Browsing by Author "Lewis, Melissa"
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Item ASSESSING REPRODUCTIVE INTERCONCEPTION CARE BEHAVIORS, BARRIERS, AND FACILITATORS AMONG WOMEN RECENTLY PREGNANT AND HOMELESS(2022-08) Galvin, Annalynn M.; Thompson, Erika; Lewis, Melissa; Walters, Scott T.Interconception care, care provided to mothers between pregnancies, reduces short birth interval risks such as prematurity and low birthweight. Women experiencing homelessness have higher rates of unintended pregnancy and may experience stronger benefits from reproductive interconception care through either unintended pregnancy reductions or healthy pregnancy promotion via family planning. It is critical to build on limited research on interconception care within this population to potentially reduce poverty and cyclical, intergenerational homelessness. By utilizing a sequential explanatory mixed-methods design, this proposed study aimed to first determine prevalence ratios of interconception behaviors such as attendance of maternal postpartum visits, birth spacing and family planning counseling, and postpartum contraception outcomes of women experiencing homelessness, then identify the most salient interconception barriers and facilitators related to interconception information (e.g., knowledge), motivation (e.g., personal attitudes), and behavioral skills (e.g., perceived self-efficacy) among postpartum women who experienced homelessness during pregnancy. Using the 2016-2019 Pregnancy Risk Assessment and Monitoring System, the prevalence of interconception care behaviors among women experiencing homelessness and the associations between housing status and interconception care behaviors were estimated. The sample (n=100,706) was primarily non-Hispanic White (59.4%), married (61.9%) women with private insurance (59.4%) and less than a 4-year degree (63.0%). Approximately 2.4% of participants experienced housing instability in the 12 months before their child was born. Perinatal housing instability was significantly associated with lower odds of attending a postpartum maternal visit (aOR=0.45, 95% CI 0.37, 0.56) and (aOR=1.30, 95% CI 1.07, 1.57) when compared to women who did not experience homelessness in the last 12 months from the time of the interview. Findings from aim 1 determined specific interconception care behavior deficits to further explore via one-hour semi-structured interviews with 12 women experiencing homelessness while pregnant who had given birth within the last four years. Eligible women were recruited through local agency partnerships using purposive sampling. Interviews were audio-recorded, coded to consensus, and analyzed for themes. Information-related themes included knowledge and misconceptions about perinatal processes (e.g., pregnancy, labor and delivery, becoming pregnant, preventing pregnancy) as well as information-seeking themes. Motivation-related themes included attitudes about recent interconception care experiences, perinatal social influences, perceived susceptibility to future pregnancy, and attitudes regarding reasons for not engaging in postpartum pregnancy prevention. Behavioral skill-related themes included objective ability to engage in perinatal behaviors during housing instability, as well as perceived self-efficacy related to barriers and facilitators to engaging in reproductive interconception pregnancies as well as ease of pregnancy. Macro-related themes included housing effects on perinatal period, how perinatal experiences affected seeking stable housing, and how the interconnected nature of housing and other macro-level factors influenced reproductive interconception care. These findings establish a baseline understanding of interconception behaviors and the associated barriers and facilitators related to interconception care information, motivation, and behavioral skills among women experiencing homelessness. Findings may potentially strengthen current interconception practices and augment reductions in unintended pregnancy, short birth intervals, or adverse birth outcomes in future pregnancies, thus improving pregnancy outcomes and improving the health of women before, during, and after pregnancy.Item DOES BIOLOGICAL SEX MODERATE ASSOCIATIONS BETWEEN POSITIVE/NEGATIVE AFFECT AND SIMULTANEOUS/CONCURRENT ALCOHOL AND MARIJUANA USE?