Alcohol and "Heat of the Moment" Sexual Decision Making among MSM: Identifying Mechanisms of Sexual Risk and Promoting Behavior Change Through Brief Intervention

项目概要/摘要 此应用程序是为了响应 RFA-AA-21-016 的两个目标：艾滋病毒预防和酒精翻译 关于酒精对性决策影响的基本行为科学发现 1)。测试干预措施 旨在解决“一时冲动”的性决策（即，当醉酒和性行为时） 引起）和2）。扩展实验室研究以测试人体内的认知和动机机制 自然环境中酒精和性唤起对性决策的潜在影响。该应用程序是 我们之前的酒精挑战实验室研究对 MSM 中 CAI 的影响因素进行了研究。 这项研究表明，中毒与性唤起增强和 CAI 增加有关 意图。与双重过程理论一致，中毒和兴奋与情绪的转变有关。 决策过程的特点是性奖励动机相对于安全套的作用增强 使用动机和执行功能的作用相应降低。这种模式表明 通过加强安全套使用的针对性策略，预防干预措施可能有效减少 CAI 动机并减少对“一时冲动”中努力/受控处理的依赖。我们进行了试点 整合动机访谈、个性化认知咨询和短信的干预措施 减少了 MSM 的饮酒量和 CAI。该干预措施的部分目的是为了促进更多 与安全套相关的规划并增加实施脚本的使用，以促进在“高温天气”中使用安全套 当下。”在AIM 1中，我们将干预试点工作扩展到更大的样本和密集的 纵向设计包括干预前和干预后为期 3 周的经验抽样方法 (ESM) 测试干预的作用机制。具体来说，我们假设 A. 干预措施将是 与减少酒精中毒和 CAI 有关，B. 干预措施将减少人与人之间的关联 C. 中毒和性唤起与 CAI 的相关性，以及 C. 中毒和安全套相关的计划将调解关联 4 个月随访时干预条件与 CAI 之间的关系。特别重要的是假设 B，它 测试干预措施是否会影响“一时冲动”的性决策 线索很突出。目标 2 将我们的实验室研究扩展到自然环境，以测试双过程 理论衍生的连接中毒、唤醒和 CAI 的机制。在这里，我们测试是否性延迟折扣和 工作记忆在人体内介导中毒和唤醒与 CAI 的关联，并且如果 这些影响是干预后三周内干预效果的基础。拟议的研究 将增进对影响“热点”中性决策的人体内过程的理解 “时刻”，当追求即时满足的峰值时，测试简短干预的有效性，并确定 干预对接近 CAI 的人内过程以及人与人之间的影响 行为改变的机制。

PROJECT SUMMARY/ABSTRACT This application is in response to two objectives of RFA-AA-21-016: HIV Prevention and Alcohol to translate basic behavioral science findings about alcohol’s effects on sexual decision-making to 1). Test an intervention designed to address sexual decision-making in the “heat-of-the-moment” (i.e., when intoxicated and sexually aroused), and 2). Extend laboratory research to test cognitive and motivational within-person mechanisms underlying alcohol and arousal effects on sexual decision-making in the natural environment. The application is informed by our previous alcohol challenge laboratory research on factors contributing to CAI among MSM. This research showed that intoxication was associated with heightened sexual arousal and increased CAI intentions. Consistent with dual process theories, intoxication and arousal were associated with a shift in decision-making process characterized by an increased role of sexual reward motivation relative to condom use motivation and a corresponding decrease in the role of executive functioning. This pattern suggests that prevention interventions may be effective in reducing CAI by targeting strategies that enhance condom use motivation and reduce the reliance on effortful / controlled processing in the “heat-of-the-moment.” We piloted an intervention that integrates motivational interviewing, personalized cognitive counseling, and text messaging that decreased alcohol consumption and CAI in MSM. The intervention is designed, in part, to foster increased condom-related planning and increase the use of implementation scripts to foster use of condoms in the “heat- of-the-moment.” In AIM 1, we extend the pilot work on the intervention to a larger sample and an intensive longitudinal design comprised of 3-weeks of experience sampling method (ESM) pre- and post- intervention to test the intervention’s mechanisms of action. Specifically, we hypothesize that A. the intervention will be associated with reduced alcohol intoxication and CAI, B. the intervention will reduce within-person associations of intoxication and arousal with CAI, and C. intoxication and condom-related planning will mediate associations between intervention condition and CAI at 4-month follow-up. Of particular importance is hypothesis B, which tests whether the intervention affects sexual decision-making in the “heat-of-the-moment” when compelling cues are prominent. Aim 2 extends to the natural environment our laboratory research to test dual-process theory derived mechanisms linking intoxication, arousal, and CAI. Here, we test if sexual delay discounting and working memory mediate, within-person, associations of intoxication and arousal with CAI and if changes in these effects underlie the intervention effects during the 3-week post-intervention period. The proposed study will advance understanding of within-person processes affecting sexual decision-making in the “heat-of-the- moment” when drive for immediate gratification peaks, test the effectiveness of a brief intervention, and identify the intervention’s effects on both within-person processes proximal to CAI as well as between-person mechanisms of behavior change.