Doing More Good than Harm? The Effects of Participation in Sex Research on Young People in the Netherlands

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1 Arch Sex Behv DOI /s y ORIGINAL PAPER Doing More Good thn Hrm? The Effects of Prticiption in Sex Reserch on Young People in the Netherlnds Lisette Kuyper John de Wit Philippe Adm Liesbeth Woertmn Received: 13 My 2010 / Revised: 16 April 2011 / Accepted: 21 April 2011 Ó Springer Science+Business Medi, LLC 2011 Abstrct Ethicl guidelines for reserch with humn prticipnts stress the importnce of minimizing risks nd mximizing benefits. In order to ssist Institutionl Review Bords (IRBs) nd reserchers to mke more informed risk/benefit nlyses with regrd to sex reserch mong dolescents, the current study exmined the effects of prticiption in sex reserch mong 899 young people (15 25 yers old). Prticipnts completed three questionnires on wide rnge of sexulity-relted mesures. They lso completed scles mesuring their levels of distress, need for help, nd positive feelings due to their reserch prticiption. In generl, negtive effects of reserch prticiption seemed limited, while benefits of prticiption ppered substntil. Severl differences with regrd to sociodemogrphic chrcteristics were found (e.g., femles experienced more distress then mles nd younger or lower educted prticipnts experienced more positive feelings). In ddition, victims of sexul coercion reported more distress nd need for help due to their prticiption, but lso experienced more positive feelings. No significnt differences were found in reltion to experience with sexul risk behviors (e.g., experience with one-night-stnds). L. Kuyper (&) Rutgers Nisso Groep, P.O. Box 9022, 3506 GA Utrecht, The Netherlnds e-mil: l.kuyper@rng.nl J. de Wit L. Woertmn Deprtment of Socil Psychology, University of Utrecht, Utrecht, The Netherlnds J. de Wit P. Adm Ntionl Centre in HIV Socil Reserch, University of New South Wles, Sydney, Austrli P. Adm Institute for Prevention nd Socil Reserch, Utrecht, The Netherlnds Severl limittions of the study were discussed, s were implictions for future reserch. Overll, the findings cution IRBs nd reserchers ginst being overly protective regrding the inclusion of young people in sex reserch. Keywords Institutionl Review Bord Sex reserch Reserch prticiption Reserch effects Hrm Benefits Introduction Ethicl guidelines for reserch with humn prticipnts stress the importnce of minimizing potentil hrm for prticipnts while mximizing the nticipted benefits (Americn Psychologicl Assocition, 2002;NtionlInstitutesofHelth,1979; World Medicl Assocition, 2008). Institutionl Review Bords (IRBs) determine whether the potentil risks for prticipnts re justified nd if potentil hrm is outweighed by the nticipted benefits of the study. IRBs nd reserchers decisions regrding socil or psychologicl reserch proposls nd protocols seem, due to lck of sufficient empiricl dt, mostly bsed on worst-cse scenrios, ssumptions, nd necdotes (DePrince & Freyd, 2004; Gunslus et l., 2007;Newmn&Kloupek,2004;Okes,2002;Rosenbum & Lnghinrichsen-Rohling, 2006; Rosnow, Rotherm- Borus, Ceci, Blnk, & Koocher, 1993; Wgener et l., 2004; Wlker, Newmn, Koss, & Bernstein, 1997). An erly study by Ceci, Peters, nd Plotkin (1985) showed tht IRBs decisions regrding socil nd psychologicl reserch were lso bsed on sociopoliticl concerns. Notbly, this study found tht proposls on neutrl topics (e.g., job discrimintion bsed on height) were more often pproved thn studies on more sensitive topics (e.g., job discrimintion bsed on gender). In ddition to potentilly problemtic sociopoliticl influences,

2 Arch Sex Behv nother problem is tht IRBs nd reserchers cn under- or overestimte the risks of socil nd behviorl science reserch (Okes, 2002). In the bsence of empiricl dt regrding the effects of prticiption in sex reserch on young people,reserch regrding dolescents nd sexulity might be n re in which judgments bsed on politicl, culturl, religious or emotionl grounds cn esily influence the decision of IRBs nd reserchers. These ctors my be hesitnt, both with respect to including dolescents who cn be seen s vulnerble popultion (Flicker & Gut, 2008) s well s in sking questions on sexul topics, which re commonly considered s privte nd sensitive (Lee & Renzetti, 1990). Issues regrding subjective decisions nd common sense risk benefit nlyses cn be solved by providing objective, empiricl dt bout the effects of reserch prticiption (Gunslus et l., 2007;Mustnski,2011;Newmn&Kloupek,2004; Okes, 2002). Unfortuntely, even regrding reserch prticiption in generl, only few studies hve been conducted (DePrince & Freyd, 2004; Kssm-Adms& Newmn, 2002; Okes, 2002; Rosenbum& Lnghinrichsen-Rohling, 2006; Ybrr, Lnghinrichsen-Rohling, Friend, & Diener-West, 2009). Jorm, Kelly, nd Morgn (2007) concluded in theirsystemtic review of prticipnt distress in psychitric reserch tht prticiption overll yielded more positive thn negtive effects. Lnghinrichsen-Rohling, Art, O Brien, Bowers, nd Klibert (2006)investigtedwhether prticipting in reserch on sensitive issues (e.g., suicidlity, druguse,ndbusive experiences) ws