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Archives of Sexual Behavior, Vol. 26, No. 3, 1997 Effect of Testosterone Administration on Sexual Behavior and Mood in ...

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Archives of Sexual Behavior, Vol. 26, No. 3, 1997

Effect of Testosterone Administration on Sexual Behavior and Mood in Men with Erectile Dysfunction Raul C. Schiavi, M.D.,1.2 Daniel White, B.S.,1 John Mandeli Ph.D.,1 and Alice C. Levine, M.D.1

This double-blind placebo controlled, cross-over study was carried out to assess the effect of testosterone administration on sexual behavior mood, and psychological symptoms in healthy men with erectile dysfunction. Biweekly injections of 200 mg of testosterone enanthate were given over a period of 6 weeks separated by a washout period of 4 weeks. Blood samples for hormonal assessment, behavioral and psychological ratings were obtained prior to each injection. Luteinizing hormone remained significantly depressed but circulating testosterone had returned to baseline levels by 2 weeks following each hormonal injection. The ejaculatory frequency during the testosterone phase was statistically higher than during the placebo phase. There were marked, although statistically nonsignificant, increases in median frequency of reported sexual desire, masturbation, sexual experiences with partner, and sleep erections during the testosterone period. Testosterone did not have demonstrable effects on ratings of penile rigidity and sexual satisfaction. Mood variables and psychological symptoms did not change following hormonal administration. Results suggest that androgen administration to eugonadal men with erectile dysfunction may activate their sexual behavior without enhancing erectile capacity and without effects on mood and psychological symptoms. KEY WORDS: testosterone; androgens; luteinizing hormone; sexual behavior; erectile dysfunction. This work was supported by National Institute on Aging Grant AG-06895. 1The Mount Sinai School of Medicine, New York, New York 10029. 2To whom correspondence should be addressed at Human Sexuality Program, Department of Psychiatry, Mount Sinai School of Medicine (Box 1084), 1 Gustave L. Levy Place, New York, New York 10029. 231 0004-0002/97/0600-0231$12.50/0 C 1997 Plenum Publishing Corporation

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Schiavi, White, Mandeli, and Levine INTRODUCTION

Testosterone replacement studies on hypogonadal male patients have consistently shown activation of sexual desire and restoration of sleep-related erections and ejaculatory capacity (Skakkebaek et al., 1981; Salmimies et al., 1982; Kwan et al., 1983 O'Carroll et al., 1985) but they have failed to demonstrate a predictable effect on affect and mood. Androgen treatment of men with abnormally low circulating testosterone has been found to decrease tension and fatigue, enhance relaxation and cheerfulness, and to have an effect on anger and irritability by some investigators (Skakkebaek et al., 1981; O'Carroll et al., 1985) but not by others (Davidson et al., 1979; Salmimies et al., 1982; Pirke and Kockott, 1982). There is clinical consensus that, in the presence of normal sexual desire, testosterone is not therapeutically effective in eugonadal men with erectile dysfunction (Bancroft, 1988). Controlled studies of androgen administration to physically healthy, sexually dysfunctional men are, however, few and none has systematically assessed the possible effect of testosterone on associated psychological symptoms and affective states. Anderson et al. (1992) conducted a placebo-controlled study of exogenous testosterone on the sexual behavior and mood of normal men. Weekly testosterone injections up to 2 months induced increased sexual awareness and arousability but did not result in changes in sexual behavior or in mood. The clinical interest in the therapeutic effects of androgens on erectile capacity has obscured the possibility that hormonal interventions may have a broader action on emotions and behavior in physically healthy sexually dysfunctional men. The present double-blind, placebo-controlled, crossover study was conducted to assess the effect of testosterone on the sexual behavior, mood, and psychological symptoms of a group of eugonadal men with erectile dysfunction. METHOD Subjects

Media announcements were made inviting couples to volunteer in a study on the therapeutic effects of testosterone in men with the primary diagnosis of erectile dysfunction or hypoactive sexual desire. Criteria for inclusion were (i) ages 45 to 74; (ii) married or living with a sexual partner for at least 1 year; (iii) possession of a high school diploma, and (iv) English as the primary language. Exclusion criteria were (i) evidence of a

Effect of Testosterone in Men with Erectile Dysfunction

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medical disorder; (ii) drug intake, especially medications with neurological, vascular or endocrine action; (iii) alcohol or other substances of abuse; (iv) presence of major psychopathology, and (v) obesity (more than 20% above ideal body weight according to the 1983 Metropolitan Life Insurance Tables). The operational definition of erectile dysfunction was inability to achieve and maintain vaginal penetration until orgasm on at least 50% of the attempts during the preceding 6 months. Hypoactive sexual desire (HSD) was defined on the basis of reported frequency as well as desire for any sexual activity of less than twice per month during the preceding 6 months. Between May 1992 and December 1993 we screened 160 couples/subjects over the phone who were considered ineligible, mainly because of illness, use of medication, lack of motivation, or partner willingness to participate. Forty men were interviewed, 18 men with a primary erectile dysfunction were accepted into the study following a comprehensive medical evaluation and 12 completed all phases of the investigation. In 3 subjects the erectile difficulties were associated with a decrease in sexual desire. Only 1 man met the criteria of HSD as the primary dysfunction and was excluded from this analysis. The median age of the sample was 60 (range 46-67); 8 men were married and 4 were divorced and living with a sexual partner. The median duration of their relation was 8 years (range 1-30). The subjects were predominantly Caucasian (91.7%), and college educated (83.3%). Six volunteers held professional or clerical jobs, 5 were retired, and 1 man was unemployed. The median duration of their erectile problems was 4 years with a range from 6 months to 12 years. Experimental Protocol All subjects underwent an extensive interview to gather psychosexual, medical, and marital information and to diagnose sexual dysfunction. They were administered a battery of psychological tests that included the Brief Michigan Alcoholism Screening test for alcohol abuse (Selzer, 1971), and the Dyadic Adjustment scale to evaluate marital adjustment (Spanier, 1976). The study was conducted according to a randomized, double-blind, crossover design comparing the effects of biweekly intramuscular injections of 200 mg of testosterone enanthate and placebo (sesame oil vehicle). The drug and placebo administration phases lasted 6 weeks and were separated by a washout period of 4 weeks. Blood samples for hormonal determinations were obtained between 8 and 10 AM prior to each biweekly injection at which time the subjects also completed a self-rating questionnaire as-

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Schiavi, White, Mandeli, and Levine

sessing their sexual behavior over the preceding 2 weeks and the Profile of Mood States (POMS; Mc Nair et al., 1971). In addition the SCL 90-R (Derogatis, 1977) was administered before and after drug/placebo periods to evaluate possible changes in psychological symptoms.

Hormonal Assessments Plasma testosterone, luteinizing hormone (LH), and prolactin were measured in duplicate by established radioimmunoassay procedures (Furuyama et al., 1970; Fogel et al., 1972; Hwang et al., 1971). Mean intra-assay variability has been 8.6% for testosterone, 11.8% for LH, and 6.5% for prolactin. The interassay coefficient of variation values for testosterone, LH, and prolactin were 9.9, 14.8, and 13.4%, respectively. Quality control pools were run in each assay and all samples for each subject were analyzed in the same assay to eliminate error due to interassay variability. In addition to the above hormones, we conducted duplicate determinations of bioavailable testosterone (Tremblay and Dube, 1974) and dihydrotestosterone (Puri et al., 1981). Mean intra-assay and interassay coefficients of variation were 1.6 and 14.6%, respectively, for bioavailable testosterone and 7.3 and 9.9%, respectively, for dihydrotestosterone.

Psychological Assessments Brief Sexual Function Questionnaire. The questionnaire consists of 19 items recorded on graded scales of frequency of sexual desire, fantasy, behavior, and nocturnal erections, degree of penile erection, and sexual satisfaction over the preceding 2 weeks. The questionnaire has demonstrated acceptable test-retest reliability, construct validity, and concurrent validity (Reynolds et al., 1988). POMS. This is an adjective check list consisting of 65 items factored in 6 mood scales: vigor/activity, depression/rejection, tension/anxiety, anger/hostility, fatigue/inertia, and confusion/bewilderment The instrument has adequate validity and reliability and has proven to be an effective measure for the assessment of drug effects on mood (Mc Nair et al., 1971). SCI-90-R. This is a validated self-report inventory composed of 90 items, each evaluated on a 5-point scale of distress from not-at-all to extremely. It is composed of nine primary symptom dimensions and two global indices: the Global Severity Index (GSI) and the Positive Symptom Distress Index (PSDI; Derogatis, 1977).


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Statistical Methods The experimental design was that of a two-period crossover design in which seven subjects received placebo followed by testosterone and five subjects received testosterone followed by placebo. A preliminary test for the presence of differential carryover effects was first conducted by the method of Grizzle (1965) for the normally distributed hormonal data and by the method of Koch (1972) for the nonparametric behavior, mood, and psychological symptom data. As recommended by Grizzle (1965), this test was run at the 10% level of significance. If this test resulted in nonsignificance, a test for a difference in direct treatment effects (i.e., testosterone vs. placebo) was carried out using the method of Grizzle (1965) and Koch (1972) for the parametric and nonparametric data, respectively. Because of the small sample, the Wilcoxon Rank Sum tests utilized in the Koch (1972) procedure applied the small-sample tables of exact significance levels. Repeated measures analysis of variance was carried out for hormonal variables in the first period only. RESULTS

Statistical tests for the presence of differential carryover effects were nonsignificant at the p > 0.10 level for all hormones, behavior and mood variables. Hence, we concluded that 4 weeks was a sufficiently long washout period. Table I compares mean hormonal levels during the testosterone and placebo administration phases. Testosterone enanthate resulted in a significant hormonal decrement in LH but in no changes in testosterone, bioavailable testosterone, prolactin, and dihydrotestosterone measured 2 weeks after each intramuscular injection. The time-related LH changes over the testosterone and placebo phases in the first period are illustrated in Fig. 1. A repeated measures analysis of variance for LH demonstrated a significant Time x Treatment interaction, F(3, 30) - 5.4, p 0.005, with a significant linear decline in LH for testosterone but no change over time in LH for placebo. None of the other hormones showed significant patterns of change over the study period. The effects of testosterone and placebo administration on reported sexual behavior are summarized in Table II. There was a statistically significant increase in frequency of ejaculation during the testosterone phase compared to the placebo phase. Reported frequency of sexual desire, masturbation, sexual experiences with partner, and awareness of early morning erections, had markedly higher, although nonsignificant, median values during the testosterone than during the placebo periods. Testosterone admini-

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Table I. Effects of Testosterone and Placebo Administration on Plasma Hormone Concentrationsa Period 1= placebo Period 1= testosterone Period 2=testosterone Period 2=placebo (n = 7) (n = 5) Significance: SD Hormones X X SD t(10)b Testosterone (ng/ml) 481 Baseline 455 Period 1 473 Washout 420 Period 2 Bioavailable testosterone (% unbound) 25.1 Baseline 25.6 Period 1 28.9 Washout 28.7 Period Luteinizing hormone (ng/ml) 41.0 Baseline 40.6 Period 1 43.8 Washout 19.7 Period 2

205 143 173 87

412 318 303 397

48 66 125 73

1.83, ns

9.5 9.4 12.1 12.8

27.7 24.5 25.9 27.6

4.7 5.4 4.6 4.9

0.00, ns

6.6 9.3 17.2 4.8

39.9 20.6 33.4 45.2

6.9 8.5 10.7 13.1

6.93, p< 0.0001

Prolacting (ng/ml) 6.4 3.2 5.5 2.0 -0.28, ns Baseline 3.6 4.9 2.0 6.9 Period 1 5.1 1.3 6.2 1.6 Washout 2.0 5.2 1.8 7.5 Period Dihydrostestosterone (ng/ml) 15.4 12.9 0.64, ns 40.0 37.7 Baseline 30.4 34.1 10.7 10.1 Period 1 15.7 27.4 14.9 34.0 Washout 13.9 12.0 36.0 35.1 Period 2 aEach observation for Period 1 and Period 2 represents the mean of three biweekly determinations. bTest for direct treatment effects (i.e., testosterone vs. placebo) as in Grizzle (1965). stration did not have demonstrable effects on ratings of penile erection or in sexual satisfaction. Mood variables assessed with the POMS did not change following testosterone administration (Table III). All values fell within the normative range with the exception of vigor which was markedly elevated across all phases of the study. Figure 2 illustrates the profile of the SCL-90-R psychological symptom status at the end of the testosterone and placebo periods. All symptom dimensions and the global indices are within the normative range and did not demonstrate a significant change as a consequence of testosterone administration.


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Fig. 1. Time related changes over the testosterone and placebo phases. Table II. Effects of Testosterone and Placebo Administration on Sexual Behaviora Testosterone Placebo period period Psychosexual variable Mdn Range Mdn Range Pb Sexual desire Masturbation Sex with partner Morning erections Ejaculation Masturbation Sex with partner

Frequency (times per week) 6 3.6 0-7 0-7 ns O.S8 0.16 0-2 0-2 ns 0.54 1.25 0-2.7 0-2 ns 0.67 1.25 0-7 0-7 ns 0.97 2.15 0-2 0-4 0.02 (rank sum = 47) Degree of erections (1=none; 6=full) 5.85 5.5 1-6 3-6 ns 5.5 5.5 4-6 ns 1-6 Sexual satisfaction (1=dissatisfied; 7= satisfied) 5 2-7 ns 4.65 2-7

aValues

are median of 12 subjects; rating during the testosterone and placebo administration periods represent the mean of three biweekly assessments. bWilcoxon Rank Sum Test for direct treatment effects (i.e., testosterone vs. placebo) as in Koch (1972). DISCUSSION

The assessment of androgen administration on behavior requires periodic blood monitoring to evaluate the dynamic effects of the hormonal intervention over time. The injection schedule in this investigation was

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Table DDL Effects of Testosterone and Placebo Administration on Mooda Testosterone period Variables Tension Depression Anxiety Vigor Fatigue Bewilderment

Mdn T score

49 53 58.5

66 51 47

Range 43-65 51-60 53-69 60-76 45-63 44-61

Placebo period Mdn T score

49 54.5 60.5

69 49.5

51

Range 45-60 51-74 53-86 54-76 45-75 44-61

aValues

are median T scores of Profile of Mood States (POMS) for 12 subjects; ratings during the testosterone and placebo administration periods represent the mean of three biweekly assessments.

