Expectancies specific to condom use mediate the alcohol and sexual risk relationship

The present study tested the role of alcohol expectancies for condom use in mediating the alcohol and risky sex relationship. Expectancies for condom use are specific anticipations for alcohol's effect on one's ability to use a condom. College students (N = 563) reported on beliefs, intentions and actual sexual and drinking behavior. Among the sexually active, alcohol was directly related to future intention to use a condom in drinking situations for men, but not for women. In the men, alcohol expectancies for condom use mediated the relationship between drinking and condom intention. Beliefs that alcohol negatively impacts one's ability to use condoms were associated with more drinking and lower intentions to use a condom. These expectancies may help explain how alcohol affects risky sex in men. Gender differences and implications are discussed.     

Use of Drinking Protective Behavioral Strategies and Sexual Perceptions and Behaviors in U.S. College Students

Alcohol use among college students is linked to an increased likelihood of engaging in risky sexual behaviors, including casual sex and unprotected sex. These behaviors increase college students' risks for negative social and health-related consequences. This study examined the relationship between drinking behaviors and protective behavioral strategies (PBS), expectancies and perceptions of sexual risk, and actual alcohol-related sexual behaviors and consequences. Sexually active college students completed Web-based self-report measures of drinking behaviors and use of PBS, alcohol expectancies and perceptions of risk, and sexual behaviors and related consequences (n = 524; 57.1% women). Findings indicated that PBS were related to lower expectancies of sexual risk and sexual disinhibition, and among lighter drinkers, lower expectancies of sexual enhancement from alcohol. PBS were also related to decreased perceptions of sexual-related risks, some alcohol-related sexual behaviors, including number of drinks before/during sex, and number of sexual consequences, but were not related to abstaining during sex, frequency of alcohol-related sexual behaviors, or general condom use. These findings demonstrate a disconnect between perceived and actual risks among college students, such that decreased perceptions of risk may not be associated with protective behaviors. Prevention and intervention implications are discussed.     

Sexual risk behaviors and alcohol: Higher base rates revealed using the unmatched‐count technique

HIV/AIDS is a disease whose only known prevention is behavioral. Risky sex is one of the ways in which people become infected with HIV, as well as other STDS. Estimating the base rates of risky sex and risky sex after drinking proves difficult. This study uses the unmatched‐count technique (UCT) to estimate base rates for sexual risk behaviors and sexual risk behaviors after drinking and compares the findings with those estimates found using conventional methods. UCT does not require the participant to directly answer sensitive questions, and, thus, may provide more accurate reporting than other methods. In a population of college students, the UCT revealed higher estimates of base rates for having had sex, having had sex without a condom, and having had sex without a condom after drinking than an anonymous self‐report survey. These higher estimates provide a better feel for the level of these risk behaviors, may help understand the relationship between alcohol and risky sex, and point to the need to target more interventions for condom use and condom use in the presence of drinking among college students.     

Do Alcohol and Marijuana Use Decrease the Probability of Condom Use for College Women?

Alcohol and marijuana use are thought to increase sexual risk taking, but event-level studies conflict in their findings and often depend on reports from a limited number of people or on a limited number of sexual events per person. With event-level data from 1,856 sexual intercourse events provided by 297 college women (M _age = 18 years; 71% White), we used multilevel modeling to examine associations between alcohol and marijuana use and condom use as well as interactions involving sexual partner type and alcohol-sexual risk expectancies. Controlling for alternative contraception use, partner type, regular levels of substance use, impulsivity and sensation seeking, and demographics, women were no more or less likely to use condoms during events involving drinking or heavy episodic drinking than during those without drinking. However, for drinking events, there was a negative association between number of drinks consumed and condom use; in addition, women with stronger alcohol-sexual risk expectancies were marginally less likely to use condoms when drinking. Although there was no main effect of marijuana use on condom use, these data suggest marijuana use with established romantic partners may increase risk of unprotected sex. Intervention efforts should target expectancies and emphasize the dose-response relationship of drinks to condom use.     