(2021) LoParco, Cassidy; Zhou, Zhengyang; Seamster, Morgan; Litt, Dana M.; Lewis, MelissaPurpose. Using both alcohol and marijuana is risky, particularly when using both with overlapping effects. However, it is unclear how positive and negative affect are associated with simultaneous alcohol and marijuana use (SAM; using both with overlapping effect) and concurrent alcohol and marijuana use (CAM; defined in this study as using both substances in the past month without overlapping effect), and what role sex plays in these associations. Methods. Baseline data among past-year alcohol or marijuana users age 15–25 (N=417; mean age 21.2 (SD=2.7); 63.8% female) were used from a larger study. A logistic and an ordinal logistic regression model examined if sex moderated associations between positive/negative affect and past-month 1) CAM (yes/no) and 2) SAM use (ordinal categorical variable measuring occasions), respectively. Models controlled for age, sex, race, and ethnicity due to prior associations with outcomes. Results. Although the main effects of positive and negative affect were not associated with CAM or SAM use, the interactions suggest that with each increased unit of negative affect, males had a 7% (OR=1.07, 95% CI: 1.01–1.17) and 9% (OR=1.09, 95% CI: 1.01–1.17) higher odds of using CAM and higher level of SAM use, respectively. Females with higher levels of negative affect did not have higher odds of CAM or SAM use. Conclusions. Interventions aiming to decrease SAM/CAM use could target males who are experiencing high levels of negative affect. Future studies utilizing longitudinal data are needed to assess if causal associations between positive/negative affect, sex, and SAM/CAM use exist.Item Examination of Pregaming: Associations with Drinking Cognitions, Alcohol Use, and Negative Consequences at the Daily-Level among Adolescents and Young Adults(2024-03-21) Cross, Allison; Zhou, Zhengyang; Fairlie, Anne; Litt, Dana; Lee, Christine; Lewis, MelissaPurpose: While research indicates that adolescents and young adults pregame (i.e., drink before going to an event or gathering), it is unclear how daily-level cognitions relate to pregaming behavior and how pregaming relates to alcohol consumption and consequences. We examined (1) occasion-level associations between drinking cognitions (i.e., willingness, attitudes, injunctive norms) and pregaming among adolescents and young adults, and (2) occasion-level associations between pregaming with quantity of alcohol consumed and negative consequences. We also explored potential moderating effects of age on the above associations as well as the moderating effects of the number of drinks on the association between pregaming and the number of negative consequences on drinking days. Methods: Participants from Texas (age 15-25) were enrolled in a longitudinal ecological momentary assessment (EMA) study employing a 3-week EMA burst format (8 surveys weekly, up to 2 times per day). These bursts were scheduled quarterly over a span of 12 months. Participants who reported any drinking days were included in the present analyses. The final analytic sample included 490 individuals ages 15-25 (53.6% Female, 45.2% White Non-Hispanic, Mean Age = 21.2 SD = 2.7). Data were analyzed with mixed effects multilevel models. Results: Multilevel models revealed that occasion-level drinking cognitions (i.e., occasions with higher willingness to drink and more positive attitudes toward pregaming than one’s usual) were associated with greater likelihood of pregaming (Willingness: odds ratio (OR=1.80) = X, p < 0.0001; attitudes: OR = 1.54, p = 0.0009), whereas injunctive norms were not significantly associated. Compared to drinking days when people did not pregame, pregaming days were associated with consuming more drinks (rate ratio (RR) = 1.79, p < 0.0001). For consequences, the positive association between alcohol use and number of consequences was reduced on pregaming days (p of the interaction term between number of drinks and pregame = 0.04). Age was not a significant moderator in any models tested. Conclusion: This study contributes to the literature by examining occasion-level associations between drinking cognitions with pregaming and the role of pregaming in experiencing negative consequences. These findings can be used to inform individual-level intervention approaches by incorporating risk information about willingness and attitudes and their association with pregaming.Item EXAMININATION OF THE LONGITUDINAL ASSOCATION BETWEEN ALCOHOL-INDUCED BLACKOUTS AND AUDIT SCORES AND THE MODERATING EFFECTS OF IMPULSIVITY AMONG ADOLESCENTS AND