Neuroticism and relationship quality: A meta-analytic review.

Regardless of participant age, length of relationship, country of origin, and numerous other factors, prior research has established a robust negative association between neuroticism and relationship quality. As so much has already been studied on the topic of neuroticism and relationship quality, this study explored the association between neuroticism and relationship quality using meta-analytic methodology, examined moderators, and outlined future studies for the field. After searching through databases and the references of included studies, 148 published studies were identified that reported an effect size between neuroticism and relationship quality. Reported effect sizes resulted in an overall aggregate correlation of r = -.238 and differentiated effect sizes for male actor and partner correlations, and female actor and partner correlations were similar. Results indicated that participant race, participant sexual orientation, and whether the effect sizes were taken from cross-sectional or longitudinal data did not moderate the relationship. However, the region of the world that the participants were from, the type of measurement tool used, participant age, and the length of time spent in a relationship were all significant moderators of our variables. We outline a model for how neuroticism operates through emotions, interpretations, and behaviors, which offers information for ways couples' practitioners could work to mitigate the association between neuroticism and relationship quality. Future directions for the field are delineated. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Quantifying Patient Risk Threshold in Managing Pancreatic Intraductal Papillary Mucinous Neoplasms.

OBJECTIVE: We aimed to better understand patients' treatment preferences and quantify the level of cancer risk at which treatment preferences change (risk threshold) to inform better counseling of patients with intraductal papillary mucinous neoplasms (IPMNs). SUMMARY BACKGROUND DATA: The complexity of IPMN management provides an opportunity to align treatment with individual preference. METHODS: We surveyed a sample of healthy volunteers simulating a common scenario: undergoing an imaging study that incidentally identifies an IPMN. In the scenario, the estimated risk of cancer in the IPMN was 5%. Patients were asked their treatment preference (surgery or surveillance), to quantify the level of cancer risk in the IPMN at which their treatment preference would change (i.e. risk threshold), and their level of cancer anxiety as measured on a 5-point Likert scale. We examined associations between participant characteristics, treatment preferences, and risk threshold using multivariable linear regression. RESULTS: The median risk threshold among the 520 participants was 25% (IQR 2.3-50%). The risk threshold had a bimodal distribution: 40% of participants had a risk threshold between 0-10% and 47% had a risk threshold above 30%. When informed that the risk of cancer was 5%, 62% of participants (n=323) preferred surveillance, and the remaining 38% (n=197) preferred surgery. After adjusting for potential confounders, participants who expressed "worry" or "extreme worry" about the malignancy risk of IPMN had significantly lower risk thresholds than participants who were "not at all worried" (Coefficient -12, 95%CI -21 to -2, P=0.015 and Coefficient -18, 95%CI -29 to -8, P<0.001, respectively). CONCLUSIONS: Participants varied in treatment preference and risk threshold of incidentally identified IPMNs. Given the uncertainty in estimating the true malignant potential of IPMNs, a better understanding of a patient's risk threshold, as influenced by patient concern about malignancy, will help inform the shared decision-making process.

Impact of Decarceration Plus Alcohol, Substance Use, and Mental Health Screening on Life Expectancies of Black Sexual Minority Men and Black Transgender Women Living With HIV in the United States: A Simulation Study Based on HPTN 061.

BACKGROUND: Given the disproportionate rates of incarceration and lower life expectancy (LE) among Black sexual minority men (BSMM) and Black transgender women (BTW) with HIV, we modeled the impact of decarceration and screening for psychiatric conditions and substance use on LE of US BSMM/BTW with HIV. METHODS: We augmented a microsimulation model previously validated to predict LE and leading causes of death in the US with estimates from the HPTN 061 cohort and the Veteran's Aging Cohort Studies. We estimated independent associations among psychiatric and substance use disorders, to simulate the influence of treatment of one condition on improvement on others. We used this augmented simulation to estimate LE for BSMM/BTW with HIV with a history of incarceration under alternative policies of decarceration (ie, reducing the fraction exposed to incarceration), screening for psychiatric conditions and substance use, or both. RESULTS: Baseline LE was 61.3 years. Reducing incarceration by 25%, 33%, 50%, and 100% increased LE by 0.29, 0.31, 0.53, and 1.08 years, respectively, versus no reductions in incarceration. When reducing incarceration by 33% and implementing screening for alcohol, tobacco, substance use, and depression, in which a positive screen triggers diagnostic assessment for all psychiatric and substance use conditions and linkage to treatment, LE increased by 1.52 years compared with no screening or decarceration. DISCUSSION: LE among BSMM/BTW with HIV is short compared with other people with HIV. Reducing incarceration and improving screening and treatment of psychiatric conditions and substance use could substantially increase LE in this population.

