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Impulsivity as a Risk Factor for HIV Transmission in Men who have Sex with Men: A Delay Discounting Approach

Jones, Jeb (2012)
Master's Thesis (77 pages)
Committee Chair / Thesis Adviser: Sullivan, Patrick S
Committee Members:
Research Fields: Health Sciences, Epidemiology; Psychology, Behavioral
Partnering Agencies: Does not apply (no collaborating organization)
Keywords: delay discounting; MSM; sexual risk
Program: Rollins School of Public Health, Epidemiology (Epidemiology)
Permanent url: http://pid.emory.edu/ark:/25593/bnkw0

Abstract

Background: Delay discounting (DD) is a measure of impulsivity that has been used with much success in the area of substance abuse research. However, impulsivity likely plays a role in decision-making processes involved in other risky behaviors as well. The goal of the current research was to assess whether the results of a monetary DD task would be predictive of sexual risk-taking in a group of internet-using men who have sex with men (MSM). Methods: Participants (n=1402) were men ≥ 18 years old, resided in the United States, and reported having sex with ≥ one man in the previous 12 months. Recruitment occurred via advertisements on Facebook that linked to an online survey. The survey included questions about the participant's demographics, sexual history and behavior, drug use, sexual compulsivity, and a monetary DD task which was comprised of a previously validated series of questions to quantify subjective decline in value of money as the delay to receiving the money increases. The data from the survey were fit to a logistic regression model to describe associations of DD with unprotected anal intercourse (UAI) in the prior 12 months, controlling for education and drug use. Results: The DD parameter (k) was highly skewed, thus analyses were conducted using the natural log transform of k. Two exploratory analyses were conducted. In the first, above-median rates of delay discounting were not found to be significantly associated with reporting any UAI partners in the previous 12 months, controlling for education and drug use (aOR = 1.17, CI95: 0.92-1.50). In the second analysis, high (top 20%) rates of delay discounting were significantly associated with reporting multiple (>2) UAI partners in the previous 12 months, controlling for income (aOR = 1.55, CI95: 1.13-2.12). Discussion: Above-median DD was not found to be significantly associated with UAI. However, high DD was found to be a significant predictor of multiple UAI partners. Future studies should examine the utility of DD as a predictor of risky sexual behavior, as well as explore the possibility of HIV prevention interventions targeting DD.

Table of Contents

Table of Contents -- Background...1 -- Methods...4 -- PARTICIPANTS...4 -- MATERIALS...4 -- KIRBY DELAY DISCOUNTING QUESTIONNAIRE...4 -- DATA ANALYSIS...5 -- Results...7 -- DEMOGRAPHICS...7 -- DELAY DISCOUNTING...7 -- BIVARIATE ANALYSES...7 -- LOGISTIC REGRESSION...8 -- FUTURE DIRECTIONS...14 -- References...17 -- Appendix A. Tables and Figures...20 -- TABLE 1. DEMOGRAPHICS...20 -- TABLE 2. BIVARIATE ANALYSES OF ABOVE-MEDIAN DELAY DISCOUNTING WITH DEMOGRAPHIC AND BEHAVIORAL VARIABLES...21 -- TABLE 3. BIVARIATE ANALYSES OF HIGH DELAY DISCOUNTING WITH DEMOGRAPHIC AND BEHAVIORAL VARIABLES...22 -- TABLE 4. ADJUSTED ODDS RATIOS FOR REPORTING UAI IN THE PREVIOUS 12 MONTHS...23 -- TABLE 5. ADJUSTED ODDS RATIOS FOR REPORTING 3 OR MORE UAI PARTNERS IN THE PREVIOUS 12 MONTHS...24 -- FIGURE 1. FLOW CHART OF STUDY POPULATION INCLUSION...25 -- Appendix B. Emory University Men's Health and Behavior Survey...25 -- Appendix C. Annotated SAS Code...34 -- Appendix D. IRB Approval Letter...70

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