A Behavioral Economic Examination of Sexual Behaviors in the Era of Pre-exposure Prophylaxis via Explanatory Sequential Mixed Methods.

Pre-exposure prophylaxis (PrEP) use may be associated with condom use decisions. The current investigation examined sexual decision-making in the context of PrEP among young adult men who have sex with men (MSM) between 18 and 30 years old, using an explanatory sequential mixed methods design. For the quantitative aim, 99 MSM currently taking PrEP (i.e., PrEP-experienced) and 140 MSM not currently taking PrEP (i.e., PrEP-naive) completed an online survey, including the Sexual Delay Discounting Task (SDDT), which captures likelihood of condom use. For the qualitative aim, 15 people from each group were interviewed about their (1) conceptualizations of risky sex and (2) ways they manage their sexual risk. Participants were, on average, 25.69 years old (SD = 3.07) and 64% White. Results from the quantitative aim revealed, controlling for covariates, PrEP-experienced participants exhibited significantly lower likelihood of (1) using an immediately available condom and (2) waiting for a delayed condom (i.e., sexual delay discounting) compared to PrEP-naive participants. Qualitative themes explaining what young adult MSM consider to be risky sex included: (1) any sex as risky sex, (2) risky sex as "sex without a conversation," and (3) risky sex as sex with risk for physical harm. Themes on ways young adult MSM manage sexual risk were classified as proactive, reactive, and passive. Results suggest that PrEP use is related to condom use decisions. Taken together, quantitative differences in sexual delay discounting, but qualitatively similar conceptualizations and management of risky sex, suggest that the SDDT may be a useful tool in sex research to capture processes (i.e., delay discounting) underlying sexual decision-making that may be missed by traditional self-reports. Implications of results, including potentially providing (good quality) condoms with every PrEP prescription, and future research topics are discussed.

Correspondence between alcohol use measured by a wrist-worn alcohol biosensor and self-report via ecological momentary assessment over a 2-week period.

BACKGROUND: Transdermal alcohol biosensors measure alcohol use continuously, passively, and non-invasively. There is little field research on the Skyn biosensor, a new-generation, wrist-worn transdermal alcohol biosensor, and little evaluation of its sensitivity and specificity and the day-level correspondence between transdermal alcohol concentration (TAC) and number of self-reported drinks. METHODS: Participants (N = 36; 61% male, M age  = 34.3) wore the Skyn biosensor and completed ecological momentary assessment (EMA) surveys about their alcohol use over 2 weeks. A total of 497 days of biosensor and EMA data were collected. Skyn-measured drinking episodes were defined by TAC > 5 µg/L. Skyn data were compared to self-reported drinking to calculate sensitivity and specificity (for drinking day vs. nondrinking day). Generalized estimating equations models were used to evaluate the correspondence between TAC features (peak TAC and TAC-area under the curve (AUC)) and number of drinks. Individual-level factors (sex, age, race/ethnicity, body mass index, human immunodeficiency virus status, and hazardous drinking) were examined to explore associations with TAC controlling for number of drinks. RESULTS: Using a minimum TAC threshold of 5 µg/L plus coder review, the biosensor had sensitivity of 54.7% and specificity of 94.6% for distinguishing drinking from nondrinking days. Without coder review, the sensitivity was 78.1% and the specificity was 55.2%. Peak TAC (ß = 0.92, p < 0.0001) and TAC-AUC (ß = 1.60, p < 0.0001) were significantly associated with number of drinks. Females had significantly higher TAC levels than males for the same number of drinks. CONCLUSIONS: Skyn-derived TAC can be used to measure alcohol use under naturalistic drinking conditions, additional research is needed to accurately identify drinking episodes based on Skyn TAC readings.

The inclusion of women and minorities in smoking cessation clinical trials: a systematic review.

This study assesses the impact of the 1993 NIH Revitalization Act on the inclusion and subgroup analysis of women and minorities in trials of FDA-approved smoking cessation pharmacotherapy. Female representation, while commensurate with population levels, declined significantly for trials that began recruitment after 1993(M = 47.2% vs. M = 53.9%), and fewer than half reported analyses by gender. Minorities continued to be under-represented in later trials; however, significant improvement in representation (M = 16.1% vs. M = 10%) and analysis by race occurred. Industry-sponsored studies had lower minority representation than NIH funded studies. Recommendations are offered to improve subgroup analyses and minority inclusion.