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Annals of Behavioral Medicine
Published in: Annals of Behavioral Medicine 1/2017

01-02-2017 | Original Article

Using Integrative Data Analysis to Examine Changes in Alcohol Use and Changes in Sexual Risk Behavior Across Four Samples of STI Clinic Patients

Authors: Jennifer L. Walsh, PhD, Lance S. Weinhardt, PhD, Seth C. Kalichman, PhD, Michael P. Carey, PhD

Published in: Annals of Behavioral Medicine | Issue 1/2017

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Abstract

Background

Patients in sexually transmitted infection (STI) clinics report high levels of alcohol use, which are associated with risky sexual behavior. However, no studies have examined how changes in alcohol use relate to changes in sexual risk behavior.

Purpose

We used parallel process latent growth modeling to explore how changes in alcohol use related to changes in sexual behavior across four samples of clinic patients.

Methods

Patients participating in HIV prevention trials from urban clinics in the Northeastern and Midwestern USA (N = 3761, 59 % male, 72 % Black) completed measures at 3-month intervals over 9–12 months. Integrative data analysis was used to create composite measures of alcohol use across samples. Sexual risk measures were counts of partners and unprotected sex acts. Parallel process models tested whether alcohol use changes were correlated with changes in the number of partners and unprotected sex.

Results

Growth models with good fit showed decreases that slowed over time in sexual risk behaviors and alcohol use. Parallel process models showed positive correlations between levels of (rs = 0.17–0.40, ps < 0.001) and changes in (rs = 0.21–0.80, ps < 0.05) alcohol use and number of sexual partners across studies. There were strong associations between levels of (rs = 0.25–0.43, ps < 0.001) and changes in (rs = 0.24–0.57, ps < 0.01) alcohol use and unprotected sex in one study recruiting hazardous drinkers.

