Category: Treatment - Other
Keywords: Prevention | Alcohol | Risky Behaviors
Presentation Type: Symposium
Heavy alcohol use and risky sexual behavior are known to co-occur in Emergency Department (ED) patients, placing these individuals at higher risk for HIV/STIs. Our recent RCT demonstrated the efficacy of a brief multi-target motivational intervention (MI) to reduce alcohol use and risky sex among high-risk ED patients (Monti et al., 2016). This study aims to examine the mechanisms of behavior change underlying intervention effects at 3 months. A priori hypotheses include: 1) increased alcohol-related readiness to change (RTC) and self-efficacy will mediate the effect of MI on alcohol outcomes (average drinks per week, and number of heavy drinking days) compared to brief advice (BA); 2) increased sex-related RTC and self-efficacy will mediate the effect of MI on sex-risk outcomes (sex under the influence, and condomless sex with non-steady partners) compared to BA; and 3) reductions in alcohol use will mediate sex-risk reductions. RTC and self-efficacy were assessed via self-report at baseline and post intervention. Alcohol and sex-risk outcomes were assessed via 30-day Timeline Followback interview at baseline and 3-months. Mediation models were tested using the PROCESS SPSS macro (Hayes, 2013). Of 372 patients enrolled, 302 (81%; 141 MI, 161 BA) completed a 3-month follow-up. This sample was 54% female, and relatively young (Mage=29.9 years). Post-intervention RTC and self-efficacy ratings were higher among MI patients, but did not mediate the effects of MI on alcohol or sex-risk outcomes. However, as hypothesized, reductions in alcohol use mediated the effect of MI on sex under the influence, with a significant indirect path accounting for approximately 47% of the direct treatment effect. Furthermore, a chained mediation model showed that the effect of MI on condomless sex with non-steady partners was mediated by a significant indirect path in which treatment-related reductions in alcohol use were associated with less sex under the influence, which in turn was associated with less condomless sex events. These findings provide strong justification for multi-target intervention strategies incorporating alcohol use reduction into HIV/STI prevention programs.
Saturday, November 18
10:15 AM – 11:45 AM
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