Journal of Sex & Marital Therapy
ISSN: 0092-623X (Print) 1521-0715 (Online) Journal homepage: http://www.tandfonline.com/loi/usmt20
Validation of the Pornography Consumption Inventory in a Sample of Male Brazilian University Students Danilo Antonio Baltieri, Ana Saito Junqueira Aguiar, Vitor Henrique de Oliveira, Ana Luisa de Souza Gatti & Renata Almeida de Souza Aranha e Silva To cite this article: Danilo Antonio Baltieri, Ana Saito Junqueira Aguiar, Vitor Henrique de Oliveira, Ana Luisa de Souza Gatti & Renata Almeida de Souza Aranha e Silva (2015) Validation of the Pornography Consumption Inventory in a Sample of Male Brazilian University Students, Journal of Sex & Marital Therapy, 41:6, 649-660, DOI: 10.1080/0092623X.2014.958793 To link to this article: http://dx.doi.org/10.1080/0092623X.2014.958793
Accepted author version posted online: 04 Sep 2014. Published online: 10 Oct 2014.
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Date: 05 November 2015, At: 12:51
JOURNAL OF SEX & MARITAL THERAPY, 41(6), 649–660, 2015 C Taylor & Francis Group, LLC Copyright ISSN: 0092-623X print / 1521-0715 online DOI: 10.1080/0092623X.2014.958793
Validation of the Pornography Consumption Inventory in a Sample of Male Brazilian University Students
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Danilo Antonio Baltieri, Ana Saito Junqueira Aguiar, Vitor Henrique de Oliveira, Ana Luisa de Souza Gatti, and Renata Almeida de Souza Aranha e Silva ABC Medical School, Department of Neurosciences, Santo Andr´e, S˜ao Paulo, Brazil
Few measures are available to examine pornography use constructs, and this can compromise the reliability of statements regarding harmful use of pornography. This study aimed to confirm the factorial validity and internal consistency of the Pornography Consumption Inventory in a sample of male Brazilian university students. The inventory consists of a 4-factor, 15-item, 5-point Likert-type scale. After translation and back-translation of the inventory, it was administered to 100 male medical students. An initial model that included all 15 items of the inventory showed some substandard fit indices. Therefore, another model was tested, excluding an item that had loaded onto two different factors. Goodness-of-fit indices were better for the new model. Overall, findings from this study support using the inventory on Portuguese-speaking individuals. With additional replication across populations, other settings, and treatment-seeking patients, the Pornography Consumption Inventory could also potentially be shortened to 14 items.
Pornography consumption is a mass phenomenon in Western culture. Although it is difficult to reliably determine the prevalence of pornography use, it is estimated that about 43% of Internet traffic goes to a sexually explicit site, 70% of men between 18 and 24 years visit a pornographic site at least once a month (Weiss, 2014), and almost 55% of male college students in Brazil consume pornography occasionally or frequently (D’Abreu, 2013). In addition to using the Internet, people commonly use magazines, books, and videos for sexual stimulation, which are easily visible in newsstands throughout Brazil. This accessibility may considerably increase the rates of pornography exposure. Psychosocial concern regarding pornography use derives from fears that consumption may adversely affect persons, for example, by damaging the connection among emotions, intimacy, and sexuality; increasing gender inequality; and stimulating imitation of risky and unhealthy behaviors (Goldstein & Kant, 1973; Jonas, Hawk, Vastenburg, & de Groot, 2014; McKee, 2005). Exposure to sexually explicit materials can be related to drug misuse, group sex, risky sexual behaviors, and unhealthy lifestyle among adolescents (Haggstrom-Nordin, Hanson, & Tyden, 2005; Mattebo, Tyden, Haggstrom-Nordin, Nilsson, & Larsson, 2013; Svedin, Akerman, & Priebe, 2011; Willoughby, Carroll, Nelson, & Padilla-Walker, 2014), and attitudes supporting Address correspondence to Danilo Antonio Baltieri, Avenida Ang´elica, n. 2100, conjunto 13. S˜ao Paulo - S.P. Brazil. CEP: 01228-200. E-mail: [email protected] Color versions of one or more of the figures in this article can be found online at www.tandfonline.com/usmt.
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violence against women among adults (Hald, Malamuth, & Yuen, 2010; Vega & Malamuth, 2007). On the contrary, other studies have failed to show a direct association of pornography exposure with risky sexual behaviors (Luder et al., 2011), intimacy deficits (Stulhofer, Busko, & Landripet, 2010) or an increase at sexual aggression rates (Math et al., 2014), suggesting that other factors or motivations underlying consumption may better explain such deleterious effects. One controversial proposal in the literature on the consequences of pornography use has been that pornography should be used as a source of sexual education for young people, particularly emphasizing safer sex practices (Albury, 2014). Given these controversial findings and proposals, studies that use validated instruments to evaluate pornography use and motivations are necessary. To date, few measures are available to examine pornography use constructs, and this dearth can compromise the reliability of previous findings. Without established measurement tools, it is difficult to develop population norms for pornography consumption, a requirement for setting apart normal from deviant use (Short, Black, Smith, Wetterneck, & Wells, 2012). Moreover, the mere classification of material as pornographic has been a challenge for researchers, with the current consensus being that pornography means sexually explicit material figuring naked or semi-naked bodies engaged in sexual acts or genital stimulation (Kor et al., 2014; Traeen & Nilson, 2006). Previous studies have proposed motivations for pornography use, including to create distraction (Cooper, Morahan-Martin, Mathy, & Maheu, 2002); to obtain sexually related information, to establish personal connections; to get sexual entertainment or arousal (Goodson, McCormick, & Evans, 2000); to have fancy connections (Short et al., 2012); to explore stigmatized aspects of sexuality (McKenna, Green, & Smith, 2001); to manage moods and to cope with frustration, boredom, and loneliness (Paul & Shim, 2008). However, potential associations between these motivations and physical, social, and psychological problems have yet to be investigated by a sufficient number of studies using validated measures. In Brazil, there is no validated instrument currently available that evaluates pornography use. Thus, our study aimed to confirm the factorial validity and internal consistency of the Pornography Consumption Inventory (PCI) in a sample of Brazilian University men. The PCI was originally tested among hypersexual men and showed high internal consistency and reliability. In this inventory, the developers hypothesized four main reasons for pornography consumption: (a) to cope with uncomfortable emotions and stressful experiences; (b) to satisfy sexual curiosity; (c) to facilitate sexual pleasure; and (d) to satisfy desires for excitement, fantasy, novelty, and variety (Reid, Li, Gilliland, Stein, & Fong, 2011). For the purposes of this study and following the definition given by the original developers of the PCI, material was considered pornographic if it creates or elicits sexual thoughts, feelings, or behaviors; and if it contains explicit images or descriptions of sexual acts involving the genitals (e.g., vaginal or anal intercourse, oral sex, or masturbation; Hald & Malamuth, 2008; Reid et al., 2011). Given that our study involved a nonclinical sample, we hypothesized that average total PCI scores would be lower than that originally found among hypersexual men. Moreover, on the basis of literature regarding sexual curiosity, mood management, sexual pleasure, and search for variety as motivations for pornography use in nonclinical samples (Goodson et al., 2000; Paul & Shim, 2008), we hypothesized that the PCI in a healthy sample of young men would retain the four factors.
