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Gebru NM, James TG, Ahn S, Cheong J, Berry MS, Cook RL, Leeman RF. A Behavioral Economic Examination of Sexual Behaviors in the Era of Pre-exposure Prophylaxis via Explanatory Sequential Mixed Methods. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1541-1559. [PMID: 38472604 PMCID: PMC11124550 DOI: 10.1007/s10508-024-02822-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 11/28/2023] [Accepted: 01/24/2024] [Indexed: 03/14/2024]
Abstract
Pre-exposure prophylaxis (PrEP) use may be associated with condom use decisions. The current investigation examined sexual decision-making in the context of PrEP among young adult men who have sex with men (MSM) between 18 and 30 years old, using an explanatory sequential mixed methods design. For the quantitative aim, 99 MSM currently taking PrEP (i.e., PrEP-experienced) and 140 MSM not currently taking PrEP (i.e., PrEP-naive) completed an online survey, including the Sexual Delay Discounting Task (SDDT), which captures likelihood of condom use. For the qualitative aim, 15 people from each group were interviewed about their (1) conceptualizations of risky sex and (2) ways they manage their sexual risk. Participants were, on average, 25.69 years old (SD = 3.07) and 64% White. Results from the quantitative aim revealed, controlling for covariates, PrEP-experienced participants exhibited significantly lower likelihood of (1) using an immediately available condom and (2) waiting for a delayed condom (i.e., sexual delay discounting) compared to PrEP-naive participants. Qualitative themes explaining what young adult MSM consider to be risky sex included: (1) any sex as risky sex, (2) risky sex as "sex without a conversation," and (3) risky sex as sex with risk for physical harm. Themes on ways young adult MSM manage sexual risk were classified as proactive, reactive, and passive. Results suggest that PrEP use is related to condom use decisions. Taken together, quantitative differences in sexual delay discounting, but qualitatively similar conceptualizations and management of risky sex, suggest that the SDDT may be a useful tool in sex research to capture processes (i.e., delay discounting) underlying sexual decision-making that may be missed by traditional self-reports. Implications of results, including potentially providing (good quality) condoms with every PrEP prescription, and future research topics are discussed.
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Affiliation(s)
- Nioud Mulugeta Gebru
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main St., Box G-S121-3, Providence, RI, 02912, USA.
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA.
- Southern HIV and Alcohol Research Consortium (SHARC), University of Florida, Gainesville, FL, USA.
| | - Tyler G James
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Seungjun Ahn
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - JeeWon Cheong
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
| | - Meredith S Berry
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Robert L Cook
- Southern HIV and Alcohol Research Consortium (SHARC), University of Florida, Gainesville, FL, USA
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Robert F Leeman
- Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA
- Department of Health Sciences, Northeastern University, Boston, MA, USA
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Gebru NM, Kalkat M, Strickland JC, Ansell M, Leeman RF, Berry MS. Measuring Sexual Risk-Taking: A Systematic Review of the Sexual Delay Discounting Task. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2899-2920. [PMID: 35838897 PMCID: PMC9555011 DOI: 10.1007/s10508-022-02355-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
The Sexual Delay Discounting Task (SDDT; Johnson & Bruner, 2012) is a behavioral economic task that assesses sexual risk-taking by measuring likelihood of immediate and delayed condom use. The SDDT is ecologically valid and has been used to test effects of various substances on sexual risk-taking. However, considerable variety in implementation, analysis, and reporting of the SDDT may limit rigor and reproducibility of findings. The current review synthesized studies that used the SDDT to evaluate these possible variabilities systematically. A two-step search (citation-tracking and keyword-based search) was conducted to identify studies that met inclusion criteria (i.e., used the SDDT). Eighteen peer-reviewed articles met inclusion criteria. The SDDT has been implemented primarily in three populations: individuals who use cocaine, men who have sex with men, and college students. Comparable results across diverse populations support the SDDT's validity. A few studies administered substances before the SDDT. Evidence suggests that while cocaine and alcohol increased sexual risk-taking under some conditions, buspirone decreased preference for immediate condomless sex. There was also heterogeneity in the determination of data orderliness (i.e., outliers) and inconsistent reporting of task design and analysis. Considerable differences present in methodologic approaches could influence results. Reducing variation in the administration, analysis, and reporting of the SDDT will enhance rigor and reproducibility and maximize the task's tremendous potential.
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Affiliation(s)
- Nioud Mulugeta Gebru
- Department of Health Education and Behavior, Center for Behavioral Economic Health Research;, University of Florida, P.O. Box 118210, Gainesville, FL, 32611, USA.
- Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA.
| | - Meher Kalkat
- Department of Health Education and Behavior, Center for Behavioral Economic Health Research;, University of Florida, P.O. Box 118210, Gainesville, FL, 32611, USA
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Margaret Ansell
- Department of Health Education and Behavior, Center for Behavioral Economic Health Research;, University of Florida, P.O. Box 118210, Gainesville, FL, 32611, USA
| | - Robert F Leeman
- Department of Health Education and Behavior, Center for Behavioral Economic Health Research;, University of Florida, P.O. Box 118210, Gainesville, FL, 32611, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Meredith S Berry
- Department of Health Education and Behavior, Center for Behavioral Economic Health Research;, University of Florida, P.O. Box 118210, Gainesville, FL, 32611, USA
- Department of Psychology, University of Florida, Gainesville, FL, USA
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Johnson MW, Strickland JC, Herrmann ES, Dolan SB, Cox DJ, Berry MS. Sexual discounting: A systematic review of discounting processes and sexual behavior. Exp Clin Psychopharmacol 2021; 29:711-738. [PMID: 33001694 PMCID: PMC8977071 DOI: 10.1037/pha0000402] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Behavioral processes underlying sexual behavior are important for understanding normal human functioning and risk behavior leading to sexually transmitted infections (STIs). This systematic review examines delay and probability discounting in human sexual behavior through synthesis of 50 peer-reviewed, original research articles. Sixteen studies focusing exclusively on monetary delay discounting found small effect size positive correlations with sexual risk behaviors. Eleven studies examined delay or probability discounting of sexual behavior itself using tasks that varied duration, frequency, or quality of sex to determine value. Results show delay and uncertainty of sex causes systematic decreases in value. These studies also show consistent medium effect size relationships between sexual discounting measures and sexual health and substance use, supporting utility above and beyond monetary discounting. Twenty-three studies have modeled clinically relevant decision-making, examining effects of delay until condom availability and STI contraction probability on condom use. Observational and experimental designs found condom-use discounting is elevated in high-risk substance use populations, is sensitive to context (e.g., partner desirability), and is more robustly related to sexual risk compared with monetary discounting or condom use decisions when no delay/uncertainty was involved. Administering cocaine, alcohol, and, for some participants, methamphetamine increased condom-use discounting with minimal effect on monetary discounting or condom use when no delay/uncertainty was involved. Reviewed studies robustly support that sexual behavior is highly dependent on delay and probability discounting, and that these processes strongly contribute to sexual risk. Future research should exploit these systematic relationships to design behavioral and pharmacological approaches to decrease sexual risk behavior. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Matthew W. Johnson
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Justin C. Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Sean B. Dolan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - David J. Cox
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Meredith S. Berry
- Human Behavioral Pharmacology and Decision-Making Laboratory, Department of Health Education and Behavior, University of Florida, Gainesville, FL, United States
- Department of Psychology, University of Florida, Gainesville, FL, United States
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Jones J, Guest JL, Sullivan PS, Sales JM, Jenness SM, Kramer MR. The association between monetary and sexual delay discounting and risky sexual behavior in an online sample of men who have sex with men. AIDS Care 2018; 30:844-852. [PMID: 29397755 DOI: 10.1080/09540121.2018.1427851] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Delay discounting is a measure of impulsivity that has been found to be associated with numerous health-related outcomes. To the extent that delay discounting is associated with sexual risk-taking, it might serve as a marker for HIV risk or as the basis for novel HIV prevention interventions. The goal of the current study was to examine the association between monetary and sexual delay discounting and condomless anal intercourse (CAI) in a cross-sectional sample of men who have sex with men. Based on previous findings, we examined whether these associations were age-dependent. Sexual, but not monetary, delay discounting was found to be associated with CAI in the past 12 months. These results suggest that delay discounting is associated with sexual risk-taking. More high risk sexual behaviors and their associations with delay discounting should be investigated in the future.
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Affiliation(s)
- Jeb Jones
- a Department of Epidemiology , Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Jodie L Guest
- a Department of Epidemiology , Rollins School of Public Health, Emory University , Atlanta , GA , USA.,b Department of Family and Preventive Medicine , School of Medicine, Emory University , Atlanta , GA , USA
| | - Patrick S Sullivan
- a Department of Epidemiology , Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Jessica M Sales
- c Department of Behavioral Sciences and Health Education , Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Samuel M Jenness
- a Department of Epidemiology , Rollins School of Public Health, Emory University , Atlanta , GA , USA
| | - Michael R Kramer
- a Department of Epidemiology , Rollins School of Public Health, Emory University , Atlanta , GA , USA
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