeking from a professional, was the only factor predictive of higher levels of CCSK. Results indicate that YDPs might play an important role in providing sexuality information to youth. Communities interested in ameliorating disparities among youth might want to consider including CBOs and YDPs in an ecological approach to sexual health education. © Taylor & Francis Group, LLC.
• Fisher, C., Herbenick, D., Reece, M., Dodge, B., Satinsky, S., & Fischtein, D. (2010). Exploring sexuality education opportunities at in-home sex-toy parties in the United States. Sex Education, 10(Issue 2). doi:10.1080/14681811003666341
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  While debates about adolescent sexuality education persist in the United States, little attention has been paid to adult sexuality education. Research suggests that teachable moments may be present in interactions between adult bookstore employees and the consumers who shop at these venues. The purpose of this study was to explore the potential for in-home sex-toy parties as an avenue for adult sexuality education for women. A total of 1197 women who facilitate in-home sex-toy parties for a large US-based company completed an online questionnaire related to their experiences facilitating these parties. As part of this larger survey, participants reported in an open-ended question the three most commonly asked questions they received when facilitating a party in the previous three months. Questions reported (n=3149) were analyzed for commonalities using qualitative methods. Resulting themes were then compared with Sexuality Information and Education Council of the United States (SIECUS) guidelines for comprehensive sexuality education to assess the potential for teachable moments at the events. Of the 36 topical areas identified by SIECUS, 31 areas were represented in questions reported by consultants indicating a strong potential for teachable moments related to sexuality education. In-home sex-toy parties may provide an additional avenue through which to increase adult sexual literacy. © 2010 Taylor & Francis.
• Herbenick, D., Reece, M., Sanders, S. A., Dodge, B., Ghassemi, A., & Fortenberry, J. D. (2010). Women's vibrator use in sexual partnerships: Results from a nationally representative survey in the United States. Journal of Sex and Marital Therapy, 36(Issue 1). doi:10.1080/00926230903375677
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  Little is known about women's use of vibrators within sexual partnerships. Data were collected from a population-based, cross-sectional survey of 2056 women aged 18-60 years in the United States. Partnered vibrator use was common among heterosexual-, lesbian-, and bisexual-identified women. Most vibrator users indicated comfort using them with a partner and vibrator use was related to positive sexual function as measured by the Female Sexual Function Index (FSFI). In addition, partner knowledge and perceived liking of vibrator use was a significant predictor of sexual satisfaction for heterosexual women (p < .01). Clinical and research implications are discussed. Copyright © Taylor & Francis Group, LLC.
• Jeffries IV, W. L., Dodge, B., Bandiera, F. C., & Reece, M. (2010). Beyond abstinence-only: Relationships between abstinence education and comprehensive topic instruction. Sex Education, 10(Issue 2). doi:10.1080/14681811003666317
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  In the United States, a debate exists as to whether abstinence-only or comprehensive sexuality education strategies are most beneficial for school-age youth. Despite abstinence being a fundamental component of comprehensive education, the two are often characterized as polar opposites. Few studies have examined overlaps between the approaches. The purpose of this study was to examine relationships between abstinence education and comprehensive topic instruction among sexuality education teachers. Data came from public school teachers (n=199) in Florida. Abstinence instruction was measured using the Section 510 A-H guidelines. Comprehensive topic instruction was measured using the Sexuality Information and Education Council of the United States' guidelines. Logistic regression analyses measured relationships between abstinence and comprehensive topic instruction. Nearly one-half of teachers taught all eight A-H guidelines, and the majority taught most comprehensive sexuality education topics. The odds of teaching comprehensive sexuality education topics generally increased as teachers taught more of the federal government's abstinence guidelines. This suggests that abstinence instruction, a core element of comprehensive sexuality education, may increase alongside instruction on other comprehensive topics. We discuss the relevance our findings have for understanding the nature of both abstinence and comprehensive sexuality education. © 2010 Taylor & Francis.
• Johnson, B. T., Redding, C. A., Diclemente, R. J., Mustanski, B. S., Dodge, B., Sheeran, P., Warren, M. R., Zimmerman, R. S., Fisher, W. A., Conner, M. T., Carey, M. P., Fisher, J. D., Stall, R. D., & Fishbein, M. (2010). A network-individual-resource model for HIV prevention. AIDS and Behavior, 14(Issue 2). doi:10.1007/s10461-010-9803-z
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  HIV is transmitted through dyadic exchanges of individuals linked in transitory or permanent networks of varying sizes. A theoretical perspective that bridges key individual level elements with important network elements can be a complementary foundation for developing and implementing HIV interventions with outcomes that are more sustainable over time and have greater dissemination potential. Toward that end, we introduce a Network-Individual-Resource (NIR) model for HIV prevention that recognizes how exchanges of resources between individuals and their networks underlies and sustains HIV-risk behaviors. Individual behavior change for HIV prevention, then, may be dependent on increasing the supportiveness of that individual's relevant networks for such change. Among other implications, an NIR model predicts that the success of prevention efforts depends on whether the prevention efforts (1) prompt behavior changes that can be sustained by the resources the individual or their networks possess; (2) meet individual and network needs and are consistent with the individual's current situation/developmental stage; (3) are trusted and valued; and (4) target high HIV-prevalence networks. © 2010 Springer Science+Business Media, LLC.
