Skip to main content
eScholarship
Open Access Publications from the University of California

Scholarly Works (6 results)

  • Thesis
  • Peer Reviewed
UCLA Electronic Theses and Dissertations (2014)

Rates of sexually transmitted infections (STIs) in the U.S. military have historically been higher than those of civilians. One likely contributor to high military STI rates is the high prevalence of behaviors that correspond with transmission of STIs, including binge drinking, lack of condom use, and multiple sexual partnerships. Other potential contributors include the high prevalence of mental health conditions as well as unwanted sexual contact (i.e., sexual assault). In particular, women in the military tend to have higher rates of STIs than both their male colleagues in the military and their female peers in the general population. This dissertation aims to better understand the differences in sexual risk behaviors and risk for STIs between men and women in the military, and between women in the military and women in the general U.S. population. It also aims to describe the factors associated with unwanted sexual contact and mental health among service women in particular.

This dissertation utilizes data from the 2008 Department of Defense Survey of Health Related Behaviors among Active Duty Personnel (HRBS) in order to estimate the prevalence of STIs and sexual risk behaviors among military personnel. Chapter 1 identifies and provides background information on women in the military as well as STI risk factors. Chapter 2 compares STI risk behaviors between men and women in the military and describes the factors that are associated with report of an STI and with report of multiple sexual partners, among both genders. Chapter 3 examines the relationships between unwanted sexual contact, sexual risk behaviors, mental health, and substance use among women in the military. Finally, Chapter 4 utilizes data from the 2007-2010 National Health and Nutrition Examination Survey (NHANES) in order to estimate the prevalence of STIs and sexual risk behaviors among women in the general population. These estimates are then compared to those of service women in the 2008 HRBS. Findings from this dissertation expand the current understanding of sexual risk behaviors among women in the military, and have implications for the development of interventions that promote sexual health among female service members in the United States.

    Cover page: Sexually Transmitted Infections in the U.S. Military: How Gender Influences Risk
    • Article
    • Peer Reviewed
    UCLA Previously Published Works (2014)

    Background

    Sexually transmitted infections (STIs) are prevalent in the U.S. military. However, there are limited data on risk-factor differences between sexes.

    Methods

    We used data from the 2008 Department of Defense Survey of Health Related Behaviors among active duty military personnel to identify risk factors for self-reported STIs within the past 12 months and multiple sexual partners among sexually active unmarried service members.

    Results

    There were 10,250 active duty personnel, mostly white (59.3%) aged 21 to 25 years (42.6%). The prevalence of any reported STI in the past 12 months was 4.2% for men and 6.9% for women. One-fourth of men and 9.3% of women reported 5 or more sexual partners in the past 12 months. Binge drinking, illicit substance use, and unwanted sexual contact were associated with increased report of sexual partners among both sexes. Family/personal-life stress and psychological distress influenced number of partnerships more strongly for women than for men (Adjusted Odds Ratio [AOR]=1.58, 95% Confidence Interval [CI]=1.18-2.12 and AOR=1.41, 95% CI=1.14-1.76, respectively). After adjusting for potential confounders, we found that the report of multiple sexual partners was significantly associated with the report of an STI among men (AOR, 5.87 [95% CI, 3.70-9.31], for ≥5 partners; AOR, 2.35 [95% CI, 1.59-3.49], for 2-4 partners) and women (AOR, 4.78 [95% CI, 2.12-10.80], for ≥5 partners; AOR, 2.35 [95% CI, 1.30-4.25], for 2-4 partners).