YOUNG ADULTS(2024-03-21) Cross, Allison; Graupensperger, Scott; Litt, Dana; Hicks, Haleigh; Lewis, MelissaPurpose: Adolescent and young adult alcohol consumption and related consequences present persistent public health concern and research highlights the role that alcohol-induced blackouts (AIB) may have on the development of alcohol use disorders. Moreover, impulsivity, specifically premeditation and urgency, are noted to have significant associations with drinking. However, less is known about these associations over time among adolescents and young adults. Therefore, this study examined longitudinal associations between AIB and hazardous alcohol use risk (AUDIT scores) in adolescents and young adults, while exploring the moderating effects of premeditation and urgency. Methods: Participants were recruited for a longitudinal ecological momentary assessment (EMA) study examining cognitions and alcohol use. Data were collected at baseline and 12-month follow-up from participants who reported past month alcohol use. The analytic sample consisted of 556 participants (58.6% females; 70.8% White Non-Hispanic, ages 15-25 [mean = 21.5, SD = 2.5]). Data were analyzed using generalized linear models (GLM). Results: Results revealed a significant association between baseline AIB and AUDIT scores at 12-month follow-up such that a one-unit increase in AIB scores was associated with a 12% increase in residual change of AUDIT scores (RR = 1.12, p = .001). Premeditation was inversely associated with AUDIT scores, such that on average, a one-unit increase corresponded to an 8% relative reduction in AUDIT scores (RR = 0.92, p = .032). Finally, urgency was not significantly associated with AUDIT scores (RR = 1.07, p = .053). Premeditation, but not urgency, significantly moderated the effect of AIB on change in AUDIT scores such that for those with relatively higher premeditation scores, a one-unit increase in AIB corresponds to a 22% increase in AUDIT scores (RR = 1.13, p= .009). Conclusion: Findings suggest a significant association between AIB and AUDIT scores one year later, controlling for baseline AUDIT scores. Furthermore, the moderating effect of premeditation suggests that those with higher premeditation who are still engaging in AIB may be doing so with intentions to engage in high-risk drinking. Targeting prevention programs, towards adolescents and young adults with a history of AIB, especially those who with elevated premeditation, may be effective in mitigating the risk of alcohol use disorder development.Item EXAMINING ASSOCIATIONS BETWEEN YOUNG ADULT ANXIETY, DEPRESSION, AND WILLINGNESS TO ENGAGE IN ALCOHOL, MARIJUANA, AND SIMULTANEOUS ALCOHOL AND MARIJUANA USE(2021) Seamster, Morgan; LoParco, Cassidy; Astorga, Angeles; Litt, Dana M.; Lewis, MelissaPurpose: Research indicates that young adults use alcohol and marijuana independently, or simultaneously (SAM; alcohol and marijuana use at the same time so that effects overlap) to cope with emotional distress (i.e., anxiety, depression). Given that behavioral willingness (i.e., openness) can be viewed as a predisposition to behavior, understanding mental health-related factors associated with willingness to engage in different types of substance use (i.e., alcohol, marijuana, SAM) may aid in identifying young adults at risk for harmful substance use. Methods: Participants ages 18-25 (N=363;60.1% female) completed baseline of a larger ecological momentary assessment study. Linear regression analyses controlling for age, gender, and past-month substance use examined associations between depressive and anxious distress and a willingness to engage in alcohol, marijuana, and SAM use. Results: Reports of higher depressive symptoms were associated with more willingness to use alcohol (B= 0.21, t = 2.85, p < .01) and engage in SAM use (B= 0.13, t = 2.25, p < .05). Anxious symptomology was associated with less willingness to use alcohol (B= -0.22, t = -2.99, p < .01), and more willingness to use marijuana (B= 0.15, t = 1.99, p < .05). Conclusions: Findings suggest that depressive and anxious distress are differentially associated with a willingness to engage in different types of substance use, depending on whether alcohol and marijuana are used independently or simultaneously. Therefore, targeted intervention strategies for young adults with depressive or anxious symptoms through early identification of willingness cognitions could prevent harmful substance use.Item Examining