Sex, Drugs & Science

Kimberly Nelson

June 10, 2020 Valerie Earnshaw & Carly Hill Season 1 Episode 2
Sex, Drugs & Science
Kimberly Nelson
Chapters
Sex, Drugs & Science
Kimberly Nelson
Jun 10, 2020 Season 1 Episode 2
Valerie Earnshaw & Carly Hill

Dr. Kim Nelson is an Assistant Professor of Community Health Sciences at Boston University, and winner of the 2020 Early Career Investigator Award from the Society for Behavioral Medicine. Kim breaks down state resolutions identifying porn as a public health issue, talks about her work on porn literacy for young sexual minority men, describes what sex education would look like in her ideal world, and shares how her all-lady scientist squad is taking on minor consent laws. Carly shares about her own sex education experiences, and Valerie and Carly encourage listeners to send complaints about the show to Kim (knels@faux.com). 

Read more about Kim’s work here: https://www.bu.edu/sph/profile/kimberly-nelson/
Follow Kim on Twitter: @KMNelsonPhD

Show Notes Transcript

Dr. Kim Nelson is an Assistant Professor of Community Health Sciences at Boston University, and winner of the 2020 Early Career Investigator Award from the Society for Behavioral Medicine. Kim breaks down state resolutions identifying porn as a public health issue, talks about her work on porn literacy for young sexual minority men, describes what sex education would look like in her ideal world, and shares how her all-lady scientist squad is taking on minor consent laws. Carly shares about her own sex education experiences, and Valerie and Carly encourage listeners to send complaints about the show to Kim (knels@faux.com). 

Read more about Kim’s work here: https://www.bu.edu/sph/profile/kimberly-nelson/
Follow Kim on Twitter: @KMNelsonPhD

Valerie:

I'm Valerie Earnshaw.

Carly:

And I'm Carly Hill.

Valerie:

And this is Sex, Drugs and Science. Today's conversation is with Kimberly Nelson, who is an assistant professor in Community Health Sciences at Boston University's School of Public Health. All right, Dr. Nelson, thank you so much for joining us on Sex, Drugs and Science. We're super excited to talk with you. We, um, want to pick your brain about lots of things, but probably first among them is all about pornography, so...

Kimberly:

Fair. Yeah, I study pornography. That's true.

Valerie:

Yes, so we saw. Okay, so one thing we were interested in, we saw this recent article that BU had covered on changes in, or the introduction of resolutions in different states, calling pornography a public health crisis. So apparently by 2016, there were 17 states. The article said that had done this and A) I totally missed the boat. I didn't, wasn't aware that this was happening. So can you give us a little bit of context? Like what are these resolutions about? What's the problem here? What's the perceived problem?

Kimberly:

Yeah. So the resolutions are very interesting and are not surprising. They're non-binding resolutions. So the first thing to know about them is they're basically just words without any, like, "oompf" other than words. They're like a declaration by the state that pornography is a public health crisis, but there's no "then what". And the idea is that essentially, when you make such a declaration, when you do these non-binding resolutions, is you're flagging this as an important issue that resources should be put towards, but it doesn't actually, like ,allocate any resources. Um, so it's an interesting little, like, legislative process.

Valerie:

Yeah. So it's just like, kind of like wagging my finger at you.

Kimberly:

Yeah. It's a little lagging the finger, but it also...

Valerie:

Like "whatever, we all want to say pornography is bad" type of thing.

Kimberly:

Yeah.

Valerie:

Okay.

Kimberly:

As a state, we want to say that pornography is bad. Um...

Valerie:

Okay.

Kimberly:

...and the way that we're going to say that is that we're going to focus on it being a public health issue.

Valerie:

Okay.

Kimberly:

Because as a moral issue, you can't really get into that as a state, but you can say, "Oh, this is bad for public health," and get more buy-in for the general populace.

Valerie:

So that's, that's an interesting nuance of the framing. So what are they, how is it fair to make an argument that pornography is bad for public health? Like, what is their, what are they trying to say with that? In what ways are they saying that pornography is bad for health?

Kimberly:

There's a very long laundry list. If you ever get to...get to read one of these resolutions. First off, almost all of the resolutions are modeled off of the first one, which was Idaho. And, uh, the language that, uh, was used in that first resolution is basically mirrored in all of the subsequent resolutions. And the language is actually written by a conservative, uh, Christian group...

Valerie:

Hmm. Curious.

Kimberly:

...who started pushing this agenda, uh, on multiple legislatures, but sort of like one first with Idaho. Um, and they claim pornography is bad in so, so many ways. Uh, that it changes brain chemistry, that it changes the way it increases violence, uh, that it, uh, makes men less likely to be faithful in their marriages, or maybe even not want to be married. Um, it is, uh, detrimental to our kids. It leads to sex trafficking, um...

Valerie:

Makes you go blind...

Kimberly:

Just a lot of different things. And, and what's interesting about that is that it's not all wrong. Um, there is some research to show that there are not the greatest effects of pornography on health, uh, but not the full laundry list that they're referring to. And that laundry list completely disregards any of the potential beneficial effects of pornography. Um, and so instead of giving sort of like a balanced view of how, uh, pornography is being consumed and its effect on health, they're giving a very slanted one sided view, uh, that focuses on a limited amount of studies. So the overall, uh, literature on pornography, as it stands currently, is that it doesn't actually impact the health of most people who consume it. Um, there is some evidence to show that under certain circumstances for some individuals, it can be hard for them and harmful to their health, um, particularly around relationships. Um, people who are already have sort of like the telltale markers of being prone to engaging in violence, if they view more violent porn, they might be more likely to engage in violence with their partners. Um, but you have to meet all of those criteria to have that effect.

Valerie:

Right.

Kimberly:

Um, and a lot of the research on porn is very mixed. Um, and that really has to do with the fact that it really doesn't affect all people in the same way. Um. And for most people, and most people view porn... For most people, it's fine.

Valerie:

Okay. You mentioned actually that there are some, I'm curious about what these benefits of porn watching might be.

Kimberly:

Yeah. So there's some evidence to suggest that, uh, pornography watching is a really great way to explore your own, uh, sexual preferences, what you're interested in, who you're attracted to, sexual behaviors you might be interested in engaging in, um... For sexual and gender minority individuals, it can be very affirming, um, to see representation in media of people who are like you. Um because for those, uh, individuals, they don't get to see that very often in sort of our mainstream media. So it can give them a sense of belonging, and a place where they don't feel as "othered".

Valerie:

Right.

Kimberly:

Um, and then the flip side of that, of course, because everything is the balance, is pornography is not the most accurate representation of sexual behaviors or sexual relationships, or let's say communication with partners or, uh, engaging in safer sex behaviors. So on the one hand, it can be really great and affirming and really, um, helpful for people to explore their own sexuality. And on the other hand, not the most accurate. So...

Valerie:

Is there like variation in porn? Like is there like a porn spectrum? Cause I have some like vague awareness of, you know, there's like feminist porn and there, I mean, there seems to be like all of these different kind of niches. So, so it seems like some of these things might also, I mean, they're dependent on the person watching the porn, but then they're also probably dependent on the porn that they're consuming or watching as well.

Kimberly:

Absolutely. Yeah. So it's the research, um, generally suggests that it's not the amount of porn you watch, it's what you're watching. Um, and so, uh, it's really about like your exposure to certain behaviors or, um, you know, certain things that are being portrayed on the porn that might not be the most healthy that's gonna potentially then be related to your actual behavior. Um, again, for most people, that's not the case. For some people, it is. Um, and so yeah, there's... Porn has so many genres within it. Uh, it's a very, very, uh, it's by some measure considered the largest media industry in the world and makes the most amount of money of any media industry in the world.

Valerie:

Huh.

Kimberly:

Um, and so, although interestingly, there's no good way to measure that. So like...

Valerie:

Okay. Well, I was wondering with measurement, when you were saying it depends on the type or, you know, depends on what's in the porn that you're watching. So do you have, are there like validated porn measures where you're asking people, like, "what is it that you're watching?" Or yeah.

Kimberly:

Yeah. I mean, validated.

Valerie:

Per se, okay. There are measures...

Kimberly:

Basically, there are measures...

