Just-in-the-Moment Adaptive Interventions (JITAI): A Meta-Analytical Review.

A just-in-time, adaptive intervention (JITAI) is an emerging type of intervention that provides tailored support at the exact time of need. It does so using enabling new technologies (e.g., mobile phones, sensors) that capture the changing states of individuals. Extracting effect sizes of primary outcomes produced by 33 empirical studies that used JITAIs, we found moderate to large effect sizes of JITAI treatments compared to (1) waitlist-control conditions (k = 9), Hedges's g = 1.65 and (2) non-JITAI treatments (k = 21), g = 0.89. Also, participants of JITAI interventions showed significant changes (k = 13) in the positive direction (g = 0.79). A series of sensitivity tests suggested that those effects persist. Those effects also persist despite differences in the behaviors of interests (e.g., blood glucose control, recovering alcoholics), duration of the treatments, and participants' age. Two aspects of tailoring, namely: (1) tailoring to what (i.e., both people's previous behavioral patterns and their current need states; with these effects additive) and (2) approach to tailoring (i.e., both using a human agent and an algorithm to decide tailored feedback; with these effects additive), are significantly associated with greater JITAI efficacy.

Are insecure attachment styles related to risky sexual behavior? A meta-analysis.

OBJECTIVE: Attachment theory provides a powerful framework for understanding individual differences affecting interpersonal relationships and a range of health behavior outcomes. However, no meta-analyses have yet to examine the relationship between adult attachment styles and risky sexual behaviors. The purpose of this meta-analysis was to synthesize the results of the association between adult attachment and risky sexual behaviors. METHOD: Keywords were searched via PsycINFO, Web of Science, and Google Scholar. We used comprehensive meta-analysis (CMA) 3.0 to systematically synthesize and analyze the 42 effect sizes from 16 studies (total N = 7,233). RESULTS: Attachment anxiety has a small effect on having multiple partners (Fisher's Z = .09, 95% CI [0.021, 0.154]; I² = 80.4%) and engaging in condomless sex (Fisher's Z = .09, 95% CI [.006, 0.175]; I² = 82.5%), whereas attachment avoidance has a small effect on having multiple partners (Fisher's Z = .06, 95% CI [0.019, 0.109]; I² = 57.6%) but no effect on engaging in condomless sex (Fisher's Z = .05, 95% CI [-0.024, 0.117]; I2 = 73.9%). Furthermore, average age of participants in a study (z = 3.31, ß = .01, p = .001) and type of risk population (z = 3.03, ß = .12, p = .002) were found to be significant moderators. CONCLUSIONS: Insecure attachment styles are related to risky sexual behaviors and the correlation between attachment anxiety and having multiple partners is stronger as the average age of participant increases and when the study population is specifically an at-risk population. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The relationship between social norms and sexual risk-reduction intentions and behavior among men who have sex with men: Findings from an eHealth intervention.

Normative-based research has found that norms are significant predictors of safe sex behavioral intentions and behavior. Research shows that group identity moderates the relationship between norms and intentions/behavior. The present study used the theory of normative social behavior to evaluate whether identification with characters in an HIV-prevention interactive video moderated the relationship between sexual risk-taking norms and risk reduction intentions/behavior. Participants included 540 men between the ages 18 and 30 enrolled in a randomized controlled trial with a 3-month follow-up. We found support for the hypothesized interaction. At low levels of character identification, the negative relationship between sexual risk-taking norms and risk reduction intentions was strong. However, as character identification increased, the link between norms and intentions became weaker. The mean intentions score of high-risk norm participants was elevated to the level reported by low risk norm participants, demonstrating the favorable effect of character identification on narrative persuasion in entertainment-education. The utility of a social norms approach to health behavior change is discussed in the context of eHealth interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Young Men's Shame about Their Desire for other Men Predicts Risky Sex and Moderates the Knowledge - Self-Efficacy Link.

BACKGROUND: Nationally, HIV incidence is rising rapidly among young (18-24 years old) men who have sex with men (YMSM). Knowledge of safer sex generally enhances self-efficacy for safer sex, an important predictor of safer-sex behaviors. Recent findings suggest that a strong negative social emotion (i.e., shame) increases YMSM's sexual risk-taking. Unchangeable shame (e.g., desire for other men) might undermine (moderate) the link between knowledge and self-efficacy or between self-efficacy and unprotected anal intercourse (UAI): this may be less likely for changeable shame (e.g., shame about risky sexual behavior). AIM: To test the hypotheses that shame (i.e., sexual desire shame), but not shame about behavior (i.e., sexual behavior shame), will be positively related to UAI and will moderate the relationship between knowledge and self-efficacy and/or self-efficacy and UAI among YMSM. METHOD: In an online national study, 1177 young adult (18-24 years old) MSM reported one or more acts of UAI in the past 90 days with a casual partner. Eligible MSM filled out a survey in which they provided information about their knowledge of safer sex, self-efficacy for safer sex, reported levels of shame, and reported past 90-day UAI. RESULTS: Sexual desire shame was negatively correlated with knowledge and self-efficacy and positively correlated with UAI, the pattern reversed for sexual behavior shame. Sexual desire shame significantly lowered the knowledge to self-efficacy and the self-efficacy to UAI links. Sexual behavior shame also reduced the link from knowledge to self-efficacy, but not the self-efficacy to UAI link. CONCLUSION: The present study shows that there are different types of shame that may produce different effects with different implications for health behavior. Sexual desire shame may better reflect an emotion that is activated prior to risky behavior (e.g., when men reflect upon or feel desire for another man). Sexual behavior shame, on the other hand, better reflects what has already happened, thus, those higher in knowledge, efficacy, and therefore, safer sex are least likely to experience shame behavior.