Familiarity with Location and People in Association with Protective Behavioral Strategy Use Among Adolescents and Young Adults at the Daily-Level(2023) Cross, Allison; Zhou, Zhengyang; Fairlie, Anne; Litt, Dana M.; Graupensperger, Scott; Lewis, MelissaPurpose: Despite protective behavioral strategies (PBS) often being a central component to alcohol prevention programs, many adolescents and young adults who drink alcohol use few to no PBS. Therefore, it is important to determine factors associated with PBS use. Situational factors such as social and physical environments have shown to influence drinking behavior. In addition, many PBS are often related to peers and location and thus may influence PBS use or nonuse. The study aimed to investigate the associations between situational familiarity (i.e., familiarity with locations and people) and PBS use at the daily level among adolescents and young adults. Method: Participants were recruited in Texas for a longitudinal ecological momentary assessment (EMA) study that involved a 3-week EMA burst design (8 surveys per week; up to 2x/day) with bursts occurring quarterly over 12-months. Participants who reported drinking days and answered PBS items were included in the current analyses. Data: The analytical sample consisted of 3,921 drinking days from 579 participants (55.44% females; 45.12% White, Non-Hispanic; ages 15 to 25 (mean = 21.04)). Data were analyzed with mixed effects zero-inflated Poisson models for each PBS outcome (i.e., serious harm reduction, limiting/stopping, manner of drinking). Results: Within-person results indicated when participants had elevated (i.e., higher than their own average) familiarity with location (e.g., How familiar are you with the locations you were at yesterday?), they were less likely to use harm reduction PBS (RR) = 0.94, p < 0.001) and limiting/stopping PBS (RR = 0.96, p = 0.001). Results showed that on drinking days with elevated familiarity with people (e.g., How familiar are you with the people you were with yesterday?), individuals were more likely to use limiting/stopping PBS (RR = 1.04, p = 0.01). There were no significant daily-level associations between familiarity with people or location and manner of drinking PBS. Conclusion: Results suggest that adolescent and young adult PBS use, particularly serious harm reduction and limiting/stopping PBS, can vary based on familiarity with people and location on a daily level. Alcohol prevention approaches, such as just-in-time intervention strategies, should consider how to increase PBS use even when drinking in more familiar situations or with less familiar people.Item Examining Fear of Missing Out (FoMO) as a Moderator of the Association Between Peak Drinks and Alcohol-Induced Blacking Out(2021) Lowery, Ashley; Zhou, Zhengyang; Astorga, Angeles; Litt, Dana M.; Lewis, MelissaPurpose: Heavy drinking remains a public health concern among adolescents and young adults due to adverse outcomes including blackouts. Moreover, studies have also linked heavy drinking to the Fear of Missing Out (FoMO). Further investigation into the relationship between FoMO and alcohol-induced blackouts is merited. Therefore, this study aims to examine whether FoMO moderates the association between peak alcohol consumption and experiencing alcohol-induced blackouts. Methods: Participants ages 15-25 (N = 233; Mean age = 21.54 (SD = 2.46); 36% male) completed both baseline and daily surveys as part of a larger EMA intervention study Zero-inflated Poisson model was fit to examine the interaction effect between FoMO and peak drinks on self-reported experiences of alcohol-induced blackouts, controlling for relevant covariates (i.e., age, biological sex). Results: Findings indicated the effect of peak alcohol consumption was moderated by FoMO on both the likelihood (log odds ratio = 0.048, p-value = 0.017) and average number (log incidence rate ratio = 0.296, p-value = 0.003) of alcohol-induced blackouts. Specifically, the effect of peak alcohol consumption on alcohol-induced blackouts was stronger for the average number of blackouts but weaker for the likelihood of experiencing any blackouts among those with higher level of FoMO. Conclusions: Findings support previous literature examining FoMO as a risk factor for experiencing alcohol-related harm among adolescents and young adults. Therefore, future research should seek to target FoMO cognitions as an additional way to reduce heavy drinking among adolescents and young