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Internet Pornography use in the Context of External and Internal Religiosity


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Past studies have demonstrated an inverse relationship between religiosity and such problem behaviors as crime, delinquency, alcoholism, and substance use. Religiosity may be a protective factor against problem behaviors. Recently, a new problematic behavior has emerged, Internet pornography. Popular Christian literature has suggested that Internet pornography use is common among Christians. However, there have been few research studies examining this issue in Christian populations. This study examined the extent of Internet pornography use among 751 males and females who were attending a conservative Christian university, perceived consequences and benefits of viewing, and the relationship between internal, external and quest religiosity and Internet pornography use. Findings suggest that the majority of males had some involvement in Internet pornography, but regular viewing was significantly lower than has been found in the general population. Internal and external religiosity showed only a weak, though statistically significant, inverse relationship with regular Internet pornography use.
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Mental- and Physical-Health Indicators and Sexually Explicit
Media Use Behavior by Adultsjsm_2030764..772
James B. Weaver, III, PhD, MPH,* Stephanie Sargent Weaver, PhD, MPH,* Darren Mays, PhD, MPH,*
Gary L. Hopkins, MD, DrPH,Wendi Kannenberg, MPH,and Duane McBride, PhD
*Centers for Disease Control and Prevention, Atlanta, GA, USA; Center for Media Impact Research, Institute for the
Prevention of Addictions, Andrews University, Berrien Springs, MI, USA
DOI: 10.1111/j.1743-6109.2010.02030.x
Introduction. Converging evidence from culturally diverse contexts indicates that sexually explicit media use behav-
ior (SEMB; i.e., pornography consumption) is associated with risky sexual health perceptions and behaviors, many
that involve high risks of HIV/STD transmission.
Aim. Essentially unexplored, and the focus here, are potential relationships between SEMB and nonsexual mental-
and physical-health indicators.
Main Outcome Measures. Variability in six continuously measured health indicators (depressive symptoms, mental-
and physical-health diminished days, health status, quality of life, and body mass index) was examined across two
levels (users, nonusers) of SEMB.
Methods. A sample of 559 Seattle–Tacoma Internet-using adults was surveyed in 2006. Multivariate general linear
models parameterized in a SEMB by respondent gender (2 ¥2) factorial design were computed incorporating
adjustments for several demographics.
Results. SEMB was reported by 36.7% (n =205) of the sample. Most SEMB users (78%) were men. After adjusting
for demographics, SEMB users, compared to nonusers, reported greater depressive symptoms, poorer quality of life,
more mental- and physical-health diminished days, and lower health status.
Conclusions. The findings show that mental- and physical-health indicators vary significantly across SEMB, sug-
gesting the value of incorporating these factors in future research and programmatic endeavors. In particular, the
findings suggest that evidence-based sexual health promotion strategies simultaneously addressing individuals’
SEMB and their mental health needs might be a useful approach to improve mental health and address preventable
sexual health outcomes associated with SEMB. Weaver JB, III, Weaver SS, Mays D, Hopkins GL, Kannenberg
W, and McBride D. Mental- and physical-health indicators and sexually explicit media use behavior by
adults. J Sex Med 2011;8:764–772.
Key Words. Health-Risk Factors; Mental Health; Pornography; Sexually Explicit Materials; X-Rated; Sexual
Public health professionals have long recog-
nized the potential adverse consequences
resulting from using sexually explicit media
content for entertainment purposes (i.e., reading
and/or watching pornography) as substantial
public health concerns [1–4]. Almost four decades
ago, for instance, Calderone [5] speculated that
media portrayals of sexually explicit behaviors
yielded undesirable consequences for “various
members of the community” and stressed the need
for public health to address the issue “in behavioral
and value terms.” Almost 25 years ago, Koop [3],
reporting on his Surgeon General’s Workshop on
Pornography and Public Health, concluded that
sexually explicit media use stimulates “attitudes
and behavior that...impair the mental, emo-
tional, and physical health of children and adults
and may thus contribute significantly to the
J Sex Med 2011;8:764–772 © 2010 International Society for Sexual Medicine
morbidity burden in our society.” More recently,
such concerns were reaffirmed by Perrin and his
colleagues [6], who concluded that “Pornography
is...aproblem with ramifications for the public’s
Although published [7,8] prevalence estimates
of sexually explicit media use vary widely (20–
65%), the behavior appears widespread among
American adults. Evidence from 14 recent surveys
in the General Social Survey Series [9], for
instance, reveals an average overall sexually
explicit media use behavior (SEMB) prevalence
estimate of 24.7% (standard deviation [SD] =
2.1%, range =7.7%), with men (mean [M] =
32.9%, SD =3.1%, range =12.5%) more likely
(odds ratio [OR] 2.31, 95% confidence interval
[CI] 2.16–2.47) to report SEMB than women
(M =17.3%, SD =2.5%, range =8.9%).1In other
words, millions of Americans, particularly males,
use sexually explicit media.
The health and social consequences of SEMB
are evident within an extensive and diverse research
literature. Initial studies of adults, for instance,
demonstrated that exposure to pornography is
capable of altering perceptions and dispositions
toward sexuality and relationships formed on its
basis [10,11]. Several experimental studies showed
that repeated exposure to common, nonviolent
pornography significantly shifted sexual norms
toward “greater acceptance of pre- and extramarital
sex and greater tolerance of nonexclusive sexual
access to intimate partners,” [12,13] diminished the
“societal significance assigned to the institution of
marriage” and perceptions of its “future viability”
[13], and changed “values to the effect that men
ought to dominate women – and not only in the
sexual realm” [13]. These shifts emerged for both
male and female research participants, although at
times to differing degrees. Controlled investiga-
tions have also revealed that exposure to pornogra-
phy can elevate sexual callousness towards women
[14,15], trivialize rape as a criminal offense [16],
and facilitate aggressive attitudes and behaviors
[17–20]. Corresponding associations between
SEMB and risky sexual health attitudes and percep-
tions are evident in studies of adolescents and
emerging adults [8,21–31].
