Kerstin E. E. Schroder

Methodological challenges in research on sexual risk behavior: II. Accuracy of self-reports.

Assessing sexual behavior with self-report is essential to research on a variety of health topics, including pregnancy and infertility, sexually transmitted infections, and sexual health and functioning. Recent methodological research has provided new insights regarding the accuracy of self-reports of sexual behavior. We review these studies, paying particular attention to a promising new development: the use of computer-assisted assessments. The collection of sexual risk behavior data with computers has increased dramatically in recent years, but little is known about the accuracy of such assessments. We summarize the evidence, discuss methodological issues that arise in studies evaluating the accuracy of self-reports, and offer recommendations for future research.

Money doesn't talk, it swears: how economic stress and resistance resources impact inner-city women's depressive mood.

We examined the differential impact of chronic versus acute economic stress on depressive mood among a sample of 1241 low-income, single, European and African American women. Based on Hobfolls (1988, 1989) conservation of resources (COR) theory, we predicted that acute resource loss would be more distressing than chronic economic lack. That is, although chronically impoverished conditions are stressful, the attendant resource losses created will be more distressing. We further predicted that mastery and social support would be more beneficial in offsetting the negative consequences of acute resource loss than the negative consequences of chronic economic lack, because acute loss creates identifiable demands that resources may address. Hence, we hypothesized that mastery and social support would show stress buffering effects only for material loss, not chronic lack. The findings generally supported the hypotheses, but mastery buffered only European American womens resource loss and social support buffered only African American womens resource loss. The findings are discussed in light of implications for prevention within theoretical and cultural contexts.

Methodological challenges in research on sexual risk behavior: I. Item content, scaling, and data analytical options

Investigation of sexual behavior involves many challenges, including how to assess sexual behavior and how to analyze the resulting data. Sexual behavior can be assessed using absolute frequency measures (also known as counts) or with relative frequency measures (e.g., rating scales that range from never to always). We discuss these 2 assessment approaches in the context of research on HIV risk behavior. We conclude that these 2 approaches yield nonredundant information and, more important, that only data yielding information about the absolute frequency of risk behavior have the potential to serve as valid indicators of HIV contraction risk. However, analyses of count data may be challenging because of non-normal distributions with many outliers. Therefore, we identify new and powerful data analytical solutions that have been developed recently to analyze count data and discuss limitations of’acommonly appliedmethod(viz., analysis of covariance using baseline scores as covariates).

Reducing HIV-risk behavior among adults receiving outpatient psychiatric treatment: results from a randomized controlled trial.

This study investigated the efficacy of a 10-session, HIV-risk-reduction intervention with 221 women and 187 men receiving outpatient psychiatric care for a mental illness. Patients were randomly assigned to the HIV intervention, a structurally equivalent substance use reduction (SUR) intervention, or standard care; they were assessed pre- and postintervention and at 3- and 6-month follow-ups. Patients receiving the HIV-risk-reduction intervention reported less unprotected sex, fewer casual sex partners, fewer new sexually transmitted infections, more safer sex communications, improved HIV knowledge, more positive condom attitudes, stronger condom use intentions, and improved behavioral skills relative to patients in the SUR and control conditions. Patients receiving the SUR intervention reported fewer total and casual sex partners compared with control patients. Exploratory analyses suggested that female patients and patients diagnosed with a major depressive disorder were more likely to benefit from the HIV-risk-reduction intervention.

HIV risk behavior among psychiatric outpatients: association with psychiatric disorder, substance use disorder, and gender.

People living with a mental illness are disproportionately vulnerable to human immunodeficiency virus. The current study sought to examine the influence of psychiatric disorder, substance use disorder, and gender on risky sexual behavior in this vulnerable population. Participants were 228 female and 202 male outpatients (66% mood disorder, 34% schizophrenia), each of whom took part in a Structured Clinical Interview for the DSM-IV and a comprehensive assessment of sexual risk behavior. Univariate and multivariate analyses tested a priori hypotheses. The results indicated that risk behavior was more frequent among patients diagnosed with a mood disorder (compared with those diagnosed with schizophrenia) or a substance use disorder (compared with those without a comorbid disorder) or both. We recommend routine human immunodeficiency virus risk screening and risk reduction programs for this vulnerable population.

