Cognitive mediation of alcohol's effects on women's in-the-moment sexual decision making.

Objective: To test a cognitive mediation model examining whether cognitive appraisals mediate alcohol consumption effects on condom request and unprotected sex intentions. Design: Female social drinkers (N = 173) participated in an experiment comparing four beverage conditions: control, placebo, target BAL = .04%, and target BAL = .08%. Subjects projected themselves into a hypothetical sexual encounter with a new sex partner. Measures: Appraisals of the situation's sexual potential, impelling and inhibiting cognitions, and behavioral intentions were assessed at several points. Results: Findings support the theoretical model, indicating that alcohol's effects on direct condom request and unprotected sex intentions were mediated through cognitive appraisals. Conclusion: Prevention interventions should include information about alcohol's effects on cognitions that may lead to ineffective condom negotiation and unprotected sex. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of acute alcohol intoxication, partner risk level, and general intention to have unprotected sex on women's sexual decision making with a new partner.

Women account for a quarter of all new HIV/AIDS cases, with approximately 65% having contracted the infection via heterosexual contact. Few experimental studies have examined interactions among background, partner, and situational characteristics in predicting women's sexual decisions. The Cognitive Mediation Model provides a useful theoretical framework for assessing likelihood of unprotected sex. Female social drinkers (n = 230) who had answered questions related to their general intention to have unprotected sex were randomly assigned to an experimental condition based on partner risk level (unknown, low, high) and beverage (control, placebo, low dose, high dose). Participants projected themselves into a story depicting a sexual situation with a man and answered questions about their cognitive appraisals, assertive condom request, and likelihood of unprotected sex. Alcohol effects on appraisal of sexual potential differed by partner risk condition. In the unknown and low risk conditions, placebo and alcohol participants appraised the situation as having greater sexual potential than controls whereas in the high risk condition, only those who consumed alcohol did so. Sexual potential appraisals in turn predicted impelling cognitions about having sex, which in turn predicted assertive condom request and unprotected sex intentions. General intention for unprotected sex independently predicted cognitive appraisals and outcomes. These findings highlight the need for prevention programs that focus on teaching women how to pay attention and consider sexual risk cues presented by potential partners, particularly when under the influence of alcohol. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Alcohol use, expectancies, and sexual sensation seeking as correlates of HIV risk behavior in heterosexual young adults.

Most theoretical models of HIV risk behavior have not considered the role of personality factors, and few studies have examined mechanisms accounting for dispositional influences on sexual risk taking. This study elaborated on a conceptual model emphasizing sexual sensation seeking, alcohol expectancies, and drinking before sex as key predictors of HIV risk (S. C. Kalichman, L. Tannenbaum, & D. Nachimson, 1998). Multiple groups structural equation modeling was used to determine whether gender moderated relationships among these variables in a sample of 611 heterosexual, young adult drinkers (49% women, 76% Caucasian, mean age = 25 years). The model provided an excellent fit to the data, and gender differences were not substantiated. Sexual sensation seeking predicted HIV risk directly as well as indirectly via sex-related alcohol expectancies and drinking in sexual contexts. Findings suggest that expectancies and drinking before sex represent proximal mechanisms through which dispositional factors influence sexual risk outcomes. Moreover, these relationships appear to be similar in men and women. Interventions could benefit from targeting alcohol expectancies and drinking before sex in individuals with a dispositional tendency toward sexual risk taking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol, sexual arousal, and intentions to use condoms in young men: Applying alcohol myopia theory to risky sexual behavior.

Data from 7 studies were aggregated to examine how reported sexual arousal and alcohol intoxication interact to affect attitudes and intentions toward engaging in unprotected sexual intercourse in college-age men (N?=?358). When participants were in a sober or placebo condition, their self-reports of sexual arousal had no effect on their responses. When participants were intoxicated, however, those who felt sexually aroused reported more favorable attitudes, thoughts, and intentions toward having unprotected sex than did those who did not feel aroused. These findings support alcohol myopia theory (C. A Steele & R. A. Josephs, 1990), which states that alcohol intoxication restricts attentional capacity so that people are highly influenced by the most salient cues in their environment. It is suggested that sexual arousal is a powerful internal cue that interacts with alcohol intoxication to enhance attitudes and intentions toward risky sexual behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of sexual arousal and sexual partner characteristics in HIV+ MSM's intentions to engage in unprotected sexual intercourse.