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METHOD
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Procedure Permission to use the PCI was obtained from the developers. The original version was translated in accordance with standard processes (Guillemin, Bombardier, & Beaton, 1993). The English version of the instrument was translated into Portuguese by a team including one professor, four psychiatrists, and two psychologists with experience in sexual disorders and competency in English and Portuguese, and two independent bilingual native speakers. The team worked collaboratively to ensure that the instrument had semantic equivalence across the languages and conceptual equivalence across cultures. The translation coordinator compared both versions and reconciled any differences. Also, the team compiled the Portuguese version and chose the most appropriate wording for clarity and similarity to the original. The final Portuguese version was formalized after the team discussed culturally problematic issues. The Portuguese version was then independently translated back to English by two translators, neither of whom had previously seen the original scale. The back-translated versions were also evaluated and discussed by the team. A pilot study was then performed on a small sample (n = 10) of healthy individuals from diverse educational levels to examine whether any items on the PCI were perceived as difficult. No problematic items requiring revision were found. A cross-sectional study was then performed to confirm the factorial validity and internal consistency of the PCI in a sample of male Brazilian university students. The investigators were specially trained medical graduate students. This study was approved by the Ethics Committee of ABC Medical School, Santo Andr´e, S˜ao Paulo, Brazil. Participants A total of 250 medical students 18 years of age and older and attending first through fifth year at ABC Medical School were randomly selected and contacted to join this study. Participants were assured that participation was voluntary, that only the researchers would see the data, and that all data would be kept confidential. No financial reward was provided because this is not allowed under Brazilian law. Only participants who reported consuming pornography were included in this analysis, resulting in 109 questionnaires being retained. Of these questionnaires, nine were discarded because of incomplete answers. Measures This was a cross-sectional study in which subjects provided information through a self-reported questionnaire. This questionnaire included some questions evaluating sociodemographic characteristics and the instrument to be validated (PCI). The PCI was originally developed using two samples of hypersexual men (n = 105 and n = 107; Reid et al., 2011). It is a four-factor, 15-item, 5-point Likert-type scale ranging from 1 (never like me) to 5 (very often like me). Items are summed to generate scores, with higher scores indicating a greater tendency to consume pornography in the manner described by the
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factor. Original reliability analyses showed high internal reliability for the overall scale (α = .93) and for all four subscales: emotional avoidance (α = .95), sexual curiosity (α = .89), excitement seeking (α = .85), and sexual pleasure (α = .90). Means and standard deviations for the total PCI scores and subscales in a sample of hypersexual men were as follows: total PCI, M = 48.6, SD = 13.8; emotional avoidance, M = 16.6, SD = 6.3; sexual curiosity, M = 9.6, SD = 4.2; excitement seeking, M = 10.4, SD = 3.3; and sexual pleasure, M = 11.9, SD = 3.4. In addition to the PCI, we administered the Beck Depression Inventory (BDI) to evaluate depressive symptoms and possibly exclude those participants with scores ≥17. This inventory measures behavioral responses related to depression among adults and adolescents. In this 21item instrument, scores greater than 10 (score range = 0–63) indicate the presence of a depressive syndrome, whereas scores of 17 or greater suggest the presence of a moderate or severe depression (Beck, Rial, & Rickels, 1974; Furlanetto, Mendlowicz, & Romildo Bueno, 2005). Sensitivity of 100% and specificity of 0.83 are obtained with a cutoff score of 9/10. Analysis Confirmatory factor analysis was conducted to examine the construct validity of the PCI. The maximum likelihood estimation procedure was used to estimate the parameters of the four-factor model. Comparative fit index, Tucker-Lewis index, root mean square error of approximation, and standardized root mean square residual were used to evaluate model fit. The following cutoffs indicate excellent fit: close to 0.95 or higher for comparative fit index, close to 0.90 or higher for Tucker-Lewis index, close to 0.06 or lower for root mean square error of approximation, and close to 0.08 or lower for standardized root mean square residual (Gilson et al., 2013; Hu & Bentler, 1999). Given that the chi-square value depends on sample size, we calculated the ratio of chi-square relative to the degrees of freedom (χ 2/df ). A value of 2 or lower is an acceptable χ 2/df ratio (Tabachnick & Fidell, 2007). The scale’s reliability was evaluated using Cronbach’s alpha coefficient. Correlation analyses between subscales were also carried out. All analyses were performed with SPSS/AMOS 20.
