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

项目摘要/摘要 本申请是为了响应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。测试一项干预措施 旨在解决“一时冲动”(即，醉酒和性行为时)的性决策 唤醒)，和2)。扩展实验室研究以测试认知和激励的人内机制 在自然环境中，酒精和性唤醒对性决策的潜在影响。该应用程序是 受我们之前的酒精挑战的启发，实验室研究了导致男男性行为者发生脑感染的因素。 这项研究表明，醉酒与高度性唤醒和CAI增加有关 意图。与双过程理论一致，醉酒和性唤醒与 决策过程，其特征是性奖励动机相对于避孕套的作用增加 使用动机和执行功能的作用相应减少。这一模式表明 预防干预可能通过针对增加避孕套使用的策略来有效地减少脑梗塞 激励，减少在“一时冲动”时对费力/受控的处理过程的依赖。我们领航了 集激励性访谈、个性化认知咨询和短信功能于一体的干预手段 这降低了男男性接触者的酒精消耗量和认知能力。这一干预措施的部分目的是促进 与避孕套相关的规划和增加使用实施脚本，以促进避孕套的使用在炎热- 就在那一刻。“在目标1中，我们将干预试点工作扩大到更大的样本和密集的 纵向设计包括干预前后3周的经验抽样法(ESM)，以 测试干预的作用机制。具体地说，我们假设A.干预将是 减少酒精中毒和认知功能障碍B。干预将减少人与人之间的联系 醉酒和性唤醒与计算机辅助教学和C.醉酒和与避孕套相关的计划将调解联系 干预情况与4个月随访时计算机辅助教学的关系。特别重要的是假设B，它 测试干预是否会在“一时冲动”时影响性行为决策 暗示是突出的。目标2将我们的实验室研究扩展到自然环境，以测试双工艺 理论推导出了连接醉酒、性唤醒和计算机辅助教学的机制。在这里，我们测试性延迟折扣和 工作记忆在人内、醉酒和觉醒与计算机辅助教学的联系中起中介作用 这些影响构成了干预后3周内的干预效果。建议进行的研究 将促进对影响性行为决策的人内过程的理解 当追求即时满足达到顶峰时，测试一次短暂干预的有效性，并确定 干预对近侧人与人之间过程的影响 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.