A First Glimpse at the Latent Structure of Sleep Valuation Using a Sleep Valuation Item Bank

Introduction

Sleep valuation is the relative worth individuals place on sleep. Our prior study using a Sleep Valuation Item Bank (SVIB) showed that sleep valuation relates to age, gender, and health status. In this study, the psychometric properties of the SVIB and its latent factor structure were explored. We also investigated how sleep valuation factors relate to demographic, psychological, and sleep features.

Methods

Participants (N = 854) were recruited through TurkPRIME and completed a survey consisting of demographic, psychological, and sleep-related questions. The distributional properties of the SVIB items were quantified. Cronbach's alpha and correlation analyses were used to assess the internal consistency and test-retest reliability of SVIB items. Iterated principal factoring with a Promax rotation was used on the SVIB to explore its latent factor structure. Multiple regression analyses were used to investigate the variables associated with each factor.

Results

The factor analysis identified 29 items with factor loadings ≥0.4 on four major factors, tentatively called (1) sleep wanting, (2) sleep prioritizing, (3) sleep onset preference, and (4) sleep devaluation. While women had higher sleep wanting and lower sleep devaluation scores than men, they had lower sleep prioritizing. Older individuals tended to value sleep less but also devalued it less than younger participants. Finally, although both individuals with insomnia and depression devalued sleep, depressed individuals prioritized it more than those who were less depressed, while individuals with insomnia symptoms wanted sleep and preferred sleep onset more than those with less insomnia symptoms.

Discussion

The current SVIB captures broad dimensions of sleep valuation (wanting, prioritizing, preferring) and sleep devaluation. These broad dimensions had distinct patterns across person-level factors. Recognition of individual differences in sleep valuation may help target sleep health advocacy efforts and individualized treatment approaches, including for those with depression or insomnia.

What is Normal Pornography Use in a Highly Religious Area? Exploring Patterns of Pornography Use in Utah

BACKGROUND

Pornography has become mainstream in society, including in the state of Utah, which is a highly religious, conservative state.

AIM

The purpose of this study is to gather basic descriptive norms for pornography use in the state of Utah (given its unique religious profile), establish clinical cutoffs based on frequency and duration of pornography consumption, and begin to establish a clinical picture of problematic pornography use in a regionally representative sample.

METHODS

We recruited a representative sample of 892 Utahns via CloudResearch.com. Participants completed the following measures: Consumption of Pornography - General (COPS); Problematic Pornography Use Scale; Clear Lake Addiction to Pornography Scale; The Inventory of Depression and Anxiety Symptoms (Second Version).

OUTCOME

Documentation of pornography use norms among Utahns.

RESULTS

In our sample, 79% reported viewing pornography in their lifetime (85% of men, 75% of women). The most common frequency of pornography viewing was weekly or monthly among men, and monthly or every 6 months among women, which is comparable to national averages. Men and women showed significantly different pornography use frequencies. We demonstrate a relationship between higher levels of pornography use and higher perceived levels of pornography use as a problem or "addiction" and depression scores and explore the typical demographics of our highest pornography users.

CLINICAL TRANSLATION

This study will aid clinicians in using the COPS to derive normal pornography use compared to above average pornography use among pornography users from a religious background, especially for clinicians who seek to provide normative data to clients presenting with problematic pornography use like in motivational interviewing interventions.

STRENGTHS AND LIMITATIONS

Strengths include our measures generally demonstrated strong validity, we provide the beginnings of sound clinical implementation of the COPS for benchmarking pornography use in a clinical setting in Utah, and that our sample was representative of the state of Utah according to current census data. Limitations include those commonly seen in survey-based data collection methods, and that findings from our unique Utah sample may not be as relevant among other religious or cultural samples.

CONCLUSION

Our findings provide an updated picture of pornography use in the state of Utah and suggest that even those high in religiosity continue to use pornography. Our results can provide a spectrum of pornography use, aiding a pornography user in treatment to be able to compare his or her use to this norm. Esplin CR, Hatch SG, Ogles BM, et al. What is Normal Pornography Use in a Highly Religious Area? Exploring Patterns of Pornography Use in Utah. J Sex Med 2022;19:823-833.

