Anne Markey Bowen

Interests

Research

Senior AthletesCondom use as HIV preventionAcceptance and Commitment TherapyAvatars and Virtual Worlds for delivering psychotherapy interventions

Teaching

Undergraduate: Mechanisms of Learning, Health Psychology, Psychology of Chronic Illness, Applied Behavior AnalysisGraduate: Psychotherapy, Child Psychotherapy, Research in Psychotherapy, Behavioral Medicine, Integrated Primary Care.

Courses

Scholarly Contributions

Chapters

• Moring, J., Page, T., Bowen, A. M., & Angiola, J. (2014). HIV prevention and treatment issues in rural America: A focus on regional differences. In Rural Public Health: Best Practices and Preventive Models(pp 169-186). New York: Springer Publishing.
• Sarah, C., Candice, D., & Bowen, A. M. (2008). The Internet: The New Frontier in HIV Prevention. In Communication Perspectives on HIV/AIDS for the 21st Century. New York: Lawrence Erlbaum Associates.

Journals/Publications

• Bowen, A. M. (2016). New Nurse Practitioners’ Perceptions of Preparedness for and Transition Into Practice. The Journal for Nurse Practitioners, 12(8), 545-552. doi:org/10.1016/j.nurpra.2016.04.018
• Moring, J., Bowen, A., Thomas, J., & Bira, L. (2015). The Emotional and Functional Impact of the Type of Tinnitus Sensation. Journal of clinical psychology in medical settings.
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  One to three percent of individuals with tinnitus experience significant reduction in quality of life. Factors that contribute to distress include personality variables, intolerance to loud noises, external locus of control, and pre-existing anxiety. Characteristics of tinnitus itself, such as perceived loudness, can also cause functional impairment. It is unknown whether different tinnitus sensations have various effects on either emotional or functional impairment, which can reduce quality of life. While audiological tests can determine pitch and loudness of tinnitus, questionnaires also can be easily used to assess subjective characteristics of tinnitus. In this study, 370 participants, recruited via email from a national tinnitus organization, completed online surveys that assessed tinnitus-related distress and provided qualitative descriptions of their tinnitus sensation. Self-reports of tinnitus sensation were rated by five independent coders, with excellent agreement. Individuals who reported a combination of tinnitus sensations were found to experience significantly more functional impairment and avoidant behavior. Future research should utilize more sophisticated approaches to categorize individuals' tinnitus sensation and to examine associated emotional and functional differences. Providers should appropriately refer patients for tinnitus management and empirically-supported therapies aimed at reducing tinnitus related distress and functional impairment.
• Moring, J., Bowen, A., Thomas, J., & Joseph, J. (2015). Acceptance Mediates the Relationship Between Tinnitus-Related Cognitions and Anxiety Sensitivity. American journal of audiology, 24(2), 235-42.
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  Negative cognitions related to tinnitus sensation have been previously shown to affect the level of emotional distress. Anxiety sensitivity is another psychological factor that influences individuals to more closely monitor their own bodily sensations, resulting in increased negative cognitions and negative emotional responses among tinnitus patients. However, increasing acceptance of tinnitus sensation may attenuate emotional distress. The goal of this research was to investigate the relationship between negative tinnitus-related cognitions, acceptance, and anxiety sensitivity.
• Schonnesson, L. N., Bowen, A. M., & Williams, M. L. (2015). Project SMART: Preliminary Results From a Test of the Efficacy of a Swedish Internet-Based HIV Risk-Reduction Intervention for Men Who Have Sex With Men. Archives of sexual behavior.
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  In Sweden, 57 % of HIV transmission occurs among MSM, and other sexually transmitted infections are increasing, supporting the need for innovative interventions. The Internet is a potentially useful HIV-prevention platform, but there is a lack of such programs in Sweden. The purpose of this exploratory study was to test the efficacy of the Internet-based SMART intervention to decrease HIV sexual risks in Swedish MSM. The intervention was adapted from the Wyoming Rural AIDS Prevention Project to the Swedish context, which was guided by the Information-Motivation-Behavioral (IMB) skills model and consisted of six sessions. A total of 112 men responded to a pretest questionnaire and were randomly assigned to the SMART intervention or to a waitlist group. Fifty-four men dropped out, leaving a final sample of 58 participants. Twenty-five were assigned to the SMART intervention and 33 to a waitlist group. One month post intervention, the number of casual anal sex partners significantly decreased (t = 2.19, p = .04). Compared with the waitlist group, men in the intervention group increased their HIV knowledge (β = 0.70, p = .01), their belief of condom use as an act of responsibility (β = 1.19, p = .04), their willingness to use a condom with every new partner all the time (β = 1.39, p = .03), and their confidence in using condoms in challenging situations (β = 1.65, p = .02). Condom use was not analyzed due to the small sample size. Despite the small sample, high drop-out, and short follow-up, the study provides support for the efficacy of the Internet interventions, the SMART intervention specifically, for reducing the proportion of casual anal sex partners and improving the three cognitive components of the IMB model for Swedish MSM.
• Moring, J., Bowen, A., & Thomas, J. (2014). Use of the Implicit Association Test for the Measurement of Tinnitus-Related Distress. AMERICAN JOURNAL OF AUDIOLOGY, 23(3), 293-302.
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  Purpose: A priming stimulus activates and increases an association with the target stimulus. The goal of this research was to investigate whether current tinnitus measures are susceptible to increased error due to priming and, if so, to examine the feasibility of using the Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998) for an alternative measurement of tinnitus-related distress.
• Moring, J., Bowen, A., & Thomas, J. (2014). Use of the implicit association test for the measurement of tinnitus-related distress. American journal of audiology, 23(3), 293-302.
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  A priming stimulus activates and increases an association with the target stimulus. The goal of this research was to investigate whether current tinnitus measures are susceptible to increased error due to priming and, if so, to examine the feasibility of using the Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998) for an alternative measurement of tinnitus-related distress.
• Ross-Bailey, L. L., Moring, J., Angiola, J., & Bowen, A. (2014). The Influence of Sexual Scripts and the "Better than Average" Effect on Condom Responsibility. JOURNAL OF COLLEGE STUDENT DEVELOPMENT, 55(4), 408-412.
• Angiola, J. E., & Bowen, A. M. (2013). Quality of Life in Advanced Cancer: An Acceptance and Commitment Therapy View. COUNSELING PSYCHOLOGIST, 41(2), 313-335.
• Black, A. C., Serowik, K. L., Schensul, J. J., Bowen, A. M., & Rosen, M. I. (2013). Build a Better Mouse: Directly-Observed Issues in Computer Use for Adults with SMI. PSYCHIATRIC QUARTERLY, 84(1), 81-92.
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  Integrating information technology into healthcare has the potential to bring treatment to hard-to-reach people. Individuals with serious mental illness (SMI), however, may derive limited benefit from these advances in care because of lack of computer ownership and experience. To date, conclusions about the computer skills and attitudes of adults with SMI have been based primarily on self-report. In the current study, 28 psychiatric outpatients with co-occurring cocaine use were interviewed about their computer use and opinions, and 25 were then directly observed using task analysis and think aloud methods as they navigated a multi-component health informational website. Participants reported low rates of computer ownership and use, and negative attitudes towards computers. Self-reported computer skills were higher than demonstrated in the task analysis. However, some participants spontaneously expressed more positive attitudes and greater computer self-efficacy after navigating the website. Implications for increasing access to computer-based health information are discussed.
• Black, A. C., Serowik, K. L., Schensul, J. J., Bowen, A. M., & Rosen, M. I. (2013). Build a better mouse: directly-observed issues in computer use for adults with SMI. The Psychiatric quarterly, 84(1), 81-92.
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  Integrating information technology into healthcare has the potential to bring treatment to hard-to-reach people. Individuals with serious mental illness (SMI), however, may derive limited benefit from these advances in care because of lack of computer ownership and experience. To date, conclusions about the computer skills and attitudes of adults with SMI have been based primarily on self-report. In the current study, 28 psychiatric outpatients with co-occurring cocaine use were interviewed about their computer use and opinions, and 25 were then directly observed using task analysis and think aloud methods as they navigated a multi-component health informational website. Participants reported low rates of computer ownership and use, and negative attitudes towards computers. Self-reported computer skills were higher than demonstrated in the task analysis. However, some participants spontaneously expressed more positive attitudes and greater computer self-efficacy after navigating the website. Implications for increasing access to computer-based health information are discussed.
