Roots of Sexual Abuse: A Pathway Model for Adolescents Who Offend

Theoretical models implicate insecure attachment, peer isolation, hostile masculinity, and the use of sex for coping in sexual perpetration against children. This study builds on previous research and tests the direct and indirect effects of attachment, interpersonal and sexual control problems, and masculine adequacy to explain sex offending against children in adolescents. Structural equation modeling was used to conduct a path analysis using 464 adolescent males. A significant path model was fitted that identified three paths between anxious attachment, social isolation, sexual dyscontrol, masculine adequacy, and offending against a child. The model partially confirms previous research on adolescents who commit sexual abuse. The best fitting model indicates a direct path from anxious attachment to sexual offending against a child, but also indicates two indirect paths, where anxious attachment and committing child sexual abuse was partially mediated by social isolation and masculine adequacy, which, in turn, were negatively associated with each other, and a path including sexual dyscontrol, which was positively associated with both social isolation and masculine adequacy. The results suggest that commission of child sexual abuse by adolescent males is related to individual proclivities, social experiences, and attitudes toward sexuality and masculinity.

Effectiveness of a paediatric weight management intervention for rural youth (iAmHealthy): Primary outcomes of a cluster randomised control trial

BACKGROUND

Youth in rural areas are disproportionally affected by obesity. Given the unique barriers rural populations face, tailoring and increasing access to obesity interventions is necessary.

OBJECTIVE

This paper evaluates the effectiveness of iAmHealthy, a family-based paediatric obesity intervention delivered to rural children, compared to a Newsletter Control.

METHODS

Participating schools (n = 18) were randomly assigned to iAmHealthy or Newsletter Control. iAmHealthy consists of individual health coaching and group sessions delivered via televideo to a participant's home. The child and parent's body mass index (BMI), child physical activity and child dietary intake were assessed at baseline, post-treatment (8 months) and follow-up (20 months). Multilevel modeling estimated the effect of treatment at both time points.

RESULTS

Parent and child dyads were recruited (n = 148) and randomised to iAmHealthy (n = 64) or the Control group (n = 84). The Control group had significant increases in child BMIz from baseline to follow-up. iAmHealthy youth had no significant changes in BMIz from baseline to post or follow-up. Child dietary intake, physical activity and parent BMI results are also discussed.

CONCLUSIONS

This trial extends previous paediatric obesity work by simultaneously increasing convenience and dose of treatment. Results suggest iAmHealthy resulted in a change in BMIz trajectories and long-term health behaviour for youth.

Prospectively predicting naturalistic exposure to fitspiration and thinspiration in young women with disordered eating by leveraging an ecological momentary assessment design

OBJECTIVE

Although a growing body of research has examined the impacts of ED-salient content, such as fitspiration and thinspiration, on eating disorder (ED) symptoms, there is less known about the characteristics of who may be at risk for accessing this content on Instagram. Current research is limited by cross-sectional and retrospective designs. This prospective study used ecological momentary assessment (EMA) to predict naturalistic exposure to ED-salient content on Instagram.

METHODS

Female university students with disordered eating (N = 171, Mage = 20.23, SD = 1.71, range = 18-25) completed a baseline session, followed by a seven-day EMA protocol, in which they reported on Instagram use and exposure to fitspiration and thinspiration. Mixed-effects logistical regressions were used to predict exposure to ED-salient content on Instagram from four principal components (e.g., behavioral ED symptoms and trait social comparison) controlling for duration of Instagram use (i.e., dose) and day of study.

RESULTS

Duration of use was positively associated with all types of exposure. Purging/cognitive restraint and excessive exercise/muscle building prospectively predicted access to any ED-salient content and fitspiration only. Restricting positively predicted thinspiration only access. Purging/cognitive restraint positively predicted accessing fitspiration and thinspiration (dual exposure). Day of study was negatively associated with any exposure, fitspiration only, and dual exposure.

CONCLUSIONS

Baseline ED behaviors were differentially associated with exposure to ED-salient Instagram content; however, duration of use was also a significant predictor. Limiting use of Instagram may be important for young women with disordered eating to reduce probability of encountering ED-salient content.