adults.Item Examining Willingness and Intentions to Drink Alcohol as Predictors of Protective Behavioral Strategies(2019-03-05) Lowery, Ashley; Leon, Marcela; Galvin, Annalynn; Litt, Dana M.; Lewis, Melissa; LoParco, CassidyPurpose: Willingness and intentions are components of the Prototype Willingness Model (PWM), which predicts adolescent and young adult health-risk behaviors. However, research has yet to examine intentions and willingness as predictors of health-protective behaviors, such as alcohol-related protective behavioral strategies (PBS). PBS are behavioral strategies to reduce the amount of alcohol consumed or risk for negative consequences. Longitudinal and daily-level findings have shown PBS to be associated with alcohol-related consequences. As such, we hypothesized that willingness and intentions to drink any alcohol or engage in heavy-episodic drinking (4+ women, 5+ men) will be associated with subsequent PBS use. Methods: A total of 1,034 participants (mean age 19.5, 45% male) completed longitudinal data as part of a larger experimental study. Linear regressions controlling for age and sex were used to test all models. Results: Study findings indicated that the harm reduction PBS subscale was significantly predicted by intentions of heaviest drinking day (ß = 0.027, t = 2.261, p Conclusions: Willingness and intentions, the primary components of the PWM, were shown to predict the health-protective behaviors of alcohol-related PBS. A targeted intervention among those who are more willing to drink may promote the use of PBS, which in turn may reduce alcohol-related consequences.Item Late Night Social Networking Use and the Associations with Adolescent and Young Adult Sleep Quality, Substance Use, and Anxiety(2019-03-05) LoParco, Cassidy; Galvin, Annalynn; Leon, Marcela; Lewis, Melissa; Litt, Dana M.; Lowery, AshleyPurpose: Research has shown social networking site use to be associated with adolescent and young adult health and risk behavior generally, but less is known about whether late night use is related to health and well-being. The purpose of this study is to examine late night use (between the hours of 11pm and 5am) of specific social networking site platforms (Snapchat, Instagram, Facebook) in relation to sleep quality, substance use (alcohol, marijuana), and anxiety. Methods: Adolescents and young adults ages 15-20 (mean age of 18.39, (SD = 1.32), 47% male) completed a survey from which the current data are drawn as part of a larger experimental study (N=306). Linear regressions were carried out, controlling for age, sex, education status, race, alcohol and marijuana use, and anxiety in all models. Results: Findings indicated that past week late night use of Instagram was associated with fewer hours of sleep at night on average (t = -2.02, p t = 3.44, pt = 2.11, p t = 2.78, p t = -2.12, p all p-values [greater than] .05). Finally, linear regression results indicated that past week late night use of Snapchat was positively associated with past month anxiety (t = 2.102, p Conclusions: Together, these findings contribute to the growing literature supporting the association between social media use and various aspects of well-being in adolescents and young adults. The present findings suggest that late night social networking site use by platform is an important factor that warrants further investigation in the context of adolescent and young adult sleep, substance use, and anxiety. IRB #: 2018-009Item Parent and Teen Feedback on a Prototype of a Novel Parent-Based Intervention for Adolescent Alcohol Use and Social Networking Site Use(2022) Seamster, Morgan; Kannard, Emma; Resendiz, Raul; Walker, Travis; Lewis, Melissa; Litt, Dana M.Purpose: Social networking site (SNS) use has been associated with increased alcohol use and risky health behaviors in adolescents. Previous research has demonstrated the role of parents in mitigating the adverse effects of SNS on alcohol use. As an emerging area of research, digital parent-based interventions (PBIs) may be used to prevent adolescent risk behaviors related to alcohol and SNS. To ensure the efficacy of these interventions, parent and adolescent feedback is essential to optimize user engagement and acceptability. The current investigation aimed to gather parent and teen perspectives on usability and acceptability of a prototype digital PBI, developed in part based on previous focus group findings, for adolescent alcohol use and SNS use. Methods: A total