Effects of alcohol, expectancies, and partner type on condom use in college males: event-level analyses

Alcohol, Sexual Arousal, and Partner Familiarity as Predictors of Condom Negotiation: An Experience Sampling Study

Numerous contextual factors contribute to risky sexual decision-making among men who have sex with men (MSM), with experimental laboratory-based studies suggesting that alcohol consumption, sexual arousal, and partner familiarity have the potential to impact condom negotiations during sexual encounters. The purpose of the current study was to extend this line of inquiry outside of the laboratory and into the everyday lives of MSM. We collected six weeks of daily data on alcohol consumption and sexual behaviors from 257 moderate- and heavy-drinking MSM to examine the within- and between-subjects effects of alcohol consumption, average daily sexual arousal, and partner familiarity on condom negotiation processes during sexual encounters. We hypothesized that alcohol consumption, higher levels of average daily sexual arousal, and greater partner familiarity would all contribute to a reduced likelihood of condom negotiation prior to sexual activity, and that they would also affect the difficulty of negotiations. Contrary to hypotheses, none of these three predictors had significant within-subjects effects on condom negotiation outcomes. However, partner familiarity and average daily sexual arousal did exert significant between-subjects effects on the incidence of negotiation and negotiation difficulty. These findings have important implications for risk-reduction strategies in this population. They also highlight the challenges of reconciling results from experimental laboratory research and experience sampling conducted outside of the laboratory on sexual risk behavior.

Sexual alcohol expectancies moderate the relation between alcohol use and sexual behavior among men who have sex with men

BACKGROUND

HIV transmission remains a significant health concern for men who have sex with men (MSM) in the United States. Heavy episodic drinking (HED) is related to increased rates of condomless anal intercourse (CAI) among MSM, though evidence suggests that this association may vary by individual difference factors. The present secondary analysis tested whether sexual alcohol expectancies (SAEs) moderate the associations between frequency of HED and anal intercourse (AI) with and without a condom among moderate-to-heavy drinking HIV- MSM.

METHODS

Two hundred and forty-eight moderate-to-heavy drinking MSM completed self-report questionnaires including the Sexual Behavior Questionnaire, the Modified Daily Drinking Questionnaire, and the Sexual Alcohol Expectancies Questionnaire.

RESULTS

Negative binomial regressions indicated that SAEs moderated the association between frequency of HED and AI with a condom, but not between the frequency of HED and condomless AI (CAI).

CONCLUSIONS

These results suggest that stronger SAEs play a role in alcohol-related sexual behavior among MSM, but do not provide evidence that SAEs are associated with increased risk for HIV transmission through CAI.

Cross-Lagged Associations of Insecure Attachment Style, Alcohol Use, and Sexual Behavior During Emerging Adulthood

Insecure romantic attachment style has been associated with greater substance use and higher risk sexual behavior, but the temporal nature of these associations is not well-understood. This study examined whether having a more insecure attachment style was associated with greater engagement in higher-risk sexual behavior over time and, if so, whether this was mediated by more frequent alcohol use. We used three annual waves of survey data from a diverse California cohort (N = 2371) who were assessed from ages 19 to 21-22 years. Separate cross-lagged models examined temporal associations of insecure romantic attachment style (anxious and avoidant), past month alcohol use frequency, and sexual behavior (number of sex partners, condomless sex with casual and steady partners). Attachment anxiety was not directly associated with sexual behavior. Rather, a consistent pattern across waves showed that greater attachment anxiety was associated with more frequent alcohol use at the next wave, which, in turn, was associated with having more sex partners and condomless sex with casual and steady partners one year later. In contrast, greater attachment avoidance was directly associated with having fewer sex partners, and its associations with condomless sex differed across partner type and assessment waves. Attachment avoidance was unrelated to alcohol use frequency. Results indicated that both anxious and avoidant attachment styles were associated with higher-risk sexual behavior, but in different ways and through different mechanisms. Future research may want to examine whether the effectiveness of sexual risk reduction programs for young people is enhanced by discussing attachment style and tailoring the curriculum accordingly.

Sex in the Context of Substance Use: A Study of Perceived Benefits and Risks, Boundaries, and Behaviors among Adolescents Participating in an Internet-Based Intervention

Little research has examined adolescents' perspectives of sex with substance use. This study examined (1) adolescents' perceived benefits and risks of sex with substance use, as well as boundaries; (2) the potential for positive and negative social influences among adolescents when they discuss these topics; and (3) whether exposure to health-promoting content is associated with trajectories of sex with substance use over a 6-month period. To address the first two objectives, 176 comments were analyzed from 71 adolescents (90% female) aged 14-18 years who participated in an Internet-based sexual health promotion intervention and posted to at least one message board addressing sex with substance use. Adolescents' perceived benefits and risks of sex with substance use primarily reflected concern for the experience of sex in the moment; perceived risks and boundaries primarily reflected concern for the ability to develop and maintain meaningful relationships. Comments of 63% and 22% of adolescents, respectively, were evaluated to have potential for health-promoting and risk-promoting social influence. To address the third objective, trajectories of self-reported sex with substance use were compared between 89 intervention and 54 control participants. No significant differences were observed. However, a dose-response effect was observed; intervention participants who completed less than one third of assigned tasks reported increases in sex with alcohol or marijuana use over time, while no marked changes or much smaller changes in sex with substance use were observed among intervention participants who completed one third or more tasks. Implications for prevention and intervention programs are discussed.

Emotional Outcomes of Casual Sexual Relationships and Experiences: A Systematic Review

Casual sexual relationships and experiences (CSREs) are common and emotionally significant occurrences. Given the uncommitted, often emotionally complicated nature of CSREs, researchers have asked whether these experiences may have positive and/or negative emotional consequences. We reviewed 71 quantitative articles examining emotional outcomes of CSREs, including subjective emotional reactions (e.g., excitement, regret) and emotional health (e.g., depression, self-esteem). Overall, people evaluated their CSREs more positively than negatively. In contrast, CSREs were associated with short-term declines in emotional health in most studies examining changes in emotional health within a year of CSRE involvement. Emotional outcomes of CSREs differed across people and situations. Women and individuals with less permissive attitudes toward CSREs experienced worse emotional outcomes of CSREs. Alcohol use prior to CSREs, not being sexually satisfied, and not knowing a partner well were also associated with worse emotional outcomes. These findings suggest directions for prevention/intervention related to CSREs. For example, skill-building related to sexual decision-making may help individuals decide whether, and under what circumstances, CSREs are likely to result in positive or negative emotional outcomes. In addition, the limitations of extant research suggest directions for future inquiry (e.g., examining whether verbal and nonverbal consent practices predict emotional outcomes of CSREs).

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.