Conclusions

Across four samples of clinic patients, reductions in alcohol use were associated with reductions in the number of sexual partners. HIV prevention interventions may be strengthened by addressing alcohol use.
Appendix
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Literature
1.
Centers for Disease Control and Prevention. STD Trends in the United States: 2010 National Data for Gonorrhea, Chlamydia, and Syphilis. Atlanta: U.S. Department of Health and Human Services; 2011.
2.
World Health Organization. Global Prevalence and Incidence of Selected Curable Sexually Transmitted Infections: Overview and Estimates. Geneva, Switzerland, 2001
3.
Fleming DT, Wasserheit JN. From epidemiological synergy to public health policy and practice: The contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sex Transm Infect. 1999; 75: 3-17.CrossRefPubMedPubMedCentral
4.
Hutchinson AB, Farnham PG, Dean HD, et al. The economic burden of HIV in the United States in the era of highly active antiretroviral therapy: Evidence of continuing racial and ethnic differences. J Acquir Immune Defic Syndr. 2006; 43: 451-457.CrossRefPubMed
5.
Howards PP, Thomas JC, Earp JA. Do clinic-based STD data reflect community patterns? Int J STD AIDS. 2002; 13: 775-780.CrossRefPubMed
6.
Otten MW, Zaidi AA, Peterman TA, Rolfs RT, Witte JJ. High rate of HIV seroconversion among patients attending urban sexually transmitted disease clinics. AIDS. 1994; 8: 549-553.CrossRefPubMed
7.
Leichliter JS, Ellen JM, Gunn RA. In: Aral SO, Douglas JM, eds. STD Repeaters: Implications for the Individual and STD Transmission in a Population Behavioral Interventions for Prevention and Control of Sexually Transmitted Diseases. New York: Springer; 2007: 354-373.
8.
Newman LM, Warner L, Weinstock HS. Predicting subsequent infection in patients attending sexually transmitted disease clinics. Sexually Transmitted Diseases. 2006;33:737–742. 710.1097/1001.olq.0000218865.0000237084.f0000218866.
9.
Mehta S, Erbelding E, Zenilman J, Rompalo A. Gonorrhoea reinfection in heterosexual STD clinic attendees: Longitudinal analysis of risks for first reinfection. Sex Transm Infect. 2003; 79: 124-128.CrossRefPubMedPubMedCentral
10.
Peterman TA, Tian LH, Metcalf CA, et al. High incidence of new sexually transmitted infections in the year following a sexually transmitted infection: A case for rescreening. Ann Intern Med. 2006; 145: 564-572.CrossRefPubMed
11.
Weinstock H, Sweeney S, Satten GA, Gwinn M. HIV seroincidence and risk factors among patients repeatedly tested for HIV attending sexually transmitted disease clinics in the United States, 1991 to 1996. STD Clinic HIV Seroincidence Study Group. J Acquir Immune Defic Syndr Hum Retrovirol. 1998; 19: 506-512.CrossRefPubMed
12.
Scott-Sheldon LA, Fielder RL, Carey MP. Sexual risk reduction interventions for patients attending sexually transmitted disease clinics in the United States: A meta-analytic review, 1986 to early 2009. Ann Behav Med. 2010; 40: 191-204.CrossRefPubMedPubMedCentral
13.
Appel PW, Piculell R, Jansky HK, Griffy K. Assessing alcohol and other drug problems (AOD) among sexually transmitted disease (STD) clinic patients with a modified CAGE-A: Implications for AOD intervention services and STD prevention. Am J Drug Alcohol Abuse. 2006; 32: 225-236.CrossRefPubMed
14.
Lane J, Proude EM, Conigrave KM, de Boer JP, Haber PS. Nurse-provided screening and brief intervention for risky alcohol consumption by sexual health clinic patients. Sex Transm Infect. 2008; 84: 524-527.CrossRefPubMed
15.
Cook RL, Comer DM, Wiesenfeld HC, et al. Alcohol and drug use and related disorders: An underrecognized health issue among adolescents and young adults attending sexually transmitted disease clinics. Sex Transm Dis. 2006;33:565–570. 510.1097/1001.olq.0000206422.0000240319.0000206454
16.