of 29 parents (female = 86.2%, avg. age = 44) and 27 teens (female = 55.6%, avg. age = 16) dyads were recruited from across Texas. Parents and teens attended groups separately and were presented with prototype intervention content, including website modules and video content. Groups were asked to discuss initial reactions to and thoughts about usability (i.e., ease of navigation, layout and design, etc.) and acceptability (i.e., favorability of overall PBI, likelihood of using different features, etc.). Transcripts were reviewed to generate themes and trends in participant feedback across groups. Conclusions and Implications: Both parents and teens reported that dynamic module navigation features, which allow for tailoring of educational content to user interests, appeared highly usable. Participants generally agreed that a feature allowing parents to send video content directly to their teens from the PBI was an important aspect of the program, as it would provide an opportunity for both parents and teens to independently prepare for joint conversations and learning. Both parents and teens emphasized the importance of video narrator relatability including delivery tone, age, gender, and diversity. Participants expressed desire for visually stimulating content based on user learning styles. Lastly, parents reported preferences toward fact-based and research-oriented content, whereas teens preferred intervention content with humor or shock value. Overall, feedback yielded important guidance for optimizing features to improve engagement and user learning. Findings are currently being integrated into the final digital PBI to be tested in an upcoming pilot study.Item Perceived Vulnerability When Drinking: Daily-Level Associations with Alcohol Use and Consequences by Sexual Minority Status Among Adolescent Girls and Young Adult Women(2024-03-21) Vrotsos, Katherine; Graupensperger, Scott; Litt, Dana; Lewis, MelissaPurpose: Although cross-sectional research on perceived vulnerability (i.e., the likelihood of experiencing consequences if the individual were to engage in a behavior) when drinking suggests that greater perceived vulnerability is associated with less alcohol use and fewer alcohol-related consequences between-persons, there has been minimal research and mixed findings on within-person perceived vulnerability to alcohol-related consequences at the daily-level. Women have been found to experience more alcohol-related consequences compared to men, which may relate to their levels of perceived vulnerability. Additionally, sexual minority girls and women appear to be at increased risk for engaging in greater alcohol use and experiencing more alcohol-related consequences compared to heterosexual women, which may exacerbate their perceived vulnerability. The present study aims to (1) examine daily-level associations between perceived vulnerability and alcohol use and consequences among adolescent girls and young adult women and (2) assess whether sexual minority status moderates the association between perceived vulnerability and alcohol use and consequences at the daily-level. Methods: Participants were recruited as part of a longitudinal ecological momentary assessment (EMA) study conducted in Texas. Participants completed up to two surveys each day (eight surveys per week) in 3-week EMA bursts, which were repeated quarterly across the 12-month study. The sample for the current study included 410 cisgender (i.e., gender identity aligns with sex assigned at birth) adolescent girls and young adult women ages 15 to 25 (M= 20.8) who reported drinking days (44.9% White, Non-Hispanic; 39.8% sexual minority). The analytic sample included 3526 drinking days. Planned Analyses: In each multilevel model, daily-level predictors will be centered-within-person and person-level predictors will be grand-mean-centered. Age, race/ethnicity, weekend/weekday, week in burst, and burst number will be used as covariates in all models. Perceived vulnerability will be used as the predictor for (H1a) alcohol use (i.e., number of drinks) estimated with a mixed effects zero-truncated negative binomial model (count outcome starting at 1) and (H1b) the number of alcohol-related consequences estimated with a mixed-effects zero-inflated negative binomial model (count outcome with excessive zeros). Sexual minority status will be used as a moderator within these models (H2). Hypothesized Results: On drinking days when individuals report greater