Objective: This study investigated the effects of sexual arousal and sexual partner characteristics as determinants of HIV+ men who have sex with men's (MSM) intentions to engage in unprotected sex. Design: In a computer-based controlled experiment, 67 HIV+ MSM underwent a sexual arousal manipulation and indicated their intentions to engage in unprotected sex with hypothetical partners who differed in terms of HIV serostatus, physical attractiveness, relationship type, and preference for condom use. Main Outcome Measures: Computer-delivered questions assessed HIV+ MSM's intentions to engage in various sexual acts with each hypothetical partner. Results: As predicted, sexually aroused HIV+ MSM indicated stronger intentions to engage in unprotected sex than nonaroused HIV+ MSM; and having a partner who was attractive, HIV+, long term, or who preferred not to use condoms, also led to riskier intentions. Several significant interactions among these factors were found, which were generally consistent with predictions and with theory and research on cognitive processing and decision making. Conclusions: These findings have implications for understanding risky sexual behavior among HIV+ individuals and for the development of interventions to reduce this risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-regulation as a protective factor against risky drinking and sexual behavior.

Prior research suggests that high dispositional self-regulation leads to decreased levels of risky drinking and sexual behavior in adolescence and the early years of college. Self-regulation may be especially important when individuals have easy access to alcohol and freedom to pursue sexual opportunities. In the current 1-year longitudinal study, we followed a sample of N = 1,136 college students who had recently reached the legal age to purchase alcohol and enter bars and clubs to test whether self-regulation protected against heavy episodic drinking, alcohol-related problems, and unprotected sex. We tested main effects of self-regulation and interactions among self-regulation and established risk factors (e.g., sensation seeking) on risky drinking and sexual behavior. High self-regulation inversely predicted heavy episodic drinking, alcohol-related problems, and unprotected sex, even when taking into account gender and risk factors. Moreover, in predicting unprotected sex, we found three-way interactions among self-regulation, sensation seeking, and heavy episodic drinking. Self-regulation buffered against risk associated with heavy drinking but only among those low in sensation seeking. The protective effects of self-regulation for risky drinking and sexual behavior make it a promising target for intervention, with the caveat that self-regulation may be less protective among those who are more drawn to socially and emotionally rewarding stimuli. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Women's responses to sexual aggression: The effects of childhood trauma, alcohol, and prior relationship.

This study examined effects of alcohol consumption (control, moderate dose, high dose) and type of relationship (new, established) on women's responses to escalating male sexual aggression. The role of childhood trauma was also examined. After consuming a beverage, participants (N=220) projected themselves into a story portraying a social interaction with a man that depicted escalating sexual aggression. The story was paused 3 times to assess assertive, polite, and passive resistance as well as consent. Alcohol consumption increased consent and interacted with type of relationship to increase passive resistance and with level of sexual aggression to increase polite resistance. Assertive resistance increased and other responses decreased as the man's sexual aggression escalated. Childhood trauma lowered consent initially and increased passive resistance when rape was threatened. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sensation seeking, alcohol use, and sexual behaviors among sexually transmitted infection clinic patients in Cape Town, South Africa.

Alcohol use is associated with risks for HIV/AIDS. The association between alcohol and sexual risk may be accounted for by sensation seeking personality. However, sensation seeking in relation to substance use and HIV risk has not been examined in Africa. In this study, 292 men and 219 women receiving sexually transmitted infection (STI) diagnostic and treatment services in Cape Town, South Africa, completed anonymous behavioral surveys. Structural modeling was used to test a model of alcohol use and sensation seeking in relation to sexual risk behaviors. Results showed that sensation seeking and alcohol use in sexual contexts were related to HIV risks, controlling for gender and marital status. The association between sensation seeking and HIV risk was partly accounted for by alcohol use in proximity to sex. In contrast to studies conducted in the United States, sensation seeking was not related to alcohol-sex outcome expectancies. These findings suggest that alcohol use is an important HIV transmission risk factor for many STI clinic patients and that interventions for individuals who are characterized as sensation seekers are urgently needed in South Africa. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug use and risky sexual behavior.