• Martinez, O., & Dodge, B. (2010). El barrio de La Chueca of Madrid, Spain: An emerging epicenter of the global LGBT civil rights movement. Journal of Homosexuality, 57(Issue 2). doi:10.1080/00918360903488913
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  The purpose of this article is to examine and deconstruct the lesbian, gay, bisexual, and transgender (LGBT) barrio (community) of Chueca in Madrid, Spain, from political and sociological perspectives. First, we develop a critical framework for understanding the historical, political, social, cultural, and economic changes that took place in Spain after Franco's death in relation to LGBT issues. Ethnographic research was conducted from May to July 2007 in the Spanish cities of Madrid, Barcelona, and Ibiza, and focused primarily on the community of Chueca. A social constructionist perspective was used to examine sociocultural issues in this ethnosexual community through an in-depth study of the dynamics of this barrio. The theoretical framework of intersectionality and the constitutive relations among social identities is exemplified in Chueca. Hence, individuals in Chueca and their intersectionality perspective reveal that their identities influence and shape their beliefs about gender and symbols. We describe how Chueca reflects recent progressive changes in LGBT-related laws and statutes drafted by the federal government and how these have influenced the high level of societal acceptance toward intimate same-sex relationships in Spain. Additionally, we exemplify and present Chueca as an enclave that has been affected by the globalization of the private market, "gay" identity, and enterprise, having a direct effect on cultural norms and social behaviors. Last, we examine the current state of the Chueca community relative to other developing LGBT Latino/a communities in the United States. © Taylor & Francis Group, LLC.
• Reece, M., Briggs, L., Dodge, B., Herbenick, D., & Glover, R. (2010). Perceptions of condom fit and feel among men living with HIV. AIDS Patient Care and STDs, 24(Issue 7). doi:10.1089/apc.2010.0021
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  Promoting consistent and correct condom use remains a priority public health activity, although some HIV- and STI-related providers remain challenged by some men's resistance to condoms, which some claim do not fit properly or do not feel comfortable. Although these perceptions have been examined across multiple populations, they have not been documented among men living with HIV. During spring 2008, data were collected from 215 men living with HIV at HIV service organizations in the Midwestern and Southeastern United States. Participants completed the Condom Fit and Feel Scale and measures related to demographics and condom use during sexual interactions within the past 90 days. Men were primarily homosexual, African American, with a high school degree or higher, and unemployed. More than half of participants had used condoms for sexual intercourse within the previous 90 days. The majority of the men reported few problems with the fit and feel of condoms, with 63.1% reporting that condoms "fit my penis just fine," and 80.9% reported being able consistently to find condoms that they perceived to be "sized appropriately for my penis." Some men did report specific characteristics of condoms that challenged fit and feel, including 20.6% endorsing (always or often) that condoms feel too tight, 15.9% that condoms are too short, 17.8% or that condoms would not roll down far enough to cover their penis completely (15.6%). These data provide insights into mechanisms through which providers can help to increase men's access to the diverse range of condoms in the marketplace. © 2010, Mary Ann Liebert, Inc. 2010.
• Reece, M., Herbenick, D., Dodge, B., Sanders, S. A., Ghassemi, A., & Fortenberry, J. D. (2010). Vibrator use among heterosexual men varies by partnership status: Results from a nationally representative study in the United States. Journal of Sex and Marital Therapy, 36(Issue 5). doi:10.1080/0092623x.2010.510774
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  This nationally representative study documents that vibrator use among heterosexually identified men in the United States is common, with 43.8% reporting use of a vibrator at some point in their lives, with most vibrator use by heterosexual men occurring within the context of sexual interactions with a female partner. Approximately 94% of male vibrator users reported that they had used a vibrator during sexual play with a partner, and 82% reported that they had used a vibrator during sexual intercourse. These data support the work of therapists and educators who often make recommendations for the incorporation of vibrators into partnered relationships. Copyright © 2010 Taylor & Francis Group, LLC.
• Reece, M., Herbenick, D., Sanders, S. A., Dodge, B., Ghassemi, A., & Fortenberry, J. D. (2010). Prevalence and predictors of testicular self-exam among a nationally representative sample of men in the United States. International Journal of Sexual Health, 22(Issue 1). doi:10.1080/19317610903392953
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  Men's gender roles and norms may influence their sexual behaviors and sexual health care practices in numerous specific ways and contexts. Health professionals encourage men's performance of testicular self-exams (TSE), yet estimates of monthly TSE from convenience samples range from 2% to 10%. In this population-based study of 655 U.S. men aged 18 to 44 years, TSE prevalence during the past month was 40.3% and was predicted by geographic location, sexual behaviors, genital self-image, and having a physical exam within the past year. National TSE prevalence rates will be useful to those who work to reduce the morbidity and mortality associated with testicular cancer. © Taylor & Francis Group, LLC.
• Reece, M., Herbenick, D., Schick, V., Sanders, S. A., Dodge, B., & Fortenberry, D. J. (2010). Background and considerations on the National Survey of Sexual Health and Behavior (NSSHB) from the investigators. Journal of Sexual Medicine, 7(Issue 5). doi:10.1111/j.1743-6109.2010.02038.x
• Reece, M., Mark, K., Schick, V., Herbenick, D., & Dodge, B. (2010). Patterns of condom acquisition by condom-using men in the United States. AIDS Patient Care and STDs, 24(Issue 7). doi:10.1089/apc.2010.0011
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  Condom-distribution programs have striven to make condoms more accessible to sexually active individuals, particularly adolescents and populations disproportionately affected by HIV and other STIs. Despite such programs, little is known about where condom-using men in the United States acquire their condoms. The purpose of this study was to document condom-access trends among a large sample of sexually active condom-using men in the United States. Data were collected from 1,832 men from all 50 U.S. states and the District of Columbia by using an Internet-based survey in which men provided details regarding the source of condoms that they had used within the past 30 days. Men reported acquiring their condoms from a variety of sources, including free condom-distribution programs (56.7%) and from venues where they had purchased condoms for themselves (75.7%). Bivariate analyses indicated that participants who reported using free condoms tended to be younger, self-identified as not heterosexual, or not currently in a monogamous relationship. Further, results indicated that those participants who accessed only free condoms did not differ from those who used only purchased condoms, indicating that perhaps efforts to make condoms more accessible through public health distribution campaigns are reaching a more general population of condom-using men than expected. Findings illustrate the importance of continuing free condom-distribution efforts but also suggest benefits of facilitating linkages between public health and a community's retail venues to increase access to the growing diversity of condoms in the marketplace. © 2010, Mary Ann Liebert, Inc. 2010.