Engagement with Activity Monitoring During a Behavioral Activation Intervention: A Randomized Test of Monitoring Format and Qualitative Evaluation of Participant Experiences

Behavioural activation (BA) is an efficacious treatment approach. Activity monitoring is a key component of brief BA treatments; however, no studies have examined the most efficacious format for monitoring. The present pilot study tested brief versus intensive activity monitoring approaches during a BA intervention administered in a college orientation course. Outcomes characterised (1) engagement with the treatment protocol via activity monitoring and (2) participant qualitative experiences with monitoring and the intervention as reported during focus group interviews. Four course sections were randomly assigned to receive monitoring forms that were brief (assessed activities three times daily) or intensive (assessed activities hourly). Forms were provided electronically to students via a web-based platform which tracked completion. There were no significant differences in monitoring frequency (38.0 vs. 23.0 days; p = .154) or the duration of monitoring engagement (62.0 vs. 36.0 days; p = .054) between the brief and intensive conditions. Qualitative findings suggested that participants in both conditions found utility in activity monitoring, particularly during the first month as they transitioned to college. Overall, findings indicated that participants may find utility in monitoring during the first month of a BA intervention using either brief or intensive monitoring forms.

Rationale and design of integrating a parents first obesity intervention with a pediatric weight management intervention for rural families - Evaluating the ripple effect

Rural families are disproportionately affected by obesity. Obesity often runs in families and is impacted by hereditary components, the shared home environment, and parent modeling/child observational learning. Moreover, parent changes in weight predict child changes in weight. Thus, targeting the family unit has the potential to enhance outcomes for adults and children simultaneously. Additionally, engaging rural nurses in medical clinics and schools may be important in determining whether rural telehealth programs are successfully implemented and sustained. This paper describes the rationale and design of a randomized control trial (RCT) evaluating the effectiveness of an integrated adult- and child-focused obesity treatment tailored for rural participants. Outcomes of this study include participant weight loss from baseline to 9-months, device-measured physical activity, and dietary intake. This project will additionally compare reach between clinic and school settings and evaluate the impact of nurse engagement. This study will include 240 participants from eight rural communities who will be randomized to either a Parent +Family-based group or a Newsletter +Family-based group. Parents in the Parent +Family-based group will receive a 3-month adult obesity treatment designed for adult behavior change as a first step. Then, parents and children together will enter the family-based program (iAmHealthy), allowing for potential enhancement of a theorized ripple effect. Parents in the Newsletter +Family-based group will receive 3 monthly newsletters and then participate in the 6-month family-based intervention designed for child behavior change. This study is the first RCT to examine the effectiveness of an integrated adult- and child-focused obesity treatment program. Registered with ClinicalTrials.gov NCT ID NCT05612971.

A Health Behavior and Lifestyle Intervention Pilot Trial for Childbearing Adolescents

We pilot tested a multiple health behavior change (MHBC) intervention to improve breastfeeding rates, healthy eating/active living, and depression prevention among pregnant and parenting adolescent mothers. We also assessed utility of the MHBC mHealth approach by examining health behavior coaction and intervention acceptability. We used a longitudinal randomized controlled trial to compare the tablet-delivered momHealth to a control condition (usual care). Delivered between 32 weeks of pregnancy and one month postpartum, momHealth included nine multi-media education modules, simultaneous daily educational text messaging, and weekly videoconferences for individual and group support. Main outcomes included “any” and “exclusive” breastfeeding initiation and continuation for 5 weeks and 3 months postpartum; number of fruit and vegetable servings; minutes of moderate/vigorous physical activity per day; and depressive symptoms. Sixty-two adolescents aged 16–19 having their first baby were randomized. Compared to Control, more momHealth participants were still breastfeeding at 5 weeks (chi-square = 3.91, df = 1, P = .048). Mothers who breastfed for 3 months were more likely to eat adequate daily fruits/vegetables. Participants positively rated the intervention. momHealth positively affected early breastfeeding continuation and trended toward positive outcomes in healthy living and depressive symptoms. A fully powered trial is planned to test the intervention more effectively.