A First Glimpse at the Latent Structure of Sleep Valuation Using a Sleep Valuation Item Bank.

Introduction: Sleep valuation is the relative worth individuals place on sleep. Our prior study using a Sleep Valuation Item Bank (SVIB) showed that sleep valuation relates to age, gender, and health status. In this study, the psychometric properties of the SVIB and its latent factor structure were explored. We also investigated how sleep valuation factors relate to demographic, psychological, and sleep features. Methods: Participants (N = 854) were recruited through TurkPRIME and completed a survey consisting of demographic, psychological, and sleep-related questions. The distributional properties of the SVIB items were quantified. Cronbach's alpha and correlation analyses were used to assess the internal consistency and test-retest reliability of SVIB items. Iterated principal factoring with a Promax rotation was used on the SVIB to explore its latent factor structure. Multiple regression analyses were used to investigate the variables associated with each factor. Results: The factor analysis identified 29 items with factor loadings ≥0.4 on four major factors, tentatively called (1) sleep wanting, (2) sleep prioritizing, (3) sleep onset preference, and (4) sleep devaluation. While women had higher sleep wanting and lower sleep devaluation scores than men, they had lower sleep prioritizing. Older individuals tended to value sleep less but also devalued it less than younger participants. Finally, although both individuals with insomnia and depression devalued sleep, depressed individuals prioritized it more than those who were less depressed, while individuals with insomnia symptoms wanted sleep and preferred sleep onset more than those with less insomnia symptoms. Discussion: The current SVIB captures broad dimensions of sleep valuation (wanting, prioritizing, preferring) and sleep devaluation. These broad dimensions had distinct patterns across person-level factors. Recognition of individual differences in sleep valuation may help target sleep health advocacy efforts and individualized treatment approaches, including for those with depression or insomnia.

What is Normal Pornography Use in a Highly Religious Area? Exploring Patterns of Pornography Use in Utah.

BACKGROUND: Pornography has become mainstream in society, including in the state of Utah, which is a highly religious, conservative state. AIM: The purpose of this study is to gather basic descriptive norms for pornography use in the state of Utah (given its unique religious profile), establish clinical cutoffs based on frequency and duration of pornography consumption, and begin to establish a clinical picture of problematic pornography use in a regionally representative sample. METHODS: We recruited a representative sample of 892 Utahns via CloudResearch.com. Participants completed the following measures: Consumption of Pornography - General (COPS); Problematic Pornography Use Scale; Clear Lake Addiction to Pornography Scale; The Inventory of Depression and Anxiety Symptoms (Second Version). OUTCOME: Documentation of pornography use norms among Utahns. RESULTS: In our sample, 79% reported viewing pornography in their lifetime (85% of men, 75% of women). The most common frequency of pornography viewing was weekly or monthly among men, and monthly or every 6 months among women, which is comparable to national averages. Men and women showed significantly different pornography use frequencies. We demonstrate a relationship between higher levels of pornography use and higher perceived levels of pornography use as a problem or "addiction" and depression scores and explore the typical demographics of our highest pornography users. CLINICAL TRANSLATION: This study will aid clinicians in using the COPS to derive normal pornography use compared to above average pornography use among pornography users from a religious background, especially for clinicians who seek to provide normative data to clients presenting with problematic pornography use like in motivational interviewing interventions. STRENGTHS AND LIMITATIONS: Strengths include our measures generally demonstrated strong validity, we provide the beginnings of sound clinical implementation of the COPS for benchmarking pornography use in a clinical setting in Utah, and that our sample was representative of the state of Utah according to current census data. Limitations include those commonly seen in survey-based data collection methods, and that findings from our unique Utah sample may not be as relevant among other religious or cultural samples. CONCLUSION: Our findings provide an updated picture of pornography use in the state of Utah and suggest that even those high in religiosity continue to use pornography. Our results can provide a spectrum of pornography use, aiding a pornography user in treatment to be able to compare his or her use to this norm. Esplin CR, Hatch SG, Ogles BM, et al. What is Normal Pornography Use in a Highly Religious Area? Exploring Patterns of Pornography Use in Utah. J Sex Med 2022;19:823-833.

