Health Education Research Advance Access originally published online on February 3, 2006
Health Education Research 2006 21(4):488-500; doi:10.1093/her/cyh075
Health-related social control and relationship interdependence among gay couples
1 Health Behavior and Health Education, School of Public Health, CB #7440, University of North Carolina, Chapel Hill, NC 27599, USA
2 Department of Community and Family Medicine, Division of Community Health, Duke University Medical Center, Durham, NC 27710, USA
3 Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA 94105, USA
*Correspondence to: M. A. Lewis. E-mail: megan.lewis{at}unc.edu
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Abstract |
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How gay partners influence each other to promote health and prevent human immunodeficiency virus (HIV) is poorly understood. The present study combined qualitative and quantitative methods to examine the experience of health-related social control and relationship processes among a sample of 60 gay male couples. Couples completed semistructured interviews and separate self-administered questionnaires. Findings suggest that partners attempt to change a variety of behaviors, many of which are not HIV related, that they use a variety of social control tactics, some of which are specific to HIV prevention, and that their care and concern for each other and their relationship motivate social control to change health behaviors. The implications for health behavior change research and intervention are discussed.
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Introduction |
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Many fields have demonstrated that involvement in close relationships confers a health advantage [1, 2]. The interpersonal mechanisms that explain the health advantage of close relationships remain poorly understood. This is especially true for gay couple relationships, which have not been subject to much study. Understanding how gay couples function to promote and influence health is important for two reasons. First, gay couples lack the macrolevel institutional supports which may make them more dependent on their relationship, and partners are thus more likely to be an important source of interpersonal influence [3]. Moreover, gay couples also report less social support from family and friends, suggesting that their socio-emotional needs are more likely to be met within the relationship [4]. The lack of macro-support, coupled with lower network support, makes understanding how relationship functioning and influence get enacted in gay couples paramount, because the partner may be the most influential person in each other's life. This suggests that involving partners in interventions to change health behaviors may be a high-impact leverage point.
Second, understanding how gay couples function to influence health is also important because human immunodeficiency virus (HIV) has had a disproportionate effect on the gay community. It may be the case that HIV risk behaviors are the subject of different types of influence tactics compared with other health behaviors. Sexual behavior within and outside the relationship may be difficult to discuss or threatening to the relationship. Discussing sexual behavior also may be more emotional than other health behaviors, such as physical activity, because sex is viewed as a sign of intimacy and trust. Finally, partners can potentially conceal sex outside the relationship from each other, and therefore may be harder to regulate within the relationship. Understanding the influence tactics gay couples use to regulate each others' health behaviors generally, and HIV-related behavior specifically, could inform interventions capitalizing on gay men's intimate relationships to prevent HIV infection and promote health in general.
To this end, the present study examines health-related social control among gay male couples. Health-related social control refers to interactions between social network members, or in the present case partners, that involve explicit attempts to regulate and influence health behaviors [5]. Using a mixed-methods approach that combined a qualitative approach with quantitative methods, the study addressed three questions. First, what kinds of social control tactics do gay partners use in their attempts to change each others' health-related behaviors? Second, do gay partners use different social control tactics for HIV-related behaviors and for other health-related behaviors in their attempts to change each others' behavior? Third, do constructs from interdependence theory [6, 7], such as relationship interdependence and comparison level for alternatives (CL-alt), distinguish either the types of behaviors that gay partners target for change or the social control tactics that they use in attempts to change each others' health behaviors?
Social control and influence tactic use among gay couples
Previous research has found that social control is associated with the practice of fewer health-compromising behaviors and more health-enhancing behaviors [8, 9]. Research with married couples indicates that marital partners attempt to influence a variety of health practices, many of which are related to the prevention of disease and promotion of good health [8, 10]. In addition, spouses use a variety of social control tactics to influence their partners' health behaviors [10–12]. The tactics that are viewed as most successful by marital partners may be best conceptualized as capitalizing on the interdependent and communal nature of intimate relationships, rather than the simple exercise of power [10]. Particular styles of social control tactic use appear to be more effective than others. Previous work suggests that positive, direct and bilateral tactics are associated with health-enhancing behavior changes, while negative, indirect and unilateral tactics are not [5, 13]. To date, there are no studies of health-related social control conducted with gay couples. As Huston and Schwartz [14] pointed out 10 years ago, the interpersonal processes that underlie gay relationships, including social control processes, are poorly understood, and this is still the case.
