1. A Longitudinal Analysis of Sex-Related Alcohol Expectancies as Moderators of the Relationship between Alcohol and Risky Sex An Honors Thesis Proposal, Submitted to the Department of Psychology, Old Dominion University Bradley Wetzell Fall, 2009

2. Overview Relevance Background Alcohol and sexual risk-taking Expectancy /alcohol myopia theories Sex-related alcohol expectancies Proposed research / Hypotheses Method Participants Measures Procedure Proposed analyses / Expected results Conclusion 2 Bradley Wetzell, August 2009

3. Relevance STI’s and Unwanted Pregnancies (CDC, 2009) HIV Males 15-19 Cases doubled 1997-2007 1 Million Adolescents with other STI’s As of 2006 Chlamydia, gonorrhea, syphilis HPV 25% females, 15-19 45% females, 20-24 Births (2004 – 2006) More than 850,000 Unmarried women, under 24 3 Bradley Wetzell, August 2009

4. Relevance Why such trends? Alcohol’s role? Alcohol use in teens / young adults (NIAAA, 2008) 72% 12th Graders 83% College Students Highest rates of problem drinking ages 18 – 24 Renewed interest in alcohol / risky sex 4 Bradley Wetzell, August 2009

5. Background Alcohol and sexual risk-taking Stall, McKusick, Wiley, & Coates, 1986 Data on alcohol use / sex / sex-risk P’s never drank during sex = High risk 3x less likely P’s drank rarely during sex = High risk 2x more likely 90% Able to identify risk reduction techniques Cooper, 2002 Meta-analysis, 44 studies Alcohol generally predicts risky sex, BUT Influence differs across behaviors Consistently predicts ‘indiscriminant sex’ NOT consistent with ‘protective behaviors’ Theoretical framework for such inconsistencies? 5 Bradley Wetzell, August 2009

6. Background Expectancy theory Marlatt & Rohsenow, 1980 Balanced placebo design Expectancies overtook pharmacology Affected cravings, aggression, anxiety, mood-states, sexual arousal, cognitive and motor abilities Foundations of expectancy theory Explains individual differences Does NOT explain situational differences 6 Bradley Wetzell, August 2009

7. Background Alcohol myopia theory Steele & Josephs, 1990 Social behavior = Interplay of internal / external cues Alcohol narrows access to cues (most salient available) Inhibition conflict = myopia occludes internal inhibition cues, resulting in disinhibition BUT… COULD result in inhibition, given right circumstance Fits available data, helps explain anomalies (e.g., condom use) 7 Bradley Wetzell, August 2009

8. Background Expectancies still important (Cooper, 2006) Myopia narrows focus Expectancies influence direction of focus Sex-related expectancies Predict sexual behavior in general Risky sexual behavior = Inconclusive 8 Bradley Wetzell, August 2009

9. Background Sex-related alcohol expectancies (SRAE) Leigh, 1990 Constructed 13-item SRAE scale Principle component analysis / 3 subscales Enhanced sex (e.g., “I am a better lover.”) Decreased nervousness (e.g., “I feel less shy.”) Increased riskiness (e.g., “I have sex with people I wouldn’t have sex with when sober.”) Related to drinking in sexual situations and sexual behavior while under the influence 9 Bradley Wetzell, August 2009

10. Background Sex-related alcohol expectancies (SRAE) Dermen & Cooper, 1994a Improved on Leigh’s SRAE scale Added measures for ‘disinhibition’ Improved ‘sex-risk’ measures Confirmatory factor analysis 13-item scale / 3 subscales Enhancement (e.g., “I am a better lover.”), α = .83 Sex-risk (e.g., “I am less likely to use a condom.”), α = .70 Disinhibition (e.g., “I find it harder to say no to sexual advances.”), α = .79 10 Bradley Wetzell, August 2009

