Racial disparities in Death rates and Death incidences in Xinjiang: A study of multilevel ecological mechanisms.

Health disparities based on racial status are well-researched by social scientists, but this field of knowledge has rarely been investigated beyond the Western context. As the largest province in China, Xinjiang has over 50% non-Han populace-and this group is subjected to various forms of inequalities. The current study is the first to quantitatively demonstrate the disparity in mortality between the Han majority and Turkic minority in Xinjiang. We have developed a theory-driven framework to approach race as a fundamental cause of mortality disparity through both individual and context-level pathways that trigger the proximate determinants of death. We compiled the 2015 China Microcensus with the Sixth Decennial Census (2010) and web-extracted point-of-interest information for data at different ecological levels. The results reveal that the mortality rate is significantly pronounced for Turks at the county-level and Turks' death incidence is elevated at the household level. The inclusion of variables at the individual- and context-level explains about 38% of the mortality disparity between Han and Turks, but the significant disparity remains strong after considering the covariates, the "healthy migrant" scenario, geographical clustering, and exposure risk. We cautiously suggest the remaining unexplained portion of the mortality disparity may be due to unobserved racial inequity and urge the academic community to further investigate this underexplored subject.

Vaping in a Time of Pandemics: Risk Perception and Motivations for Electronic Cigarette Use.

INTRODUCTION: Prior studies on the association between the intensity of and motives for vaping e-cigarettes have highlighted the psychological dynamics of motivational changes, but less about how vaping motives may shift as a function of risk perceptions exacerbated by unanticipated events. This study frames the COVID-19 pandemic as an exacerbating threat to pulmonary health, and tests how e-cigarette users' risk perceptions of COVID-19 are related to different motives for vaping and ultimately the intensity of e-cigarette use. AIMS AND METHODS: An online survey of e-cigarette users in the United States (n = 562) was conducted during April 2020 when much of the United States was under "lockdown" conditions. We distinguished three types of vaping motives (health, socialization, and dependence) and established the classification with confirmatory factor analysis. Structural equation modeling was conducted for path analyses and mediation tests. RESULTS: All three vaping motives were significantly associated with greater use intensity. A heightened risk perception of e-cigarette users' vulnerability to COVID-19 was inversely associated with use intensity (-.18, p < .01) and health motives for vaping (-.27, p < .001), but not associated with socialization and dependence motivations. Health motives for vaping mediated 35% of the association between COVID-19 risk perceptions and use intensity. CONCLUSIONS: Our findings indicate that risk perceptions of exacerbated threats may reduce e-cigarette use directly, and also indirectly through shifting certain types of motivations for vaping. Beyond elucidating the relational dynamics between vaping psychology and health risks, these results also indicate health professionals may leverage the pandemic to promote nicotine cessation or reduced use. IMPLICATION: Little is known about how vaping motives shift after unanticipated events such as pandemics. This study contributes to knowledge of how the use of e-cigarettes is motivated by different dimensions of rationales and exogenous risks. Exploiting the emergence of the COVID-19 pandemic, we found risk perceptions are associated with the intensity of e-cigarette use indirectly specifically through health motivations. Risk perceptions are not associated with socialization and dependence motives for vaping.

The Moderation Role of Neuroticism for Anxiety among Burdened Dementia Caregivers: A Study on Care Giver-Recipient Dyads.

Caregiving burden proves to be a risk factor of anxiety disorders and anxiety affection. The current study investigates how an endogenous personality dimension - neuroticism - moderates the association between caregiving burden and anxiety affection. Between 2015 and 2017, the study deployed a cross-sectional survey of 674 (response rate = 89%) older adults who were hospitalized for dementia at two hospitals. From all primary caregivers of these patients, 661 agreed to participate in the survey which yielded 661 matched dyads as the final sample. Caregiving burden, neuroticism, and anxiety affection were each measured by established assessment instruments. We employed multivariate OLS regression to test the moderator and regressor effects. We found that care burden is a significant risk factor of higher levels of anxiety affection (ß = .17, p < .001), and accounts for 4.6% of the variance in anxiety. Neurotic personality is also significantly associated with a greater level of anxiety (ß = .26, p < .001). Neurotic personality moderates the association between anxiety and care burden (ß = .24, p < .001). Our findings suggest that social and healthcare workers should assess caregiver personality and burden as well as provide support, resources, and coping strategies to those with neurotic personality traits or high care burden in an effort to reduce anxiety among caregivers.