RESULTS Descriptive Analysis One hundred male students participated in this study. The mean age was 21.42 years (SD = 3.02), 80% were White, 99% were single, 23% were freshmen, and 92% were heterosexual. Only 4% reported having an alcohol use problem and 1% reported having a drug use problem. Only 20 participants had a BDI score ≥10 (but lower than 17). Confirmatory Factor Analysis Mardia’s coefficient of multivariate kurtosis was used to check normality. This coefficient was 36.71 with a critical ratio of 8.09, suggesting that the data were nonnormal. To address nonnormality, the PCI was evaluated using bootstrapping (500 bootstrap samples) and the Bollen-Stine
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FIGURE 1 First model of a confirmatory factor analysis of the Pornography Consumption Inventory (standardized parameter estimates). PCI number refers to the item number in the Pornography Consumption Inventory.
bootstrap test statistic was conducted to verify absolute fit, with p = .12. A nonsignificant BollenStine p value indicates an excellent global fit. Outliers were checked using Mahalanobis distance (D2), which did not result in wide disparity. Raw data were used for the confirmatory factor analysis and the metric of latent factors was defined by setting factor variables to 1. As illustrated in Figure 1, all PCI items had high factor loadings (≥0.62); only one item (item 5) had a loading of 0.59. As shown in Table 1, internal reliability values were high for the overall scale (α = 0.86) and for the subscales—emotional avoidance (α = .86), sexual curiosity (α = .78), excitement seeking (α = .73), and sexual pleasure (α = 0.87)—suggesting that the PCI is an internally consistent measure. The χ 2/df ratio was 1.53, suggesting that sample size
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TABLE 1 Factor Loadings for Pornography Consumption Inventory Items, Alpha Coefficients, Means, and Standard Deviations
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Item (English/Portuguese)
Pornography Consumption Inventory total scale Factor 1: Emotional avoidance Fator 1: Esquiva a` s emoc¸o˜ es 2. It provides an opportunity to be distracted from life’s challenges. 2. Uso como uma maneira para me distrair dos problemas da vida. 3. I turn to it when I’m feeling down, sad, or lonely. 3. Eu busco quando estou me sentindo triste, para baixo, solit´ario. 10. I use it to change my mood when I am anxious, stressed, or angry. 10. Eu uso para mudar o meu humor, quando estou ansioso, estressado ou com raiva. 12. I use it to avoid feeling uncomfortable or unpleasant emotions. 12. Eu uso para evitar sentimentos ruins e emoc¸o˜ es negativas. 15. I use it to disconnect from unpleasant circumstances or situations I experience. 15. Eu uso para me desconectar de situac¸o˜ es negativas que vivencio. Factor 2: Sexual curiosity Fator 2: Curiosidade sexual 1. I use it to learn more about a sexual activity or practice. 1. Eu uso para aprender mais sobre atividades e pr´aticas sexuais. 4. I’m curious about what types of sex other people have. 4. Eu sou curioso sobre que tipo de sexo outras pessoas fazem. 8. I use it to expand my knowledge about sexual possibilities. 8. Eu uso para expandir meus conhecimentos sobre possibilidades sexuais. 13. It fuels an interest I have to understand more about sex. 13. Desperta interesse para entender mais sobre sexo. Factor 3: Excitement seeking Fator 3: Busca por excitac¸a˜ o
Factor loading First model (α = .86, M = 33.46, SD = 10.12)
Final model (α = .85, M = 32.52, SD = 8.67)
(α = .86, M = 8.91, SD = 4.17)
(α = .84, M = 6.99, SD = 3.29)
0.62
0.59
0.76
0.75
0.77
—
0.84
0.88
0.76
0.77
(α = .78, M = 8.62, SD = 3.30) 0.67
0.67
0.65
0.66
0.77
0.77
0.64
0.64
(α = .73, M = 5.98, SD = 2.69) (Continued on next page)
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TABLE 1 Factor Loadings for Pornography Consumption Inventory Items, Alpha Coefficients, Means, and Standard Deviations (Continued)
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Item (English/Portuguese) 5. I use it to escape into a fantasy world. 5. Eu uso para entrar em um mundo de fantasias. 6. I use it to provide some novelty or variety in my life. 6. Eu uso para obter alguma novidade ou divers˜ao na minha vida. 11. It gives me a sense of excitement. 11. Uso para me sentir entusiasmado. Factor 4. Sexual pleasure Fator 4: Prazer sexual 7. I use it to sexually arouse myself. 7. Eu uso para me excitar sexualmente. 9. I use it to feel physical pleasure. 9. Eu uso para sentir prazer f´ısico. 14. I use it to help me masturbate, for a physical release. 14. Eu uso para me masturbar, para relaxamento.
Factor loading 0.59
0.60
0.70
0.72
0.68
0.66
(α = .87, M = 10.93, SD = 3.04) 0.75
0.75
0.90
0.90
0.83
0.83
Note. Factor loading was conducted using a confirmatory factor analysis.
was adequate. Although this model showed high internal reliability, good fit indices (standard root mean square residual = 0.06 and Tucker-Lewis index = 0.91), and adequate χ 2/df ratio and Bollen-Stine bootstrap p value, other model fit indices demonstrated substandard values (comparative fit index = 0.93 and root mean square error of approximation = 0.07, 95% CI [0.05, 0.09]). Therefore, post hoc modifications were carried out to improve the fit of the model. The changes were based on statistical and theoretical logic. Examination of modification indices indicated a high modification index between the emotional avoidance factor and the emotional avoidance item “I use it to change my mood when I am anxious, stressed, or angry” (item 10, modification index = 5.63), with an elevated value for the parameter change estimate (0.12). A parameter change estimate of >0.10 is considered large enough to justify model modification. In addition, there was a high modification index between item 10 and the excitement seeking factor (modification index = 6.07) with a parameter change estimate of 0.11. These data suggest that item 10 may be cross-loading onto two PCI factors. This would reduce the discriminant validity of the PCI because indicator variables must measure distinctively different concepts. Item 10 was dropped from the final model, which was then reassessed and showed substantiated improvement in fit, as illustrated in Figure 2 (χ 2/df = 1.29; comparative fit index = 0.96; Tucker-Lewis index = 0.95; root meat square error of approximation = 0.05, 95% CI [0.01, 0.08]; standard root mean square residual = 0.05). The Bollen-Stine bootstrap p value in this model was .27. The final model was compared with the first one, using the Bayesian information criterion and Akaike’s information criterion. Although these criteria do not have conventional cutoffs, smaller values indicate better fit (Kline, 2005); their values were
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FIGURE 2 Final model of a confirmatory factor analysis of the Pornography Consumption Inventory (standardized parameter estimates). PCI number refers to the item number in the Pornography Consumption Inventory.
293.87/200.45 and 247.88/159.64 for the first and final model, respectively. Reliability analysis of the scale in the final model also found high internal reliability for the overall scale (α = .85) and for the subscales, as shown in Table 1.
