Rick S. Zimmerman

A Network-Individual-Resource Model for HIV Prevention

HIV is transmitted through dyadic exchanges of individuals linked in transitory or permanent networks of varying sizes. A theoretical perspective that bridges key individual level elements with important network elements can be a complementary foundation for developing and implementing HIV interventions with outcomes that are more sustainable over time and have greater dissemination potential. Toward that end, we introduce a Network-Individual-Resource (NIR) model for HIV prevention that recognizes how exchanges of resources between individuals and their networks underlies and sustains HIV-risk behaviors. Individual behavior change for HIV prevention, then, may be dependent on increasing the supportiveness of that individual’s relevant networks for such change. Among other implications, an NIR model predicts that the success of prevention efforts depends on whether the prevention efforts (1) prompt behavior changes that can be sustained by the resources the individual or their networks possess; (2) meet individual and network needs and are consistent with the individual’s current situation/developmental stage; (3) are trusted and valued; and (4) target high HIV-prevalence networks.

Sensation Seeking and Impulsivity: Combined Associations with Risky Sexual Behavior in a Large Sample of Young Adults

Although prior studies have shown that sensation seeking and impulsive decision-making are related to sexual risk-taking, it is still unclear whether these personality traits operate independently or synergistically. The purpose of this study was to elucidate the joint contribution of these personality traits to HIV and sexually transmitted disease (STD) risk behaviors using data from a large sample of sexually active young adults (N = 2,386). Regression modeling indicated that both sensation seeking and impulsive decision-making were consistently associated with sexual risk behaviors across 11 risk-related outcomes. Results further indicated that sensation seeking and impulsive decision-making operated synergistically with respect to the outcome variables of sex acts using drugs, acts with a partner using alcohol, and acts with a partner using drugs. In contrast to this, sensation seeking and impulsive decision-making operated independently with respect to the other sexual risk outcomes. Theoretical implications, as well as implications for HIV/STD prevention among high sensation seekers and impulsive decision-makers, are discussed.

Non-medical use of prescription drugs, polysubstance use, and mental health in transgender adults

BACKGROUND In recent years, the non-medical use of prescription drugs (NMUPD) has increased dramatically and has been associated with adverse health outcomes. Prior work has not examined this behavior in large samples of transgender adults. METHODS Transgender adults (N=155) recruited from community venues in the Mid-Atlantic region completed anonymous, self-administered surveys assessing demographic information, NMUPD and other substance use, the non-medical use of hormones, psychosocial factors, and psychiatric symptoms. RESULTS Overall, 26.5% of participants reported lifetime NMUPD with the most commonly reported medications used non-medically being prescription analgesics (23.9%), anxiolytics (17.4%), stimulants (13.5%), and sedatives (8.4%). Non-medical use of hormones was also frequently reported (30.3%). Participants reporting NMUPD were also more likely to report the use of illicit drugs. NMUPD, but not the non-medical use of hormones, was associated with lower self-esteem, more gender identity-based discrimination, and more self-reported symptoms of anxiety, depression, and somatic distress. Psychiatric symptoms remained statistically associated with NMUPD after controlling for demographic factors and other substance use. CONCLUSIONS Prescription drug misuse was relatively common in this sample and was robustly associated with emotional distress. Substance use and mental health interventions for this population may benefit from incorporating the assessment and treatment of NMUPD.

Sexual revolution in China: implications for Chinese women and society

Abstract China is undergoing rapid changes in sexual mores due to several reasons such as decreasing control of the state over private lives of individuals, globalization of its economy, and some policies initiated by the state. There is increased acceptance of premarital sex and extramarital sex in China, especially among youth. In historically conservative China, influenced by Confucian ideals of patriarchal dominance for centuries, the sexual freedom currently enjoyed by many is unprecedented. This has impacted womens status and sexual lives in several positive ways such as increasing freedom of sexual expression, control over their bodies, sexual choices, and increasing equality with men in all spheres of life. However several negative consequences such as a rise in STD/HIV prevalence, commercial sex, and divorce rates have also been attributed to the ongoing sexual revolution in China. Recommendations combating these and suggestions for directions in future research are discussed.

In-Depth Investigation of Interpersonal Discussions in Response to a Safer Sex Mass Media Campaign

We know from theory and limited research that people talk about campaign messages—and that these conversations may play an important role in campaign reach and possibly even efficacy. We know very little, however, about what individuals talk about and with whom they talk. The current study seeks to fill this gap by reporting qualitative and descriptive quantitative data from interviews conducted with 139 young adults about conversations that took place in the context of a large, televised safer sex mass media campaign. Results indicated that public service announcements (PSAs) were often viewed in the company of friends and significant others, and that it was not uncommon for conversations about the PSAs to take place. Three broad categories of conversations that took place involved discussions about PSA realism, the seriousness of the message, and humor. While in some cases conversations seemed to advance the goal of the campaign (e.g., participants discussed sexually transmitted disease [STD] risk and condom use), in other cases they did not (e.g., participants discussed the lack of realism in a particular PSA). Implications for campaign theory, design, and implementation are discussed.