Fig. 2. SCL-90-R psychological symptom profile at the end of the testosterone and placebo periods. SOM, somatization; O-C, obsessive-compulsive; INT, interpersonal sensitivity; DEP, depression; ANX, anxiety; HOS, hostility; PHOB, phobic anxiety; PAR, paranoid ideation; PSY, psychoticism.

based on evidence from hypogonadal men that a regimen of 200 mg of testosterone enanthate every 2 weeks was effective in maintaining their serum testosterone and LH concentrations within normal ranges (Snyder and Lawrence, 1980; Sokol et al., 1982). We found, however, that compensatory feedback mechanisms operating in eugonadal men had returned circulating


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testosterone to baseline levels by the time hormonal assessments were carried out 2 weeks following androgen injections. Although there was evidence of lasting central effects, as shown by marked LH decrements, more frequent hormonal injections would have been necessary to sustain abovebaseline testosterone concentrations during the study. It is of interest that a statistically significant increase in reported frequency of ejaculation occurred in response to androgen treatment in the absence of reported changes in sexual desire and erectile capacity. No subject felt that androgen treatment had improved their erectile rigidity and it appeared that the increase in sexual activity with their partners reflected more frequent sexual play rather than enhanced erectile function. The majority of volunteers were unable to identify correctly during the debriefing session when the testosterone phase had occurred and did not feel that hormonal administration had been of therapeutic value. The behavioral evidence suggests that the androgen's primary action was on sexual drive rather on erectile function, which was the source of the original complaint, and explains their continued dissatisfaction at the completion of treatment. There is no evidence that the present androgen regimen had an effect in any of the mood and psychological symptom dimensions assessed during the study. The narrowness of differences in psychological measures and lack of a directional trend across study periods argues against the possibility that the negative findings are the result of low statistical power due to the small sample. Controlled studies of androgen administration to physically healthy sexually dysfunctional men are scarce. Benkert et al. (1979) conducted a double-blind placebo-controlled evaluation of testosterone undecanoate on eugonadal impotent men. Androgen was no more effective than placebo in restoring sexual potency but the testosterone levels hud fallen rather than increased during hormonal treatment. No differences were noted in depression or anxiety scores between the androgen-treated and placebo groups. O'Carroll and Bancroft (1984) carried out a double-blind crossover comparison of two groups of 10 eugonadal men complaining of loss of sexual interest or erectile dysfunction. Androgen injections resulted in a substantial elevation in circulating testosterone which was associated, in the low sexual desire group, with a modest increase in sexual interest. Testosterone therapy did not have an effect on erectile activity or in mood in either group. Several investigators (Wu et al., 1982; Pirke and Kockolt, 1982; Carani et al., 1990) speculated that the testosterone levels necessary to optimally activate specific androgen-dependent components of male sexuality, such as sexual desire may in some individuals be within the normal range. It has also been proposed (Bancrott, 1984; Schiavi et al., 1993) that the thresh-

240


old required to sustain the behavioral effects of testosterone may increase with age. We examined the data obtained from 5 of the 6 subjects above 60 years of age who had baseline testosterone levels in the low range of normal but we did not observe that their behavioral or mood responses differed from the remainder of the group. In conclusion, this controlled, crossover study indicates that testosterone administration to healthy, eugonadal men with erectile dysfunction increases the frequency of sexual activity but does not enhance erectile capacity. To the extent that the increase in ejaculatory frequency reflected sexual interest, albeit not recognized or acknowledged by the subjects, these findings are consistent with a large body of information from hypogonadal patients. There is no evidence that exogenous testosterone had significant effects on the subjects' affective state and psychological symptoms. It should be noted, however, that the drug regimen did not maintain supraphysiological levels throughout the hormonal phase of the study. Further controlled research on a larger group, with different strategies of drug administration and psychological assessment, is required to address this largely unexplored aspect of behavioral endocrinology.

REFERENCES Anderson, R. A., Bancroft, J., and Wu, F. C. W. (1992). The effects of exogenous testosterone on sexuality and mood in normal men. J. Clin. Endocrinol. Metab. 75: 1503-1507. Bancroft, J., (1984). Androgens, sexuality and the ageing male. In Labrie, F., Proulx (eds.), Endocrinology, Elsevier, Amsterdam, pp. 913-917. Bancroft, J. (1988). Reproductive hormones and male sexual function In J. M. A. Sitson (ed.), Handbook of Sexology, Vol. 6, Elsevier, Amsterdam, pp. 297-315. Benkert, O., Witt, W., Adam, W., and Leitz, A. (1979). Effects of testosterone undecanoate on sexual potency and the hypothalamic-pituitary-gonadal axis of impotent males. Arch. Sex. Behav. 8: 471-479. Carani, C, Zini, D., Baldini, A., Delia Casa, L., Ghizzani, A., and Marrama, P. (1990). Effects of androgen treatment in impotent men with normal and low levels of free testosterone. Arch. Sex. Behav. 19: 223-234. Davidson, J. M., Camargo, C, and Smith, E. R. (1979). Effects of androgen on sexual behavior in hypogonadal men. J. Clin. Endocrinol. Metal 48: 955-958. Derogatis, L. R. (1977). SCL-90-R: Administration, Scoring and Procedures Manual, Clinical Psychometrics Research, Baltimore. Fogel, M., Rubin, B. L., and Ossowski, R. (1972). Serum FSH, LH and progesterone in single and multiple gestations following induction of ovulation.Am. J. Obstet. Gynecol. 112: 629639. Furuyama, S., Mayes, D. M., and Nugent, C. A. A. (1970). A radioimmunoassay for plasma testosterone. Steroids 16: 115-428. Grizzle, J. F. (1965). The two period change-over design and its use in clinical trials. Biometrics 21: 467-480. Hwang, P., Guyda, H. J., and Friesen, H. G. (1971). A radioimmunoassay for human prolactin. Proc.Nat.Acad. Sci. 68: 1902-1906.


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Koch, G. G. (1972). The use of nonparametric methods in the statistical analysis of the two-period change-over design. Biometrics 28: 577-584. Kwan, M., Greenleaf, W. J., Mann, J., Crapo, L., and Davidson, J. M. (1983). The nature of androgenization on male sexuality: combined laboratory self-report study on hypogonadal men. J. Clin. Endocrinol. Metab. 57: 557-562. Mc Nair, D. M., Lorr, M., and Droppleman, L. F. (1971). Profile of Mood States Manual, Educational & Industrial Testing Service, San Diego, CA. O'Carroll, R., and Bancroft, J. (1984). Testosterone therapy for low sexual interest and erectile dysfunction in men: A controlled study. Br. J. Psychiat. 145: 146-151. O'Carroll, R., Shapiro, C., and Bancroft, J. (1985). Androgens, behavior and nocturnal erection in hypogonadal men: the effects of varying the replacement dose. Clin. Endocrinol. 23: 527-538. Pirke, K. M., and Kockott, G. (1982). Endocrinology of sexual function. Clin. Endocrinol. Metab. 11: 625-634. Puri, V., Pun, C. P., and Kumar, T. C. A. (1981). Serum levels of dihydrotestosterone in male rhesus monkeys estimated by a nonchromatographic radioimmunoassay method /. Steroid Biochem. 14: 877-881. Reynolds, C F., Ill, Frank, F., Thase, M. F., Houck, P. R., Jennings, J. R., Howell, J. R., Lilienfeld, S. O., and Kupfer, D. J. (1988). Assessment of sexual function in depressed, impotent and healthy men: Factor analysis of a brief sexual function questionnaire for men. Psychiat. Res. 24: 231-250. Salmimies, P., Kockott, G., Pirke, K. M., Vogt, H. J., and Schill, W. B. (1982). Effects of testosterone replacement on sexual behavior in hypogonadal men. Arch. Sex. Behav. 11: 345-353. Schiavi, R. C., White, D., Mandeli, J., and Schreiner-Engel, P. (1993). Hormones and nocturnal penile tumescence in healthy aging men. Arch. Sex. Behav. 22: 207-215. Selzer M. (1971). The Michigan Alcoholism Screening Test: The quest for a new diagnostic instrument. Am. J. Psychiat. 127: 1653-1658. Skakkebaek, N. E., Bancroft, J., Davidson, D. W., and Warner, P. (1981). Androgen replacement with oral testosterone undecanoate in hypogonadal men: a double blind controlled study. Clin. Endocrinol. 14: 49-61. Snyder, P., and Lawrence, D. A. (1980). Treatment of male hypogonadism with testosterone enanthate. J. Clin. Endocrinol. Metab. 51: 1335-1339. Sokol, R. Z. Palacios, A., Campfield, L. A., Saul, C, and Swerdloff, R. S. (1982). Comparison of the kinetics of injectable testosterone in eugonadal and hypogonadal men. Fertil Steril. 37: 425-430. Spanier, G. B. (1976). Measuring dyadic adjustment: New scale for assessing the quality of marriage and similar dyads. J. Marr. Fam. 38: 15-29. Tremblay, R. R., and Dube, J. Y. (1974). Plasma concentrations of free and nonTeBG bound testosterone in women on oral contraceptives. Contraception 10: 599-605. Wu, F. C. W., Bancroft, J., Davidson, D. W., and Nicol, K. (1982). The behavioral effects of testosterone undecanoate in adult men with Klinefelter's syndrome: A controlled study.

Clin. Endocrinol. 16: 489-497.


The Perception of Sexual Attractiveness: Sex Differences in Variability John Marshall Townsend, Ph.D,1.3 and Timothy Wasserman, M.S.2

Results of three independent studies supported predictions derived from evolutionary theory: Men's assessments of sexual attractiveness are determined more by objectively assessable physical attributes; women's assessments are more influenced by perceived ability and willingness to invest (e.g., partners' social status, potential interest in them). Consequently, women's assessments of potential partners' sexual attractiveness and coital acceptability vary more than men's assessments. The proposition that polygamous women's assessments of men's sexual attractiveness vary less than those of monogamous women (because the former allegedly are more influenced by target persons' physical attributes) was also tested. In Study 1 male college students showed more agreement than females in their rankings of the sexual attractiveness of opposite-sex target persons. Target persons' flesh and bodily display enhanced this sex difference. In Study 2 men exhibited less variance than did women in their ratings of target persons' acceptability for dating and sexual relations. Women who viewed models described as having low status showed more variability than did women in the high-status condition. In Study 3 women showed more variability than men did in their ratings of 20 opposite-sex celebrities' sexual attractiveness. Studies 2 and 3 included the Sociosexual Orientation Inventory (SOI)—a measure of polygamous attitudes and behavior. Women's SOI scores did not affect the variability of their assessments in either Study 2 or 3. In Study 3 men with low SOI scores showed less variability than did men with high SOI scores. Alternative explanations of the findings are examined. Theoretical and empirical implications are discussed. KEY WORDS: sexual attractiveness; sex differences; evolution; sexuality; perception. 1Department

of Anthropology, 209 Maxwell, Syracuse University, Syracuse, New York 13244-1090. 2Office of Evaluation and Research, Syracuse University, Syracuse, New York 13244-1090. 3To whom correspondence should be addressed. 243 0004-0002/97/0600-0243$12.50/0 C 1997 Plenum Publishing Corporation

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Townsend and Wasserman

INTRODUCTION Researchers have consistently identified the following sex differences in sexuality and partner selection. Men are more willing than women to engage in sexual relations in the absence of emotional involvement and marital potential and are more likely to seek sexual relations with a variety of partners for the sake of variety (Blumstein and Schwartz, 1983; Kinsey et al., 1953; Roche, 1986; Townsend, 1995; Udry and Billy, 1987; Wilson, 1981,1987). Men are more readily aroused sexually than women by visual stimuli, e.g., the sight of a potential sex partner (Ellis and Symons, 1990; Kinsey et al., 1953; Townsend, 1993). Men place more emphasis on physical attractiveness in choosing partners for sex or marriage, and women place more emphasis on partners' socioeconomic status (SES) (Berscheid and Walster, 1974; Dion, 1981; Hatfield and Sprecher, 1986). Researchers guided by evolutionary theory explain sex differences in sexuality and mate preferences in terms of differential parental investment (Buss, 1989a; Buss and Schmitt, 1993; Kenrick and Keefe, 1992; Kenrick et al., 1990; Symons, 1979). Because males have fewer risks and costs in low-investment copulation, natural selection favored males who were stimulated by physical attributes that signaled fertility. Curvaceous hips and breasts and signs of youth and health are not merely symbols of female fertility; they are indices of fertility, and women who exhibit these characteristics are considered more sexually attractive than women who do not exhibit them (Singh, 1993). Because women's minimum possible parental investment is vastly greater than men's, selection favored a more selective process of mate evaluation in females, with more emphasis on partners' potential for parental investment—social dominance, prowess, nurturance—and less emphasis on physical attributes that serve as cues to fertility (Buss and Barnes, 1986; Sadalla et al., 1987; Townsend, 1995). Symons (1979) argued that the discrepancy in minimum possible parental investment caused, through natural selection, the mechanisms that mediate sexual emotion and perception to differ in men and women. Women's emotional-perceptual mechanisms motivate them to seek out and detect partners' ability and willingness to invest, to evaluate the quality of investment, and to counteract shirking and false advertising (Buss, 1989b; Buss and Schmitt, 1993; Townsend et al., 1995). Men's emotional-perceptual mechanisms motivate them to copulate with a variety of nubile partners, to spread investments among several individuals in order to realize this goal, and to evaluate coital acceptability largely on the basis of physical attributes (Townsend, 1992, 1995; Townsend et al., 1995; Townsend and Roberts, 1993).

Attractiveness

245

An evolutionary perspective has important implications for research on attractiveness and mate selection. First, if women are generally choosier than men in selecting potential sex partners, women's ratings of men's sexual attractiveness and acceptability should typically be lower than men's ratings of women's sexual attractiveness and acceptability. Studies that sprang from different theoretical backgrounds and used different methods have supported this proposition (Buss and Schmitt, 1993; Kenrick et al., 1990; Reis et al., 1980; Sadalla et al., 1987; Townsend and Levy, 1990a; Townsend and Roberts, 1993). Second, men should show relatively high agreement when rating the sexual attractiveness of women because men's assessments are tied to objectively assessable physical attributes (Cunningham, 1986; Singh, 1993). In comparison, women should show greater variability in their ratings of men's sexual attractiveness because they are more influenced by factors like the men's social type, subculture, personality, and willingness to invest in them. Few studies have addressed this issue because researchers tend to focus on subjects' mean ratings or rankings of target persons' attractiveness rather than on the variability of ratings (Berscheid and Walster, 1974). When the focus is on means, men and women tend to show high agreement in their ratings of the attractiveness of both male and female stimulus persons (Berscheid and Walster, 1974; Reis et al., 1980). The few studies that have analyzed variability, however, suggest that women exhibit greater variability than men in their ratings of the attractiveness of opposite-sex persons (Morse et al., 1974; Reis et al., 1980). A study of gay and heterosexual men and women also supported this view (Jankowiak et al., 1992). When gay and heterosexual women were asked to rate the "good looks" of photographs, they had difficulty in separating purely physical attributes from other types of attractiveness, e.g., personality traits, SES cues, whether the portrayed person was the type with whom they could and would have a more involved relationship. In comparison, men concentrated on physical attributes when rating "good looks" and consequently showed more agreement in their rankings than did women. A major problem with studies of sexual attractiveness is that most have failed to include (or to manipulate systematically) the types of traits that influence women's perceptions more than men's, e.g., target person's social background, personality type, or religion. When information that is more important to women than to men is limited or absent from research designs, women base their attractiveness judgments on facial features or other physical features by default, thus creating a misleading picture of male-female differences and similarities (Morse et al., 1976; Townsend and Levy, 1990a). A second problem is that many studies of attractiveness have reified the concepts "attractiveness," "physical attractiveness," and "sexual attrac-

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tiveness." In such studies investigators require subjects to rate or rank the importance of these abstractions rather than including examples of actual physical attributes (e.g., Buss and Barnes, 1986; Simpson and Gangestad, 1991a, 1992; Sprecher, 1989). These procedures assume that when men and women rate these abstractions, they are evaluating the same traits (Townsend and Levy, 1990a). This assumption ignores evidence that certain traits have different or even opposite effects on men's and women's ratings of "physical" and "sexual" attractiveness (e.g., target: person's age, costume, dominance, SES, and flesh display; see Townsend, 1993, and Townsend and Roberts, 1993, for reviews). Having actual persons (or photographs of actual persons) to represent physical attractiveness is particularly important for evolutionary studies, since visual assessment of fertility cues is one of the pivotal postulated sex differences in mate evaluation (Cunningham, 1986; Ellis and Symons, 1990; Symons, 1979,1987; Singh, 1993). Studies that use college yearbook photographs do provide actual physical attributes (e.g., Graziano et al., 1993; Townsend and Levy, 1990b), but such studies omit stimulus person's physique, which is an important index of women's fertility and therefore a major determinant of women's sexual attractiveness, but is a much weaker index and determinant of men's fertility and sexual attractiveness (Singh, 1993). Yearbook photographs also limit important cues to social class and type because yearbooks tend to have particular dress and grooming requirements (cf. Townsend, 1993; Townsend and Levy, 1990a, 1990b). The primary goal of this study is to analyze sex differences in variability of perception of sexual attractiveness. The first two studies build on previous work by using photographs of whole stimulus persons, some of whom are in bathing suits, in order to explore the effects of subject's gender and models' physique display on variation in rankings of sexual attractiveness. Study 3 examines variability in subjects' ratings of celebrities. For convenience, predictions appear along with results. A second goal of this investigation is to examine associations between variability in perceptions of sexual attractiveness and subjects' polygamous behavior and attitudes. The Sociosexual Orientation Inventory (SOI) measures polygamous attitudes and behavior. Simpson and Gangestad argue that women with high scores on the SOI engage in lowinvestment sexual relations with physically attractive men because the men's physical attributes signal heritable fitness, rather than because of any material or emotional investments the men might offer (Simpson and Gangestad, 1991a, 1991b, 1992; Thornhill and Gangestad, 1993). Women with high SOI scores thus trade off male investment for male physical attributes (Gangestad and Simpson, 1990; Gangestad, 1993). If this is

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true, then we might expect women with high SOI scores to exhibit less variability in their ratings of sexual attractiveness than women with low scores because the former group's assessments, like men's, are tied to more objectively assessable physical attributes. This prediction is tested in Studies 2 and 3. Hypothesis The central hypothesis of Studies 1, 2, and 3 is: In rating the sexual attractiveness of potential partners, women are more influenced than men by factors like target persons' dominance, status, subculture, perceived personality, and willingness to invest in them. In comparison, men's assessments are determined more by objectively assessable physical attributes. Consequently, men's evaluations of sexual attractiveness tend to vary less than do women's evaluations. Flesh and bodily display increase this sex difference in variability because they provide more of the information that men use to determine coital acceptability. Specific predictions derived from this hypothesis are tested in each of the studies.