Uncertainty Stress, and Its Impact on Disease Fear and Prevention Behavior during the COVID-19 Epidemic in China: A Panel Study.

Objectives: We examined changing trends of uncertainty stress, and its impact on disease fear and prevention behaviors during the Chinese COVID-19 epidemic, using a prospective observational study. Methods: We employed a longitudinal design. We recruited participants for an online panel survey from chat groups on social media platforms. There were 5 waves of interviews. Information on uncertainty stress and related variables were collected via the online survey. Descriptive statistics and the GIM program were used for data analysis. Results: Participants numbered 150 for the linkable baseline survey and 102 (68%) for the final survey. Uncertainty stress (ß = -.047, SE = .118, p > .05) did not show a statistically significant temporal change trend over the observation period. Disease fear manifested a statistically significant downwards trend (ß = -.342, SE = .157, p < .05), and prevention behaviors indicated an upwards trend (ß = .048, SE = .021, p < .05) during the observation period. Uncertainty stress was positively associated with disease fear (ß = .45046, SE = .05964, p < .001), and negatively associated with self-efficacy (ß = -.6698, SE = .01035, p < .001), and prevention behaviors (ß = -.02029, SE = .00876, p =.021). Conclusion: This study yielded new information about uncertainty stress among Chinese people during the COVID-19 epidemic. Policy changes and public education are essential for minimizing the negative effects of uncertainty stress in disease prevention.

Perceived Beliefs, Uncertainty, and Behavioral Responses During the COVID-19 Outbreak in China: Findings From a Convenience Sample.

PURPOSE: To investigate perceived beliefs, uncertainty, and behavioral responses among Chinese residents toward the COVID-19 outbreak, and explore their relationships amid an incipient pandemic. DESIGN: A cross-sectional correlational survey with a combination of a convenience and snowball sampling design. SETTING: This study was conducted online from February 7 to 14, 2020, the third week after the lockdown of Wuhan city on January 23. PARTICIPANTS: A total of 2,654 residents was contacted, 2,534 agreed to participate, and 2,215 completed valid questionnaires. The sample covered 30 provinces, municipalities, autonomous regions of China, and a broader region. MEASURES: The Uncertainty About COVID-19 Scale was applied to assess perceived public uncertainty. Five dimensions of health beliefs about COVID-19 and 12 health-related response behaviors were measured. ANALYSIS: Univariate analysis and multiple linear regression models were used to identify associations. Mediation was assessed by a bootstrapping technique. RESULTS: Five constructs of health beliefs were found to be significant predictors of multiple response behaviors. Uncertainty about COVID-19 has a direct relationship with general response behaviors (ß=-0.119**) and sanitization practices (ß=-0.068**). Emergency coping behaviors aside, uncertainty also partially mediated associations between perceived susceptibility, perceived effectiveness, and perceived barriers influencing general response behaviors and sanitization practices, respectively. CONCLUSION: Findings provide evidence-based information to government and policymakers for designing effective health communication messages and intervention strategies by targeting the key constructs of the health belief model and reducing perceived uncertainty about COVID-19. They support public health-related response behaviors to prevent COVID-19 spread among the population.

Changing trends of mental and behavioral responses and associations during the COVID-19 epidemic in China: a panel study.

This prospective observational study examined changing trends in mental and behavioral responses, and their association with perceived risk, severity, self-efficacy and isolation status during the Chinese COVID-19 epidemic. There were five waves of interviews. Descriptive statistics and non-parametric test methods were used for data analysis. Participants numbered 150 for the linkable baseline survey and 102 completed all 5 survey waves and were included in the analysis. Mental stress, emotional status and lifestyle manifested a statistically significant downwards trend across the total period of this panel study. The number of reported new confirmed patients perceived high risk and perceived severity were positively associated with mental stress, emotional status and lifestyle. Self-efficacy was negatively associated with each type of mental and behavioral response. The more time people were confined to their home, the more serious the emotional and lifestyle problems. Dose-response relationships were noted between the number of reported new confirmed patients and mental stress, emotional status and lifestyle during the five observation points. This study yielded new information about mental and behavioral responses among Chinese people during the COVID-19 epidemic. Policy changes and health education are essential for minimizing the adverse health effects of these responses.