Reexamined findings from a national survey (M. T. Temple et al, 1993) that did not support an association between contiguous alcohol use and condom use with a new sexual partner. Data were available on the drug use and sexual behavior variables for 725 (mean age 36.1 yrs) of the original 2,058 interviewees. Results support an association between drug use (other than alcohol) and decreased likelihood of condom use with a new sexual partner. Individuals who used drugs and did not use condoms scored significantly higher on a scale assessing characteristic impulsivity, risk-taking, and sensation seeking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expectancies, alcohol, and sexual arousal in male social drinkers.

Randomly assigned 40 undergraduate males, all social drinkers, to 1 of 2 expectation conditions in which they were led to believe that the beverage they were administered contained either vodka and tonic or tonic only. For half of the Ss in each expectation condition, the beverage contained vodka; the others drank only tonic. After their drinks, measures of penile tumescence were taken from Ss using a penile strain gauge during 2 erotic films, 1 depicting a heterosexual interaction, the other a male homosexual interaction. Although analyses of variance failed to reveal any effect of alcohol per se, there were significant effects of expectation on penile tumescence during both the heterosexual and homosexual films. Ss who believed that they had consumed an alcoholic beverage manifested significantly greater sexual arousal than those believing they had consumed a nonalcoholic beverage, regardless of the contents of their drinks. Although no consistent effects were observed on additional measures of sexual arousal, including the TAT, the Word Association Test, and forehead skin temperature, there was a significant positive correlation between self-report measures of sexual arousal and penile tumescence. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expectancies, alcohol, and sexual arousal in women.

A total of 40 university female volunteers, all social drinkers aged 18–35 yrs, were randomly assigned to 1 of 2 expectancy conditions in which they were led to believe that the beverage they were administered contained either vodka and tonic or tonic only. For half the Ss in each expectancy condition, the beverage actually contained vodka; for the other half, tonic only. After their drinks, measures of vaginal pressure pulse obtained with a vaginal photoplethysmograph were recorded during a nonerotic control film and 2 erotic films depicting a heterosexual or a homosexual interaction. The 2 groups that received alcohol, regardless of whether they believed that their drinks contained alcohol, showed significantly reduced sexual arousal during both erotic films. No effects of expectancy or an interaction between alcohol and expectancy were obtained. Ss' subjective estimates of intoxication were significantly correlated with their self-report of sexual arousal during both erotic films. The differences between these results and previous findings using similar procedures with male social drinkers are discussed. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality and cognitive factors influencing substance use and sexual risk for HIV infection among gay and bisexual men.

Substance use reliably predicts sexual risk behavior, and sensation-seeking personality characteristics have been found to covary with these associations. In a study of 289 gay and bisexual men attending a large gay pride event, the authors examined the role of substance use sexual outcome expectancies in explaining associations between sensation seeking, substance use, and risky sex. Consistent with previous research, alcohol and other drugs were associated with sexual behavior. However, path analyses showed that sensation seeking accounted for variance in sexual behavior over and above substance use before sex and that sensation seeking predicted substance use expectancies that in turn predicted substance use before sex. It was concluded that altering substance use outcome expectancies may be an important strategy for HIV risk reduction for individuals high in sensation seeking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of alcohol on sexual arousal in women.

During weekly experimental sessions each of 16 university females received in counterbalanced order 4 doses of beverage alcohol prior to viewing a control film and an erotic film. Half of the Ss were instructed beforehand that alcohol would increase their degree of sexual arousal in response to the erotic film; the other half were told that alcohol would decrease their sexual arousal. Measures of vaginal pressure pulse obtained by means of a vaginal photoplethysmograph showed a significant negative linear relation with alcohol doses. A significant Sessions * Instructional Set interaction indicated that Ss in the increase-set condition experienced less sexual arousal. This result is attributed to performance pressure induced by the demand characteristics of the instructional set. Additional measures of sexual arousal, including TAT responses and self-report, showed no differences. With increasing levels of intoxication, however, a greater proportion of Ss reported enhanced sexual arousal. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol's effects on requisites for sexual risk reduction in men: An initial experimental investigation.

The effects of alcohol intoxication on mediators of condom use were examined in a laboratory-based experiment. Twenty men were randomly assigned to either an alcohol or a nonalcohol beverage administration condition. Participants in the experimental condition drank vodka and tonic to achieve a blood alcohol level of 0.08%, whereas controls drank tonic only. All participants then completed a battery of measures related to condom and AIDS-related knowledge, motivation to use condoms, and behavioral self-efficacy regarding condom use. Findings from this exploration study, which should be considered preliminary because of the small sample size, indicated that participants who received alcohol tended to report more negative attitudes toward condoms and lower self-efficacy to initiate condom use than controls. AIDS knowledge, appraisal of social norms regarding condom use, and perceived risk of infection were unaffected by alcohol consumption. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of alcohol and cognitive set on sexual arousal to deviant stimuli.

