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  1. 1. ORIGINAL PAPER Promotion of Sexual Health and Sexual Responsibility in Women’s Health and Men’s Health Magazines P. Cougar Hall • Joshua H. West • Brianna Magnusson • Abigail Cox Ó Springer Science+Business Media New York 2014 Abstract This study analyzed the promotion of sexual health and sexual responsibility in Women’s Health and Men’s Health magazines as characterized by the Surgeon General’s Call to Action along with sexual health objectives targeted by Healthy People 2020 and sexual healthy behavior outcomes established by the Centers for Disease Control and Prevention. This study also identified the most frequently addressed sexual health topics included in Women’s Health and Men’s Health. Two coders conducted a content analysis of a total of 599 articles from 64 issues (32 Women’s Health and 32 Men’s Health) published between January 2009 and November 2012. More than half of all articles addressing sexual health were found to promote sexual health (57 %). Promotion of sexual responsibility was rare with variables such as ensuring that pregnancy occurs only when desired, recog- nition and tolerance for diversity, limiting the number of sexual partners, and using birth control consistently each mentioned in 3 % of articles in this study sample. Among topics coded, improving sex life (29 %), what men like (19 %), and what women like (18 %) were the most common in Women’s Health while What women like (46 %), improving sex life (27 %), and other men’s sexual health (16 %) were the most frequent topics in Men’s Health. Among the least common topics men- tioned were homosexuality (0.16 %) and HIV/AIDS (0.33 %). No articles addressed rape or dating violence. P. C. Hall (&) Brigham Young University, RB 229-E, Provo, UT 84602, USA e-mail: cougar_hall@byu.edu J. H. West Brigham Young University, RB 229-D, Provo, UT 84602, USA B. Magnusson Brigham Young University, RB 229-B, Provo, UT 84602, USA A. Cox Brigham Young University, RB 221, Provo, UT 84602, USA 123 Sexuality & Culture DOI 10.1007/s12119-014-9239-0
  2. 2. Keywords Sexual health Á Sexual responsibility Á Magazines Á Women’s health Á Men’s health Introduction Sexual health and sexual responsibility are primary concerns of government agencies charged with promoting public health. For three decades the United States Department of Health and Human Services (USDHHS) has collaborated with a variety of other federal agencies in establishing the Healthy People objectives and benchmarks for improving the health of all Americans. Included in the Healthy People 2020 objectives are goals related to the promotion of sexual health and sexual responsibility. As the leading spokesperson on matters of public health in the Unites States, the Surgeon General reports directly to the USDHHS on public health and scientific issues related to sexual health. The Centers for Disease Control and Prevention (CDC) likewise works to promote sexual health and have established desired healthy behavior outcomes related to sexual health. Sexual health is a state of physical, mental and social well-being in relation to sexuality (USDHHS 2001). It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence (World Health Organization 2006). Personal sexual responsibility is an essential component of sexual health at both the individual and community level. The US Surgeon General’s 2001 report entitled The Surgeon General’s Call to Action to Promote Sexual Health and Responsible Sexual Behavior, identifies five components of personal sexual respon- sibility: (1) understanding and awareness of one’s sexuality and sexual development; (2) respect for oneself and ones’ partner; (3) avoidance of physical or emotional harm to either oneself or one’s partner; (4) ensuring that pregnancy occurs only when welcomed; (5) recognition and tolerance of diversity in sexual values within any community (USDHHS). The Call to Action recommends increasing public awareness as a key strategy in promoting sexual health and responsible sexual behavior. One potential source for disseminating information and raising awareness presented in the Call to Action is mass media, including magazines. Magazines are a frequent and trusted source of general health and sexual health information among both adults and adolescents (Hesse et al. 2005). Health and lifestyle magazines, in particular, represent a popular publication genre where sexual health issues are frequently presented. Women’s Health (WH) and Men’s Health (MH) magazines published by Rodale Press Inc. are two of the most popular magazines in this genre providing readers with content related to fitness, nutrition, sexuality, fashion, travel, technology, and finance. WH magazine is among the most circulated women’s health and lifestyle magazines in the world. WH has 17 editions in 27 countries, reaches 15 million readers per month, enjoys a US circulation of 1.5 million, and ranks among the top 20 of all US magazines for single-copy sales (Rodale Inc 2013a). Each issue of WH includes columns such as Ask the Guy Next Door, Sex Scoop, Health Dose, Sex and Love, and Kiss and Tell. MH is the most circulated P. Cougar Hall et al. 123