Class Status and Social Mobility on Tobacco Smoking in Post-Reform China Between 1991 and 2011.

INTRODUCTION: There is growing attention to social mobility's impact on tobacco use, but few studies have differentiated the two conceptually distinct mechanisms through which changes in social class can affect tobacco smoking: the class status effect and the mobility effect. AIMS AND METHODS: I applied Diagonal Reference Modeling to smoking and heavy smoking among respondents of the 1991 China Health and Nutrition Survey who were revisited two decades later in 2011 (n = 3841, 49% male, baseline mean age was 38 years). I divided the sample into six social classes (non-employment, self-employed, owners, workers, farmers, and retirees) and measured social mobility by changes in income and occupational prestige. RESULTS: About 61.7% of men were smokers and those from the classes of workers, owners, and self-employees consumed more cigarettes compared to the unemployed, but women smokers (3.7%) tend to be from the lower classes (unemployed and farmers). Controlling for social class, each 1000 Yuan increase in annual income led to smoking 0.03 more cigarettes (p < .05) and 1% increase (p < .05) in the likelihood of heavy smoking among men, but the income effect is null for women. Upwardly mobile men (a 10-points surge in occupational prestige) smoked like their destination class (weight = 78%), whereas men with downward mobility were more similar to peers in the original class (weight = 60%). CONCLUSIONS: Contrary to the social gradient in smoking in other industrial countries, higher class status and upward mobility are each associated with more smoking among Chinese men, but not among women. IMPLICATIONS: Tobacco control policies should prioritize male smoking at workplaces and the instrumental purposes of using tobacco as gifts and social lubricant. Taxation may counter the surge in smoking brought by individuals' income increase after upward mobility. Caution should be paid to women joining the similar social gradient in smoking as they gain foothold in the labor market.

Behavioral and psychosocial correlates of road traffic injuries: evidence from a nationwide study on Chinese undergraduates.

Objective: The purpose of this study was to investigate the prevalence and behavioral and psychosocial correlates of road traffic injuries (RTIs) among Chinese university students.Methods: A cross-sectional survey was conducted among fifty universities in China, using a multi-stage sampling methodology. The participants were asked to report their RTIs in the past year. The chi-square test and binary logistic regression analysis were utilized to identify factors associated with RTIs, including specific types of RTIs.Results: Among the 11,770 participants, a total of 1,482 university students reported at least one RTI yielding an overall weighted injury prevalence of 12.96% over the past year. Estimated weighted prevalence by type was 6.10%, 5.94%, 5.12%, and 5.35% for automobile (car, truck, or bus), bicycle, motorcycle, and pedestrian injuries, respectively. Logistic regression analysis found that students who studied at low-level universities, smoked cigarettes, drank alcohol, slept less than 7 hours, went to bed after 12:00 am, or students with psychological distress were more likely to experience overall and four types of RTIs. Students who studied in the eastern universities had a higher likelihood of automobile injury, motorcycle injury and pedestrian injury than those who studied in western universities.Conclusions: Several critical factors associated with RTIs were identified. These findings have implications for the design and implementation of RTI prevention and interventions programs targeted at university students.

The effectiveness of the "SMG" model for health-promoting lifestyles among empty nesters: a community intervention trial.