Is Pornography Consumption Related to Risky Behaviors During Friends With Benefits Relationships?

BACKGROUND

Friends with benefits encounters are a relatively new pattern of relating among emerging adults where risky sexual behavior may occur.

AIM

To understand whether pornography consumption is associated with riskier behaviors during friends with benefits encounters.

METHODS

Cross-sectional study of 2 samples of emerging adults who have engaged in friends with benefits relationships (study 1, N = 411; study 2, N = 394). For binary outcomes, we used logistic regression and report odds ratios. For ordinal outcomes, we used ordered logistic regression and reported odds ratios. We tested for moderation by biological sex.

RESULTS

Men who consumed pornography more frequently were more likely to engage in risky sexual behaviors during their friends with benefits encounters. More frequent pornography consumption was associated with increased likelihood and amount of intoxication for both the respondent and his partner, less frequent condom use, and a higher probability of having penetrative friends with benefits encounters while intoxicated and not using a condom. For each of these outcomes, our parameter estimates from study 2 fell within the 95% confidence intervals from study 1. These associations persisted when controlling for the effects of binge drinking frequency, broader patterns of problematic alcohol use, trait self-control, openness to experience, and permissive attitudes toward casual sex. The findings of this study may inform interventions to reduce risky behaviors among emerging adults.

LIMITATIONS

Our cross-sectional studies examined only emerging adults in college with measurement that was exclusively self-reported.

CONCLUSIONS

These results are discussed in terms of sexual script theory, and several implications for intervention are outlined. Henderson E, Aaron S, Blackhurst Z, et al. Is Pornography Consumption Related to Risky Behaviors During Friends with Benefits Relationships?. J Sex Med 2020;17:2446-2455.

Does pornography consumption lead to intimate partner violence perpetration? Little evidence for temporal precedence

The relationship between pornography use and violence has been extensively researched. Numerous studies suggest that the violent content depicted in pornography may be a risk factor for relationship violence. The current study, therefore, seeks to examine whether pornography use prospectively predicts a particular form of relationship violence—intimate partner violence. Using a large longitudinal sample of university students (N = 892) over a three-month time lag with two waves and a cross-lagged panel design, we found that pornography use does not prospectively predict the perpetration of intimate partner violence, and that the perpetration of intimate partner violence does not prospectively predict pornography use. Further, gender does not moderate these relationships. Finally, strengths, limitations, and directions for future research are discussed.

Sanctification and Cheating Among Emerging Adults

Cheating-a general term for extradyadic romantic or sexual behavior that violates expectations in a committed romantic relationship-is common and leads to a number of poor outcomes. Religion has historically influenced conceptions of romantic relationships, but societal attitudes about religion are in flux as many seek to retain spirituality even as affiliations with formal religion decrease. The present study evaluated a potential predictor of cheating that is more spiritual than formally religious, the "psychospiritual" concept of relationship sanctification (i.e., the idea that one's relationship itself is sacred). In a sample of college students in committed relationships (N = 716), we found that higher levels of self-reported relationship sanctification were associated with a lower likelihood of both physical and emotional cheating even when accounting for plausible alternate explanations (general religiosity, problematic alcohol use, and trait self-control). This association was mediated via permissive sexual attitudes; specifically, higher levels of sanctification were associated with less permissive sexual attitudes which, in turn, predicted a lower likelihood of emotional and physical cheating.

Association of Alcohol Screening Scores With Adverse Mental Health Conditions and Substance Use Among US Adults

IMPORTANCE

Alcohol screening may be associated with health outcomes that cluster with alcohol use (ie, alcohol-clustering conditions), including depression, anxiety, and use of tobacco, marijuana, and illicit drugs.

OBJECTIVE

To quantify the extent to which alcohol screening provides additional information regarding alcohol-clustering conditions and to compare 2 alcohol use screening tools commonly used for this purpose.

