Self-reports of alcohol use, drug use and sexual behavior: expanding the Timeline Follow-back technique.

OBJECTIVE: The purpose of this study is to compare reports of alcohol use, drug use and sexual behavior from 30-day Summary measures with an expanded version of a Timeline Follow-back (Timeline) interview technique among gay/bisexual men entering outpatient substance abuse treatment at a gay-identified agency. METHOD: Respondents (N = 418) first completed self-administered questionnaires covering the 30-day period prior to their last use of alcohol or drugs. Summary measures included alcohol use, number of days of use for five categories of drugs and number of episodes of anal intercourse (with and without condoms) by partner type (primary or secondary). Participants then completed the Timeline interview procedure to recall their daily drinking, drug use and sexual behavior during the same 30-day period. RESULTS: The findings indicate that the Timeline method yielded significantly lower estimates of mean number of drinks consumed when heavier than usual drinking days is included in the Summary measure (124.0 vs 147.0 drinks), mean number of days drugs were used (9.3 vs 10.7) and mean number of episodes of anal intercourse with a primary partner (1.2 vs 2.2). Differences generally remained significant when assessed by length of time between the study interview and last use of alcohol or drugs, with the exception of number of anal sex episodes with primary partners. CONCLUSIONS: These findings indicate that Timeline estimates are lower than estimates using a more standard method (Summary measures). Discrepancies between these findings and those reported by other researchers indicate a need for further exploration of the effects of the mode of administration on various populations.

Acculturation, alcohol consumption and AIDS-related risky sexual behavior among African American women.

The present study examined the relationship between acculturation, alcohol consumption and AIDS-related risky sexual behavior in a national probability sample of 533 African American women. Results indicated that women who were the heaviest drinkers were also the least acculturated. However, women most likely to engage in risky sexual behavior, including having multiple partners, being nonmonogamous or in a nonmonogamous relationship, and being nonmonogamous or in a nonmonogamous relationship and not using a condom consistently, were high in acculturation rather than low. Alcohol use proved related to risky sexual behavior when considered in conjunction with respondents' level of acculturation. Women at risk for contracting AIDS were not low acculturated African American women who drank heavily, but high acculturated African American women. Findings from this study extend our understanding of risk and contain implications for research and prevention efforts in the area of alcohol use and AIDS-related sexual behavior among African American women.

PIP: The relationship between acculturation, alcohol consumption, and AIDS-related risky sexual practices was investigated in a national probability sample of 533 African American women. Data were collected in 1991-92 as part of a follow-up survey to the 1984 US National Alcohol Survey. Acculturation--the extent of adaptation to US mainstream society--was measured through use of a 10-item questionnaire related to preference for African American mass media and reliance on an African American social network. Scores on this scale ranged from 1.00 (low acculturation) to 3.78 (high acculturation). Most respondents were 18-29 years of age and lived in urban areas. Among the 306 respondents (74%) who were sexually active in the preceding year, 60 (21%) had had multiple sex partners, 130 (43%) were in a nonmonogamous relationship, and 266 (91%) had not used condoms consistently. 109 women (41%) abstained from alcohol consumption, 107 (36%) were moderate drinkers, and 90 (22%) consumed 5 or more drinks per day. When sociodemographic factors, religiosity, and attitudes toward sex were controlled, it was found that high-risk sexual practices were most prevalent among respondents with high levels of both acculturation and alcohol consumption. Heavy drinking alone was not a risk factor. Multivariate analysis indicated that women in the high acculturation/heavy drinking group were 13 times more likely to have multiple sex partners than their low acculturation/alcohol abstinent counterparts. These findings suggest the need for AIDS prevention programs for African American women that address alcohol treatment and assertiveness training.

AIDS protection and contraception among African American, Hispanic, and white women.

The goal of this study was to examine behaviors related to AIDS protection and contraception among African American, Hispanic, and white women. Data were collected in 1991 and 1992 as part of a large-scale National Alcohol Survey in which respondents were asked questions about AIDS-related sexual behavior and attitudes in face-to-face interviews. Results indicated that a significant proportion of women and their partners in each ethnic group did not use any form of protection during their most recent sexual encounter. The findings suggest that it may be useful to combine efforts to reduce unintended pregnancies with efforts for AIDS protection.

Alcohol and AIDS-related sexual behavior among Hispanics: acculturation and gender differences.