A similar lack of focus on gay couples exists in the social–psychological literature that examines social influence tactics. Those studies that have examined how couple members try to influence each other to use condoms to prevent HIV have predominantly focused on heterosexual couples [15–17]. The few studies that have examined influence tactics in gay couples indicate that relationship functioning variables, such as commitment or dependence, moderate the type of influence tactics used [18]. This suggests that to understand how health-related social control is enacted in gay couples, factors that make partners more or less interdependent need to be considered.
Relationship interdependence and health-related social control among gay couples
Interdependence theory is a dyad-level theory that explains how influence and communication affect behavior by taking into account the outcomes experienced by partners [6, 19]. The outcomes that couple members experience are determined partially by the factors that influence how the relationship functions. Previous research in heterosexual and same sex couples indicates that a variety of relationship functioning variables such as attachment, autonomy, equality or commitment make partners more or less interdependent, by creating pushes and pulls on the relationship [3]. In our previous work, we have described the amalgam of these push/pull forces that either bring partners together (pull) and make them more influential or drive partners apart (push) and make them less influential, as ‘relationship interdependence’ [7]. In support of this idea, research shows that many relationship functioning variables appear to affect the use of social influence in relationships [18, 20, 21]. This suggests that relationship interdependence may affect the use of social control tactics. Partners in more interdependent relationships may be more reluctant to use negative tactics which might disrupt the relationship [21], and thus use more positive tactics.
Another construct from interdependence theory that could affect the outcomes partners experience is termed ‘comparison level for alternatives’ [3, 22]. CL-alt refers to whether or not an alternative relationship offers more costs or benefits, compared with the current relationship [19]. When beneficial outcomes in the primary relationship exceed benefits from alternative relationships, the individual is more satisfied, and reliant upon his partner, more committed to the relationship and less likely to seek an alternative relationship [23]. The use of health-related social control tactics may be influenced by CL-alt experienced by gay couple members because those partners who have alternatives may be less invested in their relationship, less committed [24] and therefore use more negative and fewer positive tactics.
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Methods |
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Participants
Sixty gay identified couples were recruited through snowball sampling and other solicitation methods (e.g. newspaper advertisements, gay men's social organizations) in the Boulder and Denver, CO, USA, areas. Of the 120 men who participated, 112 completed the demographic questions included in a structured questionnaire. Eighty-two percent of these men identified themselves as White, Non-Hispanic, 9% as Latino, 4% as African American, 2% as Asian Pacific Islander and 3% as other. The average age was 37 years, with a range from 20 to 63 years. The majority of the participants had completed some years of college or graduated from college. Annual income from all sources ranged from less than $15 000 to $150 000 or more. Of the 60 couples, 11 were serodiscordant, 7 HIV-positive seroconcordant and 38 HIV-negative seroconcordant. Data were incomplete on the remaining four couples. Eighty percent of couples lived together. The length of cohabitation ranged from 6 months to 29 years, with an average of 5.5 years.
Design and procedure
The data for the following analyses are drawn from two sources: (i) a 20-min semistructured audiotaped interview that each couple self-administered and thus completed in privacy and (ii) a self-administered questionnaire (SAQ) that each partner completed separately and in private, and that took 30–45 min to complete. We decided that both the semistructured couple interview and the partner completed SAQ would remain anonymous because methodological work in HIV prevention has shown that answers to questions about sexual behavior and HIV may be more valid when given in anonymity [25]. During the semistructured audiotaped interviews, each couple was given an interview guide that asked the following questions: (i) discuss the kinds of health-related behaviors that concern HIV or acquired immunodeficiency syndrome you have tried to get your partner to change; (ii) discuss the kinds of health-related behaviors, in general, you have tried to get your partner to change and (iii) tell us why you decided to talk about these two behaviors. All tapes were transcribed excluding five conversations that were inaudible, and any personal identifiers were removed. Responses to these questions served as the basis for the qualitative data presented in the following sections of this paper. Couples were assigned an identification number that linked their taped conversation with the SAQs, but this number was not linked with their names in any way.
After the semistructured couple interview, each partner completed an SAQ in a separate room to ensure privacy. The SAQ asked more in-depth questions about health behaviors couples may have mentioned in their interview, relationship functioning variables, health and socio-demographics. Responses to questions in the SAQ served as the basis for the quantitative data presented in the Results section. Each couple member was paid $25.00.
Measures
Social control tactics
The taped conversations were coded for any possible instance of a social control tactic being mentioned by couples during their interview. A list of these coded tactics was compiled and then classified as being positive, negative or neutral by a research assistant to the project. Classifications were informed by previous social control research that classified tactics into positive and negative dimensions [11].