Short-Term Consequences of Sex: Contextual Predictors and Change Across College

Although sexual experiences are normative by young adulthood, individuals continue to explore and develop their sexual behaviors and cognitions across the college years. Thus, perceived consequences of sexual experiences may change. Similarly, characteristics of sexual experiences such as partner type, alcohol use, and sexual behavior type predict perceived consequences, and these associations may change over time. In this study, we addressed links between characteristics of sexual experiences (casual vs. committed partner, heavy alcohol use on sex days, and kissing/touching only vs. oral/penetrative sex) and short-term perceived consequences of sexual experiences (physical satisfaction, emotional intimacy, not satisfied, guilt, not ready), using daily data collected longitudinally across seven college semesters. We also examined whether perceived consequences of sex change across college and whether within-person daily associations between sexual experience characteristics and perceived consequences of sex change across college. An ethnically and racially diverse sample of traditionally aged first year university students (N = 566; 54% female; 98% heterosexual) completed online surveys, yielding 8,838 daily reports about sexual behaviors. Multilevel models indicated that partner type, heavy alcohol use, and sexual behavior type predicted within-person differences in perceived consequences of sex. Interactions between characteristics of sexual experiences and college semester indicated that differences in perceived consequences of sexual experiences with casual versus committed partners lessened over time. The likelihood of reporting physical satisfaction and guilt after only kissing/touching (but not oral/penetrative sex) decreased across college semesters. Findings inform understanding of normative sexual development by demonstrating that perceived consequences and their predictors change across time.

Sex, marijuana and baby booms

We study the behavioral changes caused by marijuana use on sexual activity, contraception, and birth counts by applying a differences-in-differences approach that exploits the variation in timing of the introduction of medical marijuana laws (MMLs) among states. We find that MMLs cause an increase in sexual activity, a reduction in contraceptive use conditional on having sex, and an increase in number of births. There is also suggestive evidence on temporary increases in the state-year gonorrhea rate. These changes may be attributed to behavioral responses including increased attention to the immediate hedonic effects of sexual contact, increased sexual frequency, as well as delayed discounting and ignoring the future costs associated with sex. Our findings on births suggest that behavioral factors can counteract the physiological changes from marijuana use that tend to decrease fertility. Our findings are robust to a broad set of tests.

Associations of Alcohol and Marijuana Use With Condom Use Among Young Adults: The Moderating Role of Partner Type

This study used multiple levels of analysis to examine associations of alcohol and marijuana (AM) use with condom use, including the moderating role of partner type, in a general sample of 754 sexually active young adults (mean age = 18.6, SD = 0.63; 77% non-White). Multivariable models examined associations over the past 30 days (global) and at the most recent sexual event (event specific). Over the past 30 days, participants who had a recent casual partner and used both substances reported a higher proportion of condom-protected sexual events during this period compared to AM nonusers, whereas those who had a recent steady partner and used alcohol, marijuana, or both substances reported a lower proportion of condom-protected sexual events compared to AM nonusers. At the most recent sexual event, participants who used both substances were four times more likely than AM nonusers to have condom-protected sex if the event involved a casual partner; however, there were no significant associations if the event involved a steady partner. Marijuana use, particularly combined with alcohol use, deserves greater attention in the context of condom use. Future research should consider different levels of analysis and partner types to fully understand these complex associations.

Growing Up, Hooking Up, and Drinking: A Review of Uncommitted Sexual Behavior and Its Association With Alcohol Use and Related Consequences Among Adolescents and Young Adults in the United States

Hookups are uncommitted sexual encounters that range from kissing to intercourse and occur between individuals in whom there is no current dating relationship and no expressed or acknowledged expectations of a relationship following the hookup. Research over the last decade has begun to focus on hooking up among adolescents and young adults with significant research demonstrating how alcohol is often involved in hooking up. Given alcohol’s involvement with hooking up behavior, the array of health consequences associated with this relationship, as well as its increasing prevalence from adolescence to young adulthood, it is important to determine the predictors and consequences associated with alcohol-related hooking up. The current review extends prior reviews by adding more recent research, including both qualitative and experimental studies (i.e., expanding to review more diverse methods), research that focuses on the use of technology in alcohol-related hookups (i.e., emerging issues), further develops prevention and intervention potentials and directions, and also offers a broader discussion of hooking up outside of college student populations (i.e., expanding generalization). This article will review the operationalization and ambiguity of the phrase hooking up, the relationship between hooking up and alcohol use at both the global and event levels, predictors of alcohol-related hooking up, and both positive and negative consequences, including sexual victimization, associated with alcohol-related hookups. Throughout, commentary is provided on the methodological issues present in the field, as well as limitations of the existing research. Future directions for research that could significantly advance our understanding of hookups and alcohol use are provided.

Gênero e consumo de álcool entre jovens: avaliação e validação do Inventário de Conformidade com Normas Masculinas

Resumo Normas sociais de papel de gênero influenciam comportamentos e afirmam identidades e pertencimento a determinados grupos. Mesmo que alterem-se conforme padrões éticos, sociais e culturais, vão existir normativas dominantes. Este estudo validou para a realidade brasileira o Inventário de Conformidade com Normas Masculinas (CMNI-29) e buscou indícios da sua aplicabilidade a fatores específicos do consumo de bebidas alcoólicas de jovens universitários. Foram coletados dados de 341 homens, entre 19 e 25 anos, residentes em Minas Gerais e São Paulo. Os participantes completaram o CMNI-29 e perguntas sobre seu consumo de álcool. Mesmo com as adaptações realizadas para a adequação ao contexto, o inventário foi considerado válido. De maneira geral, os dados de confiabilidade se mostraram satisfatórios e atingiu-se validade convergente e discriminante para todas as dimensões da masculinidade. O CMNI-29 mostrou-se uma medida útil para compreender as múltiplas dimensões da masculinidade no comportamento. Além disso, indícios de influência das normas sobre a frequência de consumo de álcool foram encontrados. O uso da escala amplia o escopo de pesquisa de gênero no país, e possibilita a busca de seu efeito com outras variáveis e comportamentos de saúde que atingem esta população.

Swiping right: Alcohol, online dating, and sexual hookups in postcollege women

The development of online dating has created a cultural shift in how emerging adults approach dating. The present study examined retrospective and event-level associations between alcohol, online dating, and sexual hookups among a sample of single, postcollege women. Participants completed baseline and 24 electronic daily diary surveys on alcohol use, sexual behavior, and method for meeting their sexual partners. We examined the influence of alcohol on sexual hookups, and how method of meeting a partner, and location prior to the hookup influenced level of intoxication during a sexual hookup. There was a within-person effect of alcohol on likelihood of engaging in a sexual hookup whereby hookups were more likely on days when women reported higher levels of intoxication relative to their average drinking. Spending time at bar/party prior to a sexual hookup was associated with higher levels of intoxication prior to a sexual hookup relative to being at other locations. Measured in the daily diary surveys, meeting a sexual hookup partner online was associated with lower levels of intoxication during the hookup relative to when meeting at bars/parties, even when including location just prior to the hookup in the model. The baseline retrospective analyses also indicated that meeting a partner online was associated with drinking less frequently before a sexual hookup relative to meeting a partner at a bar/party. Interventions to address alcohol use, method for meeting a partner, and location prior to hookups could be effective in decreasing potential negative consequences of alcohol-related sexual behavior in emerging adult women. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A content analysis of sexual health and substance use information presented on study abroad websites: Findings and recommendations

Objective: Despite study abroad students frequently engaging in risky behaviors, there is a dearth of research exploring prevention efforts taken by study abroad programs. The goal of this project was to examine information presented on study abroad program websites regarding sexual assault, alcohol use, drug use, and risky sexual behavior. Participants: A total of 753 universities in the US were selected from the Carnegie Classification of Institutes database. Method: Coders evaluated the website of each institution's study abroad program for the presence of information about the four factors of interest. Results: Sixty-seven percent of the websites provided no information on any of these risk behaviors. Chi-square analyses revealed institutional demographic differences in the presentation of prevention information. We also identified three emerging themes about avenues for modifying website content. Conclusion: Study abroad programs can provide more detail and action oriented information on their websites for students.

