Intoxicated sexual risk taking: an expectancy or cognitive impairment explanation?

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.

Tracking COVID-19 vaccination expectancies and vaccination refusal in the United States

To identify factors that predict COVID-19 vaccination refusal and show how expectancies affect vaccination acceptance for non-vaccinated adults, we used a monthly repeated cross-sectional sample from June/2021 to October/2021 to collect data on vaccination behaviors and predictor variables for 2,116 US adults over 50 years of age. Selection bias modeling - which is required when data availability is a result of behavioral choice - predicts two outcomes: (1) no vaccination vs. vaccination for the entire sample and (2) the effects of expectancy indices predicting vaccination Refuser vs. vaccination Accepters for the unvaccinated group. Vaccine refusers were younger and less educated, endorsed common misconceptions about the COVID-19 epidemic, and were Black. Vaccination expectancies were related to vaccination refusal in the unvaccinated eligible group: negative expectancies increased vaccine refusal, while positive expectancies decreased it. We conclude that behavior-related expectancies (as opposed to more stable psychological traits) are important to identify because they are often modifiable and provide a point of intervention, not just for COVID-19 vaccination acceptance but also for other positive health behaviors.

Prevalence and associated factors of early initiation of sexual intercourse among youth in Ethiopia: systematic review and meta-analysis

BACKGROUND

Early sexual initiation refers to engaging in sexual activity at a young age, typically before the age of 18. Even though many studies have been conducted in Ethiopia, the result is inconsistent between studies. In the study area, the pooled prevalence and associated factors of early initiation of sexual intercourse among youth were not done before. Therefore, this study aimed to determine the pooled prevalence and associated factors of early initiation of sexual intercourse among Youth in Ethiopia.

METHODS

This study used a systematic review and meta-analysis of studies conducted from 2008 to 2022, in Ethiopia. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. PubMed, Cochrane Library, Hinari, and Google Scholar electronic databases were searched. The analysis was performed using STATA 17 software. Heterogeneity and publication bias were assessed using forest plots, I2, Cochran's Q statistics and Funnel plots, Egger test, and Begg rank tests respectively. Duval and Tweedie's 'trim and fill' method was also performed to adjust the pooled estimate. Pooled analysis was conducted using the inverse-variance fixed-effects model.

RESULTS

A total of 10 articles were included in this systematic review and meta-analysis. The pooled prevalence of early initiation of sexual intercourse among youth in Ethiopia was 24.7% (95%CI: 10.4, 38.9). Being female (AOR = 3.57; 95% CI: 1.387, 5.743), having poor knowledge of HIV/AIDS prevention (AOR = 3.65; 95% CI: 1.981,5.309), alcohol use (AOR = 2.05; 95% CI: 1.415, 2.679), khat chewing (AOR = 3.03; 95% CI: 1.800, 4.254), Viewed pornographic film(AOR = 4.21, 95% CI: 2.135, 6.283), Cigarette smoking (AOR = 2.74; 95% CI: 2.102, 3.370) and Poor family controls (AOR = 4.39; 95% CI: 2.572, 6.199)were associated factors of early initiation of sexual intercourse.

CONCLUSIONS

The pooled prevalence of early initiation of sexual intercourse among Youth in Ethiopia was high. Being female, poor knowledge of HIV/AIDS prevention, alcohol use, khat chewing, Viewing pornographic films, Cigarette smoking, and poor family controls were associated factors of early initiation of sexual intercourse. It is recommended that targeted interventions be put in place to address the high prevalence of early initiation of sexual intercourse among youth in Ethiopia. These interventions should focus on addressing the associated factors such as poor knowledge of HIV/AIDS prevention, alcohol use, khat chewing, viewing pornographic films, cigarette smoking, and poor family controls. It is important that these interventions are gender-sensitive and take into consideration the unique challenges faced by females in accessing sexual and reproductive health services.

Alcohol Consumption Modifies Susceptibility to HIV-1 Entry in Cervical Mucosa-Derived CD4+ T cells of Women Resident in a Fishing Community of Lake Victoria, Uganda

Background

A significant overlap exists in the burden of Alcohol Use Disorders (AUDs) and the HIV epidemic in Sub-Saharan Africa. Over 60% of HIV infections occur in women, mostly through the cervical mucosa. Absorption and systemic circulation of alcohol induces global physiological and immune effects, including at the genital mucosa. Alcohol alters expression of cell surface receptors, mucosal barrier permeability, inflammatory responses, and lymphocyte trafficking and homing. However, a substantial knowledge gap exists on whether these cellular and or immunological effects of alcohol modify the consumers' CD4+ T cell susceptibility to HIV-1 entry at the cervical mucosa. HIV seronegative women, aged 18-49 years were recruited from Kasenyi and Kigungu fish landing sites of Lake Victoria. They were categorized as Alcohol Consumers (n=27) or non-Alcohol Consumers (n=26) based on the World Health Organization Alcohol-Use-Disorder-Test (WHO-AUDIT) at a cut-off score of >=8/40 and <8/40, respectively. Cytobrush-collected Cervical Mononuclear Cells [CMCs] and Peripheral Blood Mononuclear Cells [PBMCs] from heparinized whole-blood were surface stained for CD4+ T cell immunophenotyping. To measure susceptibility to HIV entry, CMCs and PBMCs were co-cultured overnight with equal amount of GFP-tagged HIV-1 pseudo-virus particles. Both immunophenotyping and HIV entry were measured on a BD LSR II flow cytometer.

Results

There was no significant difference in the frequency of CD4+ T cells in blood (p=0.451) or mucosa (p=0.838) compartments across study groups. However, we observed a combined four-fold higher HIV entry (p=0.0001) into cervical versus blood-derived CD4+ T cells regardless of alcohol consumption status. More so, cervical-derived CD4+ T cells of alcohol-consumers showed a two-fold increase in susceptibility to HIV entry (P=0.0185) compared to the non-alcohol consumer group. Double positive α4β7+CD4+T cells of alcohol consumers exhibited a higher HIV entry compared to those from alcohol non-consumers(p=0.0069).

Conclusion

This study demonstrates that cervical CD4+ T cells are more susceptible to HIV entry than those from blood. Also, cervical CD4+ T cells of alcohol consumers are more susceptible than those of non-consumers. Differences in frequencies of α4β7+ CD4+ T between alcohol consumers and non-consumers' cells may account for the increased susceptibility to HIV entry.

The Effect of Alcohol and Sexual Arousal on Explicit and Implicit Condom Attitudes and Intentions to Use a Condom

Alcohol and sexual arousal are contextual determinants of condomless sex. Dual-process theory postulates that two types of cognitive processing contribute to the regulation of behavior: one that is fast, intuitive and automatic, and another that is slower and deliberative. This study applied a dual-process model to investigate condomless sexual behavior, highlighting the potential importance of implicit attitudes in condomless sex. We investigated whether the impact of alcohol and sexual arousal on condom use-related attitudes and intentions was explained by diminished working memory capacity, as dual-process models suggest. We also investigated whether this effect could be explained by implicit and explicit attitudes toward condom use. Male participants (N = 30) were randomized using a 2 × 2 within-subjects design that manipulated alcohol intoxication (placebo vs. alcohol beverages) and sexual arousal (neutral vs. erotic movie clips). We measured participants' working memory capacity, intentions to use a condom, and explicit and implicit attitudes toward condom use. Significant main effects of alcohol intoxication and sexual arousal on working memory capacity were found. No significant interaction was found for the combined effect of alcohol intoxication and sexual arousal on intentions to use a condom. There was no significant effect of implicit attitudes on intentions to use a condom, although a trend toward significance (p = 0.06) was found for the effect of implicit attitudes on intentions to use a condom when participants were in a state of alcohol intoxication. Theoretical and practical implications of this study are discussed.