Relationship interdependence
We operationalized relationship interdependence as the amalgam of the ‘pushes and pulls’ on the relationship by using several measures of relationship functioning that were probed in the SAQ. First, we created an index of the ‘pushes’ toward the relationship we termed ‘positive interdependence’ by summing scores on the following measures: (i) a one-item measure of relationship closeness [26], (ii) a one-item measure of relationship satisfaction where higher scores reflect greater satisfaction [11], (iii) an average relationship commitment score where higher scores reflect more commitment [3] and (iv) an average relationship equality score where higher scores reflect great equality in the relationship [3]. These four areas of relationship functioning were summed to create an overall index of positive interdependence, where higher scores reflect more positive interdependence, or pushes toward the relationship. Second, we created an index of the ‘pulls’ away from the relationship we termed ‘negative interdependence’, where higher scores reflect more pulls away from the relationship by summing the following measures: (i) an average negative autonomy score where higher scores reflect less dependence on the relationship [3] and (ii) an average relationship stress score developed for the purposes of the study, where higher scores reflect greater relationship stress. Each partner's negative interdependence score was subtracted from the positive interdependence score, and the partner scores were added together to create a relationship interdependence score for the couple. The average couples' score was 44, and the range was 17–66. Higher scores reflect greater pushes toward the relationship than pulls away from it.
Comparison level for alternatives
CL-alt was measured by a question that enquired how couples handled sex in and out of their relationship. This decision was made because gay men report having sex outside of primary relationships more frequently than lesbian and heterosexual partners [27]. Participants were considered to have alternatives if they reported engaging in sexual activities with somebody other than their partner. They were considered to have no alternatives if they reported not engaging in sexual activities with somebody other than their partner. This operationalization of CL-alt may not reflect the actual costs and rewards received in their relationships, but it does capture whether or not each partner had alternatives, and may be a proxy for the costs and rewards in these relationships. Using both partners' scores, each couple was classified as (i) neither partner had alternatives, (ii) one partner had alternatives or (iii) both partners had alternatives.
Analysis approach
We used NUD*IST and NVIVO to analyze the transcripts for recurrent themes and mentions of social control as well as behavior-specific social control tactic use. Four members of the research team initially read each interview on hard copy. Each member drafted a list of sensitizing concepts [28]. The individual lists were compiled and discussed collectively. A codebook was then developed using the collective list. The codes were given titles and definitions to help ensure intercoder reliability. Estimates of equivalence were calculated by comparing the coding of two research assistants who independently applied the same operational definitions to a sample of randomly selected interviews. The level of agreement was very high (95%). The qualitative data were coded by going through the transcripts and applying the codes to the text. The coding scheme was also entered into NUD*IST. This process generated text related to each code as needed. The frequencies of the codes were also calculated in an effort to detect patterns and guide interpretation [29].
We used a mixed-method approach by taking scores from the quantitative data that were calculated using SPSS 10.1, and integrating them into the qualitative data set. To answer our first research question related to the kinds of social control tactics partners used, we coded all instances of a tactic being mentioned according to the coding definitions derived from the process just described. To answer our second research question we coded the tactics mentioned with reference to specific behaviors, including general health behaviors and HIV-related behaviors. To answer our third research question related to the role of relationship interdependence and CL-alt in social control of health behaviors, we created high, medium and low categories of relationship interdependence by calculating the mean (44) and standard deviation (10) of the relationship interdependence score. Based on these scores a range was created to categorize couples. Scores <34 (one standard deviation below the mean) were considered to have low interdependence, scores from 34 to 54 were considered to have moderate interdependence and scores >54 (one standard deviation above the mean) were considered to have high interdependence. We entered these values as well as the CL-alt scores into the qualitative data set. In addition, we used the social control tactics categorized as positive, negative or neutral to answer this third research question, because there were not enough mentions of each specific type of tactic to yield meaningful interpretations.
There is some debate about the appropriate analytic approach for qualitative data. Some argue against the use of numbers in analyzing, interpreting and representing qualitative data, while others argue that numbers can be used to generate and explore meaning in qualitative data [29–31]. Our mixed-method approach makes use of both numerical and non-numerical analysis strategies. Counts enable us to establish frequencies and explore patterns of association in partners' behaviors, while quotations let us see what these behaviors mean to the partners themselves. Some argue that using both numerical and non-numerical approaches enhances the validity of qualitative findings [32].