Alcohol Use and Unprotected Sex Among HIV-Infected Ugandan Adults: Findings from an Event-Level Study

While alcohol is a known risk factor for HIV infection in sub-Saharan Africa (SSA), studies designed to investigate the temporal relationship between alcohol use and unprotected sex are lacking. The purpose of this study was to determine whether alcohol used at the time of a sexual event is associated with unprotected sex at that same event. Data for this study were collected as part of two longitudinal studies of HIV-infected Ugandan adults. A structured questionnaire was administered at regularly scheduled cohort study visits in order to assess the circumstances (e.g., alcohol use, partner type) of the most recent sexual event (MRSE). Generalized estimating equation logistic regression models were used to examine the association between alcohol use (by the participant, the sexual partner, or both the participant and the partner) and the odds of unprotected sex at the sexual event while controlling for participant gender, age, months since HIV diagnosis, unhealthy alcohol use in the prior 3 months, partner type, and HIV status of partner. A total of 627 sexually active participants (57% women) reported 1817 sexual events. Of these events, 19% involved alcohol use and 53% were unprotected. Alcohol use by one's sexual partner (aOR 1.70; 95% CI 1.14, 2.54) or by both partners (aOR 1.78; 95% CI 1.07, 2.98) during the MRSE significantly increased the odds of unprotected sex at that same event. These results add to the growing event-level literature in SSA and support a temporal association between alcohol used prior to a sexual event and subsequent unprotected sex.

Students' Alcohol Use, Sexual Behaviors, and Contraceptive Use While Studying Abroad

College study abroad students may represent a subgroup at risk for increased alcohol use and sexual activity while traveling. The present study explored student's alcohol use, sexual activity, and the interrelationship between the two while abroad. A sample of 372 students (M_age abroad = 20, SD = 3.3, 68% women) who had traveled abroad in the past 3 years were recruited from a large, southern university. Students completed an online survey of demographics, alcohol use, sexual behaviors, and contraceptive use. Students reported consuming an average of six drinks in one sitting, and 76% of women and men met criteria for 'hazardous drinking' while abroad. Students who met criteria for 'hazardous drinking' were more likely to engage in sexual activity; however, they also had a greater likelihood of wearing a condom. Our findings show students engage in problematic drinking and this is related to their engagement in sexual activity while abroad. Findings extend previous research and suggest study abroad programs should address norms around drinking and sexual activity prior to travel to ensure students' safety while abroad.

Risky sexual behavior among cannabis users: The role of protective behavioral strategies

Cannabis users tend to use condoms less often than cannabis abstainers, placing them at risk for sexually transmitted disease and unplanned pregnancies. This is especially problematic among college students, who experience such problems at especially high rates. Despite accumulating data indicating that cannabis users are less likely to use condoms, little research has identified potentially malleable cognitive vulnerability factors that may be related to condom use in this vulnerable population. Thus, the current study tested whether cannabis users believed others use condoms less often and/or whether they engaged in less condom-related protective behavior strategies (PBS) than cannabis abstainers and whether cannabis use status was indirectly related to condom use via these vulnerability factors. Among 214 college students (64 past-month cannabis users), cannabis users engaged in less PBS (although cannabis use was unrelated to normative beliefs). Cannabis use status was indirectly related to condom use via PBS and cannabis use status was unrelated to condom use after controlling for PBS. Results highlight the importance of PBS use among cannabis users, a group at particular risk for risky sexual behaviors.

Interventions to Engage Affective Forecasting in Health-Related Decision Making: A Meta-Analysis

Background

People often use affective forecasts, or predictions about how a decision will make them feel, to guide medical and health decision making. However, these forecasts are susceptible to biases and inaccuracies that can have consequential effects on decision making and health.

Purpose

A meta-analysis was performed to determine the effectiveness of intervening to address affective forecasting as a means of helping patients make better health-related choices.

Methods

We included between-subjects experimental and intervention studies that targeted variables related to affective forecasting (e.g., anticipated regret, anticipated affect) as a means of changing health behaviors or decisions. We determined the overall effect of these interventions on targeted affective constructs and behavioral outcomes, and whether conceptual and methodological factors moderated these effects.

Results

A total of 133 independent effect sizes were identified from 37 publications (N = 72,020). Overall, affective forecasting interventions changed anticipated regret, d = 0.24, 95% confidence interval (CI) (0.15, 0.32), p < .001, behavior, d = 0.29, 95% CI (0.13, 0.45), p < .001, and behavioral intentions, d = 0.19, 95% CI (0.11, 0.28), p < .001, all measured immediately postintervention. Interventions did not change anticipated positive and negative affect, and effects on intentions and regret did not extend to follow-up time points, ps > .05. Generally, effects were not moderated by conceptual model, intervention intensity, or behavioral context.

Conclusions

Affective forecasting interventions had a small consistent effect on behavioral outcomes regardless of intervention intensity and conceptual framework, suggesting such constructs are promising intervention targets across several health domains.

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

Predicting Condom Use: A Comparison of the Theory of Reasoned Action, the Theory of Planned Behavior and an Extended Model of TPB

ABSTRACT It was our goal to give a contribution to the prediction of condom use using socio-cognitive models, comparing classic theories to an extended model. A cross-sectional study was conducted using a questionnaire of self-reported measures. From the students who agreed to participate in the study, 140 were eligible for the full study. A confirmatory analysis was used to assess the predictive value of the researched model. The model tested had slightly better fit indexes and predictive value than classic Theories of Reasoned Action and Planned Behaviour. Although the results found, discussion continues to understand the gap between intention and behaviour, as further investigation is necessary to fully understand the reasons for condom use inconsistency.

Acute Alcohol Consumption Directly Increases HIV Transmission Risk: A Randomized Controlled Experiment

BACKGROUND

Alcohol consumption has frequently been purported as a driver of condomless sex and HIV transmission, but to date, experimental evidence for the causal risk-taking impact of alcohol among HIV-positive populations is lacking. The present experiment sought to determine whether acute alcohol consumption has a direct causal impact on condomless sex intentions among HIV-positive men-who-have-sex-with-men (MSM), and to assess whether alcohol's impact differs between MSM who are HIV-positive versus HIV-negative.

METHODS

In a randomized controlled alcohol administration experiment, HIV-positive and HIV-negative MSM were brought into a specialized barroom laboratory and randomly assigned to beverage consumption condition: alcohol (target blood alcohol concentration = 0.080%), placebo alcohol (target blood alcohol concentration = 0.000%), or water (control). Participants then underwent a video-based sexual arousal manipulation (sexually aroused/nonaroused) and indicated their intentions to engage in condom-protected and condomless sexual acts in a standardized paradigm. The primary outcome entailed intentions to engage in condomless receptive and condomless insertive anal sex.