Cook RL, Clark DB. Is there an association between alcohol consumption and sexually transmitted diseases? A systematic review. Sex Transm Dis. 2005; 32: 156-164.CrossRefPubMed
17.
Baliunas D, Rehm J, Irving H, Shuper P. Alcohol consumption and risk of incident human immunodeficiency virus infection: A meta-analysis. Int J Public Health. 2010; 55: 159-166.CrossRefPubMed
18.
Seth P, Wingood GM, DiClemente RJ, Robinson LS. Alcohol use as a marker for risky sexual behaviors and biologically confirmed sexually transmitted infections among young adult African-American women. Womens Health Issues. 2011; 21: 130-135.CrossRefPubMedPubMedCentral
19.
Seth P, Sales JM, DiClemente RJ, et al. Longitudinal examination of alcohol use: A predictor of risky sexual behavior and Trichomonas vaginalis Among African-American female adolescents. Sex Transm Dis. 2011;38:96–101. 110.1097/OLQ.1090b1013e3181f1007abe.
20.
Hutton HE, McCaul ME, Santora PB, Erbelding EJ. The relationship between recent alcohol use and sexual behaviors: Gender differences among sexually transmitted disease clinic patients. Alcohol Clin Exp Res. 2008; 32: 2008-2015.PubMedPubMedCentral
21.
Cooper ML. Alcohol use and risky sexual behavior among college students and youth: Evaluating the evidence. J Stud Alcohol. 2002;101–117.
22.
Leigh BC, Stall R. Substance use and risky sexual-behavior for exposure to HIV: Issues in methodology, interpretation, and prevention. Am Psychol. 1993; 48: 1035-1045.CrossRefPubMedPubMedCentral
23.
Weinhardt LS, Carey MP. Does alcohol lead to sexual risk behavior? Findings from event-level research. Annu Rev Sex Res. 2000; 11: 125.PubMedPubMedCentral
24.
Leigh BC. Alcohol and condom use: A meta-analysis of event-level studies. Sex Transm Dis. 2002; 29: 476.CrossRefPubMed
25.
Graves KL. Risky sexual-behavior and alcohol-use among young-adults—Results from a national survey. Am J Health Promot. 1995; 10: 27-36.CrossRefPubMed
26.
Cooper ML, Orcutt HK. Alcohol use, condom use and partner type among heterosexual adolescents and young adults. J Stud Alcohol. 2000; 61: 413-419.CrossRefPubMed
27.
Walsh JL, Fielder RL, Carey KB, Carey MP. Do alcohol and marijuana use decrease the probability of condom use for college women? J Sex Res. 2014; 51: 145-158.CrossRefPubMed
28.
Rehm J, Shield KD, Joharchi N, Shuper PA. Alcohol consumption and the intention to engage in unprotected sex: Systematic review and meta-analysis of experimental studies. Addiction. 2012; 107: 51-59.CrossRefPubMed
29.
Scott-Sheldon LAJ, Carey MP, Vanable PA, et al. Alcohol consumption, drug use, and condom use among STD clinic patients. J Stud Alcohol Drugs. 2009; 70: 762-770.CrossRefPubMedPubMedCentral
30.
Scott-Sheldon LAJ, Senn TE, Carey KB, Urban MA, Carey MP. Quantity, not frequency, of alcohol use moderates the association between multiple sexual partners and Trichomonas vaginalis among women attending an urban STD clinic. Sex Transm Infect. 2013; 89: 498-503.CrossRefPubMedPubMedCentral
31.
Kalichman SC, Cain D, Zweben A, Swain G. Sensation seeking, alcohol use and sexual risk behaviors among men receiving services at a clinic for sexually transmitted infections. J Stud Alcohol. 2003; 64: 564-569.CrossRefPubMed
32.
Kalichman SC, Simbayi LC, Jooste S, Cain D. Frequency, quantity, and contextual use of alcohol among sexually transmitted infection clinic patients in Cape Town, South Africa. Am J Drug Alcohol Abuse. 2007; 33: 687-698.CrossRefPubMed
33.
Kalichman SC, Cain D. A prospective study of sensation seeking and alcohol use as predictors of sexual risk behaviors among men and women receiving sexually transmitted infection clinic services. Psychol Addict Behav. 2004; 18: 367-373.CrossRefPubMed
34.
Steele CM, Josephs RA. Alcohol myopia—Its prized and dangerous effects. Am Psychol. 1990; 45: 921-933.CrossRefPubMed
35.
Lang AR. The social psychology of drinking and human sexuality. J Drug Issues. 1985; 15: 273-289.CrossRef
