Sexual discounting: A systematic review of discounting processes and sexual behavior.

Abstract

Behavioral processes underlying sexual behavior are important for understanding normal human functioning and risk behavior leading to sexually transmitted infections (STIs). This systematic review examines delay and probability discounting in human sexual behavior through synthesis of 50 peer-reviewed, original research articles. Sixteen studies focusing exclusively on monetary delay discounting found small effect size positive correlations with sexual risk behaviors. Eleven studies examined delay or probability discounting of sexual behavior itself using tasks that varied duration, frequency, or quality of sex to determine value. Results show delay and uncertainty of sex causes systematic decreases in value. These studies also show consistent medium effect size relationships between sexual discounting measures and sexual health and substance use, supporting utility above and beyond monetary discounting. Twenty-three studies have modeled clinically relevant decision-making, examining effects of delay until condom availability and STI contraction probability on condom use. Observational and experimental designs found condom-use discounting is elevated in high-risk substance use populations, is sensitive to context (e.g., partner desirability), and is more robustly related to sexual risk compared with monetary discounting or condom use decisions when no delay/uncertainty was involved. Administering cocaine, alcohol, and, for some participants, methamphetamine increased condom-use discounting with minimal effect on monetary discounting or condom use when no delay/uncertainty was involved. Reviewed studies robustly support that sexual behavior is highly dependent on delay and probability discounting, and that these processes strongly contribute to sexual risk. Future research should exploit these systematic relationships to design behavioral and pharmacological approaches to decrease sexual risk behavior.

Behavioral economics and safe sex: Examining condom use decisions from a reinforcer pathology framework

“…Past community‐level studies showed that the location of freely available condoms robustly controlled whether individuals took them (Amass et al, 1993; Carrigan et al, 1995; Honne & Kleinke, 1990). Prior work using the SDDT or a variant called the Sexual Probability Discounting Task (see review by Johnson et al, 2020) used behavioral economics to provide additional clarity on the role of temporal delays or risk of acquiring an STI as a context for condom acquisition, while Strickland et al (2020) added the impact of financial costs on condom purchasing. Our study is the first to demonstrate the interaction of delays and costs on how participants make choices to forego condoms, and more importantly, whether the decision to forego condoms results in abstinence or unprotected sex.…”

“…We thereby submit that the novel application of a reinforcement pathologies perspective on condom use would provide a substantive advancement to the literature. We note that previous behavioral economic work has demonstrated the role of discounting of (see review by Johnson et al, 2020) and demand for condom availability (e.g., Strickland et al, 2020) in risky sexual decisions, yet we are aware of no study to date that examines the intersection of delay discounting of and demand for condoms within an explicit reinforcement pathologies framework.…”

Behavioral economic methods to inform infectious disease response: Prevention, testing, and vaccination in the COVID-19 pandemic

“…In this series of experiments, we sought to extend this work by applying behavioral economic methods and theory to understand public health response to the COVID-19 pandemic. This work is positioned within the broader conceptual framework of behavioral economic research reviewed above that demonstrates the impact of behavioral economic variables (e.g., delay, cost, probability, framing) on engagement with health behaviors such as substance use or preventive sexual health (e.g., condom use) [ 31 , 33 , 35 , 37 – 40 ]. Here, we manipulate these behavioral economic dimensions by adapting them for direct relevance to the COVID-19 pandemic (e.g., the delay to receiving a COVID-19 testing result or cost of that test).…”

Integrating Operant and Cognitive Behavioral Economics to Inform Infectious Disease Response: Prevention, Testing, and Vaccination in the COVID-19 Pandemic

“…A small, but growing, literature suggests that these kinds of tests of novel or as-yet-unexperienced contexts can nonetheless significantly relate to real-world behavior of interest. For example, in the public health domain, studies on sexual discounting relate to HIV-risk behavior [55, 56] and simulated purchasing of a novel fake ID relate to experienced negative alcohol outcomes in underage drinkers [57]. Moreover, there is evidence that tasks such as hypothetical sexual discounting [58] or hypothetical purchase tasks for drugs [59, 60] significantly predict domain-specific outcomes or behavior beyond general monetary discounting or demand for common commodities.…”