Validity Modest evidence for convergent and divergent validity comes from within the subscales of the PCI (Table 2). Emotional avoidance was strongly positively correlated with excitement seeking only (r = 0.61, p < .01∗∗ ). Sexual curiosity was moderately positively correlated with excitement
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TABLE 2 Correlations for Pornography Consumption Inventory Total and Subscale Scores in the Final Model PCI subscale
1
2
3
4
5
1. Emotional avoidance 2. Sexual curiosity 3. Excitement seeking 4. Sexual pleasure 5. Total score
—
.17 —
.61∗∗ .41∗∗ —
.12 .36∗∗ .33∗∗ —
.68∗∗ .70∗∗ .81∗∗ .63∗∗ —
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∗p
< .05. ∗∗ p < .01.
seeking (r = 0.41, p < .01∗∗ ) and sexual pleasure (r = 0.36, p < .01∗∗ ). All subscales were strongly correlated with the overall PCI total scale score.
Depression and PCI Because our study included 20 students with BDI mean scores between 10 and 16, we evaluated whether depressive symptoms were correlated with the PCI total and subscales in the final model. Only the emotional avoidance factor was moderately and positively correlated with the BDI (r = 0.40, p < .01). Sexual curiosity (r = 0.05, p = .59), sexual pleasure (r = 0.11, p = .27), and excitement seeking (r = 0.09, p = .35) were not significantly correlated with the BDI mean scores. The correlation between total scores on the PCI and BDI was weak (r = 0.22, p = .02).
DISCUSSION Although our sample comprised healthy and young male individuals, our study confirmed the factorial validity and the internal consistency of the PCI as previously tested in hypersexual men. Our initial model, which included all 15 items of the PCI, showed some substandard fit indices. Therefore, another model was tested excluding one emotional avoidance item (item 10: “I use it to change my mood when I am anxious, stressed, or angry”), which loaded onto both the emotional avoidance and excitement seeking factors, showing better fit indices. It is worth noting however that although the original inventory could potentially be shortened to 14 items, the removal of item 10 requires additional replication across populations, other settings, and treatment-seeking patients before such a recommendation is definitively made. That item 10 was cross-loaded onto these two factors may be explicable in that etymologically the term change may mean a substitution (of one thing for another) and recompense (Weekley, 1967). Thus, an individual can consume pornography to substitute a negative mood for a better one or even to obtain a recompense for a stressful situation or job. In line with this, both the emotional avoidance and excitement seeking factors could explain this item. The authors of the original version of the PCI warned about the strong correlation between these two factors, because the tendency to seek out stimulating experiences could simply be another way of distracting
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the individual from unpleasant feelings or stress among hypersexual individuals (Reid et al., 2011). In this study, we did not test the discriminant and convergent validity of the PCI. This should be performed insofar as other studies on pornography use and motivations for its consumption are carried out using validated inventories. Moreover, the accumulating research on the PCI will be able to expose possible limitations of this instrument, thereby establishing the need for other measures. Overall, findings from this study support using the PCI with Portuguese-speaking individuals. One limitation of this study is that only medical students were examined. A second limitation is that all participants were presumably healthy, as indicated by mean scores for the total PCI and subscales being lower in both models of the present study than those found in the original sample of hypersexual men, in particular for the emotional avoidance and excitement seeking factors. As such, it is unclear whether this measure will retain its psychometric properties within general or treatment-seeking populations outside a university setting. Third, our sample included welleducated individuals, and we are not convinced that people with different education levels would generate similar results. Fourth, our results cannot be generalized to female college students, as men are more likely to expose themselves to sexually explicit material than are women (Peter & Valkenburg, 2011). Future research must use invariance analysis to assess whether the factor structure of the PCI holds across genders. Previous studies have indicated that sensation seeking and depression are associated with higher exposure to sexually explicit material among adolescents (Brown & L’Engle, 2009; Peter & Valkenburg, 2006), and both of these psychological aspects are related to diverse psychiatric disorders. Our study showed positive correlation between depressive symptoms and the emotional avoidance factor. It is possible that depressed individuals consume pornography as a way to cope with negative symptoms. Some studies have shown that young men who use pornography report lower levels of self-worth and higher levels on depression (Nelson, Padilla-Walker & Karrol, 2010), and that exposures more explicit or in some other way disturbing could contribute to depression (Ybarra & Mitchell, 2005). However, we are not aware of studies that investigate the association between motivation for pornography use and depressive symptoms. Thus, a rigorous investigation of frequency of and motivation for pornography use can cast light over the underlying psychological aspects of problematic pornography use. With a validated measure to investigate motivations for pornography use, diverse studies from different geographical regions may be compared to evaluate whether certain motivations can explain negative or even positive consequences of this use. REFERENCES Albury, K. (2014). Porn and sex education, porn as sex education. Porn Studies, 1, 172–181. Beck, A. T., Rial, W. Y., & Rickels, K. (1974). Short form of depression inventory: Cross-validation. Psychological Reports, 34, 1184–1186. Brown, J. D., & L’Engle, K. L. (2009). X-rated: Sexual attitudes and behaviors associated with U.S. early adolescents’ exposure to sexually explicit media. Communication Research, 36, 129–151. Cooper, A., Morahan-Martin, J., Mathy, R. M., & Maheu, M. (2002). Toward an increased understanding of user demographics in online sexual activities. Journal of Sex & Marital Therapy, 28, 105–129. D’Abreu, L. C. F. (2013). Pornografia, desigualdade de gˆenero e agress˜ao sexual contra mulheres [Pornography, gender inequality, and sexual aggression against women]. Psicologia & Sociedade, 25, 592–601.
