Doctor of Philosophy, Case Western Reserve University, 2005, Epidemiology and Biostatistics

Background: Recent studies have found that as many as one in three HIV infected persons may continue to engage in unprotected sex, sexual contact often occurring with seronegative or unknown status partners. While the issue of prevention has received greater attention in developed countries, little is known about the extent to which persons living with HIV/AIDS (PLWHA) might continue to engage in high-risk sexual behaviors in sub-Saharan Africa. Objectives: Propose and test a conceptual model explaining sexual-risk behaviors among PLWHA in terms of cognitive and situational factors. Methods: Cross-sectional study conducted in Abidjan, Cote d'Ivoire (West Africa). The study sample consisted of HIV-positive men and women at various stages of their illness and currently attending one of the largest outpatient clinics for HIV patients. All the data were collected through face-to-face structured interviews. Results: Three hundred forty-nine (349) valid questionnaires were completed. Fifty percent (50%) of the study sample reported one regular partner; 10% reported casual partners and 7% reported multiple partners. Over one-third of the respondents had engaged in high-risk sexual behaviors during the previous 6 months. As posited, two cognitive factors (an internal and external) emerged from the factor analysis process. Although only a small to moderate variance was explained by the model, most of the hypothesized effects were statistically significant: the internal cognitive and the situational factors were inversely related to sexual risk behaviors; the internal cognitive factor also partially mediated the relationship between situational factor and sexual risk-taking. The external cognitive had no significant effect on the outcome. Different models were found for the men and women. Conclusions: The present study indicates that the behavior of a sizable number of HIV patients may continue to increase the burden of the disease at the population. Because access to care is (open full item for complete abstract)

Committee: Mendel Singer (Advisor) Subjects:

Doctor of Philosophy (PhD), Ohio University, 2010, Psychology (Arts and Sciences)

Sexual risk behaviors, which can lead to a number of negative health consequences, continue to be a problem on college campuses (e.g., Grello, Welsh, & Harper, 2006; Gullette & Lyons, 2006; Ravert et al., 2009). The theory of planned behavior (TPB; Ajzen, 1985; 1991) has been shown to be effective in predicting sexual risk behavior (e.g., Albarracin, Johnson, Fishbein, & Muellerleile, 2001; Godin & Kok, 1996), as well as a range of other behaviors (e.g., Ajzen, 1991; Armitage & Conner, 2001). The predictive validity of the TPB has been shown to increase when other variables are included and therefore an extended version of the TPB was examined in the current study to aid in the prediction of condom use, contraceptive use, dual use (condom use plus another contraceptive method), and casual sex among college students. Structural equation modeling was utilized to test both sufficiency models as predicted by the TPB and extended models where six additional variables were allowed to have direct paths to both intentions and behavior. Specifically, the first goal of the study was to examine both the TPB sufficiency models and the extended TPB models for each of the seven behaviors to determine whether the six added variables (past sexual risk behavior, anticipated affect, moral norms, sexual excitation, sexual inhibition, and sensation seeking) had direct relationships with intentions and/or behavior and to assess which of the two types of models provide a better fit to the data. Given that there is often a discrepancy between intentions and behaviors (e.g., Sheeran, 2002), the current study also sought to further the research on factors that predict intention-behavior consistency by exploring a set of variables that may discriminate between 1) those who intended to engage in safe sex behaviors and did so and 2) those who intended to engage in safe sex behavior and did not engage in such behavior. Specifically, the second goal of the study was to determine if characteristi (open full item for complete abstract)

Committee: Christine Gidycz Ph.D. (Committee Chair); John Garske Ph.D. (Committee Member); Patricia Beamish Ph.D. (Committee Member); Julie Suhr Ph.D. (Committee Member); Benjamin Ogles Ph.D. (Committee Member) Subjects: Psychology; Social Research

Master of Science (MS), Ohio University, 2007, Psychology (Arts and Sciences)

Current measures of sexual risk taking are either too narrowly focused to be used with college students or do not have adequate psychometric properties. The goal of the current study was to develop a broad and psychometrically sound measure of sexual risk taking. Three hundred and ten undergraduate students at a mid-sized Midwestern university were surveyed to develop and gather reliability and validity information on a new measure of sexual risk, the Sexual Risk Survey. Sex differences were also explored throughout the study. The measure was found to be multidimensional with five factors. The measure demonstrated good internal consistency and test-retest reliability as well as convergent, discriminant, and concurrent validity. Although there were no sex differences in total sexual risk taking behaviors reported over the past 6 months, differences emerged in the variables that predicted sexual risk taking. Implications for these findings are discussed.