More importantly, several recent studies—
many spurred by concerns that adolescents
and emerging adults might model health impacting
sexual behaviors observed in pornography
[32–34]—suggest a more direct link between
SEMB and many sexual behaviors. Specifically, it
has long been recognized that pornography por-
trays sexual behaviors that are inconsistent with
“safe sex” recommendations [35], typically present-
ing sexual acts that involve high risks of HIV/STD
transmission [36,37] and other preventable health
outcomes including unintended pregnancy, phy-
sical trauma, and violence [38]. In heterosexual
pornography, for example, anal intercourse—
a highly predictive risk factor for sexually trans-
mitted infections [39–42]—is commonly portrayed
while risk-reducing behaviors such as condom use
are uncommon [43]. Within this light, converging
evidence from around the world suggests a corre-
spondence between SEMB and sexual risk per-
ceptions and behaviors among adolescents and
emerging adults including earlier onset of oral sex
and sexual intercourse [22,44,45]; greater likeli-
hood of having multiple sexual partners, having sex
more frequently, and engaging in anal sex [23,45–
50]; more negative attitudes toward condoms and
less frequent condom use [45,47,50,51]; and sexual
harassment and violence [52–55].
Although the existing research illustrates strong
linkages between SEMB and sexual perceptions
and behaviors, it fails to illuminate the possibility
of associations between SEMB and mental- and
physical-health indicators. Yet, earlier studies
suggest that there may be associations between
SEMB, risky sexual behaviors, and physical-
and mental-health indicators. Prior research, for
instance, shows that several markers of poor
mental health, including depression, are associated
with risky sexual behaviors [56–62]. Further, there
is some clinical [63,64] and population-based
[65,66] evidence indicating possible linkages bet-
ween depression and SEMB; however, clear evi-
dence that depression is associated with SEMB is
lacking. From a public health perspective, scrutiny
of these associations is crucial to inform the devel-
opment and implementation of sexual health inter-
vention programs targeting behaviors associated
with high risks of HIV/STD transmission and
other preventable sexual health outcomes.
Against this backdrop, we explored whether
selected mental- and physical-health indicators are
associated with SEMBs in an Internet-using adult
sample. Consistent with the expectations of others
[3,6], we hypothesized that adults reporting SEMB
1The 14 General Social Survey administrations were con-
ducted between 1986 and 2006 with nationally representa-
tive samples of U.S. adults who were asked if they had seen
“an X-rated movie in the last year.” Data analysis was
conducted by the authors using GSS Nesstar analytics
Sexually Explicit Media Use Behavior and Health 765
J Sex Med 2011;8:764–772
would also report poorer perceptions of their
mental and physical health. We further hypoth-
esized that different patterns of linkages between
SEMB and health risk indicators would emerge by
Participants and Setting
The institutional review boards at all affiliated
institutions approved the protocol for this study.
An informed consent statement was incorporated
as the introductory page of the survey instrument.
Along with the other basic required elements of
informed consent, potential respondents were told
the purpose of the study was “to examine mass
media use practices.” It was explained that they
would be asked about the time they spent using the
mass media and the media content they consumed.
They were also told that they would be asked ques-
tions about themselves and their “view of the
world.” Respondents acknowledged being pre-
sented the informed consent statement prior to
An Internet-based survey was conducted in
summer 2006 among adults living in the Seattle–
Tacoma designated market area (DMA). The
Seattle–Tacoma DMA, which includes 18 counties
encompassing most of the western half of Wash-
ington where approximately 72% of the state
population (4.6 million people) lives, was selected
for its size (13th largest U.S. media market) and
the prevalence of Internet use (ranked first in the
nation) [67].
The sample was drawn from a panel of more
than 60,000 participants maintained by e-Rewards
Marketing Research [68]. This panel was chosen,
in part, because it was constructed and is main-
tained using a “by invitation only” recruitment
methodology designed to facilitate effective demo-
graphic normalization while reducing the poten-
tial for self-selection bias [69]. A subset of panel
members (n =3,140) were solicited via e-mail
by e-Rewards to complete a consented survey,
linked via a separate secure server, about their self-
perceptions and media use. e-Rewards managed
a stratified, multiwave invitation procedure with
oversampling of less responsive demographic
groups that was designed to maximize sample rep-
resentativeness. No other eligibility requirements
were incorporated. This process yielded an Ameri-
can Association of Public Opinion Research-
adjusted response rate [70] of 23.7%, which is
comparable with other single-invitation online
surveys [71,72], and satisfied the survey quota in
approximately 48 hours.
Responses were analyzed from 559 adults with
the majority being between 35 and 54 years old
(48.5%), female (51.9%), white (82.2%), married
(62.9%), a college graduate (63.7%), and reporting
a household income of $75,000 or more (56.5%).
These sample characteristics were consistent with
those derived via random-digit-dialing sampling in
the Seattle–Tacoma DMA [67] with two excep-
tions: sample respondents reported both higher
household income and educational achievement
(see Table 1). These differences were anticipated,
however, based on demographic estimates of
Internet users [73].