Examining the Problematic Pornography Use Model: A Quantitative Exploration of Dysregulated Pornography Use.

BACKGROUND: Questions concerning problematic pornography consumption have been widely discussed, but longitudinal data examining the relationships implicated by problematic pornography use models are rare. To date, two models have been proposed that have sought to elucidate the causal mechanisms involved in a problematic pornography use model, the I-PACE model and the Pornography Problems Due to Moral Incongruence Model. AIM: We sought to clarify this issue by investigating the prospective association between variables integral to previously proposed addiction models. METHODS: Using a longitudinal TurkPrime.com sample (N = 317), and a newly developed measure of pornography consumption, we asked participants to answer questions related to their pornography usage, their distress levels, and individual differences over a six-month time frame during 2017. MAIN OUTCOME: Pornography consumption only led to distress when an individual possessed certain individual differences. Moreover, there was no evidence that pornography use mediated or suppressed the relationship between pornography consumption and distress. RESULTS: Using a series of mediation/suppression models, we found evidence to support the structure of existing theoretical models; specifically, pornography consumption amplifies the relationship between individual differences (ie, sexual compulsivity and sexual sensation seeking) and distress (ie, depression and sexual esteem) over a six-month time period. However, we failed to observe an association between pornography consumption and distress when sexual compulsivity and sexual sensation seeking were left unaccounted for within the model, suggesting pornography use likely only results in distress in those with certain individual differences. Moreover, there was no evidence that perceptions of problematic pornography use suppressed or mediated the relationship between pornography consumption and distress. CLINICAL IMPLICATIONS: These findings suggest that targeting specific individual differences -a la Acceptance and Commitment Therapy-rather than pornography consumption attitudes may be a more effective strategy to reduce problematic pornography use. STRENGTHS & LIMITATIONS: One strength of the current study was that we were able to corroborate previously hypothesized models of problematic pornography consumption. Furthermore, this was done using a newly designed measurement of pornography consumption. However, the study was not without some shortcoming. We were unable to test the pornography problems due to moral incongruence arm of the study, something that previous research has indicated may lead to distress. CONCLUSION: This paper sought to empirically examine models investigating problematic pornography use. Our findings indicate that pornography consumption will only lead to certain sorts of distress in the presence of specific individual differences ie, sexual compulsivity and sexual sensation seeking. Hatch HD, Hatch SG, Henderson E, et al. Examining the Problematic Pornography Use Model: A Quantitative Exploration of Dysregulated Pornography Use. J Sex Med 2022;19:132-143.

Policy Review and Modeling Analysis of Mitigation Measures for Coronavirus Disease Epidemic Control, Health System, and Disease Burden, South Korea.

We reviewed the timeline of key policies for control of the coronavirus disease epidemic and determined their impact on the epidemic and hospital burden in South Korea. Using a discrete stochastic transmission model, we estimated that multilevel policies, including extensive testing, contact tracing, and quarantine, reduced contact rates by 90% and rapidly decreased the epidemic in Daegu and nationwide during February‒March 2020. Absence of these prompt responses could have resulted in a >10-fold increase in infections, hospitalizations, and deaths by May 15, 2020, relative to the status quo. The model suggests that reallocation of persons who have mild or asymptomatic cases to community treatment centers helped avoid overwhelming hospital capacity and enabled healthcare workers to provide care for more severely and critically ill patients in hospital beds and negative-pressure intensive care units. As small outbreaks continue to occur, contact tracing and maintenance of hospital capacity are needed.

Is Pornography Consumption Related to Risky Behaviors During Friends With Benefits Relationships?