  3. 3. men’s health and lifestyle magazine in the world. As of 2013, MH had 40 editions in 47 countries and a US circulation of 1.8 million—the highest among all health and fitness magazines. MH ranked in the top 15 for single-copy sales making it the best- selling men’s magazine on US newsstands in 2012 (Rodale Inc 2013b). With regular columns such as Sex Bulletin, Sex & Relationships, Ask the Girl Next Door, and The Best Life, promotion of sexual health is a primary focus of MH each month. A body of research has examined sexual health messages in popular magazines. Batchelor et al. (2004) examined messages related to sexual health in media outlets, including magazines, popular with adolescents in the UK. The authors reported that the frequency of messages promoting personal decision making related to sexual activity for females was mostly encouraging. However, content specifically directed at males, addressing diversity in sexual orientation, or addressing sexual respon- sibility was largely absent. Hust et al. (2008) conducted a similar content analysis of adolescent media consumption in the US and concluded that the overwhelming majority of sexual content did not promote sexual health. Furthermore, the authors concluded that the few sexual health promotion messages identified were largely inaccurate, ambiguous, and reinforced inequitable gender stereotypes related to sexual responsibility. Larry and Grabe (2005) conducted a content analysis of sexual health promotion messages related to sexually transmitted diseases in popular men’s and women’s magazines. This study identified comparatively fewer messages in men’s magazines related to sexual health promotion and prevention of sexually transmitted disease. Walsh-Childers (1997) conducted an extensive review of sexual health coverage in women’s, men’s, and teen’s magazines. HIV/AIDS was the most common sexual health topic, appearing in 14 % of men’s magazine articles addressing sexual health. By comparison, topics coded as ‘‘non-sexual health’’ such as sexual activity, enhancing sex appeal, and sexual fantasies were present in 47 % of articles coded. Stibbe (2004) conducted a critical discourse analysis of masculinity as presented by six MH magazines. A key characteristic of the ideal man as constructed in MH is sexual prowess, or as Stibbe states, ‘‘a sexual champion’’ (p. 46). Stibbe concluded that while sexual content, essentially in the form of sexual tips, tricks, and techniques is abundant in MH, its pages are void of messages promoting sexual health and sexual responsibility. As analyzed by Stibbe, instead of promoting a sexual health goal, MH merely reinforces a form of hegemonic masculinity which turns a blind eye to safe sex practices, equitable relationships, and non-heterosexual expression. Studies of sexual health topics in magazines to this point have not utilized federal guidelines for assessing the inclusion and frequency of sexual health and sexual responsibility content. The use of such guidelines may be important insomuch as they represent the standards by which public health agencies develop sexual health interventions. The purpose of this study was to analyze the promotion of sexual health and sexual responsibility in MH magazine as characterized by the Surgeon General’s Call to Action along with sexual health objectives targeted by Healthy People 2020 and sexual health behavior outcomes established by CDC (2008). In addition, this study sought to broadly identify the most frequently addressed sexual health messages in WH and MH. Promotion of Sexual Health and Sexual Responsibility 123