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Traeen, B., & Nilson, T. S. (2006). Use of pornography in traditional media and on the Internet in Norway. Journal of Sex Research, 43, 245–254. Vega, V., & Malamuth, N. M. (2007). Predicting sexual aggression: The role of pornography in the context of general and specific risk factors. Aggressive Behavior, 33, 104–117. Weekley, E. (1967). Etymological dictionary of modern English. New York, NY: Dove. Weiss, R. (2014). The prevalence of porn. Retrieved from http://blogs.psychcentral.com/sex/2013/05/ the-prevalence-of-porn Willoughby, B. J., Carroll, J. S., Nelson, L. J., & Padilla-Walker, L. M. (2014). Associations between relational sexual behaviour, pornography use, and pornography acceptance among US college students. Culture, Health & Sexuality, 16, 1052–1069. Ybarra, M. L., & Mitchell, K. J. (2005). Exposure to internet pornography among children and adolescents: A national survey. Cyberpsychology & Behavior, 8, 473–486.
ISSN: 0092-623X (Print) 1521-0715 (Online) Journal homepage: http://www.tandfonline.com/loi/usmt20
Validation of the Pornography Consumption Inventory in a Sample of Male Brazilian University Students Danilo Antonio Baltieri, Ana Saito Junqueira Aguiar, Vitor Henrique de Oliveira, Ana Luisa de Souza Gatti & Renata Almeida de Souza Aranha e Silva To cite this article: Danilo Antonio Baltieri, Ana Saito Junqueira Aguiar, Vitor Henrique de Oliveira, Ana Luisa de Souza Gatti & Renata Almeida de Souza Aranha e Silva (2015) Validation of the Pornography Consumption Inventory in a Sample of Male Brazilian University Students, Journal of Sex & Marital Therapy, 41:6, 649-660, DOI: 10.1080/0092623X.2014.958793 To link to this article: http://dx.doi.org/10.1080/0092623X.2014.958793
Accepted author version posted online: 04 Sep 2014. Published online: 10 Oct 2014.
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Date: 05 November 2015, At: 12:51
JOURNAL OF SEX & MARITAL THERAPY, 41(6), 649–660, 2015 C Taylor & Francis Group, LLC Copyright ISSN: 0092-623X print / 1521-0715 online DOI: 10.1080/0092623X.2014.958793
Validation of the Pornography Consumption Inventory in a Sample of Male Brazilian University Students
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Danilo Antonio Baltieri, Ana Saito Junqueira Aguiar, Vitor Henrique de Oliveira, Ana Luisa de Souza Gatti, and Renata Almeida de Souza Aranha e Silva ABC Medical School, Department of Neurosciences, Santo Andr´e, S˜ao Paulo, Brazil
Few measures are available to examine pornography use constructs, and this can compromise the reliability of statements regarding harmful use of pornography. This study aimed to confirm the factorial validity and internal consistency of the Pornography Consumption Inventory in a sample of male Brazilian university students. The inventory consists of a 4-factor, 15-item, 5-point Likert-type scale. After translation and back-translation of the inventory, it was administered to 100 male medical students. An initial model that included all 15 items of the inventory showed some substandard fit indices. Therefore, another model was tested, excluding an item that had loaded onto two different factors. Goodness-of-fit indices were better for the new model. Overall, findings from this study support using the inventory on Portuguese-speaking individuals. With additional replication across populations, other settings, and treatment-seeking patients, the Pornography Consumption Inventory could also potentially be shortened to 14 items.
Pornography consumption is a mass phenomenon in Western culture. Although it is difficult to reliably determine the prevalence of pornography use, it is estimated that about 43% of Internet traffic goes to a sexually explicit site, 70% of men between 18 and 24 years visit a pornographic site at least once a month (Weiss, 2014), and almost 55% of male college students in Brazil consume pornography occasionally or frequently (D’Abreu, 2013). In addition to using the Internet, people commonly use magazines, books, and videos for sexual stimulation, which are easily visible in newsstands throughout Brazil. This accessibility may considerably increase the rates of pornography exposure. Psychosocial concern regarding pornography use derives from fears that consumption may adversely affect persons, for example, by damaging the connection among emotions, intimacy, and sexuality; increasing gender inequality; and stimulating imitation of risky and unhealthy behaviors (Goldstein & Kant, 1973; Jonas, Hawk, Vastenburg, & de Groot, 2014; McKee, 2005). Exposure to sexually explicit materials can be related to drug misuse, group sex, risky sexual behaviors, and unhealthy lifestyle among adolescents (Haggstrom-Nordin, Hanson, & Tyden, 2005; Mattebo, Tyden, Haggstrom-Nordin, Nilsson, & Larsson, 2013; Svedin, Akerman, & Priebe, 2011; Willoughby, Carroll, Nelson, & Padilla-Walker, 2014), and attitudes supporting Address correspondence to Danilo Antonio Baltieri, Avenida Ang´elica, n. 2100, conjunto 13. S˜ao Paulo - S.P. Brazil. CEP: 01228-200. E-mail: [email protected] Color versions of one or more of the figures in this article can be found online at www.tandfonline.com/usmt.