BACKGROUND: Friends with benefits encounters are a relatively new pattern of relating among emerging adults where risky sexual behavior may occur. AIM: To understand whether pornography consumption is associated with riskier behaviors during friends with benefits encounters. METHODS: Cross-sectional study of 2 samples of emerging adults who have engaged in friends with benefits relationships (study 1, N = 411; study 2, N = 394). For binary outcomes, we used logistic regression and report odds ratios. For ordinal outcomes, we used ordered logistic regression and reported odds ratios. We tested for moderation by biological sex. RESULTS: Men who consumed pornography more frequently were more likely to engage in risky sexual behaviors during their friends with benefits encounters. More frequent pornography consumption was associated with increased likelihood and amount of intoxication for both the respondent and his partner, less frequent condom use, and a higher probability of having penetrative friends with benefits encounters while intoxicated and not using a condom. For each of these outcomes, our parameter estimates from study 2 fell within the 95% confidence intervals from study 1. These associations persisted when controlling for the effects of binge drinking frequency, broader patterns of problematic alcohol use, trait self-control, openness to experience, and permissive attitudes toward casual sex. The findings of this study may inform interventions to reduce risky behaviors among emerging adults. LIMITATIONS: Our cross-sectional studies examined only emerging adults in college with measurement that was exclusively self-reported. CONCLUSIONS: These results are discussed in terms of sexual script theory, and several implications for intervention are outlined. Henderson E, Aaron S, Blackhurst Z, et al. Is Pornography Consumption Related to Risky Behaviors During Friends with Benefits Relationships?. J Sex Med 2020;17:2446-2455.

Sanctification and Cheating Among Emerging Adults.

Cheating-a general term for extradyadic romantic or sexual behavior that violates expectations in a committed romantic relationship-is common and leads to a number of poor outcomes. Religion has historically influenced conceptions of romantic relationships, but societal attitudes about religion are in flux as many seek to retain spirituality even as affiliations with formal religion decrease. The present study evaluated a potential predictor of cheating that is more spiritual than formally religious, the "psychospiritual" concept of relationship sanctification (i.e., the idea that one's relationship itself is sacred). In a sample of college students in committed relationships (N = 716), we found that higher levels of self-reported relationship sanctification were associated with a lower likelihood of both physical and emotional cheating even when accounting for plausible alternate explanations (general religiosity, problematic alcohol use, and trait self-control). This association was mediated via permissive sexual attitudes; specifically, higher levels of sanctification were associated with less permissive sexual attitudes which, in turn, predicted a lower likelihood of emotional and physical cheating.

Association of Alcohol Screening Scores With Adverse Mental Health Conditions and Substance Use Among US Adults.

Importance: Alcohol screening may be associated with health outcomes that cluster with alcohol use (ie, alcohol-clustering conditions), including depression, anxiety, and use of tobacco, marijuana, and illicit drugs. Objective: To quantify the extent to which alcohol screening provides additional information regarding alcohol-clustering conditions and to compare 2 alcohol use screening tools commonly used for this purpose. Design, Setting, and Participants: This longitudinal cohort study used data from the Veterans Aging Cohort Study. Data were collected at 8 Veterans Health Administration facilities from 2003 through 2012. A total of 7510 participants were enrolled, completed a baseline survey, and were followed up. Veterans with HIV were matched with controls without HIV by age, race, sex, and site of care. Data were analyzed from January 2019 to December 2019. Exposures: The Alcohol Use Disorders Identification Test (AUDIT) and Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) were used to assess alcohol use, with 4 risk groups delineated for each test: score 0 to 7 (reference), score 8 to 15, score 16 to 19, and score 20 to 40 (maximum score) for the full AUDIT and score 0 to 3 (reference), score 4 to 5, score 6 to 7, and score 8 to 12 (maximum score) for the AUDIT-C. Main Outcomes and Measures: Alcohol-clustering conditions, including self-reported symptoms of depression and anxiety and use of tobacco, marijuana, cocaine, other stimulants, opioids, and injection drugs. Results: A total of 6431 US patients (6104 [95%] men; median age during survey years 2003-2004, 50 years [range, 28-86 years; interquartile range, 44-55 years]) receiving care in the Veterans Health Administration completed 1 or more follow-up surveys when the AUDIT was administered and were included in the present analyses. Of the male participants, 4271 (66%) were African American, 1498 (24%) were white, and 590 (9%) were Hispanic. The AUDIT and AUDIT-C scores were associated with each alcohol-clustering condition. In particular, an AUDIT score of 20 or higher (vs <8, the reference) was associated with symptoms of depression (odds ratio [OR], 8.37; 95% CI, 6.20-11.29) and anxiety (OR, 8.98; 95% CI, 6.39-12.60) and with self-reported use of tobacco (OR, 14.64; 95% CI, 8.94-23.98), marijuana (OR, 12.41; 95% CI, 8.61-17.90), crack or cocaine (OR, 39.47; 95% CI, 27.38-56.90), other stimulants (OR, 21.31; 95% CI, 12.73-35.67), and injection drugs (OR, 8.67; 95% CI, 5.32-14.13). An AUDIT score of 20 or higher yielded likelihood ratio (sensitivity / 1 - specificity) values greater than 3.5 for depression, anxiety, crack or cocaine use, and other stimulant use. Associations between AUDIT-C scores and alcohol-clustering conditions were more modest. Conclusions and Relevance: Alcohol screening can inform decisions about further screening and diagnostic assessment for alcohol-clustering conditions, particularly for depression, anxiety, crack or cocaine use, and other stimulant use. Future studies using clinical diagnoses rather than screening tools to assess alcohol-clustering conditions may be warranted.

