Deliberative and spontaneous cognitive processes associated with HIV risk behavior

Daily Associations Among Alcohol Intoxication, Partner Familiarity, Participant Effortful Control, Urgency, and PrEP Uptake on Sexual Behavior in Men Who Have Sex with Men

The purpose of this study was to examine the effects of alcohol intoxication and its interaction with contextual or situation (partner familiarity) and individual differences variables (effortful control, urgency, and whether taking pre-exposure prophylaxis (PrEP) medication) on sexual behaviors in men who have sex with men (MSM), a subgroup for whom HIV continues to be a major public health problem in the U.S. The participants were 236 men recruited from two northeastern U.S. cities and aged 21-50 years, M = 27.8). These men participated in a 6-week (two 3-week sampling bursts) experience sampling method (ESM) study. The ESM data were collected via use of software installed on the participant's own or study-provided mobile phone. Individual differences variables were measured by participants' completing questionnaires measuring effortful control and urgency, and the participant's self-report of whether he was currently taking PrEP. The ESM data pertained to sexual behavior as well as situation variables of familiarity of relevant sexual partners and number of standard alcohol drinks consumed. The results generally were consistent with hypotheses, as alcohol intoxication showed a curvilinear relation to the occurrence of condomless anal intercourse. Furthermore, the likelihood of occurrence of condomless anal sex increased with increased familiarity of the sexual partner. Similarly, taking PrEP increased the likelihood of occurrence of condomless anal sex. At the same time, alcohol's effects were moderated by all three individual differences variables as expected, but the prediction that partner familiarity would moderate alcohol's effects on the occurrence of condomless sex was not supported. Clinical implications of the findings center on the application of the data to HIV prevention programs toward inclusion of more empirically supported, nuanced information on the relation between acute alcohol intoxication and sexual behavior. Directions for further research address the need for additional testing and refinement of a person × situation approach to alcohol and sexual behavior. Furthermore, it is argued that it is important to refine further the concept of sexual risk in the context of taking PrEP and to conduct more detailed, multivariate studies of the relation between taking PrEP and patterns of sexual behavior.

Personal and Lifestyle Determinants of HIV Transmission Risk in Spanish University Students

The increase in human immunodeficiency virus (HIV) transmission cases poses a serious public health concern. Although several previous studies have been conducted with the aim of identifying the risk factors for HIV transmission, the number of cases has been increasing, especially in youth. The present study is aimed at the identification of personal and lifestyle determinants of HIV transmission risk in a sample of 335 Spanish university students selected by convenience sampling from a public university located in Alicante (Spain). Sociodemographic factors, lifestyles, and variables of HIV risk of transmission were evaluated. Group differences on risk of HIV transmission were evaluated between participants depending on their sociodemographic characteristics (age, sex, relationship status, employment status, economic status, and sexual orientation) and lifestyle (diet, physical exercise, smoking, alcohol consumption, and stress). Linear regression models were conducted in order to identify those personal and lifestyle variables related to HIV transmission risk. The obtained results indicate that, generally, being older, in a relationship, and employed were factors related to a high risk of HIV transmission. Regarding lifestyle, poor diet, lower intensity of physical exercise, higher alcohol intake, and smoking were fundamentally associated with a higher risk of HIV transmission, through lower use of condoms and higher frequency of risky sexual behaviors. Hence, participants who develop an unhealthy lifestyle exhibit twice the probability of being at a high risk of HIV transmission, especially regarding these previously indicated behaviors. The present study points out the relevance of sociodemographic characteristics and lifestyles of university students in their proneness to developing risky behaviors for HIV infection. Future studies should be developed with larger, randomized, and more representative samples, in order to obtain significant information for the development of effective preventive strategies oriented toward the increase in the adherence to healthy lifestyles and HIV prevention.

