Assessing the effectiveness of an education program for reducing the negative effects of pornography exposure amongst young people Marshall S. Ballantine-Jones Discipline of Child & Adolescent Health, Children's Hospital Westmead Clinical School, Faculty of Medicine and Health University of Sydney A thesis submitted to fulfil requirements for the degree of Doctor of Philosophy 2020 i Statement of Originality I certify that the content of this thesis is original except as acknowledged in the text. No part of this thesis has been submitted for another degree at this or any other institution. Any assistance received has been appropriately acknowledged and any contributions to published studies are outlined.
31 July 2020 ____________________________________ __________________ Marshall Ballantine-Jones Date ii Acknowledgements I wish to express sincere gratitude and appreciation to the many people who enabled the completion of this thesis. Emeritus Professor Kim Oates, who in teaching me how to research at the highest level, demonstrated humility, kindness and patience. I hope this work justified his coming out of supervision-retirement! Professor Rachel Skinner, who provided insights and guidance at critical times. Dr Patricia Weerakoon, who planted the seeds for doctoral research in 2015.
Associate Professor Nicholas Wood and the staff of the Westmead Clinical School, for providing invaluable support and resources to advance this study, in an environment of wonderful people and high standards. My wife Rebecca, whose love, support and friendship enabled me to complete this work, and who makes me a much better person. My children, Bronte, Oscar, Felix and Spencer, of whom I am very proud, and for whom I hope my research, and efforts as a dad, help them navigate life. My father, Rev Dr Bruce Ballantine-Jones, and my stepmother Mrs Heather Ballantine-Jones, for their regular encouragement, love, interest and support.
My late mother Raema, who instilled a contagious love of knowledge, blended with wit and kindness, and demonstrated how to use superior talents to love and serve others. My parents-in-law, Brian and Rhonda Eggert, for their constant support, encouragement, generosity, love, and patience enduring the son with a Peter Pan syndrome. iii My three best friends: Dr George Athas, who gave endless support, advice, editing and inspiration. Mr Shan Joseph, for keeping me sane and fit.
And Mr Robert Thomas, for being there whenever I need him. Dr Bryan Cowling, for advice on developing the Education Intervention. Dr John Roodenberg, for the critique of the Chapter 4 baseline survey study, along with advice on thesis structure and content. Mrs Cassandra Cassis, Mrs Kathryn Findlay and Mrs Tracey Mayo, who professionally edited the text.
The public and personal support of The Anglican Archbishop of Sydney, Dr Glenn Davies. The Anglican Schools Corporation, for their financial and moral support. Mr Vanda Gould and the Anglo Australian Christian & Charitable Fund, for their generous financial and moral support Mr Russell Powell, Rev Andrew Nixon, Mr Greg Bridge, Rev David Milne and Panania Anglican Church (who generously donated office space to use), for their friendship and support. The principals, teachers, students and families of participating schools, who although anonymous, provided the resources and goodwill to conduct the various studies within this thesis.
Lastly, the many friends and supporters in the wider community, who have sent notes of support, assurances of prayers, and the encouragement to persevere through what were, on occasions, challenging times. iv Thesis Abstract Introduction A large body of research portrays pornography as having negative effects on adolescents, with limited research supporting a positive aspect. Exposure to pornography and sexualised social media may impact young people personally, relationally and socially. Despite this body of predominantly cross-sectional research, there is little evidence on how any negative effects may be countered or reduced.
Furthermore, there has only been a small number of school-based education programs seeking to address pornography and sexualised media, but they have not been empirically tested for effectiveness. A small number of interventional studies related to adolescent behaviour change may provide limited guidance on addressing adolescent attitude and behaviour change if impacted by pornography. This gap in the literature justifies the conducting an interventional study on whether known negative effects can be reduced. Objectives Building on the available research, a theoretical framework is proposed, where three strategies are incorporated into a school program to reduce the personal, relational and social negative effects of pornography exposure.