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Results |
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Before analyzing the data in relation to the specific research questions, we examined two factors related to these questions. These were as follows: What kinds of behaviors do partners mention as the target of their social control efforts? What are the reasons they give for attempting to change the health behavior of the partner?
What kinds of behaviors do partners mention as the target of their social control efforts?
A variety of health behaviors were mentioned, and behaviors were classified as attempts to decrease a health-compromising behavior, increase a health-enhancing behavior or change an HIV-related behavior. The behaviors in each of these categories are shown in Table I. Among the most frequent behaviors targeted for change were stress, smoking, drinking, physical activity and diet. As indicated in Table I, general health-related behaviors were mentioned more frequently as compared with HIV-related behaviors. Of the HIV-related behaviors mentioned by couples, taking medication regularly was the most frequently mentioned. It is important to note that bar hopping was mentioned as an HIV-related behavior. Rather than viewing bars simply as a place to drink, these were described as a social meeting place, and a place to meet potential dates or sex partners. One partner stated:
It's related to sex because we don't drink, but it's also we don't go to the bars because of the atmosphere. It's like you don't go there ‘cause there’s a real sexual atmosphere in there, and that doesn't really, it's not real conducive to couples trying to stay monogamous.
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Table I Types of health-related behaviors gay couples mentioned as targeting for change
Another partner said:
Going out to the bars ... is definitely isn't my cup of tea anymore.... And as we've gotten older our relationship has gotten stronger and we uh haven't felt the need for us to have secondary sex partners.
What are the reasons couples give for attempting to influence each others' behaviors?
Couples mentioned several reasons for attempting to change each others' health behaviors. Among the motives cited most frequently were family history, age/maturity, life circumstances, being HIV-positive (one or both partners), chronic health conditions and relationship quality. Relationship quality was repeatedly used to justify social control attempts, and encompassed several different topics, particularly enjoyment of the relationship and the desire to spend time together. One's ability or inability to enjoy the relationship was often linked with stress. As one partner reflected:
... my being a workaholic and slowing down my life down a bit and being less stressed out about the office so I can enjoy my personal relationship.
Acknowledging his partner's attempts at influencing his behavior, one partner remarked:
I'm always busy trying to do too many things and my partner, like he said, is probably trying to influence me and to some degree has been successful like reducing stress in my life and probably just getting me to enjoy life a little more.
Several individuals discussed how their partners' health behaviors were detracting from the time that they were able to spend together. As one partner explained to another:
One of the things that I've been trying to influence you about is your sleep schedule. Um, because it seems to me that, I know that you work late but by staying up late and then sleeping late you miss a lot of your day, a lot of good time, and we miss a lot of good time together.
In trying to reduce the amount of time that his partner spent drinking with his friends, another partner stated:
I would like to spend more time with you and watch movies with you and give you more of my attention.
What kinds of social control tactics do gay partners use in their attempts to change health-related behaviors?
A variety of social control tactics were mentioned in the context of changing health behaviors. As shown in Table II, discussion, nagging, changing the environment, doing the behavior together, providing alternatives, modeling the behavior and setting rules and boundaries were tactics that were mentioned most frequently. When the tactics were broken down and linked to health-compromising versus health-enhancing behaviors, it becomes evident that the tactics used in attempts to change health-compromising behaviors are more intense or vigorous than tactics that are used with health-enhancing behaviors. Nagging, providing alternatives and setting rules and boundaries, for example, were the most frequently mentioned tactics regarding health-compromising behaviors. This is in contrast to the tactics used with health-enhancing behaviors, which included discussion, doing the behavior together and asking.
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Previous social control literature has found ‘nagging’ to describe the ‘frequency’ of use of an influence tactic rather than to describe a specific type of social control tactic [10]. This is consistent with the discussions of couples in the present study as well. Participants' references to nagging to describe a partner's social control tactic always contained elements of high frequency. Words and phrases such as ‘ongoing’, ‘constantly’, ‘to death’ and ‘harp on it a lot’ were found in conjunction with the concept of nagging. The word nagging was also used in reference to a variety of social control tactics as well as frequency of use. One respondent's attempt to get his partner to stop smoking, for example, was viewed by the partner as nagging:
I was constantly trying to uh drop subtle hints and some not so subtle hints and kind of goading behavior and, as well I had the one car between us and uh so I had a rule that (partner's name) wasn't allowed to smoke in the car.
From the analyses of text and counts of social control tactics, both the frequency of social control attempts and the ‘variety’ of tactic used were revealed in participants' descriptions of attempts to get each other to change health behaviors.
Do gay partners use different social control tactics for HIV-related behaviors and for other health-related behaviors?