Effects of anonymity, gender, and erotophilia on the quality of data obtained from self-reports of socially sensitive behaviors.

This study examined the effects of anonymity, gender, and erotophilia on the quality of self-reports of socially sensitive health-related behaviors. A sample of 155 male and 203 female undergraduate students was randomly assigned to an anonymous and a confidential (i.e., nonanonymous) assessment condition. Gender, erotophilia, self-reports (of substance use, sexual behaviors, illegal activity), and perceived item threat were assessed by questionnaire. Data quality was strongly affected by experimental condition and gender. Thus, terminations were more frequent in the confidential condition and among women. In the confidential condition, women were significantly more likely to “prefer not to respond” to sensitive items compared to men. Both female gender and confidential condition were associated with lower frequency reports of sensitive health behaviors, and greater perceived threat of the assessment questions. Self-reported engagement in sensitive behaviors was positively related to both perceived question threat and erotophilia. Path analyses suggest that question threat mediates the effects of anonymity manipulations and gender on data quality (item refusal, termination), and that erotophilia mediates the effects of gender on incidence and frequency self-reports. The results indicate that anonymous assessments as well as male gender are associated with better data quality.

Coping as a mediator in recovery from cardiac surgery

Abstract Recovery from surgery can be facilitated by adaptive coping or it can be inhibited by maladaptive coping. Coping itself can be influenced by personal and social coping resources. Within a longitudinal design, 174 patients undergoing coronary artery bypass graft (CABG) surgery were surveyed before the event and interviewed afterwards. Presurgical personal and social resources, such as optimistic self-beliefs and social support, were examined along with social and ruminative ways of coping in terms of a variety of recovery outcomes. Wony, emotional states, mental activity, and physical activity were chosen as indicators of recovery. It was found that personal and social resources predicted recovery and that coping mediated presurgery resources and postsurgery readjustment. Covariance structure analysis revealed that seeking social support was an adaptive way of coping. It was positively associated with perceived self-efficacy and with recovery indicators, whereas rumination was negatively associate...

Proximal and Distal Predictors of AIDS Risk Behaviors among Inner-city African American and European American Women:

AIDS risk behavior and attitudes towards safer sex were studied in a sample of 666 African American and 626 European American women. Condom use, AIDS-related knowledge, risk perception, self-efficacy beliefs, attitudes and perceived partner attitudes, and an assertive coping style were analyzed with regard to mean differences and predictive power in both ethnic groups. Compared to European American women, African American women had less knowledge and lower self-efficacy beliefs towards safer sex behavior, but they perceived themselves to be at more risk and reported greater condom use. Further, ethnicity was found to moderate the effects of the psychological predictors on safer sex behavior. This moderator effect was tested using a structural equation modeling design. In both groups, risk perception was the strongest predictor of condom use. Among African American women, social-cognitive barriers (e.g. low self-efficacy beliefs, negative attitude towards condom use) worked as a second predictor and mediator of the effects of risk perception on condom use. In contrast, among European American women, social-cognitive factors had no effect on condom use. In general, prediction of safer sex behavior was stronger among African American women.

Coping competence as predictor and moderator of depression among chronic disease patients.

This tested the utility of the “Coping Competence Questionnaire” (CCQ) in predicting depression among chronic disease patients. Coping competence is defined as a dispositional stress resistance factor based on helplessness and hopelessness theory.Predictive power and buffering effects of the CCQ were tested in three patient samples scheduled for Coronary Artery Bypass Surgery (N=272), other heart surgeries (N=109), or lung tumor surgery (N=203). Coping competence, symptom stress, and depression were assessed before and 6-months following surgery. Hierarchical multiple regressions indicated moderator effects of coping competence in the relationship between symptom stress and depression, supporting the stress-buffer hypothesis. Symptom stress was strongly correlated with depression among patients who were low in coping competence only. Among patients high in coping competence, depression was low and unaffected by symptom stress. The results suggest that the 12-item coping competence scale may qualify as useful tool for the prediction of depression in chronic disease populations.

Effects of self-efficacy and social support on postsurgical recovery of heart patients

Coping with stressful life events can be facilitated by personal and social resources, such as perceived self-efficacy and social support. This applies also to the adaptation to surgical stress and...