The Role of Alcohol-Related Behavioral Risk in the Design of HIV Prevention Interventions in the Era of Antiretrovirals: Alcohol Challenge Studies and Research Agenda

HIV/AIDS remains a significant health threat and alcohol is a robust contributing factor. After 25 years of alcohol challenge studies investigating alcohol-related behavioral risk (ARBR), much has been learned delineating how drinking influences sexual transmission. We examine this research and consider its relevance for interventions in the era of antiretrovirals. We consider prototypic alcohol challenge methods, illustrative findings, and prevention/intervention implications, noting three perspectives: (a) scale up/extend existing interventions, including identifying under-targeted risk groups and intersecting with PrEP/PEP interventions; (b) modify existing interventions by cultivating psychoeducational content related to alcohol expectancies, alcohol myopia, sexual arousal, risk perception, sexual abdication, and condom use resistance; and (c) innovate new interventions through Science of Behavior Change approaches and repurposing ARBR paradigms. Finally, we suggest research directions concluding that until HIV incidence diminishes significantly, psychosocial interventions addressing the nexus of alcohol use, sexual transmission, and adherence to biomedical protocols will be an important priority.

How Alcohol Influences Mechanisms of Sexual Risk Behavior Change: Contributions of Alcohol Challenge Research to the Development of HIV Prevention Interventions

This paper examines the contributions of laboratory-based alcohol challenge research (ACR) to the development of HIV prevention interventions. Following a brief overview of HIV prevention interventions and related health behavior change models, we discuss how alcohol may influence mechanisms of behavior change. The paper highlights the value of ACR for: (1) elucidating mechanisms of action through which alcohol affects sexual risk behavior, (2) testing how alcohol may influence mechanisms thought to underlie HIV prevention interventions, (3) clarifying moderators of the causal influences of alcohol, (4) identifying novel intervention targets, and (5) developing strategies to reduce sexual risk among those who consume alcohol. We conclude with a discussion of the importance of using experimental research to identify mechanisms of behavior change that are specific to populations at high risk for HIV and outline some key implications for developing HIV prevention interventions that integrate the role of alcohol.

The Type of Substance Use Mediates the Difference in the Odds of Sexual Risk Behaviors Among Adolescents of the United States

Background

Although the relationship between sexual risk behaviors and substance use has been established, It remains to be studied if different types of substances have differences in the odds of sexual risk behaviors. Therefore, we aimed to identify the prevalence of sexual risk behaviors in high school students of the United States (US) and study the difference in the odds of sexual risk behaviors for various substances.

Methods

We performed a retrospective cross-sectional study using Youth Risk Behavior Surveillance System (YRBSS) data of 2019 that nationally represents US high school students in grades 9-12. We identified individuals with sexual risk behaviors as participants with four or more lifetime sexual partners and who did not use a condom during the last intercourse.

Results

Out of 11,191 participants, 463 (3.9%) engaged in sexual risk behaviors. The prevalence of substance use, including anabolic steroids (11.5 vs. 1.1%), cocaine (27.2 vs. 2.0%), marijuana (87.1 vs. 34.7%), alcohol (92.4 vs. 54.3%), e-cigarette (90.3 vs. 48.0%), and traditional cigarette (62.2 vs. 21.6%) was higher in participants with sexual risk behaviors compared to participants with no sexual risk behaviors (p<0.0001 for all substances). In regression analysis, anabolic steroid use was associated with the highest odds of sexual risk behaviors (adjusted odds ratio (aOR):4.87, 95%CI: 2.48-9.57; p<0.0001) followed by cocaine (aOR:3.80, 1.80-8.00; p=0.001), marijuana (aOR:3.36, 1.64-6.89; p<0.0001), alcohol (aOR:2.41, 1.05-5.55; p=0.039), electronic vapor products (2.05, 1.004-4.19; p=0.049), and traditional cigarette use (aOR:1.58, 1.10-2.28; p=0.016). We did not find a statistically significant increase in the odds of sexual risk behaviors for the rest of the substances.

Conclusion

Although the prevalence of sexual risk behaviors is low, the prevalence of substance use is significantly higher in participants with sexual risk behaviors. Among the different types of substances, anabolic steroid use has the highest odds of sexual risk behaviors. Therefore, clinicians should remain vigilant for anabolic steroid use when screening adolescents for substance use. Further large-scale randomized studies are needed to study the effects of anabolic steroids on sexual risk behaviors.

Horizons and Group Motivational Enhancement Therapy: HIV Prevention for Alcohol-Using Young Black Women, a Randomized Experiment

INTRODUCTION

Black women are at disproportionately greater risk for HIV and sexually transmitted infections than women of other ethnic/racial backgrounds. Alcohol use may further elevate the risk of HIV/sexually transmitted infection acquisition and transmission.

STUDY DESIGN

A random-assignment parallel-group comparative treatment efficacy trial was conducted with random assignment to 1 of 3 conditions.

SETTING/PARTICIPANTS

The sample comprised 560 Black or African American women aged 18-24 years who reported recent unprotected vaginal or anal sex and recent alcohol use. Participants were recruited from community settings in Atlanta, Georgia, from January 2012 to February 2014.

INTERVENTION

A Group Motivational Enhancement Therapy module was designed to complement a Centers for Disease Control and Prevention-designated evidence-based intervention (Horizons) to reduce sexual risk behaviors, alcohol use, and sexually transmitted infections, with 3 comparison groups: (1) Horizons + Group Motivational Enhancement Therapy intervention, (2) Horizons + General Health Promotion intervention, and (3) enhanced standard of care.

MAIN OUTCOME MEASURES

Outcome measures included safe sex (abstinence or 100% condom use); condom nonuse; proportion of condom use during sexual episodes; incident chlamydia, gonorrhea, and trichomonas infections; and problematic alcohol use measured by Alcohol Use Disorders Identification Test score. Treatment effects were estimated using an intention-to-treat protocol‒generalized estimating equations with logistic regression for binomial outcomes and Poisson regression for count outcomes. Analyses were conducted between October 2018 and October 2019.

RESULTS

Participants assigned to Horizons + Group Motivational Enhancement Therapy had greater odds of safe sex (AOR=1.45, 95% CI=1.04, 2.02, p=0.03), greater proportion of condom use (AOR=1.68, 95% CI=1.18, 2.41, p=0.004), and lower odds of condom nonuse (AOR=0.57, 95% CI=0.38, 0.83, p=0.004). Both interventions had lower odds of problematic alcohol use (Horizons: AOR=0.57, 95% CI=0.39, 0.85, p=0.006; Horizons + Group Motivational Enhancement Therapy: AOR=0.61, 95% CI=0.41, 0.90, p=0.01).

