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.

Cannabis use and sexual risk among MSM who drink: Understanding why more frequent cannabis users may engage in higher rates of condomless sex.

BACKGROUND: Condomless anal intercourse (CAI) is the major risk factor for HIV transmission among men who have sex with men (MSM). MSM who are heavier cannabis users engage in CAI more frequently. However, little is known about the processes that may underlie this association. This study sought to understand the potential role of condom attitudes and condom-related planning in the association between cannabis use and CAI. METHODS: This is a secondary data analysis of a study on alcohol use and sexual decision-making among MSM. Two hundred and fifty-eight MSM with moderate to heavy drinking were enrolled. Measures included CAI, cannabis use, attitudes about the influence of condoms on sexual pleasure, condom use planning, age, heavy episodic drinking, and use of pre-exposure prophylaxis (PrEP). RESULTS: We conducted a negative binomial regression analysis controlling for age, PrEP, and heavy episodic drinking. Cannabis use frequency was a significant predictor of CAI (b =.333, p < .001). Indirect effects showed that while heavier cannabis users exhibited less condom-related planning (b = -0.106, p = 0.015) and more negative attitudes toward the impact of condom use on pleasure (b= -0.177, p = 0.004), cannabis use had a significant indirect effect on CAI only through attitude ratings. CONCLUSIONS: MSM who are heavier cannabis users engage in more frequent CAI and exhibit an indirect effect on CAI through negative attitudes toward the impact of condoms on pleasure. These findings suggest the potential importance of addressing these condom attitudes in HIV-prevention interventions among MSM who use cannabis.

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.

Daily Associations Among Alcohol Intoxication, Partner Familiarity, Participant Effortful Control, Urgency, and PrEP Uptake on Sexual Behavior in Men Who Have Sex with Men.

The purpose of this study was to examine the effects of alcohol intoxication and its interaction with contextual or situation (partner familiarity) and individual differences variables (effortful control, urgency, and whether taking pre-exposure prophylaxis (PrEP) medication) on sexual behaviors in men who have sex with men (MSM), a subgroup for whom HIV continues to be a major public health problem in the U.S. The participants were 236 men recruited from two northeastern U.S. cities and aged 21-50 years, M = 27.8). These men participated in a 6-week (two 3-week sampling bursts) experience sampling method (ESM) study. The ESM data were collected via use of software installed on the participant's own or study-provided mobile phone. Individual differences variables were measured by participants' completing questionnaires measuring effortful control and urgency, and the participant's self-report of whether he was currently taking PrEP. The ESM data pertained to sexual behavior as well as situation variables of familiarity of relevant sexual partners and number of standard alcohol drinks consumed. The results generally were consistent with hypotheses, as alcohol intoxication showed a curvilinear relation to the occurrence of condomless anal intercourse. Furthermore, the likelihood of occurrence of condomless anal sex increased with increased familiarity of the sexual partner. Similarly, taking PrEP increased the likelihood of occurrence of condomless anal sex. At the same time, alcohol's effects were moderated by all three individual differences variables as expected, but the prediction that partner familiarity would moderate alcohol's effects on the occurrence of condomless sex was not supported. Clinical implications of the findings center on the application of the data to HIV prevention programs toward inclusion of more empirically supported, nuanced information on the relation between acute alcohol intoxication and sexual behavior. Directions for further research address the need for additional testing and refinement of a person × situation approach to alcohol and sexual behavior. Furthermore, it is argued that it is important to refine further the concept of sexual risk in the context of taking PrEP and to conduct more detailed, multivariate studies of the relation between taking PrEP and patterns of sexual behavior.

Pre-Exposure Prophylaxis (PrEP) Use is Associated With Health Risk Behaviors Among Moderate- and Heavy-Drinking MSM.