• Julie, A., & Bowen, A. M. (2013). Quality of Life in Advanced Cancer: An Acceptance and Commitment Therapy View. The Counseling Psychologist, 41, 313-335.
• Bowen, A., Moring, J., Williams, M., Hopper, G., & Daniel, C. (2012). An Investigation of Bioecological Influences Associated With First Use of Methamphetamine in a Rural State. JOURNAL OF RURAL HEALTH, 28(3), 286-295.
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  Purpose: Methamphetamine (MA) addiction is a significant problem in rural areas of the United States. Yet, little theoretically driven formative research has been conducted on the interactions of factors influencing initiation. The study was guided by Bronfenbrenner's bioecological model. Methods: Eighty-three MA users participated in an interview. Quantitative data included sociodemographic characteristics, drug use history, and psychosocial functioning. Semistructured interviews examined MA use histories with a focus on initiation. Transcripts of the interviews were coded for 5 themes related to Bronfenbrenner's influences including individual motivation, family, peers, work or school, or community as factors influencing initiation of MA use. Five dummy variables representing the presence or absence of a mention of Bronfenbrenner's 5 influences were created from the qualitative codes and entered into a hierarchical cluster analysis. Findings: The analyses revealed 4 distinct clusters: (1) predominantly female, influenced by peers and individual curiosity, (2) predominantly female, youngest age of first use, influenced by a family culture of drug use, (3) predominantly male, older age at first use, influenced by work settings and family co-workers, and (4) predominantly male, older age at first use, in the school context with a desire to increase intimacy. Conclusions: Bronfenbrenner's bioecological model was useful for classifying initiating influences and grouping individuals based on different combinations of influences. Identifying combinations of initiating factors such as work and community may facilitate tailoring of prevention programs, which may maximize efficacy and cost-effectiveness.
• Bowen, A., Moring, J., Williams, M., Hopper, G., & Daniel, C. (2012). An investigation of bioecological influences associated with first use of methamphetamine in a rural state. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 28(3), 286-95.
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  Methamphetamine (MA) addiction is a significant problem in rural areas of the United States. Yet, little theoretically driven formative research has been conducted on the interactions of factors influencing initiation. The study was guided by Bronfenbrenner's bioecological model.
• Clayton, S., Daniel, C. M., Bowen, A., Edgar, T., Noar, S., & Freimuth, V. (2012). The Internet Accessible and Affordable HIV Prevention for Rural MSM. COMMUNICATION PERSPECTIVES ON HIV/AIDS FOR THE 21ST CENTURY, 385-388.
• Ross, M. W., Nyoni, J., Bowen, A. M., Williams, M. L., & Kashiha, J. J. (2012). Sexual and geographic organisation of men who have sex with men in a large East African city: opportunities for outreach. BMJ OPEN, 2(6).
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  Objectives: To describe geographical and dispersion patterns of men who have sex with men (MSM)-related venues in a large East African city and their associations with times, participants and venue type.
• Ross, M. W., Nyoni, J., Bowen, A. M., Williams, M. L., & Kashiha, J. J. (2012). Sexual and geographic organisation of men who have sex with men in a large East African city: opportunities for outreach. BMJ open, 2(6).
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  To describe geographical and dispersion patterns of men who have sex with men (MSM)-related venues in a large East African city and their associations with times, participants and venue type.
• Williams, M., Bowen, A., Atkinson, J. S., Nilsson-Schonnesson, L., Diamond, P. M., Ross, M. W., & Pallonen, U. E. (2012). An assessment of brief group interventions to increase condom use by heterosexual crack smokers living with HIV infection. AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV, 24(2), 220-231.