Sexually Explicit Media Use Behavior (SEMB)
Respondents engaging in SEMB were distin-
guished from nonusers depending on their rating
of the importance of using “sexually explicit
content including images, videos, and/or chat
rooms.” Reponses were recorded as either “I don’t
use” (0) or ranked on a scale that ranged from
“Not at all important” (1) to “Extremely impor-
tant” (9). A dichotomous SEMB variable was
created by collapsing all responses greater than or
equal to 1 as sexually explicit media users and all
responses equal to 0 as nonusers.
Health Indicators
Self-reported depression (i.e., depressive symp-
toms) was also assessed using a 10-item version of
the Center for Epidemiologic Studies Depression
Scale [74]. Respondents were asked to report how
often they had felt or behaved consistent with each
item during the past week on a scale ranging from
“None of the time” (0) to “Every day” (7). Two
items were reverse-coded before the 10-item
average was computed to produce a single scale
(M =1.3, SD =1.0, Cronbach’s a=0.84).
Four questions derived from the 2006 Behav-
ioral Risk Factor Surveillance Survey instrument
[75] assessed respondents’ perceptions of their
health [76]. These included health status (M =3.8,
SD =0.86; “Would you say that in general your
health is excellent [5], very good [4], good [3], fair
[2], or poor [1]?”); diminished physical health
(M =2.4, SD =6.2; “Now thinking about your
physical health, which includes physical illness and
injury, for how many days during the past 30 days
was your physical health not good?”); diminished
mental health (M =2.7, SD =5.9; “Now thinking
about your mental health, which includes stress,
depression, and problems with emotions, for how
766 Weaver III et al.
J Sex Med 2011;8:764–772
many days during the past 30 days was your mental
health not good?”); and poor quality of life
(M =1.4, SD =4.3; “During the past 30 days, for
about how many days did poor physical or mental
health keep you from doing your usual activities,
such as self-care, work, or recreation?”). The
variables for diminished physical health (skew-
ness =3.4; kurtosis =11.5), diminished mental
health (skewness =3.2; kurtosis =10.1), and poor
quality of life (skewness =4.6; kurtosis =22.2)
were transformed using a base-10 logarithm to
improve normality.
Respondents were also asked their height and
weight. The body mass index (M =27.2, SD =5.6)
was then calculated using a standard formula [77].
Missing data were apparent for 16 respondents
(females, n =9; males, n =7).
Building from prior research [7,45,78,79], six mea-
sures were incorporated as covariates. These were
respondent age, household income, overall Inter-
net use, race/ethnicity, marital status, and educa-
tional achievement. Respondent age (M =44.7,
SD =13.1) was assessed with the question: “What
is the YEAR of your birth?” Household income
(M =86,829.84, SD =58,194.34) was measured by
asking respondents to “please indicate your gross
annual family income.” To improve normality,
the household income measure (skewness =4.1,
kurtosis =33.5) was transformed using a base-10
Respondents were asked how much time
they spent during a typical week “surfing the
Internet” outside of work or school responsibili-
ties to assess overall Internet use (M =7.39
hours/week, SD =8.77). A base-10 logarithm
transformation was used to improve the normal-
ity of the Internet use measure (skewness =2.9,
kurtosis =12.0).
Questions measuring race/ethnicity (white,
other), marital status (single, married, unmarried),
and educational achievement (high school or
less, post-high school, college graduate) were
Table 1 Sample characteristics as a function of sexually explicit media use behavior (SEMB), Seattle–Tacoma, WA,
USA, 2006
estimates (%)
estimates (%)
Odds ratio
(95% CI)
(n =354)
(n =205)
Age (years) (c2[2] =9.73*)
Age 18–34 29 27.1 Ref. 25.1% 30.2%
Age 35–54 42 48.4 0.95 (0.63, 1.43) 46.1% 52.7%
Age 55 or older 29 24.5 0.49 (0.30, 0.81) 28.8% 17.1%
Education(c2[2] =4.43)
High school or less 31 5.6 7.1% 2.9%
Post-high school 34 30.7 30.9% 30.4%
College plus 35 63.7 62.0% 66.7%
Gender (c2[1] =116.14*)
Male 50 48.1 7.99 (5.4, 11.9) 30.8% 78.0%
Female 50 51.9 Ref. 69.2% 22.0%
Household income(c2[3] =0.11)
Less than $35,000 19 9.8 9.6% 10.2%
$35,000–49,999 17 10.6 10.7% 10.2%
$50,000–74,999 19 23.1 22.9% 23.4%
$75,000 or more 45 56.5 56.8% 56.1%
Marital status (c2[2] =8.40)
Never married 27 26.0 22.0% 32.9%
Married 57 62.9 65.6% 58.3%
Unmarried 16 11.1 12.4% 8.8%
Race(c2[3] =6.53)
White 85 82.2 83.5% 79.9%
African American 4 3.8 4.5% 2.5%
Asian American 6 9.9 7.7% 13.7%
Other 5 4.1 4.3% 3.9%
The Seattle–Tacoma designated market area population estimates were compiled from the 2006 Claritas and Scarborough Research data (Seattle Times
Company, 2008 [67]). As a result of missing data, the size of the SEMB groups varied on specific measures as follows: race/ethnicity (nonusers, n =352; users,
n=204), marital status (nonusers, n =354; users, n =204), and education (nonusers, n =353; users, n =204).
*P<0.05 using Sidak’s adjustment.
The population and sample distributions differed significantly across household income (c2[3] =15.57, P<0.05) and education (c2[2] =128.49, P<0.05).
Across race/ethnicity, small cell sizes among the African American and Asian American and Other groups within the SEMB cohorts threatened the validity of the
chi-square test. However, a follow-up test with these three groups collapsed yielded the same statistical decision (c2[1] =1.09, not significant).