DESIGN, SETTING, AND PARTICIPANTS

This longitudinal cohort study used data from the Veterans Aging Cohort Study. Data were collected at 8 Veterans Health Administration facilities from 2003 through 2012. A total of 7510 participants were enrolled, completed a baseline survey, and were followed up. Veterans with HIV were matched with controls without HIV by age, race, sex, and site of care. Data were analyzed from January 2019 to December 2019.

EXPOSURES

The Alcohol Use Disorders Identification Test (AUDIT) and Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) were used to assess alcohol use, with 4 risk groups delineated for each test: score 0 to 7 (reference), score 8 to 15, score 16 to 19, and score 20 to 40 (maximum score) for the full AUDIT and score 0 to 3 (reference), score 4 to 5, score 6 to 7, and score 8 to 12 (maximum score) for the AUDIT-C.

MAIN OUTCOMES AND MEASURES

Alcohol-clustering conditions, including self-reported symptoms of depression and anxiety and use of tobacco, marijuana, cocaine, other stimulants, opioids, and injection drugs.

RESULTS

A total of 6431 US patients (6104 [95%] men; median age during survey years 2003-2004, 50 years [range, 28-86 years; interquartile range, 44-55 years]) receiving care in the Veterans Health Administration completed 1 or more follow-up surveys when the AUDIT was administered and were included in the present analyses. Of the male participants, 4271 (66%) were African American, 1498 (24%) were white, and 590 (9%) were Hispanic. The AUDIT and AUDIT-C scores were associated with each alcohol-clustering condition. In particular, an AUDIT score of 20 or higher (vs <8, the reference) was associated with symptoms of depression (odds ratio [OR], 8.37; 95% CI, 6.20-11.29) and anxiety (OR, 8.98; 95% CI, 6.39-12.60) and with self-reported use of tobacco (OR, 14.64; 95% CI, 8.94-23.98), marijuana (OR, 12.41; 95% CI, 8.61-17.90), crack or cocaine (OR, 39.47; 95% CI, 27.38-56.90), other stimulants (OR, 21.31; 95% CI, 12.73-35.67), and injection drugs (OR, 8.67; 95% CI, 5.32-14.13). An AUDIT score of 20 or higher yielded likelihood ratio (sensitivity / 1 - specificity) values greater than 3.5 for depression, anxiety, crack or cocaine use, and other stimulant use. Associations between AUDIT-C scores and alcohol-clustering conditions were more modest.

CONCLUSIONS AND RELEVANCE

Alcohol screening can inform decisions about further screening and diagnostic assessment for alcohol-clustering conditions, particularly for depression, anxiety, crack or cocaine use, and other stimulant use. Future studies using clinical diagnoses rather than screening tools to assess alcohol-clustering conditions may be warranted.

Registered Replication Report: Dijksterhuis and van Knippenberg (1998)

Dijksterhuis and van Knippenberg (1998) reported that participants primed with a category associated with intelligence ("professor") subsequently performed 13% better on a trivia test than participants primed with a category associated with a lack of intelligence ("soccer hooligans"). In two unpublished replications of this study designed to verify the appropriate testing procedures, Dijksterhuis, van Knippenberg, and Holland observed a smaller difference between conditions (2%-3%) as well as a gender difference: Men showed the effect (9.3% and 7.6%), but women did not (0.3% and -0.3%). The procedure used in those replications served as the basis for this multilab Registered Replication Report. A total of 40 laboratories collected data for this project, and 23 of these laboratories met all inclusion criteria. Here we report the meta-analytic results for those 23 direct replications (total N = 4,493), which tested whether performance on a 30-item general-knowledge trivia task differed between these two priming conditions (results of supplementary analyses of the data from all 40 labs, N = 6,454, are also reported). We observed no overall difference in trivia performance between participants primed with the "professor" category and those primed with the "hooligan" category (0.14%) and no moderation by gender.