  4. 4. Methods Sample The study sample was comprised of 599 articles from a total of 64 issues of WH and MH (32 each) published between January 2009 and November 2012. Procedure Following initial training related to each study measure, two coders, the principal investigator (PCH) and a research assistant, independently analyzed 15 articles from three randomly selected WH and MH issues included in the study sample. Concordance between the two coders was 88 %, exceeding inter-rater reliability standards established in the literature (Landis and Koch 1977). Thirty-two issues of WH and 32 issues of MH included in the study sample were then randomly assigned to each coder. Coders searched each of issue for articles addressing sexual health topics. Articles identified as addressing topics related to sexual health were then analyzed using the study code book. Coding results for each individual article were entered into an electronic coding sheet that captured and stored data for each article. When both coders had completed an analysis of each assigned issue, 15 articles were again randomly selected for analysis by both coders to check for rater-drift. Coder agreement was 86 %, again exceeding reliability standards. Measures Articles were coded for article length, type and topic. Length of the article was coded as small, medium, or large. Articles consisting of one paragraph or less were coded as small, those 2–5 paragraphs in length were coded as medium and articles with six or more paragraphs were coded as large. Article type was defined as (1) feature/cover story or (2) a general information article. Feature/cover story articles were limited to those included in the first page of the table of contents. General information articles were those listed on subsequent table of contents pages, often labeled ‘‘Departments’’ with regularly occurring columns of the magazine. These general information articles were coded by column title (e.g., Sex Bulletin, The Best Life). Together with article length, this is an important distinction in differentiating passing reports of sexual research, facts and figures from detailed writing related to sexuality and sexual health. Articles were coded for sexual health and sexual responsibility according to guidelines defined by the WHO, Surgeon General’s Call to Action, and Healthy People 2020/CDC. Promotion of Sexual Health Articles were coded as either promoting sexual health or not promoting sexual health based upon the following definition of sexual health: state of physical, mental and social well-being in relation to sexuality; requires a positive and respectful approach P. Cougar Hall et al. 123
  5. 5. to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. Surgeon General’s Call to Action Articles were coded for inclusion of the goals and objectives included in the Surgeon General’s Call to Action, specifically: (1) understanding and awareness of one’s sexuality and sexual development (e.g., sexual attitudes, beliefs, body changes, evolving beliefs, changes in desire and thoughts, questions about other lifestyles and orientations); (2) respect for oneself and one’s partner (e.g., sexual dignity, meeting a sexual partner’s needs, selflessness); (3) avoidance of physical or emotional harm to either oneself or one’s partner (e.g., not hurting self or partner during sexual activity, avoidance of emotional harm from sexual activity, avoiding harm caused by cheating or infidelity); (4) ensuring that pregnancy occurs only when welcomed (e.g., contraception, family planning); and (5) recognition and tolerance of diversity in sexual values within any community (e.g., recognition of sexual minorities, tolerance for diverse sexual attitudes, cultures, and orientations). Healthy People 2020/Centers for Disease Control and Prevention Articles were coded for inclusion of the following sexual health goals and sexual healthy behavior outcomes representative of both Healthy People 2020 and CDC objectives: (1) Avoid pressuring others to engage in sexual behaviors; (2) Seek health care professionals to promote sexual health; (3) Limit the number of sexual partners if sexually active; (4) Use condoms consistently and correctly if sexually active; and (5) Use birth control consistently and correctly if sexually active In addition, articles were coded for inclusion of the following 18 sexual health topics: improving sex life, what women like, what men like, improving a woman’s orgasm, improving a man’s orgasm, sexual satisfaction, HIV/AIDS, STDs, rape/ dating violence, pregnancy, condoms, other contraception, other women’s sexual health, other men’s sexual health, gay men, lesbians, drugs/alcohol, and other. Detailed topic descriptions and examples are provided Table 1. Analysis Descriptive statistics were calculated for each of the study variables. Separate rates were calculated for WH and MH. Chi square test statistics were computed to compare articles from WH and MH on variables included within the categories of article topic, promoting sexual health, Surgeon General’s Call to Action, and Healthy People 2020/CDC. Results Table 2 includes descriptive information related to article length, article type, article topic, and promotion of sexual health. The majority (62 %) of coded articles were Promotion of Sexual Health and Sexual Responsibility 123