RESULTS

A total of 282 MSM (141 HIV-positive; 141 HIV-negative) completed experimental procedures. MSM who received alcohol reported significantly stronger intentions to engage in condomless sex than those who received placebo alcohol or water (F(1,274) = 9.43, P = 0.002). The impact of alcohol did not differ between HIV-positive and HIV-negative MSM (F(1,274) = 1.86, P = 0.174).

CONCLUSIONS

The present investigation entailed the first risk-focused alcohol administration experiment to involve an HIV-positive sample, and results demonstrated that consuming alcohol had an independent, causal impact on intentions to engage in sexual behaviors that can result in HIV transmission. Findings strongly suggest that alcohol-focused initiatives should be incorporated into HIV prevention efforts.

Predictive utility and measurement properties of the Strength of Implementation Intentions Scale (SIIS) for condom use

BACKGROUND

Implementation intentions are situation-linked action plans that increase health behaviors such as condom use. Few studies have measured the strength of implementation intentions, especially regarding condom use. Non-injection drug users are at high risk for HIV due to risky sexual practices. Substance use before sex may increase risky sexual behaviors, and implementation intentions are a promising, practical route for HIV prevention.

PURPOSE

This prospective study assessed the measurement properties of the newly developed Strength of Implementation Intentions Scale (SIIS) for condom use and investigated whether the SIIS predicted condom use one-year later. The study evaluated whether behavioral intentions and alcohol or methamphetamine use before sex modified the relationship between the SIIS and condom use.

METHODS

Participants were 590 non-injection drug users convicted of nonviolent drug offenses in court-mandated outpatient drug diversion programs. They completed self-directed computer assessments at baseline and at one-year follow-up. Measures included demographics, behavioral intentions to use condoms, the SIIS for condom use, alcohol and methamphetamine use before or during sex, and condom use. Psychometric properties, direct, and interaction effects of the SIIS were evaluated using structural equation modeling and general linear regressions.

RESULTS

The SIIS, behavioral intentions, and condom use were positively correlated and there was discriminant validity between all three constructs. In addition, the SIIS predicted condom use one-year later in this high-risk population. No significant interactions were detected.

CONCLUSIONS

The SIIS is predictive of condom use behavior, is psychometrically sound and distinct from behavioral intentions, and can be incorporated into HIV prevention interventions and used as a mediator variable. In addition, it can be used as an outcome measure where a follow-up is not feasible. The SIIS can also be tailored for additional HIV-related behaviors such as HIV-testing, adhering to antiretroviral medication, prescribing and adhering to pre-exposure prophylaxis, and other health behaviors.

Number of Sexual Partners and Relationship Status Are Associated With Unprotected Sex Across Emerging Adulthood

Sex with multiple partners, consecutively or concurrently, is a risk factor for contracting sexually transmitted infections (STIs) as multiple partner-partner contacts present increased opportunity for transmission. It is unclear, however, if individuals who tend to have more partners also use protection less reliably than those with sexual histories of fewer partners. Longitudinal data can elucidate whether an individual shows a consistent pattern of sex with multiple partners. We used latent class growth analyses to examine emerging adult survey data (N = 2244) spanning 10 waves of assessment across 6 years. We identified three trajectory classes described with respect to number of partners as (a) Multiple, (b) Single, and (c) Rare. Trajectory group, relationship status, and their interactions were tested as predictors of using protection against STIs and pregnancy at each wave. The Multiple Partners class had the greatest odds ratio of reporting sex without protection against STIs and pregnancy, followed by the Single and Rare classes. Exclusive relationship status was a risk factor for unprotected sex at earlier waves, but a protective factor at most later waves. There was no significant interaction between relationship status and trajectory class in predicting use of protection. The Multiple Partners class reported more permissive values on sex and an elevated proportion of homosexual behavior. This group overlaps with an already identified at-risk population, men who have sex with men. Potential mechanisms explaining the increased risk for sex without protection, including communication, risk assessment, and co-occurring risk behaviors are discussed as targets for intervention.

Sexual temptation: substance abuse, no sex, safe sex, risky sex, and STDs

Background University students' substance abuse and risky sex contribute to sexually transmitted diseases (STDs). Purpose We develop and empirically test a formative theoretical model of sexual temptation involving substance abuse (cigarettes, alcohol, and marijuana), safe sexual behavior (use of condom/barrier for oral and vaginal intercourse), risky sexual behavior (unprotected sex and multiple sexual partners), and STDs: gonorrhea, HIV, and genital herpes. We simultaneously explore these constructs, controlling membership in social groups (fraternity/sorority, varsity athlete, and club sports) and perceived norm of substance abuse. Methods A total of 687 American university students completed the National College Health Assessment (NCHA). We use structural equation modeling (SEM) to test the goodness of fit between our formative theoretical model and actual data. Results Results reveal the following discoveries: membership in campus social groups is positively associated with STDs, whereas perceived norm of peer substance abuse is negatively related to STDs. Under the influence of substance abuse, we test three outcomes of sexual temptation as related to STDs. Those who have no sex do not contract STDs. For those who fall into temptation and have sex, substance abuse is more strongly related to risky sex which leads to STDs than safe sex which does not. Those engaging in risky sex have significantly higher cognitive impairment than those practicing safe sex. Conclusions Substance abuse contributes to STDs through risky sex only. Those having risky sex suffer higher cognitive impairment than those practicing safe sex. We provide novel implications to policy makers, practitioners, and researchers.

“Amigos con beneficios”: salud sexual y estilos de apego de hombres y mujeres

Resumen Este estudio pretende analizar las variables relacionadas con la salud sexual de los individuos que pueden tener un impacto negativo en la asunción de riesgos - el uso de preservativo y el consumo de alcohol -; también pretende describir la prevalencia de infecciones de transmisión sexual y los estilos de apego que manifiestan hombres y mujeres en el marco relacional de amigos con beneficios. Para ello, se realiza un estudio transversal descriptivo. La información fue recogida mediante un cuestionario en línea y la escala de evaluación de los estilos de apego de Casullo y Fernández Liporace. En total, una muestra de 119 personas inmersas en una relación sexual casual con un amigo cumplimentaron el cuestionario. En relación a los resultados, casi el 30% de los participantes no han utilizado el preservativo en sus relaciones sexuales aduciendo razones asociadas al displacer e incomodidad; son las mujeres las que más padecen de infecciones de transmisión sexual; el consumo de alcohol ha constituido una práctica habitual en este tipo de relación. Aunque el apego seguro ha sido el más elevado, las mujeres se han mostrado temerosas. Amigos con beneficios puede entrañar graves consecuencias para la salud de los individuos y especialmente para las mujeres. Estos resultados recomiendan que desde la salud pública se preste atención a este novedoso vínculo sexual, así como la puesta en marcha de estrategias de promoción de la salud sexual dirigidas a las prácticas de riesgo de esta relación y a la mayor fragilidad afectiva y sexual de la mujer.

Substance use and STI acquisition: Secondary analysis from the AWARE study

OBJECTIVES

Sexually transmitted infections (STIs) are significant public health and financial burdens in the United States. This manuscript examines the relationship between substance use and prevalent and incident STIs in HIV-negative adult patients at STI clinics.

