A paper presented at the Annual Meeting of the Society for the Scientific Study of Sexuality (SSSS - WR), Kona Kai Resort, Shelter Island San Diego, April 10-13, 2008. This research was supported by Sabattical Leave from the University of New Mexico to the University of Hawaii-Manoa & the University of California, 2007.
There is little debate in the behavioral science and medical literature that consumers of health-related information are routinely confused by conflicting, complex, unclear and/or inconsistent research findings (Institute of Medicine, March 2004: Health Literacy: A Prescription to End Confusion, Washington, D.C. National Academies Press). While little research has been done in this area related to sexuality research findings, some new research focusing on "health literacy" and "health risk communications" appears to have direct relevance for sexuality investigators (Wolf et al., The Emerging Field of Health Literacy Research, Am J Health Behav, 2007, v31, Supplement 1). For example, much of empirical sexuality research is quantitative in nature and presents results with language such as "probability of", "odds for" and "increased risk for". Yet we have little data on how well the average consumer of sexual information actually understands the concept of probability or odds or how investigators actually calculate or derive "increased risk". Weare now at a critical juncture in sexual science which allows researchers to stop and assess how proficient our audiences are at comprehending research reports and how best to make our outcomes more clear and thus compelling. This emerging research field has been referred to as "quantitative health literacy" or when referring to quantitative sexual information, as simply, sexual numeracy. For clarity this paper uses young people ages 14 to 18 as the reference point, although as the sexual numeracy field develops these propositions may well apply to different age cohorts.
Operationalizing Sexual Numeracy
Sexual numeracy can best be defined or operationalized as the level of understanding or comprehension an individual possesses when presented with sexuality information that is mostly quantitative in nature. Since it is a new conceptual area there is little if any empirical documentation of its psychometric properties although Duryea et al., have begun developing a valid and reliable instrument to measure this skill domain (Duryea et al., 2008, Paper to be presented at the American Public Health Association Annual Meeting, San Diego, October, 2008).
While illustrations of different sexual numeracy scenarios will be examined in subsequent sections, a brief sampling of sexual numeracy areas could include the following:
A young adult visits a clinic to get an AIDs test and is subsequently informed by the physician that they were sero-positive for the HIV antibody but that the rate of false positives was 15%. Does the patient understand what this means?
A teenage girl has first ever sex with her new boyfriend. She later reads in a textbook that the failure rate for using condoms (correctly & consistently) is
A young man and his new bride learn they are pregnant. After genetic tests they are told that one of them carries a gene for spina bifida and the probability of the baby having this condition is 25%. Is this risky or nothing to worry about?
A young woman is told that she has early stage breast cancer. Her doctor informs her that the odds of her dying from it are 1 in 12. What should she make of such odds?
In each of these scenarios the individual has received quantitative information related to sexual behavior and its consequences. While young people graduating from high school are supposed to have studied and shown competency in understanding odds, probabilities and related quantitative concepts in math courses, we do not know how well most actually DO comprehend them in real-life situations. This unknown level of skill in sexual numeracy among our youth should be of concern to all sexuality educators as well as researchers because lack of such proficiency has an array of both social as well as health consequences (Schwartz et al,Role of numeracy in understanding the benefits of mammography,Ann Intern Med, 1997, 127(11), 966-972).
Data on Health/Quantitative Literacy
There is a burgeoning wealth of research emerging examining how well adults understand health and numerically presented health information. The entire issue of the American Journal of HealthBehavior was recently devoted to the state-of-the-art research in this domain (2007, 31(Suppl 1). Unfortunately, none of the authors presented data specifically addressing sexual-based literacy or sexual numeracy.
One startling finding reported, however, was the finding from the National Adult Literacy Survey that almost a quarter of US adults were below basic proficiency in "quantitative literacy skills" (QLS). Only 33% were rated as having basic skills (Kirsch et al, US Dept of Education, 1993, NCES 93275). Even more alarming was a finding in a study of "highly educated" samples that only 55% of respondents correctly answered how many times a die would come up even in 1000 rolls (Lipkus et al, Med Dec Making, 2001,21(1), 37-44).
Medical care investigators in particular have conducted many studies on numeracy in various kinds of patients- and its ramifications. While this literature is beyond the scope or purview of this paper, a common theme is that patients with low numeracy skill have a range of problems weighing the cost to benefit ratio of various procedures. In one study, cancer patients who answered a numeracy question incorrectly...