Does Improving Marital Quality Improve Sleep? Results From a Marital Therapy Trial

For most adults, sleep is a dyadic behavior. Only recently have studies explored the dynamic association between sleep and relationship functioning among bed partners. The current study is the first to examine bidirectional associations between changes in insomnia and changes in marital quality over time, in the context of a marital therapy trial. Among husbands, improvements in marital satisfaction were associated with a 36% decreased risk of insomnia at follow-up. Regarding the reverse direction, counter-intuitively, wife baseline insomnia was associated with improvements in husbands' marital satisfaction, but only among the non-treatment-seeking comparison group. Results are discussed in terms of implications for sleep and marital therapy, and suggest that improving sleep may be an added benefit of improving the marital relationship.

Validating Machine Learning Algorithms for Twitter Data Against Established Measures of Suicidality

BACKGROUND

One of the leading causes of death in the United States (US) is suicide and new methods of assessment are needed to track its risk in real time.

OBJECTIVE

Our objective is to validate the use of machine learning algorithms for Twitter data against empirically validated measures of suicidality in the US population.

METHODS

Using a machine learning algorithm, the Twitter feeds of 135 Mechanical Turk (MTurk) participants were compared with validated, self-report measures of suicide risk.

RESULTS

Our findings show that people who are at high suicidal risk can be easily differentiated from those who are not by machine learning algorithms, which accurately identify the clinically significant suicidal rate in 92% of cases (sensitivity: 53%, specificity: 97%, positive predictive value: 75%, negative predictive value: 93%).

CONCLUSIONS

Machine learning algorithms are efficient in differentiating people who are at a suicidal risk from those who are not. Evidence for suicidality can be measured in nonclinical populations using social media data.

Is pornography consumption associated with condom use and intoxication during hookups?

In order to examine whether pornography consumption is associated with risky sexual behaviour among emerging adults, we examined two large samples of those who reported hooking up in the past 12 months (combined n =  1216). Pornography use was associated with a higher likelihood of having a penetrative hookup; a higher incidence of intoxication during hookups for men (but a lower incidence of intoxication during hookups for women); increasing levels of intoxication during hookups for men but decreasing levels of intoxication for women; and a higher likelihood of being in the riskiest category of having a penetrative hookup, without a condom, while intoxicated. For each of these outcomes, our point estimates for Study 2 fell within the 95% confidence intervals from Study 1. Controlling for trait self-control, binge drinking frequency, broader problematic patterns of alcohol use, openness to experience, and attitudes toward casual sex did not change the pattern of results. Implications for interventions to reduce sexual risk are discussed.

The influence of pornography on sexual scripts and hooking up among emerging adults in college

The explosive growth in access to the Internet has led to a commensurate increase in the availability, anonymity, and affordability of pornography. An emerging body of research has shown associations between pornography and certain behaviors and attitudes; yet, how pornography actually influences these outcomes has not been documented. In two studies (Study 1 N = 969; Study 2 N = 992) we examined the hypothesis that pornography influences potentially risky sexual behavior (hooking up) among emerging adults via sexual scripts. Our results demonstrate that more frequent viewing of pornography is associated with a higher incidence of hooking up and a higher number of unique hook up partners. We replicated these effects both cross-sectionally and longitudinally while accounting for the stability of hook ups over the course of an academic semester. We also demonstrated that more frequent viewing of pornography is associated with having had more previous sexual partners of all types, more one occasion sexual partners ("one night stands"), and plans to have a higher number of sexual partners in the future. Finally, we provided evidence that more permissive sexual scripts mediated the association between more frequent pornography viewing and hooking up. We discuss these findings with an eye toward mitigating potential personal and public health risks among emerging adults.

