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Evan S. Herrmann1, Patrick S. Johnson2, and Matthew W. Johnson3
1Division on Substance Abuse, New York State Psychiatric Institute,
Columbia University College of Physicians and Surgeons
2Department of Psychology, California State University, Chico
3Behavioral Pharmacology Research Unit, Department of Psychiatry and
Behavioral Sciences, Johns Hopkins University School of Medicine.
In an article recently published in BMJ Open, Eleftheriou et al
(2016) describe the results of an experimental study that examined the
influence of partner attractiveness on condom use intentions. Heterosexual
men completed a task where they rated the attractiveness of 20 photographs
of women, estimated the likelihood each woman had a sexually transmitted
infection (STI), and indicated their willingness to have sex with each
woman with or without a condom. Higher ratings of attractiveness and lower
ratings of STI risk were associated with lower condom use intentions.
Participant sociodemographic and sexual history characteristics associated
with STI acquisition were also associated with lower condom use
intentions. Increasing our understanding of factors that affect choices
about condom use has the potential to greatly improve public health, and
we commend the authors on their contribution. Here we draw attention to a
body of published work using a measures that have shown similar effects of
attractiveness and STI risk, but also reveal another important dimension
modulating condom use decisions: delay to condom availability.
Johnson and Bruner (2012) developed the Sexual Delay Discounting Task
(SDDT) to examine how sexual desirability, perceived STI risk, and delayed
condom availability influence decisions about condom use. On the most
commonly used version of this task, individuals view pictures of 30 men
and 30 women and select pictures of the individuals whom they would
consider having sex based on appearance alone. From these photographs,
participants select the individual they most wanted to have sex with,
least wanted to have sex with, they think is least likely to have an STI,
and most likely to have an STI. Then, they rate their likelihood of using
an immediately available condom when having sex with each individual,
using a Visual Analog Scale ranging from 0 to 100. Next, they rate their
likelihood having immediate unprotected sex vs. waiting for a specified
delay to have condom-protected sex with each individual. Seven delays are
examined, allowing for quantification of how delayed condom availability
influences choices about condom use with partners who have different
perceived levels of desirability and STI risk.
We are aware of 12 studies using the SDDT that are currently
published, in press, or under peer review. Across a variety of
populations, including cocaine users (Johnson et al., 2015, 2016,
Koffarnus et al., in press) men who have sex with men (Herrmann et al.,
2015), opioid-dependent women (Herrmann et al., 2014), non-drug-using
controls (e.g., Herrmann et al., 2015, Johnson et al., 2015), and emerging
adults (Collado et al., in press; Dariotis and Johnson, 2015; Wongsomboon
and Robles, 2016), participants reliably indicated they would be less
likely to use immediately available condoms with those whom they most (vs.
least) want to have sex and those they thought were least likely (vs. most
likely) to have a STI. Individuals who reported higher rates of real-world
risky sexual behavior and/or sociodemographic characteristics associated
with STI risk also reported lower likelihood of using immediately
available condoms on the SDDT. Condom use likelihood decreased as a
function of delay to condom availability in an orderly manner well-fit by
hyperbolic discounting functions that also describe the effects of delay
on choices for other commodities (e.g., food or money). The SDDT has
demonstrated test-retest reliability (Johnson and Bruner, 2013), and
participants at higher risk for STI infection (e.g., individuals who
report drug use or unprotected sex with multiple partners) showed larger
decreases in condom use likelihood as a function of delay. One study
(Herrmann et al., 2015) demonstrated that steeper discounting on the SDDT
was associated with increased likelihood of having unprotected sex in the
past six months specifically because a condom was not immediately
available, suggesting the task has external validity. Lastly, the SDDT is
sensitive to acute drug effects; alcohol and cocaine intoxication
increased the deleterious effects of delay on condom use likelihood
(Johnson et al., 2016, Johnson et al., under review), while the
antipsychotic buspirone increased immediate condom use likelihood (Bolin
et al., 2016).
We commend Eleftheriou et al (2016) on their contribution to the
literature, and note that the consistencies between their results and our
own provide further evidence supporting the validity of behavioral tasks
to study condom use decisions. Finally, as Eleftheriou et al (2016)
stated, we hope that the knowledge gained from these studies can inform
the development of new evidence-based interventions to reduce STI
Bolin, B. L., Lile, J. A., Marks, K. R., Beckmann, J. S., Rush, C.
R., & Stoops, W. W. (2016). Buspirone reduces sexual risk-taking
intent but not cocaine self-administration. Experimental and Clinical
Psychopharmacology, 24, 162.
Collado A., Johnson, P. S., Loya, J. M., Johnson, M. W., & Yi, R.
(in press). Discounting of Condom-Protected Sex as a Measure of High-Risk
for Sexually Transmitted Infection among College Students. Archives of
Dariotis, J. K., & Johnson, M. W. (2015). Sexual discounting
among high-risk youth ages 18-24: Implications for sexual and substance
use risk behaviors. Experimental and Clinical Psychopharmacology, 23, 49.
Eleftheriou, A., Bullock, S., Graham, C. A., Stone, N., Ingham, R.
(2016). Does attractiveness influence condom use intentions in
heterosexual men? An experimental study. Sexual Health Research.
Herrmann, E. S., Hand, D. J., Johnson, M. W., Badger, G. J., &
Heil, S. H. (2014). Examining delay discounting of condom-protected sex
among opioid-dependent women and non-drug-using control women. Drug and
Alcohol Dependence, 144, 53-60.
Herrmann, E. S., Johnson, P. S., & Johnson, M. W. (2015).
Examining delay discounting of condom-protected sex among men who have sex
with men using crowdsourcing technology. AIDS and Behavior, 19, 1655-1665.
Johnson, M. W., & Bruner, N. R. (2012). The Sexual Discounting
Task: HIV risk behavior and the discounting of delayed sexual rewards in
cocaine dependence. Drug and Alcohol Dependence, 123, 15-21.
Johnson, M. W., & Bruner, N. R. (2013). Test-retest reliability
and gender differences in the sexual discounting task among cocaine-
dependent individuals. Experimental and Clinical Psychopharmacology, 21,
Johnson, M. W., Herrmann, E. S., Johnson, P. S., Sweeney, M. M.,
& LeComte, R. S. (under review). Cracking the code of cocaine and HIV
sexual risk behavior: Cocaine administration dose-dependently increases
sexual desire and decreases condom use likelihood via delay and
Johnson, M. W., Johnson, P. S., Herrmann, E. S., & Sweeney, M. M.
(2015). Delay and probability discounting of sexual and monetary outcomes
in individuals with cocaine use disorders and matched controls. PloS one,
Johnson, P. S., Sweeney, M. M., Herrmann, E. S., & Johnson, M. W.
(2016). Alcohol increases delay and probability discounting of condom-
protected Sex: A novel vector for alcohol-related HIV transmission.
Alcoholism: Clinical and Experimental Research, 40, 1339-1350.
Koffarnus, M. N., Johnson, M. W., Thompson-Lake, D. G. Y., Wesley, M.
J., Lohrenz, T., Montague, R., & Bickel, W. K. (in press). Cocaine-
dependent adults and recreational cocaine users are more likely than
controls to choose immediate unsafe sex over delayed safer sex.
Experimental and Clinical Psychopharmacology.
Wongsomboon, V., & Robles, E. (2016). Devaluation of safe sex by
delay or uncertainty: A within-subjects study of mechanisms underlying
sexual risk behavior. Archives of Sexual Behavior, 1-14.