perceived vulnerability than their average, it is predicted that they will engage in less alcohol use (H1a) and experience fewer negative consequences (H1b). The daily-level associations between perceived vulnerability and alcohol use (H2a) and consequences (H2b) are predicted to be stronger among sexual minority individuals compared to heterosexual individuals. Potential Conclusion: The findings of this study have the potential to increase our understanding of how perceived vulnerability at the daily-level influences drinking among adolescent girls and young adult women, as well as differences based on sexual minority status. These findings could potentially improve the precision and efficacy of in-the-moment preventative interventions by identifying when girls and women are at increased risk of experiencing alcohol-related harm. Furthermore, these findings may inform the need to tailor in-the-moment interventions to target sexual minority girls and women.Item Sexarche and Its Association to Future Contraceptive Use(2020) Lewis, Melissa; Litt, Dana M.; Smith, MadisonThis study examined the association of sexarche with perceived descriptive norms for condom use, and willingness to have sex without the use of condoms or dental dams. Data on sexarche, perceived descriptive norms for condom use, and willingness to have sex without contraceptives were assessed at baseline among 402 participants from a study examining an intervention to reduce sexual risk taking (Lewis et al., 2018). Controlling for birth sex and current age, linear regressions were used to analyze the association among sexarche, perceived descriptive norms, and willingness to have sex without the use of condoms, or dental dams. The age of oral sexarche was not associated with descriptive norms for using condoms or dental damns during oral sex, t = 0.72, p = .47, β = - .04. However, the younger people were at oral sexarche, the more willing they were currently to have oral sex without a condom or dental dam, t = -2.94, p < .01, β = - .13. Penile-vaginal sexarche is associated with descriptive norms for using condoms, t = -2.56, p < .05, β = - .13, such that the younger people were penile-vaginal sexarche, the more they perceive others to use condoms during sex. The younger people were at penile-vaginal sexarche, the more willing they were to not use a condom, t = -2.51, p < .05, β = - .12. This study is useful in understanding sexarche as a factor in sexual risk-taking cognitions and suggests interventions to reduce risky cognitions before sexarche.Item Testing Impulsivity and Sex as Moderators of the Association Between Young Adult Alcohol-Related Sexual Willingness and Behavior(2020) Litt, Dana M.; Lewis, Melissa; Zhou, Zhengyang; LoParco, CassidyBackground: Young adult alcohol use is a public health concern due to both high prevalence and associations with negative consequences and related health-risk behaviors, such as risky sex. Research indicates individual differences such as impulsivity may be related to young adult health-risk behaviors and may differ based on biological sex. Purpose: This study examined longitudinal associations between willingness at baseline (i.e., openness to engaging in a behavior) and engaging in alcohol-related sexual behaviors (number of times consuming alcohol before or during sex and number of drinks consumed before or during sex) among young adults and tested impulsivity subscales (urgency, lack of premeditation, and sensation seeking) as moderators of the associations between willingness and alcohol-related sexual behaviors. Additional three-way interactions examining biological sex as a moderator of the associations between impulsivity and willingness were also conducted. Methods: Participants were young adults (N = 402; mean age 22.44) who participated in a longitudinal survey (baseline and 6-month follow-up) as part of a larger randomized controlled trial. Poisson regressions were conducted for both outcomes. Results: Findings indicate there were significant three-way interactions between willingness, biological sex, and urgency for both outcomes. The interaction between willingness, biological sex, and sensation seeking was also significantly associated with the number of times an individual drank before having sex. Conclusions: Findings indicate tailored interventions may be created for those with high impulsivity levels as well as based on biological sex to decrease risky sexual behaviors before or while driving.