upsetting for dolescents. The mjority of prticipnts reported no distress t ll nd they considered the studies interesting. Young people who hd experience with these sensitive behviors were somewht more distressed. Ybrr et l. (2009) recently studied the impct of completing self-report questionnires on violence mong young dolescents. The mjority of the prticipnts were not upset nd greed tht questions like this should be sked to young people. Severl studies exmined the effects of trum reserch (e.g., domestic violence, sexul buse, injuries or suicidlity). These studies confirmed previous findings: prticipnts mostly reported low levels of distress nd negtive consequences (Cromer, Freyd, Binder, DePrince & Blecker-Blese, 2006; DePrince & Freyd, 2004; Edwrds, Kerns, Clhoun, & Gidycz, 2009;Griffin, Resick, Wldrop,& Mechnic, 2003;Johnson& Benight, 2003; Newmn,Wlker, &Geflnd,1999;Ruzek&Ztzick,2000;Wlkeretl.,1997). Trum-relted studies focusing on victims of severe sexul buse cn shed some light on the potentil effects of prticiption in sex reserch. Trum-relted studies focused on whether prticipnts with history of (severe) sexul victimiztion were upset, or more upset thn non-victims, when questions were sked bout the (busive) sexul experiences. However, while informtive, these studies were conducted with quite homogeneous smples nd did not estblish whether certin subgroups of victims of sexul buse re more vulnerble thn others to the potentil negtive effects of reserch prticiption (e.g., younger individuls or persons from socilly mrginlized communities, such s ethnic minorities) (e.g., Fisher, Kornetsky, & Prentice, 2007; Newmn & Kloupek, 2004). Most trumrelted studies only included women (Griffin et l., 2003; Johnson & Benight, 2003; Newmnetl.,1999; Svell,Kinder& Young, 2006; Wlker et l., 1997) or students (e.g., Cromer et l., 2006; Edwrds et l., 2009; Rojs& Kinder, 2007). In ddition, most trum studies only focused on the effects of sking questions bout (severe nd enduring) sexul buse. These studies did not include questions bout other sexul (risk) behviors, such s numbers of sexul prtners or types of sexul experiences, s commonly included in sexul (helth) reserch mong young people. Asking questions bout these sexul topics might be distressing in itself. For exmple, sexulity is sensitive, privte topic nd tlking bout these privte behviors nd thoughts might be upsetting for young people. Often, explicit (dult) lnguge is used, which might lso be confronting nd disturbing for young people. In ddition, surveys of sexul topics del with behviors or thoughts tht re tboo or regrded s risk behviors. Recently, Mustnski (2011)exminedtherections of LGBT youth in nswering questions bout their sexul behvior. The mjority of the prticipnts reported tht they were comfortble with the question, while 11.1% of the LGBT youth indicted tht they felt uncomfortble. The Current Study Persisting high rtes of sexully trnsmitted infection (STI) (Gvin et l., 2009), sexul victimiztion nd perpetrtion (Brter, McCrry, Berredge, & Evns, 2009; Gvinetl., 2009; Young, Grey, & Boyd, 2009), nd dolescent pregnncies (Gvin et l., 2009; OrgnistionofEconomicCo-Opertionnd Development, 2008; Singh & Drroch, 2000) mong young people wrrnt nd require further reserch on their sexul helth. It seems therefore importnt to exmine empiriclly the effects of prticiption in sex reserch on young people. This cn ssist IRBs nd reserchers in mking more informed risk benefit nlyses. Unfortuntely, dt on the effects of prticiption in sex reserch re, to our best knowledge, scrce. The current study exmined the effects of sking questions bout vrious sexul topics in lrge-scle sexulity study in diverse smple of Dutchdolescents. The reserch questions guiding the current study were: (1) Wht re the levels of distress, need for help, nd positive feelings resulting from prticiption in self-report questionnire study on sexulity; (2) Do negtive nd positive effects differ between vrious sociodemogrphic subgroups with regrd to gender, ge, eductionl level, ethnicity, religiosity, nd sexul orienttion; (3) Do negtive nd positive effects differ between prticipnts who hve experience with different forms of sexul victimiztion (e.g., verbl mnipultion, situtionl buse nd sexul violence) nd dolescents who hve no such experiences; nd (4)

3 Arch Sex Behv Do negtive nd positive effects differ between prticipnts who hve experience with sexul risk behviors (e.g., high number of sexul prtners, sexul experience with csul prtners) nd prticipnts who hve no such experiences? Method Prticipnts The smple consisted of 889 sexully experienced young people in The Netherlnds. More femles (74.0%) thn mles (26.0%) prticipted. The prticipnts were between 14 nd 26 yers old (M = 18.70, SD = 2.52), nd were roughly eqully distributed mong different eductionl levels (48.6% lower eductionl level, 51.4% higher eductionl level). Young people from non- Western ethnic bckgrounds mde up 11.4% of the smple. The mjority (67.5%) of the prticipnts did not consider religion of personl importnce. Almost one fifth (18.8%) of the smple reported sexul experience