Valerie:

There are ways we have measured this? Okay.

Kimberly:

Yes. There are ways that this has been measured. I mean, the other thing to keep in mind is that research in this area is incredibly poorly funded.

Valerie:

Hmm,

Kimberly:

Because most funding, at least in the U.S. around, uh, sexual health is targeted towards disease, uh, or pregnancy prevention. Um, and if you can't like, directly tie pornography to a disease outcome, or like a tangible health outcome, um, it's much harder to get money on it.

Valerie:

Hmm.

Kimberly:

So a lot of the research in this area is really underfunded, which is why we don't have like a gigantic breadth of, uh, health-related porn research. Um, but back to the genre question. So there's a wide range of genre. Uh, it depends what you watch. There are, there are porn studios in existence that are trying to portray healthier behaviors in porn. The problem is that those are the ones you have to pay for...

Valerie:

Hmm. Okay.

Kimberly:

Because for those studios to stay afloat, they need people to pay for their porn.

Valerie:

Right.

Kimberly:

In a way that if you go on PornHub, everything, for the most part, is free, and those are not, like that's not...

Valerie:

...not evidence-based porn...

Kimberly:

Right. And so like, what people see is what they get for free, because there's so much of it available. Unless they get, have the finances to be able to afford to pay for a specialty porn and, um, and are particularly interested in it.

Valerie:

Okay. So it seems like uh, one part of your research is to teach, essentially teach people how to watch porn better. So, and this would fall under... This... Do you call it pornography literacy?

Kimberly:

Yeah. Porn literacy.

Valerie:

So what's...what's the idea behind porn, porn literacy?

Kimberly:

So, I think the idea behind porn literacy is really based in the concept of media literacy more generally. Um, so media literacy is a, field's been around for a really long time. Um, and it is about helping, uh, media consumers become more critical of the media they're consuming. So I think a real classic example is when, um, teachers, uh, or parents talk to their kids about like advertising, right? So like advertisers are really good at making you think that the product that they have is, you need it and it is the way that it should be. And, you know, it's very powerful. Um, and so media literacy says, "Okay, well, let's think about this. Who's making that ad? What do they have to gain from making that ad in the way that they've chosen to make it? What are they trying to sell you? And what's the reality, like what, what really is... Do you need that product? Do you really need to believe that they're saying that the greatest product on the face of the planet? What is the truth part of that, and what is the not truth part of that statement?" And so media literacy is really about helping individuals gain the skills to start thinking about those questions when they're consuming media. Who's producing it? What do they have to gain? What are the, what message are they trying to get you to buy? Um, and what part is real and what part is not real? Um, and so porn literacy is the same thing. It's helping people become more critical consumers of the porn that they're watching. Because the idea that, that I work a lot with youth now... The idea that youth are going to stop using porn, that like, somehow we're going to ban porn and they're going to stop. Like, that's not a reality based assumption. People have been... Porn has existed for as long as humans have existed, and people have been consuming it for that long too. It's not going to go away. And, in fact, if it gets banned, that will probably just make people want it more because that's...we're humans and that's what we do..

Valerie:

...make it more popular. Right.

Kimberly:

So, uh, so porn literacy is about helping people when they're consuming porn to really think about, more critically, who's producing this? Why are they producing it? What does this actually look like behind the scenes? I think a lot about like, sort of, like, helping people become more understanding of what a porn studio looks like, right? Like where is that sex scene actually happening? How many people are in that room? Like, what does it look like? What does the contract look like? Who's being paid? What are they being paid to do? Um, and then reality testing, like is the behavior that's being portrayed representative of sex and reality, uh, between people? Like, like, did they put a towel down? Right. Like, think about what sex actually looks like versus what sex looks like in porn. Is there a towel on the bed? Probably not. Did their pet interrupt them? Definitely not. Right. Like did their, for teens, did their parents walk in, or was there a chance that their parents would walk in? Most porn not, although some porn might fetishize that, so you never know. Um, and then, uh, you know, there's the, like, racial and gender stereotypes that get played out in porn. Um, and so helping people really think about power dynamics, and how that's being portrayed, and to start thinking a little bit more critically about, um, how that might... How viewing that repeatedly might be impacting their own beliefs. Um...

Valerie:

What are some of those racial and gender stereotypes that play out in porn?

Kimberly:

Oh. It's just...

Valerie:

Oh...Pandora's box.

Kimberly:

It's rough. Yeah. I mean, like, I think the classic version is there is, like, black slave fetish porn.

Valerie:

Oh, okay. Okay.

Kimberly:

So, yeah, I mean it, like porn takes it all. So like porn is like a free reign. Um, but any stereotypes that you, you can think of in your life related to, you know, women being submissive or like, or really enjoying, um, being controlled or, you know, all of those things... are, there's some truth in that for some people. And there's some, it's not so helpful if that's all you think a sexual relationship looks like.

Valerie:

Mhm. Absolutely.

Kimberly:

Like some people like to be dominated. There's nothing wrong with that inherently, but just because that's all that you're seeing doesn't mean that you have to like to be dominated.

Valerie:

Right.

Carly:

Yeah. I have a question, though. So what is that? So you said, you know, like you, you encourage people to think about things like, you know...who's funding this, what's the contract look like, who's, who's getting paid, like, where is this? How do you find that out? Like how, what are, what are the steps that you would encourage people to take to like... You know, cause I don't think like Pornhub's like, "Oh, and this was produced in this studio, if you guys wanted to check out what we're paying people," you know, like, so.

Kimberly:

You're not going to be able to, the porn industry is so secretive...

Carly:

Hmm. Right.

Kimberly:

...about their financials.

Carly:

What are some tips that you have for, for people to, um, make sure that they're viewing porn responsibly?

Kimberly:

Yeah. I think it's not necessarily that you need to, like, track it all the way back to one specific studio. I think it's a lot about sort of generally just keeping that question in mind, and knowing that that's a question that you should be asking. Right. Just having the knowledge that like somebody produced this, somebody made this, so that they could make money. Right.

Carly:

Right.

Kimberly:

They didn't make it so that you sitting at home, viewing it, are going to get something specific out of it other than they want you to be attracted enough to it, that you clicked on it, which made all of the ads show up, which made the money go into their pocket. Right. It's an industry, and I think that gets lost, um, when people are not fully thinking about the fact that like, really this is not about your pleasure. It is about making money- in the same way that advertising is about making money.

Carly:

Right.

Kimberly:

Um, and so it isn't like, we need to figure out that this movie was made by Treasure Island. Like although Treasure Island will gladly claim all of their movies, cause they are like a brand. Um, but it is about getting people to be like, "Okay, so somebody is making money with this,". Um, and even, uh, porn that is quote unquote, "amateur" is oftentimes produced.

Valerie:

Hmm.

Kimberly:

So even just having the knowledge that, like, what you're viewing is quote unquote "amateur" porn, um, it might not be the case that it is. Uh, and so it's sort of like, it's like lifting the veil. It's like, "What, what does Oz actually look like?". Um, and so getting people to really recognize that, like, it is totally fine to look at porn, and to get off looking at it, and to like enjoy it, and to enjoy your body while you're doing it. Like you're doing that, and as long as you're not hurting anybody else in that process. Um, although some people might claim that you might be hurting the actors, uh, who might be coerced into that process. Um, most people are going to look at porn and, and for the most part, it's going to be fine. But helping them really think about the fact that it is an industry, it is there to make money. Uh, it does not treat its workers particularly well. And, um, really just recognizing that like, it's there for a purpose. And the purpose is not, you...

Valerie:

So...so...What...

Kimberly:

...other than to get you to click.

Valerie:

So what happens when you increase people's porn literacy? When you get them to think about these things and kind of when you... Yeah. When you kind of raise the veil and have them take a look at Oz?

Kimberly:

Yeah. Well, so I'm currently conducting a study, that's a porn literacy intervention. So I don't know the results of my study yet. Um, but the two studies that we do have that are porn literacy based: one is actually one of my colleagues at Boston University, Emily Rothman. Um, and then there's another one out of Ireland.

Valerie:

There's only two studies on porn literacy?

Kimberly:

Correct.

Valerie:

Porn... Wait, so porn is the biggest media industry that we have. And... There's only two studies on what happens when you teach people how to watch porn?

