DIGITAL MEDIA AND SEXUAL HEALTH: A MIXED METHOD EXPLORATION OF YOUNG MEN’S EXPOSURE AND ENGAGEMENT WITH DIGITAL MEDIA SEXUAL CONTENT IN INDIA

Abstract

Nearly 90% of the world’s youth live in low-and middle-income countries, where many face significant sexual and reproductive health (SRH) challenges. India, home to the largest youth population globally, has invested considerable effort in improving SRH among young people ages 18 to 24 years. As in many locations, these efforts have historically prioritized young women due to gender inequalities and SRH vulnerabilities. Young men are often positioned negatively, as allies in advancing young women’s health, or sidelined altogether, despite having unique SRH challenges and informational needs. At the sametime, rapid internet expansion and young people’s online presence have made mass media act as a “sexual super peer,” exposing them to sexual content across digital media platforms, including social media, online games, and streaming platforms. While existing research links media exposure to sexual attitudes, early sexual initiation, and risky sexual behaviors, most evidence comes from high-income countries, focuses on isolated media platforms, rarely considers men exclusively, and fails to capture the complex ways digital media shape viewers’ SRH outcomes. This dissertation addressed these gaps through an exploratory sequential mixed-methods study conducted among young men aged 18 – 21 years in Delhi, India. Specifically, aim 1 used in-depth interviews with 22 young men to explore how they use digital media to navigate SRH content. Findings reveal how different digital media content (e.g., algorithm-driven reels on Instagram, how-to videos on YouTube, online communities on Reddit, romantic and masculine scripts in streaming content, and hyper-sexualized characters in digital games), along with other online platforms such as Google, functioned not only as private informational environments where they sought, encountered, and interpreted information about their bodies, relationships, sexual feelings, and safe sexual practices, but also as spaces that shaped their expectations around masculinity. In aim 2, we developed and validated a novel, culturally grounded, character-based measure of digital sexual media exposure called REceptivity to Characters Appearing in digital media Platforms (RECAP) using survey data from 234 young men. RECAP captures exposure across multiple digital media platforms through media characters, offering a contextually adaptable, easy-to-administer tool for measuring digital media exposure. In Aim 3, we applied RECAP to examine pathways linking sexual media exposure to 205 young men’s condom use knowledge, attitudes, peer and masculine normative beliefs, self-efficacy, intentions, and condom use behaviors. We found two indirect associations between exposure to sexual digital media content and condom use intention through masculine normative beliefs and condom use self-efficacy. By centering young men in a middle-income-country context, this study advances global SRH research by integrating culturally-grounded measurement with theory-driven condom use pathways. The findings provide actionable insights for designing gender-inclusive, digitally-relevant SRH interventions and offer an adaptable tool for measuring media exposure across diverse health domains.