Investigating change in HIV risk in a self-monitoring diary study

描述（由申请人提供）：在美国，男男性行为者（YMSM）深受艾滋病毒/艾滋病的影响，但相对较少的研究评估了这一人群的艾滋病毒风险。值得注意的是，已经发现酗酒和非法药物使用一致地预测了YMSM的性风险行为，但很少有研究关注于开发对使用物质的YMSM的干预措施。行为日记作为一种观察健康相关行为变化的调查方法被广泛使用，行为自我监控策略也经常被用于临床干预以诱导健康行为的改变。社会认知过程（如动机）影响自我监控的成功，我们之前的研究发现，在性日记研究过程中，具有更强的降低艾滋病毒风险动机的男同性恋者更有可能减少他们报告的无保护的性行为。然而，目前尚不清楚的是，动机性行为的男同性恋者仅仅是自己减少了他们的性风险行为，还是他们实际上从自我监控中受益。尽管最近有人呼吁研究自我监控和日记方法在改变YMSM性风险行为方面的效用，但仍有几个重要问题没有得到回答：1)性日记研究何时成为自我监控干预措施？2)自我监控日记对谁有干预作用？本研究的首要目标是检查性日记成为酗酒和吸毒YMSM自我监控干预的条件，以最大限度地发挥其作为观察和干预工具的价值。为了实现这一目标，我们将研究以下具体目标：目标1：使用基于网络的行为日记，描述在何种情境和背景条件下，哪些YMSM在报告的性风险行为中表现出变化；目的2：实验比较行为日记的使用频率对报告的性危险行为和参与者流失的影响；目标3：测试提供个性化风险行为反馈的效果。这项拟议的研究将招募360名酗酒和/或吸毒的YMSM（16-29岁）在线进行为期2个月的基于网络的性日记研究。根据目的1，我们将按年龄队列（青少年、初成成人、年轻人）检查报告的性风险行为变化的组间差异，以及社会认知变量（减少艾滋病毒风险的动机、意图和自我效能）和物质使用（酒精和非法药物使用）对性风险行为的影响。为了实现目标2，我们将根据行为日记的使用频率（每日日记、每周日记或不写日记）来评估报告的行为改变和参与者流失的差异。在Aim 3中，我们将通过将YMSM随机分为有反馈组和无反馈组来测试提供个性化风险行为反馈的效果。危险行为反馈将说明：性危险行为的频率，物质使用，以及这些变量之间的相关性。本研究收集的数据将帮助PI过渡到干预开发研究，并支持更大的拨款申请，为使用物质的YMSM开发自我监测干预。

DESCRIPTION (provided by applicant): Young men who have sex with men (YMSM) are profoundly impacted by HIV/AIDS in the United States, but relatively little research has evaluated HIV risk in this population. Notably, binge drinking and illicit drug use have been found to consistently predict sexual risk behavior in YMSM, but few studies have focused on developing interventions for substance-using YMSM. Behavioral diaries are widely-used as a survey method for observing change in health-related behaviors, and behavioral self-monitoring strategies are also frequently used in clinical interventions to induce health-behavior change. Social cognitive processes such as motivation influence the success of self-monitoring, and our previous research found that MSM with greater HIV risk reduction motivation were more likely to reduce their reported unprotected sex over the course of a sexual diary study. However, it is unclear whether motivated MSM simply reduced their sexual risk behavior on their own, or whether they actually benefited from self-monitoring. Despite recent calls to examine the utility of self- monitoring and diary approaches to change sexual risk behavior in YMSM specifically, several important questions remain unanswered: 1) When do sexual diary studies become self-monitoring interventions?; and 2) For whom do self-monitoring diaries serve as interventions? The overarching goal of this study is to examine the conditions under which sexual diaries become self-monitoring interventions for binge-drinking and drug- using YMSM in order to maximize their value as a tool for observation and intervention. To achieve this goal, we will examine the following specific aims: Aim 1: Describe which YMSM, under which situational and contextual conditions, show change in reported sexual risk behavior using web-based behavioral diaries; Aim 2: Experimentally compare frequencies of behavioral diary administration on change in reported sexual risk behavior and participant attrition; and Aim 3: Test the effect of delivering individualized risk behavior feedback. The proposed study will recruit 360 binge-drinking and/or drug-using YMSM (ages 16-29) online into a 2-month web-based sexual diary study. In accordance with Aim 1, we will examine group differences in change in reported sexual risk behavior by age cohort (adolescents, emerging adults, young adults), as well as the influence of social cognitive variables (HIV risk reduction motivation, intentions, and self-efficacy) and substance use (alcohol and illicit drug use) on sexual risk behavior. To achieve Aim 2, we will evaluate differences in reported behavior change and participant attrition by frequency of behavioral diary administration (daily diaries, weekly diarie, or no diaries). For Aim 3, we will test the effect of providing individualized risk behavior feedbak by randomizing YMSM into feedback or no feedback groups. Risk behavior feedback will illustrate: frequency of sexual risk behavior, substance use, and the correlation between these variables. The data collected in this study will aid the PI in transitioning to intervention development research and support a larger grant application to develop a self-monitoring intervention for substance-using YMSM.