36.
Cavan S. Liquor License; an Ethnography of Bar Behavior. Chicago: Aldine Pub. Co; 1966.
37.
38.
Latkin CA, Mandell W, Vlahov D. The relationship between risk networks’ patterns of crack cocaine and alcohol consumption and HIV-related sexual behaviors among adult injection drug users: A prospective study. Drug Alcohol Depend. 1996; 42: 175-181.CrossRefPubMed
39.
Mizuno Y, Purcell D, Borkowski T, Knight K. The life priorities of HIV-seropositive injection drug users: Findings from a community-based sample. AIDS Behav. 2003; 7: 395-403.CrossRefPubMed
40.
Latkin CA, Curry AD, Hua W, Davey MA. Direct and indirect associations of neighborhood disorder with drug use and high-risk sexual partners. Am J Prev Med. 2007; 32: S234-S241.CrossRefPubMedPubMedCentral
41.
Weir B, Bard R, O’Brien K, Casciato C, Stark M. Uncovering patterns of HIV risk through multiple housing measures. AIDS Behav. 2007; 11: 31-44.CrossRefPubMed
42.
Duncan TE, Duncan SC, Strycker LA. An Introduction to Latent Variable Growth Curve Modeling: Concepts, Issues, and Application. New York: Routledge Academic; 2013.
43.
44.
Hofer SM, Piccinin AM. Integrative data analysis through coordination of measurement and analysis protocol across independent longitudinal studies. Psychol Methods. 2009; 14: 150.CrossRefPubMedPubMedCentral
45.
Curran PJ, Hussong AM, Cai L, et al. Pooling data from multiple longitudinal studies: The role of item response theory in integrative data analysis. Dev Psychol. 2008; 44: 365.CrossRefPubMedPubMedCentral
46.
Shrout PE. Short and long views of integrative data analysis: Comments on contributions to the special issue. Psychol Methods. 2009; 14: 177.CrossRefPubMed
47.
48.
Hertzog C, Lindenberger U, Ghisletta P, Oertzen T. On the power of multivariate latent growth curve models to detect correlated change. Psychol Methods. 2006; 11: 244-252.CrossRefPubMed
49.
50.
Fisher JD, Fisher WA. Theoretical approaches to individual-level change in HIV risk behavior. In: Peterson JL, DiClemente RJ, eds. Handbook of HIV Prevention, AIDS Prevention, and Mental Health. New York: Kluwer Academic/Plenum Publishers; 2000: 3-55.CrossRef
51.
Carey MP, Senn TE, Vanable PA, Coury-Doniger P, Urban MA. Brief and intensive behavioral interventions to promote sexual risk reduction among STD clinic patients: Results from a randomized controlled trial. AIDS Behav. 2010; 14: 504-517.CrossRefPubMed
52.
Carey MP, Senn TE, Walsh JL, et al. Evaluating a brief, video-based sexual risk reduction intervention and assessment reactivity with STI clinic patients: Results from a randomized controlled trial. AIDS Behav. 2014; 1–19.
53.
Kalichman SC, Cain D, Weinhardt L, et al. Experimental components analysis of brief theory-based HIV/AIDS risk-reduction counseling for sexually transmitted infection patients. Health Psychol. 2005; 24: 198-208.CrossRefPubMed
54.
Carey MP, Vanable PA, Senn TE, Coury-Doniger P, Urban MA. Evaluating a two-step approach to sexual risk reduction in a publicly-funded STI clinic: Rationale, design, and baseline data from the Health Improvement Project-Rochester (HIP-R). Contemp Clin Trials. 2008; 29: 569-586.CrossRefPubMedPubMedCentral
55.
Weinhardt LS, A. Z, Otto Salaj LL, et al. Alcohol use disorders among STD clinic patients: An opportunity for synergistic intervention. 2003 National HIV Prevention Conference. Atlanta, GA, 2003, July.
56.
Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care. 2nd ed. Geneva, Switzerland: World Health Organization; 2001.
57.
Bauer DJ, Hussong AM. Psychometric approaches for developing commensurate measures across independent studies: Traditional and new models. Psychol Methods. 2009; 14: 101-125.CrossRefPubMedPubMedCentral
58.
Muthén BO. Multilevel covariance structure analysis. Sociol Methods Res. 1994; 22: 376-398.CrossRef
59.
Rubin DB. Multiple imputation after 18+ years. J Am Stat Assoc. 1996; 91: 473-489.CrossRef