The influence of pornography on sexual scripts and hooking up among emerging adults in college

The explosive growth in access to the Internet has led to a commensurate increase in the availability, anonymity, and affordability of pornography. An emerging body of research has shown associations between pornography and certain behaviors and attitudes; yet, how pornography actually influences these outcomes has not been documented. In two studies (Study 1 N = 969; Study 2 N = 992) we examined the hypothesis that pornography influences potentially risky sexual behavior (hooking up) among emerging adults via sexual scripts. Our results demonstrate that more frequent viewing of pornography is associated with a higher incidence of hooking up and a higher number of unique hook up partners. We replicated these effects both cross-sectionally and longitudinally while accounting for the stability of hook ups over the course of an academic semester. We also demonstrated that more frequent viewing of pornography is associated with having had more previous sexual partners of all types, more one occasion sexual partners ("one night stands"), and plans to have a higher number of sexual partners in the future. Finally, we provided evidence that more permissive sexual scripts mediated the association between more frequent pornography viewing and hooking up. We discuss these findings with an eye toward mitigating potential personal and public health risks among emerging adults.

Analyzing multiple outcomes in clinical research using multivariate multilevel models

OBJECTIVE

Multilevel models have become a standard data analysis approach in intervention research. Although the vast majority of intervention studies involve multiple outcome measures, few studies use multivariate analysis methods. The authors discuss multivariate extensions to the multilevel model that can be used by psychotherapy researchers.

METHOD AND RESULTS

Using simulated longitudinal treatment data, the authors show how multivariate models extend common univariate growth models and how the multivariate model can be used to examine multivariate hypotheses involving fixed effects (e.g., does the size of the treatment effect differ across outcomes?) and random effects (e.g., is change in one outcome related to change in the other?). An online supplemental appendix provides annotated computer code and simulated example data for implementing a multivariate model.

CONCLUSIONS

Multivariate multilevel models are flexible, powerful models that can enhance clinical research.

Examining a brief suicide screening tool in older adults engaging in risky alcohol use

Alcohol misuse increases risk of suicidal behavior in older adults. The Depressive Symptom Inventory-Suicidality Subscale (DSI-SS; Metalsky & Joiner, 1997) and its relation to suicide attempt history was examined to see if it differed for older adults as a function of their alcohol use. Structural equation modeling was used in a sample (N=1,061) of older adult outpatients to examine the scale's measurement invariance and population heterogeneity and its relation to suicide attempt history. Analyses supported the equivalence of the DSI-SS in risky and nonrisky drinkers. The DSI-SS significantly predicted past suicide attempts. Findings support the viability of the DSI-SS as suicide screening tool for older adults.

Forgiveness and relationship satisfaction: mediating mechanisms

Although the ability to forgive transgressions has been linked to overall relationship satisfaction, the mechanisms that mediate this association have not been established. We propose that the tendency to forgive a romantic partner increases relationship satisfaction via increased relational effort and decreased negative conflict. In two studies, we used structural equations modeling to examine these variables as potential mechanisms that drive this association. In Study 1 (N = 523) and Study 2 (N = 446) we found that these variables significantly mediated the association between forgiveness and relationship satisfaction. The findings were robust when examined concurrently and longitudinally, across multiple measures of forgiveness, and when accounting for baseline relationship satisfaction and interpersonal commitment. These two mechanisms parallel theorized positive and negative dimensions of forgiveness and the motivational transformation that is said to underlie forgiveness. Theoretical implications and implications for intervention are discussed.

Does college-based relationship education decrease extradyadic involvement in relationships?

We used latent growth curve modeling to examine the effectiveness of a relationship education intervention (Relationship U, or RU) on rates of extradyadic involvement in a sample of 380 college students in committed romantic relationships. RU is designed to be integrated into existing college courses; it educates students about partner selection, making healthy relationship transitions, communication skills, and the potentially negative consequences of cheating in romantic relationships and how to prevent its occurrence. Participants who received the intervention reported trajectories of less extradyadic involvement over time relative to control participants. Being female was not associated with less extradyadic involvement at baseline, but it did predict less extradyadic involvement over time across both intervention and control conditions. Implications for dissemination of relationship education are discussed.