• Reece, M., Rosenberger, J. G., Schick, V., Herbenick, D., Dodge, B., & Novak, D. S. (2010). Characteristics of vibrator use by gay and bisexually identified men in the United States. Journal of Sexual Medicine, 7(Issue 10). doi:10.1111/j.1743-6109.2010.01873.x
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  Introduction.: Recent reports indicate that vibrator use during solo and partnered sexual activities is common among heterosexual men and women in the United States. However, little research has comprehensively assessed vibrator use among gay and bisexually identified men. Aims.: This study sought to document the extent to which gay and bisexually identified men report using vibrators, the sexual and relational situations within which they use them, and how men use vibrators on their own and their partners' bodies. Methods.: Data were collected from 25,294 gay and bisexually identified men from 50 U.S. states and from the District of Columbia via an internet-based survey. Main Outcome Measure.: Measures included sociodemographics, health-related indicators, sexual behaviors, and those related to recent and past use of vibrators during solo and partnered sexual interactions with other men. Results.: Approximately half (49.8%) of gay and bisexually identified men reported having used vibrators. Most men who had used a vibrator in the past reported use during masturbation (86.2%). When used during partnered interactions, vibrators were incorporated into foreplay (65.9%) and intercourse (59.4%). Men reported frequent insertion of vibrators into the anus or rectum when using them during masturbation (87.3%), which was also common during partnered interactions (∼60%), but varied slightly for casual and relationship sex partners. For both masturbation and partnered interactions, men overwhelmingly endorsed the extent to which vibrator use contributed to sexual arousal, orgasm, and pleasure. Conclusions.: Vibrator use during both solo and partnered sexual acts was common among the gay and bisexually identified men in this sample and was described by men as adding to the quality of their sexual experiences. © 2010 International Society for Sexual Medicine.
• Schick, V., Herbenick, D., Reece, M., Sanders, S. A., Dodge, B., Middlestadt, S. E., & Fortenberry, J. D. (2010). Condom use rates in a national probability sample of males and females ages 14 to 94 in the United States. Journal of Sexual Medicine, 7(Issue 5). doi:10.1111/j.1743-6109.2010.02017.x
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  Introduction.: Given the efficacy of latex condoms for preventing pregnancy, HIV, and most STI, their promotion remains central to global sexual health efforts. To inform the development of accurate and appropriately-targeted interventions, there is a need for contemporary condom use rates among specific populations. Aims.: The purpose of this study was to establish rates of condom use among sexually active individuals in the U.S. population. Methods.: Data were collected via a national probability sample of 5,865 U.S. adolescents and adults aged 14 to 94 years. Main Outcome Measures.: Condom use was assessed during the most recent partnered vaginal or anal sexual event and over the past 10 vaginal and anal intercourse events. Results.: Condom use by men during past 10 vaginal intercourse events was slightly higher (21.5%) than that reported by women (18.4%), and consistent with rates of condom use reported during most recent vaginal intercourse by men (24.7%) and women (21.8%). Adolescent men reported condom use during 79.1% of the past 10 vaginal intercourse events, adolescent women reported use during 58.1% of the same. Condom use during past 10 anal intercourse events was higher among men (25.8%) than women (13.2%); the same was observed for most recent anal intercourse event (26.5% for insertive men, 44.1% for receptive men, and 10.8% for receptive women). Generally, condom use was highest among unmarried adults, higher among adolescents than adults, and higher among black and Hispanic individuals when compared with other racial groups. Conclusion.: These data indicate clear trends in condom use across age, gender, relationship status, and race/ethnicity. These contemporary rates of condom use will be helpful to those who lead efforts to increase condom use among individuals who may be at risk for sexually transmitted infections or who desire to prevent pregnancy. © 2010 International Society for Sexual Medicine.
• Schnarrs, P. W., Rosenberger, J. G., Satinsky, S., Brinegar, E., Stowers, J., Dodge, B., & Reece, M. (2010). Sexual compulsivity, the internet, and sexual behaviors among men in a rural area of the United States. AIDS Patient Care and STDs, 24(Issue 9). doi:10.1089/apc.2010.0117
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  Sexual compulsivity has been associated with higher frequencies of sexual behaviors that may increase risk for transmission of HIV and other sexually transmitted infections (STI). In a rural midwestern region where social and community resources for the sexual health of men who have sex with men (MSM) are relatively few, the patterns of partner-seeking and sexual behavior, and their relations to sexual compulsivity, may be different than findings from other assessments of men in urban centers. Using a community-based participatory approach (CBPR), data were collected from 309 men who were primarily white, identified as gay or homosexual, and had a mean age of 29.37 years (SD=11.33), to explore relations between scores on a measure of sexual compulsivity and their sexual partner-seeking, drug and alcohol use, and sexual behaviors with men and women. The majority of men reported having engaged in sexual activity with men in the past 30 days. Those scoring higher than the sample mean (1.65 [SD=0.66]) on the sexual compulsivity measure reported patterns of having sex with partners met online and having been the insertive or receptive partner in unprotected anal intercourse. Given the unique patterns of sexual partner-seeking in this area, interventions to decrease sexual risk-taking should take into account that the vast majority of men in rural areas are using the Internet to locate sexual partners, and prevention messages focused on rural contexts need to be tailored to include men who have a propensity for sexually compulsive behaviors. Additionally, interventions created for virtual spaces may be more sustainable with rural communities than traditional approaches to HIV/STI prevention. © Mary Ann Liebert, Inc.