Maternal well-being and family adaptation during COVID-19 in fragile X syndrome

Mothers of children with fragile X syndrome are at increased risk of experiencing anxiety and depression due to potential genetic risk and to stress associated with parenting a child with significant behavioral, emotional, and educational support needs. During the initial shutdown and subsequent restrictions of the COVID-19 pandemic, mothers of children with fragile X reported experiencing elevated levels of anxiety and depression relative to their usual levels of well-being. Many indicated that the negative consequences of exposure to COVID-19 and related stressors, as well as the impacts of the pandemic on their family, directly affected their anxiety and depression. Mothers reported on specific sources of distress as well as potential sources of resilience and positive adaptation that occurred during the first year of the COVID-19 pandemic.

iKanEat: protocol for a randomized controlled trial of megestrol as a component of a pediatric tube weaning protocol

Background

Although tube feeding routinely saves the lives of children who do not eat by mouth, chronic tube feeding can be a burden to patients, caregivers, and families. Very few randomized trials exist regarding the best methods for weaning children from their feeding tubes.

Methods

The current paper describes a randomized controlled trial of an empirically supported outpatient treatment protocol for moving children from tube to oral eating called iKanEat. Specifically, we describe the methods of randomized double-blind, placebo-controlled trial which includes a 4-week course of megestrol, the only medication used in the iKanEat protocol, to determine whether the addition of megestrol results in improved child outcomes. The primary and secondary aims are to assess the safety and efficacy of megestrol as part of the iKanEat protocol. The third aim is to provide critical information about the impact of the transition from tube to oral feeding on parent stress and parent and child quality of life.

Discussion

This trial will provide data regarding whether megestrol is a safe and effective component of the iKanEat tube weaning protocol, as well as important data on how the tube weaning process impacts parent stress and parent and child quality of life.

Trial registration

ClinicalTrials.gov NCT#03815019. Registered on January 17, 2019

Sexual Responsivity and the Effects of Negative Mood on Sexual Arousal in Hypersexual Men Who Have Sex With Men (MSM)

BACKGROUND

A number of studies have found that hypersexuality is associated with a high propensity for sexual excitation. In comparison, less is known about the relationship between hypersexuality and sexual arousal at the state level. Also, previous research has revealed a relationship between hypersexuality and negative mood. However, the possibility that sexual response might not be as negatively impacted by negative mood in hypersexual individuals has, as yet, not been tested.

AIM

The purpose of this study was to investigate sexual responsivity and the effects of negative mood on sexual arousal in hypersexual men who have sex with men (MSM).

METHODS

A total of 211 MSM were assigned to a hypersexuality (N = 81) or a control (N = 130) group using an interview patterned with a semi-structured Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders format. Participants filled out questionnaires and were shown neutral, sexual, and anxiety- and sadness-inducing films.

OUTCOMES

Changes in penile circumference and self-reported sexual arousal were the primary outcomes analyzed in this study.

RESULTS

Controlling for age and HIV status, no differences were found in genital response between hypersexual and non-hypersexual men. Also, the 2 groups did not differ in subjective sexual arousal. Moreover, no effects of negative mood were found. Time series clustering analyses revealed 3 groups-low responders and slow and fast high responders. Sexual excitation, but not sexual compulsivity or pornography use, predicted cluster membership.

CLINICAL TRANSLATION

Hypersexual MSM may benefit more from an exploration of motivational and behavioral, as compared to psychophysiological, mechanisms underlying possible links between (negative) mood and sexual behavior.

STRENGTHS & LIMITATIONS

Strengths of the study include its sample size, making it one of the larger psychophysiological sex studies; the use of clinical interviews for group assignment; the inclusion of genital response measures; and the application of time series clustering to examine differences among participants. Limitations include possible sample heterogeneity and the reliance on researcher-selected stimuli.