Reducing shame in a game that predicts HIV risk reduction for young adult MSM: a randomized trial delivered nationally over the Web.

INTRODUCTION: Men who have sex with men (MSM) often face socially sanctioned disapproval of sexual deviance from the heterosexual "normal." Such sexual stigma can be internalized producing a painful affective state (i.e., shame). Although shame (e.g., addiction) can predict risk-taking (e.g., alcohol abuse), sexual shame's link to sexual risk-taking is unclear. Socially Optimized Learning in Virtual Environments (SOLVE) was designed to reduce MSM's sexual shame, but whether it does so, and if that reduction predicts HIV risk reduction, is unclear. To test if at baseline, MSM's reported past unprotected anal intercourse (UAI) is related to shame; MSM's exposure to SOLVE compared to a wait-list control (WLC) condition reduces MSM's shame; and shame-reduction mediates the link between WLC condition and UAI risk reduction. METHODS: HIV-negative, self-identified African American, Latino or White MSM, aged 18-24 years, who had had UAI with a non-primary/casual partner in the past three months were recruited for a national online study. Eligible MSM were computer randomized to either WLC or a web-delivered SOLVE. Retained MSM completed baseline measures (e.g., UAI in the past three months; current level of shame) and, in the SOLVE group, viewed at least one level of the game. At the end of the first session, shame was measured again. MSM completed follow-up UAI measures three months later. All data from 921 retained MSM (WLC condition, 484; SOLVE condition, 437) were analyzed, with missing data multiply imputed. RESULTS: At baseline, MSM reporting more risky sexual behaviour reported more shame (r s=0.21; p<0.001). MSM in the SOLVE intervention reported more shame reduction (M=-0.08) than MSM in the control condition (M=0.07; t(919)=4.24; p<0.001). As predicted, the indirect effect was significant (point estimate -0.10, 95% bias-corrected CI [-0.01 to -0.23] such that participants in the SOLVE treatment condition reported greater reductions in shame, which in turn predicted reductions in risky sexual behaviour at follow-up. The direct effect, however, was not significant. CONCLUSIONS: SOLVE is the first intervention to: (1) significantly reduce shame for MSM; and (2) demonstrate that shame-reduction, due to an intervention, is predictive of risk (UAI) reduction over time.

Consideration of future consequences and unprotected anal intercourse among men who have sex with men.

This study of men who have sex with men (MSM) examined whether tendencies to consider the future consequences of one's actions were associated with sexual behaviors that place oneself at risk for HIV infection. A total of 339 HIV-negative MSM responded to the Consideration of Future Consequences Scale (CFC; Strathman et al., 1994) and to questions about their anal intercourse practices in the past year. In bivariate analyses, men with a stronger future orientation were less likely to engage in anal intercourse unprotected by a condom (p < .05). Multivariate analyses revealed that CFC accounted for significant variance in three of four measures of unprotected anal sex after statistically controlling for demographic covariates (education, income, ethnicity, age). CFC was a better predictor of sexual behavior and accounted for more unique variance than any of the demographic factors. Additional research is needed to confirm that CFC is an antecedent of behavior and to examine the feasibility and efficacy of focusing on CFC in HIV prevention interventions.

Hierarchical messages for introducing multiple HIV prevention options: promise and pitfalls.

In battling HIV, many interventionists advocate the use of hierarchical messages that present multiple prevention options in order of decreasing effectiveness. The purpose of the present study was to determine if hierarchical messages provide women with additional prevention options without reducing the perceived efficacy of and willingness to use the primary method mentioned (in this case, male condoms). African American and Mexican American women between 18 and 32 years of age (n=112) at risk for HIV were randomly assigned to receive either a male-condom-only message (use male condoms) or a hierarchical message (use male condoms; if not, use female condoms; if not, use spermicide). Compared with women in the male-condom-only condition, a significantly smaller percentage of women who received the hierarchical message perceived male condoms as highly effective against HIV. Women currently not using male condoms who received the hierarchical, rather than the male-condom-only, message were less likely to consider using male condoms in the future. Among current male condom users, however, the hierarchical message did not influence intent to use male condoms. These data point to the need for examining both the intended and unintended effects of hierarchical health care messages.

Evolved sex differences in the number of partners desired? The long and the short of it.

Do men seek more short-term mates than women? Buss and Schmitt (1993) showed a pattern of mean difference in the ideal number of sexual partners men and women desired over various time frames. We replicated these mean sex differences (e.g., ideal number over the next 30 years: Ms = 7.69 and 2.78 for men and women, respectively), but in both data sets the sampling distributions were highly skewed. In Study 1, we found few sex differences in medians across time frames (e.g., ideal number over the next 30 years: Mdn = 1 for both men and women). In Study 2, most college men (98.9%) and women (99.2%) said they wanted to settle down with one mutually exclusive sexual partner at some point in their life, ideally within the next 5 years. Neither medians in number of partners desired overall before settling down (replicating Study 1) nor medians in short-term partners desired before settling down (Mdn = 0) differed significantly by gender. Rather, men and women concurred: Short-term mating is not what humans typically seek.