Retail outlets prompt associative memories linked to the repeated use of nicotine and tobacco products among alternative high school students in California

Numerous studies have examined how youth are influenced by the presence of tobacco retail outlets that use point-of-sale marketing tactics to promote nicotine and tobacco products. The current investigation extends this research by assessing whether tobacco retail outlets function as environmental cues that prompt associative memories linked to the repeated use of cigarettes, electronic cigarettes, and cigars. Students (N = 1060) from 29 alternative high schools in California were recruited into a three-year cohort study. A repeated measures latent profile analysis was conducted to identify latent subgroups of students. Analyses suggested the presence of one subgroup of students that did not use nicotine and tobacco products and five subgroups of students that used multiple products. A multinomial logistic regression revealed that images of gas stations, convenience stores, and liquor stores presented in the first year of the study prompted spontaneous associations in memory that increased the odds a student would belong to one of the five subgroups that repeatedly used nicotine and tobacco products over a three-year period. These findings suggest that tobacco retail outlets may act as environmental cues that prompt the use of addictive products among at-risk youth. Policymakers should consider implementing strategies that reduce the potency and prevalence of these cues.

Editor's Choice: Deliberative and non-deliberative effects of descriptive and injunctive norms on cancer screening behaviors among African Americans

Objective: Two longitudinal studies examined whether effects of subjective norms on secondary cancer prevention behaviors were stronger and more likely to non-deliberative (i.e., partially independent of behavioral intentions) for African Americans (AAs) compared to European Americans (EAs), and whether the effects were moderated by racial identity. Design: Study 1 examined between-race differences in predictors of physician communication following receipt of notifications about breast density. Study 2 examined predictors of prostate cancer screening among AA men who had not been previously screened.Main Outcome Measures: Participants' injunctive and descriptive normative perceptions; racial identity (Study 2); self-reported physician communication (Study 1) and PSA testing (Study 2) behaviors at follow up. Results: In Study 1, subjective norms were significantly associated with behaviors for AAs, but not for EAs. Moreover, there were significant non-deliberative effects of norms for AAs. In Study 2, there was further evidence of non-deliberative effects of subjective norms for AAs. Non-deliberative effects of descriptive norms were stronger for AAs who more strongly identified with their racial group. Conclusion: Subjective norms, effects of which are non-deliberative and heightened by racial identity, may be a uniquely robust predictor of secondary cancer prevention behaviors for AAs. Implications for targeted screening interventions are discussed.

Daily associations between alcohol and sexual behavior in young adults

We tested within-person effects of alcohol on sexual behavior among young adults in a longitudinal burst design (N = 213, 6,487 days) using data collected from a previously published parent study. We differentiated effects of alcohol on likelihood of sexual activity versus use of protection against sexually transmitted diseases (STDs) or pregnancy on intercourse occasions by testing a multilevel multinomial model with 4 outcomes (no sex, oral sex without intercourse, protected intercourse, and unprotected intercourse). At the within-person level, effects of alcohol were hypothesized to be conditional upon level of intoxication (i.e., curvilinear effect). We also tested effects of four between-person moderators: gender, typical length of relationship with sexual partners, and two facets of self-control (effortful control and reactivity). Consistent with our hypothesis, low-level intoxication was associated with increased likelihood of engaging in oral sex or protected intercourse (relative to no sex) but was not related to likelihood of unprotected intercourse. The effect of intoxication on unprotected versus protected intercourse was an accelerating curve, significantly increasing likelihood of unprotected intercourse at high levels of intoxication. Between-person factors moderated associations between intoxication and sexual behavior. Effects of intoxication on both protected and unprotected intercourse were diminished for individuals with more familiar sexual partners. Effortful control exhibited a protective effect, reducing the effects of intoxication on likelihood of unprotected intercourse. Hypothesized effects of reactivity were not supported. Intoxication was a stronger predictor of oral sex and protected intercourse (but not unprotected intercourse) for women relative to men. Results highlight the inherent complexities of the alcohol-sexual behavior nexus. (PsycINFO Database Record

Affective decision-making moderates the effects of automatic associations on alcohol use among drug offenders

BACKGROUND

This study used a dual-process model of cognition in order to investigate the possible influence of automatic and deliberative processes on lifetime alcohol use in a sample of drug offenders.