BACKGROUND: With the disintegration of the extended family in recent years, the empty-nest phenomenon is increasingly common in China and the health of empty nesters is attracting more attention. Lifestyles, accounting for 53% in determining death, play a vital role in improving the health of individuals. However, it was rarely studied in promoting the health of empty nesters. In this study, we proposed a "SMG" model in empty nesters, including the self-management, mutual management, and group management, to implement health-promoting lifestyles interventions among empty nesters to provide an effective means to improve their lifestyles and health. METHODS: We conducted a prospective intervention on 350 empty nesters in three communities located in Taiyuan, China. One hundred sixty-seven empty nesters were randomly assigned to the intervention group with SMG-based health-promoting lifestyles interventions used for 7-months, and 183 were randomly assigned to the control group with no measures imposed. The Health-Promoting Lifestyle Profile (HPLP-C) was used to rate the lifestyles of empty nesters. Generalized estimation model was used to analyze the differences between the intervention and control groups over time, adjusted for education and employment. RESULTS: After 7 months of health-promoting lifestyles intervention, HPLP-C score and each dimension score in the intervention group all increase from baseline. There were significant differences after intervention associated with time and group interaction effects in aspects of HPLP-C (mean score = 8.838, 95%CI:6.369-11.306), self-realization (mean score = 1.443, 95%CI:0.352-2.534), Health responsibility (mean score = 1.492, 95%CI:0.477-2.508), physical activity (mean score = 1.031, 95%CI:0.572-1.491), nutrition (mean = 0.827, 95%CI:0.177-1.476), interpersonal relations (mean = 2.917, 95%CI:2.365-3.469) and stress management (mean score = 0.729, 95%CI:0.131-1.327). And education is contributing to the effect of the health-promoting lifestyle intervention (Estimate:8.833, p < 0.001). CONCLUSIONS: SMG-based health-promoting lifestyles intervention in empty nesters effectively improved the lifestyles of empty nesters, and the outcome was affected by education. Lifestyle change requires ongoing intervention, and community service centres must be involved in implementing the "SMG" model to provide ongoing support and improve the effect of interventions among empty nesters. TRIAL REGISTRATION: Chinese Clinical Trial ChiCTR1800015884. Registration date: 26-04-2018. Retrospectively registered.

A typology of social capital and its mixed blessing for suicidal ideation: A multilevel study of college students.

RATIONALE: Social capital is an important theoretical construct often used to explain positive behavioral outcomes. However, suicide research is often hampered by a limited definition of social capital, at the expense of its multidimensional nature, since suicide may occur when individuals are beset by overwhelming and conflicting relationships. We hypothesize not all dimensions of social capital protect individuals from suicidal ideation, and the beneficial return from some types also gradually diminishes. METHODS: We conducted a hierarchical ordinal regression analysis of combined samples of university students from 22 cities across all regions of China (n = 5025, response rate 97%). RESULTS: 1) whereas social capital, measured as network connection, embedded-resource, and generalized trust, is negatively associated with self-reported suicidal ideation, controlling for mental stress and other covariates, when measured as social participation, shows a positive association; 2) the moderate curvilinear effects of embedded resource and network connection imply that the return from some dimensions of social capital gradually diminishes. CONCLUSIONS: We leveraged the results to discuss the theoretical relevance of social capital in the suicide literature -particularly its dark side- and the need for more contextualized public health intervention programs for suicide prevention.

Smoking in the temple of the holy spirit? Geographic location matters.

Smoking at a young age poses significant risks to one's health and is linked with a wide range of deviant conducts. While prior research has looked into the ways in which individual religious characteristics may influence smoking, much less is known about how the overall religious context in which individuals are embedded may affect smoking during adolescence and early adulthood. In this study, multilevel regression analyses were used on nationally representative panel data to explore this understudied area. The results suggest that when a county has higher population share of conservative Protestants, youth living there are more likely to smoke. A similar robust relationship is also found for county-level mainline Protestant population share and smoking. By simultaneously examining both the individual and contextual religious effects on smoking, this study contributes to a renewed, more comprehensive understanding of an important public health and youth deviance issue.

Correction to: Nativity Homogeneity in Social Networks and Prostitution Patronage Among Male Migrant Laborers.

The original version of this article unfortunately missed to add the affiliation of the corresponding author. The new affiliation is "Department of Sociology and Social Work, Sun Yat-sen University, Guangzhou, China".

Relative deprivation in context: How contextual status homogeneity shapes the relationship between disadvantaged social status and health.

We examine the relationship between disadvantaged social status and adverse health outcomes within a context-contingent thesis of relative deprivation. We argue that the health effect of low relative status depends on contextual status homogeneity, which is measured as income inequality and group diversity. Applying mixed-effect modeling to the pooled 2011-2013 Chinese General Social Survey and exploring the cross-level interactions, we found that 1) people in the bottom socioeconomic quartile report significantly better health when contextual income inequality is lower; 2) racial-ethnic minorities report significantly better health when contextual ethnic diversity is higher; and 3) religious minorities also report significantly better health when contextual religious diversity is higher. Ethnic minorities and Muslims even report better health than the majorities in highly diverse contexts. Thus, contextual status homogeneity can modify or even eliminate the health disparities caused by relative deprivation. The context-level moderation of relative deprivation may be explained by the processes of social comparison, institutional resources, and social capital formation. Our findings suggest that health disparities are an interactive product of contextual homogeneity and individual's relative deprivation, and underscore the importance of the nature of the social environment where relative deprivation occurs. In this way, we contribute to knowledge about reducing health disparities along the social gradient.