Registered Replication Report: Dijksterhuis and van Knippenberg (1998).

Dijksterhuis and van Knippenberg (1998) reported that participants primed with a category associated with intelligence ("professor") subsequently performed 13% better on a trivia test than participants primed with a category associated with a lack of intelligence ("soccer hooligans"). In two unpublished replications of this study designed to verify the appropriate testing procedures, Dijksterhuis, van Knippenberg, and Holland observed a smaller difference between conditions (2%-3%) as well as a gender difference: Men showed the effect (9.3% and 7.6%), but women did not (0.3% and -0.3%). The procedure used in those replications served as the basis for this multilab Registered Replication Report. A total of 40 laboratories collected data for this project, and 23 of these laboratories met all inclusion criteria. Here we report the meta-analytic results for those 23 direct replications (total N = 4,493), which tested whether performance on a 30-item general-knowledge trivia task differed between these two priming conditions (results of supplementary analyses of the data from all 40 labs, N = 6,454, are also reported). We observed no overall difference in trivia performance between participants primed with the "professor" category and those primed with the "hooligan" category (0.14%) and no moderation by gender.

Romantic relationships and mental health.

This paper reviews the research on relationships and mental health. Individuals who are more mentally healthy are more likely to select into relationships, but relationships are also demonstrably associated with mental health. The type of relationship matters - evidence suggests that more established, committed relationships, such as marriage, are associated with greater benefits than less committed unions such as cohabitation. The association between relationships and mental health is clearly bidirectional, however, stronger effects are observed when mental health is the outcome and relationships are the predictor, suggesting that the causal arrow flows more strongly from relationships to mental health than vice versa. Moreover, improving relationships improves mental health, but improving mental health does not reliably improve relationships. Our review of research corroborates the view that relationships are a keystone component of human functioning that have the potential to influence a broad array of mental health outcomes.

Community-Based, Preclinical Patient Navigation for Colorectal Cancer Screening Among Older Black Men Recruited From Barbershops: The MISTER B Trial.

OBJECTIVES: To test the effectiveness of a preclinical, telephone-based patient navigation intervention to encourage colorectal cancer (CRC) screening among older Black men. METHODS: We conducted a 3-parallel-arm, randomized trial among 731 self-identified Black men recruited at barbershops between 2010 and 2013 in New York City. Participants had to be aged 50 years or older, not be up-to-date on CRC screening, have uncontrolled high blood pressure, and have a working telephone. We randomized participants to 1 of 3 groups: (1) patient navigation by a community health worker for CRC screening (PN), (2) motivational interviewing for blood pressure control by a trained counselor (MINT), or (3) both interventions (PLUS). We assessed CRC screening completion at 6-month follow-up. RESULTS: Intent-to-treat analysis revealed that participants in the navigation interventions were significantly more likely than those in the MINT-only group to be screened for CRC during the 6-month study period (17.5% of participants in PN, 17.8% in PLUS, 8.4% in MINT; P < .01). CONCLUSIONS: Telephone-based preclinical patient navigation has the potential to be effective for older Black men. Our results indicate the importance of community-based health interventions for improving health among minority men.

Does Improving Marital Quality Improve Sleep? Results From a Marital Therapy Trial.