STUDY 1: PHYSICAL ATTRIBUTES, SEXUAL ATTRACTIVENESS, AND BODILY DISPLAY INSTRUMENT DEVELOPMENT

The following social types exist in most high school and college environments and are generally recognizable by their costumes: head-bangers, druggies, punks, preppies, deadheads, crunchies, guidos (Townsend, 1993). Twenty male and 20 female college students were presented with a list of these social types and asked to select three types that met the following criteria: Two nonoverlapping types that occur in college populations; one type that does not attend college, i.e., a "townie"; all three types must be college-age, datable in principle at least, and immediately recognizable to most northeastern college students. Ninety percent of the participants agreed that the following three types met these criteria: preppy, crunchy-environmentalist, and townie. The participants were then asked to nominate descriptive statements about the three types' costumes, coiffures, and characteristic speech and tastes. Eighty-seven distinctive elements emerged. These elements were typed onto 3 x 5 index cards and sorted by two female and two male judges. Costume and grooming elements that were identified as characteristic of the types by 75% or more of the judges were included in the stimulus materials.

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Stimulus Materials In order to include in the current experiment a limited variety of costumes, social types, and levels of prerated physical attractiveness, seven male and seven female undergraduate models were dressed as preppies; one male and one female model were dressed as townies; six male and six female models in bathing suits were chosen from catalogs and calendars. The preppy costume consisted of a V-neck sweater over an Oxford pinstriped shirt and khaki pants. Townies wore a silk shirt with the top three buttons open, a gold medallion, and black slacks or skirt (for details, see Townsend, 1993). The female bathing suit models' breasts were covered; the males' chests were bare. The 28 models' coiffures were appropriate for their gender and the social type being depicted. For the preratings of physical attractiveness, undergraduate models were dressed in plain off-white shirts and not in the preppy or townie costumes. Models were instructed to face the camera squarely and to look pleasant. Twenty men and 20 women prerated 40 photographs for physical attractiveness. Each female model was matched with a male model who had a comparable prerating (1 = very unattractive; 6 — very attractive). The preratings of the final 28 stimulus persons' physical attractiveness were as follows: preppy, one high-attractiveness male, X = 4.01, SD = 1.14, one female, X - 3.89, SD = 0.87; two medium males, X = 2.93, SD = 1.07, two females, X = 3.09, SD = 0.75; four low-attractiveness males, X - 2.63, SD = 1.21, four females, X = 2.98, SD = 1.01; one high-attractiveness male townie, X = 4.19, SD = 1.28, one female, X = 4.40, SD = 0.98; three high-attractiveness male bathing suit models, X = 4.64, SD = 1.11, three females, X = 4.75, SD = 0.82; three medium-attractiveness male bathing suit models, X = 3.17, SD = 1.22, three females, X - 3.28, SD = 1.17.

Sample and Procedure Subjects consisted of male (n = 58) and female (n = 98) students in an introductory psychology class. Participation in the study partially fulfilled an experimental requirement for the class. Participants were informed when they signed up that the investigators were interested in heterosexual dating and sexual experience. All subjects were unmarried and between the ages of 18 and 21. Subjects were tested in small same-sex groups. They were handed the shuffled photos and ranking sheet and read the following instructions. These instructions were designed to elicit personal evaluations

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and reduce the likelihood of subjects assigning ranks merely because they thought such responses were normative or socially acceptable: Please rank the following 14 photographs according to how sexually attractive you think they are (i.e., the extent to which you would desire sexual relations with each of these people). Arrange the photos such that the most sexually attractive one is at the top or on the far left, and the least sexually attractive one is at the bottom or on the far right. Remember, rank the pictures according to how sexually attractive you personally find them. Results and Discussion Prediction 1: Compared to heterosexual men, heterosexual women will show greater variability when ranking the sexual attractiveness of oppositesex persons. Prediction 2: Models' flesh and physique display will reduce variation in men's rankings more than in women's rankings. Consistency of judgments within groups was tested by calculating for each subject the absolute deviation of stimulus rank from the mean rank given that photograph by his or her group. These deviations were then averaged over the 14 stimulus persons to obtain an average deviation for each subject. Subjects were then ranked according to the size of their average deviation. Because subjects ranked photographs, group differences in deviations were analyzed by Wilcoxon two-sample tests (Bradley, 1968). The rank sum for men was 2693; the expected sum under the null hypothesis, 4553. Women's rank sum was 9553; expected sum, 7693, z = -6.82, p < 0.0001. These results supported Prediction 1: Women showed less agreement in their rankings of opposite-sex persons' sexual attractiveness than did men. To test Prediction 2, the average deviation for models in bathing suits was subtracted from the average deviation for models in street clothes for each subject, and subjects were then ranked according to the size of the difference between the deviations for clothed and bathing suit models. The rank sum for men was 5448; the expected sum under the null hypothesis, 4553. Women's rank sum was 6798; expected sum, 7693, z - 3.28, p < 0.001. For male subjects, the difference between the average deviations for clothed and bathing-suit models was 0.52; for female subjects, 0.06. Mean ranks and their standard deviations appear in Table I. These results indicate that men and women were fairly consistent in the mean rank assigned the comparable female and male photographs, suggesting that the matching of male and female photographs by preratings of physical attractiveness was successful. Neither did male and female subjects differ drastically in the mean ranks assigned to clothed models compared to bath-

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Townsend and Wasserman Table I. Mean Sexual Attractiveness Ranks and Standard Deviations for 14 Photographsa Male subjects (n = 58)

Female subjects (n = 98)

X rank

SD

X rank

SD

1. High townie 2. High preppy 3. Low preppy 4. Low preppy 5. Med preppy 6. Med preppy 7. Low preppy 8. Low preppy 9. Med bs 10. Med bs 11. Med bs 12. High bs 13. High bs 14. High bs

6.22 10.41 9.25 12.43 10.07 10.67 10.36 11.58 4.67 4.85 5.13 2.20 4.92 2.27

3.65 2.86 2.29 1.93 2.08 2.40 1.87 1.77 2.15 2.11 1.38 1.49 2.01 1.33

5.25 11.15 11.83 8.10 9.71 6.19 9.86 11.39 6.48 5.41 6.32 6.46 4.00 2.92

3.64 2.89 2.06 2.94 2.68 3.21 3.51 2.59 2.99 2.75 3.22 3.47 2.75 2.07

X deviation bs X deviation clothes X rank bs X rank clothes

1.39 1.91 3.50 10.12

Model

2.30 2.36 5.27 9.19

a1

= most attractive rank; 14 = least attractive. bs = bathing suit; high, med, low = high, medium, low physical attractiveness preratings. Clothes = undergraduate models in street clothes (see text).

ing-suit models. Both sexes gave better ranks to the stimulus persons in bathing suits, presumably because these were all highly attractive professional models with exemplary physiques. Few undergraduate models would be in this league. These findings are consistent with the literature indicating that men and women usually agree in their relative rankings of stimulus persons (Bersheid and Walster, 1974; Reis et al., 1980). Our findings, however, supported the predictions that females show more variation in their rankings than males do, and this sex difference is enhanced when stimulus persons' physiques are fully revealed. STUDY 2: SOCIAL STATUS AND PHYSICAL ATTRIBUTES

In five antecedent studies, over 1300 university undergraduates and 160 law students reported their willingness to engage in relationships of varying levels of sexual intimacy and marital potential in response to photographs of models who had been prerated for physical attractiveness

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2S1

(Townsend, 1993; Townsend and Levy, 1990a, 1990b; Townsend and Roberts, 1993; Townsend and Wasserman, n.d.). Five different sets of models were used in these experiments, and models' social status was manipulated by varying costumes and descriptions of income, education, occupation, ambition, and various combinations of these factors. Both sexes were influenced by status cues and models' physical attractiveness in these studies, and status cues had more influence on both sexes' ratings of partners' acceptability for marriage than for casual sexual relations. The results of these studies suggested, however, that high status could compensate for low physical attractiveness, and high physical attractiveness could compensate for low status, and these trade-offs differed significantly for men and women. These antecedent studies also suggested that men and women have different thresholds of initial acceptance. Physical attributes were more effective for male evaluators in moving target persons into the potentially acceptable pool. For men, high physical attractiveness could put models squarely in the desirable range of rating scales for dating and sexual relations regardless of the models' ascribed earning power, education, and occupation. In contrast, low ascribed status and achievement moved women's ratings of target persons' acceptability for dating, sex, and marriage into the undecided to negative range regardless of target persons' physical attractiveness. For the highest status, most physically attractive models, women's expressed willingness to marry equaled or exceeded their willingness to copulate, and their willingness to date always exceeded their willingness to copulate. In comparison, for the highest status, most physically attractive partners, men's expressed willingness to copulate equaled or exceeded their willingness to date, and their willingness to copulate always exceeded their willingness to marry (Townsend and Levy, 1990a, 1990b; Townsend, 1993; Townsend and Roberts, 1993). Simpson and Gangestad argue that women with high SOI scores are willing to waive their normal requirements for material and emotional investment if male partners are sufficiently physically attractive (Simpson and Gangestad, 1991a, 1991b, 1992; Thornhill and Gangestad, 1993). Other studies, however, suggest that polygamous women are as interested in investment as are more monogamous women (Townsend, 1995). In fact, polygamous women's standards for partners' current and future status may be higher than those of monogamous women (Townsend et al., 1995; Townsend and Wasserman, n.d.). Polygamous women are definitely influenced by partners' physical attributes, but physical attributes seem to have their strongest effects within a pool of partners that is defined by factors like peer opinion and partners' dominance and SES (Graziano et al., 1993; Sadalla et al., 1987; Townsend, 1993; Townsend et al., 1995). Consequently,

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we do not expect women's SOI scores to reduce variability in their perceptions of sexual attractiveness. Given the exploratory nature of this study, no predictions were made regarding the relationship between men's SOI scores and variability in their perceptions of sexual attractiveness. Prediction 3: Compared to women, men will exhibit less variability in their ratings of stimulus persons' acceptability for dating and sexual relations. Prediction 4: Sex differences in variability will be as large for subjects with high SOI scores as for subjects with low SOI scores. Method Sample and Procedure Male (n = 109) and female (n = 107) students in an introductory psychology course participated for course credit. Selection of subjects and testing procedure were identical to those in Study 1. Embedded in the survey was Townsend's Mate Selection Questionnaire (MSQ; Townsend, 1989; Townsend and Roberts, 1993). Part of the MSQ consists of the three questions: "I would be willing to date/have sex with/marry this person." These questions were answered in relation to a picture and description of an opposite-sex person on 5-point Likert-type agree-disagree scales. Subjects also completed the SOI (Simpson and Gangestad 1991a, 1991b, 1992). The SOI consists of seven questions that assess polygamous behavior and attitudes: (i) number of sex partners in the previous year; (ii) number of one-night stands; (iii) number of partners foreseen in the next 5 years; (iv) frequency of sexual fantasies about people other than the current dating partner, and three attitudinal questions answered on 9-point Likert scales: (v) "Sex without love is O.K". (vi) "I can imagine myself being comfortable and enjoying 'casual' sex with different partners." (vii) "I would have to be closely attached to someone (both emotionally and psychologically) before I could feel comfortable and fully enjoy having sex with her/him." Stimulus Materials An effort was made to select models who were paragons of health, physical fitness, and physical beauty, and to choose pictures in which these features were readily visible. To this end, calendars and catalogs featuring models in bathing suits were scoured and pictures of 10 males and 10 females were chosen. These pictures were then rated by 25 men and 25

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women in an upper-division anthropology class on 6-point Likert scales (1 = least attractive, 6 = most attractive). Only the ratings by opposite-sex raters were included because sex differences in the perception of attractiveness was the subject of investigation and the design only called for participants to respond to stimulus persons of the opposite sex. One male and one female were rated, respectively, X - 4.95, SD = 1.32, X = 5.15, SD = 0.91. The slightly less attractive male and female models were rated, respectively, X = 4.33, SD = 1.20, X = 4.46, SD = 1.17. Photographs depicted the models' faces and bodies. As noted, women's breasts were concealed by their bathing satis and men's chests were bare. To represent high status, a description of reliable, high income was adopted: "This young man/woman has a steady job. He/she makes about $100,000 a year." The following description represented low status: "This young man/woman works at various temporary jobs and makes about $15,000 a year. He/she describes himself/herself as not ambitious and not interested in a high-powered career." Results and Discussion The present design contained three independent variables: sex of subject, the social status depicted, and subjects' SOI scores (which were divided into high and low groups on the basis of within-sex median splits). It yielded three dependent variables: subjects' reported willingness to go out on a Date, have Sex, or Many stimulus persons. This resulted in a 2 (Subject's Gender) x 2 (High or Low SOI score) x 2 (Model's Social Status) factorial design. Means and standard deviations of subjects' responses to the Date, Sex, and Marriage questions appear in Table II. Sex differences in the effects of the independent variables have been analyzed elsewhere (Townsend and Wasserman, n.d.) and are only summarized because our current focus is on sex differences in variation. Only the findings on the dating and sexual relations questions are presented because our interest is in sexual attractiveness rather than marital attractiveness. Models' ascribed status significantly affected women's willingness to engage in dating and sexual relations. Women's SOI scores did not mitigate the effects of models' status. Models' status did not affect men's willingness to engage in dating and sexual relations. Although a considerable number of high SOI women indicated willingness to have sexual relations with the high-status models, many high SOI women were undecided or negative about this prospect (their mean response was between "agree" and "undecided"). Most of the women, however, were willing to date these models, and their SOI scores did not affect their willingness to date. In contrast,