with sme-sex prtner. Procedure This study ws prt of survey of the sexul behviors nd experiences of dolescents nd young dults in The Netherlnds. Anon-rndomsmpleofprticipnts ws recruited dvertisements in youth medi (e.g., websites, miling lists, TV progrms, nd mgzines) nd on electronic blckbords of severl voctionl schools. The ds invited prticipnts to visit the website of the study, clled Spek up now! (in Dutch), nd complete n on-line questionnire regrding their good nd their bd sexul experiences. In ddition to the questionnire, the website lso contined bckground informtion bout the survey, contct informtion of the reserch tem, nd list of cre providers with whom the prticipnts could get in touch with if they experienced need for help due to their experiences or their reserch prticiption. Rndom smpling ws not undertken, s the study sought to include only sexully ctive young people yers old. A rndom smple of sexully ctive young people ged yers cn only be recruited by rndomly smpling from ll young people ged yers. However, s those who re sexully ctive mke up only proportion of young people ged yers, rndom smpling would require identifying, contcting, nd screening lrge numbers of potentil prticipnts, which would not be cost-effective. Also, rndom smple would include low numbers of homo- or bisexul young people who re t incresed risk for sexul helth problems, including experiencing or encting sexul coercion nd engging in behviors thtpose higherriskfor STI.Insted,the study imedtincluding sufficient members of subgroups of young people to enble comprtive nlyses ccording to key sociodemogrphic chrcteristics, including gender, ge, eductionl level, ethnicity, religiosity nd sexul orienttion. Ads were strtegiclly published to promote the inclusion of lower educted, ethnic minority nd homo- or bisexul young people in prticulr. Three different on-line questionnires were completed by the prticipnts. The study hd cross-sectionl design, but three seprte questionnires were used to decrese the burden on the prticipnts nd to be ble to bse questions bout the most prevlent scenrios of sexul coercion in the third questionnire on the informtion provided in response to the second questionnire, which contined detiled questions regrding experiences with sexul coercion. At the end of the first questionnire, prticipnts were sked whether they were willing to complete two more questionnires. Prticipnts indicting tht they wnted to continue their prticiption were skedfortheir e-milddress. Emil ddresses were stored seprtely from the dt. All dt nd emil ddresses were stored on secured server nd were only ccessible to the reserch tem. No monetry reimbursement ws provided for prticiption; insted, 10 ipod s Nno, 1 ipod Touch, nd 10 gift certifictes of 50 euro ech were rffled mong prticipnts. Informed consent ws obtined online from the prticipnts. The study protocol ws exempt from forml medicl-ethicl pprovl under previling lws of The Netherlnds. One month fter completing the first questionnire, prticipnts who provided n e-mil ddress received link to the second questionnire; fter 6 months, they received link to the third questionnire (which contined the questions regrding the effect of reserch prticiption). Of the prticipnts receiving link (N = 2,936), 46.8% completed the second questionnire (n = 1,375) nd 30.3% completedthethirdquestionnire (n = 889). The smple for the present study consisted of the 889 prticipnts who completed the third questionnire. In comprison to prticipnts completing only the first questionnire, prticipnts who lso completed the third questionnire more often were women (74.0 vs. 69.6%, v 2 (1, N = 889) = 7.96, p =.01), were slightly older (M = vs. M = 18.51, t(888) = 2.21, p =.03), hd higher eductionl levels (51.4% vs. 37.3%, v 2 (1, N = 889) = 75.37, p\.001), more often hd Western ethnic bckgrounds (88.6 vs. 82.3%, v 2 (1, N = 889) = 24.27, p\.001), nd more often reported sme-sex sexul experiences (18.8 vs. 14.1%, v 2 (1, N = 889) = 17.97, p\.001). There were no significnt differences with regrd to the level of the importnce of religion between prticipnts completing only the first nd lso the third questionnire (67.5 vs. 69.7%, v 2 (df = 1, N = 889) = 1.91). In ddition, the prticipnts completing the third questionnire did not differ on other independent mesures included in the current study, such s experience with verbl mnipultion (52.8 vs. 52.6%, v 2 (1, N = 765)\1), experience with situtionl buse (20.0 vs. 21.3%, v 2 (1, N = 765)\1), experience with sexul violence (12.7 vs. 13.7%, v 2 (1, N = 765)\1), experience with ny form of victimiztion (58.3vs. 58.6%, v 2 (1, N = 765)\1), reporting more thn verge number of sexul