When the social control tactics reported was broken down further into general health behaviors and HIV-related behaviors, there was one noticeable difference as shown in Table II. Eighty percent of the tactic use described as ‘setting rules and boundaries’ occurred in relation to HIV-related health-compromising behaviors. More specifically, this tactic appears to be used when couples discuss their guidelines for safe sex practices. As one partner explained:
Cause we've discussed, oh gosh, for many years about what is someone safe, what is questionable, and where we draw the lines to what each of us will do or won't do. And that's really a must, you know, for maintaining your own health, and I feel even if one of us crosses that boundary, the stress that it causes afterwards is just not worth it. So it's much easier to stay within our safe sex guidelines.
Referring to secondary sex partners, another partner stated:
Yeah, it's always a mutual decision and we even have rules that we follow about that. As to like no one goes off without the other, no one's alone with someone without the other one ... We've never done that but we have these rules, so we clearly outlined what's acceptable and what's not.
Setting rules and boundaries also was discussed in the context of maintaining a monogamous relationship. Monogamy was often viewed as a form of HIV prevention. As one couple illustrated:
We have been in a relationship for 6 years, going on 7 years and the relationship is entirely 100% monogamous and so while it's something we influence each other on because we certainly set some repercussions in the event that we're not monogamous and that's a high priority for both of us. It's not really a current issue because we are already being monogamous. It's something we have a common agreement on and that's the way that we protect ourselves from HIV.
Similarly, from, the conversation of a couple that had been together for 3 years:
I think in terms of specific behavior related to HIV, when we met, we were both, I think, knowledgeable about HIV and anxious to engage in safer sex. And I think that fact that even before we made that commitment to working into a monogamous relationship with each other, there were agreements that were about having safer sex with condoms and what have you and not engaging in unsafe sex.
Does relationship interdependence and CL-alt distinguish either the types of behaviors that gay partners target for change or the social control tactics that they use to change health behaviors?
Relationship interdependence and social control tactics
Examination of the social control tactics used by level of relationship interdependence yielded several interesting findings as shown in Table III. First, positive social control tactics were mentioned most frequently across all levels of relationship interdependence. Second, positive tactics were mentioned most frequently by partners in relationships with the greatest interdependence followed by those in moderate and low. Third, the use of negative social control tactics was mentioned more frequently by couples of low interdependence.
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CL-alt and social control tactics
Examination of social control tactics used by CL-alt yielded several interesting findings as seen in Table IV. First, positive social control tactics were mentioned most frequently across all levels of CL-alt. Second, positive tactics were mentioned more frequently in couples where both partners had no alternatives. Third, negative social control tactics were mentioned least frequently in couples where both partners had alternatives, and with equal frequency among couples in which neither partner or one partner had alternatives. Fourth, neutral tactics were mentioned most frequently in couples for which both had alternatives.
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Relationship interdependence and health behaviors targeted for change
Examination of the behaviors targeted for change by level of relationship interdependence yielded several interesting findings as shown in Table V. First, all couples categorized as having relationships with greater interdependence reported targeting general health behaviors and none reported HIV-related behaviors. Second, heath-enhancing HIV-related behaviors were mentioned more frequently in couples with low relationship interdependence. Third, only couples with moderate relationship interdependence mentioned targeting HIV-related health-compromising behaviors. Related to these points is this quote from one partner, from a relationship categorized as moderately interdependent, about how influencing his partner to drink less impacts their relationship and health.
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I'm trying to influence my partner to drink less or not drink at all and I'm doing this because, well we have done this for a month or so and I can see how it's helped our relationship as well as both of our physical health.
CL-alt and health behaviors targeted for change
Examination of the behaviors targeted for change by CL-alt yielded several interesting findings as well, as seen in Table VI. First, targeting HIV-related health-compromising behaviors was mentioned most frequently in couples for which partners had alternative sexual partners. As illustrated by this partner's statement:
The issue for me is, what happens at the sauna in the bookstore, it's just because I think that's my stuff more than your stuff, but to me it's a very unsafe place and a very scary place, and I always have a lot of concern about you going there. Particularly if you've been drinking, because I'm not sure that you'll be safe while you're there.
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Table VI Percentage of health behaviors mentioned as targeted for change by CL-alt
Second, targeting HIV-related health-enhancing behaviors was mentioned most frequently in couples in which both partners had no alternative sexual partners. As stated by a partner from this type of relationship:
The kinds of health behaviors that I've tried to influence my partner on are to take his medications regularly for the HIV and to see the doctor more or to see the doctor when he needs to. This is a current health behavior that I try to influence. He's not very good about taking his medication or going to the doctor when he gets sick.