Kimberly:

Correct. As far as I know.

Valerie:

Wow. Okay, sorry, continue.

Kimberly:

Those are the two that I know.

Valerie:

That's really impressive.

Kimberly:

Yeah. Well, I mean...

Valerie:

...it makes sense because it's funding streams. I understand it, but that's just, that. Yeah. Okay.

Kimberly:

And both of them were pilot studies and mine is a pilot study. Right. So there's not been like a full, big rollout porn literacy study.

Valerie:

Yeah. Okay. So what do they show?

Kimberly:

So both of them show the porn literacy was incredibly good at helping... They were both with youth and they, it was very good at helping youth become critical consumers, and to, to be able to identify and think about how porn was not necessarily reflective of real life. And, um, I can't remember for the Ireland study...I know for Emily Rothman's study, she didn't actually do sexual behavior outcomes. She did attitudes. Um, but those generally shifted in a way that was more, um, healthy. Um, and the Ireland study, similarly. It was really, both of them showed sort of preliminary evidence that porn literacy can help youth become not just better porn consumers, but start thinking about sexual behaviors with their partners in a more holistic and healthy way.

Valerie:

Okay. So we're not going to change what's important, cause that's a huge industry making lots of money. And we're not going to stop people from watching porn in part because porn can be good... Then it seems like we've got some preliminary evidence that teaching people how to watch and engage with it can lead to good outcomes, or can help to reduce the negative effects at least of porn.

Kimberly:

Yeah. I would say, I would say that's where, I mean, it's a very, as I just said, it's a very young research area.

Valerie:

Yeah.

Kimberly:

Um, and so I think the preliminary evidence shows that this has the, it has potential.

Valerie:

Mhm.

Carly:

I've been dying to know what is it like, you know, you were saying, you, you work a lot with, uh, you know, adolescents, youth... And running these focus groups... You know, asking these 14, 15 year old kids to, you know, open up and talk to you about their porn use. Like, what is that like? What is the behind the scenes? Like what do we not, you know, see about doing research like this?

Kimberly:

Uh, one is I don't do focus groups.

Carly:

Oh okay.

Kimberly:

Um, cause that, I think would not actually... You wouldn't get the... You would get a very peer influenced version. Um, so you know, teenagers in general are very susceptible to what they perceive their peer, their peer norms to be. And if you put a bunch of teenagers in a room to have a focus group, it could have a lot of potential to get them to like build off of each other, and that could be very interesting. And I know that Emily Rothman's porn literacy intervention is actually like taught in a classroom. Um, and so that's a really interesting, uh, approach. When I talk to, and gather data about teen porn use, I almost always, and this is, um, for a couple of different reasons... I usually do online surveys. Um, one is because I focus specifically on sexual minority, male adolescents. Um, and so asking them to do an online survey, opens up, uh, their ability to engage in the research without potentially, inadvertently, outing themselves to anyone. Um, they can do it in the privacy of their own home. They can, uh, feel possibly more open to being able to, uh, honestly answer questions about porn. And I ask them a lot of very detailed questions about their porn use.

Valerie:

Mhm. Which... "How long are you seeing it?" Yeah.

Kimberly:

Right, exactly.

Valerie:

Okay.

Kimberly:

Like, "When did you start?" "How young were you when you like the first time you ever looked at porn?" How old were you?"

Valerie:

"Tell me all about it?" Okay.

Kimberly:

Right. Like I have open ended questions. I have closed ended... I ask them, I ask a lot of questions. Um, and, and I asked them about that, that those perceived peer norms. So I asked them about their own porn use. And then I asked them to sort of think about how they think porn is affecting other adolescent sexual minority, male youth. Um, they have opinions. I mean, the wonderful thing about working with teens is they... Nobody talks to them about this stuff and it's, it's hyper present for them, right? They are, they are at sort of their, uh, sexual awakening, and they want to be able to understand what's happening. They want to be able to talk about it, and nobody talks to them about it. So as soon as you start talking to them about it, even if they get a little giggly and embarrassed, uh, they are mostly very happy to talk about it. Um, does that actually answer your question? I don't know.

Carly:

Yeah. No, it did. That was a fascinating answer. Yeah.

Valerie:

Yeah. We were actually talking a little bit about our own sex ed before we got on. And I was, I was really surprised to hear that Carly, what would this have been like the...2000?

Carly:

Uh, so yeah, Family Life would have been, it was like, uh...The program was from, like, fifth grade to eighth grade. I went to a small Catholic school and...

Kimberly:

Family Life.

Carly:

Family Life. Right? Yeah. That's what I was, I was telling Valerie that I took a human sexuality course in undergrad and Dr. Foley was going around, you know, he gives this whole speech on like, "Can you believe that there used to be this thing called family life where like...", You know, "...the girls would have to sign virginity pacts" and like do all these things. And then he asked us to go around and like share, you know, what sex ed was like for us. And I was like, "Yeah, I had Family Life. Like we had the whole, you know, signing of, of the pact,".

Valerie:

Carly signed a virginity pact...

Carly:

Yeah.

Valerie:

...In the 2000s.

Carly:

Yeah.

Kimberly:

They have been shown to be 100% not effective.

Carly:

No.

Kimberly:

Congratulations on that 100% not effective.

Valerie:

Yeah!

Carly:

Nope. Not once ever after signing it, except for today, did I ever think about it again if that's any...

Valerie:

Well, it's interesting because, like, we don't do well overall with sex ed in schools. And then to think about sex ed for folks who might be sexual minorities, or, and then to think about porn in the mix. I mean, this definitely seems like it'd be an area that school's not addressing. I mean, are parents addressing this? Like are.. So nobody addresses this? People just sign on and start watching porn?

Kimberly:

Yeah.

Valerie:

Okay.

Kimberly:

I mean, it's, it's a very rare parent who talks to their youth about porn early enough. So on average, youth start looking at porn between the ages of 11 and 12. So even...

Valerie:

Wow.

Kimberly:

Even if let's say Family Life, given the age, like the ages of the grades that you just gave, that a lot of those youth will have already started looking at porn. Um, and so, you know, I think there's some benefits to think about not just getting youth this information, but when, right? When should we start talking to youth about this? Does it need to be before they start consuming? And what does that look like?

Valerie:

We saw from one of your studies that youth were having... I mean, the average age of you called it "sexual debut". So for having sex for the first time was 14, and that your... The participants in this study, you said that they wished that they had information about, um, sex before 14, which is, I was, you know, like doing the math on this. So targeting... So when, when do you think is the ideal time to intervene, or to try to work on porn literacy?

Kimberly:

I think that if I had like a magic wand and could make the US not a puritanical society, I would say that we should do so... We should do something similar to the Netherlands, where their sex ed starts in kindergarten. And they do it, and it's age appropriate. And it normalizes the fact that sex is a normal behavior that most individuals are going to engage in at some point in their life.

Valerie:

Okay.

Kimberly:

Um, and I would actually start not necessarily talking about porn that young in kindergarten, but I would start talking about media.

Valerie:

Mhm, okay.

Kimberly:

Because kids engage with media, and they get engaged with media a fair amount. I think about my own, uh, quarantined child who is, uh, watching a lot of media right now. And I look at that media. I watch it with him. And I think about the subtle ways that it is likely shaping his understanding of relationships. Right. Um, think about how sort of heterosexist our media is generally, right. Even kids' shows, talk about kids like, like boy-girl pairs having crushes on each other. Or like teasing each other about liking a girl or liking a boy. Or, you know, just very like, that's all there already. So like it's all, in my opinion, should be talked about right from the get go. If kids are consuming media, we should be talking to them about what that media is saying, and how it is and it is not necessarily accurate.

Valerie:

And it seems like...

Kimberly:

Gender norms too, oof...

Valerie:

Yeah.

Kimberly:

Rough.

Valerie:

Yeah, for sure. And it seems like if we sort of primed them early at that like, think about the gender norms in Paw Patrol" or, or just think about, you know, "think about Paw Patrol more deeply", or what are they trying to sell you, you know, at these commercial breaks and things like that or within the shows. Then by the time that they are watching porn, that they may already be thinking about this or, or primed to be on the lookout if they're just consuming this as like another form of media in their lives.