Self-efficacy for refusal mediated by outcome expectancies in the prediction of alcohol-dependence amongst young adults

The present study examined the relative importance of outcome expectancies and self-efficacy [1] in the prediction of alcohol dependence [2] and alcohol consumption in a sample of young adult drinkers drawn from a milieu previously reported as supportive of risky drinking. In predicting alcohol dependence, outcome expectancies were found to mediate self-efficacy and the same pattern was found for both males and females. This suggests that male and female drinkers may become more similar as they progress along the drinking continuum from risky drinking to dependent drinking. However, in women, in comparison to men, a greater array of expectancies and self-efficacy scales were found to predict heavy drinking, as measured by quantity and frequency. These results suggest that heavy drinking women are particularly at risk of developing drinking related complications and that preventative education needs to take into account gender differences.     

Condom Negotiation Strategies as a Mediator of the Relationship between Self-Efficacy and Condom Use

College students are a group at high risk of sexually transmitted infections due to inconsistent condom use and engaging in other risky sexual behaviors. This study examined whether condom use self-efficacy predicted the use of condom negotiation strategies (i.e., condom influence strategies) and whether condom influence strategies mediated the relationship between condom use self-efficacy and condom use within this population, as well as whether gender moderated the mediation model. Results showed a strong relationship between condom use self-efficacy and condom influence strategies. Additionally, condom influence strategies completely mediated the relationship between condom use self-efficacy and condom use. Although condom use self-efficacy was related to condom use, the ability to use condom negotiation strategies was the most important factor predicting condom use. The mediation model held across genders, except for the condom influence strategy withholding sex, where it was not significant for men. For women, condom use self-efficacy promoted the use of a very assertive negotiation strategy, withholding sex, and was consequently related to increased condom use. Overall, using assertive condom negotiation strategies (e.g., withholding sex and direct request) were found to be the most important aspects of increasing condom use for both women and men. Implications and suggestions for prevention programming are discussed.     

Sex-Related Alcohol Expectancies Among African American Women Attending an Urban STI Clinic

African American women are disproportionately affected by human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and sexually transmitted infections (STIs). Alcohol use is a significant risk factor for HIV/STI acquisition. Sex-related alcohol expectancies (SRAEs) may partially account for alcohol-related risky sexual behaviors. Using qualitative interviews we explored the link between alcohol use and risky sex among 20 African American women attending an STI clinic who had consumed four or more alcoholic drinks per drinking day (binge drinking) and/or reported vaginal or anal sex while under the influence of alcohol. Four SRAEs emerged, which we named drink for sexual desire, drink for sexual power, drink for sexual excuse, and drink for anal sex. While the desire SRAE has been documented, this study identified three additional SRAEs not currently assessed by expectancy questionnaires. These SRAEs may contribute to high-risk sex when under the influence of alcohol and suggests the importance of developing integrated alcohol–sexual risk reduction interventions for high-risk women.     

Exploring the intention-behavior relationship in the prediction of sexual risk behaviors: can it be strengthened?

Many theoretical models examining health risk behaviors, such as sexual risk taking, assume intentions directly predict behavior, and intentions are sometimes measured as a proxy for behavior. Given that there is often a discrepancy between intentions and behaviors (e.g., Sheeran, 2002 ), this study addressed factors that predict intention-behavior congruence. Specifically, utilizing a prospective design, the goal of the study was to determine if characteristics of university students' last sexual encounter predicted whether those students who intended to use condoms, contraception, or dual methods did so in their last sexual encounter with both relationship and casual partners. The seven tested variables were condom planning and preparatory behaviors, mood, sexual arousal, substance use, perceived partner attractiveness, intention certainty, and intention stability. Data were collected from 520 American undergraduate students at a medium-sized university. The six discriminant function analyses examining the intention-behavior relationship were able to correctly classify between 74% and 92% of the participants concerning whether intenders engaged in safe sex behaviors. The variables that best discriminated between behavior engagement over the six analyses were intention stability, intention certainty, and engagement in condom preparatory behaviors. The implications of these results for sexual risk prevention and intervention research are discussed.     