Third, targeting general health-compromising behaviors for change was mentioned most frequently among couples where both partners had no alternatives. Fourth, targeting health-enhancing behaviors for change was mentioned most frequently in couples where one partner had an alternative.
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Discussion |
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This study sought to advance our understanding about the use of health-related social control in gay couples, and the interrelationships of health-related social control and constructs from interdependence theory. We examined the health behaviors that gay partners reported trying to change in each other (both general and HIV specific), the social control tactics they mentioned as using in attempts to get each other to change and whether relationship interdependence and CL-alt distinguished behaviors and social control tactics. This research was motivated by the premise that gay partners may likely be the most influential people in each others' life, as is the case with other types of intimate dyads, such as heterosexual married couples. However, since gay partners typically report lack of social network support from family and friends, and also lack macrolevel institutional support for their relationship [4], they may be especially important to each other. This suggests that their relationship may be an important leverage point for interventions which seek to promote their health, and prevent HIV. Related to this point, several conclusions can be drawn from this research.
Most importantly, findings suggest that partners value their relationship, and that care and concern for each other motivate attempts at social control. Both the comments offered by gay partners and the quantitative relationship interdependence scores integrated into the qualitative data support this conclusion. Positive social control tactics were used more frequently than negative social control tactics, and positive tactics increased with frequency across higher levels of relationship interdependence, while negative tactics were mentioned most frequently by couples with low relationship interdependence. Further, positive tactics were mentioned more frequently in couples where both partners had no alternative sexual partners. This pattern of results suggests one of caring and concern for health and well-being among gay couples, and that couple-based approaches to health promotion and HIV prevention may be a promising avenue for intervention research. For example, Remien and colleagues have found that, compared with usual care, a couples-focused intervention can improve adherence to HIV medications among couples where one partner is HIV positive by addressing barriers, developing communication and enhancing partner support [33].
Most interesting is the fact that health-related social control was not limited to HIV risk behaviors. Gay couples, like other couples in committed relationships that are characterized by mutual obligation and deep affection, seek to promote health-enhancing behaviors and prevent health-compromising behaviors [8, 10]. The results showed that the majority of behaviors gay partners attempted to influence in their partners were general health practices that are related to the leading causes of mortality, including smoking, alcohol use, physical activity and dietary practices. HIV-related behaviors were mentioned, but not as frequently. The consistency in these findings suggests that, in close relationships, health-related social control attempts are motivated by a desire to prevent disease and promote health.
This sample of gay couples reported a variety of social control tactics, many of which were similar to the tactics reported in our previous studies with married couples. Commonalities in reported tactics include discussing the behavior change, doing the behavior together, providing alternatives, changing the environment, offering to help and modeling the behavior [10]. That heterosexual and gay couples both report similar behaviors to target for change, and similar social control tactics to change these behaviors, suggests that interventions used in heterosexual couples promoting general health behavior change may also be transferable to gay couples.
Another important finding of this research relates to the frequency with which certain social control tactics couples were mentioned in relation to HIV. Specifically, ‘setting rules and boundaries’ was mentioned a majority of the times in relation to enhancing safer sex practices. In a close, ongoing relationship, unprotected sexual behavior becomes a sign of trust and intimacy [34, 35]. Thus, the message of HIV prevention campaigns may be at odds with the development of trusting, intimate relationships in gay couples. An assessment of whether or not unprotected sex in close relationships actually increases HIV risk must take into account ‘negotiated safety’ [36]. Studies that have used negotiated safety to adjust rates of unsafe sex for gay men in relationships have found lower rates of risk than initially assumed [37]. Our findings suggest that the way negotiated safety may take place in gay couples is by partners setting rules and boundaries around sexual behavior within and outside their relationship. Intervention efforts that focus on promoting safer sex may find that promoting rules and boundaries around sex fits well with gay couples' conceptions of ways to prevent HIV while also protecting the intimacy and trust in their relationship. This conclusion is supported by other qualitative work showing that gay couples use agreements as a way to regulate HIV risk in their relationship, especially when one partner is HIV positive [38].