Kimberly:

Agreed.

Valerie:

So you could generalize that.

Kimberly:

I think it could generalize that way. Because once you really start thinking about media in this way, it... You don't exactly shut it off, like it's not, it doesn't like suddenly go away. Um, and so I think having those critical thinking skills starting at a young age would not be harmful in any way and it would potentially be quite beneficial.

Valerie:

I love that you are pulling in these public health interventions. You said this one was from the Netherlands? Because this just reminds me of your own public health application to your own life. When you had jewels that you brought in this, what was it? Where did this baby box come from?

Kimberly:

Oh, the baby box. Sweden, I think. Or is it Norway? It was one of the Scandinavian countries.

Valerie:

Yeah. And I loved it. So, um, I was at Kim's baby shower, and one of the things on the baby shower list was this like baby box, which was like a box that came with like lots of like gender neutral clothes. Like I think you got the fox one, right? I mean, the box wasn't at the shower, but that was like, you were basically like, "All I need is this baby box,".

Kimberly:

Correct.

Valerie:

And then, and then the baby can sleep in the box. Right. And then it has like, some other things for the baby. Right?

Kimberly:

It has everything that you need to have a newborn.

Valerie:

Yeah, okay.

Kimberly:

It has clothes, diapers, ointments...

Valerie:

Yeah.

Kimberly:

...bottles, and a place for it to sleep. Like you literally could have a baby, and you could just have a baby box and you would be okay, for...

Valerie:

Yeah.

Kimberly:

...at least a couple of months.

Valerie:

So Kim... So, and there's been research on this baby box, that it leads to better infant outcomes. Right?

Kimberly:

Yeah.

Valerie:

And so they are like, everybody gets them in some places of the world. And I think that they were like rolling them out in different places in the US, but...

Kimberly:

Yeah. New Jersey, I think has a baby box thing now. Um, I feel like there's another state as well.

Valerie:

Yeah. But I just loved this like application of like, here's this like public health practice, and I'm going to do it to my life, to my life. And it does seem that like all of these, like public health applications come out of places like the Netherlands and, you know, others kind of Scandinavian places where they really got public health on lockdown. Yeah.

Kimberly:

Well, I, or at least are thinking about very creative ways of being...

Valerie:

Yeah!

Kimberly:

...open to options that might be useful.

Valerie:

So why is it important? I mean, it sounds like it's important to focus on young people watching pornography because you want to get them before they start. Or you want to try to try to curb this off early in life so that they're thinking about it as they go on. Is that the basic idea behind studying adolescents specifically or working with adolescents?

Kimberly:

Yeah. Um, I think what is very interesting for me about working with teens, and I particularly am interested in working with teens who haven't necessarily had their sexual debut yet. Exactly what you're talking about. It's really about helping to reach youth before, or right around the time where they're starting to have sex. Um, and there's a lot of research that suggest that health behaviors that are engaged in during adolescence actually carries through adulthood.

Valerie:

Hmm.

Kimberly:

Um, and this is across all sorts of health behaviors, um, exercise, eating, um, you know, cardiovascular health. It like really crosses over. Uh, and so if we can help youth have their first behaviors be healthy, they are more likely to keep doing those behaviors across their teenage years and into adulthood.

Valerie:

Okay.

Kimberly:

Um, so for me, it really is important because not only do we have the opportunity to intervene at a potentially, um, high risk time period, because teens are the perfect combination of like starting to have really good executive functioning skills. And are very prone to peer influence, and are not so great at emotion regulation...

Valerie:

So perfect storm for...

Kimberly:

It's the perfect storm. Um, and so if we can, even in that time period help to decrease their risk, that's going to have like immediate benefits, but it also is going to have longterm benefits for them.

Valerie:

So it seems that, and I know that you've done a lot of thinking about this though, that asking teen... Teenagers about the porn that they're watching and their perceptions of porn. And then also, you know, doing porn literacy interventions with them, or you're teaching them how to watch porn, could raise some interesting ethical issues for you. You know what I mean? Typically when we do a research study, we have to go essentially get parental permission for, um, for people who are under yeah. For people who are under 18 to be involved in a research study. So I had to like tell the parent all about it, and then they have to sign off saying that their child is allowed to participate in that research. So, how do you think about some of the... But, you know, I can imagine that this would be complicated for your population, population. So how do you think about some of these sort of like ethical issues with the research that you do?

Kimberly:

Yeah. I mean, it's very interesting. So, I get waivers of guardian permission for all of the research that I do. And I do that for a variety of different reasons. Um, one is, uh, it is not actually, um, necessarily beneficial in this particular case. There's a lot of research to show that youth 14 and up are, have the same ability to understand consent materials as adults. Um, so having a guardian involved isn't necessarily going to make it so that they better understand what they're agreeing to participate in. Which is one of the, uh, one of the reasons that guardians are typically involved in the research process... Is that they're supposed to be helping their youth make an informed choice. Um, so if you take away the idea that youth are unable to make an informed choice on their own, um, then possibly guardian permission is not... Not so helpful. Uh, the other thing, and the other reason, particularly for the youth that I work with, that I get a waiver of guardian permission is because it actually has the potential to be harmful for some of the youth, for their guardians to be involved. Um, particularly for youth who are not out to their guardians about their sexual orientation or attraction to other male youth. Um, if they're not out to their guardian, and the study requires them to be out to their guardian, that's going to have two different effects. One, it's going to bias my sample to only include youth who are out, um, which is not necessarily the most vulnerable youth, uh, or the youth who will need this type of intervention.

Valerie:

Right, right.

Kimberly:

Um, and then for youth who are not out, it could potentially out them. And that process could be very harmful for some of them. Not all of them necessarily, but for some of them, um, you know, including being kicked out of the house or like financially cut off. Or cause, you know, intense family discord, um, none of which are beneficial to that youth. Um, and so it's really those factors that I think about balancing, um, what is a parent or guardian really going to bring to the consent process that is going to be protective of this youth? And if I don't think that they're going to be able to help them necessarily, um, that's a factor. And then also the like potential for harm. I will say, and this oftentimes gets, um, a little bit muddied when people hear that I get a waiver regarding permission. They say, "Well, you can't just block out the parents," and I'm not asking them to. Youth have every right to involve their parents in this process. I'm not telling them not to. They can absolutely tell their parents that they might be interested in taking part in a study, and ask their parents for help as a part of the process of consenting and all of that. I'm not saying they don't, they shouldn't do that. I'm saying they don't have to.

Valerie:

Mhm. Yeah, I think that's an important difference.

Kimberly:

And I think that that's really a key distinction.

Valerie:

Yeah, absolutely.

Kimberly:

The other thing I do is... I do a capacity to consent assessment, where I make sure I asked the youth questions about the consent materials that they've just read through to make sure they really understand what they're getting into. What the risks and benefits are, what the procedures are, and what they should do if they feel uncomfortable, or if they want to stop. Um, so youth are not able to participate in my studies if they can't accurately answer those questions.

Valerie:

That's fantastic. I mean, we should do that with all of our studies. Um, whenever you have to, I mean, whenever we want to propose a new study, we have to take it to this ethics board. So a group of people, um, who review our protocol and ask us questions and essentially decide, you know, if it's a safe study to do or not. So I imagine that you have really fun conversations with your ethics boards. Do you have like, uh, are you at the point where you've got like a little packet for them with like research and like, "here's, here's the reasons why I do what I do?" Like, are you a frequent flyer there? Like, do you go to every monthly, full board meeting?

Kimberly:

I wish I actually love IRB reviews. So I wish, I wish they would invite me.

Valerie:

They don't invite you?! You would be...I would invite, yeah. You would be invited at ours.

Kimberly:

Um, it, it depends on the IRB. This is the really hard thing about doing research across different institutions is that, uh, institutional review boards or IRBs, are different. And their norms within their IRB communities are different, and their beliefs about this type of work or guardian permission. There's no, um, universal standard.

Valerie:

Okay.

