Cocaine-dependent adults and recreational cocaine users are more likely than controls to choose immediate unsafe sex over delayed safer sex

Retail demand for emergency contraception in United States following New Year holiday: time series study

OBJECTIVE

To estimate the increase in sales of emergency contraception following the New Year's Eve/New Year's Day holiday.

DESIGN

Time series analysis using autoregressive integrated moving average (ARIMA) model.

SETTING

Traditional (that is, "bricks and mortar") retail outlets-grocery stores, drug stores, mass merchandisers, club stores, dollar stores, and military outlets-in the United States from 2016 to 2022.

DATA SOURCE

Marketing data on weekly aggregated sales of items classified as emergency contraception gathered between 2016 and 2022 (n=362). On the basis of dates, weeks were classified as following the New Year holiday (n=6) or not (n=356).

MAIN OUTCOME MEASURE

Weekly sales of levonorgestrel emergency contraception per 1000 women of reproductive age in the US population.

RESULTS

Sales of levonorgestrel emergency contraception significantly increased after the New Year holiday (0.63 (95% confidence interval 0.58 to 0.69) unit increase per 1000 women aged 15-44). Holidays that share some aspects of the elevated risks of unprotected sexual intercourse with the New Year holiday (Valentine's Day, St Patrick's Day, US Independence Day) were associated with increased sales, albeit to a lesser degree, with respective sales increases per 1000 women aged 15-44 of 0.31 (0.25 to 0.38), 0.14 (0.06 to 0.23), and 0.20 (0.11 to 0.29). Holidays without these expectations (Easter, Mother's Day, Father's Day) were not significantly associated with sales of levonorgestrel emergency contraception.

CONCLUSIONS

Increased sales of emergency contraception following the New Year's holiday suggest that this period is associated with increased risks of unprotected vaginal intercourse compared with other holidays. Targeting behavioral risks, prevention strategies to mitigate sexual violence, and improving access to contraception around holidays may limit the risks associated with unprotected vaginal intercourse.

Neurological, Behavioral, and Pathophysiological Characterization of the Co-Occurrence of Substance Use and HIV: A Narrative Review

Combined antiretroviral therapy (cART) has greatly reduced the severity of HIV-associated neurocognitive disorders in people living with HIV (PLWH); however, PLWH are more likely than the general population to use drugs and suffer from substance use disorders (SUDs) and to exhibit risky behaviors that promote HIV transmission and other infections. Dopamine-boosting psychostimulants such as cocaine and methamphetamine are some of the most widely used substances among PLWH. Chronic use of these substances disrupts brain function, structure, and cognition. PLWH with SUD have poor health outcomes driven by complex interactions between biological, neurocognitive, and social factors. Here we review the effects of comorbid HIV and psychostimulant use disorders by discussing the distinct and common effects of HIV and chronic cocaine and methamphetamine use on behavioral and neurological impairments using evidence from rodent models of HIV-associated neurocognitive impairments (Tat or gp120 protein expression) and clinical studies. We also provide a biopsychosocial perspective by discussing behavioral impairment in differentially impacted social groups and proposing interventions at both patient and population levels.

Measuring Sexual Risk-Taking: A Systematic Review of the Sexual Delay Discounting Task

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.

Sexual discounting: A systematic review of discounting processes and sexual behavior

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).

Impulsivity across substance use categories: Consideration of sex/gender

PURPOSE OF REVIEW

The goal was to review recent (1/2015-2/2020) evidence of impulsivity as a feature of substance use disorders or use of substances (alcohol, cannabis, nicotine, opioids, stimulants) in males compared to females in terms of: a) impulsivity in substance-using groups (or substance-using compared to control groups), and b) relationship between impulsivity and substance use behavior, clinical severity, or treatment outcomes.