Committee: John Garske (Advisor) Subjects:

PHD, Kent State University, 2005, College of Arts and Sciences / Department of Psychological Sciences

The current study tested a mediational model of the relationships between childhood physical (CPA) and sexual abuse (CSA) and sexual risk in adulthood. Posttraumatic stress disorder and adult sexual assault were hypothesized to mediate the relationships between childhood abuse and behavioral and relational risk for HIV in adulthood. Participants were 202 young, inner-city women who participated in a large-scale HIV prevention project. Structural equation modeling and a series of regression analyses were used to test the proposed relationships. Results suggested that both CSA and CPA were significantly associated with PTSD and rape in adulthood. CPA was significantly related to an increased number of sexual partners and high-risk sexual relationships in adulthood. In contrast, CSA was not associated with high-risk sexual behaviors or relationships in adulthood. Support was not found for a mediational role of either PTSD or adult rape on behavioral or relational risk. Limitations of the current study and future directions for research are reviewed.

Committee: Stevan Hobfoll (Advisor) Subjects: Psychology, Clinical

Doctor of Philosophy, The Ohio State University, 2018, Human Ecology: Human Development and Family Science

Homeless youth frequently engage in high risk sex behaviors putting them at risk for Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (STIs), and unplanned pregnancy (Edidin et al., 2012; Halcon & Lifson, 2004). Previous attempts to intervene have had limited success (Naranbhai et al., 2011). While previous research has documented high prevalence rates and risk factors for engaging in sexual risk behaviors (Halcon & Lifson, 2004; Edidin et al., 2012), less is known about homeless youths' perceptions regarding potential benefits and consequences of their sexual risk behaviors. The current dissertation presents the results of three qualitative studies that explored homeless youths' motivation for engaging in sexual risk behaviors and their perception of the potential risks. The studies used qualitative interviews with 30 substance using homeless youth (ages 14-24). Interviews were coded by three coders using grounded theory methods (Strauss & Corbin, 1998) and NVivo 10 software. The first study explored homeless youths' motivation for engaging in sex and how the potential threat of HIV/STIs impacted their decisions. Youth reported similar emotional and physical benefits of having sex as housed youth. However, the stressful context of experiencing unmet needs appeared to influence youth to make impulsive decisions about sex that were often based on their immediate feelings/needs. Consequently, they rarely considered the threat of HIV/STIs when deciding to have sex. Further, youth were generally unconcerned about their risk of contracting HIV/STI because they either underestimated their level of risk or did not believe they would be significantly impacted by contracting HIV or an STI. The second study examined youths' perception of how substance use influences their decisions to have sex and engage in sex work. Youth differed in whether they believed substance use impacted their decisions. Some youth believed their decisions about sex were not i (open full item for complete abstract)

Committee: Natasha Slesnick (Advisor); Suzanne Bartle-Haring (Committee Member); Keeley Pratt (Committee Member); Irene Hatsu (Committee Member) Subjects: Social Research

Master of Arts (MA), Bowling Green State University, 2015, Cross-Cultural, International Education

Research shows that many international students are coming into the United States from countries with high prevalence rates of sexually transmitted diseases, minimal sexual health knowledge, and pre-conceived notions surrounding sexual health. What results from this at colleges across the country is an unavoidable intersection of international students and sexuality, with many administrators of such institutions feeling uncertain or unwilling to include sexual health in their education model. Through my unequivocal belief that resources related to sexual health education are a crucial need on every college campus, for every population, I decided to focus specifically on international students. The overall purpose of this case study is three-fold: (a) to explore the differences in backgrounds in sexual health education and practices for a diverse cross-section of international students studying at BGSU, (b) to investigate whether there is a need for colleges to implement sexual health education for international students in the United States, and (c) to speculate what strategies/curricula could be implemented. Through 24 written, qualitative surveys and 13 follow-up interviews, I sought to answer two research questions, with the first being: From international students' perspectives, how have their social, cultural, familial, and religious backgrounds and practices shaped their home country's stance on sexual health and, subsequently, their own upbringing? My second research question is: From international students' perspectives, what is their perception of the influence of American culture, their perception of access to sexual health information and education programs, level of interest in and preferred format of this kind of education? In an effort to answer these questions, I investigate five major themes in my research that serve as the core foundation of this thesis: (a) prior sexual health knowledge and educational accessibility; (b) cultural ideals about vi (open full item for complete abstract)

Committee: Sherri Horner Ph.D (Advisor); Christopher Frey Ph.D (Committee Member); Mary Krueger Ph.D (Committee Member) Subjects: Comparative; Early Childhood Education; Education; Education Policy; Ethics; Families and Family Life; Gender; Health; Health Education; Higher Education; Multicultural Education; Personal Relationships; Teaching; Womens Studies

Doctor of Philosophy (Ph.D.), Bowling Green State University, 2013, Media and Communication