Ref. =referent categories of dummy-coded variables; CI =confidence interval.
Sexually Explicit Media Use Behavior and Health 767
J Sex Med 2011;8:764–772
also assessed (Table 1). These variables were refe-
rence cell dummy-coded prior to inclusion in
subsequent analyses.
Statistical Analyses
The primary exposure variable for all analyses
was SEMB (nonuser, user). The six continuously
measured health indicators were the response vari-
ables. Bivariate analyses (see Table 1) revealed a
relationship between respondent gender and
SEMB. In light of this finding and prior research
[9,79–82], respondent gender was examined as a
moderator of SEMB in subsequent analyses. Con-
sequently, the focal relationships between SEMB
and the six health indicators were tested using
multivariate general linear models parameterized
in a SEMB by respondent gender (2 ¥2) factorial
design with covariate adjustment.
Of the 559 adult respondents, 36.7% reported
SEMB. More men (78%) than women (22%)
reported SEMB (see Table 1; OR 7.99, 95% CI
5.4–11.9). Continuous measures for age (OR 0.97,
95% CI 0.95–0.99) and Internet use (OR 1.84,
95% CI 1.27–2.67) both varied significantly across
SEMB, indicating that younger respondents and
those spending more time online were more likely
to engage in the behavior.
Results from the SEMB (nonuser, user) by
gender (female, male) factorial models, adjusting
for the covariates, are detailed in Table 2. The
SEMB main effects were significant for five of the
six health indicators examined: depressive symp-
toms (hp2=0.03), health status (hp2=0.02), dimin-
ished physical health days (hp2=0.01), diminished
mental health days (hp2=0.01), and poor quality of
life (hp2=0.01). Significant gender main effects
were evident for diminished mental health days
(hp2=0.02) and poor quality of life (hp2=0.02).
None of the interaction effects were significant.
The age, income, and overall Internet use covari-
ates were significant contributors to some models
as indicated in Table 2.
The means associated with the significant
SEMB main effects, displayed in Table 3, reveal
that sexually explicit media users, compared
to nonusers, reported the most negative health
indicators (i.e., higher depressive symptoms,
lower health status, more diminished physical and
mental health days, and poorer quality of life).
Additionally, female respondents reported more
diminished mental health days (M =0.37) and
Table 2 General linear models (F) for health indicators as a function of sexually explicit media use behavior (SEMB)
and gender, Seattle–Tacoma, WA, USA, 2006
Source (F)
Assessments of health indicators
of life
Fixed effects
Gender 2.38 0.74 3.818.31** 9.43** 2.57
SEMB 15.46*** 8.46** 6.97** 5.94* 5.52* 0.73
Gender ¥SEMB 2.16 1.42 0.37 2.04 0.53 0.16
Overall Internet use 1.76 (–) 0.53 0.48 4.22* 5.95* 0.23
Age (–) 11.87*** (–) 1.13 0.90 (–) 6.10* 1.68 4.21*
Income (–) 1.05 0.96 (–) 3.33 (–) 3.48 5.33* (–) 0.77
R/E: Other Ref. Ref. Ref. Ref. Ref. Ref.
R/E: White (–) 3.63 0.12 1.30 0.39 0.67 3.38
Single Ref. Ref. Ref. Ref. Ref. Ref.
Unmarried 0.00 0.01 (–) 0.01 (–) 0.21 0.53 (–) 1.35
Married (–) 0.95 (–) 0.03 0.01 0.00 0.35 (–) 1.11
High school or less Ref. Ref. Ref. Ref. Ref. Ref.
Post-high school 0.00 (–) 2.58 0.61 1.13 0.30 0.78
College graduate (–) 1.80 0.47 (–) 0.00 (–) 0.37 0.18 (–) 1.49
Model R20.11 0.06 0.03 0.09 0.06 0.07
The referent categories of dummy-coded variables are indicated by “Ref.” The model covariates with negative regression coefficients are indicated by (–).
R/E =race/ethnicity.
768 Weaver III et al.
J Sex Med 2011;8:764–772
poorer quality of life (M =0.23) than their male
counterparts (mental health, M =0.25; quality of
life, M =0.13).
The findings demonstrate that SEMB is prevalent
among adult Seattle–Tacoma Internet users. Over
one-third of the sample (36.7%), with more men
(78%) than women (22%), reported SEMB.
These estimates are over twice as large as those
observed in the General Social Survey Series
[9] which, most likely, is a consequence of the
Internet-user only sampling frame of this study
and differences between the studies in how SEMB
was operationalized.
More importantly, the findings provide primary
evidence that fundamental health risk factors are
correlated with SEMB among adults. Consistent
with our hypothesis, sexually explicit media users
evidenced more impaired mental and physical
health than nonusers. Specifically, SEMB was
associated with greater depressive symptomatol-
ogy, a greater number of diminished mental and
physical health days per month, a lower health
status, and a poorer quality of life.
Contrary to our second hypothesis, in
covariate-adjusted factorial models, respondent
gender did not emerge as a significant moderator
of the association between SEMB and the health
indicators. Gender differences were evident for
SEMB (men were more likely to report use) and
on two health indicators (women reported more
days of diminished mental health and a poorer
quality of life). All interaction effects explained
only trivial variability, however, suggesting that the
health indicators associated with SEMB are rela-
tively stable for both males and females.