OBJECTIVE

The objective was to determine if automatic/implicit associations in memory can exert an influence over an individual's alcohol use and if decision-making ability could potentially modify the influence of these associations.

METHODS

168 participants completed a battery of cognitive tests measuring implicit alcohol associations in memory (verb generation) as well as their affective decision-making ability (Iowa Gambling Task). Structural equation modeling procedures were used to test the relationship between implicit associations, decision-making, and lifetime alcohol use.

RESULTS

Results revealed that among participants with lower levels of decision-making, implicit alcohol associations more strongly predicted higher lifetime alcohol use.

CONCLUSION

These findings provide further support for the interaction between a specific decision function and its influence over automatic processes in regulating alcohol use behavior in a risky population. Understanding the interaction between automatic associations and decision processes may aid in developing more effective intervention components.

The Role of Memory Associations in Excessive and Problem Gambling

Outcome expectancies (OEs), or beliefs about the consequences of engaging in a particular behaviour, are important predictors of addictive behaviours. In Study 1 of the present work, we assessed whether memory associations between gambling and positive outcomes are related to excessive and problem gambling. The Gambling Behaviour Outcome Association Task (G-BOAT) was administered to a sample of 96 community-recruited gamblers. On the G-BOAT, participants responded to a list of positive outcome phrases with the first two behaviours that came to mind. Those with more problematic gambling (as measured on the Problem Gambling Severity Index) and greater gambling involvement (as measured by time and money spent gambling on the Gambling Timeline Followback) responded to positive outcome phrases on the G-BOAT with more gambling-related responses. In Study 2, we administered G-BOAT to a community-recruited sample of 61 gamblers, who also completed a computerized reaction time measure of implicit gambling OEs, an explicit self-report measure of gambling OEs, and a measure of gambling frequency. Consistent with Strack and Deutch’s (2004) reflective-impulsive model, memory associations on the G-BOAT and positive OE scores on the explicit Gambling Expectancy Questionnaire each predicted unique variance in frequency of gambling behaviour. These studies are among the first to demonstrate the important role of memory associations in excessive and problem gambling.Les résultats escomptés (RE), c’est-à-dire la croyance dans les conséquences d’un comportement donné, constituent une importante variable explicative des comportements liés à la dépendance. L’étude 1 a évalué si des associations mémorielles entre le jeu et des résultats positifs sont reliées aux problèmes de jeu compulsif. La tâche d’association de résultats découlant de comportements liés au jeu (Gambling Behaviour Outcome Association Task [G-BOAT]) a été administrée à un échantillon de 96 joueurs recrutés au sein de la collectivité. Dans le cadre de la G-BOAT, une liste de locutions exprimant un résultat positif était présentée aux participants et ceux-ci devaient répondre en indiquant pour chacune des locutions les deux premiers comportements qui leur venaient à l’esprit. Ceux qui présentaient un problème de jeu plus grave (selon l’indice de jeu problématique) et qui s’adonnaient davantage au jeu (selon le suivi du temps passé à jouer et de l’argent dépensé effectué à l’aide de l’outil Gambling Timeline Followback) ont donné des réponses liées au jeu plus fréquemment que les autres. Dans le cadre de l’étude 2, la G-BOAT a été administrée à un échantillon de 61 joueurs recrutés au sein de la collectivité. Ceux-ci ont en outre fait l’objet d’une mesure informatisée du temps de réponse (TR) pour les RE liés au jeu implicites, d’une autoévaluation des RE liés au jeu explicites et d’une mesure de la fréquence des comportements liés au jeu. Conformément au modèle de réflexion et impulsion de Strack et Deutch (2004), les associations mémorielles obtenues dans le cadre de la G-BOAT et les résultats relatifs aux RE positifs obtenus dans le cadre du questionnaire sur les attentes quant au jeu ont dans les deux cas permis de prévoir une variance unique concernant la fréquence des comportements liés au jeu. Ces études fournissent ainsi un premier ensemble de données probantes relativement à l’importance des associations mémorielles dans l’apparition des problèmes de jeu compulsif.