METHODS

A secondary analysis of Project AWARE was performed based on 5012 patients from 9 STI clinics. STIs were assessed by laboratory assay and substance use by self-report. Patterns of substance use were assessed using latent class analysis. The relationship of latent class to STI rates was investigated using Poisson regression by population groups at high risk for STIs defined by participant's and partner's gender.

RESULTS

Drug use patterns differed by risk group and substance use was related to STI rates with the relationships varying by risk behavior group. Substance use treatment participation was associated with increased STI rates.

CONCLUSIONS

Substance use focused interventions may be useful in STI clinics to reduce morbidity associated with substance use. Conversely, gender-specific sexual health interventions may be useful in substance use treatment.

The Role of Condom Use Self-Efficacy on Intended and Actual Condom Use Among University Students in Ghana

Little attention has been paid to the dimensions that help to predict and understand condom use among university students within an African context. A cross-sectional study involving 518 university students in Accra, Ghana was conducted to determine how the Condom Use self-Efficacy Scale-Ghana (CUSES-G) can predict both actual condom use and future condom use. Of all the participants, 84% were sexually active but less than half of the sample (48%) reported to have used condom during their last sexual intercourse. A hierarchical regression analysis showed that components of the Condom Use Self-Efficacy Scale (CUESE-G) such as appropriation, assertiveness, pleasure and intoxication, and STDs predicted condom use and condom use intentions. Behavioural change campaigns targeting university students should encourage condom use self-efficacy, as this would strengthen condom use, which is economically cheap and practically effective means of preventing STIs including HIV.

Sex Partner Type, Drug Use and Condom Use Self-Efficacy Among African Americans from Disadvantaged Neighborhoods: Are Associations with Consistent Condom Use Moderated by Gender?

Gender inequalities in sexual behavior are explored from the perspective of the theory of gender and power. This study focused on the effect of sex partner type (steady versus casual), drug use, and condom use self-efficacy regarding consistent condom use (CCU) among a community-based sample of adults. The sample included 1,357 African American men and women (M age 37.0, SD 13.1 years; 44% women, 66% men) from 61 disadvantaged census block groups in Atlanta, GA as part of a study of individual and neighborhood characteristics and HIV risk-taking. Having a steady partner decreased the odds of CCU, while higher condom use self-efficacy increased the odds of CCU. Among non-drug users, having a drug-using partner was associated with decreased odds of condom use for women only. Women with drug-using partners, especially a steady partner, were least likely to report CCU. Therefore, interventions intended to empower CCU among women need to expand beyond acknowledging the reduced control that women who use drugs demonstrate to also consider those who have drug-using sexual partners.

Development and validation of the East Africa Alcohol Expectancy Scale (AFEXS)

OBJECTIVE

The purpose of this study was to develop and validate the East Africa Alcohol Expectancy Scale (AFEXS), a measure of alcohol expectancies for use with HIV-positive adults in East Africa.

METHOD

The study was conducted in several phases. The first involved development of the scale and an exploratory factor analysis (EFA) with a total of 209 HIV-positive, Ugandan men (n = 120) and women (n = 89). The second phase involved a confirmatory factor analysis (CFA) as well as validity analyses with a second, demographically similar, sample of 181 HIV-positive Ugandan men (n = 109) and women (n = 72). All participants were recruited from two ongoing cohort studies taking place at an HIV clinic in rural southwestern Uganda.

RESULTS

The EFA resulted in a 13-item, three-factor scale that explained 67% of the variance and showed excellent internal consistency (α = .89). The CFA showed good model fit with a final 11-item scale, χ(2)(41) = 68.60, p = .004; comparative fit index = .97; root mean square error of approximation = .06, 90% CI [.03, .09], that again showed excellent internal consistency and yielded the following three factors: sex-related (α = .94), release of inhibition (α = .61), and negative expectancies (α = .73).

CONCLUSIONS

The AFEXS is the first psychometrically validated alcohol expectancy scale available for use in Africa. The extent to which the AFEXS can be used with other populations and with adults from countries outside of East Africa requires ongoing validation.

Heterogeneity in the Relationship of Substance Use to Risky Sexual Behavior Among Justice-Involved Youth: A Regression Mixture Modeling Approach

Justice-involved adolescents engage in high levels of risky sexual behavior and substance use, and understanding potential relationships among these constructs is important for effective HIV/STI prevention. A regression mixture modeling approach was used to determine whether subgroups could be identified based on the regression of two indicators of sexual risk (condom use and frequency of intercourse) on three measures of substance use (alcohol, marijuana and hard drugs). Three classes were observed among n = 596 adolescents on probation: none of the substances predicted outcomes for approximately 18 % of the sample; alcohol and marijuana use were predictive for approximately 59 % of the sample, and marijuana use and hard drug use were predictive in approximately 23 % of the sample. Demographic, individual difference, and additional sexual and substance use risk variables were examined in relation to class membership. Findings are discussed in terms of understanding profiles of risk behavior among at-risk youth.

Relationship between depressive symptoms, alcohol use, and antiretroviral therapy adherence among HIV-infected, clinic-attending patients in South Africa

Despite the prevalence of depression and alcohol use among HIV-infected individuals, few studies have examined their association together in relation to nonadherence to antiretroviral therapy in sub-Saharan Africa. This study examined depressive symptoms, alcohol use, and other psychosocial factors (stigma, demographic characteristics) in relation to nonadherence to antiretroviral therapy among clinic-attending, HIV-infected individuals in South Africa ( n = 101). Nonadherence was assessed using event-level measurement (missed doses over the past weekend). Multivariable logistic regression analyses revealed that only alcohol use, over and above depressive symptoms and education level, was associated with antiretroviral therapy nonadherence(AOR = 1.15; 95%CI = 1.02-1.29; p < .05). Findings point to the independent association of alcohol use and nonadherence to antiretroviral therapy above and beyond depressive symptoms.

Risky sexual behaviors among sexually active first-year students matriculating at a historically Black college: Is a positive self-image an instigator?

A sample of 498 sexually active first-year students matriculating at a historically Black college in North Carolina was used to determine correlates of risky sexual behaviors. In an Ordinary Least Squares regression, the self-esteem element "I take a positive attitude toward myself" (B = 1.12, p = .05), non-condom use because of partner issues (B = .53, p = .05) and being drunk or high (B = 1.20, p = .001), oral sex (B = 1.74, p = .001), anal sex (B = .61, p = .04), and bisexuality (B = .85, p = .03) all increased the number of these behaviors. Higher scores on the condom usage scale (B = -.38, p = .002) were found to decrease the number of risky sexual behaviors. Illicit drug use was an underpinning of the surprisingly positive relationship between positive self-image and risky sexual behaviors. It was concluded that school-based social workers, mental health care professionals, and community-based prevention providers can play a critical role in the training of peer facilitators, development, and supervision of peer-driven risk-reduction programs to address the complex interplay among self-esteem, sex, and substances.