While this study illustrates that health corollar-
ies of SEMB extend well beyond enactment of
health-risky sexual behaviors, there are some
caveats to acknowledge. That this investigation
used a cross-sectional design is foremost, and the
reader is reminded that attribution of causality is
ill-advised. All study measures were based on
respondent self-report which may represent a
source of bias. Furthermore, the SEMB measure
did not enable us to distinguish between varying
degrees of sexually explicit media use or isolate
specific characteristics of the sexually explicit media
content selected and consumed by respondents;
either of which could impact the observed relation-
ships with health assessments. In addition, sample
characteristics (e.g., concentrated in western
Washington State, drawn from an Internet-based
panel) may limit generalizability. While the sam-
pling procedures were constructed to minimize
potential biases, the response rate may have
affected the findings due to selection bias. Finally,
the significant, but relatively small, associations
between SEMB and health self-assessments raise
the question of practical significance. Recognizing
that small research effects may translate into impor-
tant social and practical significance across larger
populations [83], we believe the observed associa-
tions have instrumental “real-world” implications.
These limitations notwithstanding, the current
findings highlight important areas for future
Most obviously, our understanding about inter-
relationships among mental health indicators,
SEMB, and sexual risk behaviors among adults
requires further development. Indeed, while our
findings point to depressive symptomatology as a
determinant associated with SEMB, the specific
nature and directionality of the relationship
between depression and SEMB remains uncertain.
Similarly, clearer articulation of the interrelation-
ships between mental health distress, SEMB,
and risky sexual health perceptions and behaviors
is needed. Given that reciprocal relationships
are probable, future research explicating these
possibilities will require more extensive research
designs (e.g., longitudinal studies); inclusion
Table 3 Health indicators as a function of sexually explicit media use behavior (SEMB), Seattle–Tacoma, WA, USA, 2006
Health indicators (M/SE) SEMB nonusers SEMB users
between means 95% CI
Depression 1.18a, 0.06 1.58b, 0.08 0.40* 0.20, 0.60
Health status 3.84b, 0.05 3.59a, 0.07 -0.26* -0.43, -0.08
Diminished physical health 0.21a, 0.02 0.32b, 0.04 0.11* 0.03, 0.20
Diminished mental health 0.26a, 0.02 0.37b, 0.04 0.11* 0.02, 0.19
Poor quality of life 0.14a, 0.02 0.22b, 0.03 0.08* 0.01, 0.15
Body mass index 27.10, 0.32 27.60, 0.48 0.50 -0.65, 1.65
The missing data on body mass index excluded 16 respondents (N =543; SEMB nonuser, n =343; SEMB user, n =200; female, n =281; male, n =262). Least
square means having different lowercase superscript letters, also indicated by an asterisk (*) for difference between means, differ at P<0.05 by the two-tailed t-test.
M=mean; SE =standard error; CI =confidence interval.
Sexually Explicit Media Use Behavior and Health 769
J Sex Med 2011;8:764–772
of more extensive environmental (e.g., social
support) [24,84,85] and personal (e.g., individual
differences) determinants [86–88]; and more
sophisticated analytical strategies (e.g., multilevel
models, structural equation models). Neverthe-
less, the findings suggest that evidence-based
sexual health promotion strategies simultaneously
addressing individuals’ SEMB and their mental
health needs might be a useful approach to
improve mental health and address preventable
sexual health outcomes associated with SEMB.
Among a sample of Internet-using adults, we
found that over one-third (36.7%) reported sexu-
ally explicit media use and that individuals indicat-
ing engagement in this behavior evidenced higher
depressive symptoms, more diminished mental
and physical health days per month, a lower health
status, and a poorer quality of life. These associa-
tions did not vary significantly by gender. Self-
reported depressive symptoms, corresponding
with prior research on sexual risk behaviors, was
most strongly linked with sexually explicit media
use. Further exploration of these relationships may
contribute to public health efforts targeting behav-
iors associated with high risks of HIV/STD trans-
mission and/or other preventable sexual health
The authors are indebted to Dog˘an Erog˘lu and John V.
Stevens, Jr. for their significant contributions to this
project. This research was supported in part by a grant
from the Center for Media Impact Research in the
Institute for Prevention of Addictions at Andrews Uni-
versity and by appointments of the second and third
authors to the Research Participation Program at the
Centers for Disease Control and Prevention (CDC)
administered by the Oak Ridge Institute for Science and
Education through an interagency agreement between
the U.S. Department of Energy and the CDC. The
findings and conclusions in this article are those of the
authors and do not necessarily represent the views of
the CDC or the U.S. Department of Health and
Human Services.
Corresponding Author: James B. Weaver, III, PhD,
MPH, Centers for Disease Control and Prevention,
1600 Clifton Road, NE, MS E-21, Atlanta, GA 30333,
USA. Tel: 404-498-0976; Fax: 404-498-0945; E-mail:
Conflict of Interest: None.
Statement of Authorship
Category 1
(a) Conception and Design
James B. Weaver, III; Stephanie Sargent Weaver;
Darren Mays; Gary L. Hopkins; Wendi Kannen-
berg; Duane McBride
(b) Acquisition of Data
James B. Weaver, III; Stephanie Sargent Weaver;
Gary L. Hopkins; Wendi Kannenberg; Duane
(c) Analysis and Interpretation of Data
James B. Weaver, III; Stephanie Sargent Weaver;
Darren Mays
Category 2
(a) Drafting the Article
James B. Weaver, III; Stephanie Sargent Weaver;
Darren Mays
(b) Revising It for Intellectual Content
James B. Weaver, III; Stephanie Sargent Weaver;
Darren Mays; Gary L. Hopkins; Wendi Kannen-
berg; Duane McBride
Category 3
(a) Final Approval of the Completed Article
James B. Weaver, III; Stephanie Sargent Weaver;
Darren Mays; Gary L. Hopkins; Wendi Kannen-
berg; Duane McBride
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... In addition to individual difference variables of pornography consumption, selfreported reasons can also be considered as factors that drive individuals to use pornography. Studies reported that sexual arousal and sexual enhancement were the predominant motivations for pornography consumption among the self-reported reasons [14,15]. Aside from the sexual arousal and enhancement, coping and boredom are linked with greater use of pornography as well [16,17]. ...
