Online Program

Behavioral versus biological outcomes on sexual risk: A comparison of intervention effect sizes

Wednesday, November 6, 2013 : 1:10 p.m. - 1:30 p.m.

Ofer Harel, PhD, University of Connecticut, Storrs, CT
Tania B. Huedo-Medina, PhD, Statistics & Allied Health Sciences, University of Connecticut, Storrs, CT
Michael Sagherian, University of Connecticut, Storrs, CT
Jennifer Pellowski, Department of Psychology, University of Connecticut, Storrs, CT
Seth C. Kalichman, PhD, Department of Psychology, University of Connecticut, Storrs, CT
Michael Carey, PhD, Department of Psychiatry and Human Behavior, Brown University, Providence, RI
BACKGROUND: Sexual risk-behavior measures can be biological using laboratory assays or behavioral using self-report. Accurate assessment of sexual risk behavior is necessary to make a correct evaluation of sexually transmitted interventions (STIs). The main goal of this work is to compare biological and behavioral outcomes in behavioral interventions of STI/HIV studies. METHODS: Datasets from two published comprehensive meta-analyses were supplemented by additional Diffusion of Effective Behavioral Interventions (DEBIs). Studies were located using the reference section of the two meta-analyses and the Centers for Disease Control and Prevention (CDC). Fifty-seven studies with 276 separate interventions were included. Weighted effect sizes for biological measures, STIs, including or not HIV, and behavioral measure (self-report) for condom use were calculated under random-effects assumptions. Finally, specificity and sensitivity of the behavioral measure were obtained. Positive effect sizes indicated increased condom use and fewer incident STIs, including HIV. RESULTS. Only 35% of the interventions had an increase of condom use with an equivalent reduction in STI and HIV incidences. However, the self-report had a specificity of 73%. This pattern was similar regardless the biological measure and it was more pronounced when the self-report was related to casual sex. CONCLUSIONS. Self-report lacks the power to detect positive effects of behavioral interventions that are captured by a biological test. However, both biological and behavioral test's agreement increases when the intervention effects are negative. Consideration should be given to the increased use of biological measures or elaborate more sensitive self-reports because it could improve the evaluation of behavioral interventions.

Learning Areas:

Biostatistics, economics

Learning Objectives:
Identify agreement between biological and self report measures.

Keyword(s): Biostatistics, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the PI of federally funded grant focusing on missing data in HIV prevention. Th eagreement between behavioral and biological measures are of great interest to me.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.