Risk factors of mental disorders among empty and non-empty nesters in Shanxi, China: a cross-sectional study.

BACKGROUND: China has the world's largest size of elderly population. Mental disorders of the elders deserve keen attention. This study aims to comparatively explore mental disorders and risk factors among empty and non-empty nesters. METHODS: Using the stratified random cluster sampling method, we recruited 8526 elders aged 60 years and above from 11 cities in Shanxi Province in central China, comprising 4901 empty and 3625 non-empty nesters. The mental disorders were assessed with the 12-item Chinese Health Questionnaire (CHQ-12). The binary logistic regression was performed to analyze the risk factors in the two groups. RESULTS: The prevalence of mental disorders in empty nesters was significantly higher than that in non-empty ones (26.9% vs 23.5%). Binary logistic regression showed that the empty nesters who lived alone or lived in an institution were more likely to suffer from mental disorders compared with the non-empty ones, empty nesters living with spouse showed no significant deviation. And single status, hardly or part self-care ability, having chronic diseases, having lower income, and paying less attention to daily healthy diet had positive associations with mental disorders for empty nesters, and no or partial self-care ability and having chronic diseases for non-empty nesters. CONCLUSIONS: The study indicated that empty nesters had a higher prevalence of mental disorders than non-empty ones. Empty nesters living alone, with no or partial self-care ability, chronic disease, lower income and less attention to daily healthy diet were more vulnerable to mental disorders. And the lack of self-care ability and having chronic diseases were risk factors of mental disorders for non-empty nesters.

Is college education an equalizer for social disparities in health literacy? A case study in Shanghai, China.

OBJECTIVES: The aim of the study was to illustrate the immediate effect of the college education process (across college grades) on the strength of association between parental education and college attendees' health literacy. METHODS: Cross-sectional analysis was conducted based on data from a random sample of students in one university in Shanghai, China (N = 574). Exploratory factor analysis was used to generate factors of different dimensions of health literacy. Ordinary least square regression models were estimated to investigate how college education process alters the family-based disparity in health literacy. RESULTS: The link between parental education and health-related skills did not vary significantly across grades of participants, but participants in their third (p < 0.05) and fourth year (p < 0.001) revealed a significantly weaker association between health-promoting proactivity and parental education, relative to the first-year counterparts. Also, the impact of parental education on health-related attitudes significantly declined among the fourth-year seniors, compared with first-year students (p < 0.05). CONCLUSIONS: Higher education experience is an important mechanism to alleviate the socioeconomic gap in health literacy. Such an equalizer effect, nevertheless, is contingent on the particular dimensions of health literacy.

Improvement of social support in empty-nest elderly: results from an intervention study based on the Self-Mutual-Group model.

BACKGROUND: China has the world's largest elderly population and an increasing number of empty-nest elderly. The purpose of this study is to evaluate the effectiveness of the Self-Mutual-Group model on social support of the empty-nest elderly, thus providing reference for improving their quality of life. METHODS: A intervention study was conducted between October 2016 and May 2017 at six communities in Taiyuan, Shanxi Province, China. A total of 350 empty-nest elderly aged 60-88 years were randomly assigned in the intervention group (n = 167) with a 7-month SMG-based intervention or to a control group (n = 183) with no intervention. The social support of the participating elderly (n = 350) was assessed by the Social Support Rating Scale (SSRS) at the baseline and 7 months later, respectively. RESULTS: A 7-month follow-up showed an increasing mean scores of SSRS, objective support, subjective support and support utilization of the intervention group, and reached statistical significance (P < 0.05). CONCLUSIONS: The Self-Mutual-Group model was considered to be a positive intervention and was effective in increasing social support among the empty-nest elderly. Furthermore, future research should extend the intervention period and introduce multi-point measurement to better evaluate the intervention process and outcomes. TRIAL REGISTRATION: Study on the 'SMG' Health Management Model Based on Community Organization Theory among empty-nest elderly (ChiCTR1800015884).

Nativity Homogeneity in Social Networks and Prostitution Patronage Among Male Migrant Laborers.