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Table II. Mean Reported Willingness to Date, Have Sexual Relations, and Marry Stimulus Persons— by Subjects' Gender and SOI Score and Stimulus Persons' Ascribed Statusa High status Males SOI score Above median Date

Sex Marriage Below median Date

Sex Marriage

Low status

Females

Males

Females

X

SD

X

SD

X

SD

X

SD

1.20 1.12 2.64

0.58 0.44 0.99

1.65 2.59 2.69

1.01 1.09 0.89

1.27 1.31 3.17

0.53 0.47 0.89

2.42 3.27 4.23

1.24 1.00 0.86

1.50 1.65 2.96

0.72 0.75 0.74

1.63 3.33 3.00

0.69 0.83 1.00

1.69 1.46 3.65

0.74 0.65 1.06

2.48 3.89 4.48

1.06 1.08 1.38

an

= 109 females and 107 males. 1 = strongly agree: willing to date/have sex/marry stimulus person; 3 = undecided; 5 = strongly disagree. Subjects were divided into high and low groups based on within-sex median scores on the Sociosexual Orientation Inventory (SOI; see text and Simpson and Gangestad, 1991a, for question content).

virtually all the men said they were willing to date and have sexual relations with the models, regardless of their SOI scores and the models' ascribed status, and the men's willingness to date was equivalent to their willingness to copulate. A Box-Scheffe analysis was used to test for sex differences in variability of judgments (Kirk, 1982, pp. 78-79). An ANOVA showed that Gender significantly affected the variability of subjects' reported willingness to date the models, F(1, 36) = 5.54, p < 0.03. The Gender x Status interaction for Date was also significant, F(I, 36) = 6.99, p < 0.02. All other effects were nonsignificant. ANOVAs within gender showed that Status significantly affected females' variability, F(1, 36) = 5.40, p < 0.03, but not males' variability, F(1, 36) = 2.30, p > 0.13. ANOVAs within levels of status showed that men and women exhibited comparable variability in the highstatus condition, F < 1, but differed significantly in the low-status condition, F(1, 36) = 15.61, p < 0.0003. Women's responses showed greater variability in die low-status condition than men's did (see Table II). Gender significantly affected the variability of subjects' reported willingness to have sex with the models, F = 27.67, p < 0.0001. The standard deviations in Table II indicate that men showed lower variability in reporting their willingness to have sex with target persons. For Sex, all other effects were nonsignificant. For Date and Sex, the Gender x SOI interactions were nonsignificant, respectively, F < 1, F(1, 36) = 2.12, p > 0.15. These results supported Predictions 3 and 4: Compared to women, men varied less in their evalu-

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ations of target persons' acceptability for dating and sexual relations. This sex difference was as large for subjects with high SOI scores as for subjects with low SOI scores.

STUDY 3. CELEBRITIES' SEXUAL ATTRACTIVENESS

As men or women move from contexts in which their status is known and high, to contexts in which it is unknown or low, men's attractiveness should vary more than women's attractiveness as a function of this variation in information and in dominance-status ranking (Symons, 1979). The most common illustration of this phenomenon is the observation that the most attractive boys in junior high school are no longer able to date the most attractive girls in their class when they enter high school because these girls begin dating the higher ranking males who are juniors and seniors. This experience of demotion is repeated when the male high school seniors again become freshmen in college (Townsend et al., 1995). This phenomenon has important implications for research on attractiveness and mate selection. As information on males' social background, life-style, and personality increases, variability in female judgments should also increase, both as a function of the variability of the men's social characteristics, and as a function of the female judges' social backgrounds and confidence in their ability to obtain investment from those particular men. In Study 3 we used ratings of celebrities' sexual attractiveness to test this principle. Although college students do not actually know these celebrities, the mass media contain enough images and information (or pseudo-information) about celebrities' life-styles, love life, and personalities to allow people to form impressions and preferences. Prediction 5: Women's ratings of male celebrities' sexual attractiveness will vary more than men's ratings of female celebrities' sexual attractiveness. Prediction 6: Sex differences in variability will be as large for subjects with high SOI scores as for subjects with low SOI scores. Method

Subjects Twenty male and 20 female students in an anthropology class were asked to nominate male and female celebrities (musicians or actors) whom they admired, thought were attractive, liked their music or the roles they played, and who were immediately recognizable to college age subjects.

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Only names that were familiar to all and were nominated by 50% or more of the participants made the final list of 20 men and 20 women.

Sample and Procedure One hundred fifty-three women and 160 men from an introductory psychology class participated for course credit Testing conditions and instructions were identical to those in Study 1 except in Study 3 subjects were asked to rate the "sexual attractiveness" of 20 male and 20 female celebrities on 5-point scales (1 = least attractive; 5 = most attractive). Results and Discussion Males rated female celebrities more sexually attractive than females rated male celebrities, respectively, X = 3.37, SD = 0.45; X - 2.95, SD = 0.58, t(305) = 7.41, p < 0.0001. A variance ratio test confirmed that women's ratings varied more than men's did, F(162, 169) = 1.65, p = 0.0013. These findings supported Prediction 5: Females' ratings of male celebrities' sexual attractiveness varied more than males' ratings of female celebrities' sexual attractiveness. The simple means and their standard deviations are presented in Table III. Subjects were divided into high and low SOI groups on the basis of within-sex median-splits, and an analysis of variance was performed on the 40 celebrities' standard deviations (Kirk 1982, pp. 77-79). The factorial design was thus 2 (Sex of Subject) x 2 (High or Low SOI score). The main effects for sex of subject and SOI were nonsignificant, respectively, F(l, 76) = 1.61, p > 0.20; F = 3.53, p > 0.06. The sex of subject x SOI interaction was significant, F(l, 76) = 13.61, p < 0.0005. The sex difference for high SOI subjects was nonsignificant, F = 2.93, p > 0.09. The sex difference for low SOI subjects was significant, F = 12.28, p < 0.0009. For women, the effect of SOI level was nonsignificant, F = 1.64, p > 0.20. For men, the effect of SOI level was significant, F = 15.50, p < 0.0003. Mean standard deviations were as follows, respectively: high and low SOI females, 1.08,1.12; high and low SOI males, 1.14,1.00. These contrasts and means indicate that only the low SOI males differed significantly from the other three groups, and their ratings varied less than those of the other three groups. The SOI consists of three components: the first three questions concern actual sexual behavior or foreseen behavior; the fourth question measures frequency of polygamous fantasies; the last three questions elicit attitudes toward low-investment copulation (Bailey et al., 1994; Townsend

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Table III. Mean Sexual Attractiveness Ratings and Standard Deviations for 40 Celebritiesa Male subjects (n = 160) Celebrity Luke Perry Jon Bonjovi Harry Connick, Jr. Richard Gere Kevin Costner Patrick Swayze Axl Rose Billy Joel Jean-Claude van Damme Tom Hanks Sean Connery Bruce Willis Christian Slater Sylvester Stallone Tom Cruise Kiefer Sutherland Michael Keaton Sean Perm Harrison Ford Billy Crystal Cindy Crawford Madonna Jodie Foster Kim Basinger Michelle Pfeiffer Chynna Phillips Julia Roberts Bette Midler Cher Elle McPherson Demi Moore Kirstie Alley Candice Bergen Sinead O'Connor Lita Ford Mariah Carey Chris Evert-Lloyd Kathy Ireland Jane Fonda Sigourney Weaver a1

X

3.05 2.35 2.98 3.10 3.42 3.13 1.87 2.28 3.30

Z72 3.07 2.94 2.95

Z94 3.75 2.88 2.66 2.22 3.25 2.27 4.52 3.64 3.32 4.29 4.26 3.60 4.11 1.79 2.40 4.46 3.75 3.56 2.80 1.93 2.74 3.77 2.67 4.32 2.84 2.70

SD 1.06 1.07 1.18 1.12 1.07 1.14 1.10 1.03 1.23 1.04 1.21 1.07 1.09 1.18 1.16 1.05 0.92 1.12 1.14 1.04 0.96 1.13 0.99 0.97 0.95 1.03 1.06 0.92 1.21 1.01 1.04 1.08 1.01 1.19 1.22 1.15 1.10 1.11 1.15 1.22

Female subjects (n = 153) X

3.64 2.23 3.52 3.80 3.90 3.36 1.69 1.98 3.41 2.65 3.00 2.74 3.83 2.40 4.18

306 2.57 1.96 3.21 2.11 4.32 3.01 3.42 3.90 3.99 3.32 4.03 2.10 2.34 4.02 3.91 3.32 2.94 2.18 1.95 3.09 2.18 3.42 2.42 2.71

SD 1.08 1.18 1.19 1.16 1.16 1.16 1.11 1.05 1.37 0.95 1.16 1.08 1.20 1.26 1.13 1.28 1.08 1.07 1.23 1.05 0.92 1.26 1.03 1.16 1.07 1.24 1.14 1.01 1.24 1.12 0.94 0.98 1.02 1.28 1.02 1.20 0.99 1.30 1.10 1.18

= very unattractive; 5 = very attractive.

et al., 1995). Separating the SOI into these three components revealed that only the attitude component correlated significantly with the variability in men's ratings: Behavior r = 0.05, Fantasy, 0.12; Attitude, 0.22, df = 167, p < 0.004.

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Overall, men showed less variability in their ratings. When SOI scores were inserted as a factor, only the low-SOI men differed significantly from the other three groups. Men rated female celebrities as more sexually attractive than women rated male celebrities. To analyze possible associations between SOI scores, variability, and the rating assigned, an ANOVA was performed on the subjects' mean ratings of the 20 opposite-sex celebrities. The factorial design was thus 2 (Sex of Subject) x 2 (High or Low SOI score). Sex of subject had a significant effect, F(l, 329) = 55.11, p < 0.0001. The effects of SOI and the Gender x SOI interaction were both nonsignificant, Fs < 1. Evidently, the lower variability of the low-SOI men was not associated with the value of the ratings they assigned. Prediction 6 did not receive unequivocal support. The sex difference for high-SOI subjects was nonsignificant whereas the difference for low-SOI subjects was significant. This result, however, was caused by an association between SOI and variability for men rather than by an association for women. Women's SOI scores did not affect the variability of their ratings. Thus, although this finding contradicted the prediction as it was formulated, it is nevertheless consistent with our view that the variability in women's evaluations of sexual attractiveness is not moderated by their polygamous attitudes and behavior, because in fact, polygamous women are not less influenced than monogamous women by partners' social and personality characteristics. In Study 2 the association between both sexes' SOI scores and variability was nil. In Study 3 men's scores on the SOI attitude questions correlated with variability. This discrepancy could be attributed to the difference in designs. Study 2 asked subjects whether they would be willing to date or copulate with stimulus persons (all of whom were very attractive). Study 3 asked subjects to rate the "sexual attractiveness" of celebrities who differed substantially in their rated attractiveness. The association between men's polygamous attitudes and variability in their evaluations of sexual attractiveness may thus be moderated both by the attractiveness of the stimulus person and by the nature of the question. It is also noteworthy that in Study 3 men's polygamous behavior did not correlate with variability in their perceptions of sexual attractiveness. These findings will be explored in a future project.

GENERAL DISCUSSION The results of Study 1 indicate that men show more agreement in their rankings of opposite-sex target persons. Physique display enhanced this sex difference. In Study 2 men agree more in their evaluations of target per-

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sons' acceptability for dating and sexual relations. For Date, this sex difference was qualified by a Gender x Status interaction. In the high-status condition, the gender difference was nil, but it was significant in the lowstatus condition. Target persons' status affected the variability of women's ratings but not of men's. Women in the low-status condition varied more than women in the high-status condition. As predicted, subjects' SOI scores did not affect gender differences in variability of ratings. In Study 3 women varied more in their ratings of opposite-sex celebrities' sexual attractiveness, but this sex difference was moderated by subjects' SOI scores. Men with low SOI scores showed less variability than did the other three groups (women with high and low SOI scores, and men with high scores had virtually identical mean deviations). Women's SOI scores did not affect the variability of their ratings in either Study 2 or 3. These results thus support the view that women's assessments of sexual attractiveness vary more than men's, and that variability in women's ratings is not moderated by their polygamous attitudes and behavior. Study 3 suggests, however, that variability of men's assessments may be moderated by their polygamous attitudes. The fact that the variability of men's evaluations was associated with their SOI scores in Study 3 but not in Study 2 may be attributable to differences in the tasks involved and/or in the persons being rated. These possibilities will be explored in future research. Statistical Confound One might object that very high or very low ratings could produce lower variability than ratings occurring in the middle range. If men are more likely than women to assign very high or very low ratings, this could confound results. We do not believe that this objection is valid for the following reasons. First, women did not necessarily assign medium ratings in the current studies. Some of the women's ratings were quite negative or positive. For example, in the negative range, women rated three celebrities below 2.00, whereas men rated only two celebrities below 2.00. Second, factors that increase variability of ratings would, on the average, move means toward the middle of the scale. Thus, insofar as this effect occurs, it is part of the phenomenon under investigation rather than a statistical confound. In Study 2, for example, women were almost as willing as men to date the high-status models, and the variability of the sexes' ratings in this condition did not differ significantly. Pairing the models with low-status descriptions, however, reduced women's ratings and increased their variability significantly. For male subjects, describing the models as having low status affected neither their ratings nor their variability. For

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women judges, describing a handsome man as having low status confused the issue and made some of the women more negative or ambivalent. This simultaneously increased variability and moved the mean toward the middle range. Researchers who used different methods and theoretical perspectives have found that among heterosexual subjects women tend to receive higher attractiveness ratings than men do (Kenrick et al., 1990; Morse et al., 1974; Reis et al., 1980; Townsend, and Levy, 1990a; Townsend and Roberts, 1993). Evolutionary researchers attribute this sex difference to women's greater selectivity and the number of factors they consider in mate selection (Buss and Schmitt, 1993; Kenrick et al., 1990; Sadalla et al., 1987). This interpretation is consistent with our results and analysis. As information on men's social background, life-style, and personality increases, variability in women's judgments also increases, both as a function of the variability of the men's social characteristics, and as a function of the women judges' social backgrounds and confidence in their ability to obtain investment from those particular men. Hence, women's ratings of men's attractiveness tend to be lower than men's ratings of women's attractiveness not only because women are generally choosier than men, but also because the greater variability of women's judgments reduces their mean ratings of men. Alternative Explanations

Power Numerous authors have proposed that women's emphasis on SES in choosing partners and their general aversion to casual sexual relations result from their own relative lack of power and SES (see Buss and Schmitt, 1993, and Townsend, 1987, 1989, for reviews). When women gain equal access to structural power and status, their mate preferences should become more like those of men. Available evidence does not support this theory. In fact, as women's individually achieved SES increases, their socioeconomic standards for mates increase accordingly (Buss, 1989a; Buss and Schmitt, 1993; Townsend, 1989; Townsend and Roberts, 1993; Wiederman and Allgeier, 1992). Cross-Cultural Variation One might argue that samples of North American undergraduates are not representative of the general population and that they therefore bias the results. This is a potentially valid objection but available evidence does