Adapting and applying a multiple domain model of condom use to Chinese college students

Abstract This study adapts a multiple domain model (MDM) to explain condom use among a sample of sexually active Chinese college students. A cross-sectional survey was conducted and structural equation modeling was used to test the proposed model. Preparatory behaviors, theory of reasoned action (TRA)/theory of planned behavior variables, impulsivity, length of relationship, and alcohol use were significant direct predictors of condom use. The results suggest that MDM can provide a better understanding of heterosexual condom use among Chinese youth, and help in the design of HIV-preventive and safer sex interventions in China.

Correlates of Precoital Behaviors, Intentions, and Sexual Initiation Among Thai Adolescents

This paper examines the risk and protective factors associated with sexual behaviors among Thai youth ages 13-14 (N=420) living in Bangkok, Thailand. Cross-sectional data were collected using a random sample of households methodology. Three outcomes were assessed: (1) intention to engage in sexual intercourse, (2) pre-coital behaviors, and (3) sexual initiation. Bivariate analysis indicated that parental disapproval of sex, exposure to pornographic media, refusal self-efficacy and having a boyfriend/girlfriend had the strongest relationships with all three outcomes. Multivariate analyses found that parental disapproval of sex and exposure to pornographic media (internet or TV) were significantly associated with all three outcomes. Having a boyfriend or girlfriend was associated with pre-coital behaviors and intentions and sexual refusal self efficacy was correlated with pre-coital behaviors only. The potential competing influences of parent disapproval and exposure to pornographic media on adolescent sexual behaviors should be considered when adapting HIV prevention interventions for Thai youth.

Exemplification of HAART and HIV/AIDS: A News Experiment

Recent data show that the number of deaths from HIV has declined but the disease continues to spread. An emerging line of research suggests that the apparent increase may be due to complacency, whereby faith in medicine encourages risk-taking behavior. This study examines the hypothesis that certain approaches in the news media could disproportionately influence perceptions of treatment success even when paired with statistics. College students and gay men, recruited in the community, were exposed to a fictional news story in which the ratio of four cases of people taking antiretroviral (ARV) medications was varied in two conditions. The story was either consistent with or inconsistent with the success-rate data presented by an alleged medical expert in the story. Participants’ perceptions of ARV success were estimated following exposure to the story. As expected, the personal news stories influenced estimation of ARV success more than the presence of statistical success rate data. Consistent with previous exemplification research, the size of the effect suggests that the stories influenced judgments of the true success rate by roughly 10 to 20%. The effect was moderated by sexual orientation, but not by gender. Exemplification as a journalistic tendency may be one factor that contributes to unrealistic faith in medical advancements. These data suggest that future research should explore in detail the extent and context of HIV/AIDS reporting using exemplification theory with considerations for how reporting might be modified to have less of an effect on increased sexual risk-taking.

The effects of framing and fear on ratings and impact of antimarijuana PSAs.

A laboratory experiment, funded by the U.S. National Institutes of Health, involved 243 U.S. undergraduate students and employed a 2 (gain-framed vs. loss-framed) × 2 (high vs. low threat) plus control group pretest-posttest experimental design to assess the combined effects of frame (gain vs. loss) and level of threat of public service announcements (PSAs) about marijuana on attitudes, beliefs, and intentions related to marijuana, as well as the relationship of message condition to ratings of PSAs. Results suggest that loss-framed messages may lead to greater perceived threat, as well as reactance, and gain-framed messages may lead to a greater reduction in positive attitudes toward marijuana than loss-framed messages. Finally, frame and threat may interact in a complex way. Further research is suggested to replicate these findings. A substantial body of carefully crafted and systematic research studies examining both content and features of messages increasingly informs mass media prevention efforts, including the development of public service announcements (PSAs). Although the significance of messages on commercial broadcast stations may be diminishing with the increasing role and impact of new media, many of the basic questions addressed by this research are likely to apply across media channels. Nonetheless, important questions about what makes a message effective in changing an individuals attitudes or behavior remain to be answered. In this paper, the authors focus on two theoretically derived strategies that offer possibilities for developing persuasive messages: framing and threat.

Reactions to Safer-Sex Public Service Announcement Message Features Attention, Perceptions of Realism, and Cognitive Responses

For this article, we conducted a qualitative investigation of participants’ reactions to five televised public service announcements (PSAs) that were aired as part of a large safer-sex mass media campaign to increase condom use among young adults. We conducted qualitative interviews (N = 139) to determine which features of PSAs participants thought were most effective in terms of attention and recall, perceived realism of characters and situations, and cognitive responses. Our analysis of the results highlights the importance of high-sensation-value messages for gaining attention as well as the critical role of personal relevance for enhancing perceptions of realism. Cognitive responses to PSAs were mostly positive, but there was evidence of third-person effects. That is, many participants indicated that the safer-sex messages were important for other people but not for themselves. We discuss the implications of our results for designing PSAs that are attention-catching, realistic, and persuasive.