• Dodge, B., Reece, M., & Herbenick, D. (2009). School-based condom education and its relations with diagnoses of and testing for sexually transmitted infections among men in the United States. American Journal of Public Health, 99(Issue 12). doi:10.2105/ajph.2008.159038
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  An intense social and political debate continues in the United States regarding sexuality education. Included in the debate are those who favor comprehensive approaches, those who favor abstinence-only approaches, and those who favor no sexuality education. In this study, we showed that men who received school-based condom education were less likely to have been diagnosed with sexually transmitted infections (STIs) and were more likely to ever have been tested for sexually transmitted infections than were men without such education. School-based condom education is associated with less, rather than more, STI risk.
• Reece, M., Herbenick, D., & Dodge, B. (2009). Penile dimensions and men's perceptions of condom fit and feel. Sexually Transmitted Infections, 85(Issue 2). doi:10.1136/sti.2008.033050
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  Objectives: Sexual health professionals continue to promote correct and consistent condom use among sexually active individuals yet research indicates that some men remain resistant to using condoms because of perceptions that they do not fit properly or feel comfortable. This study empirically assessed relations between men's penile dimensions and their perceptions of condom fit and feel. Methods: Data related to demographics, a bivariate calculation of erect penile length and circumference, and perceptions of condom fit and feel were analysed from 1661 adult men from 50 US states Results: While many men reported that condoms generally fit fine and feel comfortable, at clearly identifiable intersections of length and circumference relations between penile dimensions and perceptions of condom fit and feel existed, particularly for those men who felt that condoms were "too long" (p
• Reece, M., Herbenick, D., Sanders, S. A., Dodge, B., Ghassemi, A., & Fortenberry, J. D. (2009). Prevalence and characteristics of vibrator use by men in the United States. Journal of Sexual Medicine, 6(Issue 7). doi:10.1111/j.1743-6109.2009.01290.x
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  Introduction. While vibrating products have been recommended by clinicians for the treatment of male sexual dysfunctions, knowledge is lacking with regard to the prevalence of vibrator use among men in the United States, the characteristics of men who use vibrators, and whether there are relations between vibrator use and sexual function among men. Aims. To establish lifetime and recent prevalence rates for vibrator use by men in the United States, to document the characteristics of men who use vibrators and their reasons for using vibrators, and to explore relations between men's vibrator use and sexual function. Methods. During April 2008, data were collected from a population-based cross-sectional survey of 1,047 men aged 18-60 years in the United States. Analyses were conducted using poststratification data weights. Main Outcome Measure. Measures included sociodemographics, health status and health-related behaviors, sexual behaviors, vibrator use, and sexual function. Results. For both solo and partnered sexual activities, the prevalence of men who had incorporated a vibrator into sexual activities during their lives was 44.8%, with 10.0% having done so in the past month, 14.2% in the past year, and 20.5% over 1 year ago. Men who had used vibrators, particularly those with more recent use, were more likely to report participation in sexual health promoting behaviors, such as testicular self-exam. Men who had used vibrators recently also scored higher on four of the five domains of the International Index of Erectile Function (erectile function, intercourse satisfaction, orgasmic function, and sexual desire). Conclusions. Among men in the United States, vibrator use during solo and partnered sexual interactions is common and is associated with a wide array of positive sexual health characteristics. Future research should continue to explore ways in which men incorporate vibrators into solo sexual acts, partnered sexual play, and sexual intercourse. Reece M, Herbenick D, Sanders SA, Dodge B, Ghassemi A, and Fortenberry JD. Prevalence and characteristics of vibrator use by men in the United States. © 2009 International Society for Sexual Medicine.
• Bandiera, F. C., Jeffries IV, W. L., Dodge, B., Reece, M., & Herbenick, D. (2008). Regional differences in sexuality education on a state level: The case of Florida. Sex Education, 8(Issue 4). doi:10.1080/14681810802433986
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  Introduction: In Florida, a state that consistently leads the nation in adverse sexual health outcomes among adolescents, numerous demographic and socio-cultural differences exist across the North, Central, and South regions. However, little is known about regional differences in sexuality education and beliefs among teachers. Methodology: Using a mail-based survey of 462 teachers, we examined regional differences in parental consent requirements, abstinence instruction, student language barriers, availability of Spanish curricula, teacher beliefs regarding the dissemination of accurate safer sex information, and missing data. t-tests and multivariate logistic regression analyses were conducted. Results: North Floridian teachers taught more abstinence than those in Central and South Florida. Additionally, they had fewer students with language barriers, offered less Spanish curricula, and, in general, possessed less favorable attitudes toward presenting accurate safer sex information. However, South Floridian teachers were most likely to report parental consent requirements in their schools. These findings largely remained in multivariate analyses. Conclusions: The present study identified several noteworthy regional differences in sexuality education in Florida. Recommendations are given for developing and implementing programs that account for these differences within the state.