We examined the relationship of acculturation to alcohol use and risky sexual behavior among Hispanic men (N = 269) and women (N = 294). Data were obtained from a 1991/1992 general population survey on alcohol that included questions on sexual behavior. Guided by a conceptual/theoretical framework, we focused on gender and acculturation differences as we examined the relationship between sociodemographic characteristics, perception of AIDS-related risk, drinking and AIDS-related sexual behavior. Logistic regression analyses were performed separately for men and women to evaluate the predictive strength of acculturation, demographic factors, and alcohol consumption on risky sexual behavior. Results indicated that less acculturated Hispanic men drank more heavily and were more likely to engage in risky sexual behavior than those who were more acculturated. Although acculturated Hispanic women drank more than those who were less acculturated, less acculturated Hispanic women engaged in more risky sexual behavior. The data indicate the need for culturally sensitive AIDS-prevention programs that are linked with alcohol treatment services for men and that are targeted to different acculturation levels for men and women.

PIP: Most at risk for heterosexually transmitted HIV infection are those engaged in multiple sexual partners and those not using condoms. This follow up survey examined the relationship of acculturation to alcohol use and risky sexual behavior among Hispanic men (269) and women (294). Data was collected from a 1991-92 general population survey on alcohol that included questions on sexual behavior. Examination of the relationship between sociodemographic characteristics, perception of AIDS-related risk, drinking and AIDS-related sexual behavior focused on gender and acculturation differences. Results indicated that less acculturated Hispanic men drank more heavily and were more likely to engage in risky sexual behavior than those who were more acculturated. Although acculturated Hispanic women drank more than those who were less acculturated, less acculturated Hispanic women engaged in more risky sexual behavior. This study suggests a need for culturally sensitive AIDS-prevention programs that are linked with alcohol treatment services for men and that are targeted to different acculturation levels for men and women.

Ethnic differences in the association between behavior with a new partner: an event-based analysis.

The relationship of alcohol consumption to risky sexual behavior at the most recent encounter with a new sexual partner in representative samples of white, Hispanic, and black adults was examined. Drinking at the new partner event was more prevalent among whites than either blacks or Hispanics. Multivariate analyses indicated that drinking in the event was an important predictor on having a casual partner and using condoms with a casual partner for men but not for women. For women, drinking during the event predicted failure to use a condom. Some of these associations were dependent on ethnicity. Hispanics who consumed alcohol at the encounter were more likely to engage in protected sex than whites or blacks. These findings suggest that alcohol is but one of many influences regulating the riskiness of a particular encounter with a new partner and that the interplay of personal, situational, and behavioral factors with risky sex are culturally dependent.

Alcohol, sexual practices, and risk of AIDS among blacks, Hispanics, and whites.

The association of alcohol consumption and unsafe sexual behavior known to increase the risk of HIV transmission was examined among blacks, Hispanics, and whites. Data were obtained from a 1990 general population survey on alcohol use that included questions on sexual behavior. Analyses examined sex and ethnic differences in patterns of sexual behavior and the influence of demographic factors and alcohol use on risky sexual behavior. Patterns of sexual behavior differed by ethnicity and sex, with black and Hispanic men reporting more frequent sexual intercourse and a greater number of sexual partners. Women who were single and heavier drinkers with a longer history of sexual activity and of Hispanic origin were more likely to engage in risky sexual behavior. Men who were younger, single, heavier drinkers, and less religious were more likely to engage in unsafe sex, with black men being most at risk. The association of alcohol with unsafe sexual behavior implies that combining AIDS education with interventions that aim at reducing levels of alcohol use might lead to more effective AIDS prevention programs among high-risk populations.

Early life experiences and residential stability: a ten-year perspective on sheltered care.

The effects of early family losses and disruptions on the ability of seriously mentally disabled individuals to achieve stable living arrangements were investigated. Factors found to predict instability were early losses, early disruptions, psychological symptoms, and youth. Among factors found to predict stability were increased age and a diagnosis of schizophrenia.

'Unstandard' ways of answering standard questions: protocol analysis in alcohol survey research.

The purpose of this paper is to discuss the history and development of protocol analysis as a useful approach for survey research in the alcohol field, and to describe the results of a pilot study which used protocol analysis to assess the recall strategies used for four standard alcohol questions commonly used in surveys. Twenty-nine subjects were interviewed and asked to think aloud their responses to four alcohol items: frequency of drinking, average quantity, frequency of drinking over 5 drinks, and frequency of drunkenness. Results indicate that respondents most often used anchoring and adjustment and context strategies to arrive at their answers. Suggestions for facilitating the use of specific strategies during an interview are given.