Protocol for a Controlled Experiment to Identify the Causal Role of Acute Alcohol Consumption in Condomless Sex among HIV-Positive MSM: Study Procedures, Ethical Considerations, and Implications for HIV Prevention

Although alcohol consumption is frequently perceived as a driver of condomless sex and subsequent HIV acquisition, the causal nature of this relationship remains unclear, and little is known about alcohol's direct versus indirect impact on the sexual risk dynamics of those who are HIV-positive. To address this gap, we present the protocol for an in-progress NIAAA-funded controlled experiment, wherein a sample of HIV-positive men-who-have-sex-with-men (MSM) undergoes an alcohol consumption manipulation (alcohol/placebo/control) and sexual arousal induction (sexually aroused/non-aroused), and then reports intentions to engage in condom-protected and condomless sexual acts with hypothetical sexual partners differing in HIV serostatus (HIV+/HIV-/HIV status unknown), condom use preference (use/don't use/not stated), and physical attractiveness (attractive/unattractive). Study outcomes will identify alcohol's impact on HIV-positive MSM's condomless sex intentions in the context of experimentally-manipulated factors as well as risk-relevant personality traits and alcohol-related expectancies. Detailed experimental procedures, ethical considerations, and potential implications for HIV prevention are discussed.

A qualitative analysis of emerging adult black men's sexual decision-making behavior and substance use

Emerging adult Black men and substance users may have an increased risk for compromised sexual health. This study qualitatively investigated how substance use affects the sexual decision-making of emerging adult Black men. Nineteen Black men in college (18-24 years) completed a semi-structured interview about their sexual attitudes, behaviors, and perceptions and their substance use. Results show that substance use may not independently affect sexual risk behavior among emerging adult Black men. Findings highlight the importance of using approaches that incorporate structural and sociocultural factors when framing research and interventions related to substance use, sexual decision making, and Black men.

Men's condom use resistance: Alcohol effects on theory of planned behavior constructs

OBJECTIVE

This study is a novel investigation of (a) the utility of the Theory of Planned Behavior (TPB) to predict men's condom use resistance (CUR; i.e., attempts to avoid condom use with a partner who wants to use one and (b) the effects of alcohol on endorsement of TPB-CUR constructs.

METHOD

Using an alcohol administration protocol, a between- and within-subjects experiment was conducted with a community sample of 312 young male nonproblem drinkers who have sex with women. After assessing endorsement of TPB-CUR constructs (e.g., attitudes, norms, self-efficacy, control, and intentions) in a sober state, beverage condition was experimentally manipulated between subjects and endorsement of TPB-CUR constructs was reassessed.

RESULTS

Analyses included repeated measures multivariate analyses of variance (MANOVAs) with beverage condition (no alcohol vs. alcohol) as the between-subjects factor and time (prebeverage vs. postbeverage) as the within-subjects factor. Between-subjects, intoxicated participants reported significantly stronger CUR intentions, more favorable CUR attitudes and normative perceptions, and greater CUR self-efficacy than sober participants. There were significant within-subject changes for CUR intentions, attitudes, normative perceptions, and self-efficacy. Neither between- nor within-subjects effects were found for CUR control. An exploratory multigroup path analysis indicated that the relationships among the TPB-CUR constructs were similar for alcohol and no alcohol groups.

CONCLUSIONS

Findings indicated that alcohol intoxication increased men's CUR intentions and self-efficacy and led to more positive CUR attitudes and norms, yet had no effect on CUR control. Future research should examine whether there are similar effects of intoxication on TPB constructs related to other sexual risk behaviors.

An Interactive Website to Reduce Sexual Risk Behavior: Process Evaluation of TeensTalkHealth

Background

Different theoretical frameworks support the use of interactive websites to promote sexual health. Although several Web-based interventions have been developed to address sexual risk taking among young people, no evaluated interventions have attempted to foster behavior change through moderated interaction among a virtual network of adolescents (who remain anonymous to one another) and health professionals.

Objective

The objective was to conduct a summative process evaluation of TeensTalkHealth, an interactive sexual health website designed to promote condom use and other healthy decision making in the context of romantic and sexual relationships.

Methods

Evaluation data were obtained from 147 adolescents who participated in a feasibility and acceptability study. Video vignettes, teen-friendly articles, and other content served as conversation catalysts between adolescents and health educators on message boards.

Results

Adolescents’ perceptions that the website encouraged condom use across a variety of relationship situations were very high. Almost 60% (54/92, 59%) of intervention participants completed two-thirds or more of requested tasks across the 4-month intervention. Adolescents reported high levels of comfort, perceived privacy, ease of website access and use, and perceived credibility of health educators. Potential strategies to enhance engagement and completion of intervention tasks during future implementations of TeensTalkHealth are discussed, including tailoring of content, periodic website chats with health educators and anonymous peers, and greater incorporation of features from popular social networking websites.

Conclusions

TeensTalkHealth is a feasible, acceptable, and promising approach to complement and enhance existing services for youth.

Daily co-occurrence of alcohol use and high-risk sexual behavior among heterosexual, heavy drinking emergency department patients

BACKGROUND

Global association and experimental studies suggest that alcohol use may increase sexual behavior that poses risk for exposure to sexually transmitted infections (STI) among heterosexual men and women. However, results from longitudinal and daily recall studies exploring the co-occurrence of alcohol use with various sexual risk outcomes in more naturalistic contexts have been mixed, and the bulk of this research has focused on college students.

METHODS

The current study enrolled heavy-drinking emergency department (ED) patients and used a cross-sectional, 30-day Timeline Followback (TLFB) method to examine the daily co-occurrence between alcohol use and three sexual behavior outcomes: Any sex, unprotected intercourse (UI), and UI with casual partners (versus protected intercourse [PI] with casual partners, or UI/PI with steady partners).

RESULTS

Results indicated that increasing levels of alcohol use on a given day increased the odds of engaging in any sexual activity and that heavy drinking (but not very heavy drinking) on a given day was associated with an increased odds of engaging in UI with either steady or casual partners. However, day-level alcohol use was not associated with an increased odds of UI with casual partners.

CONCLUSIONS

These findings suggest that alcohol may play an important role in increasing risk for HIV/STIs among heterosexuals, and support the continued need to target heavy drinking in sex risk reduction interventions. However, our results also suggest that alcohol may not universally result in unprotected sex with casual partners, a behavior posing perhaps the highest risk for HIV/STI transmission.

Daily Associations Between Drinking and Sex Among College Students: A Longitudinal Measurement Burst Design

Daily links between alcohol use and sexual behaviors were examined in a longitudinal study of college students. Hierarchical linear models predicted sexual behaviors by characteristics of persons (N=731; Level 3), semesters (N=4,345, Level 2), and days (N=56,372, Level 1). On a given day, consuming more drinks and binge drinking were associated with greater odds of kissing, touching, oral sex, and penetrative sex. Consistent with alcohol myopia and expectancy theories, associations between binge drinking and sexual behaviors were stronger for students not in romantic relationships, for students with stronger alcohol-sex expectancies, and for oral and penetrative sex. Findings suggest that within-day links between alcohol use and sexual behaviors are evident across college, with variations based on individual and relationship factors.