This research also suggests that examining aspects of the couple's relationship is useful for understanding how influence related to health and well-being is enacted among gay male couples. In a series of related studies, Kurdek [4, 39, 40] has examined how aspects of couple functioning, similar to those used to quantify relationship interdependence in the present study, are related to relationship outcomes like commitment, satisfaction or relationship dissolution. His findings suggest that what we have termed relationship interdependence is important for these kinds of relationship outcomes. Our findings extend this work by examining how relationship interdependence is related to important health-related outcomes in gay men's relationships. Those studying how couple functioning impacts couple outcomes have rarely examined health outcomes. Similarly, those studying HIV in gay couples have rarely included both partners or examined how couple functioning is related to HIV risk. This study is unique in that it does both, and our findings suggest that examining how the couple functions to enact health and reduce HIV risk is a potentially fruitful approach.
The findings of the present research must be considered in the context of the study's limitations. Our sample of gay couples was small and predominantly White. Although the demographics of our sample compare with demographics of larger studies of gay men in relationships [41], the findings need to be validated with other larger samples that have more minority couples. Also, we quantified various aspects of couples' discussions as a way of capturing the importance of different behaviors and social control tactics, but many of the frequencies of mentions were small, and the conclusions drawn here should not be overgeneralized until other studies replicate the information presented. These limitations, however, are balanced by the strengths of the present research, including a focus on the couple rather than the individual, an integration of qualitative and quantitative methods and focusing on both general health practices and HIV-related behaviors of gay couples. Future research that addresses these limitations while maintaining the strengths will inevitably contribute to an understanding of how gay couples function to promote health and prevent HIV.
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References |
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1. House JS, Landis KR, Umberson D. Social relationships and health. Science 1988 241:540–5.
2. Ryff CD and Singer B. Interpersonal flourishing: a positive health agenda for the new millennium. Pers Soc Psychol Rev 2000 4:30–44.
3. Kurdek LA. Developmental changes in relationship quality in gay and lesbian co-habitating couples. Dev Psychol 1995 31:86–94.[Medline]
4. Kurdek LA. Are gay and lesbian cohabiting couples really different from heterosexual married couples? J Marriage Fam 2004 66:880–900.[CrossRef][Web of Science]
5. Lewis MA and Butterfield RM. Antecedents and reactions to health-related social control. Pers Soc Psychol Bull 2005 31:416–27.
6. Kelley HH and Thibaut TW. Interpersonal Relations: A Theory of Interdependence. New York: John Wiley & Sons 1978.
7. Lewis MA, DeVellis B, Sleath B. Interpersonal communication and social influence. In Glanz K, Lewis FM, Rimer BK (Eds.). Health Behavior and Health Education: Theory, Research, and Practice. San Francisco, CA: Jossey-Bass 2002 pp. 363–402.
8. Lewis MA and Rook KS. Social control in personal relationships: impact on health behaviors and psychological distress. Health Psychol 1999 18:63–71.[CrossRef][Web of Science][Medline]
9. Umberson D. Gender, marital status and the social control of health behavior. Soc Sci Med 1992 34:907–17.[CrossRef][Web of Science][Medline]
10. Lewis MA, Butterfield RM, Darbes LA, Johnston-Brooks CH. The conceptualization and assessment of health-related social control. J Soc Pers Relat 2004 21:669–87.[Abstract]
11. Butterfield RM and Lewis MA. Health-related social influence: a social ecological perspective on tactic use. J Soc Pers Relat 2002 19:505–26.
12. Tucker JS and Mueller JS. Spouses' social control of health behaviors: use and effectiveness of specific strategies. Pers Soc Psychol Bull 2000 26:1120–30.
13. Lewis MA and Butterfield RM. Social control in marital relationships: effects of one's partner on health behaviors. Journal of Applied Social Psychology in press.
14. Huston M and Schwartz P. The relationships of lesbians and gay men. In Wood JT and Duck S (Eds.). Under-studied Relationships: Off the Beaten Track. Thousand Oaks, CA: Sage Publications 1995 pp. 89–121.
15. Bird ST, Harvey SM, Beckman LJ, Johnson CH. Getting your partner to use condoms: interviews with men and women at risk of HIV/STDs. J Sex Res 2001 38:233–40.
16. Noar SM, Morokoff PJ, Harlow LL. Condom influence strategies in a community sample of ethnically diverse men and women. J Appl Soc Psychol 2004 34:1730–51.[CrossRef]
17. Lam AG, Mak A, Lindsay PD, Russell ST. What really works? An exploratory study of condom negotiation strategies. AIDS Educ Prev 2004 16:160–71.[CrossRef][Web of Science][Medline]
18. Howard JA, Blumstein P, Schwartz P. Sex, power, and influence tactics in intimate relationships. J Pers Soc Psychol 1986 52:102–109.