Adolescents at risk for drug abuse: a 3-year dual-process analysis

AIMS

To test longitudinal additive and synergistic dual-process models in youth at documented risk for drug use. The specific dual-process approach examined suggests that engaging in drug use behaviors results from a dynamic interplay between automatically activated associative memory processes and executive reflective/control processes.

DESIGN

This 3-year, three-wave population-based prospective study used mobile computer-based assessments.

SETTING

Self-directed computer assessments were completed in school settings in the Los Angeles metropolitan area, California, USA.

PARTICIPANTS

Seven hundred and twenty-five at-risk adolescents (44% female) in continuation high schools were recruited during 9th grade (age at recruitment, 14-16).

MEASUREMENTS

Key outcome measures included past year alcohol, marijuana and cigarette use at each assessment. Predictors included working memory capacity (WMC), associative memory, the interaction term WMC by associative memory, sex, age, ethnicity and acculturation.

FINDINGS

A significant cross-sectional interaction revealed tobacco-relevant associations were weaker predictors of cigarette use among males with higher WMC than among those with lower WMC (P < 0.004). Alternatively, drug-relevant associations were stronger predictors of past year alcohol (P < 0.001) and marijuana use (P = 0.02) among females with higher WMC than among those with lower WMC. Longitudinal analyses revealed no significant interactions after adjusting for predictive effects of previous drug use. With respect to WMC, females with higher WMC were less likely to use marijuana at 2-year follow-up (P = 0.03). First-order effects of drug-related associations predicted greater alcohol and marijuana use prospectively in males at 1- and 2-year follow up (P ≤ 0.03), and greater past year alcohol and marijuana use in females at 1-year follow up (P ≤ 0.03).

CONCLUSIONS

Drug-relevant memory associations play a key role in drug use behavior in at-risk youth.

Impulsivity, Sensation Seeking, and Risk-Taking Behaviors among HIV-Positive and HIV-Negative Heroin Dependent Persons

Objective. The aim of this study was to compare impulsivity and risky decision making among HIV-positive and negative heroin dependent persons. Methods. We compared different dimensions of impulsivity and risky decision making in two groups of 60 HIV-positive and 60 HIV-negative male heroin dependent persons. Each group was comprised of equal numbers of current (treatment seeker) and former (abstinent) heroin addicts. Data collection tools included Balloon Analogue Risk Task (BART), Iowa Gambling Task (IGT), Barratt Impulsiveness Scale (BIS), and Zuckerman Sensation Seeking Scale (SSS). Results. In SSS, comprised of four subscales including thrill and adventure seeking (TAS), experience seeking (ES), disinhibition (DIS), and boredom susceptibility (BS), there was a borderline difference in DIS (P = 0.08) as HIV-positive group scored higher than HIV-negative group. Also, ES and total score were significantly higher among HIV-positive patients. In BART, HIV-positive subjects scored higher in risk taking than HIV-negative subjects as reflected in higher Average Number of puffs in Successful Balloons (ANSB). In BIS, HIV-positive group scored significantly higher in cognitive impulsivity (CI) (P = 0.03) and nonplanning impulsivity (NPI) (P = 0.05) in comparison to HIV-negative group. Also, current heroin addicts scored significantly higher in NPI compared to former addict HIV-negative participants (P = 0.015). IGT did not show any significant difference between groups. Conclusion. Higher levels of impulsivity and risk taking behaviors among HIV-positive heroin addicts will increase serious concerns regarding HIV transmission from this group to other opiate dependents and healthy people.