    Conclusions

    Factors associated with the report of increasing sexual partnerships and report of an STI differed by sex. Sex-specific intervention strategies may be most effective in mitigating the factors that influence risky sexual behaviors among military personnel.
      • Article
      • Peer Reviewed
      UCLA Previously Published Works (2015)
      Many U.S. military women are exposed to unwanted sexual contact during military service, which can have important implications for mental health. Using data from the 2008 Department of Defense Survey of Health Related Behaviors, we employed multiple logistic regression methods to examine whether unwanted sexual contact was associated with stress, screening positive for mental disorders, or substance use, among active duty service women. The sample included 7,415 female military personnel, of whom 13.4% reported unwanted sexual contact (including any touching of genitals) since entering the military. After adjusting for potentially confounding variables, factors independently associated with unwanted sexual contact included military-related stress (adjusted odds ratio [AOR] = 2.44), family/personal life-related stress (AOR = 1.78), and gender-related stress (AOR = 1.98) in the past 12 months. In addition, screening positive for depression, anxiety, posttraumatic stress disorder, or psychological distress, and suicidal ideation or attempt were associated with unwanted sexual contact (AOR = 1.57-2.11). For drug/alcohol use, only misuse of tranquilizers/muscle relaxers (past 12 months) was associated with report of unwanted sexual contact (AOR = 1.35). Given the prevalence of unwanted sexual contact and corresponding adverse health outcomes in this sample of active duty women, strategies to create military structural/cultural changes and reduce gender-related stress and sexism are needed.
        Cover page: Mental Health and Substance Use Factors Associated With Unwanted Sexual Contact Among U.S. Active Duty Service Women
        • Article
        • Peer Reviewed
        UCLA Previously Published Works (2014)

        Background

        Rectal products used with anal intercourse (AI) may facilitate transmission of STIs/HIV. However, there is limited data on rectal douching behavior in populations practicing AI. We examined the content, types of products, rectal douching practices and risk behaviors among those reporting AI.

        Methods

        From August 2011 to May 2012, 1,725 women and men reporting receptive AI in the past 3 months completed an internet-based survey on rectal douching practices. The survey was available in English, French, German, Mandarin, Portuguese, Russian, Spanish, and Thai and included questions on sexual behaviors associated with AI including rectal douching. Differences by rectal douching practices were evaluated using chi-square methods and associations between reported douching practices and other factors including age and reported STI history were evaluated using logistic regression analysis.

        Results

        Respondents represented 112 countries, were mostly male (88%), and from North America (55%) or Europe (22%). Among the 1,339 respondents (66%) who reported rectal douching, most (83%) reported always/almost always douching before receptive AI. The majority of rectal douchers reported using non-commercial/homemade products (93%), with water being the most commonly used product (82%). Commercial products were used by 31%, with the most common product being saline-based (56%). Rectal douching varied by demographic and risk behaviors. The prevalence of rectal douching was higher among men (70% vs. 32%; p-value < .01), those reporting substance-use with sex (74% vs. 46%; p-value < .01), and those reporting an STI in the past year (69% vs. 57% p-value < .01) or ever testing HIV-positive (72% vs. 53%; p-value < .01). In multivariable analysis, adjusting for age, gender, region, condom and lubricant use, substance use, and HIV-status, douchers had a 74% increased odds of reporting STI in the past year as compared to non-douchers [adjusted odds ratio (AOR) = 1.74; 95% CI 1.01-3.00].

        Conclusion

        Given that rectal douching before receptive AI is common and because rectal douching was associated with other sexual risk behaviors the contribution of this practice to the transmission and acquisition of STIs including HIV may be important.
          Cover page: Prevalence and types of rectal douches used for anal intercourse: results from an international survey
          • Article
          • Peer Reviewed
          UCLA Previously Published Works (2015)
          Women in the US military report a high prevalence of sexual risk behaviours, such as binge drinking and new or multiple sexual partnerships. However, demographical differences pose challenges to making comparisons with civilians. Two public-use datasets were used to compare prevalence of sexual risk behaviours between sexually active military and civilian women, after adjusting for demographic factors. It was found that women in the military reported a higher prevalence of binge drinking and new/multiple sexual partners as compared with civilians, which suggests that military women are a high-risk group and the military environment may at least partially facilitate these risk behaviours.
            • Article
            • Peer Reviewed
            UC San Francisco Previously Published Works (2015)
              Top