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Smith MS, South SC. Risky Sexual Behaviors as a Transaction of Individual Differences and Situational Context. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2539-2560. [PMID: 37103633 DOI: 10.1007/s10508-023-02592-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 02/21/2023] [Accepted: 03/19/2023] [Indexed: 06/19/2023]
Abstract
Risky sexual behaviors (RSBs) incur large societal and personal costs. Despite widespread prevention efforts, RSBs and associated consequences (e.g., sexually transmitted infections) continue to rise. A proliferation of research has emerged on situational (e.g., alcohol use) and individual difference (e.g., impulsivity) factors to explain this rise, but these approaches assume an unrealistically static mechanism underlying RSB. Because this prior research has resulted in few compelling effects, we sought to innovate by examining the interaction of situation and individual differences in explaining RSBs. A large sample (N = 105) completed baseline reports of psychopathology and 30 daily diary reports of RSBs and associated contexts. These data were submitted to multilevel models including cross-level interactions to test a person-by-situation conceptualization of RSBs. Results suggested that RSBs are most strongly predicted from interactions of person- and situation-level factors in both protective and facilitative directions. These interactions outnumbered main effects and commonly included partner commitment as a central mechanism. These results point to theoretical and clinical gaps in preventing RSB and urge a departure from prior ways of conceptualizing sexual risk as a static outcome.
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Affiliation(s)
- Madison Shea Smith
- Department of Psychological Sciences, Purdue University, 703 3rd Street, West Lafayette, IN, USA.
| | - Susan C South
- Department of Psychological Sciences, Purdue University, 703 3rd Street, West Lafayette, IN, USA
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Examining HIV Risk and Exchange Sex Among Current and Formerly Homeless Young Adults. AIDS Behav 2021; 25:165-174. [PMID: 34302283 PMCID: PMC8542003 DOI: 10.1007/s10461-021-03364-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 01/14/2023]
Abstract
This study investigated HIV risk among homeless and formerly homeless young adults by examining risky sex behaviors (e.g., condomless sex, exchange sex, and sex with multiple persons) using 90-day and daily recall methods. Data came from a sample of young adults (aged 18–27) with current (n = 101) or past (n = 109) homelessness experience in Los Angeles, California, recruited between 2017 and 2019. Baseline surveys queried demographics and sexual history. Daily retrospective surveys queried sexual events. Multiple logistic regressions were used to test the effects of demographic characteristics including homelessness history, relationship status, substance use, and sexual history on risky sex outcomes. In this sample, 26% reported never using a condom during anal or vaginal sex in the past 90 days, 5% reported testing positive for HIV, 82% had limited to no knowledge of preexposure prophylaxis, and 8% reported having had exchange sex during a 7-day measurement period, with those experiencing homelessness more likely to report. The study suggests supportive housing can reduce the occurrence of exchange sex but that HIV prevention services are still needed in homeless and housing programs to promote safe sexual practices.
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Shrier LA, Burke PJ, Parker S, Edwards R, Jonestrask C, Pluhar E, Harris SK. Development and pilot testing of a counseling-plus-mHealth intervention to reduce risk for pregnancy and sexually transmitted infection in young women with depression. Mhealth 2020; 6:17. [PMID: 32270009 PMCID: PMC7136654 DOI: 10.21037/mhealth.2019.11.05] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/18/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Depressed young women have elevated rates of unintended pregnancy and sexually transmitted infections (STIs). The objective of this study was to develop and pilot-test a counseling-plus-mHealth intervention to reduce sexual and reproductive health (SRH) risk in young women with depressive symptoms. METHODS Using the Behavior-Determinants-Intervention logic model, we developed the Momentary Affect Regulation-Safer Sex Intervention (MARSSI) to address the challenges that depression imposes on SRH risk reduction efforts of high-risk young women: (I) in-person counseling using motivational interviewing (MI) to elicit motivation for safer sex and develop a behavior change plan, and teaching cognitive-behavioral skills to manage negative thoughts and affective states; (II) 4-week Ecological Momentary Intervention (EMI) on a smartphone to report momentary phenomena related to depression and SRH risk, and receive personalized, tailored messages prompting healthy behaviors and encouraging cognitive-behavioral skill use when risk-related cognitions and negative affect are reported; and (III) booster counseling to review behavior change goals and plans and teach a new cognitive-behavioral skill. We developed the counseling through iterative interviews with 11 participants and developed the EMI through a 2-week trial with three participants, then revised MARSSI to reflect participant feedback. We next conducted a pilot-test among depressed, high-risk female adolescent clinic patients age 15-24. Pilot participants completed mental health, motivation to change behavior, and SRH behavior assessments and provided feedback at baseline, post-EMI, and at 3-month follow-up. We analyzed participant retention, counseling duration, app engagement, intervention quality ratings, and participant feedback, and compared mental health and SRH risk behavior across the study. RESULTS Seventeen participants completed the initial counseling session, 15 participated in the EMI, 14 returned for the booster session, and 14 completed the 3-month follow-up. App engagement was high for all 4 EMI weeks (≥1 report/day for median ≥6 days/week). Post-intervention, most or all participants agreed with each positive statement about the messages, reported "Excellent" MARSSI usefulness, and attributed improvements to MARSSI. Compared to baseline, post-EMI depressive symptoms, confidence to change self-selected risk behavior, and confidence to use the cognitive restructuring skill improved. At 3 months, depressive symptom scores remained lower and confidence to use cognitive restructuring remained higher, compared to baseline. Participants also reported lower frequency of sex, lower proportion of condom-unprotected sex events, and, among those using effective contraception, more consistent condom use at 3-month follow-up vs. baseline. CONCLUSIONS MARSSI was feasible, acceptable, and engaging to young women with depression and SRH risk behavior, and was associated with increased confidence to reduce SRH risk, decreased SRH risk behaviors, increased confidence to use cognitive restructuring, and decreased depressive symptoms over 3 months. Future research is warranted to evaluate MARSSI's efficacy to improve motivation, skills, affect, and behaviors, as well as reproductive health outcomes in high-risk depressed young women.
