Purpose
Examine the event-level association between alcohol consumption and the likelihood of unprotected sex among college-age young adults considering contextual factors of partner type and amount of alcohol consumed.
Methods
A 30-day web-based structured daily diary was used to collect daily reports of sexual behaviors and alcohol use from sexually-active young adults (N = 116) yielding 2,764 diary records. Each day we assessed the prior evening’s behavior regarding, alcohol consumption, opportunities for sex, sexual intercourse, condom use, and contextual factors including type of sexual partner.
Results
Based on multilevel models, drinking proximal to events of sexual intercourse increased the likelihood of unprotected sex with casual but not steady partners. For women there was a positive association between number of drinks and a greater likelihood of unprotected sex with casual partners but a negative association with steady partners. Drinking during situations involving opportunities for sex with casual partners increased the likelihood of sex. For women especially, drinking more increased the likelihood of sex occurring regardless of partner type.
Conclusions
Failure to assess the contextual determinants of the alcohol—unprotected sex association may result in underestimates of the magnitude of this association. These data highlight an important area for intervention with young adults: reducing alcohol-involved sexual risk behavior with casual partners, especially among women.
A motivational/individual differences model of infidelity is proposed in the course of empirically evaluating the traditional dichotomy between emotional and sexual motives. A scale assessing motivations for infidelity was developed and administered to 432 college students, 120 of whom reported past dating infidelity. Four motivations were identified and were associated as predicted with Big Five and other trait constructs; Sex was predicted by male gender, lower age, and unrestricted sociosexual orientation (SO); Dissatisfaction was predicted by female gender and Extraversion; Neglect was predicted by Neuroticism; and Anger by Neuroticism and low Agreeableness. As predicted, a two-factor model provides a poorer fit with the data than a multi-factor model. Unrestricted SO partially mediates the gender difference in endorsement of a sex motive for infidelity.
We evaluated the efficacy of LifeWindows, a theory-based, computer-administered antiretroviral (ARV) therapy adherence support intervention, delivered to HIV + patients at routine clinical care visits. 594 HIV + adults receiving HIV care at five clinics were randomized to intervention or control arms. Intervention vs. control impact in the intent-to-treat sample (including participants whose ARVs had been entirely discontinued, who infrequently attended care, or infrequently used LifeWindows) did not reach significance. Intervention impact in the On Protocol sample (328 intervention and control arm participants whose ARVs were not discontinued, who attended care and were exposed to LifeWindows regularly) was significant. On Protocol intervention vs. control participants achieved significantly higher levels of perfect 3-day ACTG-assessed adherence over time, with sensitivity analyses maintaining this effect down to 70% adherence. This study supports the utility of LifeWindows and illustrates that patients on ARVs who persist in care at clinical care sites can benefit from adherence promotion software.
High levels of adherence to antiretroviral therapy (ART) are critical to the management of HIV, yet many people living with HIV do not achieve these levels. There is a substantial body of literature regarding correlates of adherence to ART, and theory-based multivariate models of ART adherence are emerging. The current study assessed the determinants of adherence behavior postulated by the Information-Motivation-Behavioral Skills model of ART adherence in a sample of 149 HIV-positive patients in Mississippi. Structural equation modeling indicated that ARTrelated information correlated with personal and social motivation, and the two sub-areas of motivation were not intercorrelated. In this Deep South sample, being better informed, socially supported, and perceiving fewer negative consequences of adherence were independently related to stronger behavioral skills for taking medications, which in turn associated with self-reported adherence. The IMB model of ART adherence appeared to well characterize the complexities of adherence for this sample.
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