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violence against women among adults (Hald, Malamuth, & Yuen, 2010; Vega & Malamuth, 2007). On the contrary, other studies have failed to show a direct association of pornography exposure with risky sexual behaviors (Luder et al., 2011), intimacy deficits (Stulhofer, Busko, & Landripet, 2010) or an increase at sexual aggression rates (Math et al., 2014), suggesting that other factors or motivations underlying consumption may better explain such deleterious effects. One controversial proposal in the literature on the consequences of pornography use has been that pornography should be used as a source of sexual education for young people, particularly emphasizing safer sex practices (Albury, 2014). Given these controversial findings and proposals, studies that use validated instruments to evaluate pornography use and motivations are necessary. To date, few measures are available to examine pornography use constructs, and this dearth can compromise the reliability of previous findings. Without established measurement tools, it is difficult to develop population norms for pornography consumption, a requirement for setting apart normal from deviant use (Short, Black, Smith, Wetterneck, & Wells, 2012). Moreover, the mere classification of material as pornographic has been a challenge for researchers, with the current consensus being that pornography means sexually explicit material figuring naked or semi-naked bodies engaged in sexual acts or genital stimulation (Kor et al., 2014; Traeen & Nilson, 2006). Previous studies have proposed motivations for pornography use, including to create distraction (Cooper, Morahan-Martin, Mathy, & Maheu, 2002); to obtain sexually related information, to establish personal connections; to get sexual entertainment or arousal (Goodson, McCormick, & Evans, 2000); to have fancy connections (Short et al., 2012); to explore stigmatized aspects of sexuality (McKenna, Green, & Smith, 2001); to manage moods and to cope with frustration, boredom, and loneliness (Paul & Shim, 2008). However, potential associations between these motivations and physical, social, and psychological problems have yet to be investigated by a sufficient number of studies using validated measures. In Brazil, there is no validated instrument currently available that evaluates pornography use. Thus, our study aimed to confirm the factorial validity and internal consistency of the Pornography Consumption Inventory (PCI) in a sample of Brazilian University men. The PCI was originally tested among hypersexual men and showed high internal consistency and reliability. In this inventory, the developers hypothesized four main reasons for pornography consumption: (a) to cope with uncomfortable emotions and stressful experiences; (b) to satisfy sexual curiosity; (c) to facilitate sexual pleasure; and (d) to satisfy desires for excitement, fantasy, novelty, and variety (Reid, Li, Gilliland, Stein, & Fong, 2011). For the purposes of this study and following the definition given by the original developers of the PCI, material was considered pornographic if it creates or elicits sexual thoughts, feelings, or behaviors; and if it contains explicit images or descriptions of sexual acts involving the genitals (e.g., vaginal or anal intercourse, oral sex, or masturbation; Hald & Malamuth, 2008; Reid et al., 2011). Given that our study involved a nonclinical sample, we hypothesized that average total PCI scores would be lower than that originally found among hypersexual men. Moreover, on the basis of literature regarding sexual curiosity, mood management, sexual pleasure, and search for variety as motivations for pornography use in nonclinical samples (Goodson et al., 2000; Paul & Shim, 2008), we hypothesized that the PCI in a healthy sample of young men would retain the four factors.
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METHOD
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Procedure Permission to use the PCI was obtained from the developers. The original version was translated in accordance with standard processes (Guillemin, Bombardier, & Beaton, 1993). The English version of the instrument was translated into Portuguese by a team including one professor, four psychiatrists, and two psychologists with experience in sexual disorders and competency in English and Portuguese, and two independent bilingual native speakers. The team worked collaboratively to ensure that the instrument had semantic equivalence across the languages and conceptual equivalence across cultures. The translation coordinator compared both versions and reconciled any differences. Also, the team compiled the Portuguese version and chose the most appropriate wording for clarity and similarity to the original. The final Portuguese version was formalized after the team discussed culturally problematic issues. The Portuguese version was then independently translated back to English by two translators, neither of whom had previously seen the original scale. The back-translated versions were also evaluated and discussed by the team. A pilot study was then performed on a small sample (n = 10) of healthy individuals from diverse educational levels to examine whether any items on the PCI were perceived as difficult. No problematic items requiring revision were found. A cross-sectional study was then performed to confirm the factorial validity and internal consistency of the PCI in a sample of male Brazilian university students. The investigators were specially trained medical graduate students. This study was approved by the Ethics Committee of ABC Medical School, Santo Andr´e, S˜ao Paulo, Brazil. Participants A total of 250 medical students 18 years of age and older and attending first through fifth year at ABC Medical School were randomly selected and contacted to join this study. Participants were assured that participation was voluntary, that only the researchers would see the data, and that all data would be kept confidential. No financial reward was provided because this is not allowed under Brazilian law. Only participants who reported consuming pornography were included in this analysis, resulting in 109 questionnaires being retained. Of these questionnaires, nine were discarded because of incomplete answers. Measures This was a cross-sectional study in which subjects provided information through a self-reported questionnaire. This questionnaire included some questions evaluating sociodemographic characteristics and the instrument to be validated (PCI). The PCI was originally developed using two samples of hypersexual men (n = 105 and n = 107; Reid et al., 2011). It is a four-factor, 15-item, 5-point Likert-type scale ranging from 1 (never like me) to 5 (very often like me). Items are summed to generate scores, with higher scores indicating a greater tendency to consume pornography in the manner described by the
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factor. Original reliability analyses showed high internal reliability for the overall scale (α = .93) and for all four subscales: emotional avoidance (α = .95), sexual curiosity (α = .89), excitement seeking (α = .85), and sexual pleasure (α = .90). Means and standard deviations for the total PCI scores and subscales in a sample of hypersexual men were as follows: total PCI, M = 48.6, SD = 13.8; emotional avoidance, M = 16.6, SD = 6.3; sexual curiosity, M = 9.6, SD = 4.2; excitement seeking, M = 10.4, SD = 3.3; and sexual pleasure, M = 11.9, SD = 3.4. In addition to the PCI, we administered the Beck Depression Inventory (BDI) to evaluate depressive symptoms and possibly exclude those participants with scores ≥17. This inventory measures behavioral responses related to depression among adults and adolescents. In this 21item instrument, scores greater than 10 (score range = 0–63) indicate the presence of a depressive syndrome, whereas scores of 17 or greater suggest the presence of a moderate or severe depression (Beck, Rial, & Rickels, 1974; Furlanetto, Mendlowicz, & Romildo Bueno, 2005). Sensitivity of 100% and specificity of 0.83 are obtained with a cutoff score of 9/10. Analysis Confirmatory factor analysis was conducted to examine the construct validity of the PCI. The maximum likelihood estimation procedure was used to estimate the parameters of the four-factor model. Comparative fit index, Tucker-Lewis index, root mean square error of approximation, and standardized root mean square residual were used to evaluate model fit. The following cutoffs indicate excellent fit: close to 0.95 or higher for comparative fit index, close to 0.90 or higher for Tucker-Lewis index, close to 0.06 or lower for root mean square error of approximation, and close to 0.08 or lower for standardized root mean square residual (Gilson et al., 2013; Hu & Bentler, 1999). Given that the chi-square value depends on sample size, we calculated the ratio of chi-square relative to the degrees of freedom (χ 2/df ). A value of 2 or lower is an acceptable χ 2/df ratio (Tabachnick & Fidell, 2007). The scale’s reliability was evaluated using Cronbach’s alpha coefficient. Correlation analyses between subscales were also carried out. All analyses were performed with SPSS/AMOS 20.