• Bandiera, F. C., Pereira, D. B., Arif, A. A., Dodge, B., & Asal, N. (2008). Race/ethnicity, income, chronic asthma, and mental health: A cross-sectional study using the behavioral risk factor surveillance system. Psychosomatic Medicine, 70(Issue 1). doi:10.1097/psy.0b013e31815ff3ad
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  OBJECTIVE: To examine the relationships among race/ethnicity, income, and asthma on mental health outcomes in individuals surveyed as part of the Centers for Disease Control and Prevention 2004 Behavioral Risk Factor Surveillance System (BRFSS). Racial and ethnic disparities in asthma prevalence exist, which may be explained in part by socioeconomic status. Individuals with asthma often have comorbid mental health conditions, the rates of which are also marked by significant racial and ethnic disparities. METHODS: We obtained 2004 BRFSS demographic, asthma, and mental health data on Hispanics, non-Hispanic Whites, and non-Hispanic Blacks. Linear regression analysis was used to examine the main and interaction effects of race/ethnicity, income, and history of asthma on poor mental health (n = 282,011), as well as on depression (n = 14,907) and anxiety (n = 14,871) specifically. RESULTS: A significant three-way interaction emerged among race/ethnicity, income, and history of chronic asthma on number of days of poor mental health. Among the most impoverished (income
• Dodge, B., Jeffries IV, W. L., & Sandfort, T. G. (2008). Beyond the down low: Sexual risk, protection, and disclosure among at-risk black men who have sex with both men and women (MSMW). Archives of Sexual Behavior, 37(Issue 5). doi:10.1007/s10508-008-9356-7
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  Little information is available about sexual risk, protective, and disclosure practices among Black bisexually active men and how these may be amenable to intervention when necessary. In-depth interviews were conducted with 30 at-risk urban Black men who have sex with both men and women (MSMW). Participants reported protecting themselves and their partners through routine HIV testing, using condoms consistently, engaging in strategic positioning during sexual activity, and limiting the number of sexual partners. In addition, they described several reasons for not using protection, including not having condoms available, enjoying sexual activity more without condoms, and perceiving female partners to be "safer" than male partners. Disclosure of bisexuality was complex and reportedly difficult, in particular to female and gay-identified male partners. Future interventions must not only build protection and disclosure skills among MSMW, but also increase broader social awareness and acceptance of male bisexuality. © 2008 Springer Science+Business Media, LLC.
• Dodge, B., Reece, M., & Gebhard, P. H. (2008). Kinsey and beyond: Past, present, and future considerations for research on male bisexuality. Journal of Bisexuality, 8(Issue 3-4). doi:10.1080/15299710802501462
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  Dr. Alfred C. Kinsey and his colleagues left behind a legacy of work that has served as a foundation for scholars worldwide as they explore human sexual behavior, including bisexuality. To truly reflect on the extent to which Kinsey's work has influenced researchers' conceptualizations of male bisexuality, and considers past, current, and future directions for work in this area, this article reflects lessons learned through conversations with one of the original members of Kinsey's team, Dr. Paul Gebhard. These dialogues provided his perspectives on our contemporary treatment of bisexuality in research and the extent to which it has (not) taken full advantage of the frameworks provided by Kinsey's original work. The insights gained through these interactions, combined with a review of some of the past and current work on male bisexuality, offer valuable reference points for future research efforts. © The Haworth Press.
• Dodge, B., Reece, M., Herbenick, D., Fisher, C., Satinsky, S., & Stupiansky, N. (2008). Relations between sexually transmitted infection diagnosis and sexual compulsivity in a community-based sample of men who have sex with men. Sexually Transmitted Infections, 84(Issue 4). doi:10.1136/sti.2007.028696
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  Objective: To assess relations between sexual compulsivity and a history of sexually transmitted infection (STI) diagnosis and testing among a community-based sample of men who have sex with men (MSM) in a mid-size urban area of the midwestern United States. Methods: Sexual health data were collected from 504 MSM in the metropolitan area of Indianapolis, Indiana, using a community-based participatory research approach. Sexual compulsivity scores were assessed using the Sexual Compulsivity Scale (SCS). Results: The reliability and construct validity of the SCS were determined to be high in the total study sample. Men who scored high on the SCS reported higher levels of sexual risk behaviour with both male and female partners and were significantly more likely to have been diagnosed with STI (including chlamydia, gonorrhoea, both hepatitis A and B, and syphilis) than other men. Men who scored high on the SCS were not more likely than other men to have been tested for STI, despite higher levels of sexual risk. Conclusions: The SCS may be useful as a supplemental instrument in public health programmes and healthcare settings that encourage men to assess their sexual behaviours and make decisions to pursue STI or HIV screening. For those already diagnosed with an STI, the SCS may help providers to identify the cognitive and affective components of sexual behaviours that increase the likelihood that an STI will be transmitted to a sexual partner.
• Dodge, B., Zachry, K., Reece, M., López, E. D., Herbenick, D., Gant, K., Tanner, A., & Martinez, O. (2008). Sexuality education in florida: Content, context, and controversy. American Journal of Sexuality Education, 3(Issue 2). doi:10.1080/15546120802104443
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  As with many states, Florida has official directives that are intended to influence what type of sexuality education, if any, takes place in public school classrooms. However, little is known about contextual factors that facilitate or challenge the ability of teachers to implement effective sexuality education initiatives. Levels of sexually transmitted infections (STIs) and unintended pregnancies continue to rise in Florida; indeed, the state ranks second in annual incident HIV infections. The need exists to examine the capacity of Florida's schools to develop educational responses to these issues. Methodology: Community-based participatory research (CBPR), scientific review, and a statewide mail-based survey were used to collect quantitative and qualitative data from 479 public school personnel throughout Florida. Results: Even though the vast majority of teachers (87%) acknowledged that some form of sex education took place in their schools, it was not accessible to all students, was most often afforded little time, occurred late in the students' academic career, had little to no uniformity in terms of what was being taught and who was teaching it, had no standards in terms of training or quality assurance, and may not adequately address the realistic needs of students. Conclusions and Recommendations: Teachers in Florida reported numerous barriers to providing comprehensive sexuality education. State organizations and advocacy groups located within Florida may consider initiating campaigns to promote comprehensive sexuality education in Florida's public schools.