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Affiliation(s)
- Lydia A. Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Pamela J. Burke
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Sarah Parker
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Rori Edwards
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Cassandra Jonestrask
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Emily Pluhar
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Sion Kim Harris
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Barker DH, Scott-Sheldon LAJ, Gittins Stone D, Brown LK. Using Composite Scores to Summarize Adolescent Sexual Risk Behavior: Current State of the Science and Recommendations. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:2305-2320. [PMID: 31429032 PMCID: PMC6759377 DOI: 10.1007/s10508-019-01526-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 06/10/2023]
Abstract
Composite scores offer the advantage of summarizing across multiple sexual risk behaviors to both simplify results and better capture the influence of core contextual, interpersonal, and intrapersonal dynamics that affect multiple sexual risk behaviors. There is inconsistency in how researchers utilize composite scores with minimal guidance on the advantages and disadvantages of frequently used approaches. Strengths and weaknesses of each approach are discussed in the context of assessing adolescent sexual risk behavior. A latent variable model and three commonly used composites were applied to data combined across four clinical trials (n = 1322; 50% female). Findings suggested that the latent variable approach was limited due to minimal correlations among sexual risk behaviors, that choice of composite had minimal impact on cross-sectional results so long as there is sufficient variability in risk behavior in the sample, but composite choice could impact results from clinical trials particularly for subgroup analyses. There are unique challenges to creating composites of adolescent risk behavior, including the fluidity and infrequency of adolescent sexual relationships that result in many participants reporting no sexual behavior at any given assessment and a low correlation between the number of partners and condomless sex acts. These challenges impede application of data-driven approaches to defining sexual risk composites. Recommendations to improve consistency in reporting include: (1) reporting each type of risk behavior separately prior to forming a composite, (2) aggregating across assessments to increase the chance of observing sexual risk behaviors, and (3) continued work toward a unified definition of adolescent sexual risk behavior that can guide the development of appropriate measurement models.
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Affiliation(s)
- David H Barker
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Box-G-BH, Providence, RI, 02906, USA.
- Division of Child and Adolescent Psychiatry, Rhode Island Hospital, Providence, RI, USA.
| | - Lori A J Scott-Sheldon
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Box-G-BH, Providence, RI, 02906, USA
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Daniel Gittins Stone
- Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Larry K Brown
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Box-G-BH, Providence, RI, 02906, USA
- Division of Child and Adolescent Psychiatry, Rhode Island Hospital, Providence, RI, USA
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Lansing AH, Guthrie KM, Hadley W, Stewart A, Peters A, Houck CD. Qualitative Assessment of Emotion Regulation Strategies for Prevention of Health Risk Behaviors in Early Adolescents. JOURNAL OF CHILD AND FAMILY STUDIES 2019; 28:765-775. [PMID: 31680761 PMCID: PMC6824428 DOI: 10.1007/s10826-018-01305-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The ability to regulate emotions has been linked to a variety of adolescent health risk behaviors, including sexual risk behaviors, especially for adolescents who are experiencing mental health symptoms. However, there is limited information available on intuitive emotion regulation strategies for early adolescents with mental health symptoms to facilitate the adaptation of emotion regulation interventions for psychopathology to health risk behavior prevention. For example, interventions to prevent sexual risk behaviors in early adolescence have yet to specifically target emotion regulation. This paper describes the use of focus groups to identify emotion regulation strategies that were understood by and acceptable to early adolescents with mental health symptoms who are also more likely to engage in risky health behaviors. Qualitative data were collected through focus groups (k=5 groups) with 15 early adolescents with mental health symptoms. The most commonly generated emotion regulation strategies were leaving the situation, distraction, physical release, expressing oneself to someone, positive thinking, and considering other options. Translation of these findings for use in preventive health-risk behavior interventions (including for sexual risk) is discussed.