Among men who have sex with men (MSM), acute alcohol consumption is associated with higher rates of condomless anal intercourse, which is linked with a greater likelihood of exposure to HIV and other sexually transmitted infections. While pre-exposure prophylaxis (PrEP) to prevent HIV infection has become more widespread in this population in recent years, so too have concerns that PrEP uptake may be associated with health risk behaviors. This study investigated differences in sexual behaviors and drug use habits between PrEP users and nonusers in a sample of moderate- and heavy-drinking MSM. Results indicated that PrEP use was associated with riskier sexual practices, weaker self-regulatory cognitions related to condom use, and more frequent illicit drug use. These findings suggest that moderate-and heavy-drinking MSM who use PrEP may comprise a unique risk group that could benefit from targeted counseling or other interventions to reduce their risk of negative health consequences.

A Single Session of Attentional Bias Modification Reduces Alcohol Craving and Implicit Measures of Alcohol Bias in Young Adult Drinkers.

BACKGROUND: Attentional bias modification (ABM) techniques for reducing problematic alcohol consumption hold promise as highly accessible and cost-effective treatment approaches. A growing body of literature has examined ABM as a potentially efficacious intervention for reducing drinking and drinking-related cognitions in alcohol-dependent individuals as well as those at-risk of developing problem drinking habits. METHODS: This study tested the effectiveness of a single session of visual probe-based ABM training in a cohort of 60 non-treatment-seeking young adult drinkers, with a focus on examining mechanisms underlying training efficacy. Participants were randomly assigned to a single session of active ABM training or a sham training condition in a laboratory setting. Measures of implicit drinking-related cognitions (alcohol Stroop and an Implicit Association Task) and attentional bias (AB; alcohol visual probe) were administered, and subjective alcohol craving was reported in response to in vivo alcohol cues. RESULTS: Results showed that active ABM training, relative to sham, resulted in significant differences in measures of implicit alcohol-related cognition, alcohol-related AB, and self-reports of alcohol craving. Mediation analysis showed that reductions in craving were fully mediated by ABM-related reductions in alcohol-Stroop interference scores, suggesting a previously undocumented relationship between the 2 measures. CONCLUSIONS: Results document the efficacy of brief ABM to reduce both implicit and explicit processes related to drinking, and highlight the potential intervention-relevance of alcohol-related implicit cognitions in social drinkers.

Attentional bias to alcohol stimuli predicts elevated cue-induced craving in young adult social drinkers.

Considerable evidence has identified biased cognitive processing of alcohol-related stimuli as an important factor in the maintenance of alcohol-seeking and relapse among individuals suffering from alcohol use-disorders (AUDs). In addition, a large body of research has demonstrated that exposure to alcohol cues can elicit powerful alcohol cravings. Little is known, however, about the possible relationship between attentional bias and cue-induced cravings, and even less is known about these processes in social drinkers without a personal history of AUDs. The goal of this study was to examine the possibility that attentional biases toward alcohol-related stimuli would predict elevated cue-induced alcohol craving in this population. Young adult social drinkers (N=30, Mean age=22.8±1.9, 61% female) recruited from an urban university population completed a visual dot probe task in which they were presented with alcohol and neutral stimulus pictures that were immediately followed by a visual probe replacing one of the pictures. Attentional bias was measured by calculating reaction times to probes that replaced alcohol stimuli vs. neutral stimuli. Participants then completed a classic alcohol cue-exposure task and reported cravings immediately before and after alcohol and neutral cue-exposures. Not surprisingly, exposure to alcohol cues elicited significant cravings. Consistent with the study hypothesis, larger attentional biases toward alcohol stimuli predicted higher levels of alcohol craving. Findings demonstrate that heightened attention to alcohol stimuli can significantly impact motivation to consume in healthy young adults, and suggest a possible pathway linking cognitive processes early in the drinking trajectory to the later development of AUDs.

Favorable associations with alcohol and impaired self-regulation: A behavioral economic analysis.