Kimberly:

Um, and so that makes it tricky. So it depends. Um, I always provide empirical evidence to support the claims that I'm making around, um, guardian permission. Um, and there thankfully is quite a bit, including some research that I've done about, uh, waivers of guardian permission, particularly for sexual health research, with sexual and gender minority youth. Um, there's a wonderful group out of Northwestern and another group that collaborates with them out of Fordham, um, that have just done really very clever, smart work around this to collect the empirical data that we need to show... To support the points that this would bias samples, it would potentially be harmful for some youth. Um, and that, uh, involving the guardian doesn't necessarily mean that the youth would have more or better understanding of the studies.

Valerie:

Mhm. That seem like a really key point that like, you know, if this isn't necessarily helping then... And it's harmful, then why do it? Yeah.

Kimberly:

Yeah. I mean the whole point of IRB reviews is to make sure that what's happening, isn't that the risks and benefits weigh out. Right?

Valerie:

Right, mhm. So as we're talking about this, one thing I realized that, you know...we've known each other for years now, one thing I've never asked you is how did you, how did you get interested in this like topic of research? It's so, you know, it's not often that you hear someone say like, "So this is a topic of study that is really underfunded and hard,"... You know, because that means it's actually like a really challenging career path for you. We could argue, I mean, to say that like, "I'm going to develop expertise and a program of research and this thing, that's going to be hard for me to get research grants for, but I need these research grants to like progress in my career," So how did you, how did you get involved in like pornography and pornography literacy overall? And then also, you know, as someone who doesn't identify as an adolescent sexual minority, man, why this, like, why this population? Like, how did these, how did this interest kind of come together for you?

Kimberly:

Yeah, so, um, it all started back in San Francisco...

Valerie:

Mmm, of course it did...

Kimberly:

...yeah, in the early 2000s.

Valerie:

Okay.

Kimberly:

Um, so I graduated from undergrad, and I went to undergrad at Wesleyan University. And Wesleyan graduates go to two places primarily when you graduate. You either go to New York City or you go to San Francisco.

Valerie:

Okay. Did you flip a coin to decide? Were you like, "Heads New York, tails San Fransisco"?

Kimberly:

You know, I don't really understand that decision making process. I decided I wanted to live in San Fransisco.

Valerie:

Yeah, I don't understand 22 year olds anymore either. So, okay. So you landed in San Francisco, you're eating your sourdough bread. You're thinking about pornography. I don't know. What were you thinking?

Kimberly:

So I ended up getting a internship at, um, what was then called the UCF AIDS Health Project. It's now called the UCF Alliance Health Project.

Valerie:

Okay.

Kimberly:

Um, and I was, uh, a intern on, I was their research intern, um, and they were conducting a study that was a behavioral intervention for HIV prevention with, um, men who have sex with men. So gay, bisexual, and other men who have sex with men.

Valerie:

Mhm.

Kimberly:

And the intervention was actually a counseling intervention that was integrated into the HIV test counseling, um, that was being done. And so as a part of that, I got to, uh, not only become an HIV test counselor certified in California, but I also became one of the interventionists. And, um, when my internship ended, I actually became their research coordinator. Um, and what was very interesting about that time in San Francisco is, uh, some of the last, really large gay porn studios that had been in LA moved to San Francisco. And so there started being these like large, uh, gay porn release parties and like, it became like a whole scene. And I, um, in addition to being invited to some of those parties, which was totally amazing...Um, as an HIV test counselor, more and more of the people that I was counseling were framing their behaviors in terms of the porn they were seeing. So they would say "I had a total porn star moment. I did XYZ in the back of this bar,".

Valerie:

Oh, okay.

Kimberly:

Or "Like a porn star, I did blah, blah, blah blahbity blah,". And so it sort of got me like thinking about how porn consumption was impacting the behaviors and the way that people were thinking about sex.

Valerie:

Mhm.

Kimberly:

I then went to go get an MPH in epidemiology, um, from the University of Washington in Seattle. So I moved to Seattle. Highly recommend, Seattle is amazing. Um, and, you know, as was so much in research, it really is about like random happenstance things that sort of like get you on a path. Um, and so I was like in the middle of my epi program, and I was taking this course, I don't even remember what the course was. It was like Community... Something. I don't remember. It was a required course. The course itself was not particularly great...

Valerie:

Oh, okay!

Kimberly:

...but we had an assignment and the assignment was, if you could develop any public health intervention that you wanted to, what would you do?

Valerie:

Okay.

Kimberly:

And I was so, sort of, fed up with how I felt the course... I decided that I would do a porn interview. And so I decided that porn stars were like peer opinion leaders. And so I created a peer opinion leader intervention that was using porn stars to promote HIV prevention.

Valerie:

So what types of interventions have opinion leaders has been used in within the field of HIV?

Kimberly:

I think mostly it has been really about, um, condom use, cause it was pre-PREP when peer opinion leaders started really coming out. And they were particularly used among tight knit, African American and Black communities.

Valerie:

And so basically there are people who are going around in their communities saying like "Hey, aren't condoms great?" Right?

Kimberly:

Basically.

Valerie:

That's their, that's the gig. Okay.

Kimberly:

That's their job. There are people who are like, well-respected already in their communities and are well known. And so it's people who are already like leaders in the opinion and have good sort of like clout, I think.

Valerie:

Got it.

Kimberly:

So I wrote this paper about how a porn star should be peer opinion leaders. And, um, I, the paper was fine. I don't even know how I get onto these...

Valerie:

I mean, what got you interested in the topic...

Kimberly:

It got me sort of like thinking a little bit more about how I could think about the intersections between pornography and health. And so at that same time, I was applying to PhD programs in Psychology. Um, and uh, because I am, I was a bizarre human being, I only applied to two...

Valerie:

No, because you're baller, you're like, "I'm going to get into this,".

Kimberly:

One was in social psych...

Valerie:

Yeah, oh okay!

Kimberly:

And one in clinical psych. Um, and I was interviewing at the Clinical Psychology PhD program at the University of Washington and my, who would become my mentor, asks everybody when she interviews them, what they want to do, their dissertation on.

Valerie:

Oh, wow.

Kimberly:

It's a brutal question.

Valerie:

I would have failed that question. Okay, so continue...

Kimberly:

And I came up with an answer that was related to her work...She does work... This is Jane Simoni. She does amazing work on like adherence and, um, HIV medication adherence. Uh, she does some work around peer stuff. Um, she now has moved into global health. Um, but at the time, she was really known for her work in, in medication adherence. So I became, I like came up with some answer around medication adherence, even though that had never been sort of like my main jam, and then sort of like off-handedly at the end of that, I was just like, "Or, I've been really thinking a lot about how porn intersects with sexual behaviors. And I think it could be really interesting to think about how, uh, gay, bisexual, and other sexual minority men are engaging with pornography and how that's interacting with their HIV risk,". And she was like "Interesting," and she left it at that. And I was like, 'Well, but I could never do that study cause like no IRB would ever agree to that,". Um, and then I talked to who had become my secondary advisor, also on my interview loop. And I just was like, well, I'm just going to tell him that idea cause he's a sex researcher. Um, and I was like, "But the IRB would never let me do that," and he's like, "Why not? Of course they would let you do that. You should definitely do that,". Um, and so I came into my PhD program with my dissertation idea in hand.

Valerie:

That's amazing.

Kimberly:

Um, and I wrote a F31, which is an NIH, uh, pre doctoral, um...

Valerie:

Award grant...

Kimberly:

...educational thing that pays for your classes, but it also gives you like a small pot of money to do research. Um, and I applied for it in my first year and I got it the first go. Um, and it was about, uh, doing a large mixed methods study about pornography use in adult, uh, sexual minority men. Um, and, uh, so that was interesting. Um,

Valerie:

What did you find?

Kimberly:

That not surprisingly, almost all sexual minority, male, uh, adults use porn...

Valerie:

Similar to most adults, yeah, mhm.

Kimberly:

There's some evidence to show that actually sexual minority men view it the most out of all adults.

Valerie:

Okay.

Kimberly:

So there's like everyone hangs out at sort of like 85% and above but like...

Valerie:

Okay.

Kimberly:

...gay, bisexual and sexual minority men are like between the like 98 and 99%.

Valerie:

Got it.

Kimberly:

Um, and, uh, and what that research showed was that, uh, their sexual risk behaviors were actually associated with viewing sexual risk behavior, specifically condom-less anal sex. So those who reported more condom-less anal sex in the porn they were viewing were more likely to report having, uh, engaged in condom-less anal sex themselves.