Research on the Effects of Alcohol and Sexual Arousal on Sexual Risk in Men who have Sex with Men: Implications for HIV Prevention Interventions

The purpose of this paper was to describe and appraise the research evidence on the effects of acute alcohol intoxication and sexual arousal on sexual risk behaviors in men who have sex with men (MSM) and to examine its implications for design of HIV prevention interventions that target MSM. Toward that end, the paper begins with a discussion of research on sexual arousal in men and alcohol and their acute effects on sexual behaviors. This is followed by a review of empirical evidence on the combined acute effects of alcohol and sexual arousal in heterosexual men (the large majority of studies) and then in MSM. The empirical evidence and related theoretical developments then are integrated to derive implications for developing effective HIV prevention interventions that target MSM.

Acute Effects of Intoxication and Arousal on Approach/Avoidance Biases Toward Sexual Risk Stimuli in Heterosexual Men

This study tested the effects of alcohol intoxication and physiological arousal on cognitive biases toward erotic stimuli and condoms. Ninety-seven heterosexual men were randomized to 1 of 6 independent conditions in a 2 (high arousal or control) × 3 (alcohol target BAC = 0.08, placebo, or juice control) design and then completed a variant of the Approach-Avoidance Task (AAT). The AAT assessed reaction times toward approaching and avoiding erotic stimuli and condoms with a joystick. Consistent with hypotheses, the alcohol condition exhibited an approach bias toward erotic stimuli, whereas the control and placebo groups exhibited an approach bias toward condom stimuli. Similarly, the participants in the high arousal condition exhibited an approach bias toward erotic stimuli and the low arousal control condition exhibited an approach bias toward condoms. The results suggest that acute changes in intoxication and physiological arousal independently foster biased responding toward sexual stimuli and these biases are associated with sexual risk intentions.

Development of a theory-guided pan-European computer-assisted safer sex intervention

HIV is a growing public health problem in Europe, with men-having-sex-with-men and migrants from endemic regions as the most affected key populations. More evidence on effective behavioral interventions to reduce sexual risk is needed. This article describes the systematic development of a theory-guided computer-assisted safer sex intervention, aiming at supporting people living with HIV in sexual risk reduction. We applied the Intervention Mapping (IM) protocol to develop this counseling intervention in the framework of a European multicenter study. We conducted a needs assessment guided by the information-motivation-behavioral (IMB) skills model, formulated change objectives and selected theory-based methods and practical strategies, i.e. interactive computer-assisted modules as supporting tools for provider-delivered counseling. Theoretical foundations were the IMB skills model, social cognitive theory and the transtheoretical model, complemented by dual process models of affective decision making to account for the specifics of sexual behavior. The counseling approach for delivering three individual sessions was tailored to participants' needs and contexts, adopting elements of motivational interviewing and cognitive-behavioral therapy. We implemented and evaluated the intervention using a randomized controlled trial combined with a process evaluation. IM provided a useful framework for developing a coherent intervention for heterogeneous target groups, which was feasible and effective across the culturally diverse settings. This article responds to the need for transparent descriptions of the development and content of evidence-based behavior change interventions as potential pillars of effective combination prevention strategies.

Evaluation of internal validity using modern test theory: Application to word association