4 Arch Sex Behv prtners (35.9 vs. 37.4%, v 2 (1, N = 889)\1), nd experience with csul sex (49.4 vs. 50.3%, v 2 (1, N = 899)\1). The first questionnires consisted of rnge of mesures pertining to sociodemogrphics, bckground nd (sexul) behviors, sexul motives nd ttitudes, nd sexul nd reltionl communiction skills. The second questionnire consisted of mesures pertining to sexul coercion nd violence. The third questionnire consisted of mesures pertining to the evlution of vrious scenrios of potentillyunwntedsexul behviors nd experiences. At the end of the third questionnire, prticipnts were sked series of questions bout the potentil effects of their reserch prticiption. More informtion on the specific instruments used in the current study cn be found in Kuyper, de Wit, Adm, Woertmn, nd vn Berlo (2010). The specific mesures used in the current study re described in more detil below. Mesures Independent Vribles Sociodemogrphics Gender indicted whether prticipnts identified s mle or femle. Age 1 ws mesured by sking prticipnts their ge in yers. On bsis of this question, prticipnts were divided into two subgroups: younger thn 18 yers or 18 yers nd over. Eductionl level ws ssessed by three questions. The first question exmined whether prticipnts were still in school, college, or university or not. If yes, they were sked bout their current eductionl chievement. If they hd finished or quit school, college or university, they were sked bout the highest level of eductionl they hd completed. On the bsis of their nswers, prticipnts were divided into two subgroups: higher eductionl level (finished or still studying t university, college or pre-university eduction) nd lower eductionl level (finished or still studying t other, lower [voctionl] eductionl levels). Ethnicity ws coded by three items regrding the country in which the prticipnt ws born, the country in which their mother ws born, nd the country in which their fther ws born. Prticipnts were divided into two subgroups: Dutch or Western prticipnts who were born in the Netherlnds or nother Western country nd of whom both prents were lso born in the Netherlnds or nother Western country, nd non-western prticipnts who were born in non-western country, or of whom one or both prents were born in non-western country. 1 Age, religion, nd number of sexul prtners were originlly mesured with continuous scles. The items were dichotomized to enhnce comprbility cross the different independent vribles nd ensure more clrity to the reder. Anlyses were lso run with the originl continuous vribles nd no different results were found. Religion 1 ws mesured by sking wht religion currently ment to prticipnts in their lives, with responses given on five-point scle (1 = mens nothing; 5 = mens lot). Prticipnts were divided into two subgroups: those for whom religion ws unimportnt (scores 1 nd 2) nd those for whom it ws somewht to very importnt (scores 3 through to 5). Sexul orienttion ws ssessed by behviorl indiction. Prticipnts were sked the gender of their sexul prtners (1 = only men; 2 = mostly men, sometimes women; 3 = eqully often men nd women; 4 = mostly women; 5 = only women). Tking the gender of the prticipnt into ccount, responses were recoded into dichotomous vrible indicting whether prticipnt (lso) hd sexul experience with sme-sex prtner or not. Sexul Victimiztion Three different forms of sexul victimiztion were mesured by the Sexul Experience Survey (SES; Koss et l., 2007), which is known for its good relibility nd vlidity. The SES ws dpted for the young, prtly lower educted, Dutch smple. 2 It ws exmined whether prticipnts hd experienced sexul victimiztion since their 14th birthdy. Answers were given on 3-point scle (1 = never; 2 = once; 3 = more thn one). Bsed on the responses, nswers were combined into dichotomous mesure indicting whether prticipnts hd experienced specific type of sexul victimiztion or not. Experiences regrding the three seprte forms of sexul coercion (verbl mnipultion, situtionl buse, sexul violence) were lso combined into one overll mesure, indicting whether prticipnts hd hd experienced ny form of sexul victimiztion since their 14th birthdy. Verbl mnipultion ws exmined by three items tht indicted whether prticipnts hd hd sex they did not wnt to hve becuse their prtner verblly mnipulted them. The specific items were: Someone kept insisting or ngging to hve sex with me while I did not wnt to, Someone becme ngry, ws displesed or sid unkind things to hve sex with me while I did not wnt to, nd Someone lied, thretened to end the reltionship or thretened to spred rumors to hve sex with me while I did not wnt to. 2 The originl SES ws dpted in severl wys, due to culturl nd lnguge differences nd the fct tht the current study used young smple tht lso consisted of dolescents from lower eductionl level. The revision wsbsedonfeedbckfrompilotgroup ofyoungpeople, thedvisory bord of the study, nd n expert in youth communiction. The revision ws mde in collbortion with the uthor of the originl scle (M. P. Koss, personl communictions, November 19, 2008; November 24, 2008; Jnury 5, 2009). The short version of the SES ws used, but two items from the long version were lso included. Severl extensive items were either shortened or split into seprte items. The ttempt items were excluded. The phrse while I did not wnt to ws dded to the questions regrding verbl pressure. Following the suggestion of Price nd Byers (1999), the response options never, once, nd more thn once were used insted of the originl response options 0/1/2/3/3?.