Partner‐specific relationship characteristics and condom use among young people with sexually transmitted diseases

This study describes associations of partner‐specific relationship characteristics with consistent condom use among 297 young people (ages 13–24) with sexually transmitted diseases (STD). Relationship‐specific variables were relationship quality, reasons for sex, relationship duration, duration of sexual relationship, coital frequency, “established” versus “new” sexual partner, cohabitation, children, sexual coercion, and drug or alcohol use associated with coitus. Relationship characteristics associated with consistent condom use included lower relationship quality, lower emotional reasons for sex, lower coital frequency, sex with a new partner, noncohabitation, and not having a child with the partner. Controlling for sociodemographic variables, factors exhibiting independent associations with consistent condom use were lower relationship quality, lower coital frequency, and not having a child with the partner. While condom use with potentially high risk new partners is important, other types of relationships are also risky but associated with lower likelihood of consistent condom use. Better understanding of complex relationship characteristics is necessary to improve STD intervention programs.     

Underestimating Protection and Overestimating Risk: Examining Descriptive Normative Perceptions and Their Association with Drinking and Sexual Behaviors

Individuals who engage in risky sexual behavior face the possibility of experiencing negative consequences. One tenet of social learning theory is that individuals engage in behaviors partly based on observations or perceptions of others’ engagement in those behaviors. The present study aimed to document these norms–behavior relationships for both risky and protective sexual behaviors, including alcohol-related sexual behavior. Gender was also examined as a possible moderator of the norms–behavior relationship. Undergraduate students (n = 759; 58.0% female) completed a Web-based survey, including various measures of drinking and sexual behavior. Results indicated that students underestimate sexual health-protective behaviors (e.g., condom use and birth control use) and overestimate the risky behaviors (e.g., frequency of drinking prior to sex, typical number of drinks prior to sex, and frequency of casual sex) of their same-sex peers. All norms were positively associated with behavior, with the exception of condom use. Furthermore, no gender differences were found when examining the relationship between normative perceptions and behavior. The present study adds to the existing literature on normative misperceptions as it indicates that college students overestimate risky sexual behavior while underestimating sexual health-protective behaviors. Implications for interventions using the social norm approach and future directions are discussed.     

Sex and Drugs and Starting School: Differences in Precollege Alcohol-Related Sexual Risk Taking by Gender and Recent Blackout Activity

Research has demonstrated a link between alcohol use and multiple forms of risky sexual behavior, particularly among college-age individuals. Studies have also linked heavy alcohol use to other problems, such as impaired consciousness resulting from an alcohol-induced blackout, which may impact sexual decision making. However, research has rarely examined sexual risk taking (SRT) in relation to blackouts, nor has it examined this construct during the precollege transition (i.e., the interval of time between high school graduation and college matriculation). This study examined the intersection between alcohol-involved SRT, blackouts, and gender in a sample of precollege individuals with prior alcohol use (N = 229; 54% male, 63% White). Results indicated that, despite drinking less per occasion, women reporting recent blackouts were at increased risk for experiencing unwanted, unsafe, and regretted sexual behaviors compared to men with recent blackouts and their peers with no recent blackouts. Women with recent blackouts also reported differences in alcohol expectancies that may increase their risk for experiencing negative consequences while drinking, including higher social expectancies and lower negative expectancies of danger. Future directions for research and implications for precollege interventions are discussed.     