11. Background Sex-related alcohol expectancies (SRAE) Dermen & Cooper, 1994b P’s Report sexual activity / circumstances, last 30 days SRAE better than general expectancies for predicting alcohol use before or during sex Less useful for predicting drinking at parties or on dates For heavy drinkers: Expect disinhibition = More alcohol at parties and on dates Expect sex-risk = More alcohol on dates Alcohol as excuse? 11 Bradley Wetzell, August 2009

12. Background Sex-related alcohol expectancies (SRAE) Dermen, Cooper & Agocha, 1998 P’s recall 3 key past sexual experiences Assessed alcohol use Assessed risk Assessed SRAE (disinhibition, sex-risk) Sig. interactions btw. alcohol use / SRAE On two occasions, but not all three No theoretical basis for contradiction Conclusion: Inconsistencies due to instability of behavioral prediction on specific occasions (Epstein, 1979; 1980) 12 Bradley Wetzell, August 2009

13. Proposed Research Evidence for SRAE moderating alcohol / risky sex, but inconclusive No further attempts to clarify via aggregation Follow-up appropriate: Clear alcohol / risky sex link Link not fully understood High rate of alcohol use / abuse among teens and young adults Clear need to develop better intervention methods to curb rise in STI’s and unwanted pregnancies 13 Bradley Wetzell, August 2009

14. Proposed Research Purpose Clarify the relationship between alcohol use and risky sexual behavior by examining the moderating role of SRAE using aggregation. Variables Demographics(Predictor): Gender, age, race/ethnicity Alcohol use(Predictor) Sex-related alcohol expectancies(Predictor / Moderator): Individually held beliefs regarding alcohol’s effects on sexual experience Risky Sex(Criterion): Sexual activity that increases the relative risk of unwanted pregnancy or contracting an STI 14 Bradley Wetzell, August 2009

15. Proposed Research Hypotheses: (a) SRAE, as measured by Dermen & Cooper’s scale (1994a), will remain stable over time. (b) The disinhibition and sex-risk dimensions of this scale will moderate the relationship between alcohol use and risky sexual behavior, such that higher expectancies will be more likely to participate in risky sexual behavior while drinking. 15 Bradley Wetzell, August 2009

16. Method Participants Convenience sample ODU psychology department undergraduate research pool Expect majority to be Caucasian Females, with median age of 19 Recruit online via SONA Voluntary signup Use confidential ID number Will earn up to 3.5 hours of research credit 1.0 hour for baseline Up to 2.5 more hours for follow-ups Hours can be converted to optional course credit 16 Bradley Wetzell, August 2009

17. Method Participants Notification statement Presented electronically prior to baseline data collection Informs anonymity Informs right to leave any question blank Informs right to discontinue participation at any time without negative repercussions All ethical guidelines will be followed 17 Bradley Wetzell, August 2009

18. Method Participants A priori power analysis G*Power 3 (Faul, Erdfelder, Lang & Buchner, 2007) Effect size from total-R2 values from Dermen, Cooper, & Agocha (1998) Power = .80 N = 132 Expect to recruit 145 participants, with at least two follow-ups 18 Bradley Wetzell, August 2009

19. Method Measures SRAE Scale (Dermen & Cooper, 1994a) 13-item scale, assesses beliefs regarding alcohol’s effects on sexual behavior in 3 dimensions: Enhancement: Extent to which alcohol enhances sex Disinhibition: Extent to which alcohol disinhibits sexual behavior Sex-risk: Extent to which alcohol promotes sexual risk taking Questions preceded with stem “After a few drinks of alcohol…” 6-point Likert scale responses (“1-strongly disagree” to “6- strongly agree”) Baseline and Follow-Up Phases 19 Bradley Wetzell, August 2009

20. Method Measures Weekly Inventory of Sexual Activity, Alcohol Use and Risk Assessment 7-Day grid indicating frequency of sexual activity each day Sex = Vaginal / Anal Penetration 20 Bradley Wetzell, August 2009

