Center of Innovation in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Blvd., Houston, TX, 77021, USA.
Department of Veterans Affairs, South Central Mental Illness Research Education Clinical Center, Houston, TX, USA.
Arch Sex Behav. 2024 Apr;53(4):1499-1518. doi: 10.1007/s10508-024-02826-4. Epub 2024 Mar 1.
Unhealthy alcohol use and sexually transmitted infections (STIs) are significant public health concerns for US college students. Because alcohol use and condomless sex often co-occur in this population, alcohol-associated condomless sex has been identified as a behavioral intervention target. Existing theoretical frameworks have not garnered sufficient empirical support to serve as the foundation for interventions. The primary goal of the current study was to use a mixed-methods approach to develop a model of college student alcohol-associated condomless sex that combines elements from well-established health behavior theories. In Aim 1, multilevel modeling was used to predict condomless vaginal sex in a sample of heterosexual college student drinkers (N = 53). Aim 2 consisted of in-depth interviews (n = 18) to gather perceptions about the role of alcohol in sexual activity and identify supplemental constructs omitted from theories in Aim 1. The multilevel model explained a significant proportion of variance in condomless vaginal sex at the between- and within-person level. Themes derived from the in-depth interviews identified complementary elements of condom use decision-making. Findings from both aims were synthesized to construct a combined model of alcohol-associated condomless sex. This model can be further refined and ultimately serve as the foundation of an alcohol-STI prevention-intervention.
酗酒和性传播感染（STIs）是美国大学生面临的重大公共卫生问题。由于该人群中经常同时存在酗酒和无保护性行为，因此，与酒精相关的无保护性行为已被确定为行为干预的目标。现有的理论框架没有得到足够的经验支持，无法作为干预措施的基础。本研究的主要目标是采用混合方法，从成熟的健康行为理论中提取要素，构建大学生与酒精相关的无保护性行为模型。在目标 1 中，使用多层次模型预测异性恋大学生饮酒者（N=53）中的无保护阴道性行为。目标 2 包括深入访谈（n=18），以了解参与者对酒精在性行为中的作用的看法，并确定理论中遗漏的补充结构。多层次模型在个体间和个体内水平上解释了无保护阴道性行为的很大一部分差异。深入访谈得出的主题确定了避孕套使用决策的互补要素。两个目标的结果综合起来构建了一个与酒精相关的无保护性行为的综合模型。该模型可以进一步完善，并最终作为酒精-性传播感染预防干预的基础。