... Another reason for increased porn consuming could be that some people are using sex as a surviving mechanism for coping with their loneliness, depressive symptoms, and even fear of death [34][35][36]. In a study, Baltazar et al. [15] reported that people are endorsing porn use to cope with negative affect. Again, in a study, pornography consumption is an important tool for mood management and stress relief [16]. ...
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As the COVID-19 spread globally, social distancing, self-isolation/quarantine, and national lockdowns have become crucial to control the pandemic. However, these measures may also lead to increases in social isolation, loneliness, and stress, which can alter the consumption of pornography habits. The aim of the study was thus to explore the interest pattern in pornography and coronavirus-themed pornography during the COVID-19 outbreak. Google Trends® was employed to determine the most popular porn websites (Porn, XNXX, PornHub, xVideos, and xHamster), and coronavirus-themed pornography worldwide and in six nations with different COVID-19 outbreak and self-isolation recommendations. We analyzed every search trend on Google® from January 9, 2020 to May 25, 2020 using “joint point regression analysis”. Comparisons of week relative search volume (WRSV) and temporal patterns were analyzed to assess the change of interest in search terms during nations lockdowns. Paired t-test was used to compare WRSV values among the porn websites during the national lockdowns and the equivalent timespan of the weeks in the previous 4 years. The research trend of almost every keyword increased with significant inflection points for those nations with a straight “stay at home orders” (China, Italy, Spain, and France). “PornHub” and “Porn” showed the highest increase of interest worldwide with an average weekend percentage change (AWPC) of 4.9 and 3.8, respectively. The mean WRSV for keywords in USA and Sweden did not show a similar increase as the other nations. The WRSV percentage change with the historical data had a peak during the straight nations’ lockdowns (p < 0.01). All the nations had a significant increase in WRSV coronavirus-themed pornography for each keyword (p < 0.01) with an AWPC, ranging worldwide between 18.5 and 61.8 (p < 0.01), after the beginning of self-quarantine. As strengths this study uses a big data technology to collect worldwide trend of interest, however, data are anonymous and do not allow analysis of subpopulation groups. In conclusion, we demonstrated an increased interest in pornography and coronavirus-themed pornography after the outbreak of COVID-19 in nations with a straight “stay at home orders”.
... pornography use) and religious commitment (Perry and Hayward 2017;Short et al. 2015). Other studies, however, reflect inconsistent findings in this area (Baltazar et al. 2010). ...
... For instance, Grubbs et al. (2015) noted that there is an overwhelming presence of guilt and shame within faithbased youth communities for disregarding religious values that in turn may cause detachment from community, or from faith itself. Furthermore, according to Baltazar et al. (2010), 43% of males and 20% of females who struggle with SA/HD reported a deterioration in the quality of their relationship with GOD/Christ. ...
Sexual addiction (SA) and hypersexual disorder (HD) describe prevalent contemporary phenomena that the public remains poorly educated about. Notwithstanding widespread agreement among concerned stakeholders that SA and HD constitute an understudied and underappreciated challenge, the analysis digested in this research converges around the synthesis that Christian Education (CE) stakeholders have not yet had the intrepidity to meaningfully confront this issue. While SA/HD may cause serious bio-psychosocial and spiritual distress, including severe consequences for the affected and their family members, neither the condition, nor its aetiology, is well understood (or even acknowledged) by psychiatrists and medical professionals. Even the latest edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not include any mention of SA/HD. This treatise arises from a literature study, which the authors have supplemented with corresponding critical analysis. The synthesis suggests that religious/spiritual beliefs strongly impinge on both SA/HD aetiology and recovery prospects. Moreover, this study argues for more thematisation of SA/HD within CE environments. CE settings can provide a wholesome contextual environment where a better understanding of SA/HD can be mainstreamed and normalised—rather than moralised—for the greater good of both sufferers and society. This chapter charts pertinent perspectives, challenges and opportunities.
... On the one hand, religious orientations could prevent or reduce pornography consumption. People with greater religiosity may show relatively decreased tendencies to use pornography for multiple reasons [43,[45][46][47]. Church attendance, rather than religious identity per se, has been linked to lower likelihood of pornography use [48][49][50]. ...
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Purpose of Review The present review focuses on relationships between sexuality and religion, moral values, and ethics. Recent Findings Religious and ethical beliefs and moral values may influence sexuality including perception of pornography and its frequency of use, and engagement in sexual behaviors including pornography viewing may impact these domains. Summary Within this context, implications for sexuality and related psychiatric conditions and models (e.g., relating to compulsive sexual behavior disorder and moral incongruence) are considered.
... That is, pornography use is also often a result of coping motivations or a desire to reduce negative affect (Bőthe et al., 2020;Grubbs, Wright, et al., 2019). Using pornography in response to stress, depressive symptoms, and anxiety is commonly reported in studies of pornography use motivations (Baltazar et al., 2010;Paul & Shim, 2008), often being the second most common reason for such use after the pleasure-seeking reasons mentioned above (Grubbs, Wright, et al., 2019). ...