21. Method Measures Weekly Inventory of Sexual Activity, Alcohol Use and Risk Assessment Alcohol Use (0 = no, 1 = yes) 21 Bradley Wetzell, August 2009

22. Method Measures Weekly Inventory of Sexual Activity, Alcohol Use and Risk Assessment 3-Function Risk Assessment (Content from Dermen , Cooper & Agocha, 1998) Condom use (1 = no, 0 = yes) Prior risk-related discussion (1 = No to all, 0 = Yes to any) Sex history Drug history Risk of STI / Pregnancy Partner Intimacy (Dichotomized, 1 = 1,2 or 3; 0 = 4,5 or 6) 6-point Likert Range = “1-Someone I just met”, to “6-Spouse or Fiancé” Composite score = 0 to 3 Higher score = Higher risk Baseline / follow-up phases 22 Bradley Wetzell, August 2009

23. Method Measures Demographic Variables Standard Demographic Questionnaire Age Gender Race / Ethnicity Marital Status Housing Status Greek Membership Status Height Weight Baseline Phase Only 23 Bradley Wetzell, August 2009

24. Method Procedure Baseline Phase Ps sign up on-line from available times Scheduled in groups of four, MGB 229 Seated at one of four standard desktop computers Presented with notification statement Indicate consent by clicking “Next” Presented with battery of measures, including: SRAE scale Sexual activity inventory and risk assessment Demographics Approximately one hour 24 Bradley Wetzell, August 2009

25. Method Procedure Follow-Up Phase If Ps elect, will provide SONA ID number Reminder emails sent each Monday Link to the follow-up measures, to include: SRAE Scale Sexual activity inventory and risk assessment Each follow-up to take approximately 15 minutes Ps could potentially complete 10, for a total of 2.5 hours 25 Bradley Wetzell, August 2009

26. Hypothesis A SRAE, as measured by Dermen and Cooper’s (1994a) scale will remain stable over time Intraclass Correlation Test-retest reliability Subscale scores compared across time-points Coefficients of 0.61 or above will be considered stable (Fleiss, Nee, & Landis, 1979; Landis & Koch, 1977) 26 Proposed Analyses Expected Results Bradley Wetzell, August 2009

27. Hypothesis B The disinhibition and sex-risk dimensions of the SRAE scale will moderate the relationship between alcohol use and risky sex Hierarchical regression (Baron & Kenny, 1986) Criterion = Aggregated sex-risk score Step 1 = Demos for gender, race/ethnicity and age Step 2 = Aggregated SRAE results for disinhibition and sex-risk Step 3 = Aggregated alcohol use Step 4 = SRAE x Alcohol use Significant interactions between alcohol use and SRAE will support moderation hypothesis (Baron & Kenny, 1986) 27 Proposed Analyses Expected Results Bradley Wetzell, August 2009

28. Conclusion Further support for the role of expectancies in affecting behavior while drinking Clarify previously inconclusive results regarding moderating role of SRAE Provide direction for more effective intervention methods for risky sexual behavior “Self-fulfilling prophecy” effect 28 Bradley Wetzell, August 2009