BACKGROUND: Recent research has demonstrated that both poor self-regulation and favorable implicit associations toward alcohol can play important roles in predicting drinking. Less well studied, however, is how the interplay between implicit associations and self-regulation may impact decisions about alcohol consumption. Behavioral economics is one important tool that may provide insight into the cognitive processes that impact demand for alcohol and drinking decisions. METHODS: Healthy young adult participants completed an Implicit Association Task (IAT) that measured the strength of associations between approach/avoid attributes and target alcohol/neutral images. Impaired self-regulation was assessed by a classic delay discounting task. Participants also completed an Alcohol Purchase Task (APT), which yields multiple behavioral economic indices, chief among which are intensity (the number of drinks a participant would consume if the drinks were free) and elasticity (the degree to which an increased per-drink price impacts the number of drinks consumed in a hypothetical drinking situation). Finally, participants completed a timeline follow-back assessment of past-90-day drinking. RESULTS: Findings indicated that implicit approach associations toward alcohol predicted increased demand for alcohol on the APT. Although delay discounting did not have a direct effect on demand for alcohol, there was a significant interaction between IAT and delay discounting, such that higher implicit alcohol approach associations predicted particularly high demand for alcohol among participants with poorer self-regulation. APT and IAT, in turn, predicted self-reported drinking behavior. CONCLUSIONS: These results suggest that favorable attitudes toward alcohol, together with poor self-regulation, can significantly impact drinking decisions in healthy young adults.

Gender and Impulsivity: Effects on Cue-Induced Alcohol Craving.

BACKGROUND: Numerous studies have demonstrated that trait impulsivity is linked to increased risk of developing alcohol-use disorders and other substance abuse. Impulsivity has also been shown in some studies to potentiate cue-induced drug cravings. Despite considerable evidence of gender differences in impulsivity and drug craving among individuals suffering from alcohol dependence and other drug use, little research has focused on these processes in healthy young men and women who may be at risk for developing alcohol-use disorders. The objective of this study was to investigate the relationship between impulsivity and cue-induced craving, as well as possible gender differences in these effects among healthy young adults. METHODS: To that end, female (n = 22) and male (n = 14) social drinkers aged 18 to 25, recruited from an urban university campus, completed the Barratt Impulsiveness Scale and reported their alcohol cravings immediately before and after laboratory exposure to alcohol cues. RESULTS: Findings indicated that exposure to cues elicited increased alcohol cravings, but these effects did not differ by gender. Interestingly, a significant interaction of impulsivity and gender revealed that impulsivity predicted significantly higher cue-induced cravings in women, but not men. CONCLUSIONS: Findings underscore the importance of better understanding the interaction of situational factors (e.g., exposure to alcohol cues) and dispositional factors (e.g., impulsivity) as potential contributors to drinking motivation. Future prospective research is needed to identify gender-specific risk factors for the development of problem drinking.

Computer-mediated communication preferences predict biobehavioral measures of social-emotional functioning.

The use of computer-mediated communication (CMC) as a form of social interaction has become increasingly prevalent, yet few studies examine individual differences that may shed light on implications of CMC for adjustment. The current study examined neurocognitive individual differences associated with preferences to use technology in relation to social-emotional outcomes. In Study 1 (N = 91), a self-report measure, the Social Media Communication Questionnaire (SMCQ), was evaluated as an assessment of preferences for communicating positive and negative emotions on a scale ranging from purely via CMC to purely face-to-face. In Study 2, SMCQ preferences were examined in relation to event-related potentials (ERPs) associated with early emotional attention capture and reactivity (the frontal N1) and later sustained emotional processing and regulation (the late positive potential (LPP)). Electroencephalography (EEG) was recorded while 22 participants passively viewed emotional and neutral pictures and completed an emotion regulation task with instructions to increase, decrease, or maintain their emotional responses. A greater preference for CMC was associated with reduced size of and satisfaction with social support, greater early (N1) attention capture by emotional stimuli, and reduced LPP amplitudes to unpleasant stimuli in the increase emotion regulatory task. These findings are discussed in the context of possible emotion- and social-regulatory functions of CMC.