RECENT FINDINGS

Of 361 papers identified by the searches, 69 met inclusion criteria, and 39 were highlighted for considering sex/gender in relation to impulsivity in substance-using populations. Taken together, findings supported higher impulsivity in males and females who use substances, relative to controls; and higher impulsivity was linked with more substance use/severity in both sex/genders. There were mixed findings regarding male versus female differences in impulsivity among individuals who use substances, or in the magnitude of the relationship between impulsivity and substance use severity.

SUMMARY

The current body of evidence does not point to a consistent sex/gender difference in the role of impulsivity within and across substance use disorders. Impulsivity is a clinically-relevant construct for male and female individuals who use substances, across a range of substances.

The Hotel Room Purchase Task: Effects of Gender and Partner Desirability on Demand for Hypothetical Sex in Individuals with Disordered Cocaine Use and Controls

Hypothetical purchase tasks allow for rapid assessment of behavioral economic demand for numerous commodities and are useful in evaluating reinforcer pathologies, such as substance and behavioral addiction. Currently, there is not a task for evaluating demand for sex without requiring implicit engagement in sex work. The current study used a novel purchase task with hotel rooms for sex as the hypothetical commodity to assess demand for sex in individuals with disordered cocaine use, a population that frequently engages in risky sexual behavior. Adults meeting criteria for cocaine abuse or dependence (13 males, ten females) and noncocaine-using controls (eight males, three females) chose hypothetical sexual partners from a series of photographs and endorsed two partners with whom they would most and least like to have sex. Participants then completed the hotel purchase task for both partners, wherein they reported how many nights at a hotel room, at prices from $10 to $1280 per night, they would purchase in a year. Demand intensity was significantly greater and demand elasticity was significantly lower for the most preferred relative to the less preferred partner. Males demonstrated significantly greater intensity and lesser elasticity for sex than females. Demand metrics did not differ between the cocaine and control group. This task may serve as a useful measure of demand for sex without requiring implicit hypothetical engagement in sex work. Future studies exploring the relation between task performance and other characteristics such as sexual dysfunction, in addition to acute substance administration effects, may further determine the task's clinical utility.

Demographic and sexual risk predictors of delay discounting of condom-protected sex

Objective: Sexual delay discounting describes the decreased likelihood of condom-protected sex if a condom is not immediately available, which can be quantitatively summarised using the Sexual Delay Discounting Task (SDDT). The present studies determined the extent to which condom use likelihood as assessed by the SDDT is associated with self-reported sexual risk behaviours and demographics in two online samples of adults. Design: Study 1 (n = 767) assessed demographics, sexual risk behaviour, and delay discounting, and examined relations between these variables using correlation and regression. Study 2 (n = 267) examined whether real-world instances of unprotected sex because a condom was not immediately available predicted greater sexual discounting. Main outcome measures: Sexual delay discounting, condom use. Results: Both studies observed significant positive relations between sexual delay discounting and self-reported sexual risk behaviours, and found that males tended to show greater sexual discounting. In Study 2, 46% of the sample self-reported having unprotected sex because a condom was not immediately available, and these individuals showed significantly greater sexual delay discounting. Conclusion: These results extend prior findings by demonstrating that delay is a critical variable underlying real-life sexual risk behaviour among non-clinical samples. The SDDT is an ecologically valid measure of these processes.

Substance Use and Sexual Risk Behavior Among Male and Transgender Women Sex Workers at the Prostitution Outreach Center in Amsterdam, the Netherlands

OBJECTIVES

Male and transgender women sex workers (TSWs) are vulnerable for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV), and substance use might be a relevant contributing factor. We assessed sociodemographic characteristics and substance use among sex workers; divided into 3 groups: Transgender women sex workers, male sex workers who have sex with men only or also with females (MSW-M), male sex workers who have sex with females only (MSW-F).

METHODS

A survey on substance use and sexual (risk) behavior was offered during routine STI screening at the Prostitution and Health Centre (P&G292) in Amsterdam. Bacterial STI positivity (chlamydia (including lymphogranuloma venereum), gonorrhea, and/or infectious syphilis), and substance use were compared (χ test, Fisher exact test).