In spite of its prevalence in the contemporary media landscape, the effects of exposure to sexually explicit materials have received relatively little attention from media and communication scholars. From a Social Cognitive Theory (SCT) perspective, the present study investigated whether the consumption of sexually explicit materials predicts the adoption of risk behaviors, particularly sex- and body image-related risk behaviors. In addition, the study focused on the psychological mechanisms - represented by the Sexual Self-Concept (SSC) - that could facilitate the adoption of said risk behaviors. In order to address these issues, quantitative data was collected using a self-administered online survey design. Also, in response to mounting criticism according to which quantitative research methods could offer only truncated snapshots of individuals' interactions with sexually explicit materials, a second, qualitative data set was collected using a self-administered diary design. The analysis of the quantitative data revealed that consumption of sexually explicit media content significantly predicts SSC scores. In turn, SSC was found to be a significant predictor of the adoption of sex-related risk behaviors (sex risk partners and sex risk practices). SSC was found to not be a significant predictor of body image health-related risk behaviors. A path model revealed that the SSC moderates the adoption of risk behaviors, thus supporting the theoretically-driven hypothesis that the SSC functions as a psychological mechanism that could facilitate the adoption of risk behaviors. Also, the path model revealed that age and gender significantly predict the adoption of risk behaviors. Thematic analysis of the qualitative data revealed a complex and nuanced picture of participants' interactions with sexually explicit media content. The underlying assumption of most quantitative studies of pornography is that exposure to pornography is likely to have detrimental effects on (open full item for complete abstract)

Committee: Srinivas Melkote Ph.D. (Advisor); Sandra Faulkner Ph.D. (Committee Member); Michael Horning Ph.D. (Committee Member); Michael Bradie Ph.D. (Committee Member) Subjects: Communication; Mass Media

PhD, University of Cincinnati, 2010, Education : Educational Studies

Despite the increased interest in the social institutional role of the Black Church in the African American community, few scholars have given serious attention to the role (or lack thereof) of the Black Church in addressing the sexual risk-taking behaviors of African American youth. The escalating concern with the increase in STD/STI contraction, unplanned pregnancies, and HIV/AIDS among African American youth has incited interest for expanding systematic research focusing on the African American youth population. The primary purpose of this study is to examine the perceptions of ministerial leaders and sexual health advocates in regards to the sexual risk behaviors of African American youth. This study differs from previous research by focusing specifically on the African American youth population as well as Black Churches within a specific southern geographical location that is traditionally defined as the ‘Bible Belt' region. The specificity of this geographical region is directly related to the disproportionate impact of sexual risk behaviors in that area for African American youth, as reported by the CDC. This study describes the perceptions of Black ministerial leaders and sexual health advocates regarding the relevance and effectiveness of the Black Church as a social and religious institution. More specifically, the research is focused on sex education and faith in the lives of African American youth. In contrast to majority reports this study suggests that the voice of the Black Church is not silent. The voice of Black Church leadership acknowledges HIV/AIDS as a dire health challenge and pandemic in the African American community. More specifically, participants overwhelming agree that the church has a social responsibility to address sexuality issues, including the provision of faith-based sex education for African American youth. While the contention of sexual health advocates indicate that the Black Church has a long way to go in addressing preventive (open full item for complete abstract)

Committee: Vanessa Allen-brown PhD (Committee Chair); Mary Anne Pitman PhD (Committee Member); Roger Collins PhD (Committee Member); Wendy Coleman PhD (Committee Member) Subjects: Religious Education

Master of Arts, Miami University, 2012, Psychology

The present study explored the impact of sex motives and relationship status on two components of risk perception (i.e., risk recognition and behavioral risk response) in college women with and without a history of sexual assault. Risk perception was assessed with a vignette of an encounter that culminates in rape. Results indicated that in the context of coping, self-affirmation and partner-approval avoidance-based sex motives, sexual victimization was associated with impaired risk perception, but only for women in a relationship. For non-victimized women, being in a relationship was a protective factor associated with better risk recognition. Enhancement sex motives negatively impacted risk perception for all women; on the contrary, intimacy sex motives did not impact risk perception for any women. Furthermore, three-way interactions indicated that avoidance-based sex motives were associated with delayed risk perception among some women, particularly victims in a relationship and single non-victims. Implications for prevention programs are discussed.