CONCLUSIONS

Complementing an evidence-based HIV prevention intervention with Group Motivational Enhancement Therapy may increase safer sexual behaviors and concomitantly reduce alcohol use among young Black women who consume alcohol.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT01553682.

Unwanted Sex Due to Intoxication among Australians Aged 16-69 Years

Intoxication can be a factor in unwanted sex, but research on the extent of the issue in both women and men is limited. We assessed the prevalence, correlates, and 10-year time-trends of unwanted sex due to intoxication among a representative sample of 4,279 women and 3,875 men aged 16-69 years in Australia and considered how these vary by gender. In 2012-13, 16% of women and 10% of men reported ever having had a sexual experience when they "did not want to because they were too drunk or high at the time." For both women and men, this was associated with younger age, bisexual activity, and reports of lifetime injection drug use, sexually transmitted infections, and forced sex. Among women only, it was associated with drinking above guideline levels and ever having terminated a pregnancy. Among men only, it was associated with current tobacco smoking, elevated psychosocial distress, and poor general health. Compared with 2001-02 data, fewer men reported unwanted intoxicated sex, while there were no changes for women as a whole. Interpreting these findings through an intersectional assemblage framework supports stronger understanding of the multiple factors influencing sexuality and substance use with implications for promoting equity, safety, and sexual health.

Using marijuana, drinking alcohol or a combination of both: the association of marijuana, alcohol and sexual risk behaviour among adolescents

Background Although the association between alcohol use and sexual risk behaviour has been well-documented, there is little understanding of whether marijuana use alone or combining marijuana with alcohol use contributes to sexual risk behaviour among adolescents.

METHODS

A diverse sample of sexually active adolescents (n = 616) aged 12-18 years (50.32% Hispanic; 31.17% Black) completed a survey on alcohol use, marijuana use and sexual risk behaviour during a visit to a primary care clinic.

RESULTS

Adolescents were more likely to report having had two or more sexual partners in the past 3 months if they reported using both alcohol and marijuana (OR=3.90, P<0.0001), alcohol alone (OR=2.51, P<0.0001) or marijuana alone (OR=1.89, P<0.001) compared with adolescents who reported no use during the past month. Adolescents were more likely to report having both two or more partners and condomless sex if they used both alcohol and marijuana (OR=3.19, P<0.001) or alcohol alone (OR=3.41, P<0.01) in the past month compared with adolescents who reported using marijuana alone or had no use of either.

CONCLUSIONS

Providers should screen for both alcohol and marijuana use among adolescents and discuss how use of alcohol or alcohol in conjunction with marijuana may be associated with sexual risk behaviours.

Adolescents' Sex-Related Alcohol Expectancies and Alcohol Advertisements in Magazines: The Role of Wishful Identification, Realism, and Beliefs about Women's Enjoyment of Sexualization

In the United States, approximately one in five sexually active teens report alcohol or drug use before their last sexual encounter. The co-occurrence of alcohol with sex increases risky behaviors, such as having unprotected sex. Magazines that target adolescents often feature alcohol advertisements with sexual innuendo and female objectification. Such advertisements may inform adolescents' expectancies that alcohol can facilitate sex. With an experimental design and path analysis, we examined 874 adolescents' (ages 15-17, M = 16.05) exposure to objectifying alcohol ads, their perceptions of the ads, and their attitudes about women's sexualization in relation to sex-related alcohol expectancies. For female adolescents we assessed their enjoyment of sexualization, and for male adolescents, we assessed their perceived enjoyment of sexualization among women. Teens' perceptions that alcohol ads promote the co-occurrence of alcohol with sex mediated the effect of ad exposure and perceived realism of the ads on sex-related alcohol expectancies. The enjoyment of sexualization construct mediated the effect of wishful identification and perceived realism on sex-related alcohol expectancies. Wishful identification also directly related to sex-related alcohol expectancies. Results challenge the alcohol industry's compliance with advertisement regulations and suggest media literacy as a strategy to promote healthy sex-related alcohol expectancies among adolescents.

Safer sex intentions modify the relationship between substance use and sexual risk behavior among black South African men who have sex with men

Due to the global burden of HIV, a better understanding of the relationship between substance use and HIV risk behavior is a public health priority, particularly among populations with high rates of HIV infection. The current study explored the moderating effects of psychosocial factors on the relationship between substance use and sexual risk behavior. Among 480 black South African men who have sex with men recruited using respondent-driven sampling, a cross-sectional survey was conducted that included questions about their last sexual event that involved anal sex. Substance use was not associated with unprotected anal intercourse (UAI) ( P = 0.97). The effect of substance use on UAI was modified by safer sex intentions ( P = 0.001). Among those with higher safer sex intentions, substance use was positively associated with UAI (aOR = 5.8, 95%CI = 1.6–21.3, P < 0.01). This study found that among men who have sex with men with high intentions to engage in safer sex, substance use was associated with increased risky sexual behavior.

Alcohol and Sexual Health Behavior: "What We Know and How We Know It"

Alcohol, despite salutary associations with sexuality, has been implicated in sexual health problems. This review examines the relationship between alcohol and outcomes related to sexual health. Methodological considerations limiting causal assertions permissible with nonexperimental data are discussed, as are advantages of experimental methods. Findings from laboratory experiments are reviewed evaluating causal effects of acute alcohol intoxication on a variety of outcomes, including sexual arousal, sexual desire, orgasm, and sexual risk behaviors related to sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). Several variables exerting mediating and moderating influences are identified. It is concluded that acute alcohol intoxication is capable of exerting a causal impact on multiple constituent components of sexual responding related to sexual health. Both alcohol expectancy and alcohol myopia theories have been supported as explanations for these causal effects. Furthermore, for sexual risk behavior, noteworthy recent developments include research highlighting the importance of women's sexual victimization history and men's condom use resistance. Limitations and implications associated with this body of research are also discussed.

"I Wasn't in My Right Mind": Qualitative Findings on the Impact of Alcohol on Condom Use in Patients Living with HIV/AIDS in Brazil, Thailand, and Zambia (HPTN 063)

PURPOSE

There have been significant biomedical improvements in the treatment and prevention of HIV over the past few decades. However, new transmissions continue to occur. Alcohol use is a known barrier to medication adherence and consistent condom use and therefore may affect treatment as prevention (TasP) efforts. The purpose of this study was to further explore how alcohol is associated with condom use and sexual transmission behavior in three international cities.

METHOD

HIV Prevention Trials Network 063 was an observational mixed-methods study of HIV-infected patients currently in care in Rio de Janeiro, Brazil; Chiang Mai, Thailand; and Lusaka, Zambia. Across these three global cities, 80 qualitative interviews were conducted from 2010 to 2012. From these interviews, quotes related to substance use, almost all of which were alcohol, were analyzed using thematic analysis to identify how the use was related to sexual transmission behaviors.

RESULTS

Overall, the theme that alcohol impairs cognitive abilities emerged from the data and included the following subthemes: expectancies, impaired decision-making, loss of control, and less concern for others. Themes specific to international settings and risk subgroups were also identified.