Parental mediation of media messages does matter: more interaction about objectionable content is associated with emerging adults' sexual attitudes and behaviors

An online survey of undergraduates explored the effects of recalled parent-child interaction regarding media on their critical thinking skills, beliefs about alcohol and sex, and current reports of attitudes and risky sexual behaviors. Students from a northwestern university completed the questionnaire three times during the fall of 2011. Effective parental mediation was found to be a protective factor against the negative effects of objectionable content on sexual attitudes and behaviors through its effect on critical thinking toward media content and expectancies. Participants whose parents critiqued media portrayals reported a higher level of critical thinking. More critical orientation toward media decreased the effects of objectionable content on expectancies and sexual behaviors. On the other hand, participants whose parents endorsed media portrayals reported lower levels of critical thinking. Developing critical thinking toward media is an effective approach to helping young people make good decisions about their health. Although viewers' understanding of media content may be biased by the emotional aspect of decision making, critical thinking was shown to decrease the appeal of mediated messages on behaviors. Parents play an important role in developing children's critical thinking skills, and those who mediate their children's media use can establish behaviors that will prove beneficial to their children later in life.

Factors associated with alcohol and/or drug use at sexual debut among sexually active university students: cross-sectional findings from Lebanon

Background

Sexual activity accompanied by substance use can impair youth decision-making and enhance risk-taking behaviors. Less is known, however, about the sexual values, perceptions and subsequent sexual practices of youth whose sexual debut occurs while using alcohol/drugs.

Methods

A cross-sectional anonymous online survey was conducted in April-August 2012 among undergraduate and graduate university students (aged 18 to 30) attending the 4th largest private university in Beirut. Pearson’s Chi-square and regression models were run using Stata/IC 10.0.

Results

940 university students had engaged in oral, anal and/or vaginal sex, of whom 10% admitted to having had consumed alcohol or taken drugs at sexual debut, a behavior that was more common in the males, less religious, non-Arabs, students living alone or who had lived abroad. Students who used alcohol/drugs at sexual debut were twice as likely to have: their first oral and vaginal sex with an unfamiliar partner [odds ratio (OR) = 2.6, 95% confidence interval (CI): (1.6, 4.2) and OR = 2.1 (1.2, 3.5), respectively], controlling for sex, nationality, current relationship status, living abroad after the age of 12, and spirituality. Students who had sex the first time while using alcohol/drugs were three times as likely to report having had 11 or more subsequent sexual partners versus one or two [OR = 3.0 (1.5-6.0)]; and almost twice as likely to ever engage in something sexual they did not want to do [OR = 1.7 (1.1, 2.8)]. Perceived peer pressure to have sex by a certain age [OR = 1.8 (1.1, 2.9)], and perceived peer norms to consume alcohol/drugs before sex [OR = 4.8 (2.3, 9.9)] were also strong correlates of having sex for the first time while using alcohol and/or drugs.

Conclusions

Findings stress the importance of sexuality education for youth, and the need to begin understanding the true interplay – beyond association - between youth sexual practices and substance use behaviors from a broader public health perspective.

The impact of childhood abuse on inpatient substance users: specific links with risky sex, aggression, and emotion dysregulation

Adults with substance use disorders (SUDs) report a high prevalence of childhood abuse. Research in the general population suggests specific types of abuse lead to particular negative outcomes; it is not known whether this pattern holds for adults with SUDs. We hypothesized that specific types of abuse would be associated with particular behavioral and emotional outcomes among substance users. That is, childhood sexual abuse would be associated with risky sex behaviors, childhood physical abuse with aggression, and childhood emotional abuse with emotion dysregulation. 280 inpatients (M age=43.3; 69.7% male; 88.4% African American) in substance use treatment completed the Childhood Trauma Questionnaire (CTQ), HIV Risk-Taking Behavior Scale, Addiction Severity Index, Difficulties with Emotion Regulation Scale (DERS), Distress Tolerance Scale (DTS), and Affect Intensity and Dimensions of Affiliation Motivation (AIM). Consistent with our hypotheses, the CTQ sexual abuse subscale uniquely predicted exchanging sex for cocaine and heroin, number of arrests for prostitution, engaging in unprotected sex with a casual partner during the prior year, and experiencing low sexual arousal when sober. The physical abuse subscale uniquely predicted number of arrests for assault and weapons offenses. The emotional abuse subscale uniquely predicted the DERS total score, AIM score, and DTS score. Among substance users, different types of abuse are uniquely associated with specific negative effects. Assessment of specific abuse types among substance users may be informative in treatment planning and relapse prevention.

Hooking up in the college context: the event-level effects of alcohol use and partner familiarity on hookup behaviors and contentment

The current study examined hooking up experiences through event-level analyses, including the connections involving alcohol use, the extent of physical contact, and postevaluations of the hookup event. Participants were 828 college students (67.0% female). Of students who reported hooking up sometime within the past year (54.8%), chi-square analyses revealed that they were more likely to have been drinking when they met their partners the night of the hookup. Females who were drinking beforehand and females who met their partners that night were more likely to feel discontent with their hookup decisions. Among participants who consumed alcohol prior to their last hookup, a notable 30.7% of females and 27.9% of males indicated that they would likely not have hooked up with their partners had alcohol not been involved. Further, 34.4% of females and 27.9% of males indicated that they would not have gone as far physically if they had not been drinking. Among participants who reported both drinking beforehand and hooking up with unfamiliar partners, greater number of drinks consumed was associated with more advanced sexual behaviors. The current findings highlight the potential risks associated with alcohol use in the hooking up culture.

Being drunk and high during sex is not associated with condom use behaviours: a study of high-risk young Black males

Objective To assess the relationship between the frequency of being drunk and high during sex, and condom use errors and problems (CUEP) among a sample of high-risk young Black males recruited from the United States.

METHODS

Data were collected in clinics treating sexually transmissible infections in three cities in the southern United States. Males 15-23 years of age (n=697) who identified as African-American and reported recent (past 2 months) condom use were eligible. Measures of alcohol and drug use, as well as condom use behaviours were assessed by audio-computer assisted self-interview. Eighteen CUEP were included in this assessment.

RESULTS

Sixteen bivariate correlations were obtained. The magnitude of the coefficients was small, ranging from 0.01 to 0.13. Only three were significant. These were positive associations between the frequency of being drunk and the frequency of unprotected vaginal sex, as well as the frequency of the 18-item measure of CUEP. A significant correlation was also found between the frequency of being high during sex and the frequency of unprotected vaginal sex. Adjustments for age did not change the findings.

CONCLUSIONS

Interventions designed to promote safer sex behaviours among young Black males attending sexually transmissible infection clinics are no more likely to benefit patients through the inclusion of messages and training attempting to dissuade the use of alcohol and drugs before or during sex.

Do alcohol and marijuana use decrease the probability of condom use for college women?

Alcohol and marijuana use are thought to increase sexual risk taking, but event-level studies conflict in their findings and often depend on reports from a limited number of people or on a limited number of sexual events per person. With event-level data from 1,856 sexual intercourse events provided by 297 college women (M age = 18 years; 71% White), we used multilevel modeling to examine associations between alcohol and marijuana use and condom use as well as interactions involving sexual partner type and alcohol-sexual risk expectancies. Controlling for alternative contraception use, partner type, regular levels of substance use, impulsivity and sensation seeking, and demographics, women were no more or less likely to use condoms during events involving drinking or heavy episodic drinking than during those without drinking. However, for drinking events, there was a negative association between number of drinks consumed and condom use; in addition, women with stronger alcohol-sexual risk expectancies were marginally less likely to use condoms when drinking. Although there was no main effect of marijuana use on condom use, these data suggest marijuana use with established romantic partners may increase risk of unprotected sex. Intervention efforts should target expectancies and emphasize the dose-response relationship of drinks to condom use.