Word association tests (WATs) have been widely used to examine associative/semantic memory structures and shown to be relevant to behavior and its underpinnings. Despite successful applications of WATs in diverse research areas, few studies have examined psychometric properties of these tests or other open-ended cognitive tests of common use. Modern test theory models, such as item response theory (IRT) models, are well suited to evaluate interpretations of this class of test. In this evaluation, unidimensional IRT models were fitted to the data on the WAT designed to capture associative memory relevant to an important applied issue: casual sex in a sample of 1,138 adult drug offenders. Using association instructions, participants were instructed to generate the first behavior or action that came to mind in response to cues (e.g., "hotel/motel") that might elicit casual sex-related responses. Results indicate a multitude of evidence for the internal validity of WAT score interpretations. All WAT items measured a single latent trait of casual sex-related associative memory, strongly related to the latent trait, and were invariant across gender, ethnicity, age groups, and sex partner profiles. The WAT was highly informative at average-to-high levels of the latent trait and also associated with risky sex behavior, demonstrating the usefulness of this class of test. The study illustrates the utility of the assessments in this at-risk population as well as the benefits of application of the modern test theory models in the evaluation of internal validity of open-ended cognitive test score interpretation. (PsycINFO Database Record

Response inhibition moderates the association between drug use and risky sexual behavior

BACKGROUND

HIV infection is problematic among all drug users, not only injection drug users. Drug users are at risk for contracting HIV by engaging in risky sexual behaviors.

OBJECTIVE

The present study sought to determine whether inhibitory processes moderate the relationship between problematic drug use and HIV-risk behaviors (unprotected sex and multiple sex partners).

METHODS

One hundred ninety-six drug offenders enrolled in drug education programs were administered a battery of computer-based assessments. Measures included a cued go/no-go assessment of inhibitory processes, the Drug Abuse Screening Test (DAST) assessment of problematic drug use, and self-report assessment of condom use and multiple sex partners.

RESULTS

Findings revealed that response inhibition assessed by the proportion of false alarms on the cued go/no-go moderated the relationship between problematic drug use and an important measure of HIV risk (condom nonuse) among drug offenders. However, response inhibition did not moderate the relationship between problematic drug use and another measure of HIV risk: multiple sex partners.

CONCLUSIONS

Among this sample of drug offenders, we have found a relationship between problematic drug use and condom nonuse, which is exacerbated by poor control of inhibition. These findings have implications for the development of HIV intervention components among high-risk populations.

Understanding how adherence goals promote adherence behaviours: a repeated measure observational study with HIV seropositive patients

BACKGROUND

The extent to which patients follow treatments as prescribed is pivotal to treatment success. An exceptionally high level (> 95%) of HIV medication adherence is required to suppress viral replication and protect the immune system and a similarly high level (> 80%) of adherence has also been suggested in order to benefit from prescribed exercise programmes. However, in clinical practice, adherence to both often falls below the desirable level. This project aims to investigate a wide range of psychological and personality factors that may lead to adherence/non-adherence to medical treatment and exercise programmes.

METHODS

HIV positive patients who are referred to the physiotherapist-led 10-week exercise programme as part of the standard care are continuously recruited. Data on social cognitive variables (attitude, intention, subjective norms, self-efficacy, and outcome beliefs) about the goal and specific behaviours, selected personality factors, perceived quality of life, physical activity, self-reported adherence and physical assessment are collected at baseline, at the end of the exercise programme and again 3 months later. The project incorporates objective measures of both exercise (attendance log and improvement in physical measures such as improved fitness level, weight loss, improved circumferential anthropometric measures) and medication adherence (verified by non-invasive hair analysis).

DISCUSSION

The novelty of this project comes from two key aspects, complemented with objective information on exercise and medication adherence. The project assesses beliefs about both the underlying goal such as following prescribed treatment; and about the specific behaviours such as undertaking the exercise or taking the medication, using both implicit and explicit assessments of patients' beliefs and attitudes. We predict that i) the way people think about the underlying goal of their treatments explains medication and exercise behaviours over and above the effects of the behaviour-specific thinking and ii) the relationship between adherence to exercise and to medical treatment is stronger among those with more favourable views about the goal. Results from this study should identify the key contributing factors to inform subsequent adherence research and afford a more streamlined assessment matrix. The project also aims to inform patient care practices. UK CLINICAL RESEARCH NETWORK REGISTRATION NUMBER: UKCRN 7842.