48 undergraduate male social drinkers were randomly assigned to 1 of 2 expectancy set conditions in which they were led to believe that the beverage they were administered contained alcohol or no alcohol. For half of the Ss in each expectancy condition, the beverage was an alcoholic malt liquor; the others drank a nonalcoholic malt beverage. After their drinks, changes in penile tumescence (PT) in response to normal and deviant tape recordings and to self-generated fantasy were measured physiologically by a mercury-in-rubber strain gauge. The cognitive set (expectancy) significantly increased PT in response to the various erotic recordings. Alcohol did not significantly influence levels of sexual arousal. Ss who believed they had consumed an alcoholic beverage evidenced significantly more arousal to the forcible rape recording and to the sadistic stimuli than Ss who believed that they had consumed a nonalcoholic beverage, regardless of the actual contents of the beverage. The cognitive set, as well as the alcohol, significantly influenced heart rate, skin temperature, and subjective reports of sexual arousal. Self-report measures of sexual arousal were positively correlated with PT. Mosher Forced-Choice Guilt Inventory scores were not significantly correlated with PT, although the Sex Guilt subscore was negatively correlated with the subjective measure of sexual arousal for the heterosexual intercourse and forcible rape tapes. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol, sexual arousal, and self-control.

Investigated the effects of alcohol on self-regulation using delay of gratification for viewing time for an erotic film as the primary dependent measure. Other measures included reflection–impulsivity, locus of control, sexual-guilt scores, and continuous recording of Ss' penile tumescence. Using a balanced placebo design with 50 undergraduate men, Ss were led to believe that they had consumed an alcoholic or a nonalcoholic beverage, and half of each of these 2 groups received either alcohol or tonic water. In addition, the effects of 3 doses of alcohol (placebo, low dose, high dose) were investigated. Instructional set, regardless of drink content, resulted in longer delay times and increased thoughts with sexual content. Although there was no significant relation between increasing dose of alcohol and delay time, there was an interaction between scores on Rotter's Internal–External Locus of Control Scale and alcohol dose. Externalizers showed an inverse linear relation between increasing dose of alcohol and delay time. Internalizers showed the opposite trend. Results support other research showing that expectations about drinking can be more potent predictors of behavior than the pharmacological impact of alcohol. Implications for the self-regulation of sexual behavior under the influence of alcohol are discussed. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of alcohol and expectancy set on male sexual arousal.

Assigned 48 undergraduate males to 8 experimental groups. The 6 Ss within each group received 1 of 4 dose levels (.08, .4, .8, or 1.2 g/kg body weight) of beverage alcohol and 1 of 2 different sets of expectancy instructions regarding sexual arousal. Changes in penile tumescence, in response to an erotic film, were measured physiologically by a mercury-in-rubber strain gauge. Muscle tension levels were also monitored during the film viewing. The following adjunctive measures of sexual arousal were also employed: (a) sexual imagery, (b) the subjective report of arousal, and (c) the estimation of the extent of penile erection. Alcohol significantly reduced the levels of penile tumescence (negative linear relation). The expectancy instructions regarding alcohol's effect did not significantly influence the penile response. Sexual imagery was negatively correlated with penile tumescence, whereas the subjective reports of sexual arousal and the estimations of penile erection were positively correlated with the physiological measure of sexual arousal. Muscle tension levels were not significantly influenced by alcohol or the expectancy set; neither was muscle tension correlated with penile tumescence. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acculturation, sexual behavior, and alcohol use among Latinas

We explored the relationship of alcohol use to unsafe sex in Latinas. Telephone interviews were conducted with 523 currently sexually active Latinas aged 18-49 years. Only 7.5% of these women used alcohol half of the time or more prior to sex. "Regular" alcohol users had more sexual partners, but also had more experience with condom use, used condoms with primary partners as frequently as nonusers of alcohol, and used condoms more with secondary partners. While Latinas who use alcohol prior to sex more often have multiple sexual partners, alcohol use does not appear to interfere with condom use.