• Herbenick, D., Reece, M., Hollub, A., Satinsky, S., & Dodge, B. (2008). Young female breast cancer survivors: Their sexual function and interest in sexual enhancement products and services. Cancer Nursing, 31(Issue 6). doi:10.1097/01.ncc.0000339252.91194.6c
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  Although American women are living longer after a breast cancer diagnosis, they may experience significant alterations in sexual function. However, little is known about the types of strategies that women are interested in using to address these sexual issues. This study used a reliable and valid instrument, the Sexual Function Questionnaire, to assess survivors' sexual function. Data were collected from 115 women who were younger than 50 years at diagnosis. Compared to normative controls, survivors scored significantly lower, indicating lower functioning, on most subscales of the Sexual Function Questionnaire and the overall measure, with the exception of the masturbation subscale on which they scored significantly higher. Most participants indicated moderate or strong interest in sexual enhancement products and comfort purchasing sexual enhancement products through various venues. Nurses and other health professionals might consider collaborations with entities of the adult retail industry to provide survivors with information about sexual enhancement products and their therapeutic potential. Copyright © 2008 Lippincott Williams & Wilkins.
• Jeffries IV, W. J., Dodge, B., & Sandfort, T. G. (2008). Religion and spirituality among bisexual black men in the USA. Culture, Health and Sexuality, 10(Issue 5). doi:10.1080/13691050701877526
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  Traditionally, religion has been a major source of institutional support and well-being for Black people in the USA. However, when juxtaposed against sexuality, religion's positive effect upon the lives of non-heterosexual individuals is questionable. Research suggests that non-heterosexuals often abandon structured religion for spirituality due to the homonegativity perpetuated through religious institutions. Although studies have examined religion and spirituality among gays and lesbians, few have examined their roles in the lives of bisexuals. In this study, we analyzed qualitative interviews from 28 bisexual Black men who resided in New York City. In addition to church attendance, participants expressed belonging to religious communities through activities such as music ministry. Despite rejection because of their bisexuality, some participants saw other religious individuals as being accepting of them. Others discussed the church as a place where non-heterosexuals interacted, often for meeting sexual partners. Participants evoked beliefs in God in coping with adverse life experiences; some linked faith to family and sexual responsibilities. Drawing upon relevant literature, we discuss the implications of religion and spirituality for the quality of life of bisexual Black men in the USA.
• Sandfort, T. G., & Dodge, B. (2008). "...And then there was the down low": Introduction to Black and Latino male bisexualities. Archives of Sexual Behavior, 37(Issue 5). doi:10.1007/s10508-008-9359-4
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  Although a recent proliferation of mass media has drawn attention to "the new Down Low phenomenon" (presumably "secretive" homosexuality among married Black men), relatively little research has explored bisexual behavior and identity among ethnic minority men in the United States or elsewhere. Although the study of bisexuality in Black and Latino men is significant in its own right, disproportionate rates of HIV/AIDS among these men make the current dearth of scientific information even more urgent and concerning. In this special section, we have compiled a diverse array of empirical and theoretical perspectives on Black and Latino male bisexualities. A wide range of information on the individual, social, and sexual lives of these men, and potential relations to risk behavior, are presented. This article introduces this new body of work and offers suggestions for future research directions for culturally appropriate interventions for Black and Latino bisexual men. © 2008 Springer Science+Business Media, LLC.
• Satinsky, S., Fisher, C., Stupiansky, N., Dodge, B., Alexander, A., Herbenick, D., & Reece, M. (2008). Sexual compulsivity among men in a decentralized MSM community of the Midwestern United States. AIDS Patient Care and STDs, 22(Issue 7). doi:10.1089/apc.2007.0255
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  Among men who have sex with men (MSM), sexual compulsivity has been associated with higher frequencies of sexual behaviors that may increase risk for transmission of HIV and other sexually transmitted infections (STI). In a Midwestern region where social and community resources for MSM are relatively diffuse, the patterns of partner-seeking and sexual behavior, and their relations to sexual compulsivity, may be different than findings from most other assessments of men in large urban areas. Using a community-based participatory approach (CBPR) and a cross-sectional survey, quantitative data were collected between November 2006 and January 2007 from 504 men related to sexual compulsivity, sexual partner-seeking, and sexual behavior. We sought to explore sexual behaviors in venues where men reported meeting sexual partners, based on their level of compulsivity. Venues that could be characterized as "sexualized" were better predictors of higher sexual compulsivity scores among men than those that are "social" in nature. Men who were higher in compulsivity reported patterns of saturating sexualized venues in order to find sexual partners. Given the unique patterns of sexual partner-seeking in this area, interventions to decrease sexual risk-taking should take into account that men who have a higher propensity for sexual compulsivity are visiting multiple venues, and prevention messages need to be tailored to be consistent across these contexts. In addition, these may need to be differentially designed based on the specific environment in which they are to be delivered. © 2008 Mary Ann Liebert, Inc.
• Muñoz-Laboy, M., & Dodge, B. (2007). Bisexual latino men and HIV and sexually transmitted infections risk: An exploratory analysis. American Journal of Public Health, 97(Issue 6). doi:10.2105/ajph.2005.078345
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  Objectives. We sought to determine whether there were differences in sexual risk among behaviorally and self-identified bisexual men, men who reported having sex with both men and women without reporting a bisexual identity and men who self-identified as bisexual but reported only recent homosexual behavior over the past 6 months. Methods. Through a secondary data analysis, we conducted stepwise linear regression equation modeling to determine which factors were significant predictors of sexual risk among various subgroups of bisexual Latino men. Results. Having sex with women, regardless of sexual identity, increased the likelihood of insertive unprotected anal intercourse with men. Bisexual identity was not statistically associated with unprotected anal intercourse with men. Conclusions. Future studies should begin to examine differences within groups rather than focusing on group comparisons that yield limited insights into sexual risk predictors for homosexually and bisexually active men. Further research that explores risk and protective factors in the sexual lives of Latino bisexual men is also needed.