CONCLUSION

Our analysis identified how alcohol influences sexual transmission behavior in HIV patients in three international settings. These findings may provide direction for content development for future secondary prevention interventions to effectively implement TasP internationally.

The Role of Disgust in Male Sexual Decision-Making

Sexual arousal is known to increase risky behaviors, such as having unprotected sex. This may in part relate to the emotion of disgust, which normally serves a disease avoidant function, and is suppressed by sexual arousal. In this report we examine disgust's role in sexual decision-making. Male participants received two study packets that were to be completed at home across two different time-points. Participants were asked to complete one packet in a sexually aroused state and the other in a non-aroused state. Participants were asked to rate: (1) arousal, (2) disgust, (3) willingness for sex, and (4) disease risk toward a range of female targets, which varied in level of potential disease risk (sex-worker vs. non sex-worker) and attractiveness. A measure of trait disgust was also included along with other related scales. Sexual arousal was associated with reduced disgust and reduced judgments of disease risk for all targets—these latter two variables being correlated—and with enhanced willingness to have sex with all of the depicted persons. Willingness to have sex when aroused (in contrast to non-aroused) was predicted by disease risk judgments and trait disgust, suggesting both direct (state) and indirect (trait) effects of disgust on sexual decision-making.

Causal Effects of Alcohol Intoxication on Sexual Risk Intentions and Condom Negotiation Skills Among High-Risk Men Who Have Sex with Men (MSM)

Alcohol use is a key risk factor for HIV infection among MSM, in part because intoxication may interfere with the use of prevention methods like condoms. However, few studies have examined whether this is due to alcohol's pharmacological or expectancy effects or explored the specific aspects of sexual decision-making that may be affected. In this study, high-risk, heavy drinking MSM (N = 121) were randomly assigned to receive either (1) alcohol beverages, (2) placebo beverages, or (3) control beverages, before navigating a video-based sexual risk scenario that assessed several aspects of sexual decision-making. Results showed that condom use intentions and negotiation behaviors were lower among alcohol and placebo participants compared with controls, but that few significant differences emerged between the alcohol and placebo groups. These findings contrast with similar past studies, and suggest that alcohol's expectancy effects may play a role in sexual decision-making.

Temporal Relationship of Sex Risk Behaviors and Substance Use Severity Among Men in Substance Use Treatment

Sex risk behaviors and substance use are intertwined. Many men continue to engage in high-risk sexual behaviors even when enrolled in substance use disorder (SUD) treatment. We hypothesized that changes in sex risk behaviors would coincide with changes in drug/alcohol use severity among men in SUD treatment. During an HIV risk-reduction trial, men in methadone maintenance and outpatient drug-free treatment (N = 359) completed assessments at baseline and six months after. We assessed changes in sex risk and substance use severity, using the Addiction Severity Index-Lite (ASI-Lite), controlling for treatment condition. In multinomial logistic regressions, decreased alcohol severity was significantly associated with decreases in reported sex partners, and increased alcohol severity was significantly associated with increases in reported sex partners. Increasing drug use severity was significantly associated with maintaining and initiating sex with a high-risk partner, while decreasing alcohol use severity was significantly associated with discontinuing sex under the influence. However, changes in drug/alcohol use severity were not associated with changes in unprotected sex. Substance use reductions may decrease HIV risk behaviors among male substance users. Our findings highlight the importance of integrating interventions in SUD treatment settings that address the intersection of sex risk behaviors and substance use.

Pathways From Peer Victimization to Sexually Transmitted Infections Among African American Adolescents

African American youths, especially those in low resource communities, are vulnerable to peer victimization, which can increase risk of sexually transmitted infections. However, few studies explored the relationship between these two health concerns and the pathways that may link them. The present study aimed to address this gap. We used descriptive statistics, correlation coefficients, and structural equation modeling to analyze data collected from 277 adolescents ages 13 to 24 years in Chicago. Primary results indicated that peer victimization was not directly related to acquisition of sexually transmitted infections. However, peer victimization was negatively associated with condom use, and condom use was negatively associated with sexually transmitted infections. Furthermore, affiliation with sexually active peers was positively associated with substance use. These findings have implications for bullying and sexual risk prevention and intervention of low-income youths. Attention to treatment approaches and interventions that are holistic and culturally feasible is recommended for practitioners working with urban youth.

Higher Impulsivity and HIV-Risk Taking Behaviour in Males with Alcohol Dependence Compared to Bipolar Mania: A Pilot Study

To study the association of impulsivity, high-risk behaviours and incidence of HIV infection in patients with alcohol dependence and bipolar mania. This was a cross-sectional hospital-based pilot study and the sample consisted of male patients divided into three groups: 25 patients with alcohol dependence and 25 with bipolar mania as per ICD-10 Diagnostic Criteria for Research and 25 normal controls. Severity of Alcohol Dependence Questionnaire (SADQ) and Young Mania Rating Scale (YMRS) were administered on alcohol dependent and bipolar patients, respectively. All three groups were rated on Barrett's Impulsivity Scale (BIS) and HIV Risk-taking Behaviour Scale (HRBS). None of the patients tested positive for either HIV 1 or 2. BIS motor impulsivity, BIS total score and HRBS total score were significantly higher in alcohol dependent patients as compared to bipolar mania patients. In the Alcohol dependent group, BIS score significantly correlated with education years, age of onset of alcohol use and SADQ, whereas, HRBS total score significantly correlated with SADQ scores. In the bipolar mania group, BIS significantly correlated with YMRS, and total number of episodes, whereas, there was no significant correlation of HRBS total score with any clinical variable. The findings of this pilot study underscore the link between alcohol use disorder and the impulsive behaviours that can lead to HIV infection, and highlight that those risks are higher for individuals with alcohol dependency than for individuals with bipolar disorder.

Effects of Acute Alcohol Intoxication on Empathic Neural Responses for Pain

The questions whether and how empathy for pain can be modulated by acute alcohol intoxication in the non-dependent population remain unanswered. To address these questions, a double-blind, placebo-controlled, within-subject study design was adopted in this study, in which healthy social drinkers were asked to complete a pain-judgment task using pictures depicting others' body parts in painful or non-painful situations during fMRI scanning, either under the influence of alcohol intoxication or placebo conditions. Empathic neural activity for pain was reduced by alcohol intoxication only in the dorsal anterior cingulate cortex (dACC). More interestingly, we observed that empathic neural activity for pain in the right anterior insula (rAI) was significantly correlated with trait empathy only after alcohol intoxication, along with impaired functional connectivity between the rAI and the fronto-parietal attention network. Our results reveal that alcohol intoxication not only inhibits empathic neural responses for pain but also leads to trait empathy inflation, possibly via impaired top-down attentional control. These findings help to explain the neural mechanism underlying alcohol-related social problems.

Determinants of hazardous drinking among black South African men who have sex with men

BACKGROUND

There is a known heavy burden of hazardous drinking and its associated health risks among black South African MSM; however, no study to date has identified risk factors for hazardous drinking among this nor any other African MSM population.