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not support it. First, in some ways these undergraduates are the ideal population in which to test the current hypotheses. Compared to the middle classes in Western democracies, in Third World countries women are more dependent on their husbands and male kin for their status and material resources. Consequently, more Third World women are compelled to exchange sexual access for resources than are middle-class women in industrialized societies (Buss, 1989a; Glenn, 1989). Given the typical Western college student's lack of financial and parental responsibilities, their plans for delayed marriage, and the availability of effective contraceptives, college women in Western societies are probably freer than at any other time in their lives, and freer than women have been any other time in history, to experiment sexually. There is no necessity for the undergraduate women here to be more influenced than men are by target persons' high status, and to show greater variability in their judgments of sexual attractiveness. The fact that these sex differences remain so pronounced in environments where resources and technology could obviate them attests to their robustness (Buss, 1989a; Irons, 1989). Second, the sex differences in sexuality and mate preferences we have discussed appear to be at least as strong among the following groups: African Americans (Houston, 1981; Udry and Billy, 1987); Western European adolescents and college students (Clement et al., 1984; Lewin, 1982); Latin American students (Alzate, 1984; Useche et al., 1990); young professionals as well as lower socioeconomic strata in the United States (Townsend, 1987,1989; Townsend and Roberts, 1993; Weinrich, 1977); preliterate peoples (Symons, 1979; van den Berghe, 1979); cross-national samples of college students (Buss, 1989a; Buss and Schmitt, 1993). Presumably, when the appropriate studies are conducted, these groups will also exhibit sex differences in variability of judgments comparable to those presented here. Individual Choice and Sexual Selection One might argue that the sex differences in evaluation of attractiveness discussed here could not be a product of evolution because for most of human history elders have chosen mates for their younger relatives. This objection has been answered elsewhere, so we only briefly summarize the arguments (Buss, 1989a; Symons, 1979). First, the elders who arrange marriages tend to show the same sex differences in mate preferences discussed here (other factors being equal): young healthy, nubile females for their sons, and resourceful, successful males for their daughters (Buss, 1989a; Singh, 1993,1995; Symons, 1979). In fact, not infrequently older, more powerful males usurp the newly nubile females for themselves, even when the

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females have been promised to their younger male relatives (Mead, 1928, 1935; Symons, 1979; van den Berghe, 1979). Second, most of human evolution occurred as hunter-gatherers. Among contemporary hunter-gatherers, elders usually help to choose the first husbands of young women, but the women usually have veto power, marital dissolution is common, and women are usually free to choose their subsequent mates (Lee, 1979; Lee and DeVore, 1976; Symons, 1979). Thus, although it is impossible to prove, it is likely that personal mate preferences operated in evolution for most of human history. Differential Socialization Sex-role theorists claim that factors like parental and peer influence, dolls, stories, and games create the roles and scripts that dictate male-female differences in sexuality and mate preferences (Gagnon and Simon, 1973; Long Laws and Schwartz, 1977). Studies, however, that have attempted to link the sex differences in sexuality and mate preferences described here to such environmental factors have consistently failed. In a national probability sample of 1177 college students, Spanier (1976) found that the factors that social scientists normally assumed determined people's sexual behavior were not significant predictors (e.g., nuclear family relationships, parental and peer attitudes, exposure to sexual materials, religious and moral training). College dating frequency, current religiosity, and a history of sexual assault for women were significant predictors. In their detailed study of a stratified probability sample of Canadian adults, Edwards and Booth (1976) also concluded that childhood and adolescent socialization did not have lasting effects on sexual behavior (p. 70). From their survey data and their review of pertinent literature, LaPlante et al. (1980) reached similar conclusions: "personality and attitudinal variables may have relatively little impact on people's actual sex-role and sexual behavior" (p. 352). To be convincing, proponents of sex-role explanations must show empirically that the tendencies described here covary with specific environmental factors both between and within the sexes. At present, such evidence is lacking. Perception of Attractiveness Our findings on sex differences in variability have both theoretical and empirical implications. As men or women move from contexts in which their status is known and high to contexts in which it is unknown or low, men's attractiveness should vary more than women's attractiveness as a

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function of this variation in information and in dominance-status ranking (Symons, 1979). Survey, experimental, and ethnographic data support this proposition (Townsend et al., 1995). Feingold (1992) argues that gender differences in judgments of sexual attractiveness are relatively small in initial encounters where neither party has much information on the other but are larger in meetings where more information on nonphysical traits is available. Consistent with this view, Graziano et al. (1993) showed that in their judgments of physical attractiveness and dating desirability, women were significantly affected by simulated peer opinions whereas men were not affected. Similarly, Sadalla et al. (1987) found that target persons' nonverbal dominance affected women's but not men's ratings of physical, sexual, and dating attractiveness. Our observations and interviews with college students indicated that a man's status in a local hierarchy was a crucial determinant of his sexual attractiveness to women. Men who enjoyed high status in local hierarchies tended to be highly polygamous (e.g., star athletes, prominent fraternity men, musicians in local bands). Women determined a man's status (or attempted to) before consenting to a date or sexual relations (Townsend, 1995; Townsend et al., 1995). Bars, parties, and athletic events served as competitive arenas where women observed male status, compared males, and obtained information from friends about intriguing individuals. Polygamous men were aware that their attractiveness to women depended on their status being high and known. The star athletes we interviewed confirmed that when they attended functions out of town where they were not known, they were "scrubs," but when a star professional athlete or network sportscaster introduced them and confirmed their status, women suddenly became available. When they went out partying, athletes usually wore their varsity jackets to broadcast their status. A football star said that he deliberately took off his helmet during games so that women would recognize him off the gridiron. Fraternity men said a primary motivation for joining fraternities was access to women. They stated that their access was near zero but was transformed virtually overnight when they became upperclassmen and prominent in their fraternities. Most of the polygamous males' casual relations were with female students. Campus was where they had status so that was where they enjoyed the greatest access to women (Townsend et al., 1995). Could our results be artifacts of our methods? The following lines of evidence militate against this interpretation. First, researchers who used different methods from those here have also found that females' ratings of males' sexual attractiveness varied more than males' ratings of females' attractiveness (Jankowiak et al., 1992; Morse et al., 1974; Reis et al., 1980). Second, our results are consistent with the literature on the development

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of the paraphilias, sexual orientation, and gender transposition. This literature suggests that prepubertal boys internalize specific physical attributes of a class of objects (Pillard and Weinrich, 1987; Weinrich, 1988) . These physical attributes define the class of acceptable sex objects and act as visual stimuli for sexual arousal during and after puberty. Because of this process, both heterosexual and gay males, nonfetishists as well as fetishists, share the following characteristics: (i) Once internalized, the physical attributes tend to be relatively inflexible (Barlow et al., 1973; Bell and Weinberg, 1978; Green, 1987; Pillard and Weinrich, 1987; Stoller, 1982; Weinrich, 1988). Although men may believe that partners similar to them in age and other personal characteristics would be more compatible for marriage, the physical attributes that are maximally sexually attractive remain relatively constant (Kogan and Mills, 1992; Symons, 1992; Townsend, 1992). (ii) Because men can be stimulated by viewing any superior example of the favored class, all men experience the desire to possess a great variety of individuals (or objects) within that class (Kinsey et al., 1953; Pillard and Weinrich, 1987; Symons and Ellis, 1989; Townsend, 1987,1992,1995; Weinrich, 1988). (iii) Men with a particular sexual orientation tend to agree on the relative attractiveness of sex objects within the favored class (Cunningham, 1986; Jankowiak et al., 1992). Compared to boys, girls do not internalize ritualized acts, or the physical attributes of a class of objects, the mere sight of which can then stimulate sexual arousal. Consequently, true sexual fetishism is virtually unknown among women (Kinsey et al., 1953; Stoller, 1982; Weinrich, 1988). Compared to men's criteria, women's criteria are more flexible and more variable. For example, as women age, the age of their preferred partners increases commensurately, whereas for men, the gap between their age and the preferred age of partners expands (Kenrick and Keefe, 1992; Townsend, 1992). As women's SES increases, their socioeconomic standards for mates increase accordingly. These changes can occur rapidly because as women enter new status hierarchies (e.g., high school to college, college to professional school), they form new standards by comparing the men in the new environment to each other and to their own achievements (Townsend, 1989; Townsend and Roberts, 1993; Townsend et al., 1995). Women's criteria are thus more flexible and variable than men's over the life course and across individuals because they depend more on the woman's current situation: her own age, SES, life-style, what she needs in terms of emotional and material investment and what she can acquire. In contrast, for men it would always have been adaptive to be attracted to signs of maximal fertility, but to be willing to copulate with much less attractive partners, provided that little investment was required. Research indicates that, given

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opportunity, men do exhibit these tendencies (Townsend, 1987,1992,1995; Townsend et al., 1995). Evolutionary psychologists do not deny that environmental factors, including parental and peer socialization, affect the expression of sex differences in sexuality and mate selection (Buss, 1989b; Symons, 1979,1989; Tooby and Cosmides, 1992). Hence, the central question is not whether differential socialization occurs, or whether it affects sex differences. Rather, the question to be answered is whether demonstrable sex differences in socialization are necessary and/or sufficient to account for the available evidence. At present, we believe the answer to this question is negative. Women are not blind to physical features and in experimental settings men and women can apparently reach a high degree of agreement in rating people's attractiveness (Berscheid and Walster, 1974; Reis et al., 1980). Our findings suggest, however, that men's assessments are tied to more objectively assessable physical attributes whereas women's assessments are more influenced by signs of ability and willingness to invest. Consequently, increasing information about men's achievements, social background, or subculture causes women's assessments of men's physical/sexual attractiveness to vary more than such information causes men's ratings of women's attractiveness to vary. Hence, the fact that so many studies have reported that the sexes tend to agree in their assessments of the attractiveness of both male and female stimulus persons, and that males' and females' assessments often showed comparable variability, is probably attributable to the lack of other information available, and to the fact that, in seeking to control extraneous variables, researchers eliminated significant factors from consideration rather than systematically manipulating them (Morse et al., 1976; Townsend and Levy, 1990a; Townsend and Roberts, 1993).

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Dimensions of AIDS Knowledge and Risky Sexual Practices: A Study of Northern Thai Males Mark VanLandingham, Ph.D., M.P.H.,1 Nancy Grandjean, B.A.,2 Somboon Suprasert, R.N., P.H.N.,3 and Werasit Sittitrai, Ph.D.4

The relation between AIDS-related knowledge and sexual risk-taking for a sample of young men living in northern Thailand was examined. Data were collected during the fall of 1991. The sample of 1472 men includes university students, soldiers, store clerks, and laborers. Recent commercial sex patronage was variable among the subgroups, and consistent condom use among these recent patrons was far from universal Several important misunderstandings among our respondents regarding the AIDS virus were identified. These misconceptions were most common among men of relatively low socioeconomic status (laborers and soldiers). Factor analysis identified four distinct domains of AIDS knowledge among the student and soldier groups: knowledge about the mechanics of contagion, knowledge about the consequences of infection, knowledge about appropriate strategies for avoiding the virus, and knowledge regarding inappropriate strategies for avoiding the virus. In multivariate logistic regression, knowledge about inappropriate strategies and knowledge about contagion were the only two domains predictive of recent commercial sex patronage: Men with a relatively good understanding regarding the inefficacy of inappropriate strategies and the mechanics of contagion had lower odds of recent commercial sex patronage compared with men who had a relatively poor understanding of these domains of AIDS knowledge. In the condom use analysis, knowledge about both appropriate and This research was supported primarily by grants from AIDSTECH/Family Health International and the National Institutes of Health. 1Center for Studies in Demography and Ecology, Sociology Department, Box 353340, University of Washington, Seattle, Washington 98195. 2Populaton Index, Princeton University, Princeton, New Jersey 08544. 3New Life Foundation, Chiang Mai, Thailand. 4Thai Red Cross Society, Program on AIDS, Bangkok, Thailand.

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inappropriate strategies was predictive of consistent condom use among recent commercial sex patrons. Thus programs should attempt to improve knowledge about strategies for avoiding the virus and the mechanics of contagion. Special efforts should be made to debunk existing myths about the perceived effectiveness of inappropriate strategies. KEY WORDS: AIDS; Thailand; sexual behavior; knowledge; factor analysis.

INTRODUCTION

The AIDS epidemic in Thailand began relatively late in comparison with many countries in Africa, Europe, and North America. After a slow start, however, the virus is now spreading rapidly, with projections for the end of this decade ranging from 2 to 6 million infections (Economist, 1992; McDermott, 1991). AIDS has spread especially rapidly in the northern part of the country, including Chiang Mai (Brown et al., 1994). Surveys aimed at documenting the extent of risky sexual practices in Thailand have found that unprotected intercourse with commercial sex workers is common, even while it appears that many Thai men are familiar with the AIDS virus (Deemar Corp., 1990; Nopkesorn et al., 1993; Sittitrai, 1989, as cited in Sittitrai and Barry, 1991). Recent research concludes that AIDS knowledge by itself is often a poor predictor of risky sexual practices (Becker and Joseph, 1988; Carmel, 1990; Walter et al., 1992; Decosas, 1991), and we concur that in addition to knowledge, social and individual factors are important determinants of sexual behavior. We explored these factors in other work (VanLandingham et al., 1995; VanLandingham and Grandjean, 1994). But we also believe that the importance of AIDS knowledge may be underestimated because of the difficulties involved in assessing the most important features of this knowledge. Many (but not all) surveys of AIDS-related knowledge utilize only a few items to measure AIDS knowledge, and their conclusions may thus be based on an inadequate assessment of what men know and understand about the risks and consequences of infection with the AIDS virus. Also, these individual questionnaire items may by themselves be poor proxies for the underlying understanding they seek to measure. In this paper we attempt to provide a more comprehensive assessment of the extent and types of AIDS knowledge possessed by young Thai men by using a large number of assessment items (18) along with a latent variable approach. We also seek to discern which components of this understanding are linked with two important measures of sexual risk taking: recent commercial sex patronage and condom use with commercial sex workers.

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METHOD Respondents The data for this analysis were collected by the first and third authors during the fall of 1991. The total sample of 1472 men includes university undergraduates, department store clerks, military recruits, and two groups of laborers (Table I). Chiang Mai University students were included because they represent elite northern Thai society. In general, it is the privileged who are able to attend the most prestigious universities in Thailand. Our university student respondents were selected using a probability sample of all undergraduates living in campus housing (excluding students in the medical-technical, pharmacy, dentistry, and nursing programs, who are housed in special dormitories). We used a random number generator to select students from lists of dormitory residents. Of the 524 students originally slated to be sampled, 72 could not be located; they were replaced with 72 other students randomly selected from the remaining pool of students. Two of the selected students declined to participate. We included soldiers as a study group because this group is representative of young Thai male society, exclusive of the elite. Military recruits are chosen by lottery in Thailand, but in practice the well-to-do are often able to avoid conscription. The military respondents include all of the available second-year recruits from six major army and air force bases in the province. All agreed to participate. Because we also wanted to include men living in noninstitutional settings, we selected men from three other occupational groups using convenience sampling: stock clerks employed at a local department store, semiskilled/unskilled laborers employed by the municipality, and unskilled laborers employed by a local construction firm. All available workers at these three establishments were administered the questionnaire. Like the soldiers, the construction workers and municipal workers have low educational attainment relative to the university undergraduates and clerks, but are distinct from the soldiers because they live in noninstitutional settings. The clerk group can be considered a middle-class group: intermediate in status between the elite students and the less-privileged soldiers, construction workers, and municipal workers.5 Descriptive statistics and measures of AIDS knowledge are presented for all five sample groups in Tables I 5All

of the students and soldiers self-administered the questionnaire. Among the municipal workers and construction workers, there were approximately SO individuals unable to read the questionnaire and so responded in a face-to-face format. The mode of questionnaire administration did not appear to affect responses (VanLandingham, 1993).