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Affiliation(s)
- Amy Hughes Lansing
- Bradley/Hasbro Children's Research Center, & Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Kate M Guthrie
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University & The Miriam Hospital, Providence, RI, USA
| | - Wendy Hadley
- Bradley/Hasbro Children's Research Center, & Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | | | - April Peters
- Bradley/Hasbro Children's Research Center, Providence, RI, USA
| | - Christopher D Houck
- Bradley/Hasbro Children's Research Center, & Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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Jardin C, Sharp C, Garey L, Zvolensky MJ. The Role of Impulsivity in the Relation Between Negative Affect and Risky Sexual Behaviors. JOURNAL OF SEX & MARITAL THERAPY 2017; 43:250-263. [PMID: 26829284 PMCID: PMC6029890 DOI: 10.1080/0092623x.2016.1141821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
While risky sexual behavior associates with negative affect, and impulsivity often increases during negative affective states, little is known about the interrelations of these factors. This study examined whether impulsivity explained the relation between negative affect and risky sex among college students. Negative affect exhibited an indirect effect via impulsivity on number of sexual partners for both males and females, and on inconsistent condom use for females, but not males. Results suggest risky sex may serve to regulate negative affect, proposing the importance of negative affect in future strategies to reduce risky sex among young adults.
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Affiliation(s)
- Charles Jardin
- a Department of Psychology , University of Houston , Houston , Texas , USA
| | - Carla Sharp
- b Department of Psychology , University of Houston, and Adolescent Treatment Program, The Menninger Clinic , Houston , Texas , USA
| | - Lorra Garey
- c Department of Psychology , University of Houston , Houston , Texas , USA
| | - Michael J Zvolensky
- d Department of Psychology, University of Houston, and Department of Behavioral Sciences , University of Texas MD Anderson Cancer Center , Houston , Texas , USA
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Shrier LA, Spalding A. "Just Take a Moment and Breathe and Think": Young Women with Depression Talk about the Development of an Ecological Momentary Intervention to Reduce Their Sexual Risk. J Pediatr Adolesc Gynecol 2017; 30:116-122. [PMID: 27575408 DOI: 10.1016/j.jpag.2016.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Revised: 07/26/2016] [Accepted: 08/17/2016] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE Depressed young women are at increased risk for adverse outcomes related to sexual behavior, including unintended pregnancy, HIV, and other sexually transmitted infections. Brief sexual risk reduction interventions have not targeted depressed young women's specific needs for affect management and impulse control. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We interviewed depressed young women ages 15-23 years engaging in sexual risk behavior about a proposed intervention approach. The approach was described as in-person counseling and cognitive-behavioral skills training, followed by an ecological momentary intervention (EMI) delivered via smartphone application for 4 weeks. The EMI would include reporting multiple times a day on affective states, self-efficacy for safer sex behavior, and sexual behavior, and receiving responsive messages to provide support and prompt use of cognitive-behavioral skills. Participants provided their perspectives on comfort, usability, burden, confidentiality, and potential efficacy of the EMI and recommended message content. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. RESULTS Thematic saturation was reached with 16 interviews. Participants expressed positive opinions about the EMI. They believed that reporting at random times would help them to recognize their feelings, receiving the messages would be reassuring, and overall the smartphone application would be experienced as therapeutic. They desired a high degree of personalization of the message quality, style, and voice, and provided a wide variety of message content. CONCLUSION Depressed young women believed that a flexible, personalized approach to mobile momentary intervention for addressing the link between their symptoms and behavior would be acceptable, supportive, and effective in reducing sexual risk.
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Affiliation(s)
- Lydia A Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | - Allegra Spalding
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
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Jardin C, Garey L, Sharp C, Zvolensky MJ. Acculturative Stress and Risky Sexual Behavior: The Roles of Sexual Compulsivity and Negative Affect. Behav Modif 2015; 40:97-119. [PMID: 26584611 DOI: 10.1177/0145445515613331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent syndemic models of sexual health disparities affecting racial/ethnic minorities have highlighted the role of discrimination. Yet no previous work has examined how acculturative stress (distress at the transition from one's original culture toward a new culture) associates with sexual HIV-risk behavior (SHRB). Work among other minority populations suggests sexual compulsivity (SC) may contribute to syndemic sexual health disparities as a means of coping with distress. With this in mind, the present study examined whether SC explained the relation between acculturative stress and SHRB. Separate analyses were conducted for males and females within a sample of 758 sexually initiated racial/ethnic minority college students. Among males and females, acculturative stress had an indirect effect on SHRB via SC. As the first study to examine SHRB in relation to acculturative stress, findings provide preliminary evidence that targeting SC among racial/ethnic minorities may help reduce sexual health disparities.
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Affiliation(s)
| | | | - Carla Sharp
- University of Houston, Houston, TX, USA The Menninger Clinic, Houston, TX, USA
| | - Michael J Zvolensky
- University of Houston, Houston, TX, USA University of Texas MD Anderson Cancer Center, Houston, TX, USA
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