• Reece, M., Dodge, B., Herbenick, D., Fisher, C., Alexander, A., & Satinsky, S. (2007). Experiences of condom fit and feel among African-American men who have sex with men. Sexually Transmitted Infections, 83(Issue 6). doi:10.1136/sti.2007.026484
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  Objective: To offer an empirical understanding of characteristics associated with the fit and feel of condoms among African-American men who have sex with men (MSM), a particularly high-risk group for HIV and other sexually transmitted infections (STI) in the United States. Methods: Survey data were collected from 178 adult African-American MSM attending a community event in Atlanta, Georgia. Results: Although the majority of participants reported that condoms generally fit properly and felt comfortable, a substantial number of men reported a variety of problems with the fit and feel of condoms. Specifically, 21 % reported that condoms felt too tight, 18% reported that condoms felt too short, 10% reported that condoms felt too loose, and 7% reported that condoms felt too long. There were significant associations between men's reports of condom breakage and slippage, and their perceptions of condom fit and feel. Perceptions of condom fit and feel were also related to men's reports of seeking condoms for their size-specific properties. Conclusions: The fit and feel issues that men in this sample identified may be among those that contribute to their likelihood of using, or not using, condoms consistently and correctly. A better understanding of these factors will be beneficial to both condom manufacturers and sexual health professionals who share a common goal of increasing consistent and correct condom use and reducing the incidence of HIV and other STI among this and other communities.
• William L, J. I., & Dodge, B. (2007). Male bisexuality and condom use at last sexual encounter: results from a national survey. Journal of Sex Research, 44(Issue 3). doi:10.1080/00224490701443973
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  Relatively little is known about condom use among bisexual men as separate and distinct from exclusively homosexual and heterosexual men. Most previous research on bisexual men has relied on nonprobabilistic, high-risk samples with limited generalizability. We examined the relationship between behavioral bisexuality and condom use in the 2002 cycle of the National Survey of Family Growth (NSFG). Bisexually active men positively differed from heterosexually and homosexually active men on every indicator of confounding risk. Bisexually active men, however, did not report using condoms less often than other men during their last sexual encounters with males and females. Indeed, with female partners, bisexually active men reported higher rates of condom use than did other men. These relationships remained when all sociodemographic and confounding risk factors were held constant. Our results suggest that caution must be used when making assumptions about condom use in the general population of bisexual men from nonprobabilistic samples.
• Melendez, R. M., Exner, T. A., Ehrhardt, A. A., Dodge, B., Remien, R. H., Rotheram-Borus, M. J., Lightfoot, M., & Hong, D. (2006). Health and health care among male-to-female transgender persons who are HIV positive. American Journal of Public Health, 96(Issue 6). doi:10.2105/ajph.2004.042010
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  Recent studies have reported high rates of HIV infection among male-to-female transgender persons, but little research has examined how male-to-female transgender persons manage living with HIV. We compared demographic and health characteristics of 59 male-to-female transgender persons who were HIV positive with 300 nontransgender control subjects who were HIV positive. We found several demographic differences between the groups, but no significant differences in HIV-related health status. Ma1e to female transgender persons were less likely than the control group to take highly active antiretroviral therapy.
• Remien, R. H., Exner, T., Kertzner, R. M., Ehrhardt, A. A., Rotheram-Borus, M. J., Johnson, M. O., Weinhardt, L. S., Kittel, L. E., Goldstein, R. B., Pinto, R. M., Morin, S. F., Chesney, M. A., Lightfoot, M., Gore-Felton, C., Dodge, B., & Kelly, J. A. (2006). Depressive symptomatology among HIV-positive women in the era of HAART: A stress and coping model. American Journal of Community Psychology, 38(Issue 3-4). doi:10.1007/s10464-006-9083-y
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  Objective: An enhanced stress and coping model was used to explain depression among HIV-positive women in healthcare and community settings where highly active anti-retroviral treatment (HAART) was commonplace. Method: HIV-infected women in four cities (N=978) were assessed, cross-sectionally, for mental and physical health, stress, social support, and other background factors. Results: Self-reported level of depressive symptomatology was high. Number of physical symptoms, illness intrusiveness, and perceived stress were positively associated with depressed mood, while coping self-efficacy and social support were negatively associated. Stress mediated the effect of health status on depression and coping self-efficacy mediated the effect of psychosocial resources on depression. Our enhanced stress and coping model accounted for 52% of variance in depressive symtpomatology. Conclusions: Interventions focused on improving coping self-efficacy, bolstering social supports, and decreasing stress in the lives of HIV-positive women may help to reduce the negative effects of HIV disease on mood. © Springer Science+Business Media, LLC 2006.
• Sanders, S. A., Graham, C. A., Yarber, W. L., Crosby, R. A., Dodge, B., & Milhausen, R. R. (2006). Women who put condoms on male partners: Correlates of condom application. American Journal of Health Behavior, 30(Issue 5). doi:10.5993/ajhb.30.5.2
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  Objective: To identify correlates of women applying condoms. Methods: Cross-sectional survey of 533 sexually-active women; questionnaire. Results: Of the condom users (n=322), 31.7% reported applying condoms at least once-an average on 59.7% of the occasions. Compared to nonappliers, appliers had more positive affect toward sexually related situations (erotophilia, P=.004) and a higher frequency of sex (P=.003). Condom users, compared to nonusers, were significantly younger (P=.001), were less likely to be in sexually exclusive relationships (P=.001) or married (P=.01), and reported more partners in the past 3 months (P=.001), Conclusions: Condom-applying women may have more positive attitudes toward sexuality and engage in a higher frequency of sexual activity.