CONCLUSION

Given the lack of any effects of negative mood on sexual response in hypersexual MSM, future studies could explore in more depth possible motivational and behavioral effects, including, for example, the impact of negative mood on the tendency to seek out sex as a form of distraction or for validation or emotional support. Janssen E, Prause N, Romine RS, et al. Sexual Responsivity and the Effects of Negative Mood on Sexual Arousal in Hypersexual Men Who Have Sex With Men (MSM). J Sex Med 2020;17:1751-1760.

Weight change before and after adenotonsillectomy in children: An analysis based upon pre-surgery body mass category

OBJECTIVES

To determine the standardised body mass index (BMIz) trajectory before and after adenotonsillectomy/tonsillectomy between children in different weight classifications in a larger sample than has been studied previously, and to identify which patient factors would explain the difference in these outcomes.

DESIGN

We used a retrospective chart review and leveraged data of weight status pre- and post-adenotonsillectomy/tonsillectomy from a cohort of paediatric patients seen between May 2004 and April 2017.

SETTING

Data were collected from an electronic medical record at a single Midwest paediatric health system.

PARTICIPANTS

The study population included a convenience sample of 1,751 paediatric patients who underwent adenotonsillectomy or tonsillectomy and had at least two height and weight measurements recorded on the same date both before and after surgery.

MAIN OUTCOME MEASURES

Change in BMIz trajectories before and after surgery.

RESULTS

Of 1751 paediatric patients (ages 3-11) underwent adenotonsillectomy/tonsillectomy procedures. Age at time of surgery and gender were not significant predictors. Children in different weight classifications demonstrated differences in BMIz trajectory after surgery. Children with overweight/obesity experience a decrease in BMIz, whereas children with underweight or normal weight experience an increase in BMIz.

CONCLUSIONS

Improvement in weight status is seen after surgery: increased BMI for those underweight and decreased BMI for those with overweight/obesity. We advocate for behavioural strategies as a first-line treatment in children with underweight or overweight/obesity, and results suggest that coordinating these efforts alongside adenotonsillectomy/tonsillectomy when indicated for medical reasons may be warranted. However, further research is needed to confirm these findings due to the observational nature of this study.

The Impact of Dose and Dose Frequency on Word Learning by Kindergarten Children With Developmental Language Disorder During Interactive Book Reading

Purpose

The goal was to determine whether interactive book reading outcomes for children with developmental language disorder (DLD) were affected by manipulation of dose (i.e., the number of exposures to the target word during a book reading session) and dose frequency (i.e., the number of repeated book reading sessions) and whether pretreatment factors predicted treatment response variation.

Method

Thirty-four kindergarten children with DLD (aged 5;0–6;2 [years;months]) were taught 1 set of words using the Dose 6 and Dose Frequency 6 format from a prior study (Storkel, Voelmle, et al., 2017) and taught a different set of words using an alternative format, either Dose 4 × Dose Frequency 9 or Dose 9 × Dose Frequency 4, determined through random assignment. Word learning was tracked for each treatment via a definition task prior to, during, and after treatment.

Results

Results showed that children with DLD learned a significant number of words during treatment regardless of the dose and dose frequency format but that significant forgetting of newly learned words occurred in all formats once treatment was withdrawn. Individual differences in word learning were related to Clinical Evaluation of Language Fundamentals Core Language and Understanding Spoken Paragraphs scores.

Conclusion

When administered at an adequate intensity, variation in the dose and dose frequency of interactive book reading does not appear to influence word learning by children with DLD. Although interactive book reading continues to show promise as an effective word learning intervention for children with DLD, further development is needed to enhance the effectiveness of this treatment approach.