29. References Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173-1182. Retrieved June 8, 2009, from PsycINFO database. Centers for Disease Control and Prevention. (2009). Sexual and Reproductive Health of Persons Aged 10-24 Years, United States, 2002-2007. Last Updated: July 17, 2009. Retrieved July 19, 2009, from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5806a1.htm?s_cid=ss5806a1_e. Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2003). Applied multiple regression/correlation analysis for the behavioral sciences (3rd ed.). Mahwah, NJ US: Lawrence Erlbaum Associates Publishers. Cooper, M. L. (2002). Alcohol use and risky sexual behavior among college students and youth: Evaluating the evidence. Journal of Studies on Alcohol, 101-117. Retrieved March 13, 2009, from PsycINFO database. Cooper, M. L. (2006). Does Drinking Promote Risky Sexual Behavior?: A Complex Answer to a Simple Question. Current Directions in Psychological Science, 15(1), 19-23. Retrieved June 16, 2009, from PsycINFO database. Dermen, K. H., & Cooper, M. L. (1994a). Sex-related alcohol expectancies among adolescents: I. Scale development. Psychology of Addictive Behaviors, 8(3), 152-160. Retrieved March 16, 2009, from PsycINFO database. Dermen, K. H., & Cooper, M. L. (1994b). Sex-related alcohol expectancies among adolescents: II. Prediction of drinking in social and sexual situations. Psychology of Addictive Behaviors, 8(3), 161-168. Retrieved March 16, 2009, from PsycINFO database. Dermen, K. H., & Cooper, M. L. (2000). Inhibition conflict and alcohol expectancy as moderators of alcohol's relationship to condom use. Experimental and Clinical Psychopharmacology, 8(2), 198-206. Retrieved July 13, 2009, from PsycINFO database. Dermen, K. H., Cooper, M. L., & Agocha, V. B. (1998). Sex-related alcohol expectancies as moderators of the relationship between alcohol use and risky sex in adolescents. Journal of Studies on Alcohol, 59(1), 71-77. Retrieved March 13, 2009, from PsycINFO database. 29 Bradley Wetzell, August 2009

30. References Epstein, S. (1979). The stability of behavior: I. On predicting most of the people much of the time. Journal of Personality and Social Psychology, 37(7), 1097-1126. Retrieved June 9, 2009, from PsycINFO database. Epstein, S. (1980). The stability of behavior: II. Implications for psychological research. American Psychologist, 35(9), 790-806. Retrieved June 8, 2009, from PsycINFO database. Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175-191. Fleiss, J. L., Nee, J. C., & Landis, J. R. (1979). Large sample variance of kappa in the case of different sets of raters. Psychological Bulletin, 86(5), 974-977. Landis, J. R., & Koch, G. G. (1977). The Measurement of Observer Agreement for Categorical Data. Biometrics, 33(1), 159-174. Retrieved August 1, 2009, from JSTOR database. Leigh, B. C. (1990). The relationship of sex-related alcohol expectancies to alcohol consumption and sexual behavior. British Journal of Addiction, 85(7), 919-928. Retrieved June 9, 2009, from PsycINFO database. Marlatt, G. A., & Rohsenow, D. J. (1980). Cognitive processes in alcohol use: Expectancy and the balanced placebo design. In N. K. Mello (Ed.), Advances in substance abuse: Behavioral and biological research (Vol. 1, pp. 159-199). Greenwich, CT: JAI Press. National Institute on Alcohol Abuse and Alcoholism. (2008). Research Findings on College Drinking and the Minimum Legal Drinking Age. Last Updated: October, 2008. Retrieved July 19, 2009, from http://www.niaaa.nih.gov/NR/rdonlyres/F099FF68-37B3-4EBC-8573-93CC768A74AA/0/CollegeDrinkingMLDA.pdf. Stall, R., McKusick, L., Wiley, J., & Coates, T. J. (1986). Alcohol and drug use during sexual activity and compliance with safe sex guidelines for AIDS: The AIDS behavioral research project. Health Education Quarterly, 13(4), 359-371. Retrieved June 9, 2009, from PsycINFO database. Steele, C. M., & Josephs, R. A. (1990). Alcohol myopia: Its prized and dangerous effects. American Psychologist, 45(8), 921-933. Retrieved July 21, 2009, from PsycINFO database. 30 Bradley Wetzell, August 2009

31. A Longitudinal Analysis of Sex-Related Alcohol Expectancies as Moderators of the Relationship between Alcohol and Risky Sex An Honors Thesis Proposal, Submitted to the Department of Psychology, Old Dominion University Bradley Wetzell Fall, 2009