RESULTS

From 2014 until 2015, 99 (60.4%) of 164 eligible visitors participated (n = 69 MSW-M [69.7%], n = 15 TSW [15.2%], and n = 15 MSW-F [15.2%]). Transgender women sex workers reported the highest number of sex partners in the previous 6 months (median: MSW-M 60 vs. TSW 300 vs. MSW-F 12; P < 0.001). The 3 groups did not differ in having condomless anal or oral sex. Bacterial STI positivity was 29.0% in MSW-M, 26.7% in TSW, and 13.3% in MSW-F (P = 0.56). Three new HIV infections were diagnosed, all in MSW-M, whereas 20.3% of MSW-M and 20.0% of TSW were known HIV-positive compared with none of MSW-F (P = 0.14). Illicit substance use during working time in <6 months was 40.5% among MSW-M, 40.0% among TSW, and 20.0% among MSW-F (P = 0.02). The most reported reason for substance use was: "sex work becomes physically easier."

CONCLUSIONS

Bacterial STI positivity and illicit substances use during work were high in all 3 sex worker groups, emphasizing the importance of combined and targeted interventions. In-depth qualitative research is needed to better understand intentions and reasons for substance use.

Single- and cross-commodity delay discounting of money and e-cigarette liquid in experienced e-cigarette users

BACKGROUND

Delay discounting (DD) research has improved our understanding of important behavioral processes associated with tobacco use. Little research has explored DD among e-cigarette users, and these studies have exclusively examined money as the only available commodity. This secondary analysis of a laboratory study explored discounting for money and e-liquid among e-cigarette users using two single-commodity discounting (SCD) tasks and one cross-commodity discounting (CCD) task. A secondary goal was to explore the extent to which results from the SCD and CCD tasks were correlated to each other and with measures of e-cigarette use.

METHODS

E-cigarette users (N = 27) completed two SCD tasks and one CCD task. The SCD tasks assessed choices between various amounts of either money now versus money later (M-M) or e-liquid now versus e-liquid later (mL-mL). The CCD task assessed choices between e-liquid now versus money later (mL-M). Discounting results were compared using logk and AUClog.

RESULTS

Discounting was greatest in the mL-mL task, followed by the M-M task, and then the mL-M task. AUClog and logk were significantly correlated across all discounting tasks. Attempts to quit vaping was positively associated with logk and negatively associated with AUClog and in both SCD tasks.

CONCLUSIONS

E-cigarette users discount e-liquid more than money in a SCD task. However, when the two commodities, money and e-liquid (CCD), are compared the substance of abuse is discounted to a lesser extent. Interventions that provide alternative reinforcers to compete with the reinforcing effects of nicotine intake may be especially indicated for treating e-cigarette dependence.

Concordance between monetary and sexual delay discounting in men who have sex with men

Background Delay discounting has been found to be associated with numerous health-related outcomes, including risky sexual behaviour. To date, it is unclear whether delay discounting measured in different domains is associated within individuals. The goal of this study was to assess the concordance of monetary and sexual delay discounting in men who have sex with men.

METHODS

Participants completed an online survey, including the Monetary Choice Questionnaire and the Sexual Discounting Task. Linear regression models were used to assess the association between monetary and sexual discount rates.

RESULTS

Sexual discount rates did not predict monetary discount rates. There was a substantial amount of clustering of sexual discount rates, requiring sexual discounting data to be categorised.

CONCLUSIONS

Monetary and sexual delay discounting are distinct processes that are not necessarily associated within individuals, and monetary delay discounting is not an appropriate proxy measure for sexual impulsivity. Data from the Sexual Discounting Task are typically rank-transformed for analysis. These data suggest that this might be an invalid method of analysis. Future studies should investigate the distribution of their data to determine if it is appropriate to analyse sexual discounting data as a continuous measure.