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and II, but because the clerks, municipal workers, and construction workers are convenience samples, they are excluded from the factor and multivariate analyses. Measures The survey (see Appendix) includes questions about the respondents' sexual behavior (especially commercial sex patronage and condom use), the conditions of commercial sex patronage (e.g., the role of alcohol and companions), and 18 questions covering AIDS-related knowledge. Questions regarding the conditions of commercial sex patronage were based on our exploratory research conducted during the Spring of 1991, numerous interviews with Thai and foreign researchers working in this area, and our own knowledge of Thai culture. The AIDS knowledge questions are designed to assess various aspects of the respondents' knowledge about AIDS and HIV infection, e.g., how one contracts the virus, how one avoids the virus, and the consequences of infection. Several of the knowledge questions were adapted from the National Health Interview Survey, which is administered periodically in the United States by the National Center for Health Statistics. These questions are in the public domain. Others are taken (with permission) from a study by DiClemente et al. (1991). For the factor and multivariate analyses, the knowledge items were dichotomized to distinguish between responses indicating accurate understanding of the HIV virus and those indicating inaccurate or incomplete understanding. The knowledge factors were constructed so that higher factor loadings indicate greater knowledge or understanding. The individual items and the dichotomous codings are detailed in the Appendix. Table I displays the sociodemographic, life-style, and attitudinal factors we include to help control for potential spurious relations between AIDS knowledge and sexual behavior, i.e., occupation, age, marital status, risktaking propensity, alcohol consumption, and attitude towards condoms. Table I also presents descriptive information about the sexual experience of our respondents. The proportion sexually experienced varies widely among the subgroups, ranging from a low of 34% for the university students to a high of 96% for the municipal workers; the life table median age of 6Risk-taking

propensity is measured by an item asking whether the individual generally enjoys doing dangerous things, prefers to play it safe, or doesn't concern himself with matters of personal safety. We use five or more drinks over the course of an evening during the past month as a proxy for intoxication, which was commonly cited by our informants as an excuse for commercial sex visitation and unprotected intercourse. The respondent's attitude about condom use is assessed by a question asking whether the person agrees that an individual can use a condom and still get pleasure from sex.

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first intercourse for the various subgroups is between 17 and 18 for the soldiers, clerks, and laborers. The students tend to delay first intercourse to a later age than the other subgroups: by age 23, less than half of the students had experienced first intercourse. Most of the sexually experienced men have had sex with commercial sex workers (Q21).7 In fact, commercial sex workers were the most common type of sexual partner reported by the unmarried respondents (VanLandingham et al., 1993). Commercial sex visitation has a long history in Thai society (Bamber et al., 1993: Boonchalaksi and Guest, 1994), and this tradition continues among many of the men in our sample, even in the face of an expanding AIDS epidemic. Between 42 and 73% of the men in each group who had ever visited a commercial sex worker also did so during the 6 months prior to the survey (Q23). Condoms are unpopular among Thai men, both for contraceptive purposes with wives (Chayovan et al., 1988) and for sexually transmitted disease (STD) protection with commercial sex partners (Nopkesorn et al., 1993). Less than half of the municipal workers and soldiers who visited commercial sex workers during the 6-month period prior to the survey reported consistent condom use (Q48). However, 83% of the student and 70% of the clerk commercial sex patrons reported consistent use during this period, suggesting that condom use varies by socioeconomic status (SES) in this population. The last two items in Table I serve as the dependent variables in the multivariate analyses. Procedures and Data Analyses In the Results section, we first report univariate responses to the individual knowledge questions for each sample group. Our next step identifies domains of knowledge (factors) represented by the individual knowledge items using exploratory factor analysis. Factors were extracted using principal components analysis and orthogonal rotation using the varimax method. Factor loadings were obtained using the regression method, and these loadings were used to construct the knowledge factors used in the final step of the analysis, the multivariate logistic regression models of the effects of AIDS knowledge on two outcome variables.8 For the first multivariate model, we estimated the odds of recent commercial sex pa7The

"Q" numbers refer to items in the original questionnaire; see Appendix for exact wording of questions. 8As an alternative approach, we constructed scales of the most important knowledge items constituting each AIDS knowledge factor. These scales were used as predictors in the multivariate analyses and resulted in findings very similar to those reported in Tables IV and V.


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tronage (during the 6-month period prior to the survey) among men ever visiting a commercial sex worker. We utilize this subsample of respondents because men who have a history of commercial sex visitation are at risk for subsequent visitation and HIV infection. For the second multivariate model, we estimated the odds of consistent condom use (always use vs. nonuse or inconsistent use) among respondents who recently visited a commercial sex worker. Our interest in this analysis focused on whether the respondent always uses a condom, because only consistent condom use provides a high level of protection against the AIDS virus. We conducted focus group discussions with the students and the clerks to explore some of the dynamics and conditions of condom use, and several participants reported that condom use among men who are inconsistent users often depends upon their level of intoxication and/or visual inspection of the commercial sex worker. Given the very high levels of HIV among northern Thai commercial sex workers (Brown et al., 1994), consistent use should be the category of interest. Also, categories of inconsistent use, e.g., "sometimes or usually use," are vague, more open to respondent interpretation, and difficult to explain given the broad range of use they encompass. Coding by whether a respondent always uses a condom is both more precise and more interpretable.

RESULTS Descriptive Statistics Table II presents the frequencies of responses to the questions measuring AIDS knowledge by sample subgroup. Nearly all of the respondents have heard of AIDS (Q64), but there were important differentials among the subgroups regarding the extent of this knowledge. Although most of the students, soldiers, and clerks understood that "a person can be infected with the AIDS virus and not have symptoms of the disease AIDS" (Q66), only 44% of the construction workers said that this statement was true. Over one third of both the construction and municipal workers did not realize that there is currently no cure for or recovery from AIDS (Q69). Nearly one fifth of both the construction and the municipal workers felt that there was a great possibility of contracting the AIDS virus from mosquitoes (Q73); 13% of the municipal workers thought there was a great possibility of contracting the virus by sharing someone's comb (Q74). When the set of responses is broadened to include both "great possibility" and "could be possible" responses (not shown in Table II), significant propor-

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tions of all three groups thought it possible that a person could contract AIDS from mosquitoes (laborers, 46%; military, 27%; students, 14%) or by sharing the comb of an infected person (laborers, 34%; military, 33%; students, 23%). Over a third of each group except the students believed that urinating after intercourse was at least somewhat effective in reducing the chances of contracting HIV (Q85). Over 40% of each group except the students believed that they could "tell by looking at a commercial sex worker whether she has AIDS or not" (Q87); only 10% of the students agreed with this statement. Over one fourth of the soldiers, construction workers, and municipal workers agreed that unprotected intercourse is safe in "clean" commercial sex establishments (Q88). Average numbers of questions answered correctly (or answered in a way that indicates a good understanding of the AIDS virus) range from a high of 14 of 18 for the students to a low of 9 of 18 for the construction workers. Put another way, only 6% of the students answered 10 or fewer questions correctly compared with over half of the respondents in the two laborer groups. For these 18 questions measuring AIDS-related knowledge, Cronbach's standardized alpha ranges from .63 to .79, indicating an acceptable level of consistency among the questionnaire items assessing AIDSrelated knowledge. In an earlier version of this paper, we examined the bivariate relationships between the individual AIDS knowledge items and sexual behavior, and, like other researchers, found that the associations are inconsistent. But in the next section, we go beyond simple cross-tabulations of AIDS knowledge items by outcome measures to a search for underlying domains of AIDS knowledge that are represented by the questionnaire items. We then examine the effects of the identified AIDS knowledge domains on two measures of sexual risk taking in the final section of the results. The remainder of the analysis is limited to the soldier and student groups; the clerks, construction workers, and municipal workers are convenience samples and thus cannot be considered representative of identifiable populations. Factor Analysis We used factor analysis to identify domains of AIDS-related knowledge among the 18 individual knowledge items. The communalities and rotated factor matrix for the 18 items along with the eigenvalues of the five domains are presented in Table HI for men ever visiting commercial sex workers. These results are used in the multivariate analysis of recent


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commercial sex patronage presented in Table V. Analogous measures for men visiting commercial sex workers during the 6 months prior to the survey are presented in Table IV, and these computations are used in the multivariate analysis of condom use in Table VI. We utilized the first four of the five identified domains. The fifth domain had a marginal eigenvalue and was not readily interpretable.9 For illustrative purposes, if we consider factor loadings of .5 or higher (rotated factor matrices in Tables III and IV), the four distinct factors of AIDS-related knowledge load on identical AIDS knowledge items for the two samples (men ever visiting a commercial sex worker and men recently visiting a commercial sex worker). We conceptualized these four AIDS knowledge factors as follows: 1. Knowledge about inappropriate strategies for avoiding the virus (Q88-90: limitation of intercourse to clean, expensive, or Thaionly commercial sex workers is ineffective) 2. Knowledge about contagion (Q70, 72, 74: not spread through casual contact; Q73: not spread by mosquitoes) 3. Knowledge about the consequences of infection (Q66: AIDS infection can be asymptomatic; Q67: there are therapies that delay the onset of symptoms; Q69: there is currently no cure for infection) 4. Knowledge about appropriate strategies for avoiding the virus (Q83: abstinence; Q84: condom use; Q86: monogamy with uninfected partner)10 Multivariate Logistic Regression Analysis Recent Commercial Sex Patronage The four identified domains of AIDS-related knowledge were tested in the multivariate analysis reported in Table V for their associations with recent commercial sex patronage among the students and soldiers ever visiting a commercial sex worker. Control measures in this analysis were occupational group (soldiers vs. students), age, marital status, risk-taking 9The

omitted fifth factor is correlated with two individual knowledge items that have no apparent connection (Q64: have heard about AIDS and Q85: urinating after intercourse is ineffective for avoiding the AIDS virus). 10Three of the other knowledge items load highly on the factors (but with factor loadings of less than 0.5) in ways that are consistent with our factor conceptualizations. Knowing that taking particular drugs cannot prevent HIV infection (Q68) and knowing that one cannot tell by looking if a prostitute is infected (Q87) both load highly on Factor I (Knowledge about inappropriate strategies) in both factor analyses. And knowing that needle sharing (Q71) is a method of contagion loads highly on Factor 2 (Contagion) in both analyses.

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Table V. Logistic Regression Results for Recent Prostitute Visitation Among the Soldiers and Students Ever Visiting a Prostitute Exponentiated betas Explanatory variables and coding schemes

All variables

Controls 3.98C Occupational group: soldiers vs. students 1.04 Age 0.23e Marital status: married or cohabiting vs. other [Q5] 0.89 Describes self as a person who plays it safe [Q17] 1.94C Five or more drinks in one sitting in last month [Q15] Attitude regarding condoms Most people can use a condom and still enjoy sex: agree vs. 1.27 disagree or don't know [Q95] AIDS knowledge 0.64C Factor 1: Inappropriate strategies 0.80a Factor 2: Contagion 0.93 Factor 3: Consequences of infection 1.02 Factor 4: Appropriate strategies -1.02 Constant

n Improvement over null model (x2/df) % correctly classified

583 104/10 72

Significant variables

4.13C 0.23C

l.9r

0.65C 0.81a

-0.22 583 101/5 73

< 0.05. < 0.01. cp < 0.001. ap

bp

propensity, heavy-drinking behavior, and a measure of the respondent's attitude about condoms. These measures were included to reduce the likelihood of spurious associations between AIDS knowledge and recent commercial sex patronage that could arise from confounding relationships between the AIDS knowledge measures (our major interest) and the control variables. Two AIDS knowledge domains had significant associations with this first outcome variable. The first is accurate knowledge regarding inappropriate strategies. Men who have a relatively good understanding of the inefficacy of what we label inappropriate strategies have lower odds of recent commercial sex patronage compared with men who have a relatively poor understanding of the efficacy of these strategies. The second AIDS 11The

AIDS knowledge domains were constructed in such a way that the correlations among them are zero, so inclusion of more than one knowledge domain should not confound their separate effects. The effects of the knowledge domains do change (some are larger) in the absence of the control variables, indicating that the controls are important for estimating the net effects of AIDS knowledge.


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knowledge factor having a significant association with recent commercial sex patronage is knowledge about contagion. Men who have a relatively good understanding of the mechanics of HIV transmission have lower odds of recent commercial sex patronage than men who have a relatively poor understanding of this dimension of AIDS knowledge. The other two knowledge domains (appropriate strategies and consequences of infection) are not predictive of recent commercial sex visitation in this model. Our measures of condom attitudes, age, and risk-taking propensity did not help distinguish the men who recently visited commercial sex workers from those who did not. But we did find that unmarried men have higher odds of recent commercial sex patronage than did married men, and that recent heavy drinking and being in the soldier group (relative to the students) both increased the relative odds of recent commercial sex patronage. A test for an interaction effect between occupational group and the knowledge factors was not significant, indicating that the effects of the knowledge factors do not differ for the students and soldiers. Overall, both the full model and the model including only factors leading to a significant reduction in the model deviance, resulted in vast improvements over the null model, and these models classified 72% and 73%, respectively, of the cases into the correct dependent variable category. Both models are also superior to a classification scheme based on knowledge of the distribution of the dependent variable, which would lead to a success rate of 67%. Consistent Condom Use Among Recent Commercial Sex Patrons A second multivariate analysis predicted consistent condom use among men who visited commercial sex workers during the 6 months prior to the survey; these results are reported in Table VI. Soldiers, risk takers, heavy drinkers, and men who feel that condoms spoil sex (or who are unsure) were less likely to consistently use condoms than were men in the comparison groups. As in the model predicting recent commercial sex patronage, this analysis also found that the knowledge domain regarding inappropriate strategies for avoiding the virus was a significant predictor of AIDS risktaking behavior, in this case consistent condom use. Additionally, men who have a relatively good understanding regarding appropriate strategies for avoiding the virus have higher odds of consistent condom use. The domain measuring knowledge about contagion was insignificant in this model, but the coefficient was in the expected direction, and may have been significant in an analysis with more cases (p = 0.11). The domain measuring

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VanLandingham, Grandjean, Suprasert, and Sittitrai Table VI. Logistic Regression Results for Consistent Condom Use (Always vs. Not Always) Among the Soldiers and Students Recently Visiting a Prostitute

Explanatory variables and coding schemes Controls Occupational group: soldiers vs. students Age Marital status: married or cohabiting vs. other [Q5] Describes self as a person who plays it safe [Q17] Five or more drinks in one sitting in last month [Q15] Attitude regarding condoms Most people can use a condom and still enjoy sex: agree vs. disagree or don't know [Q95] AIDS knowledge Factor 1: Inappropriate strategies Factor 2: Contagion Factor 3: Consequences of infection Factor 4: Appropriate strategies Interaction effects Soldier sample and Factor 1 Soldier sample and Factor 4 Constant

n Improvement over null model (x2/df) % correctly classified ap bp cp

Exponentiated betas Significant variables Significant All and variables variables interactions 0.15C 0.92 0.76 2.18b 0.60a

0.12C

0.10c

2.04* 0.62a

2.07* 0.61a

1.92*

2.09b

2.04*

1.59= 1.22 1.12 1.58c

1.56C

4.21b

1.54C

5.74*

1.02

0.34a 0.25a 1.24

2.69 386 108/10 71

386 100/6 68

386 110/8 69

< 0.05. < 0.01. < 0.001.

knowledge about the consequences of infection did not approach statistical significance. Significant interaction effects existed between occupational group and the significant domains of knowledge (inappropriate strategies and appropriate strategies). Both of the coefficients indicated that these two domains of knowledge had less of an effect on condom use for the soldier sample than for the student sample. All three models of condom use resulted in significant improvements over the null model, and correctly classified 68-71% of the cases. Simply knowing the distribution of condom use would result in a success rate of approximately 50%.