Valerie:

Okay.

Kimberly:

Cross-sectional, so could go either way. It could be the people, like, who engage in condom-less, anal sex, like viewing it more. Or it could be the viewing it more is associated with engaging in it more.

Valerie:

Got it. Okay.

Kimberly:

Could go either way. Um, but that research was happening at the same time as... Two other researchers were doing almost the same study. So Simon Rosser in Minnesota, Eric Schrimshaw at Columbia, um, were also doing basically the same study, and we all got the same results.

Valerie:

Hold on, though. So basically what's happening is you're a PhD student with this F grant with this F award, which is a pretty small study, and you're doing this work that has not yet been done. And then we've got these two big deal, more senior researchers in the field, who are doing the studies as well. So that's pretty impressive... I mean, the fact that you're engaging in that level of science as a PhD student, is like really pretty incredible, I mean, that's amazing.

Kimberly:

It was also very intimidating.

Valerie:

Fair. Yeah. Okay.

Kimberly:

They also had like at the time, Eric, I don't think had his art yet, but like Simon said he was a full RO1. I mean, it was like,

Valerie:

It's like a huge, huge grant. I mean, it's like a multi-million dollar grant.

Kimberly:

He had money. I had, like, no money.

Valerie:

Yeah. Yeah. And you had like, yeah, you have a couple thousand dollars, maybe, to do it.

Kimberly:

Like, I had $50,000, I think.

Valerie:

Okay.

Kimberly:

Um, but the more that I was thinking about how this media interacts with sexual behavior, the more I got interested in what was going on with youth, um, and particularly around, uh, how do we reach youth and help them?

Valerie:

Okay.

Kimberly:

Do we see that association with youth? And if we do, how can we help youth? Um, and so I did my, uh, I moved from Seattle to Boston, but did my postdoc at Brown. Uh, and, uh, I decided to pitch a career development award that was specifically about, um, understanding porn use and sexual minority, male youth, and developing a porn literacy intervention for them. Which I'm, I'm literally right in the middle of doing my online RCT right now, halfway through recruitment. No, we're more than halfway through recruitment.

Valerie:

Hey, congratulations!

Kimberly:

I'm 65% through recruitment.

Carly:

Nice!

Valerie:

Awesome. That's a good milestone to hit.

Kimberly:

Yeah.

Valerie:

So, could you tell us a little about about what it looks like?

Kimberly:

Yeah. It's a bizarre time...

Valerie:

Yeah, mhm.

Kimberly:

...to be running an RCT. And I had a decision point, um, cause I was supposed to start it on April 1st. And I was like, "Well, I could postpone the study until people are able to actually see sexual partners again,". Um, because it's a pilot study...

Valerie:

Oh, right! Okay, so your dependent variable, the thing that you're looking to see how it impacts is, sexual behavior. And people are alone in their houses maybe, or at least if you're a young person, you know, you're probably not in a house with your partner. You're in a house with people you're not having sex with. Okay.

Kimberly:

Correct.

Valerie:

Okay. Caught up, continue.

Kimberly:

Um, so I could postpone the whole thing, or I could capitalize on this very unique moment where youth are stuck at home and uh, and help get some, what I'm hoping is good sex ed to them. And so I decided to move forward and I was also, my current IRB is wonderful. And so I was able to add COVID specific questions to the study. And so in addition to asking them about their sexual behaviors, um, I'm also asking them about like their in-person sexual behaviors. I also added some questions specific to, uh, additional online sexual behaviors that I thought they might be engaging more in um, now that they're stuck at home. Like more sexting, um, more chatting with, uh, men on men seeking, men, uh, apps, um, possibly more masturbation, um, porn watching. Um, I also put in a question about, uh, trading pictures and videos for money to see if that is going to go up as youth are most likely to lose their jobs in this process.

Valerie:

Okay.

Kimberly:

Um, and then I asked some questions about how worried they are about COVID, um, how, if they are not social distancing at this moment. Um, and then I ask them open ended questions about how it's impacting their sex life, and then also how it's impacting their life in general.

Valerie:

Okay.

Kimberly:

Um, and, uh, you know, I basically just like kissed my sexual behavior outcome goodbye in that process...

Valerie:

But what a smart way to pivot by, especially including all of these sort of like online behaviors that people might be engaging in and seeing what that looks like at this moment is super smart. Cause there is a lot of things that people are doing online and I've got to imagine that if we're not particularly, you know...if that's not going to, as you said, be related to a disease outcome necessarily, or pregnancy outcome that it's going to be underfunded. So we probably don't know a ton about all of these online sort of sexual behaviors, especially that adolescent sexual minority men are engaging in, would be my guess.

Kimberly:

Yeah. Well, and then there's the added, you know, it might not impact their in-person disease acquisition...

Valerie:

Mhm.

Kimberly:

...now, but it might later.

Valerie:

Oh, for sure.

Kimberly:

Right. Because it might be that they're, uh, doing a lot of chatting with a lot of different guys online, and they might meet up with them later. Right. So like, and there... Then there's like the legal implications of sexting when you're underage, and, um, any sort trading of pictures and videos for money. Um, so even though, you know, their chance of getting an...you know, getting HIV or an STD at this point is pretty low because they're not seeing their partners. That doesn't mean that the behaviors they're engaging in now won't necessarily translate to higher risk behaviors later.

Valerie:

Well done pivot. Yeah, super smart.

Kimberly:

I thankfully was able to consult with some incredibly awesome, uh, sexual health, adolescent researchers as I was...

Valerie:

Okay.

Kimberly:

Like, trying to put this together.

Valerie:

Still figuring it out.

Kimberly:

Yeah.

Valerie:

Well, it's interesting cause there's like this flurry right now of people who are doing all sorts of research studies, and they're like, "Okay, how do I measure something related to COVID?". And there's often not like a research question, you know? And so the fact that you were so quickly able to think deeply about how this environmental change might be impacting your, you know, your participants, and then figure out also how to capture it. I mean, sometimes baking those ideas, it takes like a year or it can just take a very long time. So to be able to do that quickly, to react, to, to get it in with your IRB, is super impressive. I mean, that's going to be really interesting data and important to look at.

Kimberly:

Yeah. I mean, it already is. I did our preliminary...

Valerie:

Oh, okay! What are you seeing?

Kimberly:

...analysis of it...Uh, with the first 60, uh, participants and, uh, I'm, I am now thinking about how to change the three month questions to maybe add some stuff to it. Um, but generally, uh, this is really devastating for the youth. Um, and, uh, you know, for a fair amount of them, because they're not required to be sexually active, to participate in my study, it's not changing their sex life.

Valerie:

Okay.

Kimberly:

They didn't have partners, they are not seeing partners. Like that's, you know, find some of them are reporting, you know, increased masturbation, increased porn use. That's not surprising. Um, but it's really the... It's palpable, the mental health effects that this is going to have. Um, because if you think about your teenage years and you think about the amount of milestones that happen when you're a teenager, um, you know, sexual debut is one of them, but also prom, and dating for the first time, and graduation, and, um, you know, learning from your peers and figuring out who you are. Um, so many of those things are not happening. Um, and then there's just the mental toll of social, social isolation generally. Um, which is even, I think probably, uh, a couple more folds harder for sexual minority youth because they are already isolated in many ways, particularly those who are not out. Um, and so any sort of connection they had to their community, and not being able to tap into that. And even if they try to tap into that worrying that their parents will find out that they're tapping into, that is really challenging. Um, so it's got, it's got me thinking a lot about like next steps for how to, how to understand further the like depth and length of that, uh, social isolation for these youth, and then, uh, how we can think about helping them.

Valerie:

Yeah. And then given that this is, you know, Sex, Drugs and Science, well, um, there's a lot of research out there showing that folks with worse mental health, on different indicators, greater anxiety, greater stress, um, greater depressive symptoms...that those folks also engage in, um, you know, greater substance use as a coping mechanism or sexual behaviors, you know, that may not involve condoms, that sort of thing. So that's a really interesting way to think about it that this mental health impact that's going to happen on certain populations is going to sort of play out over the long term. And also this idea that, you know, for some it's, it's a, it's, they're kind of more vulnerable to it. You know, I'm not, I didn't miss prom this month. Like I just missed going into my office a lot. So, um, the things that people are missing out on might be different. It depends, like there might be age pattern effects. Yeah. That's really interesting.