Relationships among impulsive, addictive and sexual tendencies and behaviours: a systematic review of experimental and prospective studies in humans

Impulsivity's relationships to addictive and sexual behaviours raise questions regarding the extent impulsivity may constitute a vulnerability factor for subsequent addictive and sexual behaviours and/or results from each of these. Here, we systematically reviewed empirical support for impulsivity as a precipitating factor or a consequence of addictive or sexual behaviours. We restricted ourselves to recent, human studies with assessments over time, including at least one measure of impulsivity, addictive and sexual behaviours, yielding a review including 29 published reports from 28 studies. Findings point to generalized, self-reported impulsivity as a predictor of addictive and sexual behaviours at a wide range of severity, with elements of both impulsivity and compulsivity to these acts. Alcohol consumption often increases impulsive behaviour, including inclinations towards impulsive and potentially compulsive sexual acts. Research using the Sexual Delay Discounting Task has yielded findings linking impulsivity, addictive and sexual behaviour and as such is a valuable research tool that should be used more extensively. The present review identified gaps to be addressed in further research that concurrently examines facets of impulsivity, addictive and sexual behaviours, especially because criteria for compulsive sexual behaviour disorder have been included in the eleventh edition of the International Classification of Diseases. This article is part of the theme issue 'Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications'.

Impact of time perspectives on texting intervention to reduce HIV/STI transmission among female sex workers in Tijuana and Ciudad Juarez, Mexico

Text messages may sustain post-counseling gains in behavioral improvements and reduce HIV/STI incidence. However, their effectiveness may depend on the messages' time perspective and characteristics of the individual. We evaluated the impact of time perspective on a text messaging intervention designed to maintain improvements in safer sex practices among drug-using and non-drug-using female sex workers (FSWs) in Tijuana (n = 141) and Cd. Juarez (n = 129), Mexico. FSWs received the efficacious Mujer Segura intervention, and were randomized to receive safer sex maintenance text messages with either a short-term or future-oriented time perspective. The outcome was HIV/STI incidence rate over 6-month follow-up. In Tijuana, combined HIV/STI incidence density was lower among FSWs in the FUTURE group (31.67 per 100 py) compared to women in the SHORT-TERM group (62.40 per 100 py). Conversely, in Cd. Juarez, HIV/STI incidence density was lower (although non-significant) among FSWs in the SHORT-TERM group (19.80 per 100 py) compared to those in the FUTURE group (35.05 per 100 py). These findings suggest that future-oriented text messages may sustain post-counseling improvements in sexual risk behavior among FSWs, but findings may vary by FSWs' characteristics (e.g., drug use), and by region and context.

Examining factors associated with unprotected sexual behavior among Black Americans postrelease from incarceration in New York City

Black Americans are overrepresented among incarcerated individuals and those infected with sexually transmitted infections. We assessed unprotected sexual behavior among 165 formerly incarcerated Black Americans in New York City, New York. Most participants (63%) reported engaging in unprotected sexual behavior post-incarceration. According to our regression results, less time spent in jail and reporting multiple sexual partnerships were associated with a greater likelihood of engaging in unprotected sexual behavior. High rates of unprotected sexual behavior may place formerly incarcerated Black Americans at risk for sexually transmitted infections. Discharge planning programs that include STI/HIV prevention information and education may be useful for this population.

The Effects of Condom Availability on College Women's Sexual Discounting

College students commonly engage in risky sexual behaviors, such as casual sexual encounters and inconsistent condom use. Discounting paradigms that examine how individuals devalue rewards due to their delay or uncertainty have been used to improve our understanding of behavioral problems, including sexual risk. The current study assessed relations between college women's sexual partners discounting and risky sexual behavior. In this study, college women (N = 42) completed two sexual partners delay discounting tasks that assessed how choices among hypothetical sexual partners changed across a parametric range of delays in two conditions: condom availability and condom unavailability. Participants also completed two sexual partners probability discounting tasks that assessed partner choices across a parametric range of probabilities in condom availability and unavailability conditions. Additionally, participants reported risky sexual behavior on the Sexual Risk Survey (SRS). Participants discounted delayed partners more steeply in the condom availability condition, but those differences were significant only for those women with three or fewer lifetime sexual partners. There were no consistent differences in discounting rate across condom availability conditions for probability discounting. Sexual partners discounting measures correlated with risky sexual behaviors as measured by the SRS, but a greater number of significant relations were observed with the condoms-unavailable delay discounting task. These findings suggest the importance of examining the interaction of inconsistent condom use and multiple partners in examinations of sexual decision-making.