RESULTS Descriptive Analysis One hundred male students participated in this study. The mean age was 21.42 years (SD = 3.02), 80% were White, 99% were single, 23% were freshmen, and 92% were heterosexual. Only 4% reported having an alcohol use problem and 1% reported having a drug use problem. Only 20 participants had a BDI score ≥10 (but lower than 17). Confirmatory Factor Analysis Mardia’s coefficient of multivariate kurtosis was used to check normality. This coefficient was 36.71 with a critical ratio of 8.09, suggesting that the data were nonnormal. To address nonnormality, the PCI was evaluated using bootstrapping (500 bootstrap samples) and the Bollen-Stine
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FIGURE 1 First model of a confirmatory factor analysis of the Pornography Consumption Inventory (standardized parameter estimates). PCI number refers to the item number in the Pornography Consumption Inventory.
bootstrap test statistic was conducted to verify absolute fit, with p = .12. A nonsignificant BollenStine p value indicates an excellent global fit. Outliers were checked using Mahalanobis distance (D2), which did not result in wide disparity. Raw data were used for the confirmatory factor analysis and the metric of latent factors was defined by setting factor variables to 1. As illustrated in Figure 1, all PCI items had high factor loadings (≥0.62); only one item (item 5) had a loading of 0.59. As shown in Table 1, internal reliability values were high for the overall scale (α = 0.86) and for the subscales—emotional avoidance (α = .86), sexual curiosity (α = .78), excitement seeking (α = .73), and sexual pleasure (α = 0.87)—suggesting that the PCI is an internally consistent measure. The χ 2/df ratio was 1.53, suggesting that sample size
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TABLE 1 Factor Loadings for Pornography Consumption Inventory Items, Alpha Coefficients, Means, and Standard Deviations
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Item (English/Portuguese)
Pornography Consumption Inventory total scale Factor 1: Emotional avoidance Fator 1: Esquiva a` s emoc¸o˜ es 2. It provides an opportunity to be distracted from life’s challenges. 2. Uso como uma maneira para me distrair dos problemas da vida. 3. I turn to it when I’m feeling down, sad, or lonely. 3. Eu busco quando estou me sentindo triste, para baixo, solit´ario. 10. I use it to change my mood when I am anxious, stressed, or angry. 10. Eu uso para mudar o meu humor, quando estou ansioso, estressado ou com raiva. 12. I use it to avoid feeling uncomfortable or unpleasant emotions. 12. Eu uso para evitar sentimentos ruins e emoc¸o˜ es negativas. 15. I use it to disconnect from unpleasant circumstances or situations I experience. 15. Eu uso para me desconectar de situac¸o˜ es negativas que vivencio. Factor 2: Sexual curiosity Fator 2: Curiosidade sexual 1. I use it to learn more about a sexual activity or practice. 1. Eu uso para aprender mais sobre atividades e pr´aticas sexuais. 4. I’m curious about what types of sex other people have. 4. Eu sou curioso sobre que tipo de sexo outras pessoas fazem. 8. I use it to expand my knowledge about sexual possibilities. 8. Eu uso para expandir meus conhecimentos sobre possibilidades sexuais. 13. It fuels an interest I have to understand more about sex. 13. Desperta interesse para entender mais sobre sexo. Factor 3: Excitement seeking Fator 3: Busca por excitac¸a˜ o
Factor loading First model (α = .86, M = 33.46, SD = 10.12)
Final model (α = .85, M = 32.52, SD = 8.67)
(α = .86, M = 8.91, SD = 4.17)
(α = .84, M = 6.99, SD = 3.29)
0.62
0.59
0.76
0.75
0.77
—
0.84
0.88
0.76
0.77
(α = .78, M = 8.62, SD = 3.30) 0.67
0.67
0.65
0.66
0.77
0.77
0.64
0.64
(α = .73, M = 5.98, SD = 2.69) (Continued on next page)
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TABLE 1 Factor Loadings for Pornography Consumption Inventory Items, Alpha Coefficients, Means, and Standard Deviations (Continued)
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Item (English/Portuguese) 5. I use it to escape into a fantasy world. 5. Eu uso para entrar em um mundo de fantasias. 6. I use it to provide some novelty or variety in my life. 6. Eu uso para obter alguma novidade ou divers˜ao na minha vida. 11. It gives me a sense of excitement. 11. Uso para me sentir entusiasmado. Factor 4. Sexual pleasure Fator 4: Prazer sexual 7. I use it to sexually arouse myself. 7. Eu uso para me excitar sexualmente. 9. I use it to feel physical pleasure. 9. Eu uso para sentir prazer f´ısico. 14. I use it to help me masturbate, for a physical release. 14. Eu uso para me masturbar, para relaxamento.
Factor loading 0.59
0.60
0.70
0.72
0.68
0.66
(α = .87, M = 10.93, SD = 3.04) 0.75
0.75
0.90
0.90
0.83
0.83
Note. Factor loading was conducted using a confirmatory factor analysis.
was adequate. Although this model showed high internal reliability, good fit indices (standard root mean square residual = 0.06 and Tucker-Lewis index = 0.91), and adequate χ 2/df ratio and Bollen-Stine bootstrap p value, other model fit indices demonstrated substandard values (comparative fit index = 0.93 and root mean square error of approximation = 0.07, 95% CI [0.05, 0.09]). Therefore, post hoc modifications were carried out to improve the fit of the model. The changes were based on statistical and theoretical logic. Examination of modification indices indicated a high modification index between the emotional avoidance factor and the emotional avoidance item “I use it to change my mood when I am anxious, stressed, or angry” (item 10, modification index = 5.63), with an elevated value for the parameter change estimate (0.12). A parameter change estimate of >0.10 is considered large enough to justify model modification. In addition, there was a high modification index between item 10 and the excitement seeking factor (modification index = 6.07) with a parameter change estimate of 0.11. These data suggest that item 10 may be cross-loading onto two PCI factors. This would reduce the discriminant validity of the PCI because indicator variables must measure distinctively different concepts. Item 10 was dropped from the final model, which was then reassessed and showed substantiated improvement in fit, as illustrated in Figure 2 (χ 2/df = 1.29; comparative fit index = 0.96; Tucker-Lewis index = 0.95; root meat square error of approximation = 0.05, 95% CI [0.01, 0.08]; standard root mean square residual = 0.05). The Bollen-Stine bootstrap p value in this model was .27. The final model was compared with the first one, using the Bayesian information criterion and Akaike’s information criterion. Although these criteria do not have conventional cutoffs, smaller values indicate better fit (Kline, 2005); their values were
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FIGURE 2 Final model of a confirmatory factor analysis of the Pornography Consumption Inventory (standardized parameter estimates). PCI number refers to the item number in the Pornography Consumption Inventory.