60.
Schafer JL. Analysis of Incomplete Multivariate Data. New York: Chapman and Hall; 1997.CrossRef
61.
62.
Graham J, Olchowski A, Gilreath T. How many imputations are really needed? Some practical clarifications of multiple imputation theory. Prev Sci. 2007; 8: 206-213.CrossRefPubMed
63.
Muthén LK, Muthén BO: Mplus User’s Guide (7 Ed.). Los Angeles, CA: Muthén & Muthén, 1998–2013.
64.
Tabachnick BG, Fidell LS. Using Multivariate Statistics. 5th ed. Boston: Pearson/Allyn & Bacon; 2007.
65.
Schwarz G. Estimating the dimension of a model. Ann Stat. 1978; 6: 461-464.CrossRef
66.
Cox DR, Hinkley DV. Theoretical Statistics. London: Chapman and Hall; 1979.
67.
68.
Tucker LR, Lewis C. A reliability coefficient for maximum likelihood factor analysis. Psychometrika. 1973; 38: 1-10.CrossRef
69.
Kline RB. Principles and Practice of Structural Equation Modeling. New York: Guilford; 2011.
70.
Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Model. 1999; 6: 1-55.CrossRef
71.
Metcalf CA, Douglas JM Jr, Malotte CK, et al. Relative efficacy of prevention counseling with rapid and standard HIV testing: A randomized, controlled trial (RESPECT-2). Sex Transm Dis. 2005; 32: 130-138.CrossRefPubMed
72.
Leonard KE, Mudar P. Peer and partner drinking and the transition to marriage: A longitudinal examination of selection and influence processes. Psychol Addict Behav. 2003; 17: 115.CrossRefPubMed
73.
Fishbein M, Pequegnat W. Evaluating AIDS prevention interventions using behavioral and biological outcome measures. Sex Transm Dis. 2000; 27: 101-110.CrossRefPubMed
74.
Schroder KE, Carey MP, Vanable PA. Methodological challenges in research on sexual risk behavior: I. Item content, scaling, and data analytical options. Ann Behav Med. 2003; 26: 76-103.CrossRefPubMedPubMedCentral
75.
Vanable PA, McKirnan DJ, Buchbinder SP, et al. Alcohol use and high-risk sexual behavior among men who have sex with men: The effects of consumption level and partner type. Health Psychol. 2004; 23: 525.CrossRefPubMed
76.
Babor TF, McRee BG, Kassebaum PA, et al. Screening, Brief Intervention, and Referral to Treatment (SBIRT) toward a public health approach to the management of substance abuse. Subst Abus. 2007; 28: 7-30.CrossRefPubMed
77.
78.
Moyer VA. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2013; 159: 210-218.PubMed
79.
Ickovics JR. “Bundling” HIV prevention: Integrating services to promote synergistic gain. Prev Med. 2008; 46: 222-225.CrossRefPubMed
80.
World Health Organization. Global Status Report on Alcohol and Health—2014. World Health Organization; 2014.
81.
Booth RE, Watters JK, Chitwood DD. HIV risk-related sex behaviors among injection drug users, crack smokers, and injection drug users who smoke crack. Am J Public Health. 1993; 83: 1144-1148.CrossRefPubMedPubMedCentral
82.
Cheong J, MacKinnon DP, Khoo ST. Investigation of mediational processes using parallel process latent growth curve modeling. Struct Equ Model. 2003; 10: 238-262.CrossRef
83.
Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Arch Intern Med. 1998; 158: 1789-1795.CrossRefPubMed
84.
Cudeck R, Du Toit SH. A version of quadratic regression with interpretable parameters. Multivar Behav Res. 2002; 37: 501-519.CrossRef
85.
Deegan J. On the occurrence of standardized regression coefficients greater than one. Educ Psychol Meas. 1978; 38: 873-888.CrossRef
Metadata
Title
Using Integrative Data Analysis to Examine Changes in Alcohol Use and Changes in Sexual Risk Behavior Across Four Samples of STI Clinic Patients
Authors
Jennifer L. Walsh, PhD
Lance S. Weinhardt, PhD
Seth C. Kalichman, PhD
Michael P. Carey, PhD
Publication date
01-02-2017
Publisher
Springer US
Published in
Annals of Behavioral Medicine / Issue 1/2017
Print ISSN: 0883-6612
Electronic ISSN: 1532-4796
DOI
https://doi.org/10.1007/s12160-016-9826-4

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