For most adults, sleep is a dyadic behavior. Only recently have studies explored the dynamic association between sleep and relationship functioning among bed partners. The current study is the first to examine bidirectional associations between changes in insomnia and changes in marital quality over time, in the context of a marital therapy trial. Among husbands, improvements in marital satisfaction were associated with a 36% decreased risk of insomnia at follow-up. Regarding the reverse direction, counter-intuitively, wife baseline insomnia was associated with improvements in husbands' marital satisfaction, but only among the non-treatment-seeking comparison group. Results are discussed in terms of implications for sleep and marital therapy, and suggest that improving sleep may be an added benefit of improving the marital relationship.

Validating Machine Learning Algorithms for Twitter Data Against Established Measures of Suicidality.

BACKGROUND: One of the leading causes of death in the United States (US) is suicide and new methods of assessment are needed to track its risk in real time. OBJECTIVE: Our objective is to validate the use of machine learning algorithms for Twitter data against empirically validated measures of suicidality in the US population. METHODS: Using a machine learning algorithm, the Twitter feeds of 135 Mechanical Turk (MTurk) participants were compared with validated, self-report measures of suicide risk. RESULTS: Our findings show that people who are at high suicidal risk can be easily differentiated from those who are not by machine learning algorithms, which accurately identify the clinically significant suicidal rate in 92% of cases (sensitivity: 53%, specificity: 97%, positive predictive value: 75%, negative predictive value: 93%). CONCLUSIONS: Machine learning algorithms are efficient in differentiating people who are at a suicidal risk from those who are not. Evidence for suicidality can be measured in nonclinical populations using social media data.

Impact and Cost-Effectiveness of Hypothetical Strategies to Enhance Retention in Care within HIV Treatment Programs in East Africa.

OBJECTIVES: Attrition from care among HIV infected patients can lead to poor clinical outcomes. Our objective was to evaluate hypothetical interventions seeking to improve retention-in-care (RIC) for HIV-infected patients in East Africa, asking whether they could offer favorable value compared to earlier ART initiation. METHODS: We used a micro-simulation model to analyze two RIC focused strategies within an East African HIV treatment program--"risk reduction," defined as intervention(s) that decrease the risk of attrition from care; and "outreach," defined as interventions that find patients and relink them with care. We compared this to earlier ART treatment as a measure of the potential health benefits forgone (e.g., opportunity cost). RESULTS: Reducing attrition by 40% at an average cost of $10 per person remains a less efficient use of resources compared to ensuring full access to ART (cost- effectiveness ratio $1300 vs $3700) for ART eligible patients. An outreach intervention had limited clinical benefit in our simulation. If intervention costs are <$10 per person, however, an intervention able to achieve a 40% (or greater) reduction in attrition may be a cost-effective next implementation option following implementation of earlier ART treatment. CONCLUSIONS: Our results suggest that programs should consider retention focused programs once they have already achieved high degrees of ART coverage among eligible patients. It is important that decision makers understand the epidemiology and associated outcomes of those patients who are classified as lost to follow up in their systems prior to implementation in order to achieve the highest value.

Is pornography consumption associated with condom use and intoxication during hookups?

In order to examine whether pornography consumption is associated with risky sexual behaviour among emerging adults, we examined two large samples of those who reported hooking up in the past 12 months (combined n =  1216). Pornography use was associated with a higher likelihood of having a penetrative hookup; a higher incidence of intoxication during hookups for men (but a lower incidence of intoxication during hookups for women); increasing levels of intoxication during hookups for men but decreasing levels of intoxication for women; and a higher likelihood of being in the riskiest category of having a penetrative hookup, without a condom, while intoxicated. For each of these outcomes, our point estimates for Study 2 fell within the 95% confidence intervals from Study 1. Controlling for trait self-control, binge drinking frequency, broader problematic patterns of alcohol use, openness to experience, and attitudes toward casual sex did not change the pattern of results. Implications for interventions to reduce sexual risk are discussed.

The influence of pornography on sexual scripts and hooking up among emerging adults in college.