Supplemental Material

https://doi.org/10.23641/asha.9745181

iAmHealthy: Rationale, design and application of a family-based mHealth pediatric obesity intervention for rural children

Children in rural areas are disproportionately affected by pediatric obesity. Poor access to healthcare providers, lack of nutrition education, lower socioeconomic status, and fewer opportunities to be physically active are all unique barriers that contribute to this growing health concern. There are very few pediatric obesity interventions that have been developed that target this unique population. iAmHealthy is a family-based behavioral, nutrition and physical activity intervention developed with input from rural children and families that capitalizes on the innovative use of mobile health applications (mHealth). iAmHealthy is a 25-contact hour multicomponent intervention delivered over an 8-month period targeting 2nd-4th grade school children and their families. This paper describes the rationale, design, participant/school enrollment, and planned implementation of a randomized controlled trial of the iAmHealthy intervention in comparison to a monthly newsletter delivered through rural elementary schools. Child Body Mass Index z-score (BMIz) is the primary outcome, along with child 24-hour dietary recall, and child accelerometer-determined physical activity and sedentary behavior as secondary outcomes. The study will include 18 schools (with 8 children each) resulting in a final planned sample size of 144 children. This project also has a strong focus on dissemination and implementation science, and thus includes many measures related to the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Data collection is completed at baseline, end of intervention (8 months), and follow-up (20 months). This study is the first randomized controlled trial to deliver a rurally tailored, empirically supported, family-based behavioral intervention for pediatric obesity solely over mHealth. Registered with ClinicalTrials.gov NCT ID 03304249.

CLASS-WIDE FUNCTION-RELATED INTERVENTION TEAMS (CW-FIT): Student and Teacher Outcomes from a Multisite Randomized Replication Trial

The purpose of the study was to conduct a randomized controlled trial (RCT) to demonstrate efficacy of the Classwide Function-Related Intervention Teams (CW-FIT) program. The study was designed to replicate an initial RCT conducted by the CW-FIT developers in 1 site, with 2 additional research groups not involved in its development. The study was conducted across 3 states, in 21 culturally diverse schools, and with 83 teachers (classrooms) assigned to CW-FIT and 74 teachers (classrooms) assigned to the comparison group. The CW-FIT intervention included teaching prosocial skills and use of differential attention (teacher praise and points) for appropriate behaviors using a group contingency, class teams, goal setting, points, and rewards. Class-wide student on-task behavior improved, teacher praise and attention to appropriate behaviors increased, and reprimands decreased in the CWFIT classes with significantly fewer changes over time for the comparison group.

Concurrent Validity and Reliability for the Communication Complexity Scale

PURPOSE

The Communication Complexity Scale (CCS; Brady et al., 2012) was created to fill a void in measures of expressive communication skills in individuals who communicate primarily with presymbolic or early symbolic means. CCS scores reflect expressive communication observed during interactive communication contexts.

METHOD

Two studies were completed to examine the reliability and validity of the revised CCS scores. Participants in both studies had minimal verbal skills (i.e., produced less than 20 functional words). Study 1 examined interobserver agreement, test-retest reliability, and concurrent validity for 239 participants with intellectual disabilities between the ages of 3-66 years, assessed with the protocol developed at the University of Kansas (KU CCS). CCS scores were compared with scores from the Vineland Adaptive Behavior Scales-Second Edition (Sparrow, Cicchetti, & Balla, 2005) and the Communication Matrix (Rowland & Fried-Oken, 2010). Study 2 examined the reliability and concurrent validity for CCS scores derived from 110 children (chronological age = 3-9) with autism from diverse backgrounds. These children were assessed with the Early Social Communication Scale (Mundy et al., 2003). CCS scores were compared with rates of communication derived from the Early Social Communication Scale.

RESULTS

CCS scores were moderately correlated with scores from existing measures of early communication. In addition, CCS scores from different raters were reliable, and test-retest scores were highly similar.

CONCLUSIONS

These findings support the validity and reliability of the CCS when used with individuals across a wide range of ages and with various types of disabilities. The CCS can be used in research and clinical practice to describe extant communication levels in individuals with minimal verbal skills.

Interactive Book Reading to Accelerate Word Learning by Kindergarten Children With Specific Language Impairment: Identifying Adequate Progress and Successful Learning Patterns

Purpose

The goal of this study was to provide guidance to clinicians on early benchmarks of successful word learning in an interactive book reading treatment and to examine how encoding and memory evolution during treatment contribute to word learning outcomes by kindergarten children with specific language impairment (SLI).

