Bryan, Ray, and Cooper (2007) conducted both global- and event-level analyses to better understand the relationship between alcohol use and the use of condoms among 300 adolescents involved in the criminal justice system. Within this convenience sample, 267 participants (89%) participated in both the baseline assessment and the 6-month follow-up assessment. The investigators found that,
[a]t the global level of analysis, there was a significant moderating effect of alcohol-related sexual-enhancement expectancies,10 such that the relationship between alcohol and condom use was negative and significant only among individuals with higher sexual-enhancement expectancies. At the time-limited global level [i.e., covering the 6-month time interval between baseline and follow-up measures], impulsive sensation seeking at baseline was negatively associated with condom use at 6-month follow-up. At the event level, there was a Gender x Alcohol interaction such that alcohol use was unrelated to condom use among males but was strongly and negatively related among females. (p. 327)
Bryan and colleagues conclude from these data that,
at least for this group of high-risk adolescents, a focus on decreasing overall alcohol use would not be an effective strategy for reducing risky sexual behavior. ... [These] data suggest that a more effective strategy would be to target the situation-specific event-level influence of alcohol on condom use. For example, instead of gearing intervention content toward reduction of alcohol use generally, ... [a clinician] could ... focus on helping young people be aware of and prepared for situations in which they drink and might have the opportunity for sexual activity. Specific skills include having a friend "keep an eye on them," always having condoms with them in party situations, and moderating alcohol consumption when sexual activity is likely. (p. 334)
Mizuno et al. (2007) identified correlates of negative condom beliefs that varied by gender among a convenience sample of 348 injecting drug users (IDUs) living with HIV who had a main partner of the opposite gender. In multivariate analyses, the investigators "found more significant correlates for women than for men. With men, perception that their sex partner is not supportive of condom use (negative partner norm) was the only significant correlate ... . Among women, negative partner norm ...; having less knowledge about HIV, STD, and hepatitis ...; lower self-efficacy for using a condom ...; and more episodes of partner violence ... were significantly associated with negative condom beliefs ..." (p. 523).
With regard to intervention possibilities, Mizuno and colleagues point to the significance of a negative partner norm regarding condom use, which suggests that men's negative condom beliefs might be addressed by working with the man and his partner. The challenge, then,
is to come up with a strategy so that men would perceive strong normative pressure to use a condom from their partners. One potential strategy would be couples-based interventions where men and women each practice to develop norms supporting condom use. Another strategy would be to provide women with skills to clearly communicate their positive beliefs about condoms and also to apply appropriate pressure on their partners to use condoms. Partner violence may need to be factored into the discussion, particularly for women, as that might affect how they could comfortably apply such pressure. (p. 532)
Continuing this focus on research with drug users, Mitchell, Severtson, and Latimer (2007) analyzed data drawn from a sample of 229 IDUs in Baltimore and
found a complex relationship between knowledge of someone who died from AIDS and risky injection drug use behavior. Cognitive performance moderated the effect of knowing someone who had died from AIDS on engaging in risky injection drug use behaviors, such that individuals who had lower cognitive scores and knew someone who had died from AIDS were more likely to be in the high-risk group for injection behavior. ... In addition, ... [Mitchell and colleagues] found that individuals with higher cognitive performance who also knew someone who had died from AIDS were less likely to engage in risky injection practices. Although these IDUs were part of a riskier social network, their greater cognitive skills served a protective function. IDUs with greater cognitive reserve may have been more likely to recognize their risk, generate solutions to reduce their risk, weigh the consequences of each alternative, and successfully implement the least risky option. (p. 294)
The investigators suggest that
[t]hese results can be used to target groups of IDUs who are at greater risk for drug-related HIV infection, especially those individuals with less cognitive ability within higher risk social groups. Simple health messages may be insufficient to change behavior among these individuals, who may need more intensive interventions that help them recognize and process the health threat as well as assess and implement effective coping strategies. These findings also suggest that an assessment of IDUs' cognitive abilities should be conducted prior to interventions. (p. 294)
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10 "Expectancy theory ... [posits that individuals'] beliefs about the effects of alcohol will influence both the situations under which they consume alcohol and their behavioral and social reactions to alcohol consumption" (p. 328).
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Fall 2007 Newsletter / Volume 9, Issue 1 
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