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A Multi-Methodological Study of a Possible Syndemic Among Female Adult Flim Actresses

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A Multi-Methodological Study of a Possible Syndemic Among Female Adult Flim Actresses University of South Florida Scholar Commons Graduate Theses and Dissertations Graduate School 2011 A Multi-Methodological Study of a Possible Syndemic among Female Adult Flim Actresses Candace Danielle Sibley University of South Florida, [email protected] Follow this and additional works at: https://scholarcommons.usf.edu/etd Part of the American Studies Commons, and the Other Education Commons Scholar Commons Citation Sibley, Candace Danielle, "A Multi-Methodological Study of a Possible Syndemic among Female Adult Flim Actresses" (2011). Graduate Theses and Dissertations. https://scholarcommons.usf.edu/etd/3344 This Thesis is brought to you for free and open access by the Graduate School at Scholar Commons. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Scholar Commons. For more information, please contact [email protected]. A Multi-Methodological Study of a Possible Syndemic among Female Adult Film Actresses by Candace Sibley A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Public Health Department of Community and Family Health College of Public Health University of South Florida Major Professor: Julie Baldwin, Ph.D. Amina Alio, Ph.D. Eric Buhi, Ph.D. Dawood Sultan, Ph.D. Date of Approval: July 8, 2011 Keywords: Syndemic Theory, Sexually Transmitted Infections, Health Disparities, Occupational Health, Pornographic Film Copyright © 2011, Candace Sibley Dedication To all the people in the world who struggle against seemingly insurmountable odds to succeed, when it seems impossible hold fast, keep your head down, work harder, because success is closer than you think. Acknowledgements I would like to thank my committee for believing in and supporting me. Your investment in my future will never be forgotten. Dr. Baldwin, your support is truly limitless, thank you for helping me grow and teaching me lessons that will serve me for the rest of my life. Dr. Alio, thank you for being an incredible role model, and your invaluable contribution to my growth. Dr. Buhi, thank you for your wonderful guidance and your terrific support. Dr Sultan, thank you for helping me through this process, and providing important mentorship. Dr. Mbah, thank you, for taking the time to teach me and ensuring that I have the tools to succeed in the future. Melissa Johnson, Dr. Teri Malo and Dr. Mary Martinasek thank you for providing feedback, and helping me get to the finish line of this thesis. Mommy (Ann Basley) and Daddy (Ted Basley) thank you for supporting me in every way possible; you are the best parents in the world. Cristian Chandler, Emelda Curry, and Maisha Standifer thank you for being my teachers, supporters, and friends. Table of Contents List of Tables .......................................................................................................................v List of Figures .................................................................................................................... vi List of Acronyms .............................................................................................................. vii Abstract ............................................................................................................................ viii Chapter One: Introduction ...................................................................................................1 Statement of the Problem .........................................................................................3 HIV/STI Disparities among Sex Workers ...............................................................4 HIV/STI Disparities among Adult-Film Performers ...............................................4 History of HIV Outbreaks in the Adult Film Industry .............................................7 Rationale for the Study ............................................................................................8 Purpose of the Inquiry… ........................................................................................11 Study Aims.............................................................................................................12 Quantitative Hypotheses ........................................................................................12 Qualitative Objectives and Research Questions ....................................................13 Qualitative research Objectives .............................................................................13 Mixed Method Objectives and Research Quesitons ..............................................13 Significance of the Study .......................................................................................14 Chapter Two: Relevant Literature and Conceptual Framework ........................................15 Section I: Overview of Relevant Literature ...........................................................15 Philosophy of Relevant Literature .............................................................15 Existing Studies on HIV/STI Risk among Marginalized Population ........17 Shift to Synergism and Syndemics ............................................................18 Existing Syndemic Studies ........................................................................21 Geographical Differences in the AFI .........................................................25 Section II: Conceptual Framework ........................................................................26 Ecosocial Theory .......................................................................................26 Internal Microsystem ..................................................................................31 External Microsystem ................................................................................32 Mesosystem................................................................................................34 Macrosystem ..............................................................................................35 Applying the expanded Syndemic Framework to AFI Actresses ..........................42 Chapter Three: Methods ....................................................................................................45 Introduction ............................................................................................................45 i Research Design .....................................................................................................48 Phase I: Secondary Quantitative Data Analysis.....................................................49 Participants and Primary Data Procedures .................................................49 Description of the use of the Primary Data Collection Instrument ............50 Characteristics of Female Adult Performer Sample and Normative Sample........................................................................................................51 Rationale for Secondary Data Analysis and Logistic Regression .............52 Demographic (Control) Variables .....................................................53 Predictors ..........................................................................................54 Childhood Sexual Abuse…………………………… .........54 Adult Sexual Abuse……………………………….. ...........54 Intimate Partner Violence ....................................................55 Substance Abuse……………………………………. .........55 Depression Score .................................................................56 Syndemic Theory Testing Variable .....................................57 Outcome Variables ............................................................................57 Self –Reported HIV Risk ....................................................58 Personal Sex Number ..........................................................59 Other Sex Work ...................................................................59 Analytic Procedure .....................................................................................59 Description and Rationale for Construction of Logistic Regression Models ............................................................................59 Phase II: Ethnography ............................................................................................63 Rationale for adding Ethnography .............................................................64 Recruitment and Challenges to Research ..................................................65 Components of Ethnographic Design ........................................................66 Description of the Qualitative Instrument ..................................................68 Qualitative Data Analysis ..........................................................................68 Qualitative Rigor ...............................................................................69 Preliminary Limitations of Qualitative Research .............................70 Mixed Methods Data Analysis...................................................................71 Ethical Concerns ........................................................................................71 Chapter Four: Results .......................................................................................................74 Phase I: Quantitative Findings ...............................................................................74 Demographics ............................................................................................74 Descriptive Statistics ..................................................................................76
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