• Muñoz-Laboy, M. A., & Dodge, B. (2005). Bisexual practices. Journal of Bisexuality, 5(Issue 1). doi:10.1300/j159v05n01_06
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  Recent studies indicate that bisexually active Latino and African-American men are at significantly higher risk for HIV/AIDS than exclusively homosexually active men and exclusively heterosexually active men. This two-year ethnographic study was conducted to examine the sexual practices and factors that shape the sexual negotiations of a sample of bisexually active Latino men in order to contribute to the development of more relevant and effective prevention of HIV and other sexually transmitted infections for this target group. Data collection methods involved ethnographic observations and detailed sexual histories of eighteen bisexually active Latino men in the metropolitan New York City area. For the men in this study, tensions between sexual and gender identities, interconnections of power and sexual activity, importance of the family context, and silences produced within social and sexual environments based on notions of “appropriate” masculinity and sexuality were identified as the critical factors influencing the processes of negotiating sexual practices and HIV/STI risk. Based on these findings, we believe masculinity could serve as an effective tool with which to build new and innovative HIV/STI prevention efforts for bisexually active Latino men. © 2005, Taylor & Francis Group, LLC. All rights reserved.
• Dodge, B., Reece, M., Cole, S. L., & Sandfort, T. G. (2004). Sexual compulsivity among heterosexual college students. Journal of Sex Research, 41(Issue 4). doi:10.1080/00224490409552241
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  A growing body of literature suggests that an association exists between sexual compulsivity and participation in sexual behaviors that are high risk in terms of HIV/STD infection. In most of these studies, sexual compulsivity has been measured using the Sexual Compulsivity Scale (SCS; Kalichman & Rompa, 1995). As yet, sexual compulsivity has only been assessed with this scale among individuals who are members of "high risk" groups for HIV infection or who are HIV-positive. In this study, we found support for reliability and construct validity of the SCS in a sample of 876 heterosexual college students, a group not yet examined in the sexual addiction and compulsivity literature. Construct validity was substantiated by the presence of significant relationships of sexual compulsivity with frequencies of sexual behaviors and numbers of sexual partners. The scale was also related to gender and age. Sexual compulsivity scores were associated with frequency of risky sexual behaviors. The relationships between sexual compulsivity and solo, partner, public, and risky sexual behaviors remained significant when we controlled for demographic variables. Although we found support for construct validity of the SCS in our sample, it is not clear whether the scale distinctly measures sexual compulsivity or taps into other constructs, such as sexual desire and sexual exploration.
• Reece, M., & Dodge, B. (2004). A study in sexual health applying the principles of community-based participatory research. Archives of Sexual Behavior, 33(Issue 3). doi:10.1023/b:aseb.0000026623.69017.df
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  The principles of community-based participatory research were applied to an exploratory sexual health study that examined "cruising for sex" among men on a college campus. In the context of a study seeking a broad interpretation of the health implications of cruising, and when faced with methodological challenges, the researchers found these principles to provide invaluable guidance. A review of the research process is offered and the manner in which the principles of community-based participatory research were operationalized for this study is described.
• Reece, M., & Dodge, B. (2004). Exploring indicators of sexual compulsivity among men who cruise for sex on campus. Sexual Addiction and Compulsivity, 11(Issue 3). doi:10.1080/10720160490521222
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  Assessments of sexual compulsivity were included in an exploratory study of 30 men who had a history of cruising for sexual partners on college campuses. A quantitative measure of sexual compulsivity was used to assess sexual compulsivity scores and to make comparisons with other populations from previous research. Qualitative data were analyzed to assess the extent to which cruisers described consequences of their behavior that have been suggested by professionals as indicative of sexual compulsivity. Some cruisers had characteristics indicative of sexual compulsivity and many described negative or potentially negative outcomes that would be anticipated to result from, or that are perhaps related to, compulsive sexual behavior. While the findings may need to be considered within the cultural and developmental context of men on college campuses, they provide insights into the need for additional training for health and social service providers and into the direction of future research in this area. Copyright © Taylor & Francis, Inc.
• Reece, M., & Dodge, B. (2003). Exploring the Physical, Mental and Social Well-Being of Gay and Bisexual Men Who Cruise for Sex on a College Campus. Journal of Homosexuality, 46(Issue 1-2). doi:10.1300/j082v46n01_03
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  A mixed methods design was used to collect data from 30 men who were currently, or had a history of, participating in anonymous public sex in college campus venues. Data were analyzed to assess the extent to which participation in these behaviors was associated with both positive and negative outcomes across the areas of physical health, mental health and social well-being. Findings indicated that cruising for sex on a college campus simultaneously presents challenges to, and supports, the health of gay and bisexual men. Recommendations for interfacing with these men by campus and community health providers are given. © 2003 by The Haworth Press, Inc. All rights reserved.
• Crosby, R. A., Sanders, S. A., Yarber, W. L., Graham, C. A., & Dodge, B. (2002). Condom use errors and problems among college men. Sexually Transmitted Diseases, 29(Issue 9). doi:10.1097/00007435-200209000-00010
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  Background: An essential yet understudied aspect of condom use is whether they are used correctly. Goal: The goal of the study was to comprehensively evaluate condom use errors and problems reported by heterosexual college men (N = 158). Study Design: A cross-sectional survey, involving a 3-month recall period, was conducted. Results: Of the 158 participants, 60% did not discuss condom use with their partner before sex; 42% reported they wanted to use condoms but did not have any available; 43% put condoms on after starting sex; 15% removed condoms before ending sex; 40% did not leave space at the tip; 30% placed the condom upside down on the penis and had to flip it over; and 32% reported losing erections in association with condom use. Nearly one-third reported breakage or slippage during sex. Few participants reported errors related to lubrication, storage, and reusing condoms. Higher error scores were associated with breakage/slippage rather than with consistency of condom use. Conclusion: Condom use errors were common, and error scores were associated with breakage and slippage. Increasing the focus on correcting potential user failures may be an important public health strategy.