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DISCUSSION Many of the men who responded to this survey had serious misunderstandings about the AIDS virus. Substantial proportions believed that they could determine by visual inspection whether a commercial sex worker was infected with HIV and that unprotected intercourse was safe if one patronized only "clean" commercial sex establishments. Many did not understand that infection can be asymptomatic, or that infection is incurable. These misunderstandings are concentrated among (but not limited to) men of relatively low SES, represented in this study by the soldiers, municipal workers, and construction workers. Furthermore, these deficiencies in knowledge correlate with sexual behaviors that put men at risk of contracting and spreading HIV. Although relations between the individual knowledge items and sexual practices are inconsistent and difficult to interpret, factor analysis provides a mechanism for grouping the individual items together into general domains of AIDSrelated knowledge that can then be more meaningfully related to behaviors that put men and their partners at risk of contracting the AIDS virus. In our multivariate analysis of the students and soldiers who had ever visited a commercial sex worker, we find that both misunderstandings of the mechanics of contagion and confidence in ineffective strategies for avoiding the virus (e.g., visually inspecting partners or patronizing clean, expensive, or Thai-only commercial sex establishments) are associated with recent commercial sex patronage. Misunderstandings about these two domains appear to affect men's propensity to continue visiting commercial sex workers, so it is important to ensure that men understand the primary modes of transmission, and to debunk existing myths that may support beliefs that it is possible to continue visiting commercial sex workers if one chooses the establishments or commercial sex workers carefully. Among the subsample of students and soldiers who did visit a commercial sex worker during the 6 months prior to the survey, knowledge about the effectiveness of appropriate strategies (e.g., abstinence, consistent condom use, or monogamy with an uninfected partner) and an understanding of the ineffectiveness of inappropriate strategies (described above) are both associated with consistent condom use in multivariate analysis. In addition to debunking myths that appear to make men overconfident in engaging in unprotected intercourse with commercial sex workers, another policy that may provide protection is an emphasis on the strategies that do work, e.g., abstinence, monogamy, or condom use if one does patronize commercial sex workers.

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Unfortunately, this analysis also indicates that these two dimensions of AIDS knowledge (appropriate strategies and inappropriate strategies) have less effect on condom use among the soldiers (who are relatively unlikely to use them in the first place) than among the students, indicating that programs targeting the former group probably require more effort for a given effect than those targeting the latter. It may be that soldiers are less able to incorporate or utilize information about AIDS and HIV than are the students, or there may be specific features of soldier culture that militate against consistent condom use. In spite of the difficulties involved, programs seeking to educate men about the dangers of unprotected intercourse with commercial sex workers should target men from relatively underprivileged backgrounds, because these men are more likely to be misinformed and to engage in risky sexual practices than are men from more privileged backgrounds. Past educational efforts have emphasized the consequences of HIV infection, but in this study we do not find significant associations between this domain of knowledge and actual sexual practice. Educational programs should now especially seek to debunk existing myths about the perceived utility of ineffective strategies, because this domain of knowledge is associated with both measures of unsafe sexual behavior in multivariate analyses. It is also important that Thai patterns of sexual behavior, levels of AIDS knowledge, and seroprevalence rates be closely monitored with periodic surveys. One indication that the Thai population is responding to the epidemic is the recent fall in STD rates among men reporting to STD clinics (Hanenberg et al., 1994). It is essential that the data reported here be updated periodically to assess the current level of AIDS knowledge in this population, identify areas of deficiencies, and determine which aspects of this knowledge currently predict relatively safe sexual behaviors.

ACKNOWLEDGMENTS

Sara McLanahan, Anne Pebley, and Noreen Goldman provided valuable advice in planning the survey. The comments and suggestions of Herb Costner, Avery Guest, and the anonymous Archives reviewers (especially reviewer C) are also gratefully acknowledged. An earlier version of this paper was presented at the annual meeting of the American Sociological Association, Los Angeles, August 1994. 12However,

the individual knowledge item (Q69) "There is no cute for AIDS" does have fairly consistent and strong associations with the measures of sexual behavior, indicating that this particular aspect of the consequences of HIV infection should continue to be stressed.


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APPENDIX Phrasing and Coding of the AIDS Knowledge Questions from the Original Questionnaire Q64. Have you ever heard of AIDS? [1 vs. 2] (1) Yes (2) No Q66. A person can be infected with the AIDS virus and not have symptoms of the disease AIDS. [1, 2 vs. 3-5] (1) Definitely true (2) Probably true (3) Probably false (4) Definitely false (5) Don't know Q67. There are drugs available to treat AIDS that can lengthen the life of an infected person. [1, 2 vs. 3-5] (1) Definitely true (2) Probably true (3) Probably false (4) Definitely false (5) Don't know Q68. There is a drug available to the public that protects a person from contracting AIDS. [3, 4 vs. 1, 2, 5] (1) Definitely true (2) Probably true (3) Probably false (4) Definitely false (5) Don't know Q69. There is no cure for AIDS at present. [1, 2 vs. 3-5] (1) Definitely true (2) Probably true (3) Probably false (4) Definitely false (5) Don't know How likely do you think it is that a person will contract the AIDS virus from . . . Q70. Working near someone infected with the AIDS virus? [3, 4 vs. 1, 2, 5]

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(1) Great possibility (2) Could be possible (3) Probably not possible (4) Definitely not possible (5) Don't know Q71. Sharing needles for drug use with someone who has the AIDS virus? [1, 2 vs. 3-5] (1) Great possibility (2) Could be possible (3) Probably not possible (4) Definitely not possible (5) Don't know Q72. Attending school with students who have the AIDS virus? [3, 4 vs. 1, 2, 5] (1) Great possibility (2) Could be possible (3) Probably not possible (4) Definitely not possible (5) Don't know Q73. Mosquitoes or other insects? [3, 4 vs. 1, 2, 5] (1) Great possibility (2) Could be possible (3) Probably not possible (4) Definitely not possible (5) Don't know Q74. By sharing a comb with an infected person? [3, 4 vs. 1, 2, 5] (1) Great possibility (2) Could be possible (3) Probably not possible (4) Definitely not possible (5) Don't know How effective would you say the following strategies are in reducing the chances of contracting the AIDS virus: Q83. Not having sexual intercourse [1 vs. 2-4] (1) Very effective (2) Somewhat effective (3) Not effective (4) Don't know how effective


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Q84. Using condoms during sexual intercourse [1 vs. 2-4] (1) Very effective (2) Somewhat effective (3) Not effective (4) Don't know how effective Q85. Urinating after sexual intercourse [3 vs. 1, 2, 4] (1) Very effective (2) Somewhat effective (3) Not effective (4) Don't know how effective Q86. Having sexual intercourse with only one person who is not infected with the AIDS virus [1 vs. 2-4] (1) Very effective (2) Somewhat effective (3) Not effective (4) Don't know how effective Please indicate whether you agree or disagree with the following statements: Q87.I can tell by looking at a female commercial sex worker whether she has the AIDS virus or not. [3, 4 vs. 1, 2, 5] (1) Strongly agree (2) Agree (3) Disagree (4) Strongly disagree (5) Don't know AIDS {translation error} Q88. It is safe to have sex with female commercial sex workers without using condoms if one goes only to the clean and disease-free commercial sex establishments. [3, 4 vs. 1, 2, 5] (1) Strongly agree (2) Agree (3) Disagree (4) Strongly disagree Q89. It is safe to have sex with female commercial sex workers without using condoms if one goes only to high-class commercial sex workers in the expensive commercial sex establishments. [3, 4 vs. 1, 2, 5] (1) Strongly agree (2) Agree (3) Disagree (4) Strongly disagree

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(5) Don't know Q90. It is safe to have sex with female commercial sex workers without using condoms if one goes only to commercial sex establishments where only Thai men go (and not foreigners). [3, 4 vs. 1, 2, 5] (1) Strongly agree (2) Agree (3) Disagree (4) Strongly disagree (5) Don't know

REFERENCES Bamber, S. D., Hewison, K. J., and Underwood, P. J. (1993). A history of sexually transmitted diseases in Thailand: Policy and politics. Genitourinary Med. 69: 148-157. Becker, M., and Joseph, J. (1988). AIDS and behavioral change to reduce risk: A review. Am. J. Public Health 78: 395-410. Boonchalaksi, W., and Guest, P. (1994). Prostitution in Thailand. Institute for Population and Social Research, Nakhon Pathom. Brown, T., Sittitrai, W., Vanichseni, S., and Thisyakorn, U. (1994). The recent epidemiology of HIV and AIDS in Thailand. AIDS 8 (Suppl. 2): S131-S141. Carmel, S. (1990). The Health Belief Model in the research of AIDS-related preventive behavior. Public Health Rev. 18: 73-85. Chayovan, N., Kamnuansilpa, P., and Knodel, J. (1988). Thailand Demographic and Health Survey, Institute for Resource Development, Columbia, MD. Decosas, J. (1991). Highlights: social epidemiology. AIDS Soc. 2(4): 7. Deemar Corp. (1990, June). Presentations of Findings, Knowledge, Attitudes and Practices. Study on AIDS in Urban Thailand, Deemar Corp., Bangkok, Thailand. DiClemente, R. J., Lanier, M. M., Horan, P. F., and Lodico, M. (1991). Comparison of AIDS knowledge, attitudes, and behaviors among incarcerated adolescents and a public high school in San Francisco. Am. J. Public Health 81: 628-630. Economist. (1992). Sense about sex [Editorial], February 8. Hanenberg, R., Rojanapithayokorn, W., Kunasol, P., and Sokal, D. C. (1994). Impact of Thailand's HIV-control programme as indicated by the decline of sexually transmitted diseases. Lancet 344: 243-245. McDermott, J. (1991). Asia—the smoldering volcano. Aids Soc. 2: 1-2. Nopkesorn, T., Mastro, T. D., Sangkharomya, S., Sweat, M., Singharaj, P., Limpakarnjanarat, K., Gayle, H. D., and Weniger, B. G. (1993). HIV-1 infection in young men in northern Thailand. AIDS 7: 1233-1239. Sittitrai, W. (1989). Research on human sexuality in pattern HI countries. Cited in Sittitrai, W., and Barry, J. (1991), Human Sexuality, Research Perspectives, International

Development Research Centre, Ottawa, Canada. VanLandingham, M. (1993). Two perspectives on risky sexual practices among northern Thai males: the Health Belief Model and the Theory of Reasoned Action. Unpublished Ph.D. dissertation. VanLandingham, M., and Grandjean, N. (1994). Some cultural underpinnings of male sexual behavior in Thailand. Paper presented at the IUSSP Conference on Sexual Subcultures and Migration in the Era of AIDS/STDs, Bangkok, Thailand. VanLandingham, M., Suprasert, S., Grandjean, N., and Sittitrai, W. (1995). Two views of risky sexual practices among northern Thai males: the Health Belief Model and the Theory of Reasoned Action. J. Health Soc. Behav. 36: 195-211.


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VanLandingham, M., Suprasert, S., Sittitrai, W., Vaddhanaphuti, C., and Grandjean, N. (1993). Sexual activity among never-married men in Northern Thailand. Demography 30: 297-313. Walter, H. J., Vaughan, R. D., Gladis, M. M., Ragin, D. F., Kasen, S., and Cohall, A. T. (1992). Factors associated with AIDS risk behaviors among high school students in an AIDS epicenter. Am. J. Public Health 82: 528-532.


Sexual Content-Induced Delay With Double-Entendre Words James H. Geer, Ph-D.1,3 and Jeffrey S. Melton, M.A.2

Seventy-three men and 72 women made lexical decisions to target words that followed sentences constructed so that the last word was a sexual double-entendre. Prime target relatedness, erotic versus nonerotic target, stimulus onset asynchrony, and participant's gender were varied in a between-subjects design. A second analysis that substituted sentence context for prime target relationship also was conducted. Data were collected on the emotionality and social acceptability of priming sentences and target words. Results revealed that, as with previous research on neutral words, prime target relatedness facilitated lexical decisions. Additionally, there was evidence of slowing in making lexical decisions when erotic material was presented or was part of a contextual bias. This delay was accentuated in women. A model that proposes that sexual words evoke a more complex processing sequence is presented. The model suggests that appraisal and checking or editing mechanisms, which are accentuated in women, help explain the phenomenon. KEY WORDS: gender, double-entendre; information processing; lexical decisions.

INTRODUCTION

Recent experiments involving erotic stimuli have yielded results suggesting that sexual material is processed differently than neutral material (Geer and Bellard, 1996; Geer et al., 1994; Geer and Lapour, 1990; Geer and McGlone, 1990). Participants in those experiments made decisions 1Department 2Department

of Psychology, Louisiana State University, Baton Rouge, Louisiana 70803. of Psychology, New Mexico State University, Las Cruces, New Mexico. Portions of this work was submitted by the junior author in partial fulfillment of the requirements for Honors in Psychology at Louisiana State University. 3To whom correspondence should be addressed. 295 0004lOOZOTAffiMMBHSllSQfO c 1997 Plenum Publishing Corporation

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more slowly when there was an erotic element present in stimuli than when there was only a control neutral or romantic element. We have labeled this hesitancy in decision making related to erotic material as "Sexual Content-Induced Delay" (SCID). Although some characteristic of erotic material and its processing results in slower decision time (DT), the nature of the underlying mechanisms are unclear. To study further the processing of sexual material, this experiment was designed using semantic pruning with a lexical decision task (LDT). The paradigm selected for study was drawn from work with neutral ambiguous words. The ambiguity paradigm has an established set of expected results when emotionally neutral ambiguous stimuli are used. Examination of variations that result from the introduction of erotic stimuli may help clarify mechanisms that underlie results. The current experiment used double-entendre words as ambiguous stimuli. Mistler-Lachman (1972) proposed three levels of ambiguity in written language: underlying structural level, surface structural level, and lexical ambiguity. This study focuses on lexical ambiguity. Lexical ambiguity occurs when a word has more than one meaning. Lexically ambiguous words are called homographs. Most English words are homographs; they have more than one meaning. An interesting characteristic of homographs is that while reading them or listening to them, most people seem consciously to recognize only one meaning. This occurs because of a confluence of several factors including the context in which the word is placed, the printed frequency of the word, and the dominance of one of the word's meanings. Printed frequency typically means the number of occurrences of a particular word in a million printed words. Meaning dominance is estimated using word association norms. When one meaning of a word results in the more frequent occurrence of an associated term that denotes that meaning, it is assumed that the more common associate meaning is dominant. For example, if money is a more common associate to bank than is river, the assumption is that the financial institution meaning of bank dominates. Word frequency and meaning dominance produce similar results in ambiguity research. When participants are asked to make a LDT response to an ambiguous word used in either its most frequent or its dominant sense, DT is facilitated or sped up when compared with the subordinate or less frequent meaning (Forster and Bednall, 1976; Simpson, 1981). Thus the most frequent or predominant meaning of an ambiguous word determines which meaning predominates when a homograph is presented without context. When researchers consider only context rather than meaning dominance, similar results are found (Schvaneveldt et al., 1976). That is, when