The explosive growth in access to the Internet has led to a commensurate increase in the availability, anonymity, and affordability of pornography. An emerging body of research has shown associations between pornography and certain behaviors and attitudes; yet, how pornography actually influences these outcomes has not been documented. In two studies (Study 1 N = 969; Study 2 N = 992) we examined the hypothesis that pornography influences potentially risky sexual behavior (hooking up) among emerging adults via sexual scripts. Our results demonstrate that more frequent viewing of pornography is associated with a higher incidence of hooking up and a higher number of unique hook up partners. We replicated these effects both cross-sectionally and longitudinally while accounting for the stability of hook ups over the course of an academic semester. We also demonstrated that more frequent viewing of pornography is associated with having had more previous sexual partners of all types, more one occasion sexual partners ("one night stands"), and plans to have a higher number of sexual partners in the future. Finally, we provided evidence that more permissive sexual scripts mediated the association between more frequent pornography viewing and hooking up. We discuss these findings with an eye toward mitigating potential personal and public health risks among emerging adults.

Evaluating the impact of prioritization of antiretroviral pre-exposure prophylaxis in New York.

OBJECTIVE: To compare the value and effectiveness of different prioritization strategies of pre-exposure prophylaxis (PrEP) in New York City (NYC). DESIGN: Mathematical modelling utilized as clinical trial is not feasible. METHODS: Using a model accounting for both sexual and parenteral transmission of HIV, we compare different PrEP prioritization strategies (PPS) with two scenarios ­ no PrEP and PrEP for all susceptible at-risk individuals. The PPS included PrEP for all MSM,only high-risk MSM, high-risk heterosexuals, and IDUs, and all combinations of these four strategies. Outcomes included HIV infections averted, and incremental cost effectiveness(per-infection averted) ratios. Initial assumptions regarding PrEP included a 44% reduction in HIV transmission, 50% uptake in the prioritized population and an annual cost per person of $9762. Sensitivity analyses on key parameters were conducted. RESULTS: Prioritization to all MSM results in a 19% reduction in new HIV infections. Compared with PrEP for all persons at-risk, this PPS retains 79% of the preventive effect at 15% of the total cost. PrEP prioritized to only high-risk MSM results in a reduction in new HIV infections of 15%. This PPS retains 60% of the preventive effect at 6% of the total cost. There are diminishing returns when PrEP utilization is expanded beyond this group. CONCLUSION: PrEP implementation is relatively cost-inefficient under our initial assumptions. Our results suggest that PrEP should first be promoted among MSM who are at particularly high risk of HIV acquisition. Further expansion beyond this group may be cost-effective, but is unlikely to be cost-saving.

Cost-effectiveness of different strategies to monitor adults on antiretroviral treatment: a combined analysis of three mathematical models.

BACKGROUND: WHO's 2013 revisions to its Consolidated Guidelines on antiretroviral drugs recommend routine viral load monitoring, rather than clinical or immunological monitoring, as the preferred monitoring approach on the basis of clinical evidence. However, HIV programmes in resource-limited settings require guidance on the most cost-effective use of resources in view of other competing priorities such as expansion of antiretroviral therapy coverage. We assessed the cost-effectiveness of alternative patient monitoring strategies. METHODS: We evaluated a range of monitoring strategies, including clinical, CD4 cell count, and viral load monitoring, alone and together, at different frequencies and with different criteria for switching to second-line therapies. We used three independently constructed and validated models simultaneously. We estimated costs on the basis of resource use projected in the models and associated unit costs; we quantified impact as disability-adjusted life years (DALYs) averted. We compared alternatives using incremental cost-effectiveness analysis. FINDINGS: All models show that clinical monitoring delivers significant benefit compared with a hypothetical baseline scenario with no monitoring or switching. Regular CD4 cell count monitoring confers a benefit over clinical monitoring alone, at an incremental cost that makes it affordable in more settings than viral load monitoring, which is currently more expensive. Viral load monitoring without CD4 cell count every 6-12 months provides the greatest reductions in morbidity and mortality, but incurs a high cost per DALY averted, resulting in lost opportunities to generate health gains if implemented instead of increasing antiretroviral therapy coverage or expanding antiretroviral therapy eligibility. INTERPRETATION: The priority for HIV programmes should be to expand antiretroviral therapy coverage, firstly at CD4 cell count lower than 350 cells per µL, and then at a CD4 cell count lower than 500 cells per µL, using lower-cost clinical or CD4 monitoring. At current costs, viral load monitoring should be considered only after high antiretroviral therapy coverage has been achieved. Point-of-care technologies and other factors reducing costs might make viral load monitoring more affordable in future. FUNDING: Bill & Melinda Gates Foundation, WHO.