Method

Twenty-seven kindergarten children with SLI participated in a preliminary clinical trial using interactive book reading to teach 30 new words. Word learning was assessed at 4 points during treatment through a picture naming test.

Results

The results indicate that the following performance during treatment was cause for concern, indicating a need to modify the treatment: naming 0-1 treated words correctly at Naming Test 1; naming 0-2 treated words correctly at Naming Test 2; naming 0-3 treated words correctly at Naming Test 3. In addition, the results showed that encoding was the primary limiting factor in word learning, but rmemory evolution also contributed (albeit to a lesser degree) to word learning success.

Conclusion

Case illustrations demonstrate how a clinician's understanding of a child's word learning strengths and weaknesses develop over the course of treatment, substantiating the importance of regular data collection and clinical decision-making to ensure the best possible outcomes for each individual child.

Interactive Book Reading to Accelerate Word Learning by Kindergarten Children With Specific Language Impairment: Identifying an Adequate Intensity and Variation in Treatment Response

Purpose

This study sought to identify an adequate intensity of interactive book reading for new word learning by children with specific language impairment (SLI) and to examine variability in treatment response.

Method

An escalation design adapted from nontoxic drug trials (Hunsberger, Rubinstein, Dancey, & Korn, 2005) was used in this Phase I/II preliminary clinical trial. A total of 27 kindergarten children with SLI were randomized to 1 of 4 intensities of interactive book reading: 12, 24, 36, or 48 exposures. Word learning was monitored through a definition task and a naming task. An intensity response curve was examined to identify the adequate intensity. Correlations and classification accuracy were used to examine variation in response to treatment relative to pretreatment and early treatment measures.

Results

Response to treatment improved as intensity increased from 12 to 24 to 36 exposures, and then no further improvements were observed as intensity increased to 48 exposures. There was variability in treatment response: Children with poor phonological awareness, low vocabulary, and/or poor nonword repetition were less likely to respond to treatment.

Conclusion

The adequate intensity for this version of interactive book reading was 36 exposures, but further development of the treatment is needed to increase the benefit for children with SLI.

Understanding the Personality and Behavioral Mechanisms Defining Hypersexuality in Men Who Have Sex With Men

INTRODUCTION

Hypersexuality has been conceptualized as sexual addiction, compulsivity, and impulsivity, among others, in the absence of strong empirical data in support of any specific conceptualization.

AIM

To investigate personality factors and behavioral mechanisms that are relevant to hypersexuality in men who have sex with men.

METHODS

A sample of 242 men who have sex with men was recruited from various sites in a moderate-size mid-western city. Participants were assigned to a hypersexuality group or a control group using an interview similar to the Structured Clinical Interview for the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition. Self-report inventories were administered that measured the broad personality constructs of positive emotionality, negative emotionality, and constraint and more narrow constructs related to sexual behavioral control, behavioral activation, behavioral inhibition, sexual excitation, sexual inhibition, impulsivity, attention-deficit/hyperactivity disorder, and sexual behavior.

MAIN OUTCOME MEASURES

Hierarchical logistic regression was used to determine the relation between these personality and behavioral variables and group membership.

RESULTS

A hierarchical logistic regression controlling for age showed a significant positive relation between hypersexuality and negative emotionality and a negative relation with constraint. None of the behavioral mechanism variables entered this equation. However, a hierarchical multiple regression analysis predicting sexual behavioral control indicated that lack of such control was positively related to sexual excitation and sexual inhibition owing to the threat of performance failure and negatively related to sexual inhibition owing to the threat of performance consequences and general behavioral inhibition

CONCLUSION

Hypersexuality was found to be related to two broad personality factors that are characterized by emotional reactivity, risk taking, and impulsivity. The associated lack of sexual behavior control is influenced by sexual excitatory and inhibitory mechanisms, but not by general behavioral activation and inhibitory mechanisms.

Anxious Attachment, Social Isolation, and Indicators of Sex Drive and Compulsivity: Predictors of Child Sexual Abuse Perpetration in Adolescent Males?