These strategies are: 1. peer-to-peer engagement; and 3. Methods In preparation for designing a program, an initial study was conducted to develop a baseline survey about pornography viewing and attitudes to pornography in a sample of 746 Year 10 high school students, aged 14–16 years, from NSW independent schools. The survey incorporated a number of previously validated instruments.
v The intervention was a six-lesson program, aligned with the Health and Physical Education strand of the Australian National Curriculum, conducted on 347 Year 10 students from NSW independent schools, aged 14–16. The program was developed by the researcher, in consultation with school teachers, parents, and high school students. Results After successfully validating the baseline survey, further analysis demonstrated that the participating students were representative of wider studies, making it an appropriate instrument to evaluate an intervention, while also informing how the program should be developed., self- esteem) were observed to behave differently than expected, raising additional questions about social media behaviours and narcissism, which the program could address. Initial analysis of the intervention showed participants behaved typically of both the baseline study, and adolescents in wider research.
Additionally, students exposed to social media computer applications were more likely to have narcissistic traits, which mediated the effect that pornography exposure or sexualised social media behaviours had on self-esteem. Teacher feedback about the program was positive, with enthusiastic uptake of peer engagement activities. The activities involving parent-student engagement were not carefully monitored and may not have been implemented well. The comparison of pre- and post-intervention data showed a significant increase in healthy attitudes related to pornography, positive views towards women, and responsible attitudes towards relationships.
Additionally, students with regular viewing behaviours increased their efforts to reduce viewing, while increasing their unease about ongoing pornography viewing. Female students experienced mild reductions in self-promoting social media behaviours and pornography viewing vi frequency. There was some evidence that the parental engagement strategy increased parent-student interactions, whilst peer-to-peer engagement helped reduce the influence of wider peer culture. Students did not develop problematic behaviours or attitudes after doing the course.
Students who regularly viewed pornography had higher rates of compulsivity, which mediated their viewing behaviours such that, despite increases in attitudes opposed to pornography, unease about pornography viewing, or efforts to reduce undesirable behaviours, viewing prevalence did not reduce. Additionally, there were trends of increased tensions in male parent-relationships after the home engagement activities, and female peer-relationships after the peer discussions or from the social media teaching content. Conclusion The program was effective at reducing a number of negative effects from pornography exposure, sexualised social media behaviours, and self-promoting social media behaviours, using the three strategies of didactic education, peer-to-peer engagement, and parental activities. Compulsive behaviours impeded efforts to reduce pornography viewing in some students, meaning additional therapeutic help may be required to support those struggling to produce behaviour change.
Additionally, an adolescent’s engagement with social media may produce excess narcissistic traits, effecting self-esteem, and altering their interaction with pornography and sexualised social media behaviours. vii Authorship Attribution Statement The candidate was responsible for coordinating the research under the supervision and guidance of Primary Supervisor: Emeritus Professor Kim Oates MD DSc MHP FRACP FAFPHM, Discipline of Child and Adolescent Health, Westmead Clinical School, University of Sydney. Secondary Supervisors: Professor Rachel Skinner, Discipline of Child and Adolescent Health, Westmead Clinical School, University of Sydney; Dr Patricia Weerakoon, honorary senior lecturer, Sydney Medical School - HIV, STIs and Sexual Health Unit, University of Sydney. The candidate took primary responsibility for all aspects of the research presented in this thesis, including the research of past literature, conceptualisation and design of research studies, data collection, quantitative and qualitative analyses, the interpretation and reporting of results.
Chapters 3 and 4 were reviewed by Dr Bryan Cowling and Dr John Roodenberg respectively. Chapters 1-3 were edited by Mrs Casandra Cassis. Chapters 4-10 were edited by Mrs Tracey Mayo. ____________________________________ 30/7/2020 Marshall Ballantine-Jones Date As supervisor for the candidate upon which this thesis is based, I can confirm that the authorship attribution statement above is correct.
