Lessons Learned: Conducting Research with Victims Portrayed in Sexual Abuse Images and Their Parents

Victims portrayed in sexual abuse images may be resistant to participate in research because of embarrassment or shame due to the sensitive nature and potential permanency of images. No studies we are aware of explore reactions to participating in research after this type of crime. 

Telephone interviews were conducted with convenience samples of parents (n= 46) and adolescents who were victims of child sexual abuse (n= 11; some of whom were portrayed in sexual abuse images), and online surveys were completed by adult survivors depicted in abuse images (N= 133). 

• The first lesson was that few agencies tracked this type of crime. This lack of tracking raises the question as to what types of data should be collected and tracked as part of an investigation. 
• The second lesson was that few victims at the two participating agencies had been portrayed in sexual abuse images (4%-5%). 
• The third lesson was that once possible cases were identified, we found relatively high percentages of consent to contact and interview completions. 
• This implies that researchers and service providers should not be hesitant about conducting research after an investigation of child sexual abuse. 
• The fourth lesson was that the vast majority of participants reported not being upset by the questions. 

We hope that the data presented here will encourage agencies to reconsider the types of data being tracked and will encourage researchers to conduct in-depth research with populations that are often difficult to reach to continue improving the professional response to child victimization.

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By:  Walsh WA1, Wolak J2, Lounsbury K3, Howley S4, Lippert T5, Thomas L6.

• 1University of New Hampshire, Durham, NH, USA Wendy.walsh@unh.edu.
• 2University of New Hampshire, Durham, NH, USA.
• 3National Children's Alliance, Washington, DC, USA.
• 4National Center for Victims of Crimes, Washington, DC, USA.
• 5Kaiser Permanente, Portland, OR, USA.
• 6The Harris County Children's Assessment Center, Houston, TX, USA. 
• J Interpers Violence. 2016 Mar 27. pii: 0886260516640545

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Using a Wrap Skirt to Improve the Pelvic Examination Experience

INTRODUCTION:

The study aims were to analyze the experience of women and their physicians of nakedness when moving between changing room and examination chair and during pelvic examination itself, and to assess the protective benefit of a wrap skirt in alleviating the associated discomfort and vulnerability.

MATERIAL AND METHODS:

We offered 1000 women a wrap skirt for pelvic examination and asked them to complete a post-procedure questionnaire. Physicians were invited to complete a similar but separate questionnaire. Data were analyzed using χ² contingency tables.

RESULTS:

425 women (43%, age 15-78 years) completed the questionnaire; 51% felt uncomfortable and embarrassed during the examination, Muslim women significantly more so (p < 0.001). Most women (n = 255; 58%) rated the wrap skirt a significant improvement; 69% requested it for future examinations, significantly more so if the physician was male rather than female (66% vs. 54%, p = 0.003). Even one-third of women experiencing no discomfort reported improvement. Most examiners (n = 45; 56%) found the wrap skirt beneficial; 31 (38%) were unconvinced.

CONCLUSIONS:

Pelvic examination as practiced in many countries, on women naked from the waist down throughout, causes unnecessary embarrassment. A simple protective measure such as a wrap skirt significantly alleviates the discomfort and sense of vulnerability associated with nakedness

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By:  Neuhaus LR1, Memeti E1, Schäffer MK1, Zimmermann R1, Schäffer L1.

• 1Department of Obstetrics and Gynecology, University Hospital of Zurich, Zurich, Switzerland. 
• Acta Obstet Gynecol Scand. 2016 Feb 11. doi: 10.1111/aogs.12869.

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Attitudes Toward Mental Health Help Seeking as Predictors of Future Help-Seeking Behavior and Use of Mental Health Treatments

OBJECTIVES:

The study examined the association of attitudes toward mental health help seeking and beliefs about the effectiveness of treatments with future help-seeking behavior and use of specific services in the general population.

METHODS:

Data on attitudes and beliefs at baseline were taken from the U.S. National Comorbidity Survey (NCS), a general population survey conducted in 1990-1992. Help seeking from various providers and use of psychiatric medications and counseling or therapy were examined in the NCS follow-up, in which 5,001 of the original NCS participants were reinterviewed in 2001-2003.

RESULTS:

Willingness to seek professional help for a serious emotional problem and feeling comfortable talking about personal problems with professionals were significantly associated with future help seeking and treatment use. One-third (33.4%) of participants who stated at baseline that they would "definitely go" to a professional if they had a serious emotional problem sought future help, compared with 20.7% of those who would "definitely not go." Corresponding values were 33.4% and 24.4% for those who reported feeling "very comfortable" and "not at all comfortable," respectively, talking about personal problems with a professional. The associations were consistent among participants with and without a history of help seeking and with and without mood, anxiety, or substance use disorders during the follow-up. Embarrassment if friends found out and beliefs about treatment effectiveness were not associated with future help seeking or service use.

CONCLUSIONS:

Identification of attitudinal factors most closely linked to future mental health help seeking has potential implications for public mental health campaigns.

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By:  Mojtabai R1, Evans-Lacko S1, Schomerus G1, Thornicroft G1.

• 1Dr. Mojtabai is with the Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore (e-mail: rmojtab1@jhu.edu ). Dr. Evans-Lacko and Dr. Thornicroft are with the David Goldberg Centre, Department of Health Services and Population Research, Institute of Psychiatry, Kings College, London, United Kingdom. Dr. Schomerus is with the Department of Psychiatry, Greifswald University, Stralsund, Germany.
• Psychiatr Serv. 2016 Feb 14:appips201500164. 