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  The purpose of this study was to assess the efficacy of brief group interventions, the positive choices intervention (PCI) and a standard intervention (SI), to increase condom use and intention to use condoms and to change condom use attitudes and beliefs. The design of the study was a randomized comparative trial. Participants were 347 heterosexual African American crack cocaine users living with HIV infection. Data were collected at intake and at three and nine months after intake. Behavioral and sociocognitive data were collected. Although both brief interventions achieved positive results, there were significant differences in outcomes between the interventions groups. The mean number of sex partners was significantly lower in the PCI group at three months. The proportion of those assigned to the PCI reporting sex with a paid partner significantly decreased, while the proportion disclosing their serostatus to their partners increased. There were no significant differences on these measures in the SI group. Significant time effects were found on measures of condom use, condom use attitudes, and self-efficacy beliefs. These measures significantly increased from intake to one month for both groups. One significant time-by-group effect was found. The measure of situational self-efficacy significantly increased in the PCI group, but not the SI group. Results also showed significant time-by-time effects. Mean condom use, intention to use condoms, attitudes, and condom use self-efficacy beliefs showed significant difference between three and nine months. However, there was no clear pattern of change. Findings suggest that brief group interventions designed to reduce HIV can help heterosexual drug users living with HIV infection increase condom use and intention to use condoms and change condom use attitudes and beliefs. A significant time-by-group effect was observed only for situational self-efficacy, suggesting limited additional efficacy of the PCI intervention. Given similar positive findings between groups, more research is needed to determine which components of brief interventions produce changes in motivations and risk behaviors.
• Williams, M., Bowen, A., Atkinson, J. S., Nilsson-Schönnesson, L., Diamond, P. M., Ross, M. W., & Pallonen, U. E. (2012). An assessment of brief group interventions to increase condom use by heterosexual crack smokers living with HIV infection. AIDS care, 24(2), 220-31.
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  The purpose of this study was to assess the efficacy of brief group interventions, the positive choices intervention (PCI) and a standard intervention (SI), to increase condom use and intention to use condoms and to change condom use attitudes and beliefs. The design of the study was a randomized comparative trial. Participants were 347 heterosexual African American crack cocaine users living with HIV infection. Data were collected at intake and at three and nine months after intake. Behavioral and sociocognitive data were collected. Although both brief interventions achieved positive results, there were significant differences in outcomes between the interventions groups. The mean number of sex partners was significantly lower in the PCI group at three months. The proportion of those assigned to the PCI reporting sex with a paid partner significantly decreased, while the proportion disclosing their serostatus to their partners increased. There were no significant differences on these measures in the SI group. Significant time effects were found on measures of condom use, condom use attitudes, and self-efficacy beliefs. These measures significantly increased from intake to one month for both groups. One significant time-by-group effect was found. The measure of situational self-efficacy significantly increased in the PCI group, but not the SI group. Results also showed significant time-by-time effects. Mean condom use, intention to use condoms, attitudes, and condom use self-efficacy beliefs showed significant difference between three and nine months. However, there was no clear pattern of change. Findings suggest that brief group interventions designed to reduce HIV can help heterosexual drug users living with HIV infection increase condom use and intention to use condoms and change condom use attitudes and beliefs. A significant time-by-group effect was observed only for situational self-efficacy, suggesting limited additional efficacy of the PCI intervention. Given similar positive findings between groups, more research is needed to determine which components of brief interventions produce changes in motivations and risk behaviors.
• Williams, M., Freeman, R., Bowen, A., & Saunders, L. (2012). The acceptability of a computer HIV/AIDS risk assessment to not-in-treatment drug users. AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV, 10(6), 701-711.
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  The purpose of this paper is to report the results of a study assessing the acceptability of a computer HIV risk assessment instrument administered to not-in-treatment drug users. The study asked three questions related to acceptability: (1) are drug users comfortable responding to HIV risk questions using the computer assessment; (2) do drug users feel that they possess the requisite skill to respond to questions using a computer; and (3) do drug users believe that the responses they provide using the computer assessment will remain private and confidential. This study differs front other assessments of the acceptability of computer assisted data collection in that the population of interest has only limited education and