Sexual Content-Induced Delay

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an ambiguous word is placed in a context that biases one meaning of that word, DTs to subsequently presented target words are affected. If the target is related to the same meaning of the homograph and is biased by the context surrounding it, DT occurs more quickly than DT to unrelated targets. If the target word is related to a different meaning of the homograph than the context bias, there is no difference in DT between targets related to the alternate meaning of the homograph and completely unrelated targets (Onifer and Swinney, 1981; Tanenhaus et al., 1979). Which is the more powerful influence on lexical access, meaning dominance or context? In research that compares the effects of context with those of dominance, it appears that the answer is context (Onifer and Swinney, 1981; Simpson, 1981). Without context, meaning dominance assumes primary importance in resolving ambiguity. However, when context is present and is unquestionable in its bias, context overrides meaning. Stimulus onset asynchrony (SOA) has been introduced in ambiguity literature to investigate mechanisms in lexical access. SOA is the manipulation of the length of time between the offset of a pruning stimulus and the onset of the target. Posner and Snyder (1975) proposed a two-stage model of lexical access. In the first stage, following a prime's presentation, there is a swift spread of activation to all semantically related words. In the next stage, individuals focus their limited attentional resources on a small set of those related words determined by context or meaning dominance. This would mean that for a short time after the presentation of an ambiguous prime, all meanings of the homograph are automatically accessed. Subsequently, attention is focused on the contextually appropriate meaning. With few exceptions (Simpson and Burgess, 1982; Seidenberg et al., 1982), research supports Posner and Snyder's (1975) model. When a homograph is presented as the last word in a priming sentence and is followed immediately by a single word target related to either meaning of the homograph, DTs are faster than when the target is unrelated. This facilitation occurs regardless of which meaning of the homograph is biased by the sentence context. However, when the target is presented after about 200 msec, the context of the prime begins to show an effect. Targets related to the same meaning as the bias of the prime sentence show facilitation (Onifer and Swinney, 1981; Tanenhaus et al., 1979). Studies on emotionally neutral stimuli have established some general expectations concerning lexically ambiguous material when presented in a sentence context. Fust, all meanings of a word are activated. In priming experiments, if the target word is given immediately following the prime sentence, DTs to all meanings of the ambiguous word are facilitated. If the onset of the target word is delayed 200 ms or longer, the contextually

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appropriate meaning produces faster response times to targets. Semantic context overrides factors such as meaning dominance in determining which interpretation of the word is ultimately selected. Although there have been many experiments dealing with lexical ambiguity from the information-processing perspective, the area of erotically ambiguous, or double-entendre words, has been ignored. In English there is an abundance of erotic words that have both a neutral and an erotic meaning (e.g., screw and pussy). Thus far sexual double-entendre words have been used predominately as a tool to aid in the study of sex guilt (Galbraith and Mosher, 1968; Mosher 1961, 1965; Schwartz, 1975). SCID has been identified as a common finding when participants make decisions identifying sexual material. Geer and McGlone (1990) had participants read a narrative composed of erotic, romantic, and neutral sentences. After reading the story, participants performed a sentence-recognition task. Men recognized erotic sentences more accurately than women, whereas women more accurately recognized romantic sentences. Additionally, there was a gender by sentence content interaction in the DT file necessary to identify the sentence: DTs were faster to erotic sentences for men and faster to romantic sentences for women. Geer and Lapour (1990) used the visual dot probe methodology (Macleod et al., 1986). Men were faster in responding to the probe replacing erotic and romantic sentences than to neutral sentences. Women responded more quickly to dots replacing romantic sentences than to erotic. In a recognition task, Geer and Lapour found that participants were slower to recognize both erotic and romantic sentences than neutral sentences. Women were slower than men in recognizing erotic sentences, but they were faster in recognizing romantic sentences. Geer and Bellard (1996) have shown that, in an unprimed LDT, erotic words yielded slower DTs than romantic words, which in turn had slower DTs than those for neutral words. The authors also identified gender differences; women were, in general, slower than men in responding to sexually explicit words. Further, the data revealed a context effect for women, in which sexually explicit words as a context slowed lexical decisions to other explicit words. From these series of experiments, it is clear that once an erotic element has been introduced and recognized, decision times to those stimuli are slowed. These findings appear similar to the outcome of early experiments dealing with double-entendre words (Galbraith, 1968; Kerr and Galbraith, 1975). In those studies, free associative responses to the sexual meaning of a double-entendre word were slower than responses to the neutral meaning. Unfortunately, the methodologies used in those studies (e.g., hand timing) reduce the confidence we can have in the results.


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Other research literature may be relevant to the current work. Under the rubric of perceptual defense and vigilance (e.g., Dixon, 1980; Erdelyi, 1974), a series of investigations has examined perceptual responses to taboo words. That work found that perceptual processes influencing recognition thresholds were influenced by emotional reactions to stimuli. Kitayama (1991) suggested that "In early perceptual processing, affect elicited through preattentive processing of an input amplifies subsequent, attentive processing" (p. 269). At first glance, the phenomena addressed in Kitayama's work appear to resemble the SCID effect. There is, however, a crucial methodological difference. In the work on perceptual defense, the stimuli are degraded or impoverished in some manner. In the current research, this is not the case. That is not to suggest that perceptual responses are not part of the processing sequence involved in the work under investigation. We argue, however, that such effects are minimal in this study. Kitayama noted that, when stimuli are not degraded, the effects upon perceptual phenomena are attenuated. Since stimuli are not degraded in the current study, that argues that the data would not reflect preattentive perceptual effects. Thus, we suggest that the LDT is relatively unaffected by the perceptual processes studied in the perceptual defense literature. The current study also was designed to explore further two possible determinants of the SCID effect. Geer and Bellard (1996), in an unprimed LDT experiment conducted at the same time as this study, examined word emotionality and word social unacceptability as potential determinants of SCID. These variables were suggested as being related to possible explanations for the SCID phenomena. The SCID effect could result from emotional responses produced by the sexual stimulus. If emotional stimuli produce a response that competes for processing resources, the additional processing load may interfere with decision processing, producing a delay. A second hypothesis suggested that the social unacceptability of erotic stimuli may play a role. This hypothesis argues that, when making a decision in which individuals identify sexual material, participants do not wish to make an error, perhaps for fear of "looking bad." The concern could be viewed as instituting a response bias or criterion shift in which a delay functions to increase the likelihood of a correct response. This delay should be emphasized when erotic stimuli are socially unacceptable. If this hypothesis is valid, we should expect that, if everything else were held equal, words like fuck would have longer DTs than words like lovemaking. To evaluate these hypotheses, Geer and Bellard obtained ratings of emotionality and social unacceptability for target words used in a LDT. They reported that, of the two, only social unacceptability correlated with DT. The current study collects data relevant to these points.

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In summary, the present research was designed to investigate further the processing of sexual material using ambiguous stimuli. Several experimental hypotheses were proposed: 1. Double-entendre words will show the classical effect of context. Targets related to the meaning of the homograph established by the sentence context should have faster DTs than targets related to an alternate meaning of the double-entendre word. 2. The relatedness effect should interact with SOA. Long SOAs should yield a greater relatedness effect (shorter DTs) than short SOAs. 3. There will be an effect of target word content such that targets associated with the erotic meaning of the double-entendre words should yield slower DTs (the SCID effect) than targets associated with the neutral meaning. 4. The effect of gender will result in slower DTs to erotic stimuli for women than for men. 5. Ratings of target "social unacceptability" will correlate with DTs.

METHODS Design

A 2 x 2 x 2 x 2 between-subjects experimental design was used. The first two-level variable was Prime Target Relationship (related vs. unrelated). The second independent variable was Target Content (neutral or erotic), the third was SOA (0 or 625 msec), and the final independent variable was Participant Gender. It is possible to substitute Sentence Context (sexual vs. neutral) for the Prime Target Relationship variable. This latter design permitted examination of Sentence Context for its effect. Participants Participants consisted of male and female undergraduates enrolled in psychology courses at a large Southern state university. In the main experiment, 73 men and 72 women participated as participants. Forty men and 40 women participated as participants in pilot data collection. The only requirement for participation was that the participants be native English speakers. This stipulation increased the likelihood that participants would be familiar with the slang usage/erotic meaning of the double-entendre words. For their participation, participants received extra credit in their respective psychology courses. Participants were assured confidentiality,


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anonymity, and the right to withdraw from the experiment without penalty at any time. Accounting for gender, participants were randomly assigned to groups. The research protocol was approved by the University's Human Participants Committee. Measures In the main experiment each participant saw 48 priming sentences; 16 experimental and 32 filler. There were two sets of experimental priming sentences. One set primed the erotic meaning, and one set primed the neutral meaning of the terminal double-entendre word. (Appendix A contains the 32 experimental priming sentences with their associated target words.) All participants saw the same 32 nonemotional filler sentences. Target words were determined from pilot work. The experimental target words were selected from free associations given to the double-entendre words. Two target words were chosen for each experimental sentence. One target word was related to the erotic meaning and the other to the neutral meaning of the sentence's terminal double-entendre word. Depending upon condition, only one target word was chosen to follow each filler sentence. All target words for the filler sentences were neutral. On 50% of all trials, the target was a letter string that was not a word in English. These letter strings were made up of the scrambled letters in the target words. The procedure of presenting nonwords on a randomly determined half of the trials assured that participants could not simply indicate that all targets were words. Stimuli in the main experiment and the two preliminary pilot studies were presented using Micro Experimental Laboratories (MEL) software (Sneider, 1988). This software controls the presentation of stimuli and the storage of responses. MEL was used to gather reading times for prime sentences in the pilot work and to present the sentences and collect responses to target words in the main experiment. Subjective Ratings In pilot data collection, ratings for prime sentences were gathered on two 5-point scales. For the emotionality rating scale the top of each sheet had the heading "Level of Emotionality." Beneath it was a 5-point scale anchored by the phrases "highly negative" and "highly positive" at the ends and "neutral" in the center. Similarly for the scale of social unacceptability there was the heading "Level of Social Unacceptability." Beneath it was a 5-point scale anchored by the phrases "highly unacceptable" and "highly

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acceptable" with the center point labeled "moderately." The sentences were presented beneath the headings and associated scales with a preceding space where participants could indicate their rating. Procedure Before participating in the experiment, participants completed an informed consent form. There were two forms. One form was given to all participants who received erotic stimuli. It contained a section alerting participants to the presence of explicit erotic material. The second consent form did not mention erotic material. In all other aspects, the consent forms were identical. The second form was given to participants in those conditions that contained no explicitly erotic material. The purpose of this separate form was to preclude participants being alerted to the erotic content of double-entendre words. All participants in the main experiment were read the same task instructions. The instructions used are found in Appendix B. Pilot Studies The first pilot study was conducted to gather information concerning reading times for the prime sentences. Prune sentences were presented one at a time on a computer monitor. Ten men and 10 women were asked to read each sentence and press the spacebar when they had finished. The length of time (msec) between the onset of the sentence and the participant's response was stored. Inspection of reading times revealed considerable individual variation. It was judged that setting a standard presentation time for each sentence would compromise the usefulness of the SOA variable. Thus, it was decided that duration of presentation of prime sentences would be participant controlled. After reading time data for prime sentences were collected, the pilot participants were then asked to rate each prune sentence for both social unacceptability and emotionality. Ten additional men and women also were asked to perform this task, to provide a total of 20 male and 20 female ratings of the sentences. Participants were given a rating form that contained all prime sentences. The rating sheet with its heading was described previously. To help define social unacceptability, the following scenario was verbally given: "Think of socially unacceptable as being something that you wouldn't say to your grandmother while socially acceptable is something you could comfortably say to anyone." Raters were told that this was only an illustration and should not be used as the sole strategy in making ratings.


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A second pilot study was conducted to ensure that the target words for the main experiment were associated with either the erotic or neutral meaning of the double-entendre words. Each double-entendre word that was to be used as a terminal word was presented one at a time to 20 men and 20 women. These participants were asked to write four free associations to each word. By asking for multiple responses, we anticipated that participants would supply associations to both the erotic and the neutral meaning of the double-entendre words. For each double-entendre word, two words from the free association productions were selected as targets. One word was related to the erotic meaning, and the other was related to the neutral meaning of the double-entendre word. The erotic and neutral target words that were selected were matched for frequency of association. As one would expect, erotic associations were given less frequently than neutral associations. Therefore, an erotic association was chosen first for each double-entendre word. Then a neutral associate to the double-entendre word was chosen to match as closely as possible the associative frequency of its erotic counterpart. Filler targets were chosen so that their frequency of association was equal to the mean frequency of all pairs of experimental targets. Because the literature suggests that it takes longer to process ambiguous words than unambiguous words (Olson and MacKay, 1974; Rayner and Duffy, 1986), an attempt was made to make all target words unambiguous. However, because of constraints of a limited number of associates to double-entendre words and the need to equate for associative level, compliance with unambiguity for targets was not possible. In fact, 60% of the 32 target words were ambiguous (Webster's Third New International Dictionary of the English Language, 1971). Thirty-eight percent of neutral targets were ambiguous, and 22% of erotic targets were ambiguous. Because DTs for erotic targets were predicted to be slower than those of neutral targets, ambiguity in target words would not produce any target word SCID effect. The processing would be more complex for neutral targets because of the higher proportion of ambiguous words in that category. Thus, predicted findings of slower DTs to erotic words would be in spite of, rather than because of, target ambiguity. Main Study Upon arriving for the experiment, the participant was asked to read and sign the appropriate informed consent form. A male experimenter ran men, and a female experimenter ran women. After completing the form, the participant was taken to the computer terminal and read the instruc-

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tions (Appendix B) on how to perform the assigned task. The computer simultaneously presented instructions on the video screen. If there were no questions, the experimenter instructed the participant to begin six practice trials that consisted of emotionally neutral sentences and targets. If there were no questions upon completing the practice trials, the participants began the experimental trials. After completing the computer portion of the experiment, participants rated the target words they had just seen on the scales of Emotionality and Social Unacceptability. The 5-point Likert scales and instructions used in this procedure were identical to the ones used in rating prune sentences. Upon completing the target word ratings, and answering questions, participants were excused from the laboratory. RESULTS

We analyzed the sentence reading times from the pilot study. A SAS General Linear Model (GLM) analysis showed that reading times for erotic sentences were significantly longer (Xj= 1985.5 ms) than for either neutral (X = 1848.5 ms) or filler sentences (X = 1821 ms), F(l, 18) = 8.79, p < 0.002. This replicates previous research on reading tunes for erotic sentences (Geer et al., 1994). Participant Gender differences were also found with certain sentence types. For erotic sentences, reading times for men were longer (X = 2250 ms) than for women (X = 1721 ms), F(1, 18) = 5.85, p < 0.03. Men also took longer to read neutral sentences (X = 2137 ms) than did women (X = 1560 ms), F(l, 18) = 9.06, p < 0.003. These findings are not identical to the SCID effect. Participants were not making decisions concerning the sentences. Eight participants' data, four from each gender, were omitted from the analysis of the main study because their mean DT to target words exceeded 3 standard deviations above the grand mean DT. The discarding of outliers is common in lexical decision research and is justified on statistical grounds (Marascuilo and Serlin, 1988). The data of the main experiment were analyzed by the SAS GLM analysis on the data from 69 men and 68 women. The dependent variable was participants' mean DT (msec) to the target words. Responses to non-English letter strings, and filler sentences were not analyzed. In the first analysis, the independent variables were Prime Target Relationship, Target Content, Stimulus Onset Asynchrony, and Gender. SAS's GLM revealed a significant main effect for Prime Target Relationship. DTs in related conditions were significanttyjaster (X = 763.25 ms) than lexical decisions in the unrelated condition (X = 860.69) F(l, 136) = 7.29, p

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