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Dental Disease Patterns in Methamphetamine Users: Findings in a Large Urban Sample

BACKGROUND:

The authors used a large community sample of methamphetamine (MA) users to verify the patterns and severity of dental disease and establish a hierarchy of caries susceptibility by tooth type and tooth surface.

METHODS:

Using a stratified sampling approach, 571 MA users received comprehensive oral examinations and psychosocial assessments. Three calibrated dentists characterized dental and periodontal disease by using National Health and Nutrition Examination Survey protocols. The authors also collected data on substance use history and other attributes linked to dental disease.

RESULTS:

On all dental outcome measures, MA users evidenced high dental and periodontal disease, with older (≥ 30 years) and moderate or heavy MA users disproportionately affected. Women had higher rates of tooth loss and caries, as well as a greater prevalence of anterior caries. Current cigarette smokers were more likely to manifest 5 or more anterior surfaces with untreated caries and 3 or more teeth with root caries. Nearly 3% were edentulous, and a significant percentage (40%) indicated embarrassment with their dental appearance.

CONCLUSIONS:

MA users have high rates of dental and periodontal disease and manifest a dose-response relationship, with greater levels of MA use associated with higher rates of dental disease. Women and current cigarette smokers are affected disproportionately. The intraoral patterns and hierarchy of caries susceptibility in MA users are distinctive.

PRACTICAL IMPLICATIONS:

The prevalence and patterns of dental and periodontal disease could be used to alert dentists to possible covert MA use and to plan treatment. Concerns about dental appearance have potential as triggers for behavioral interventions.

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By:  Shetty V, Harrell L, Murphy DA, Vitero S, Gutierrez A, Belin TR, Dye BA, Spolsky VW.

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Identification with Stimuli Moderates Women's Affective and Testosterone Responses to Self-Chosen Erotica

Sexual thoughts are sufficient to increase testosterone (T) in women, yet erotic films are not. A key confound in past studies is autonomy in stimulus selection: women choose the content of their sexual thoughts but films have been selected by researchers. We hypothesized that self-chosen erotic films, compared to researcher-chosen erotic films, would (1) increase women's self-reported arousal, enjoyment, and identification with stimuli, and decrease negative affect; and (2) increase T. 

Participants (N = 116 women) were randomly assigned to a neutral documentary condition or one of three erotic film conditions: high choice (self-chosen erotica from participants' own sources), moderate choice (self-chosen erotica from films preselected by sexuality researchers), or no choice (researcher-chosen erotica). Participants provided saliva samples for T before and after viewing the film in the privacy of their homes. 

Compared to researcher-chosen erotica, self-chosen erotica increased self-reported arousal and enjoyment, but also unexpectedly disgust, guilt, and embarrassment. Self-chosen erotica only marginally increased identification with stimuli compared to researcher-chosen erotica. Overall, film condition did not affect T, but individual differences in identification moderated T responses: among women reporting lower levels of identification, the moderate choice condition decreased T compared to the no choice condition, but this difference was not observed among women with higher identification. 

These results highlight the importance of cognitive/emotional factors like identification for sexually modulated T. However, self-chosen erotica results in more ambivalent rather than unequivocally positive cognitive/emotional responses, perhaps because stigma associated with viewing erotica for women becomes more salient when choosing stimuli.

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By:  Goldey KL1, van Anders SM2.

• 1Department of Psychology, University of Michigan, Ann Arbor, MI, 48109, USA.
• 2Departments of Psychology and Women's Studies; Programs in Neuroscience and Reproductive Sciences; Science, Technology, and Society Program; Biosocial Methods Collaborative, University of Michigan, 530 Church Street, Ann Arbor, MI, 48109, USA. smva@umich.edu.

 

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Dr Google, Porn and Friend-of-a-Friend: Where Are Young Men Really Getting Their Sexual Health Information?

Young men are vulnerable when it comes to sexual health. They attend the general practitioner (GP) less often than females and are less likely to be offered testing for sexually transmissible infections. Access to accurate health information and education is a cornerstone of primary prevention, yet we know very little about how, where and why young people obtain information about sexual health.

One-on-one semi-structured interviews were conducted with 35 male students aged 16-19 years from two Victorian educational institutions for trade skills until data saturation was reached. Interviews were audio-recorded, transcribed and thematically analysed.

• The young men were poorly informed about sexual health. 
• Their existing knowledge mainly came from school-based sexual health education, which while valued, was generally poorly recalled and provided only a narrow scope of physiological information. 
• Young men seek sexual health information from various sources including family, the Internet, friends and pornography, with information from the latter three sources perceived as unreliable. 
• GPs were seen as a source of trust-worthy information but were not accessed for this purpose due to embarrassment. 
• Young men preferred the GP to initiate such conversations. 
• A desire for privacy and avoidance of embarrassment heavily influenced young men's preferences and behaviours in relation to sexual health information seeking.

The current available sources of sexual health information for young men are failing to meet their needs. Results identify potential improvements to school-based sexual education and online resources, and describe a need for innovative technology-based sources of sexual health education.

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By: Litras A, Latreille S, Temple-Smith M.

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