Kimberly:

Yeah. And I collect a lot of mental health and substance use data. Um, and so I'll be able to look at that as well over the course of, you know, my, my three month followup period.

Valerie:

Yes. Excellent. So I wanted to end on asking you about your RO1. Congratulations!

Kimberly:

Ahh!

Valerie:

An RO1 is a huge grant. It's a huge award and, um, you are studying minor consent laws around the US. And you're looking at kind of the impacts of these minor consent laws on, um, HIV related, right, testing, prevention, um, care outcomes. So now that we're talking to you, I mean, this seems like a really nice extension of the work that you've already been doing with the populations that you've been working with. So, and also, you know, even kind of going back to this policy conversations around porn, and this is like a really nice way of integrating in some of your interest in policy. So, what are these minor consent laws around the country and how do they vary? Because you've got to have variation, you know, in your, in your independent variable in order to study it or in your, you know, in what you're looking at. So...

Kimberly:

Uh, yeah, the minor consent laws are very interesting, um, to me. Which is why I got awhole grant about them. Um, so minor consent laws, there are a lot of different kinds of minor content laws. So there minor consent laws are specifically around like substance use treatment, um, and there are minor consent laws around mental health treatment. And the minor consent laws that I'm specifically focusing on in this grant are around access to HIV testing, treatment, and prevention services and, uh, and STD testing, treatment and prevention services. So I'll start with STD cause that's sort of the easiest to explain, because it's all bundled together. So, uh, across the United States, because we are a bunch of states, every state has its own minor consent laws. All 50 states allow most minors to self-consent. So don't need to involve their guardian to receive STD testing and treatment and prevention services kind of. And, um, the differences between the states is really about age. So when the youth can do engage in those services, uh, depends a little bit on age, and whether the state has decided that there is a like lower age limit that they have to have met to be able to self-consent.

Valerie:

Okay.

Kimberly:

What's interesting is that HIV has its own cutout. So HIV is not included in the STD laws. HIV is its own thing. Um, and, uh, in, I wanna say my last count, 32 states, let's say 32 states give or take, um, allow most adolescents to self consent to HIV testing. There's an, a sub portion of those states that also allow for STD treatment. So there are some states where, as an adolescent, you'll be able to test for HIV, but if you test positive, now your guardian has to be involved. Which is not the greatest...

Valerie:

Yeah!

Kimberly:

...if you don't have a good relationship with your guardian.

Valerie:

For sure.

Kimberly:

Um, and then there's really interesting stuff happening around prevention for HIV, specifically now that PREP has been approved for adolescent years. Um, and so there are a couple states now that specifically have minor consent laws around PREP. Um, but there are other states that sort of fold prep into HIV prevention, um, minor consent laws. So we're trying to tease that apart a little bit to better understand what youth rights are across the states around prevention services. Um, the other really tricky...there are two other tricky things with minor consent laws. One is a lot of these states then have sort of like this back, back rule where you can...if a physician decides it's in the best interest of the minor to go ahead and tell the guardian anyway, even if the youth has the right to consent themselves, the physician can choose to do that.

Valerie:

Hmm. That's interesting from a stigma perspective, because we know that when people have greater latitude in decision making, especially providers, that there's just more opportunity for stigma to like, to sort of rear its head. So...

Kimberly:

Yeah.

Valerie:

..of there are people, if there are certain types of adolescents that doctors think are, think might be like less responsible or, you know, based on their sexual orientation, or based on their gender identity, or their race, then you could imagine that those are the youth who might be most at risk for having this, um, this option exercised. Yeah, that's interesting.

Kimberly:

Yeah. Um, the other tricky part about this is about who pays. So if a youth is on their guardian's insurance, which most youth are, um, and they go in for, let's say an HIV test, and the doctor charges that to the guardian's insurance, the guardian is now going to get an explanation of benefits form from their insurance company saying that the test happened.

Valerie:

Okay.

Kimberly:

Um, and so there are some states that have worked out laws that actually protect youth in that particular scenario, but most states have not. Um, and so for it's, that's complicated, right? So think about what it would be like to be a teen and trying to understand what your rights are around this and what potential, like, pitfalls might occur.

Valerie:

Right.

Kimberly:

So all of these laws are created with this idea that it's going to decrease barriers to access in these services for youth. Um, but they're very complicated. And, uh, and so this grant is really about deep diving into the laws to figure out what all of them are. We're going to create a public health law database that tracks these laws from 1985 to current, um, so that we can really understand what the laws are, when they've changed, how they've changed. And so public health researchers can then use them to understand other behaviors by mapping them onto other data sets, which is what we're going to do. Uh, and our, uh, second aim, which is to take that public health law database, map it onto the National Survey of Family Growth, and look to see if when these laws changed. Did youth behavior change?

Valerie:

Super smart.

Kimberly:

My guess is no.

Carly:

Yeah.

Valerie:

Right. Yeah, cause they don't know about them, right?

Kimberly:

It's very fun to pitch your first very large grant. And be like, "I think there's going to be a null result here people," .

Valerie:

Yeah, no, you've got to really be a good, uh... You've got to have good grantswomanship to get that to fly. For sure.

Kimberly:

Yeah. And then our, uh, we have some preliminary data to show that youth don't know about these laws, which is not surprising in any way, shape, or form, cause where would they have even heard about them?

Valerie:

Sure.

Kimberly:

Like they're not going to hear about them in sex ed, nobody's telling them that unless it's California, which then they might be, because California has the best sex ed out of all.

Valerie:

They're like the Netherlands of the US?

Kimberly:

They're the Netherlands of the US. Um, uh, and so the last aim of the study is to do a very large national survey of adolescents from every single state, um, and DC. Um, 150 adolescents from each state.

Valerie:

Wow, okay!

Kimberly:

Um, and to assess their, uh, understanding of these laws, um, their uptake of those services, what they think the laws should be, and, uh, how they think we should get that information to them. So really trying to tap into the youth perspective about, like, what's going on with these laws, what they think would actually help. Um, I'm guessing that the legislators didn't necessarily create a youth advisory board to influence...

Valerie:

What?! Are you sure?!

Kimberly:

...these laws.

Valerie:

Yeah.

Kimberly:

Um, but I'm really excited about that study and the team that I'm working with is just amazing. Um, it really it's, uh, an all women team, and we are across five different institutions, and from, uh, Clinical Psychology to Health Policy, Economic Research to... I have a law team at Columbia. Um, I have an Internet Research Specialist in California. Uh, it's like really, it's a powerhouse team, and I could not...I have social, I have a social epidemiologist. It's like, it's really, they're amazing. Um, and so I am pumped on so many levels to do this study. Um, but I think really part of that is about this amazing, very collaborative team that I'm working with.

Valerie:

Well, it's amazing, and a real testament to you to be able to pull those people together and get them at the table along with the youth, um, who are going to be advising you along the way to pull off this sort of really exciting project. So you're going to have to come back and tell us about how it goes in a couple of years or sooner. Tell us...

Carly:

Yes, season two...

Valerie:

...about what happens in season two. Tell us about what happens at this, um, with your COVID data. But Kim, thank you so much for joining us today. We really super appreciate your time. Um, you were the first person that I called when I had the idea to do this podcast. And so I want to thank you for encouraging it. I also want to advise that, you know, if any listeners really hate the show that maybe they should, you know, tell you instead of me and Carly.

Carly:

Yeah. If it's terrible, we're sending them your way.

Kimberly:

That's fine. I'm used to it. Don't worry about it.

Valerie:

Yeah. I appreciate that. I think that that would be helpful for my own mental health. Um, is there anywhere that listeners could go to learn more about your work? I mean, when we Googled you, we saw that you have been keeping the BU press, like, very busy with like all these really great articles about you. Um, so it's, but is there anywhere in particular, other than Google Scholar, where people could go to learn more about either you, or any of these types of things?