5 Arch Sex Behv Situtionl buse ws ssessed by one item nd indicted whether prticipnts hd hd sex becuse their prtner took dvntge of sitution in which they were intoxicted ( Someone bused me when I ws drunk to hve sex with me ). Sexul violence ws exmined by four items which indicted whether prtner hd used severe or criminl forms of pressure in order to hve sex with the prticipnt. The specific items were: Someone forced me to tke drugs or drink lcohol to hve sex with me, Someone thretened to hurt me or my loved ones to hve sex with me, Someone used force or violence to hve sex with me, nd Someone worked together with other people s group to hve sex with me. Sexul Risk Behvior Number of sexul prtners 1 ws ssessed by one item sking how mny different sexul prtners the prticipnts hd hd in their life. Prticipnts were divided into two subgroups: prticipnts with n verge nd below verge number of sexul prtners, nd prticipnts with n bove verge number of sexul prtners. Sex with csul prtners ws exmined by one item sking prticipnts whether they ever hd hd sex with csul prtner (e.g., one-night-stnd). Dependent Vribles Three potentil effects of reserchprticiptionwere ssessed. All nswers were given on 5-point scle (1 = totlly disgree; 5 = totlly gree). Distress ws ssessed with three items. The specific items were: The questions gve me bd thoughts bout things tht hppened to me, The questions mde me feel down, nd The questions mde me sd. A higher score indicted more distress. Internl consistency of the items ws good (Cronbch s lph =.82) nd item scores were verged. Need for help ws exmined by two items tht sked prticipnts whether they hd experienced need for help or support due to the questions ( I felt need for help due to the questions nd I went looking for help due to the questions ). A higher score indicted higher need for help. Internl consistency of the items ws good (Cronbch s lph =.82) nd item scores were verged. Positive feelings were ssessed with four items ssessing whether the prticipnts gined nything positive from prticiptinginthe study( I likedit tht Iws bletogive myopinion, I found it relief to shre my experiences, I think it is importnt tht surveys like this re crried out, nd I think it is importnt tht young people cn spek up bout their opinions on sexulity ). A higher score ment tht prticipnts derived more positive feelings from their prticiption. Internl consistency of the items ws sufficient (Cronbch s lph =.70) nd item scores were verged. Sttisticl Anlyses Levels of distress, need for help, nd positive feelings were exmined by clculting percentges. Men scores, cross-tbultions, nd correltions were used to inspect the blnce of nd ssocitions between potentil negtive nd positive effects. Differences in experienced effects between vrious sociodemogrphic or sexul behvior subgroups were explored using multivrite nlyses of vrince (MANOVAs). In cse of significnt overll effect of sociodemogrphic or sexul experience vrible on the effect mesures, seprte univrite nlyses of vrince (ANOVAs) were performed for distress, need for help, nd positive feelings to estblish on which mesure of experienced effects the groups differed. A significnce level of p =.05 ws used for ll nlyses. Dt nlyses were conducted with SPSS (Version 19). Results Reported Levels of Distress, Need for Help, nd Positive Feelings As cn be seen in Tble 1, one in four prticipnts reported distress (e.g., feeling down or sd), but only 3.5% of the smple experienced need for help. In contrst to these negtive effects of reserch prticiption, the vst mjority (96.5%) of prticipnts reported positive feelings due to their prticiption. Correltion nlyses showed tht experiencing distress or need for help did not exclude deriving nything positive from prticiption, s would be indicted by negtive correltions between distress or need for help, nd positive feelings. The positive correltion between distress nd positive feelings demonstrted tht prticipnts who experienced distress due to the questions were lso more likely to experience positive feelings (r =.10, df = 887, p\.01). The bsence of correltion between need for help nd positive feelings showed tht prticipnts who felt need for help did not report more or less positive feelings (r =.00, df = 887). As ws to be expected, there ws significnt positive correltion between experiencing distress nd need for help (r =.49, df = 887, p\.001). To exmine the blnce of positive nd negtive experienced effects, men scores were clculted. These showed tht both the men score for distress (M = 1.94) nd need for help (M = 1.35) (both indicting, on verge, disgreement with sttements bout the negtive effects nd need for help) were lower thn the men score for positive feelings (M = 3.89) (which indicted tht, on verge, prticipnts greed with sttements bout the positive consequences). Further inspection of the dt ws conducted to exmine whether negtive blnces (costs exceeding benefits) existed on n individul level. Four prticipnts reported greement