  6. 6. less than one paragraph in length (‘‘small’’) and fewer than 1/3 of sexual health articles (29 %) contained 6 or more paragraphs (‘‘large’’). Most articles were general information (79 %) as opposed to feature or cover stores (17 %). For general information articles published in WH, the most common columns addressing sexual health were Sex Scoop (22 %) and Ask the Guy Next Door (13 %). Similarly, for articles published in MH the most common columns Table 1 Coding topics with descriptions or examples Topic Descriptions or examples Improving sex life Strategies for getting more sex Achieving better sex or sex more consistent with the potential reader’s perceived desires and interests What women like Preferences, likes and dislikes, relative to sex or sexual relationships Sexual techniques that women enjoy or endorse Physical or personality traits of a preferred or potential sex partner What men like Preferences, likes and dislikes, relative to sex or sexual relationships Sexual techniques that men enjoy or endorse Physical or personality traits of a preferred or potential sex partner Improving a woman’s orgasm Information or techniques for improving a woman’s orgasm quality, strength, duration or frequency Improving a man’s orgasm Information or techniques for improving a man’s orgasm quality, strength, duration or frequency Sexual satisfaction Information related to personal contentment of current sexual experiences and sex life (as opposed to advice on how to improve one’s sex life HIV/AIDS Any mention STDs Any mention Rape/dating violence date rape or acquaintance rape Sexual harassment Sexual cyber-bullying Date rape drugs other than alcohol Pregnancy Any mention Condoms Any mention Other contraception Any mention (e.g. vasectomy, tubal ligation, birth control pill, natural family planning) Other women’s sexual health Female reproductive health (e.g. sexuality during or just following pregnancy, cervical cancer, poly-cystic ovarian syndrome, female genital cutting, breast cancer, vaginal dryness, sexual dysfunction, abortion) Other men’s sexual health Male reproductive health (e.g. testicular cancer, prostate health, erectile dysfunction) Gay men Any mention of male non-heterosexual orientation or behavior Lesbians Any mention of female non-heterosexual orientation or behavior Drugs/alcohol Content connecting drugs and alcohol to sexual behaviors and outcomes (e.g. bars and clubs as locations for finding sexual partners, alcohol and sexual performance) Other Sexual information not coded in the categories listed above P. Cougar Hall et al. 123
  7. 7. Table 2 Article characteristics and content for a sample of articles discussing sexual health published in Men’s Health and Women’s Health January 2009–November 2012 Variable Category Men’s Health Magazine (n = 279) Women’s Health Magazine (n = 320) n % n % Article length Small 168 60.22 206 64.38 Medium 29 10.39 22 6.88 Large 82 29.39 92 28.75 Type of article General information 226 81.00 246 76.88 Feature 41 14.7 58 18.12 Ask 21 7.53 9 2.81 Ask guy next door 0 0 42 13.12 Ask girl next door 64 22.93 0 0 Sex scoop 0 0 71 22.19 Bulletin 80 28.67 0 0 The best life 15 5.38 0 0 Health dose 0 0 15 4.69 Sex ? love 0 0 37 11.56 Your 2 cents 0 0 7 2.19 On our radar 4 1.43 0 0 How to do everything better 3 1.08 0 0 Love and life 0 0 4 1.25 Kiss and tell 0 0 21 6.56 Sex secrets 0 0 2 0.63 Other 50 17.92 68 21.25 Article topic Improving sex life 75 26.88 94 29.38 What women like*** 129 46.24 57 17.81 What men like* 35 12.54 62 19.38 Improving woman’s orgasm 22 7.89 20 6.25 Improving man’s orgasm 9 3.23 5 1.56 Sexual satisfaction 13 4.66 10 3.12 HIV/AIDS 1 0.36 1 0.31 STDs 9 3.23 12 3.75 Rape 0 0 0 0 Pregnancy* 4 1.43 14 4.38 Condoms 13 4.66 10 3.12 Other contraception* 5 1.79 17 5.31 Other women’s sexual health*** 10 3.58 80 25 Other men’s sexual health*** 44 15.77 17 5.31 Gay men 1 0.36 0 0 Lesbians 2 0.72 0 0 Drugs/Alcohol 5 1.79 7 2.19 Other 22 7.89 26 8.12 * P .05; *** P .001 Promotion of Sexual Health and Sexual Responsibility 123
