Expectancies specific to condom use mediate the alcohol and sexual risk relationship - Statistical Data Included

Journal of Sex Research, May, 2002 by Joseph W. LaBrie, Jason Schiffman, Mitchell Earleywine

Young adults are one of the fastest growing groups of new cases of HIV\AIDS and other STDs in the United States (Wasserheit, 1997). Yet they continue to engage in high-risk sexual activities, such as failing to use a condom during sexual intercourse (Diclemente, 2000). Since AIDS and other STDs are primarily transmitted by sexual activity, research has examined correlates of this activity to decrease sexual risk-taking. Drinking is one correlate of sexual activity that has received much attention.

A well-established relationship between drinking and sexual activity exists in both popular culture and research. Alcohol use is related to earlier and increased incidences of sexual behavior, greater numbers of sexual partners, and greater intentions to engage in sex (Crowe & George, 1989; Epstein, Dusenbury, Botvin, & Diaz, 1994; Temple & Leigh, 1992). In addition, drinking may contribute to risky sexual behavior. Public AIDS prevention campaigns have directly targeted this proposed relationship. Alcohol use may increase the likelihood of HIV and other STD infections by decreasing the likelihood of using a condom during sex. This proposed effect of drinking is called the transmission hypothesis (Dingle & Oei, 1997).

Evidence for the transmission hypothesis was found in several studies that revealed associations between alcohol use and sexual risk-taking (e.g., Graves, 1995; Leigh & Stall 1992; McEwan, McCallum, Bhopal, & Madhok, 1992; Meilman, 1993). However, a similar association was not revealed in all studies (e.g., Gold & Skinner, 1993; Leigh, Temple, & Trocki, 1994; Weatherburn, Davies, Hickson, & Hunt, 1993). Two recent reviews of studies examining the proposed alcohol and risky sex link (Dingle & Oei, 1997; Halpern-Felsher, Millstein, & Ellen, 1996) confirmed that while there is partial support for the transmission hypothesis in the literature, it is not universal. Dingle & Oei described the findings as equivocal. Given this conflicting and equivocal evidence, researchers have focused on potential mediators that might help explain the relationship between alcohol use and risky sex. Understanding mechanisms through which alcohol adversely affects safer-sex intentions and behaviors is important for reducing risk of contracting HIV and other STDs.

Expectancy Theory and Safer Sex Models

Following the Theory of Reasoned Action (Ajzen, 1971) and the Theory of Planned Behavior (Ajzen, 1991), sex researchers have predicted condom intention as a way of determining sexual risk (e.g., Corby, Schneider-Jamner, & Wolitski, 1996; Morrison, Gillmore, & Baker, 1995; Sneed & Morisky, 1998). These theories propose that behavior is a direct result of behavioral intentions. Consistent with the theories, condom intention has been found to be a good predictor of prospective safer sex behaviors (Sheeran & Orbell, 1998). Both theories incorporate the concept of anticipated outcomes of risk-reducing behavior under their concept of attitudes, which in turn predict intentions. Other models also utilize expected outcomes. Social cognitive theory (Bandura, 1986) proposes that health-protective behavior results from a process of cognitive appraisal integrating knowledge, outcome expectancies associated with adopting risk-reduction behavior, and social influences.

The focus on outcome expectancies in models of sexual risk behavior seems particularly pertinent when examining the drinking and risky sex link given the growing interest in cognitive processes and interventions, as well as the large alcohol expectancy literature (e.g., Goldman, 1994). Tolman (1932) first introduced the expectancy concept in learning theory. Later work by Bolles (1979) and Kirsch (1985) proposed that expectancies were cognitive variables that represented information about the relationship of a response to a stimulus outcome or between a stimulus event and a subsequent response. The activation of expectancies can directly initiate a behavioral sequence previously associated with the recognized stimulus (Goldman, Del Boca, & Darkes, 1999). Expectancy theory proposes that expectancies influence almost all behavior. Thus, they can be applied to drinking and drinking-induced behavior. In alcohol research, expectancies are beliefs about the anticipated (expected) effects alcohol will have in a future situation (Roehrich & Kinder, 1991). Most of the research on expectancies has attempted to show how positive general expectancies predict drinking patterns (e.g., Marlatt & Gordon, 1985). Less attention, however, has been paid to the important possibility that alcohol expectancies may influence post-drinking behavior.

Expectancies as a Mediator of Alcohol's Relationship to Subsequent Behavior

Baron and Kenny (1986) claimed that internal cognitive processes mediate the effects of external stimuli (such as alcohol) on behavior. Mediators help explain the internal psychological processes of how or why effects occur. Expectancies are one such internal cognitive process. The possibility that post-drinking behaviors could be driven by alcohol expectancies independent of pharmacological effects was suggested by a series of placebo-type studies (Marlatt & Rohsenow, 1980).