Of the many changes in daily life brought about by the COVID-19 pandemic, social distancing efforts and governmentally mandated lockdowns were among the most drastic. Coinciding with these changes, popular pornography websites made some previously premium content available for free, spurring dramatic increases in traffic to these websites. This increase in time spent at home and reported increases in traffic to specific pornographic websites led to some speculation that pornography use might generally increase over the course of the pandemic and that problematic use might also increase. To test these speculations and quantify the effects of the pandemic and its associated restrictions on social behaviors on pornography use, we analyzed data from a longitudinal sample of American adults. Baseline, nationally representative data were collected in August, 2019 via YouGov (N=2,518). Subsequent data were collected in February, 2020 (n=1,677), May, 2020 (n=1,533), August, 2020 (n=1,470), and October, 2020 (n=1,269). Results indicated that, in May, 2020, immediately following the height of the first wave of pandemic related lockdowns, more people reported past month pornography use than at any other time point. Among those who reported use in May, 2020, only 14% reported increases in use since the start of the pandemic, and their use returned to levels similar to all other users by August of 2020. In general, pornography use trended downward over the pandemic, for both men and women. Problematic pornography use trended downward for men and remained low and unchanged in women. Collectively, these results suggests that many fears about pornography use during pandemic related lockdowns were largely not supported by available data.
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Background Pleasure-seeking reasons are the main drivers of pornography use (PU), but the regulation of unpleasant states, namely distraction from or suppression of negative emotions and stress relief, are other potential predictors of this behavior. Aim Our main objective is to develop an explanatory model of problematic PU, assessing difficulties in emotion regulation, loneliness, perceived stress, as well as age and gender as predictors. Methods A cross-sectional study was conducted that included a total of 340 participants (M = 28.50 years, SD = 10.32). Self-report inventories were administered that measured problematic PU (PPCS), difficulties in emotion regulation (DERS-SF), loneliness (UCLALS-3), and perceived stress (PSS-10). Results The findings were indicative of recreational PU, with only a small number of participants (4.6%) reporting a possible problematic PU. There were statistically significant gender differences (F(1,337) = 33.306, P ≤ .001), namely that men were more likely to report problematic PU (M = 36.03, SD = 21.30) than women (M = 25.32, SD = 9.24). Problematic PU was significantly and positively correlated either with difficulties in emotion regulation, loneliness, perceived stress and age. Stepwise multiple linear regression analysis showed that difficulties in emotion regulation (β = 0.259, P ≤ .001), loneliness (β = 0.209, P = .001), and gender (β = -0.377, P ≤ .001) define the best subset of predictors of problematic PU. Age and perceived stress were not selected as predictors in this subset. Clinical Translation The promotion of better emotion regulation abilities and strategies for adaptive coping with loneliness must be taken into consideration, namely in cases of problematic PU or compulsive sexual behavior disorder. Strengths & Limitations Being a cross-sectional study with a convenience sample and the fact that these variables explain only a part of the explained variance of the problematic PU are the main limitations. Despite the limitations, the principal contribution of this study is the understanding that gender, difficulties in emotion regulation, and loneliness remain as main predictors of problematic PU, even when combined in the explanatory model. Conclusion The current study provides a better understanding of the predictors of problematic PU related with the reduction or avoidance of unpleasant states. Emotion regulation, loneliness, and perceived stress, studied simultaneously, provide a better understanding of the complex relationships between these factors and problematic PU. Difficulties in emotion regulation and loneliness are predictors of higher problematic PU, as well as the expected gender effect. Cardoso J, Ramos C, Brito J, et al. Predictors of Pornography Use: Difficulties in Emotion Regulation and Loneliness. J Sex Med 2021;XX:XXX–XXX.
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Introduction The proactive role of women in sexuality has been socially invisible, especially in regard to pornography use. For this reason, this study aims to explore Spanish women’s sexual experiences regarding viewing, arousal, and discomfort as perceived by different types of pornography and based on the women’s sexual orientation. Methods Between January and March 2019, 2730 Spanish women between 18 and 44 years old (M = 24.16; SD = 6.04) completed a questionnaire about the consumption of heterosexual, gay, and lesbian pornography and the discomfort they felt when they were aroused by this type of material. Regarding their sexual orientation, 78.1% were heterosexual, 15.4% were bisexual, and 6.5% were lesbian. Results In general, more lesbian and bisexual women consume pornography than heterosexual women do. In any case, all of them consume and are aroused by pornographic content based on a sexual orientation that differs from their reported sexual orientation. Women experience discomfort when viewing pornography, regardless of their sexual orientation and the type of content. Particularly, the youngest women are associated with discomfort when viewing heterosexual pornography, although the discomfort of older bisexual women is associated with gay and lesbian pornography. Conclusions Regardless of their reported sexual orientation, women view and feel aroused by different types of pornographic content. In addition, this study reveals their associated discomfort, which could interfere with their sexual health. Policy Implications Sexual health strategies should include a more active role of women in sexuality, as well as a more flexible conception of their sexual orientation to prevent stigmatizing them.
Full-text available
Of the many changes in daily life brought about by the COVID-19 pandemic, social distancing efforts and governmentally mandated lockdowns were among the most drastic. Coinciding with these changes, popular pornography websites made some previously premium content available for free, spurring dramatic increases in traffic to these websites. This increase in time spent at home and reported increases in traffic to specific pornographic websites led to some speculation that pornography use might generally increase over the course of the pandemic and that problematic use might also increase. To test these speculations and quantify the effects of the pandemic and its associated restrictions on social behaviors on pornography use, we analyzed data from a longitudinal sample of American adults. Baseline, nationally representative data were collected in August 2019 via YouGov (N = 2518). Subsequent data were collected in February 2020 (n = 1677), May 2020 (n = 1533), August 2020 (n = 1470), and October 2020 (n = 1269). Results indicated that, in May 2020, immediately following the height of the first wave of pandemic-related lockdowns, more people reported past-month pornography use than at other follow-up time points, but less did so than at baseline. Among those who reported use in May 2020, only 14% reported increases in use since the start of the pandemic, and their use returned to levels similar to all other users by August 2020. In general, pornography use trended downward over the pandemic, for both men and women. Problematic pornography use trended downward for men and remained low and unchanged in women. Collectively, these results suggest that many fears about pornography use during pandemic-related lockdowns were largely not supported by available data.