19. Rusbult CE and van Lange PAM. Interdependence, interaction, relationships. Annu Rev Psychol 2003 54:351–75.[CrossRef][Web of Science][Medline]
20. Aida Y and Falbo T. Relationships between marital satisfaction, resources, and power strategies. Sex Roles 1991 24:43–56.[CrossRef]
21. Bui K-VT, Raven BH, Schwarzwald J. Influence strategies in dating relationships: the effects of relationship satisfaction, gender and perspective. J Soc Behav Pers 1994 9:429–42.
22. Rusbult CE and Arriaga XE. Interdependence theory. In Duck S (Ed.). Handbook of Personal Relationships. 2nd edn New York: John Wiley & Sons, Ltd 1997 pp. 221–50.
23. Rusbult CE, Verette J, Whitney GA, Slovik LF. Accommodation processes in close relationships—theory and preliminary empirical-evidence. J Pers Soc Psychol 1991 60:53–78.
24. Rusbult CE. Responses to dissatisfaction in close relationships: the exit-voice-loyalty-neglect model. In Perlman D and Duck S (Eds.). Intimate Relationships: Development, Dynamics, and Deterioration. Newbury Park, CA: Sage Publications 1987 pp. 209–37.
25. Catania JA, Gibson DR, Chitwood DD, Coates TJ. Methodological problems in AIDS behavioral research: influences on measurement error and participation bias in studies of sexual behavior. Psychol Bull 1990 108:339–62.[CrossRef][Web of Science][Medline]
26. Aron A, Aron EN, Smollan D. Inclusion of other in the self scale and the structure of interpersonal closeness. J Pers Soc Psychol 1992 63:596–612.[CrossRef][Web of Science]
27. Deenen AA, Gijs L, van Naerssen AX. Intimacy and sexuality in gay male couples. Arch Sex Behav 1994 23:421–31.[CrossRef][Web of Science][Medline]
28. Patton MQ. Qualitative Evaluation and Research Methods. Newbury Park: Sage 1990.
29. Morgan DL. Qualitative content analysis: a guide to paths not taken. Qual Health Res 1993 3:112–21.
30. Morgan DL. Focus groups as qualitative data. Qualitative Research Methods Series 16. Newbury Park, CA: Sage Publications 1988.
31. Sandelowski M. Real qualitative researchers do not count: the use of numbers in qualitative research. Res Nurs Health 2001 24:230–40.[CrossRef][Web of Science][Medline]
32. Mays N and Pope C. Rigor and qualitative research. Br Med J 1995 311:109–12.
33. Remien RH, Stirratt MJ, Dolezal C, et al. Couple-focused support to improve HIV medication adherence: a randomized controlled trial. AIDS 2005 19:807–14.[Web of Science][Medline]
34. Carballo-Dieguez A and Dolezal C. HIV risk behaviors and obstacles to condom use among Puerto Rican men in New York City who have sex with men. Am J Public Health 1996 86:1619–22.
35. Misovich SJ, Fisher JD, Coates TJ. Close relationships and elevated HIV risk behavior: evidence and possible underlying psychological processes. Rev Gen Psychol 1997 1:72–107.
36. Kippax S, Noble J, Prestage G, et al. Sexual negotiation in the AIDS era: negotiated safety revisited. AIDS 1997 11:191–7.[CrossRef][Web of Science][Medline]
37. Davidovich U, de Wit JBF, Stroebe W. Assessing sexual risk behavior of young gay men in primary relationships: the incorporation of negotiated safety and negotiated safety compliance. AIDS 2000 14:701–6.[CrossRef][Web of Science][Medline]
38. Hoff CC, Darbes LA, Mohosadha R, Ramos-Soto E. "Agreements" about outside sex partners support and hinder safety among gay male couples. International AIDS Conference. 2004Bangkok:.
39. Kurdek LA. Relationship outcomes and their predictors: longitudinal evidence from heterosexual married, gay cohabitating and lesbian cohabitating couples. J Marriage Fam 1998 60:553–68.[CrossRef][Web of Science]
40. Kurdek LA. Attractions and constraints as determinants of relationship commitment: longitudinal evidence from gay, lesbian, and heterosexual couples. Pers Relatsh 2000 7:245–62.[Medline]
41. Hays RB, Kegeles SM, Coates TJ. Unprotected sex and HIV risk-taking among young gay men within boyfriend relationships. AIDS Educ Prev 1997 9:314–29.[Web of Science][Medline]
Received on March 21, 2005; accepted on December 10, 2005
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