Correlates of consistent condom use among men who have sex with men recruited through the Internet in Huzhou city: a cross-sectional survey

Background

There is growing evidence that men who have sex with men (MSM) are currently a group at high risk of HIV infection in China. Our study aims to know the factors affecting consistent condom use among MSM recruited through the internet in Huzhou city.

Methods

An anonymous cross-sectional study was conducted by recruiting 410 MSM living in Huzhou city via the Internet. The socio-demographic profiles (age, education level, employment status, etc.) and sexual risk behaviors of the respondents were investigated. Bivariate logistic regression analyses were performed to compare the differences between consistent condom users and inconsistent condom users. Variables with significant bivariate between groups’ differences were used as candidate variables in a stepwise multivariate logistic regression model. All statistical analyses were performed using SPSS for Windows 17.0, and a p value < 0.05 was considered to be statistically significant.

Results

According to their condom use, sixty-eight respondents were classified into two groups. One is consistent condom users, and the other is inconsistent condom users. Multivariate logistic regression showed that respondents who had a comprehensive knowledge of HIV (OR = 4.08, 95% CI: 1.85-8.99), who had sex with male sex workers (OR = 15.30, 95% CI: 5.89-39.75) and who had not drunk alcohol before sex (OR = 3.10, 95% CI: 1.38-6.95) were more likely to be consistent condom users.

Conclusions

Consistent condom use among MSM was associated with comprehensive knowledge of HIV and a lack of alcohol use before sexual contact. As a result, reducing alcohol consumption and enhancing education regarding the risks of HIV among sexually active MSM would be effective in preventing of HIV transmission.

The temporal relationship between momentary affective states and condom use in depressed adolescents

Depressed adolescents are more likely to engage in sexual risk behaviors than their non-depressed peers. The objectives of this study were (1) to examine whether affective states predicted subsequent condom use, directly or indirectly through contextual factors and (2) to compare results obtained from structural equation models versus non-linear mixed effects models. This study used ecological momentary assessment to collect data on in-the-moment affective states and sexual behavior from 51 depressed adolescents (7 male, 44 female) aged 15-22 years. The association between positive and negative affect and condom use during a subsequent sex event was explored using several structural equation models and non-linear mixed effects models. Potential mediation by substance use before sex, partner type, reason for sex, and who wanted sex was examined. Neither positive nor negative affect was directly associated with condom use in any models; however, negative affect was associated with increased likelihood of sex with a non-main partner, which, in turn, was associated with increased condom use. Both structural equation models and non-linear mixed effects models successfully modeled the relationship between affect and condom use in momentary data while correctly accounting for the correlation of multiple observations from the same individual. The benefit of structural equation modeling was the ability to directly model the mediation of this effect by contextual factors. In this sample of depressed adolescents, negative and positive affect did not appear to be directly predictive of condom use during a subsequent sex event, although may indirectly affect condom use through sex with a non-main partner.

Relationships between marijuana dependence and condom use intentions and behavior among justice-involved adolescents

The current study examined the relationships among marijuana dependence, a theoretical model of condom use intentions, and subsequent condom use behavior in justice-involved adolescents. Participants completed baseline measures of prior sexual and substance use behavior. Of the original 720 participants, 649 (90.13 %) completed follow-up measures 6 months later. There were high levels of marijuana use (58.7 % met criteria for dependence) and risky sexual behavior among participants. Baseline model constructs were associated with condom use intentions, and intentions were a significant predictor of condom use at follow-up. Marijuana dependence did not significantly influence the relationships between model constructs, nor did it moderate the relationship of model constructs with subsequent condom use. Findings suggest that the theoretical model of condom use intentions is equally valid regardless of marijuana dependence status, suggesting that interventions to reduce sexual risk behavior among both marijuana dependent and non-dependent justice-involved adolescents can be appropriately based on the model.

Marijuana use is associated with risky sexual behaviors in treatment-seeking polysubstance abusers

BACKGROUND

Multiple types of substance use are associated with HIV risk behaviors, but relatively little research has examined the association between marijuana use and risky sexual activities in treatment-seeking polysubstance abusing patients.

OBJECTIVES

This study evaluated the relationship between marijuana use and sexual behaviors in 239 patients with cocaine, opioid or alcohol use disorders who were initiating outpatient substance use treatment.

METHODS

Participants completed the HIV Risk Behavior Scale and were classified into one of three groups based on their marijuana use histories: never (n = 66), past but not current use (n = 124) or current use (n = 49).

RESULTS

Compared to never marijuana users, current and former marijuana users had a greater likelihood of having more than 50 lifetime sexual partners (odds ratio [OR] and 95% confidence interval [CI] = 3.9 [1.0-15.7] and 5.2 [1.6-17.3], respectively). Former marijuana users had increased risk of low frequency condom use with casual partners relative to never users (OR [95% CI] = 2.9 [1.1-7.6]). Moreover, current marijuana users were more likely than never users to have had more than two recent sexual partners (OR [95% CI] = 8.1 [1.94-33.44]).

CONCLUSION

Treatment-seeking polysubstance abusers with current or past marijuana use histories may be at greater risk of HIV infection than their counterparts who do not use marijuana. These data underscore the importance of increasing awareness about the potential association between marijuana use and increased high-risk sexual behavior among polysubstance abusing patients.

Event-level association between alcohol use and unprotected sex during last sex: evidence from population-based surveys in sub-Saharan Africa

BACKGROUND

HIV and risky alcohol use are intertwined public health issues in sub-Saharan Africa. Research supports the association between alcohol and unprotected sex, but there is limited data using event-level analysis to examine this relationship.

METHODS

Using data from Demographic Health Surveys and AIDS Information Surveys collected in 8 sub-Saharan African countries (Kenya, Lesotho, Mozambique, Rwanda, Swaziland, Tanzania, Zambia, and Zimbabwe) drunkenness (reporting male partner or both male and female partner being drunk during last sexual intercourse) at last sex was tested as a predictor of unprotected last sex among the male (n = 24,512) and female (n = 28,229) participants. Partner type, HIV test results, and the other variables were evaluated as effect modifiers of this relationship.

RESULTS

Drunkenness at last sex had a negative effect on the likelihood of condom use among men (AOR 0.84, 95% CI 0.72-0.99) and a marginally significant effect among women (AOR 0.87, 95% CI 0.59-1.02) in Southern Africa. However, for men in Southern Africa, this effect was primarily observed with steady partners. Contrary to predictions, in both Southern and Eastern Africa, for men, drunkenness during sex with casual partners increased the odds of condom use.

CONCLUSIONS

These data indicate a need to implement HIV prevention efforts that consider the role of alcohol use in precipitating unprotected sex and how it varies based upon partner type.