It has been suggested that child sexual abuse is related to poor attachment to parents, which is associated with an inability to form intimate relationships. Seto and Lalumière indicated that there were too few studies of adolescent males to determine whether poor attachment was associated with perpetration. This study was designed to follow up on a previous study and further explored the association between insecure attachment to parents, social isolation, and interpersonal adequacy to child sexual abuse perpetration in adolescents. We compared two samples of adolescent males who had committed sexual offenses, those who committed offenses against children (n = 140) and those who committed offenses against peer or adults (n = 92), with a sample of similarly aged males in treatment for mental health or substance use issues (n = 93). Data were collected using a semi-structured interview and computer-administered questionnaire. We found an indirect association between anxious attachment and sexual offenses against child victims, which was accounted for by measures of social involvement and social isolation. These involvement and isolation measures also did not have a direct association with sexual offenses against child victims, in that their contribution was accounted for by a measure of Masculine Adequacy. This Masculine Adequacy, combined with decreased levels of Sexual Preoccupation and Hypersexuality and increased Sexual Compulsivity, was associated with commission of child sexual abuse. The interpersonal variables did not enter a model predicting sexual offending against peers/adults, which seemed solely associated with the interaction between Sexual Compulsivity and Hypersexuality.

HIV risk behaviors in the U.S. transgender population: prevalence and predictors in a large internet sample

To study the influence of gender on HIV risk, a sample of the U.S. transgender population (N = 1,229) was recruited via the Internet. HIV risk and prevalence were lower than reported in prior studies of localized, urban samples but higher than the overall U.S. population. Findings suggest that gender nonconformity alone does not itself result in markedly higher HIV risk. Sex with nontransgender men emerged as the strongest independent predictor of unsafe sex for both male-to-female (MtF) and female-to-male (FtM) participants. These sexual relationships constitute a process that may either affirm or problematize gender identity and sexual orientation, with different emphases for MtFs and FtMs, respectively.

Conducting Internet Research With the Transgender Population: Reaching Broad Samples and Collecting Valid Data

Health research on transgender people has been hampered by the challenges inherent in studying a hard-to-reach, relatively small, and geographically dispersed population. The Internet has the potential to facilitate access to transgender samples large enough to permit examination of the diversity and syndemic health disparities found among this population. In this article, we describe the experiences of a team of investigators using the Internet to study HIV risk behaviors of transgender people in the United States. We developed an online instrument, recruited participants exclusively via websites frequented by members of the target population, and collected data using online quantitative survey and qualitative synchronous and asynchronous interview methods. Our experiences indicate that the Internet environment presents the investigator with some unique challenges and that commonly expressed criticisms about Internet research (e.g., lack of generalizable samples, invalid study participants, and multiple participation by the same subject) can be overcome with careful method design, usability testing, and pilot testing. The importance of both usability and pilot testing are described with respect to participant engagement and retention and the quality of data obtained online.

Understanding sexual perpetration against children: effects of attachment style, interpersonal involvement, and hypersexuality

This study explores in an adolescent sample hypotheses about child sexual abuse perpetration drawn from contemporary theories that implicate insecure attachment and adolescent social development. Specifically, three 13- to 18-year-old adolescent male samples (sex offenders with child victims, sex offenders with peer/adult victims, and nonsex delinquent youth) were compared in a cross-sectional design. Participants completed a computer-administered self-report questionnaire and a semistructured attachment style interview. Attachment style was coded by two independent raters blind to study hypotheses and group membership. The results indicated an indirect effect for attachment style. Attachment anxiety affected involvement with peers and interpersonal adequacy. Feelings of interpersonal inadequacy, combined with oversexualization and positive attitudes toward others distinguished sex offenders with child victims from nonsex delinquents and from sex offenders with peer/adult victims. These data provide a preliminary model of sexual abuse perpetration consistent with contemporary theories. Attachment anxiety with a lack of misanthropic attitudes toward others appears to lead to isolation from peers and feelings of interpersonal inadequacy. Individuals with this constellation of factors may turn to children to meet their intimacy and sexual needs, both of which seem to be exaggerated compared with other troubled youth.