Previous studies have repeatedly found the association between network homogeneity based on native-place and sexual risk behaviors among migrants. However, it remains unclear why such a simple numerical property of network composition can be correlated with a sexual risk behavior. Using a dataset (n = 1591) with detailed information on the sexual behaviors among male migrant laborers in the two Chinese provinces with the highest migrant inflows, we confirmed network homogeneity is significantly associated with prostitution patronage. With structural equation modeling, we further found that half of network homogeneity's impact on prostitution patronage is mediated by three factors: peer deviance, family bonds, and hedonistic subcultural beliefs. In addition, network homogeneity's association with hedonistic subcultural beliefs is fully mediated by peer deviance. Although the nativity homogeneity in social networks is still associated with prostitution patronage, more proximate psycho-social factors are found responsible for the network effect. Health policies seeking to integrate migrant laborers, removing the policy barriers against family bonds, and providing alternative sources of social support are highly promising for reducing sexual risk behavior among this population.

Air pollution as a catalyst for supporting tobacco control policies? Evidence from a nationwide study on Chinese medical students.

PURPOSE: Few studies have discussed how the increasing ambient air pollution may affect policy-related attitudes. Medical professionals constitute an important interest group who analyse and solve public issues within a medicalised framework. The current study investigates whether ambient air pollution is associated with a greater likelihood of supporting tobacco control measures among medical students. METHODS: We conducted multistage sampling among the medical students from 42 cities in China. We employed propensity-score matching to eliminate the selection bias and used multilevel logistic regressions for the main analysis (n1=9458, n2=42). RESULTS: we found that city-level air particulate matter is consistently associated with the support for tobacco control among medical students, net of other individual-level and city-level covariates. For one standard increase in air particulate matter, people are 1.21 times more likely to fully support tobacco control measures (p<0.05). This association is significantly stronger among medical students who are financially worse-off and are ethnic majority. CONCLUSIONS: Environmental pollution has a significant correlation with people's attitudes towards health policies, even when such policies are not directly concerned with the natural environment. Policy makers may use this opportunity to implement tobacco control measures against the backdrop of China's pollution crisis.

Acculturation Versus Cultural Retention: The Interactive Impact of Acculturation and Co-ethnic Ties on Substance Use Among Chinese Students in the United States.

Acculturation is often found to increase substance use among immigrants in the U.S., but such effect may depend on how immigrants are attached to their co-ethnic community. Meanwhile, the high socioeconomic status of some new immigrant groups also challenges the classical assumption that ties to co-ethnic community are associated with deviance. With a sample (n = 960) collected from a population of Chinese students in a large public university in the U.S., we tested how do the interplays between acculturation and co-ethnic ties affect substance use. This study establishes that: (1) different dimensions of acculturation have opposite effects on substance use; (2) acculturative stress does not explain the association between acculturation and substance use; (3) acculturation increases the likelihood of substance use only when one has weak attachment to their co-ethnic community. The findings are consistent for three dependent variables: smoking, drinking, and drunkenness, and for the different constructs of acculturation and co-ethnic ties. Ties to co-ethnic community may provide important social support for immigrants, while acculturation may alleviate the insular subculture that promotes at-risk behaviors. We encourage policy makers to consider the cooperative nature of acculturation and cultural retention for the improvement of health among this growing population.

Is Social Status Related to Internet Pornography Use? Evidence from the Early 2000s in the United States.

While most studies on Internet pornography focus on individual's psychological characteristics, few have explored how social status itself is associated with Internet pornography use. As the Internet is becoming increasingly prevalent, online behaviors may have started to reflect the inequalities of the offline world. This study tested whether lower social status was associated with fewer sexual intercourse opportunities, and whether this led to higher likelihood of using Internet pornography as an alternative means of sexual release. To test the theory, I used the nationally representative sample of the General Social Survey of the U.S. between 2000 and 2004, with missing data handled by chained multiple imputation. The analyses found that lower income, longer working length, being unemployed, or a laborer in the social class strata were associated with fewer sexual intercourse opportunities as measured by three variables: marital status, the number of sex partners, and sex frequency. Lower income, less education, and longer working length were also associated with higher odds of using Internet pornography in the past 30 days, but only income was partially mediated by marital status. Social status was associated with Internet pornography use and sexual intercourse opportunities independently. The comparison of Internet pornography with the traditional X-rated movie found the unique features of Internet pornography use absent for X-rated movie.