6 Arch Sex Behv Tble 1 Prevlence of experienced effects of prticiption in the study (N = 889) Distress The questions gve me bd thoughts bout things tht hppened to me with t lest one distressing item, while not reporting ny positive feelings (.4% of the totl smple). Two prticipnts reported experiencing need for help without ny positive feelings (.2% of the smple). Differences Between Sociodemogrphic Subgroups % (Totlly) gree 16.5 The questions mde me sd 7.8 The questions mde me feel down 16.5 (Totlly) gree with t lest one distress item 26.7 Need for help I felt need for help due to the questions 2.4 I went looking for help due to the questions 1.9 (Totlly) gree with t lest one need for help item 3.5 Positive feelings I liked it tht I ws ble to give my opinion 75.9 I found it relief to shre my experiences 28.7 I think it is importnt tht surveys like these re crried out I think it is importnt tht young people cn spek up bout their opinions on sexulity (Totlly) gree with t lest one positive feeling item Tble 2 shows the differences in effects of reserch prticiption by sociodemogrphic chrcteristics of prticipnts. The overll MANOVAs for gender, Wilks lmbd =.98, F(3, 885) = 4.73, p\.01, prtil g 2 =.02; ge, Wilks lmbd =.99, F(3, 885) = 3.43, p =.01, prtil g 2 =.01; eduction, Wilks lmbd =.97, F(3, 885) = 10.47, p\.001, prtil g 2 =.03; nd religion, Wilks lmbd =.99, F(3, 885) = 3.30, p =.02, prtil g 2 =.01, were significnt, indicting differences in t lest one type of experienced effect of reserch prticiption between men nd women, younger nd older prticipnts, lower nd higher educted prticipnts, nd prticipnts who considered religion to be importnt or not. The MANOVA for ethnicity yielded mrginlly significnt effect regrding differences in experiences relted to reserch prticiption between Western nd non-western prticipnts, Wilks lmbd =.99, F(3, 885) = 2.32, p =.07, prtil g 2 =.01. The MANOVA for sexul orienttion ws not significnt, Wilks lmbd =.99, F(3, 885)\1, prtil g 2 =.01. Seprte ANOVAs for levels of distress, need for help, nd positive feelings showed which experienced effects of reserch prticiption differed between the subgroups. Women experienced more distress due to the questions thn men. Younger prticipnts reported more often tht they derived positive feelings from their reserch prticiption thn their older peers. Two differences were found between prticipnts of lower nd higher eductionl chievement: higher educted prticipnts less often reported tht they needed help, but lso experienced lower levels of positive feelings. Religious prticipnts experienced more positive feelings thn prticipnts who considered religion unimportnt. The mrginlly significntly sttisticl effect suggested tht prticipnts of non-western bckgrounds tended to experience more distress due to the questions thn young people from Western bckgrounds. Differences Between Sexul Victimiztion Subgroups Tble 2 lso displys the differences in experienced effects between prticipnts who hd experienced different types of sexul victimiztion nd prticipnts who did not report such experiences. The MANOVAs for verbl mnipultion, Wilks lmbd =.92, F(3, 761) = 22.28, p\.001, prtil g 2 =.08; situtionl buse, Wilks lmbd =.98, F(3, 761) = 5.06, p\.01, prtil g 2 =.02; sexul violence, Wilks lmbd =.92, F(3, 761) = 21.09, p\.001, prtil g 2 =.08; nd ny of these forms of sexul victimiztion, Wilks lmbd =.91, F(3, 761) = 25.03, p\.001, prtil g 2 =.09, were significnt. ANOVAs showed firly consistent picture: dolescents who hd experience with sexul victimiztion reported more distress nd need for help, but these prticipnts lso derived more positive feelings from their prticiption. The only exception ws being victim of situtionl buse. Prticipnts with this experience reported more distress due to the questions, but did not report higher need for help or more positive feelings. Differences Between Sexul Risk Behvior Subgroups Tble 2 lso shows the results of the nlyses of potentil differences between prticipnts who did nd did not hve experience with sexul risk behviors. The MANOVAs for number of sexul prtners, Wilks lmbd =.99, F(3, 885) = 1.85, p[.10, prtil g 2 =.01; nd sexul experience with csul prtners, Wilks lmbd =.99, F(3, 885) = 2.13, p =.09, prtil g 2 =.01; both yielded the sme results: no significnt differences between dolescents with or without experience with these sexul risk behviors were found. Discussion The current study exmined the effects of prticiption in sex reserch on young people, using dt from lrge-scle study on sexul coercion mong young people in The Netherlnds. Overll, the negtive effects of prticiption in this study ppered to be limited, while the benefits of prticiption seemed substntil. On n individul level, the blnce between voiding

7 Arch Sex Behv Tble 2 Differences in experienced effects of prticiption in the study for sociodemogrphic, sexul victimiztion, nd sexul risk behvior subgroups (N = 889) Sociodemogrphic chrcteristics Gender N Distress Need for help Positive feelings M SD F p g 2 M SD F p g 2 M SD F p g 2 Mle \ ns ns.00 Femle Age \ ns ns \ /18? Eduction Lower level ns \ \ Higher level Ethnicity Western Non-Western Religion Not importnt ns ns Importnt Sexul orienttion No sme-sex prtner Sme-sex prtner Sexul victimiztion Verbl mnipultion Never \ \ At lest once Situtionl buse Never \ ns ns.00 At lest once Sexul violence Never \ \ \ At lest once Any form of victimiztion Never \ \ At lest once Sexul risk behvior Number of prtners (Below) verge Above verge Csul prtner Never At lest once The overll MANOVA ws not significnt; therefore, seprte ANOVAs were not conducted hrm nd doing good seemed to be disrupted for only smll frction of the prticipnts. Differences in experienced effects of reserch prticiption were found between sociodemogrphic subgroups. More women thn men were distressed by the questions. A potentil explntion for this gender difference might be tht women re generlly less permissive towrds sexulity thn men (Ahrold & Meston, 2010;Petersen& Hyde, 2010), nd might therefore be more distressed by nswering questions bout sexulity-relted topics. Another difference with regrd to sociodemogrphics