METHODS

A cross-sectional survey was conducted among 480 black South African MSM recruited using respondent-driven sampling. All analyses were adjusted using an RDS II estimator. Multivariable logistic regression was used to assess the relationship between demographic characteristics, psychosocial factors, behavioral attributes and hazardous drinking.

RESULTS

More than half of the men (62%, 95%CI=56%-68%) screened positive as hazardous drinkers. In multivariable analyses, living in a township (versus the city of Pretoria) (aOR=1.9, 95%CI=1.2-3.1, p<.01), more gender dysphoria (aOR=1.4, 95%CI=1.0-1.8, p=.03), having ever received money or other incentives in return for sex (aOR=2.4, 95%CI=1.3-4.3, p<.01), having been sexually abused as a child (aOR=2.6, 95%CI=1.1-6.4, p=.03), having anxiety (aOR=5.4, 95%CI=1.2-24.3, p=.03), and social network drinking behavior (aOR=5.4, 95%CI=1.2-24.3, p=.03) were positively associated with hazardous drinking. Being sexually attracted only to men (aOR=0.3, 95%CI=0.1-0.8, p=.01) was negatively associated with hazardous drinking.

DISCUSSION

Hazardous drinking is highly prevalent among black South African MSM. Multiple indicators of social vulnerability were identified as independent determinants of hazardous drinking. These findings are of heightened concern because these health problems often work synergistically to increase risk of HIV infection and should be taken into consideration by efforts aimed at reducing hazardous drinking among this critical population.

Alcohol Intoxicated Witnesses: Perception of Aggression and Guilt in Intimate Partner Violence

Many witnesses to violent crimes are alcohol intoxicated, but research is lacking regarding how alcohol affects their perception of aggression and guilt. This study investigated to what extent alcohol intoxicated eyewitnesses differed from sober witnesses regarding how aggressive and guilty they perceived the involved parts in an intimate partner violence (IPV) situation. Eighty-seven healthy men ( n = 44) and women ( n = 43) were randomized to an alcohol group (0.7 g/kg) or a non-alcohol group. In a laboratory setting, alcoholic/non-alcoholic drinks were consumed before viewing a film depicting IPV between a man and a woman. Ten min after viewing, in an interview, the participants rated how aggressive and guilty they perceived the involved parts to be. Alcohol intoxicated participants perceived both parts' physically aggressive behavior as comparatively less severe, but their neutral behavior as more hostile. Sober witnesses perceived the man to be the most guilty part, whereas intoxicated witnesses distributed guilt more evenly. Alcohol had a strong but complex impact on the perception of aggression in IPV (i.e., heightened during the neutral interaction and lowered during physical aggression). These results may be explained by the cognitive consequences of alcohol's anxiety-dampening effects. Regarding the asymmetric difference in perceived guilt, stereotypical expectations of gender-appropriate behavior in an IPV situation may need to be considered.

Alcohol, Sex, and Screens: Modeling Media Influence on Adolescent Alcohol and Sex Co-Occurrence

Alcohol use and sexual behavior are important risk behaviors in adolescent development, and combining the two is common. The reasoned action approach (RAA) is used to predict adolescents' intention to combine alcohol use and sexual behavior based on exposure to alcohol and sex combinations in popular entertainment media. We conducted a content analysis of mainstream (n = 29) and Black-oriented movies (n = 34) from 2014 and 2013-2014, respectively, and 56 television shows (2014-2015 season). Content analysis ratings featuring character portrayals of both alcohol and sex within the same five-minute segment were used to create exposure measures that were linked to online survey data collected from 1,990 adolescents ages 14 to 17 years old (50.3% Black, 49.7% White; 48.1% female). Structural equation modeling (SEM) and group analysis by race were used to test whether attitudes, norms, and perceived behavioral control mediated the effects of media exposure on intention to combine alcohol and sex. Results suggest that for both White and Black adolescents, exposure to media portrayals of alcohol and sex combinations is positively associated with adolescents' attitudes and norms. These relationships were stronger among White adolescents. Intention was predicted by attitude, norms, and control, but only the attitude-intention relationship was different by race group (stronger for Whites).

Does being drunk or high cause HIV sexual risk behavior? A systematic review of drug administration studies

HIV sexual risk behavior is broadly associated with substance use. Yet critical questions remain regarding the potential causal link between substance use (e.g., intoxication) and HIV sexual risk behavior. The present systematic review was designed to examine and synthesize the existing literature regarding the effects of substance administration on HIV sexual risk behavior. Randomized controlled experiments investigating substance administration and HIV sexual risk behavior (e.g., likelihood of condom use in a casual sex scenario) were included. Across five databases, 2750 titles/abstracts were examined and forty-three total peer reviewed published manuscripts qualified (few were multi-study manuscripts, and those details are outlined in the text). The majority of articles investigated the causal role of acute alcohol administration on HIV sexual risk behavior, although one article investigated the effects of acute THC administration, one the effects of acute cocaine administration, and two the effects of buspirone. The results of this review suggest a causal role in acute alcohol intoxication increasing HIV sexual risk decision-making. Although evidence is limited with other substances, cocaine administration also appears to increase sexual risk, while acute cannabis and buspirone maintenance may decrease sexual risk. In the case of alcohol intoxication, the pharmacological effects independently contribute to HIV sexual risk decision-making, and these effects are exacerbated by alcohol expectancies, increased arousal, and delay to condom availability. Comparisons across studies showed that cocaine led to greater self-reported sexual arousal than alcohol, potentially suggesting a different risk profile. HIV prevention measures should take these substance administration effects into account. Increasing the amount of freely and easily accessible condoms to the public may attenuate the influence of acute intoxication on HIV sexual risk decision-making.

Sex and Drugs and Starting School: Differences in Precollege Alcohol-Related Sexual Risk Taking by Gender and Recent Blackout Activity

Research has demonstrated a link between alcohol use and multiple forms of risky sexual behavior, particularly among college-age individuals. Studies have also linked heavy alcohol use to other problems, such as impaired consciousness resulting from an alcohol-induced blackout, which may impact sexual decision making. However, research has rarely examined sexual risk taking (SRT) in relation to blackouts, nor has it examined this construct during the precollege transition (i.e., the interval of time between high school graduation and college matriculation). This study examined the intersection between alcohol-involved SRT, blackouts, and gender in a sample of precollege individuals with prior alcohol use (N = 229; 54% male, 63% White). Results indicated that, despite drinking less per occasion, women reporting recent blackouts were at increased risk for experiencing unwanted, unsafe, and regretted sexual behaviors compared to men with recent blackouts and their peers with no recent blackouts. Women with recent blackouts also reported differences in alcohol expectancies that may increase their risk for experiencing negative consequences while drinking, including higher social expectancies and lower negative expectancies of danger. Future directions for research and implications for precollege interventions are discussed.