The interpersonal theory of suicide

Suicidal behavior is a major problem worldwide and, at the same time, has received relatively little empirical attention. This relative lack of empirical attention may be due in part to a relative absence of theory development regarding suicidal behavior. The current article presents the interpersonal theory of suicidal behavior. We propose that the most dangerous form of suicidal desire is caused by the simultaneous presence of two interpersonal constructs-thwarted belongingness and perceived burdensomeness (and hopelessness about these states)-and further that the capability to engage in suicidal behavior is separate from the desire to engage in suicidal behavior. According to the theory, the capability for suicidal behavior emerges, via habituation and opponent processes, in response to repeated exposure to physically painful and/or fear-inducing experiences. In the current article, the theory's hypotheses are more precisely delineated than in previous presentations (Joiner, 2005), with the aim of inviting scientific inquiry and potential falsification of the theory's hypotheses.

A randomized clinical trial of a computer based preventive intervention: replication and extension of ePREP

This randomized clinical trial replicated the efficacy of the ePREP preventive intervention for mental health and relationship relevant outcomes in a sample of 77 college students. It extended previous research by demonstrating efficacy at a 10-month follow up. Participants in the ePREP condition experienced improved mental health and relationship relevant outcomes relative to those who received a placebo intervention. The impact of the ePREP intervention on these outcomes was durable to relationship dissolution with and without repartnering. The flexibility of this intervention empowers it to overcome key obstacles in the dissemination of relationship education.

Features of borderline personality disorder, perceived childhood emotional invalidation, and dysfunction within current romantic relationships

The mechanisms through which current romantic relationship dysfunction develops in individuals with borderline personality disorder (BPD) symptoms are still unclear. One possible pathway may be childhood experiences of emotional invalidation by parents, which may result in the development of poor social problem-solving skills or cognitive responses such as splitting, which impair current romantic relationships. This study examines the relationship between features of BPD and current romantic relationship dysfunction, and demonstrates that perceived emotional invalidation by parents during childhood mediates the relationship between BPD features and current romantic relationship dysfunction. Structural equations modeling was used to test the hypothesized model in 758 young adults in an ethnically diverse community sample. The proposed model fit the data well; perceived childhood emotional invalidation partially mediated the relationship between features of BPD and romantic relationship dysfunction, even when controlling for the presence of a major depressive episode in the last year. The findings of this study suggest that individuals with features of BPD experience relationship dysfunction that cannot be accounted for by comorbid depression and that perceived childhood emotional invalidation may contribute to these problems.

Suicidal ideation in college students varies across semesters: the mediating role of belongingness

The interpersonal-psychological theory of suicidal behavior (Joiner, 2005) proposes that the need to belong is fundamental; when met it can prevent suicide and when thwarted it can substantially increase the risk for suicide. We investigate one source of group-wide variation in belongingness among college students--changes in the social composition of college campuses across academic semesters--as an explanation for variation in suicidal ideation across the academic year. Our results indicate that in a sample of college students at a large southern state university (n = 309), suicidal ideation varied across academic semesters, with highest levels in summer compared to both spring and fall. Differences in suicidal ideation between summer and spring were, in large part, accounted for by belongingness. Theoretical, as well as practical, implications are discussed regarding mechanisms for seasonal variation in suicidal ideation.

Family life stress and insomnia symptoms in a prospective evaluation of young adults

The present study prospectively investigated the association between family life stress and insomnia symptoms among 115 undergraduates, ages 17-22 years. Participants completed the following questionnaires at 2 study time points, spaced 3 weeks apart: the Insomnia Severity Index, the Negative Life Events Questionnaire (NLEQ), and the Beck Depression Inventory. First, family life stress at baseline was hypothesized to predict elevated insomnia symptoms 3 weeks later, above and beyond depressive symptoms. Second, compared with academic stressors, negative family and social life events were expected to best predict increased insomnia. Regression analyses were conducted to test study predictions. Hypotheses were partially supported. Family life stress was significantly associated with increased insomnia symptomatology, even after controlling for depression. Results also revealed that negative family life events, together with academic stress, predicted the highest levels of insomnia.