  8. 8. addressing sexual health were Sex Bulletin (29 %) and Ask the Girl Next Door (23 %). Table 3 includes sexual health and sexual responsibility variables derived from the Surgeon General’s Call to Action, and Healthy People 2020/CDC objectives. Following the Surgeon General guidelines, understanding and awareness of one’s own sexuality was present in 26 % of WH articles compared to 20 % of MH articles, respect for oneself and one’s partner was less common in WH (16 %) than MH (25 %) (P .01), and avoidance of physical or emotional harm were approximately the same for both (17 %). Ensuring that pregnancy occurs only when desired (WH—2 %; MH—0.72 %) and recognition and tolerance for diversity (WH—3 %; MH—2 %) were infrequent article topics in both magazines. Among measures of Healthy People 2020/CDC objectives for sexual health, seeking a healthcare professional (WH—11 %; MH—9 %) was the most common topic mentioned. Of the remaining Healthy People 2020/CDC objectives, none exceeded 4 %. Most notably, limiting the number of sexual partners and using birth control consistently were both mentioned in 1 % of articles in this study sample. The most common article topics for WH were improving sex life (29 %), what men like (19 %), and what women like (18 %). Conversely, what women like Table 3 Proportion of sexual health articles containing sexual health promotion content as defined by the U.S. Surgeon General’s Call to Action and Healthy People 2020/CDC objectives for articles published in Men’s Health and Women’s Health January 2009–November 2012 Variable Category Men’s Health Magazine (n = 279) Women’s Health Magazine (n = 320) n % n % Promotes Sexual Health (yes): 161 57.71 185 57.81 Surgeon General’s Call to Action- Does the article promote (yes): Understanding and awareness of one’s sexuality/sexual development 55 19.71 83 25.94 Respect for oneself and one’s partner** 70 25.09 52 16.25 Avoidance of physical or emotional harm 48 17.20 54 16.88 Ensuring that pregnancy occurs only when desired 2 0.72 7 2.19 Recognition and tolerance of diversity 5 1.79 9 2.81 Healthy People 2020/CDC objectives-Does the article promote (yes): Avoid pressuring others to engage in sexual behaviors 5 1.79 2 0.62 Seek health care professional 26 9.32 34 10.62 Limit the number of sexual partners 2 0.72 1 0.31 Using condoms consistently 10 3.58 11 3.44 Using birth control consistently 1 0.36 2 0.62 ** P .01 P. Cougar Hall et al. 123
  9. 9. (46 %), improving sex life (27 %), and other men’s sexual health (16 %) were the most common article topics in MH. Improving women’s orgasm was more common than improving men’s orgasm, independent of whether the article was published in WH or MH. Among the least common article topics were those that mentioned homosexuality (0.16 %) and HIV/AIDS (0.33 %). No articles addressed rape or dating violence. More than half of all articles mentioning sexual health were found to promote sexual health (57 %). When comparing article topics between the two magazines, what women like (P .001) and other men’s sexual health (P .001) were more common in MH, compared to WH. What men like (P .05), pregnancy (P .05), other contraception (P .05), and other women’s sexual health (P .001) were all more common in WH, compared to MH. Discussion Magazines represent a popular medium for presenting and promoting sexual health messages. Sexual health topics were common in both the WH and MH magazine issues analyzed in this study. Articles mentioning sexual health in both magazines frequently focus on improving one’s sex life. Improving one’s sex life is an important health promotion topic as sexual satisfaction is related to relationship quality, marital stability, and overall quality of health (Rosen and Bachman 2008; Sprecher 2002; Yeh et al. 2006). Both what women like and what men like are also frequent topics in WH and MH magazines. In particular, nearly half of all MH articles addressing sexual health focus on what women like. Helping MH readers better meet a woman’s sexual needs is largely consistent with the goal to establish respect for oneself and one’s partner outlined in the Surgeon General’s Call to Action. With articles such as Say This, Have Sex (Men’s Health, Jan/Feb, 2009), however, the argument can be made that such a focus in MH has less to do with meeting a female partner’s needs as it does attracting a female partner to meet a man’s needs. By comparison, only one-fifth of WH articles addressing sexual health focus on what men like. Of particular note is a greater focus in WH than MH on sexual satisfaction, or getting more sex, better sex, or sex more consistent with one’s desires and interests. In MH what men like is an infrequent topic mentioned approximately once for every four mentions of what women like. Sexual satisfaction, although a topic in more than one-quarter of MH articles coded in this study, was less common in MH than in WH. The comparatively heightened focus in WH on improving sex life, what women want, and sexual satisfaction can be viewed as encouraging and liberating in the promotion of women’s sexual health. Similarly, more than one-quarter of articles addressing sexual health in WH include information directed at understanding and awareness of one’s sexuality and sexual development. Both WH and MH magazines analyzed in this study fall short in addressing many relevant sexual health topics. Very few articles in either magazine address critical topics included in the Surgeon General’s Call to Action, and Healthy People 2020/ CDC objectives for sexual health such as HIV/AIDS, STDs, rape or dating violence, pregnancy, and issues related to LGBT sexual health. Promotion of Sexual Health and Sexual Responsibility 123