Substance Use and Sexual Risk Behavior Among Black South African Men Who Have Sex With Men: The Moderating Effects of Reasons for Drinking and Safer Sex Intentions

Research studies suggest an association between substance use and sexual risk behavior, but are not completely consistent. The moderating effects of other psychosocial factors might help explain these inconsistencies. The current study therefore assessed whether substance use is associated with sexual risk behavior, and whether this relationship is modified by expectancies about the effects of alcohol, reasons for consuming alcohol, or intentions to engage in safe sex. A cross-sectional survey was conducted among 480 black South African men who have sex with men recruited using respondent-driven sampling. In multivariable analyses, the effect of alcohol use on unprotected receptive anal intercourse (URAI) was modified by drinking to enhance social interaction (R² change = 0.03, p < 0.01). The effect of drug use on URAI was modified by safe sex intentions (R² change = 0.03, p < 0.001). Alcohol use was positively associated with URAI only among those who drink to enhance social interaction (β = 0.08, p < 0.05). Drug use was positively associated with URAI only among those with high safe sex intentions (β = 0.30, p < 0.001). Our findings suggest that efforts to minimize the impact of substance use on HIV risk behavior should target men who drink to enhance social interaction and men who intend to engage in safer sex. Efforts made to increase safer sex intentions as a way to reduce HIV risk behavior should additionally consider the effects of substance use.

Acute impact of caffeinated alcoholic beverages on cognition: A systematic review

INTRODUCTION

Energy drinks are popular beverages that are supposed to counteract sleepiness, increase energy, maintain alertness and reduce symptoms of hangover. Cognitive enhancing seems to be related to many compounds such as caffeine, taurine and vitamins. Currently, users mostly combine psychostimulant effects of energy drinks to counteract sedative effects of alcohol. However, recent literature suggests that this combination conducts to feel less intoxicated but still impaired. The goal of the present article is to review cognitive impact and subjective awareness in case of caffeinated alcoholic beverage (CAB) intoxication.

METHOD

PubMed (January 1960 to March 2016) database was searched using the following terms: cognitive impairments, alcohol, energy drinks; cognition, alcohol, caffeine.

RESULTS

99 papers were found but only 12 randomized controlled studies which explored cognitive disorders and subjective awareness associated with acute CAB or AED (alcohol associated with energy drinks) intoxication were included.

DISCUSSION

The present literature review confirmed that energy drinks might counteract some cognitive deficits and adverse effects of alcohol i.e. dry mouth, fatigue, headache, weakness, and perception of intoxication due to alcohol alone. This effect depends on alcohol limb but disappears when the complexity of the task increases, when driving for example. Moreover, studies clearly showed that CAB/AEDs increase impulsivity which conducts to an overconsumption of alcohol and enhanced motivation to drink compared to alcohol alone, potentiating the risk of developing addictive behaviors. This is a huge problem in adolescents with high impulsivity and immature decision making processes.

CONCLUSION

Although energy drinks counteract some cognitive deficits due to alcohol alone, their association promotes the risk of developing alcohol addiction. As a consequence, it is necessary to better understand the neurobiological mechanisms underlying these interactions in order to better prevent the development of alcohol dependence.

Population attributable fraction of incident HIV infections associated with alcohol consumption in fishing communities around Lake Victoria, Uganda

Background

Although the association between alcohol consumption and HIV risk is well documented, few studies have examined the magnitude of new HIV infections that could be prevented by controlling alcohol use. We report the population attributable fraction (PAF) of incident HIV infections due to alcohol consumption among the HIV high-risk population of fishing communities along Lake Victoria, Uganda.

Methods

In a community-based cohort study, 1607 HIV sero-negative participants aged 18–49 years were enrolled from eight fishing communities along Lake Victoria, Uganda. At follow up 12 months later, 1288 (80.1%) were seen and interviewed. At baseline and follow-up visits, participants completed interviewer-administered questionnaires on alcohol consumption, demographics, and sexual risk behavior, and were tested for HIV infection. HIV incidence and adjusted incident rate ratios (adjusted IRRs) were estimated using Poisson regression models; the crude and adjusted PAFs of incident HIV infections associated with alcohol consumption were calculated using the Greenland and Drescher method for cohort studies.

Results

Among the 1288 participants seen at follow up, 53.5% reported drinking alcohol of whom 24.4% drank occasionally (2 days a week or less) and 29.1% drank regularly (3–7 days a week). Forty eight incident HIV infections occurred giving an incidence rate of 3.39/100 person years at-risk (pyar) (95% CI, 2.55–4.49). Compared to non-drinkers, the adjusted IRR of HIV was 3.09 (1.13–8.46) among occasional drinkers and 5.34 (2.04–13.97) among regular drinkers. The overall adjusted PAF of incident HIV infections due alcohol was 64.1 (95% CI; 23.5–83.1); ranging from 52.3 (11.9–74.2) among Muslims to 71.2 (32.6–87.7) for participants who reported ≥ 2 sexual partners in the past 12 months.

Conclusion

In fishing communities along Lake Victoria, Uganda, 64% of new HIV infections can be attributed to drinking alcohol. Interventions to reduce alcohol consumption should be integrated in HIV/AIDS prevention activities for populations in whom both HIV and alcohol consumption are highly prevalent.

Understanding Risk-taking Behavior in Bullies, Victims, and Bully Victims Using Cognitive- and Emotion-Focused Approaches

Bullying and risky behavior are two common problems among adolescents and can strongly affect a youth’s overall functioning when both coexist. Some studies suggest that bullying in adolescence may promote risky behavior as a coping strategy to deal with victimization related stress. Other studies consider bullying as an outcome of high-risk behavior. Despite the association between the two is well-established, no study has examined the risk-taking patterns among bullying groups (i.e., bully, victim, and bully victim). This study attempted to elucidate the potential relationships between bullying and risk-taking by addressing the two models: a cognitive-focused model and an emotion-focused model of risk taking, and to clarify how adolescents’ characteristics in risk taking associate with bullying outcomes.

Method: 136 Chinese adolescents (Mean Age = 14.5, M = 65, F = 71) were recruited and grouped according to bullying identity: Bully (n = 27), Victim (n = 20), Bully victim (n = 37) and Control (n = 52). Cognitive Appraisal of Risky Events (CARE) questionnaire was used to measure participants’ expectancies about the risks, benefits and involvement associated with risky activities. Cambridge Gambling Task (CGT) was administered to capture the emotion-laden process in risk taking.

Results: Cognitively, Bully was associated with an overestimation of risk while Victim was associated with an underestimation of risk and overrated benefit. Bully victim exhibited a unique pattern with an overestimation of benefit and risk. All study groups projected higher involvement in risky behavior. Behaviorally, both Bully and Bully victim were associated with high risk modulation whereas Victim was associated with impulsive decision-making. Interestingly, compared with bully, bully victim had significantly higher bullying scores, suggesting a wider range and more frequent bullying activities. In conclusion, Bully maybe a group of adolescents that is vigilant in situational deliberation and risk modulation while Victims with high impulsivity, are more likely to place themselves in risky situations. Bully victims presented the combined pattern of the two pure groups and associated with the highest risk-taking propensity. Better picture of risk taking pattern associated with different groups was illustrated, allowing better matching for future prevention and intervention program for distinct bullying individuals.