_____________________________________ 30/7/2020 Emeritus Professor Kim Oates Date viii Table of Contents Chapter 1: Introduction and Literature Review 1 1.1 Background and Thesis Structure 1 1.2 Literature Review Research Method 4 1.1 Data search method 4 1.2 Data search order 5 1.3 Data search key words 5 1.4 Limitations to search methodology 6 1.3 General Analysis of Research Data 7 1.1 Analysis of data sources 7 1.2 Cross-Sectional limitations and strengths 8 1.3 Longitudinal, interventional and controlled trial limitations and strengths 10 1.4 The Effects of Pornography on Young People 11 1.1 Positive personal effects of pornography 12 1.2 Negative personal effects of pornography 13 1.1 Objectification, sexual aggression, and negative gender attitudes 13 1.2 Mental Health and Behaviour changes 14 1.4 Is compulsive pornography viewing a form of addictive behaviour? 17 1.5 Relational effects of pornography 19 1.6 The Social effects 21 ix 1.1 Is pornography production exploitative and harmful? 21 1.2 Pornography and popular culture 23 1.3 Pornography and Religion 24 1.7 Summary of the Effects of Pornography on Young People 25 1.5 Suggestions for reducing the negative effects of pornography 26 1.1 Pornography-related curriculum 26 1.2 Other education studies for avoidance and reduction of undesirable behaviours 27 1.3 General substance abuse curriculum 28 1.3 Peer to peer relationships 32 1.4 Cognitive behavioural therapies and other responses to neurological harms 34 1.5 The neurological and behavioural effects of Abstinence 35 1.7 Chapter References 38 Chapter 2: Development of a Methodology 45 2.2 An Absence of a Theoretical Framework for the Interventional Study 46 2.1 One Framework to Consider, the DSMM 46 2.3 Core Constructs for the Intervention 49 2.1 Negative Effects Constructs 49 2.2 Positive Solutions Constructs 50 2.6 Broader integration of community involvement 50 2.4 Further Considerations for a School-Based Context? 51 2.1 Local Contexts for Program Frameworks 52 2.2 Limitations of some National Curricula 53 2.5 Need for an Assessment Instrument 55 2.7 Chapter References 57 Chapter 3: Design and Validation of Baseline Survey 58 3.1 Important considerations for a school-based baseline survey 59 3.1 Survey construction and implementation 60 3.2 Control Variable Selection 61 3.3 Survey Factors derived from Constructs 63 3.2 Validating the constructs 71 3.1 The Super Wellbeing Scale 73 3.6 Chapter References 78 xi Chapter 4: Analysis of Survey Data 82 4.1 Excluded control variables 85 4.3 Age of First-Time Viewing 87 4.5 Preferred Viewing Device 88 4.7 Sexualised Social Media Behaviours 89 4.5 Predictor Factor Results 97 4.1 Age of First-Time Exposure 97 4.2 Multiple and Simple Linear Regression on Viewing Prevalence 97 4.6 Outcome Factors influenced by Pornography Viewing 100 xii 4.1 Attitudes to Pornography 100 4.2 Women as Sex Objects 100 4.3 Uncommitted Sexual Exploration 100 4.5 Distress from Viewing 101 4.12 Sexualised Social Media Behaviour (SSMB) 103 4.9 Chapter References 114 Chapter 5: Study Protocol for Education Pilot 116 5.3 Background to Study 117 5.1 Prevalence data from a recent study 117 xiii 5.4 Aims and Hypotheses 119 5.5 Development and Review Process for Pilot Program 120 5.6 Recruitment and Implementation Process for the Pilot Program 124 5.2 Participant characteristics including sex, age range and inclusion/exclusion criteria 124 5.4 Sample size and Cohan’s ‘d’ 125 5.5 Details of where the study will be undertaken (location/site/URL) 126 5.6 Details of how data will be collected and analysed 126 5.7 Risks associated with study 127 5.8 Invitation to Principals 127 5.9 Participation Information Statements to Students, Parents and Teachers 128 5.11 Alternative teaching content 130 5.3 Potential significance of the study 133 5.8 Chapter References 135 xiv Chapter 6: Qualitative Analysis of Pilot Program 136 6.2 Teaching difficulty of lessons 138 6.3 Student engagement during the six lessons 139 6.