  10. 10. About 1.1 million people in the United States and 34 million in the world are currently living with HIV, with approximately 50,000 and 2.5 million new cases respectively each year (CDC 2013). AIDS is responsible for approximately 50,000 deaths in the U.S. and 17 million deaths globally each year. The CDC estimates that 20 million new STD infections occur annually, with a total of $16 billion in medical costs in the U.S. (CDC). Walsh-Childers (1997) reported 14 % of sexual health articles included information about HIV/AIDS. Only 21 of the 599 articles reviewed in the current study mentioned STDs in general, and just two articles discussed HIV/ AIDS in particular. One notable exception was When Did Unsafe Sex Stop Being Scary (Women’s Health, January/February, 2010) which targets the danger of a ‘‘mating-without-dating’’ multiple sex partner lifestyle and subsequent STD risks. While such articles are rare in WH, they are even harder to find in MH. In the current study STDs were discussed in approximately 3 % of sexual health articles in both WH and MH, yet there were 25 % more STD mentions in WH overall. Comparing STD content in men’s and women’s magazines, Larry and Grabe (2005) identified comparatively fewer messages targeted at men. Similar to Stibbe’s (2004) conclusion that MH has turned a blind eye to important issues such as safe sex, the findings from the current study show both WH and MH fail to take advantage of the opportunity to promote sexual health by addressing STDs, including HIV/AIDS. Rape and dating violence continue to be primary public health concerns in the US where one in six women and one in 33 men have experienced an attempted or completed rape in their lifetime (Elliot et al. 2004). Rates of unplanned pregnancies have increased for young adults over the age of 20 in recent years (Palmetto et al. 2013). Not a single mention of rape or dating violence was identified among the 599 articles analyzed in the current study. It is possible that readers of WH and MH may identify topics such as bedroom boredom, weak orgasm, and erectile dysfunction as greater threats to sexual health than rape or dating violence based upon findings from this study. Similar to the analysis by Batchelor et al. (2004) in the UK, the current study identified a void of information related to diversity in sexual orientation and sexual responsibility. Sexual health risks are highest among sexual minorities, who along with the threat of STDs and sexual violence, often face additional mental, emotional, and social challenges related to discrimination. In accordance with the Surgeon General’s Call to Action, a great need for increased attention and focus on recognition and tolerance for sexual diversity exists. There was no mention of homosexuality among the 35 issues and 320 articles coded in WH. The sole mention of male homosexuality in MH in this study sample was the following question for Jimmy the Bartender in The Best Life section of the March 2012 issue: ‘‘I’m certain my friend is gay, but hasn’t come out yet. Do I bring it up?’’ Jimmy’s response was: What makes you so sure? Is it the way he talks or dresses? Is it the things he talks about or the people he hangs out with? Maybe your hunch is dead-on, but maybe (have you considered this?) it’s not. Either way, unless you think he’s going through a tough time and you want to show support, why bring it up? If he has something to say to you, he will. Until that time, his business is none of yours. (p. 70) P. Cougar Hall et al. 123