The Complexities of Sexual Consent Among College Students: A Conceptual and Empirical Review

Headlines publicize controversies about sexual assault among college students, and universities face pressure to revise their sexual consent policies. What can the social science literature contribute to this discussion? In this article, we briefly discuss reasons for the recent upsurge in attention to these issues, the prevalence of sexual assault among college students, and aspects of college life that increase the risk of sexual assault and complicate sexual consent. We then review the conceptual challenges of defining sexual consent and the empirical research on how young people navigate sexual consent in their daily lives, focusing primarily on studies of U.S. and Canadian students. Integrating these conceptual issues and research findings, we discuss implications for consent policies, and we present five principles that could be useful for thinking about consent. Finally, we discuss some of the limitations of the existing research and suggest directions for future research.

Alcohol Use and HIV Testing in a National Sample of Women

The HIV/AIDS epidemic continues to disproportionately affect racial and ethnic minority groups and women in the United States. Prevention research suggests that reduced alcohol use and increased HIV testing are associated with lower incidence of HIV transmission among high-risk populations. Multivariable logistic regression analyses of the 2009 National Health Interview Survey data were performed for a national sample of 15,470 adult women to examine the relationship between alcohol use and likelihood of HIV testing. There is a significant association between level of alcohol use and HIV testing. Women who identified as heavy drinkers and moderate drinkers were significantly less likely to report ever testing for HIV. Findings add to the limited literature on the association between alcohol use and HIV testing behaviors among women. Given the incidence of HIV among women, this study highlights the importance of HIV testing, especially for alcohol-using women.

Toward Development of Enhanced Preventive Interventions for HIV Sexual Risk among Alcohol-Using Populations: Confronting the 'Mere Pause from Thinking'

The papers in this issue detail state-of-the science knowledge regarding the role of alcohol use in HIV/AIDS risk, as well as offer suggestions for ways forward for behavioral HIV prevention for at-risk alcohol-using populations. In light of recent evidence suggesting that the anticipated uptake of the newer biomedical HIV prevention approaches, prominently including pre-exposure prophylaxis, has been stalled owing to a host of barriers, it has become ever more clear that behavioral prevention avenues must continue to receive due consideration as a viable HIV/AIDS prevention approach. The papers collected here make a valuable contribution to "combination prevention" efforts to curb HIV spread.

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.

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

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

Alcohol Expectancies and Inhibition Conflict as Moderators of the Alcohol-Unprotected Sex Relationship: Event-Level Findings from a Daily Diary Study Among Individuals Living with HIV in Cape Town, South Africa

Literature from sub-Saharan Africa and elsewhere supports a global association between alcohol and HIV risk. However, more rigorous studies using multiple event-level methods find mixed support for this association, suggesting the importance of examining potential moderators of this relationship. The present study explores the assumptions of alcohol expectancy theory and alcohol myopia theory as possible moderators that help elucidate the circumstances under which alcohol may affect individuals' ability to use a condom. Participants were 82 individuals (58 women, 24 men) living with HIV who completed daily phone interviews for 42 days which assessed daily sexual behavior and alcohol consumption. Logistic generalized estimating equation models were used to examine the potential moderating effects of inhibition conflict and sex-related alcohol outcome expectancies. The data provided some support for both theories and in some cases the moderation effects were stronger when both partners consumed alcohol.

Drinking Patterns and HIV Risk Behaviors Among Black and Latino Men Who Have Sex Within Los Angeles County

Alcohol, the most widely used substance among men who have sex with men (85%), remains an important factor in HIV research among this high-risk population. However, research on alcohol use among Black and Latino men who have sex with men (BLMSM), a population disproportionately affected by HIV in the United States, is limited and inconclusive. This study explored sociodemographic and HIV risk with daily heavy and low-risk drinking patterns among BLMSM. BLMSM (N = 188) aged 18 to 40 years were recruited through social media, local colleges, heteronormative clubs, private men’s groups, gay establishments, and organized events in Los Angeles County. Participants completed self-administered questionnaires. Fisher’s exact tests revealed significant relationships between drinking patterns and condomless insertive anal intercourse (p = .001), race (p < .001), age (p = .02), and perception of alcohol-related HIV risk (p = .007). The Fisher’s exact tests findings for age held true in the multiple regression model (p = .014). Findings suggest that BLMSM who engage in higher risk drinking also engage in alcohol-related HIV risk. Culturally competent interventions should consider including a combined focus to explore the synergy between risky drinking patterns and HIV risk among BLMSM.

The development of a new condom use expectancy scale for at-risk adults

RATIONALE

Engaging in risky sexual behavior increases transmission of HIV.

OBJECTIVE

The present study used previously elicited salient outcomes of condom use to examine the factor structure and test the predictive utility of a condom use expectancy scale.

METHODS

Participants were drug offenders from court ordered drug diversion programs in Southern California. The condom use expectancy scale consisted of three factors: positive condom outcome items, negative condom outcome items, and safe sex items.

RESULTS

The factor analysis confirmed the three-factor structure. Positive condom use expectancies were a significant predictor of both condom use and intentions to use condoms, and negative condom use expectancies predicted non-use of condoms.

CONCLUSION

Understanding conditions of condom use can aid public health researchers and practitioners to better identify those in need of HIV prevention and how to target those needs.

Association of Alcohol Consumption with Perception of Attractiveness in a Naturalistic Environment

Aims

To investigate the relationship between objectively-assessed alcohol consumption and perception of attractiveness in naturalistic drinking environments, and to determine the feasibility and acceptability of conducting a large-scale study in these environments.

Methods

Observational study conducted simultaneously across three public houses in Bristol, UK. Participants were required to rate the attractiveness of male and female face stimuli and landscape stimuli administered via an Android tablet computer application, after which their expired breath alcohol concentration (BrAC) was measured.

Results

Linear regression revealed no clear evidence for relationships between alcohol consumption and either overall perception of attractiveness for stimuli, for faces specifically, or for opposite-sex faces. The naturalistic research methodology was feasible, with high levels of participant engagement and enjoyment.

Conclusions

We found no evidence for a relationship between alcohol consumption and perception of attractiveness in our large-scale naturalistic study. Our study is important given the large sample size, the successful translation of an experimental, laboratory-based paradigm to a naturalistic drinking environment and the high level of public engagement with the study. Future studies should use similarly ecologically-valid methodologies to further explore the conditions under which this effect may be observed and identify the mechanisms underlying any relationships.

Associations Between a Dopamine D4 Receptor Gene, Alcohol Use, and Sexual Behaviors among Female Adolescent African Americans

Adolescent African-American females are disproportionately impacted by HIV, thus there is a clear need to understand factors associated with increased HIV-risk behaviors among this vulnerable population. We sought to explore the association between a dopamine D4 receptor gene (DRD4), a genetic marker associated with natural variations in rewarding behaviors, and self-reported alcohol-use and sexual risk-behaviors, while controlling for other known correlates of risk-taking such as impulsivity, sensation seeking, and peer norms among a group of high-risk African American female adolescents to evaluate whether this biological factor enhances our understanding of patterns of risk in this vulnerable group.

Substance use and teen pregnancy in the United States: evidence from the NSDUH 2002-2012

INTRODUCTION

Few, if any, studies have systematically examined the relationship between substance use and teen pregnancy using population-based samples. We aim to provide a comprehensive examination of substance use among pregnant adolescents in the United States.