A Prospective Examination of Men’s Condom Use Resistance: Event-Level Associations with Sexual Aggression,Alcohol Consumption,and Trait Anger

Burgeoning research suggests that men engage in a variety of coercive and non-coercive tactics to avoid condom use (condom use resistance; CUR), suggesting a risk nexus regarding sexual risk and sexual aggression (SA). Laboratory-based research has found that acute alcohol intoxication is associated with CUR; however, no study has examined event-level associations among alcohol consumption, SA history, and CUR or the moderating effects of trait anger. Non-problem drinking young adult men who have sex with women (N = 430) completed a background survey and follow-up assessments regarding their sex events and alcohol consumption over three months. CUR was reported in 113 sex events; 6.2% of these involved SA and 40.7% involved alcohol consumption. Generalized estimating equations demonstrated that men with more severe SA histories were more likely to perpetrate CUR. Men lower in trait anger were more likely to perpetrate CUR the more they increased above their typical level of alcohol consumption, whereas men higher in trait anger were similarly likely to perpetrate CUR regardless of their alcohol consumption. Results suggest that men with greater SA histories and high trait anger are at increased risk of perpetrating CUR, and that risk of CUR increases among other men the more they increase their alcohol consumption beyond their average.     

The relationship between binge drinking and prosocial bystander behavior among college men

Abstract

Objectives: This study prospectively examined binge drinking’s effect on prosocial bystander behavior and indicators of bystander behavior: intentions to intervene, self-efficacy to intervene, and positive outcome expectancies for intervening. Participants: College men were recruited from February to April 2010. Methods: Pre- and posttest surveys were administered as part of a randomized controlled trial (n?=?743). Potential confounders were identified using Pearson product-moment correlations. Controlling for covariates, multiple linear regression was used to examine whether binge drinking was predictive of prosocial bystander behavior and indicators of bystander behavior. Results: Binge drinking was related to lower bystander behavior (p<.05), lower intentions to intervene (p<.001), and less positive outcome expectancies for intervening (p<.05). Conclusions: Binge drinking may reduce the ability to notice a risk situation and intervene as a prosocial bystander. Results highlight the need for bystander programs to address alcohol use within the context of bystander behavior.     

Alcohol consumption and unsafe sexual behavior in discrete events

Recent studies with samples of homosexual men have demonstrated that drinking in conjunction with sexual activity is strongly related to unsafe sexual activities known to increase the risk of AIDS transmission. Most existing studies have assessed the relationship of general measures of drinking and general frequency of risky sexual activities. Such a design, however, does not establish that drinking and risky behaviors occurred on the same occasion. In this study, adult respondents were asked about the circumstances of two sexual encounters: their most recent sexual experience and their most recent encounter involving a new sexual partner. The characteristics of encounters that involved and did not involve drinking are described. The results showed that encounters with new partners were more likely to involve alcohol, but that the presence of alcohol was not significantly associated with risky sexual activity. These findings suggest that analyses of event‐specific data illuminate a different aspect of the drinking/sex link.     

Preparing for Male Condom Use: The Importance of Volitional Predictors

Objectives: Intention is not sufficient to actually use condoms, as self-regulatory processes are needed to translate motivation into action. This study has focused on the role of preparatory behaviors as a proximal predictor of condom use and examined how they contribute to the self-regulatory processes proposed by the health action process approach model. Methods: An on-screen longitudinal study was conducted with 3 measurement points 2 weeks apart. The participants were young men aged 18 to 25 years old (N = 203) recruited from vocational training centers. Outcome expectancies, perceived self-efficacy, intention, action planning, coping planning, volitional self-efficacy, preparatory behaviors, and condom use were assessed by self-report. A structural equation analysis was used to test a series of 3 nested models, with all parameters estimated by bootstrapping. Results: The model proposed that the included preparatory behaviors provided the best fit to the data. Preparatory behaviors were the most proximal predictors of condom use, and mediation occurred in a sequential manner with preparatory behaviors preceding the volitional variables, action and coping planning, and volitional self-efficacy. Conclusions: To bridge the intention–behavior gap, preparatory behaviors play a mediating role, demonstrating how they work in conjunction with other volitional variables such as planning and self-efficacy in the translation of behavioral intentions into actual condom use.     