8 Arch Sex Behv ws tht young people with lower eductionl bckgrounds reported experiencing higher need for help due to the questions. An explntion for this difference might be tht lower educted dolescents re, in generl, less likely to seek help from specific mentl helth services (e.g., psychologist) when experiencing emotionl or mentl helth problems (Vnheusden et l., 2008). It could be tht they reported higher need for help becuse they did not previously seek help with the problems they experienced with sexulity-relted experiences (e.g., sexul victimiztion). Differences between sociodemogrphic groups in positive effects were lso found: more younger prticipnts, prticipnts of lower eductionl bckgrounds, nd prticipnts who considered religion importnt reported deriving positive feelings from their prticiption. Younger prticipnts nd prticipnts of lower eductionl levels might be more likely to derive positive feelings from their prticiption becuse of their limited possibilities of joining reserch projects. Most studies re crried out using student smples, excluding young people from lower eductionl bckgrounds nd, often, focus on prticipnts of 18 yers nd older, since younger individuls re seen s too vulnerble to prticipte (Flicker & Gut, 2008). Victims of severl types of sexul coercion reported higher levels of distress nd need for help due to their reserch prticiption. This is in line with previous studies focusing on domestic violence nd severe sexul buse (e.g., Cromer et l., 2006; DePrince&Freyd,2004; Griffinetl.,2003; Lnghinrichsen-Rohling et l., 2006). It mkes sense tht young people who hve hd negtive sexul experiences hve more bd thoughts bout wht hppened in their pst when being sked bout their sexul experiences, nd tht they feel more distressed or in need of help due to thequestions.importntly,however, these young people lso derived more positive feelings from their reserch prticiptionthn dolescents who reported no experience with sexul victimiztion. Explntions for these higher levels of positive feelings mong victims might be tht their prticiption gives them sense of purpose, empowerment, self-wreness or self-cknowledgement (Johnson & Benight, 2003; Jorm et l.,2007). There were no significnt differences in effects of reserch prticiption of prticipnts whose sexul behvior is often regrded s risky by sexul helth professionls (e.g., higher number of sexul prtners or hving hd experiences with one-nights-stnds), nd prticipnts who did not report such potentil sexul risk behvior. Although minority of prticipnts reported feelings of distress or experiencing need for help due to prticiption in the study, it is importnt tht these negtive experienced effects of reserch prticiption re tken seriously. Ybrr et l. (2009) encourged reserchers to include questions bout reserch prticiption so tht prticipnts who weredistressed could esily be detected nd provided with cre. Without wnting to dismiss the potentil negtive effects of prticiption in sex reserch on young people, questions cn be sked bout the mening of the levels of distress nd need for help tht were reported. For exmple, ethicl guidelines regrding minimizing hrm re often interpreted s voiding negtive effects tht exceed levels of distress experienced in dily life or during routine medicl or psychologicl exmintions (Becker- Blese & Freyd, 2006;DePrince& Freyd,2004;Ybrr et l., 2009). Young people who experience distress or need for help due to their prticiption in sex reserch might lso experience distress when being confronted with sexulity issues in dily life (e.g., in converstions with peers, movies, TV-shows, video gmes, mgzines). It is lso not exmined whether the experienced levels of distress exceed those experienced during other routine exmintions. Furthermore, there re uncertinties regrding the dynmics of the reported distress nd need for help. The negtive feelings rised by the questions could be trnsitory stte. It is not surprising tht young people feel sd or down directly fter nswering questions bout negtive experiences like sexul violence, but feeling distressed is not the sme s being (psychologiclly) hrmed(becker-blese & Freyd, 2006; DePrince & Freyd, 2004; Widom& Czj,2005; Ybrret l., 2009), nd these feelings might quickly fde wy. A note of cution cn lso be mde regrdingthe positivefeelings derived from sex reserch prticiption. For exmple, the Office for Humn Reserch Protections (OHRP) in the United Sttes pointed out tht feelings of benevolence derived from reserch prticiption should be not considered s benefits for the prticipnts (OHRP, 2010). The current study hd severl limittions. The min limittions were relted to the smple nd recruitment strtegy. The study did not recruit rndom smple of young people. Insted, the study oversmpled prticipnts with lower eductionl bckgrounds nd homosexul/bisexul prticipnts to enble comprtive nlyses by these nd other sociodemogrphic chrcteristics. Also, more women then men prticipted in the study. A more gender-blnced smple is desirble in future studies. Furthermore, the smple consisted of self-selected prticipnts who were recruited with ds sking them to spek up bout their good nd bd sexul experiences. This (self) selection my hve resulted in bis towrds higher levels of positive feelings derived from prticiption in the study, since young people who considered the study unimportnt or did not cre bout being ble to shre their experiences or give their opinion might not hve enrolled in the study or not completed (ll) questionnires. Selection bis might lso hve influenced the negtive feelings derived from prticiption, but it is less cler in which direction. Wlker et l. (1997) suggested two options: people who re more upset bout the topic might not prticipte (resulting in n underestimtion of negtive effects)or individuls who re less touched by the topic prticipte less (resulting in n overestimtion of negtive effects). In ddition to the potentil effects of self-selection, the response rte of prticipnts in the study who lso completed the third questionnire ws limited (30.3%). There is no doubt tht

9 Arch Sex Behv this low response rte is mjorlimittionofthecurrentstudy tht should be voided in future studies. However, it is importnt to note tht low response rtes re more often problem in the Netherlnds. Response rtes in the Netherlnds tend to be lower thn in other Western countries nd they seem to decline during the recent yers (de Leeuw & de Heer, 2001;Stoop,2005). Other lrge-scle sexulity studies in the Netherlnds report eqully low, or lower, response rtes (e.g., 28% in recent popultion study of sexul helth of Bkker & Vnwesenbeeck, 2006; 20% in recent popultion study of sexul helth of Bkker et l., 2009;24%inrepresenttiveyouthstudyofsexulhelthofde Grf, Meijer, Poelmn, & Vnwesenbeeck, 2005). The response ws lso not rndom, s reflected in differences in sociodemogrphics of prticipnts completing the different questionnires. Women, older prticipnts, nd young people of higher eductionl levels were significntly more likely to continue with the study. However, only the difference with respect to eduction seemed substntil, with 51.4% of the present study reporting higher eductionl level compred to 37.3% in the originl smple. As higher educted prticipnts less often reported tht they needed help nd reported lower levels of positive feelings derived from their reserch prticiption, this my hve contributed to n underestimtion of the levels of need for help nd positive feelings due to their reserch prticiption. Prticipnts who did not complete nd prticipnts who did complete the third questionnire did not differ on the other independent mesures such s the vrious types of sexul victimiztion experiences or sexul risk behviors. In ddition to limittions relted to the smple nd recruitment further limittion of the current study ws the lck of comprison group. Future studies might benefit from dding mesures ssessing potentil effects of prticiption to surveys of other helth issues (e.g., on mentl or physicl helth problems), collect informtion on experiences relted to routine medicl or psychologicl exmintions, or dminister short questionnire fter sexulity-relted ctivities (e.g., wtching documentry on sexul violence). This would enble reserchers to put the reported levels of distress, need for help, nd positive feelings into perspective nd exmine the specificrisk nd benefits of prticiption in sex reserch. Despite the limittions nd remining questions, the current study showed tht young people were not severely distressed by prticipting in sex reserch, nd ctully gined benefits from it. This helps to cution reserchers nd IRBs in being overly protective nd overly sensitive towrds sex reserch mong young people, nd overemphsizing theirvulnerbility. An overlysensitive ttitude might even send the wrong messge of considering young people incompetent to join sex reserch nd undermine their gency. As Widom nd Czj (2005) pointout, the ethicl principle of respect even demnds tht vulnerble groups like young people hve the right to join reserch projects, nd ethicl principles wrn ginst the exclusion of specific groups from the benefits tht scientific reserch hs to offer.ultimtely,young people might lso experience negtive effects (e.g., not feeling like being herd or being represented, nd no development in scientific knowledge on their sexul helth) from not prticipting in sex reserch. Acknowledgments The dt used in the current study were collected s prt of study on sexul coercion mong young people, which ws funded by ZonMw (The Netherlnds Orgnistion for Helth Reserch nd Development) (Grnt number ). We would like to thnk Mirre Hubers of ZonMw for reminding us of the importnce of ddressing the effects of reserch prticiption of young people. 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