Gender moderates the relationship between impulsivity and sexual risk-taking in a cocaine-using psychiatric outpatient population
Introduction
Adults who abuse substances make impulsive decisions about sexual partnerships (Johnson & Bruner, 2012) and engage in high rates of sexual risk behavior that may place them at increased risk for sexually transmitted infections, including HIV (Booth et al., 2000, Centers for Disease Control and Prevention, 2013, Leigh and Stall, 1993). Studies involving substance-using adults have demonstrated that impulsivity (measured variably by self-report questionnaires) is positively related to sexual risk-taking. Across studies, men and women who used substances and had more impulsive tendencies reported having more sexual partners, higher rates of sex without a condom, more frequent engagement in sex for trade, generally increased sexual risk-taking (Black et al., 2009, Hayaki et al., 2006, Lejuez et al., 2005, Lejuez et al., 2004, Reimers et al., 2009, Trobst et al., 2002), and a preference for immediate, riskier sexual opportunities over delayed but safer (condom-protected) alternatives (Johnson & Bruner, 2012). No gender-related differences in the association between impulsivity and sexual risk behavior were reported in those studies.
However, many studies have identified gender-related differences in decision-making about casual sexual encounters, and a predominantly male preference for immediate over delayed sex has been described. For example, in one study men applied less stringent standards than women when rating characteristics of hypothetical short-term sexual partners (Buss & Schmitt, 1993), and were more willing to have sex with a person they had known only a short time. In an experimental task, women considered more criteria when selecting potential short-term partners, and rejected a greater proportion of hypothetical partners than men (Saad, Eba, & Sejean, 2009). In a well-known study conducted on a college campus, spontaneous sexual offers proposed by a stranger of the opposite sex were more likely to be accepted by male than female students (Clark & Hatfield, 1989). Among cocaine-dependent adults, men disproportionately discounted the value of hypothetical delayed, condom-protected sexual opportunities in favor of more immediate, but riskier, sexual offers (Johnson & Bruner, 2013), and college-age men were more likely than women to choose briefer, immediate sexual opportunities over longer but delayed or less probable opportunities (Lawyer, Williams, Prihodova, Rollins, & Lester, 2010). In summary, studies have demonstrated that men were less discriminating than women when choosing short-term sexual partners, and favored immediate over safer sexual offers when given hypothetical choices.
An analysis of national survey data from U.S. adults found that impulsivity was differentially associated with sexual risk behavior for men. In that study, higher scores on self-rated impulsivity predicted lower probability of using a condom with a new sexual partner for men, but not for women (Temple, Leigh, & Schafer, 1993). To determine whether these gender-related differences extend to a clinical population, we tested the hypothesis that the relationship between impulsivity and sexual risk-taking, defined as having a recent casual sexual partner or multiple sexual partners, would be stronger for men than women in a sample of adults in outpatient psychiatric treatment reporting recent cocaine use.
Section snippets
Participants
Data for this study are a subset of pre-intervention data collected for a clinical trial comparing two behavioral interventions targeting cocaine use and sexual risk behavior (clinicaltrials.gov # NCT01327586). Adults recruited for participation were receiving outpatient treatment at state-operated mental health centers, reported any cocaine use in the past 60 days, and received Social security disability payments as their primary income. Recent sexual risk behavior was not an inclusion
Gender-related differences on participant characteristics
Men and women differed significantly on psychiatric diagnoses and age. Men were more likely to have a diagnosis of schizophrenia spectrum disorder (68% and 36%, respectively) and women were more likely than men to have a diagnosis of MDD (28% and 9%, respectively). Women were slightly older than men (Mean = 45 years, SD = 7.6; Mean = 41 years, SD = 9.9, respectively, p = .02). There were no gender differences on years of education, race distribution, probability of having a primary sexual partner, sexual
Discussion
In both models, men whose responses were more impulsive on the IMT were more likely than less impulsive men to report having a casual or multiple sexual partners. Women did not differ from men in measured impulsivity nor in reported sexual partners, but for women, these variables were unrelated.
These results provide support for our hypothesis that impulsivity is a stronger predictor of sexual risk-taking for men than for women, and results are logically consistent with sexual delay discounting
Conclusions
In this study, impulsive responses on a continuous performance task were independently associated with two sexual risk-taking outcomes for men, but not for women. Future studies should further examine the relationship between behavioral impulsivity and sexual risk behavior to determine whether interventions targeting more general impulsivity in decision-making tasks might reduce harm related to sexual risk-taking for men.
Acknowledgment
This research was supported in part by NIH Grants DA012952 (Rosen) and P20 DA027844 (Potenza).
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