College Women's Sexual Decision Making: Cognitive Mediation of Alcohol Expectancy Effects

Abstract

Objective: Alcohol has been linked to a variety of risky sexual practices, including inconsistent condom use. Due to the high rates of alcohol consumption among underage college women, greater understanding of the role of alcohol in young women's sexual decision making is warranted. Participants and Methods: Female underage (18- to 20-year-old) social drinkers (N = 94) participated in an experiment in which they projected themselves into a written hypothetical sexual situation with a new partner. One half of the situations portrayed alcohol consumption; one half did not involve alcohol consumption. Their appraisals of the situation's sexual potential, impelling and inhibiting cognitions, and sexual behavior intentions were assessed. Results: Results revealed that alcohol's expectancy effects on young women's unprotected sexual intentions were mediated by their cognitive appraisals of the situation. Conclusions: These findings indicate that alcohol expectancies and their influence on women's sexual decisions should be incorporated into sexual risk reduction efforts.     

Predictors of safer sex on the college campus: a social cognitive theory analysis.

In April and May 1989, the authors surveyed a sample of students enrolled on four college campuses in New Jersey (N = 923) concerning their HIV transmission-related behavior, knowledge, and a variety of conceptual variables taken primarily from social cognitive theory that were thought to be potentially predictive of safer sexual behavior. Analyses of sexually active, unmarried students' responses indicated that men expected more negative outcomes of condom use and were more likely to have sexual intercourse while under the influence of alcohol or other drugs, whereas women reported higher perceived self-efficacy to practice safer sex. Regression analyses indicated that, among the factors assessed, stronger perceptions of self-efficacy to engage in safer behavior, expecting fewer negative outcomes of condom use, and less frequency of sex in conjunction with alcohol or other drug use significantly predicted safer sexual behavior. Enhanced self-efficacy to discuss personal history with a new partner was associated with a greater number of risky encounters. Implications of these findings for intervention efforts with students are discussed.     

Development of a Questionnaire to Assess University Students’ Intentions to Use Behavioral Alcohol-Reduction Strategies

Abstract

Objective: To evaluate the psychometric properties of a new self-report questionnaire designed to assess college students’ intentions to employ 31 specific alcohol-reduction strategies. Method: Students attending a large public university were recruited to complete alcohol-reduction, drinking history, and personality questionnaires online. Results: Based on item–total correlations and principal components analysis, the authors eliminated 3 items and calculated average intention ratings across the remaining 28 items. The resulting scale had appropriate unidimensionality and excellent internal consistency. Correlations of intention questionnaire scores with measures of drinking history, alcohol outcome expectancies, sensation seeking, and impression management provided some support for criterion and discriminant validity of the questionnaire. Conclusion: This questionnaire could be employed as an outcome measure to evaluate prevention programs and as a clinical tool to identify clients who have little intention to employ drinking reduction strategies in heavy drinking situations.     

Depressive Symptoms,Acute Alcohol Intoxication,and Risk Rationale Effects on Men’s Condom Use Resistance

This study examined the role of depressive symptoms, acute intoxication, and risk rationale in men’s use of condom use resistance (CUR) tactics in an experimental study. Participants included 313 heterosexual male, nonproblem drinkers, ages 21 to 30. Participants were randomized to one of four beverage conditions: no alcohol, placebo, low (.04%) alcohol dose, or high (.08%) alcohol dose. They read an eroticized scenario depicting a consensual sexual encounter with a female partner who requested a condom to prevent either pregnancy or sexually transmitted infections (STIs) (risk rationale) and then indicated their intentions to use 10 different CUR tactics. Hypotheses related to the pharmacological, dosage, and expectancy effects of alcohol were tested in a generalized linear model. In intoxicated (.04% and .08%) men who were given a pregnancy risk rationale, depressive symptoms were associated with stronger intentions to use CUR tactics than in sober (control and placebo) men. Men who received a high alcohol dose (.08%) and who were given a pregnancy risk rationale reported higher intentions to use CUR tactics than those who received a lower alcohol dose (.04%). Findings suggest that the pharmacological effects of alcohol on men’s likelihood to resist condoms vary by the saliency of the risk rationale and mood-related variables.