Kimberly:

I think the, the BU website...the BU School of Public Health website is a really good sort of collection of information about me cause it lists all of the articles, but also all of the, like all of my publications. Um, it doesn't list my RO1 for some reason. I don't understand why that is, but you know...

Valerie:

But there's a really lovely article on it so people..

Kimberly:

There was a really lovely article on it.

Valerie:

There was a lovely article on it. Okay.

Kimberly:

And actually they're going to be doing an article about my COVID work...

Valerie:

Oh nice!

Kimberly:

...coming up next week. So...

Valerie:

Great! Okay. Well, you're going to be like, that's going to be like three articles in two months or something from BU School of Public Health. So, so that's good. Cause we all need more exciting things to be reading about, so...

Kimberly:

Yeah.

Valerie:

....and also a big congratulations as you know, to our early career, Um, SBM investigator winner.

Kimberly:

Awww.

Valerie:

It was a big bummer not to be able to go out to San Francisco, and to celebrate you, and scream in your face about all of this, like amazing body of research. Um, even though it's like a, it's, it's funny to... that you're an early career investigator because this is a very, like, robust and diverse body of research. So, um, so congratulations again to that. And I'm looking forward to, you know, eventually maybe getting out to San Francisco and having that sour,dough bread and going to one of these porn release parties to celebrate you.

Kimberly:

I don't know if the porn release parties are happening anymore. It might be that...

Valerie:

We're going to make that happen.

Kimberly:

Well in California. So California is interest... I'm going to side note us for a second. California is very interesting because they tried to pass a proclamation of, uh, and I think this was specifically in San Francisco, that porn actors had to use condoms. And I can't remember if it was California wide or if it was San Francisco specific. No, I think it was California wide. Um, and what that ended up doing was a lot of the porn studios then just left California.

Valerie:

Oh, okay. So we'll have to go somewhere else maybe to go to a porn release party and eat sourdough or whatever the local bread treat is. Well, that'll be our fun way. We'll have to figure out how to celebrate it, but congratulations again! It couldn't have gone to a better, um, more deserving scientist, and thanks again for joining us, Kim.

Kimberly:

Oh my God. My pleasure.

Carly:

Yeah. Thank you so much. It was great meeting with you and talking with you. This was like the most fascinating morning meeting I've ever had in my whole entire life. And now every meeting is gonna be held to this far. So...

Valerie:

Hey Carly.

Carly:

Hey Valerie.

Valerie:

So as you know, in Stigma lab, we've been thinking a lot about how people are digesting news and media related to COVID lately.

Carly:

Yes. I've done a lot of the, uh, Reddit research conspiracies.

Valerie:

Yeah. Deep dive on conspiracy beliefs. So I got thinking when I was reflecting on our conversation with Kim about this connection between, you know, pornography literacy. She did a really nice job of highlighting the connections to like media literacy earlier on in life, all the way out then to like news and social media literacy in the context of COVID.

Carly:

Right.

Valerie:

Because I think, you know, what we've been seeing is that people have a hard time, you know, to some extent, figuring out if some of these theories and rumors that are circulating around are true or false. And the conversation with Kim got me thinking about like, "Oh, I wonder if people did more thinking about why these things are circulating?". If that would help them to, to, you know, gain a greater understanding of why some of these ideas, like coronavirus has started are by 5G or it's a bio part of a bio weapons program, like why those things might be circulated for circulating for reasons other than their true. And nobody wants to talk about it.

Carly:

Right. Right. Exactly. Yeah. It is so funny though. The other thing that can said was that, um, once you, your brain starts working that way, or once you make your brain start working that way... That's why it's hard to turn it off. So, uh, I, it's funny. I have really been noticing, like there was some commercial on last night and I was like, who, who is this for? I was like, Oh, wait a minute. I'm doing exactly what Kim Nelson said I would do once I started this. But it is so important because she's right. It does, you know, it's not just about the porn literacy, although that obviously is an important part of it. But if, you know, like you said, if it starts off with the media literacy, then it's, you know, going to just go leaps and bounds from there and have someone that can think independently, and weigh these things and ask themselves these questions to like, know what to trust when there's so much information going around.

Valerie:

Yeah. It's a really cool example about, of how some of these issues that we study are so interdisciplinary and interconnected. The fact that like some of the same skills that you can use to, to watch porn are the same skills that you can use to like watch commercials targeted around diet pills, or like to navigate like COVID conspiracy use. Like just having an awareness of this information can be really useful, and also we just kind of need to do better at it, across the board in a lot of different areas. Yeah. It's really interesting.

Carly:

Right, Yeah, for sure.

Valerie:

Yeah. So Kim, you know, low key mentioned that she's part of this research team for this RO1 level project that's funded by the National Institutes of Health. Um, and that this team is like this group of women. And I wanted to underscore from it moment to tell amazing this project is and how remarkable it is that she like has assembled this group of women to work on it. So I was, I was nerding out this morning with some numbers, drinking my tea, caffeinating and I found that NIH maintains this website, it's called the NIH Data Book and it breaks down information on who receives their grant money. And it's beautiful, some of these graphs and trendlines, and it's like, you know, beautiful and stressful at the same time. But, um, so overall the success rate for NIH grants in 2019 was 20%. So first off, I mean, these grants are really challenging to get. And so the fact that she's been so successful is like really phenomenal. But then I also found that women receive 33% of these research project grants. And I assume that's like women as the principal investigator basically like the main, the person in charge of the study. So I was like, you know, so first off I was surprised 30... 33%, And it's not 50%.

Carly:

No.

Valerie:

No. Um, but then I also saw that the success rates for getting grants between men and women is pretty similar. Uh, so it said like around 20% for first submissions, and 40% for resubmissions. So to me, what it looks like that's happening there by looking at, you know, three graphs for five minutes this morning without doing a deep dive. And I'm sure other people have, but I'm wondering if this is consistent with other research, you know, about women in academia and women scientists more generally that at like earlier levels of training, we've got like a lot of women grad students and a lot of women who, um, are assistant professors in the field. And then as you go kind of up the ranks in academia, from assistant to associate to full, you see smaller and smaller like groups of women. And so the fact that, you know, we have fewer women who are, who are getting these NIH grants, even though they're fun, you know, when, they do apply, they're doing equally. Well, it looks like as men suggest to me that we've got like a women scientists falling out this sort of issue happening again.

Carly:

Which makes it even more impressive that Dr. Nelson's whole team on this project is all women.

Valerie:

I know! And I love that you said, I mean, when I was thinking that I was like, which makes us a total bummer, which makes it more impressive. What a nice, lovely so that... Yes. Yes. So totally impressive that she's like, that's this group of collaborators.

Carly:

Yeah. We're not here to compare our lab to other labs. Hang on. We're just here. We're just here to highlight the good things. No, I know.

Valerie:

We've got lovely, lovely ladies of science who we collaborate with as well. Yeah.

Carly:

For sure.

Valerie:

But it's just, it's really remarkable that Kim has this NIH RO1 award that as an assistant professor, I mean, she's operating at a really high level of science. Um, even though she's still, you know, technically like a junior faculty member, so it's just really amazing,

Carly:

Right. I think too, especially it's even more impressive when you consider all the challenges. And I think we touched on this that, you know, she has to face like, you know, in, she can't really name pornography in any of the titles of her work. Like there's all these little intricacies about, you know, uh, the, the research that she does that makes it even more challenging. So again, it's just these layers and layers of total...

Valerie:

Yeah.

Carly:

Badass-ery for lack of a better, better term. Um,

:

Yeah.

Carly:

You know, like...

Valerie:

Yeah. I wonder if she can get that on her card, "Dr. Kim Nelson, Layers of Badass-ery"

Carly:

Oh, probably. She get it tattooed really, I think is what she should do. Kim, if you're listening again, the takeaway really here...

Valerie:

All right. Well, I think, you know, now that we're recommending tattoos for our guests, we should probably wrap this up. So we'll give a big thanks to the Stigma and Health Inequities Lab at the University of Delaware, especially Natalie Brousseau, Saray Lopez, and Alissa Leung. And to Kristina Holsapple, who did the research for this episode, so thank you to her.

Carly:

Yep. And as always, we thank City Girl for letting us use their music for the podcast.

Speaker 5:

[inaudible] [inaudible] [inaudible] [inaudible] okay.