METHOD

Employing data from the National Survey on Drug Use and Health between 2002 and 2012 (n=97,850), we examine the prevalence of the past 12-month and the past 30-day substance use and substance use disorders among pregnant and non-pregnant adolescents (ages 12-17). We also examine psychosocial and pregnancy-related correlates of current substance use among the subsample of pregnant adolescents (n=810).

RESULTS

Pregnant teens were significantly more likely to have experimented with a variety of substances and meet criteria for alcohol (AOR=1.65, 95% CI=1.26-2.17), cannabis (AOR=2.29, 95% CI=1.72-3.04), and other illicit drug use disorders (AOR=2.84, 95% CI=1.92-4.19). Pregnant early adolescents (ages 12-14; AOR=4.34, 95% CI=2.28-8.26) were significantly more likely and pregnant late adolescents (ages 15-17; AOR=0.71, 95% CI=0.56-0.90) significantly less likely than their non-pregnant counterparts to be current substance users.

CONCLUSIONS

Study findings point not only to a relationship between pregnancy and prior substance use, but also suggest that substance use continues for many teens during pregnancy. We found that substance use is particularly problematic among early adolescents and that the prevalence of substance use attenuates dramatically as youth progress from the first to the second and third trimesters of pregnancy.

The (mal) adaptive value of mid-adolescent dating relationship labels

The aim of this study was to explore adolescent dating relationships through the prism of high school girls' narratives. We probed the contexts and meanings associated with different forms of dating to better understand the developmental significance of romantic relationships during adolescence. Cross-sectional, in-depth semi-structured interviews were conducted with 20 high school females. The analytic approach was phenomenological and grounded in the narratives rather than based on an a priori theoretical framework. Interviews were digitally recorded, transcribed verbatim by research staff and entered into ATLAS.ti 6, a qualitative data-management software package, prior to analysis. Teen relationships were found to vary along a Dis-Continuum from casual hookups to "official" boyfriend/girlfriend. There was a lack of consensus, and much ambiguity, as to the substantive meaning of different relationships. Labeling dating relationships seem to facilitate acquisition of important developmental needs such as identity, affiliation, and status, while attempting to manage cognitive dissonance and emotional disappointments. Findings underscore the confusion and complexity surrounding contemporary adolescent dating. Adolescent girls are using language and social media to assist them in meeting developmental goals. Sometimes their dating labels are adaptive, other times they are a cause of stress, or concealment of unmet needs and thwarted desires. Programs focused on positive youth development need to resonate with the realities of teens' lives and more fully acknowledge the complicated dynamics of teen dating relationships and how they are formalized, publicized and negotiated.

Behavioral economic decision making and alcohol-related sexual risk behavior

The discipline of behavioral economics integrates principles from psychology and economics to systematically characterize decision-making preferences. Two forms of behavioral economic decision making are of relevance to HIV risk behavior: delay discounting, reflecting preferences for immediate small rewards relative to larger delayed rewards (i.e., immediate gratification), and probability discounting, reflecting preferences for larger probabilistic rewards relative to smaller guaranteed rewards (i.e., risk sensitivity). This study examined questionnaire-based indices of both types of discounting in relation to sexual risk taking in an emergency department sample of hazardous drinkers who engage in risky sexual behavior. More impulsive delay discounting was significantly associated with increased sexual risk-taking during a drinking episode, but not general sexual risk-taking. Probability discounting was not associated with either form of sexual risk-taking. These findings implicate impulsive delay discounting with sexual risk taking during alcohol intoxication and provide further support for applying this approach to HIV risk behavior.

Gender and racial/ethnic differences in patterns of adolescent alcohol use and associations with adolescent and adult illicit drug use

OBJECTIVES

The study objective was to use latent class analyses (LCAs) to identify gender- and racial/ethnic-specific groups of adolescent alcohol users and associations between alcohol use group and adolescent and adulthood illicit drug use in a nationally-representative US sample.

METHODS

We used Wave I (1994-1995, adolescence) of the National Longitudinal Study of Adolescent Health to conduct LCAs by gender and race/ethnicity and measure associations between class membership and Wave I and Wave III (2001-2002, young adulthood) drug use. Participants included white (n=9548), African American (n=4005) and Hispanic (n=3184) participants. LCAs were based on quantity and frequency of adolescent alcohol use; physiological and social consequences of use; and peer use.

RESULTS

Males and females were characterized by different alcohol use typologies and consequences. Males in the highest severity class (i.e. drank both heavily and frequently) experienced disproportionate risk of alcohol-related consequences compared with abstainers and other alcohol-using groups. Females who drank heavily when drinking even if only occasionally, experienced high risk of alcohol-related consequences. Substantial proportions of males reported diverse alcohol-related problems, whereas females most commonly reported alcohol-related problems with dating and sexual experiences. Though levels of alcohol use and report of problems associated with use were higher among white versus minority populations, other racial/ethnic differences in patterns of alcohol use were minimal. Classification in any drinking class was a strong risk factor for adolescent and adulthood illicit drug use, with heavy drinkers at greatest risk of drug use.

CONCLUSIONS

Gender-specific adolescent alcohol and substance use prevention programs are warranted.

Self-identified heterosexual clients in substance abuse treatment with a history of same-gender sexual contact

There is virtually no literature concerning the experiences of self-identified heterosexual clients in substance abuse treatment who have a history of same-gender sexual contact (HSGS). In a U.S. urban inpatient program in 2009-2010, 99 HSGS clients were compared to 681 other heterosexual and 86 lesbian, gay, and bisexual clients regarding background factors, program completion rates, and feelings about treatment. Male HSGS participants had lower completion rates than other male heterosexual participants. Qualitative data indicated that most male HSGS participants experienced difficult emotions regarding same-gender sexual encounters, particularly those involving trading sex for money or drugs. Implications for treatment are discussed.

Effects of acute alcohol tolerance on perceptions of danger and willingness to drive after drinking

RATIONALE

Drinking and driving is associated with elevated rates of motor vehicle accidents and fatalities. Previous research suggests that alcohol impairs judgments about the dangers of risky behaviors; however, how alcohol affects driving-related judgments is less clear. Impairments have also been shown to differ across limbs of the blood alcohol concentration (BAC) curve, which is known as acute tolerance.

OBJECTIVES

The objectives of this study were to examine whether perceptions about the dangerousness of driving after drinking and willingness to drive differed across the ascending and descending limbs of the BAC curve and to test whether reductions in perceived danger were associated with willingness to drive on the descending limb.

METHODS

Fifty-six participants were randomly assigned to receive either a moderate dose of alcohol (peak BAC = 0.10 g%) or placebo. We assessed perceived dangerousness and willingness to drive at matched BACs (~0.067-0.068 g%) on the ascending and descending limbs.

RESULTS

Both perceived danger and willingness to drive showed acute tolerance in the alcohol group. Participants judged driving to be significantly less dangerous and were more willing to drive on the descending limb compared to the ascending limb. The magnitude of change in perceived danger significantly predicted willingness to drive on the descending limb.

CONCLUSIONS

Decreased impairment associated with acute tolerance may lead individuals to underestimate the dangerousness of driving after drinking and in turn make poor decisions regarding driving. This study further emphasizes the descending limb as a period of increased risk and offers support for enhancing prevention efforts by targeting drivers at declining BAC levels.