Clinical models of decision making in addiction

As research on decision making in addiction accumulates, it is increasingly clear that decision-making processes are dysfunctional in addiction and that this dysfunction may be fundamental to the initiation and maintenance of addictive behavior. How drug-dependent individuals value and choose among drug and nondrug rewards is consistently different from non-dependent individuals. The present review focuses on the assessment of decision-making in addiction. We cover the common behavioral tasks that have shown to be fruitful in decision-making research and highlight analytical and graphical considerations, when available, to facilitate comparisons within and among studies. Delay discounting tasks, drug demand tasks, drug choice tasks, the Iowa Gambling Task, and the Balloon Analogue Risk Task are included.

Recreational drug use and risk of HIV infection among men who have sex with men: A cross-sectional study in Shenzhen, China

BACKGROUND

Recreational drug use has increased in recent years, especially among MSM, and has been found to be associated with higher risk of HIV infection. However, there is limited information about current recreational drug use among MSM in Shenzhen which is an international gateway city to China with a rapidly expanding MSM population.

METHODS

A cross-sectional survey among MSM in Shenzhen was conducted and was used to collected information on demographics, sexual behavior and drug use via questionnaires. Serologic results on HIV and syphilis were obtained from laboratory assays. We performed logistic regression analysis to evaluate correlates with drug use.

RESULTS

Among the 1935 MSM surveyed, 12.7% reported use of recreational drugs in the past six months. Rush poppers had become the most frequently used drug (10.6%). Risk factors associated with the use of recreational drugs included being unmarried, non-Han ethnicity, having high education level, seeking male sex partners via the internet, having multiple male sex partners, performing receptive role during anal sex, and having unprotected anal intercourse. Recreational drug use was significantly associated with higher risk of both HIV and syphilis infections (aOR:1.89, 95% CI:1.28-2.79; aOR:1.79, 95% CI:1.25-2.60, respectively).

CONCLUSIONS

Recreational drug use is associated with increased risk of HIV and syphilis infections among MSM in Shenzhen. Rush poppers were the most popular recreational drug. This finding suggests the need for targeted prevention and behavioral intervention programs to control the recreational drug use, and to reduce HIV and other sexually transmitted diseases among MSM in Shenzhen and internationally.

Regret Expression and Social Learning Increases Delay to Sexual Gratification

Objective

Modification and prevention of risky sexual behavior is important to individuals’ health and public health policy. This study employed a novel sexual discounting task to elucidate the effects of social learning and regret expression on delay to sexual gratification in a behavioral task.

Methods

Amazon Mechanical Turk Workers were assigned to hear one of three scenarios about a friend who engages in similar sexual behavior. The scenarios included a positive health consequence, a negative health consequence or a negative health consequence with the expression of regret. After reading one scenario, participants were asked to select from 60 images, those with whom they would have casual sex. Of the selected images, participants chose one image each for the person they most and least want to have sex with and person most and least likely to have a sexually transmitted infection. They then answered questions about engaging in unprotected sex now or waiting some delay for condom-protected sex in each partner condition.

Results

Results indicate that the negative health outcome scenario with regret expression resulted in delayed sexual gratification in the most attractive and least STI partner conditions, whereas in the least attractive and most STI partner conditions the negative health outcome with and without regret resulted in delayed sexual gratification.

Conclusions

Results suggest that the sexual discounting task is a relevant laboratory measure and the framing of information to include regret expression may be relevant for prevention of risky sexual behavior.