  11. 11. The two coded incidents of female homosexualilty in MH were mentions of heterosexual or non-lesbian women enjoying ‘‘girl-on-girl’’ action, and a declaration that a man’s ‘‘threesome fantasy may not be so far-fetched’’ (Men’s Health, June, 2011, p. 42). In his review of MH, Stibbe (2004) highlighted the magazine’s singular focus on heterosexual expression. Granted both WH and MH target a heterosexual audience, yet with its large and growing circulation in the US and globally, both magazines have an opportunity to address sexual diversity in more meaningful ways and increase tolerance and understanding while promoting sexual responsibility for all. Fifty-eight percent of articles in this study sample from both WH and MH were coded as promoting sexual health. In their analysis of sexual health messages in young adolescents’ media, Hust et al. (2008) found little promotion of sexual health. While sexual content in media was common, it was rarely discussed in a way that would promote sexual health. The conceptualization used by Hust et al. was based upon national guidelines developed for sexuality education in the 1990s by the Sexuality Information and Education Council of the United States and focused on taking responsibility for sexual health, contraception, prevention of unwanted pregnancy, and prevention of STDs. The current study used a considerably broader definition of sexual health based upon the WHO and the Surgeon General’s Call to Action which may explain its discrepancy with the Hust et al. findings. It is noteworthy that coders of the current study were largely dissatisfied with the broad definition of sexual health promotion used in analyzing the WH and MH issues in this study sample. The consensus among coders following the analysis was that both WH and MH consistently missed out on opportunities to promote sexual health in meaningful ways. Coders’ perceptions of missed opportunities in promoting safer sexual practices, including the correct and consistent use of condoms to prevent unwanted pregnancies and STDs is largely supported by the results of coding for specific sexual health topics which demonstrate that these key sexual health promotion topics occur infrequently in WH and MH. Promotion of sexual responsibility in WH and MH is infrequent as measured using the Surgeon General’s Call to Action and Healthy People 2020/CDC objectives. The most infrequent measures of sexual responsibility identified in this study were using birth control consistently, ensuring that pregnancy occurs only when desired, and limiting the number of sexual partners. These findings are similar to previous research including Batchelor et al. (2004) and Walsh-Childers (1997). It is very clear that while WH and MH both commonly address sexuality and sexual health, the intent of these magazines is not to promote sexual responsibility as defined by the Call to Action or Healthy People 2020/CDC objectives. Messages related to limiting the number of sexual partners or tips on how to avoid pressuring others to engage in sexual behaviors may not sell magazines in quite the same way that Sex So Good…the Neighbors will Complain (Men’s Health, July/August, 2010) and Have Electric Sex Tonight (Women’s Health, September, 2012) can. Perhaps the Surgeon General’s expectation for promotion of sexual responsibility through the mass media is incongruent with a publisher’s expectation to produce a profit and provide readership with content it desires. Promotion of Sexual Health and Sexual Responsibility 123
  12. 12. Limitations This study has several key limitations. First, while pre- and post-measures of acceptable inter-rater reliability were established in this study, content analysis is a limited research methodology prone to rater bias. Second, the validity of a key coding variable used in this study, promotion of sexual health, may be limited. Despite a high rater-reliability, questions of validity arise given the broad definition of sexual health used in study. While more than half of all articles coded in this study were found to promote sexual health, very few addressed key components of sexual health promotion such as safe sexual experiences, and freedom from coercion, discrimination, or violence. Many articles included in this study sample were coded as promoting sexual health despite these important omissions because they generally met at least one part of the definition for sexual health. Coders were obligated to indicate an article promoted sexual health based upon codebook instructions and descriptions in instances where both WH and MH likely fell short in fully promoting key aspects of sexual health. This limitation was minimized by coding for a large number of individual article topics revealing that both WH and MH could improve their promotion of sexual health topics. Finally, this study is limited by a largely descriptive methodology of articles coded for inclusion of key topics, rather than the quality and accuracy of which those topics were presented. Future studies should explore the quality and accuracy of the sexual