Using topic coding to understand the nature of change language in a motivational intervention to reduce alcohol and sex risk behaviors in emergency department patients.

OBJECTIVE: To elucidate patient language that supports changing a health behavior (change talk) or sustaining the behavior (sustain talk). METHODS: We developed a novel coding system to characterize topics of patient speech in a motivational intervention targeting alcohol and HIV/sexual risk in 90 Emergency Department patients. We further coded patient language as change or sustain talk. RESULTS: For both alcohol and sex, discussions focusing on benefits of behavior change or change planning were most likely to involve change talk, and these topics comprised a large portion of all change talk. Greater discussion of barriers and facilitators of change also was associated with more change talk. For alcohol use, benefits of drinking behavior was the most common topic of sustain talk. For sex risk, benefits of sexual behavior were rarely discussed, and sustain talk centered more on patterns and contexts, negations of drawbacks, and drawbacks of sexual risk behavior change. CONCLUSIONS: Topic coding provided unique insights into the content of patient change and sustain talk. PRACTICE IMPLICATIONS: Patients are most likely to voice change talk when conversation focuses on behavior change rather than ongoing behavior. Interventions addressing multiple health behaviors should address the unique motivations for maintaining specific risky behaviors.

Interactive Relationships Between Sex-Related Alcohol Expectancies and Delay Discounting on Risky Sex.

BACKGROUND: Sex-related alcohol expectancies reflect the degree to which a person believes alcohol will affect her or his sexual behavior. Sex-related alcohol expectancies have been found to be predictors of drinking in sexual situations and engagement in risky sexual behavior after drinking. However, less is known about individual characteristics that may moderate these associations. Building upon recent evidence that steep delay discounting is associated with alcohol-related sexual risk taking, this study aimed to test the hypothesis that the associations between sex-related alcohol expectancies and alcohol-related sexual risk taking would be stronger among individuals who discount delayed rewards more steeply. METHODS: The current sample comprised 126 Emergency Department patients (Mage  = 27.37; 55% male) who reported high-risk alcohol use and sexual behavior during the past 3 months. Sex-related alcohol expectancies were assessed in 3 behavioral domains: increased riskiness, decreased nervousness, and enhanced sexuality. RESULTS: All 3 expectancy domains were associated with quantity and frequency of alcohol use, as well as percentage of alcohol-related condomless sex. Delay discounting moderated 2 of these relationships, such that the associations between expectancies for alcohol-induced sexual risk taking and the enhancement of sexuality and percentage of alcohol-related sexual risk-taking were significantly stronger in individuals who exhibited steeper delay discounting. CONCLUSIONS: These findings suggest that individuals who both discount delayed rewards more steeply and hold strong sex-related alcohol expectancies are a particularly high-risk population. Such individuals may benefit from a combination of novel preventive strategies targeting sex-related alcohol expectancies and impulsive decision making.

Sexual Risk Behavior and Heavy Drinking Among Weekly Marijuana Users.

OBJECTIVE: Sexual behavior that incurs increased risk for sexually transmitted infections and HIV incidence is associated with both heavy alcohol and marijuana use. Whereas detrimental effects of alcohol on increased sexual risk have been documented in event-level and laboratory studies, less is known about the combined use of alcohol and marijuana and their relative impact on sexual risk behavior. We examined the degree to which both heavy drinking and marijuana use were associated with condomless sexual intercourse with casual versus main partners in a sample of weekly marijuana smokers. METHOD: Participants reported substance use and sexual activity using a 60-day Timeline Followback interview method (n = 112). RESULTS: Results of generalized estimating equations indicated that both alcohol and marijuana use were independently associated with greater odds of having sexual intercourse but were not associated with greater odds of unprotected sex with a casual partner. Heavy drinking on a given day was associated with increased odds of having casual protected sex. Using both substances synergistically increased the likelihood of unprotected sex with a main partner. CONCLUSIONS: Findings suggest that behaviors posing higher sexual risk (condomless intercourse or sex with casual partners) occur on days when alcohol use exceeds moderate drinking guidelines. Interventions designed to reduce sexual risk behaviors may need to specifically target heavy drinking alone or when used with marijuana.

Further evidence of the heterogeneous nature of impulsivity.

'Impulsivity' refers to a range of behaviours including preference for immediate reward (temporal-impulsivity) and the tendency to make premature decisions (reflection-impulsivity) and responses (motor-impulsivity). The current study aimed to examine how different behavioural and self-report measurements of impulsivity can be categorised into distinct subtypes. Exploratory factor analysis using full information maximum likelihood was conducted on 10 behavioural and 1 self-report measure of impulsivity. Four factors of impulsivity were indicated, with Factor 1 having a high loading of the Stop Signal Task, which measures motor-impulsivity, factor 2 representing reflection-impulsivity with loadings of the Information Sampling Task and Matching Familiar Figures Task, factor 3 representing the Immediate Memory Task, and finally factor 4 which represents the Delay Discounting Questionnaire and The Monetary Choice Questionnaire, measurements of temporal-impulsivity. These findings indicated that impulsivity is not a unitary construct, and instead represents a series of independent subtypes. There was evidence of a distinct reflection-impulsivity factor, providing the first factor analysis support for this subtype. There was also support for additional factors of motor- and temporal-impulsivity. The present findings indicated that a number of currently accepted tasks cannot be considered as indexing motor- and temporal-impulsivity suggesting that additional characterisations of impulsivity may be required.