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The international literature has shown that self-perceived problematic pornography use is often related to lower levels of relationship satisfaction, as well as to higher levels of negative body image and depression. In this study, 158 Italian gay (65.8%) and bisexual (34.2%) men reported on their body image, Internet pornography use, and indicators of their individual and relational well-being. We hypothesized that individuals who report higher levels of relationship dissatisfaction, negative body image, and with higher self-perceived problematic pornography use would also present higher levels of depression. As predicted, relationship satisfaction was inversely related to male body image, self-perceived problematic pornography use, and depression. We also hypothesized the direct and indirect effects of depression on self-perceived problematic pornography use, through the mediating variable of relationship satisfaction. As predicted, depression, via relationship satisfaction, was related to self-perceived problematic pornography use. Implications for future research and policies are discussed.
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This study sought to examine the relationship between the sexual compulsivity, emotional and spiritual distress of religious and non-religious adults who sought assessment for pornography addiction on the Internet. Religious (n = 350) and non-religious (n = 114) data were analyzed separately with a one-way between-subjects multivariate analysis of variance. The Kalichman Sexual Compulsivity Scale was used to divide the religious and non-religious into three groups: non-sexually compulsive (NCs); moderately sexually compulsive and sexually compulsive (SCs). All of the dependent variables, except age, were significantly higher for SCs than NCs for the religious. For the non-religious, all of the dependent variables, except age and time spent viewing Internet pornography (IP), were significantly higher for SCs than NCs. The non-religious spent significantly more time viewing IP than the religious. Yet, the religious were significantly more sexually compulsive. Emotional distress and spiritual distress were found to be significantly higher for SCs than the NCs regardless of religiosity. The non-religious were significantly more anxious and stressed than the religious. Specific religious affiliations did not have any significant bearing on the degree of sexual compulsivity. Religious practice, being associated with less viewing of IP, suggests the likelihood that moral reasons may provide some rationale for not viewing IP. At the same time, religious practice might reinforce shame in the addiction cycle thus religious individuals may be more at-risk to developing a compulsive pattern of viewing IP. The implications of the findings and suggestions for future research are presented.
Pornography viewing has been cross-sectionally and longitudinally linked to poorer romantic relationship quality. However, only a few studies have looked at (1) the associations of changes in pornography viewing over time with relationship characteristics, (2) differential impacts of watching alone and watching with one's partner, and (3) how gender moderates these associations. The current study utilizes multilevel modeling to assess for between- and within-subject effects of watching pornography alone versus together on romantic relationship quality over time. A random national sample of 1,234 individuals, who began the study in unmarried heterosexual romantic relationships of at least 2 months' duration, completed five waves of mail-in surveys over a 20-month period. Watching pornography alone was generally associated with poorer relationship quality for men (e.g., lower relationship adjustment and commitment, less emotional intimacy), but better relationship quality for women. People who reported watching more pornography with their partner reported more relationship intimacy and increases in watching together over time were associated with increases in sexual intimacy. Both watching alone and watching together were related to higher levels of psychological aggression between partners, with few differences by gender. Implications for sex education, relationship education, and couples therapy will be discussed.
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Past studies have demonstrated an inverse relationship between religiosity and addictive behaviors, such as gambling, smoking, alcoholism, and substance use. This association suggests that religiosity may act as a buffer against such behaviors. In recent literature, Internet-based pornography involvement has been identified as an addictive behavior, and popular Christian writing has suggested that it is affecting the Church. In this study, the relationship between religiosity and cyberporn involvement was examined among 125 undergraduate, college males. Findings suggested that involvement in Internet-based pornography among participants was prevalent. Furthermore, religiosity was not inversely related to the use of online sexual materials. (PsycINFO Database Record (c) 2012 APA, all rights reserved)(journal abstract)
There are limited hemodynamic data in women with arousal or orgasmic disorders and even fewer normative control hemodynamic data in women without sexual dysfunction. In addition, there is limited experience with topical vasoactive agents (used to maximize genital smooth muscle relaxation) applied to the external genitalia during hemodynamic evaluations. The aim of this study was to report duplex Doppler ultrasound clitoral cavernosal arterial changes before and after topical PGE-1 (Alprostadil) administration in control women and in patients with arousal and orgasmic sexual disorders. We found that women with sexual arousal and orgasmic disorders had significantly (p
Religion is one of the major forces of control over sexuality, and many studies have observed an inverse relationship between religiosity and sexual permissiveness. The Religious Orientation Scale has been used to study the relationship between religious orientation and sexuality. It has been found that those with intrinsic views are more conservative in their sexual values while those who are extrinsic have more liberal views. The purpose of this study was to use the Religious Life Inventory, an instrument that also has a quest orientation, to evaluate the relationship between religious orientation and various premarital sexual activities and attitudes within a sample of conservative religious students. Inverse correlations were found for those with internal and external scores, while weak but positive correlations were found for those with quest scores. These findings suggest that those with a more open-minded position on religion may have the same open-minded position on sexuality.