health promotion messages and topics addressed in WH and MH. Conclusion While sexuality and sexual health are frequently included in WH and MH, few articles fully address sexual health and sexual responsibility as defined by leading health authorities in the US. Moving forward, public health may consider ways to partner with the publisher of WH and MH in such ways that both parties’ interests are addressed, whereby WH and MH can increase promotion of sexual health and sexual responsibility while continuing to be leading magazines for readers interested in health and fitness. Future research may address the extent to which magazine editors view such efforts as compatible with the magazines’ publishing objectives. Additionally, researchers may explore the extent to which readers would be accepting of this type of sexual health and sexual responsibility content. References Batchelor, S., Kitzinger, J., & Burtney, E. (2004). Representing young people’s sexuality in the ‘‘youth’’ media. Health Education Research, 19(6), 669–676. Centers for Disease Control and Prevention. (2008). Health education curriculum analysis tool. GA: Atlanta. Centers for Disease Control and Prevention. (2013). Incidence, prevalence, and cost of sexually transmitted infections in the United States. Retrieved from http://www.cdc.gov/std/stats/STI- Estimates-Fact-Sheet-Feb-2013.pdf on March 28, 2013. P. Cougar Hall et al. 123
  13. 13. Elliot, D., Mok, D., & Briere, J. (2004). Adult sexual assault: Prevalence, symptomology, and sex differences in the general population. Journal of Traumatic Stress, 17(3), 203–211. Have Electric Sex Tonight. (September, 2010). Women’s Health, (pp 93–94). Hesse, B., Nelson, D., Kreps, G., Crowyle, R., Arora, N., Rimer, B., et al. (2005). Trust and sources of health information. Archives of Internal Medicine, 165, 2816–2824. Hust, S., Brown, J., L’Engle, K., & Murrow, E. (2008). Boys will be boys and girls better be prepared: An analysis of the rare sexual health messages in young adolescents’ media. Mass Communication and Society, 11(1), 3–23. Jimmy the Bartender. (2012, March). Men’s Health, (p. 70). Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174. Larry, A. & Grabe, M. (2005). Media coverage of sexually transmitted infections: A comparison of popular men’s and women’s magazines. Journal of Magazine and New Media Research, Summer, 1–23. Palmetto, N., Davidson, L., Breitbart, V., & Rickert, V. I. (2013). Predictors of physical intimate partner violence in the lives of young women: Victimization, perpetration, and bidirectional violence. Violence and Victims, 28(1), 103–121. Rodale Inc. (2013a) About the brand. Retrieved from http://www.rodaleinc.com/brand/womens-health on December 19, 2013. Rodale Inc. (2013b) About the brand. Retrieved from http://www.rodaleinc.com/brand/mens-health on December 19, 2013. Rosen, R., & Bachman, G. (2008). Sexual well-being, happiness, and satisfaction, in women: The case for a new conceptual paradigm. Journal of Sex and Marital Therapy, 34(4), 291–297. Sex so Good…the Neighbors will Complain. (July/August, 2010). Men’s Health, 114–116. She Kissed a Girl (and Liked It). (2011, June). Men’s Health, 42. Sprecher, S. (2002). Sexual satisfaction in premarital relationships: Associations with satisfaction, love, commitment, and stability. Journal of Sex Research, 39(3), 190–196. Stribbe, A. (2004). Health and the social construction of masculinity in Men’s Health magazine. Men and Masculinities, 7(1), 31–51. U.S. Department of Health and Human Services. (2001). The Surgeon General’s call to action to promote the sexual health and responsible sexual behavior. Rockville, MD. U.S. Department of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthy People 2020. Washington, DC. Retrieved from www.healthypeople.gov/2020 on December 19, 2013. Walsh-Childers, K. (1997). Sexual health coverage: Women’s, men’s, teen and other specialty magazines. Columbia Journalism Review, 36(suppl), 1–12. When did Unsafe Sex Stop Being Scary. (January/February, 2010). Women’s Health, 114–117. World Health Organization. (2006). Defining sexual health: Report of a technical consultation on sexual health, 28–31 January 2002, Geneva. Retrieved from http://www.who.int/reproductivehealth/ publications/sexual_health/defining_sexual_health.pdf on May 27, 2014. Yeh, H., Lorenz, F., Wickrama, K., Conger, R., Rand, D., & Glen, H. (2006). Relationships among sexual satisfaction, marital quality, and marital instability at midlife. Journal of Family Psychology, 20(2), 339–343. Promotion of Sexual Health and Sexual Responsibility 123

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