interaction with computers. Furthermore, the study was implemented under field conditions. To conduct the study, an existing HIV risk assessment instrument was adapted for use with the computer. Only slight modifications were made to the content of the instrument. To facilitate data collection with this population, audio enhancement and touch screen were used. Three scales measuring comfort, skill and perceived privacy were developed. Results of analysis showed that drug users are comfortable responding to an HIV risk assessment using computer assisted interviewing. Drug users also perceived that they possessed the requisite skill to successfully complete the interview. And, study participants reported that they believed that their responses using the computer interview would remain private and confidential. Only minor differences in scale scores based on sociodemographic characteristics were found among study participants. Implications of the findings are discussed.
• Bowen, A., & Bourgeois, M. (2011). Attitudes toward lesbian, gay, and bisexual college students: The contribution of pluralistic ignorance, dynamic social impact, and contact theories. JOURNAL OF AMERICAN COLLEGE HEALTH, 50(2), 91-96.
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  Social psychology theories may be useful in developing new interventions to reduce prejudice against lesbian. gay, and bisexual (LGB) college students. For this preliminary study, the authors surveyed 109 college dormitory residents to determine their personal comfort with LGB students and their perceptions of other students' comfort with these individuals. They found widespread evidence of pluralistic ignorance-the students rated themselves as significantly less anti-gay than either their friends or the typical student. Students' attitudes showed geographic clustering, with the building of residence a significant predictor of students' attitudes. Finally, consistent with the contact hypothesis, the perception that 1 or 2 LGB students lived on the same floor or in the same building was associated with more positive attitudes.
• Ross, L. L., & Bowen, A. M. (2010). Sexual decision making for the "better than average" college student. Journal of American college health : J of ACH, 59(3), 211-6.
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  to examine the impact of downward social comparison and the "known partner is a safe partner" heuristic on college students' sexual decisions.
• Timpson, S. C., Williams, M. L., Bowen, A. M., Atkinson, J. S., & Ross, M. W. (2010). Sexual activity in HIV-positive African American crack cocaine smokers. Archives of sexual behavior, 39(6), 1353-8.
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  The AIDS epidemic in the United States continues to disproportionately affect minorities of color, especially African Americans. The purpose of this study was to explore the sexual behaviors of a sample of African American HIV positive crack smokers aware of their serostatus. Participants (100 men, 37 women) were included in this study based on the following criteria: a minimum age of 18 years, HIV positive serostatus, treatment with HIV antiretroviral medications for a minimum of 3 months prior to interview, crack cocaine use at least once in the 7 days prior to being interviewed, willingness to provide a urine sample to confirm recent drug use, and vaginal or anal sex at least once in the past 7 days. The questionnaire was a compilation of other reliable surveys and was designed to collect sociodemographic data, drug use, sexual behavior, condom use intentions and motivators, STD and HIV infection history, HIV medications, and adherence requirements. Participants reported having 1,266 different partners in the 30 days prior to the interview and had traded sex for money or drugs with 68%. A total of 79 participants had multiple partners and accounted for 1,247 partnerships. Rates of consistent condom use across partnerships were low, indicating that more interventions in this at-risk population are needed.
• Bowen, A. M., Williams, M. L., Daniel, C. M., & Clayton, S. (2009). Internet based HIV prevention research targeting rural MSM: feasibility, acceptability, and preliminary efficacy. JOURNAL OF BEHAVIORAL MEDICINE, 31(6), 463-477.