Committee: Terri Messman-Moore Ph.D. (Committee Chair); Margaret O’Dougherty Wright Ph.D. (Committee Member); David Waller Ph.D. (Committee Member) Subjects: Psychology

Doctor of Philosophy, Case Western Reserve University, 2009, Epidemiology and Biostatistics

Background: Latinos in the United States are at high risk for depression, anxiety, and substance abuse and HIV/AIDS has excessively impacted this community. Individuals with severe mental illness (SMI) are more likely to engage in HIV high-risk behaviors. A range of psychiatric and social factors have been considered as correlates of sexual risk behavior with findings indicating a need for future studies to provide insight into the direction and nature of these associations. Objective: To describe the HIV-risk behaviors of Puerto Rican women with SMI in Cuyahoga County, Ohio using quantitative and qualitative techniques. Aim 1 investigated the association of childhood sexual abuse (CSA) and adult HIV-risk behaviors using a retrospective cohort design. The second aim examined psychiatric and social correlates of HIV sexual risk behavior and aim 3 compared data obtained qualitatively to data obtained quantitatively using criterion validity. Methods: The study sample consisted of 53 Puerto Rican women with SMI recruited between October 2002 and December 2005. Consenting participants participated in a baseline interview, two follow-up, semi-structured interviews, and up to 100 hours of non-continuous participant observation. Descriptive, bivariate, and multivariate analyses were conducted to describe HIV-risk behaviors and assess the efficacy of two data collection methods. Results: The relationship between CSA and HIV-risk may be mediated by partner abuse and mental illness diagnosis. Psychiatric and social factors were differentially associated with sexual risk behaviors and multivariate analysis showed that increased severity of psychiatric symptoms and factors and living below the poverty line are predictive of sexual risk behaviors. The correlations between quantitative and qualitative responses concerning sexual and drug use behaviors revealed agreement in some cases and inconsistencies and contradictions in others. Conclusions: Puerto Rican women with SMI are in (open full item for complete abstract)

Committee: Sana Loue (Committee Chair); Martha Sajatovic (Committee Member); Leslie Heinberg (Committee Member); Daniel Tisch (Committee Member) Subjects: Epidemiology

Psy. D., Antioch University, 2009, Antioch Seattle: Clinical Psychology

This study examined published research on sexual risk behaviors and the people who engage in them. Using current and past literature, an extensive review and analysis of attitudes, beliefs, and causes of sexual risk behaviors was done. Sexual risk behaviors were defined within the following models: medical, alcohol and drug, societal views, self definitions, and cultural definitions. The age groups studied were: adolescence (12-17), young adulthood (18-25), middle adulthood (26-50), and later adulthood (51 and older). Studies of homosexual men and women and heterosexual women and men were reviewed as well as a comparison of gender differences. Studies about religion and culture were reviewed, as well as health, psychological co-morbidity, and substance abuse. And, finally, a review of interventions used was examined. A critical analysis was done of 164 articles to determine themes, which emerged as gender, age, ethnicity, assessments used, procedures used, limitations within the articles, and sexual orientation. Finally, an educational pamphlet was developed to target the largest at-risk group, people between the ages of 18-25 years. Based on sexual risk behavior literature, this study examines the impact that risky sexual behaviors have on a person and society, and it also highlights the importance of accessible education. The electronic version of this dissertation is at OhioLink ETD Center, www.ohiolink.edu/etd.

Committee: Mary Wieneke Ph.D. (Committee Chair); Alex Suarez Ph.D. (Committee Member); Cynde Moya Ph.D. (Committee Member) Subjects: Psychology; Public Health; Sociology

Doctor of Philosophy, University of Akron, 2008, Counseling Psychology

The present study investigated associations among African American and same sex attracted identity developmental components, psychological well-being, difficult sexual situations, and sexual risk practices among a sample (N = 73) of HIV-positive African American men who have sex with men (MSMs). The current study responds to Mays, Cochran, and Zamudio's (2004) call for empirical investigations of culturally specific determinants impacting psychological health and sexual risk behaviors among African American MSMs. The current study parallels the methodology of Diaz, Ayala, and Bein (2004) and Diaz, Bein, and Ayala (2006), linking experiences of homophobia, racism, and poverty to psychological health and sexual risk practices among gay identified Latino men. Using a similar framework, the current study investigated the impact of African American and same sex attracted identity development on psychological health and sexual risk practices within a sample of African American HIV-positive MSMs. The current study's sample reported a diverse range of sexual identities (e.g., gay, heterosexual, “on the down low;”), with all participants having engaged in consensual sex with other men. Results indicated that higher endorsement of the Anti-White African American identity (as measured by the Cross Racial Identity Scale [CRIS, Vandiver et al., 2000]), as well as lower levels of psychological well-being, and younger ages, predicted circumstances promoting unsafe sex. Higher endorsements of the African American identities of Multiculturalist Inclusive and Miseducation, as well as the same sex attracted identity of Superiority (as measured by the Lesbian and Gay Identity Scale [LGIS; Mohr & Fassinger, 2000]), predicted interpersonal barriers to unsafe sex. Additional exploratory analyses showed higher endorsements of the same sex identity of Homonegativity to predict lower levels of psychological well-being; higher endorsements of the African American identity of Assimilation, an (open full item for complete abstract)

Committee: Charles Waehler Ph.D. (Advisor) Subjects: African Americans; Behaviorial Sciences; Demographics; Developmental Psychology; Gender; Health; Multicultural Education; Psychology; Psychotherapy; Public Health; Social Psychology