293.87/200.45 and 247.88/159.64 for the first and final model, respectively. Reliability analysis of the scale in the final model also found high internal reliability for the overall scale (α = .85) and for the subscales, as shown in Table 1.
Validity Modest evidence for convergent and divergent validity comes from within the subscales of the PCI (Table 2). Emotional avoidance was strongly positively correlated with excitement seeking only (r = 0.61, p < .01∗∗ ). Sexual curiosity was moderately positively correlated with excitement
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TABLE 2 Correlations for Pornography Consumption Inventory Total and Subscale Scores in the Final Model PCI subscale
1
2
3
4
5
1. Emotional avoidance 2. Sexual curiosity 3. Excitement seeking 4. Sexual pleasure 5. Total score
—
.17 —
.61∗∗ .41∗∗ —
.12 .36∗∗ .33∗∗ —
.68∗∗ .70∗∗ .81∗∗ .63∗∗ —
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∗p
< .05. ∗∗ p < .01.
seeking (r = 0.41, p < .01∗∗ ) and sexual pleasure (r = 0.36, p < .01∗∗ ). All subscales were strongly correlated with the overall PCI total scale score.
Depression and PCI Because our study included 20 students with BDI mean scores between 10 and 16, we evaluated whether depressive symptoms were correlated with the PCI total and subscales in the final model. Only the emotional avoidance factor was moderately and positively correlated with the BDI (r = 0.40, p < .01). Sexual curiosity (r = 0.05, p = .59), sexual pleasure (r = 0.11, p = .27), and excitement seeking (r = 0.09, p = .35) were not significantly correlated with the BDI mean scores. The correlation between total scores on the PCI and BDI was weak (r = 0.22, p = .02).
DISCUSSION Although our sample comprised healthy and young male individuals, our study confirmed the factorial validity and the internal consistency of the PCI as previously tested in hypersexual men. Our initial model, which included all 15 items of the PCI, showed some substandard fit indices. Therefore, another model was tested excluding one emotional avoidance item (item 10: “I use it to change my mood when I am anxious, stressed, or angry”), which loaded onto both the emotional avoidance and excitement seeking factors, showing better fit indices. It is worth noting however that although the original inventory could potentially be shortened to 14 items, the removal of item 10 requires additional replication across populations, other settings, and treatment-seeking patients before such a recommendation is definitively made. That item 10 was cross-loaded onto these two factors may be explicable in that etymologically the term change may mean a substitution (of one thing for another) and recompense (Weekley, 1967). Thus, an individual can consume pornography to substitute a negative mood for a better one or even to obtain a recompense for a stressful situation or job. In line with this, both the emotional avoidance and excitement seeking factors could explain this item. The authors of the original version of the PCI warned about the strong correlation between these two factors, because the tendency to seek out stimulating experiences could simply be another way of distracting
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the individual from unpleasant feelings or stress among hypersexual individuals (Reid et al., 2011). In this study, we did not test the discriminant and convergent validity of the PCI. This should be performed insofar as other studies on pornography use and motivations for its consumption are carried out using validated inventories. Moreover, the accumulating research on the PCI will be able to expose possible limitations of this instrument, thereby establishing the need for other measures. Overall, findings from this study support using the PCI with Portuguese-speaking individuals. One limitation of this study is that only medical students were examined. A second limitation is that all participants were presumably healthy, as indicated by mean scores for the total PCI and subscales being lower in both models of the present study than those found in the original sample of hypersexual men, in particular for the emotional avoidance and excitement seeking factors. As such, it is unclear whether this measure will retain its psychometric properties within general or treatment-seeking populations outside a university setting. Third, our sample included welleducated individuals, and we are not convinced that people with different education levels would generate similar results. Fourth, our results cannot be generalized to female college students, as men are more likely to expose themselves to sexually explicit material than are women (Peter & Valkenburg, 2011). Future research must use invariance analysis to assess whether the factor structure of the PCI holds across genders. Previous studies have indicated that sensation seeking and depression are associated with higher exposure to sexually explicit material among adolescents (Brown & L’Engle, 2009; Peter & Valkenburg, 2006), and both of these psychological aspects are related to diverse psychiatric disorders. Our study showed positive correlation between depressive symptoms and the emotional avoidance factor. It is possible that depressed individuals consume pornography as a way to cope with negative symptoms. Some studies have shown that young men who use pornography report lower levels of self-worth and higher levels on depression (Nelson, Padilla-Walker & Karrol, 2010), and that exposures more explicit or in some other way disturbing could contribute to depression (Ybarra & Mitchell, 2005). However, we are not aware of studies that investigate the association between motivation for pornography use and depressive symptoms. Thus, a rigorous investigation of frequency of and motivation for pornography use can cast light over the underlying psychological aspects of problematic pornography use. With a validated measure to investigate motivations for pornography use, diverse studies from different geographical regions may be compared to evaluate whether certain motivations can explain negative or even positive consequences of this use. REFERENCES Albury, K. (2014). Porn and sex education, porn as sex education. Porn Studies, 1, 172–181. Beck, A. T., Rial, W. Y., & Rickels, K. (1974). Short form of depression inventory: Cross-validation. Psychological Reports, 34, 1184–1186. Brown, J. D., & L’Engle, K. L. (2009). X-rated: Sexual attitudes and behaviors associated with U.S. early adolescents’ exposure to sexually explicit media. Communication Research, 36, 129–151. Cooper, A., Morahan-Martin, J., Mathy, R. M., & Maheu, M. (2002). Toward an increased understanding of user demographics in online sexual activities. Journal of Sex & Marital Therapy, 28, 105–129. D’Abreu, L. C. F. (2013). Pornografia, desigualdade de gˆenero e agress˜ao sexual contra mulheres [Pornography, gender inequality, and sexual aggression against women]. Psicologia & Sociedade, 25, 592–601.
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