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  Internet delivered primary prevention interventions for HIV risk reduction present significant challenges. Changing lifestyle behaviors, such as beginning to use condoms, is difficult and men seeking dates on line may want to avoid thinking about HIV risk which may lead to low initiation and high dropout rates. Many Internet delivered HIV risk reduction programs have mimicked face-to-face outreach programs, failing to take advantage of the Internet's capabilities or did not conduct evaluation. This study focuses on examining the feasibility, acceptability, and efficacy of an Internet delivered HIV risk reduction program for rural men who have sex with men (MSM). The program included online recruiting, three intervention modules, each with two sessions, online questionnaires. The intervention was developed based on iterative research and the Information-Motivation-Behavioral skills model. Participants (N = 475) were randomly assigned to one of six module orders and data were collected automatically at pre-test and after each module. Data supports the feasibility and acceptability of the program as demonstrated by good retention and rapid program completion. Knowledge, self-efficacy, outcome expectancies and motivation increase in a dose response fashion. Post-intervention behavior changes included reduced anal sex and significant increases in condom use. Limitations include a short follow-up period, a predominantly young white rural sample, and the lack of an attention control. Overall the results of the study provide support for the efficacy of Internet-based interventions to reduce risk of HIV infection. Results also support traditional research methods to evaluate HIV prevention programs delivered exclusively through the Internet.
• Czuchry, M., Timpson, S., Williams, M. L., Bowen, A. M., & Ratliff, E. A. (2009). Improving Condom Self-Efficacy and Use among Individuals Living with HIV: The Positive Choices Mapping Intervention. Journal of substance use, 14(3-4), 230-239.
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  Few interventions have been designed to improve behavioral outcomes and reduce risk of HIV transmission of individuals living with HIV, most focusing on preventative efforts directed at individuals who are HIV-negative. However, people living with HIV present individual and public health risks (infection with a different strain of HIV, health complications from contracting STD's, continued sexual activity with individuals with unknown HIV status) that have become the focus of intervention efforts. The current paper explores a promising new intervention, The Positive Choices Mapping intervention (PCM), designed to increase condom self-efficacy and use among African American crack cocaine smokers who are living with HIV. The intervention was grounded in Social Cognitive Theory and incorporated an empirically backed visual representation strategy (node-link mapping). The focus of the current paper is on the main components of the intervention.
• Harzke, A. J., Williams, M. L., & Bowen, A. M. (2009). Binge Use of Crack Cocaine and Sexual Risk Behaviors Among African-American, HIV-Positive Users. AIDS AND BEHAVIOR, 13(6), 1106-1118.
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  This study describes binge use of crack cocaine, binge users, and their sexual risk behaviors in a sample of 303 African-American, HIV-positive users. Recent binge use was defined as, "using as much crack cocaine as you can, until you run out of crack or are unable to use any more" in the last 30 days. Fifty-one percent reported a recent crack binge. The typical crack binge lasted 3.7 days and involved smoking 40 rocks on average. Nearly two-thirds reported their last binge was in their own or another's home. Seventy-two percent had sex during the last binge, with an average of 3.1 partners. In multivariable logistic regression analyses, recent bingers were more likely than non-bingers to consider themselves homeless, to have any income source, to have used crack longer, and to score higher on risk-taking and need for help with their drug problem. In multivariable ordinal and logistic regression analyses, recent bingers had more sex partners in the last six months and 30 days and were more likely to have never used a condom in the last 30 days. Among male users, recent bingers were more likely to report lifetime and recent exchange of money for sex and drugs for sex. Among both male and female users, recent bingers were more likely to report lifetime trading of sex for drugs. African-American, HIV-positive binge users of crack cocaine appear to be at increased risk for HIV transmission. Further investigations of binge crack use and sexual risk behaviors and interventions targeting and tailored to this group should be considered.
• Harzke, A. J., Williams, M. L., & Bowen, A. M. (2009). Binge use of crack cocaine and sexual risk behaviors among African-American, HIV-positive users. AIDS and behavior, 13(6), 1106-18.
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  This study describes binge use of crack cocaine, binge users, and their sexual risk behaviors in a sample of 303 African-American, HIV-positive users. Recent binge use was defined as, "using as much crack cocaine as you can, until you run out of crack or are unable to use any more" in the last 30 days. Fifty-one percent reported a recent crack binge. The typical crack binge lasted 3.7 days and involved smoking 40 rocks on average. Nearly two-thirds reported their last binge was in their own or another's home. Seventy-two percent had sex during the last binge, with an average of 3.1 partners. In multivariable logistic regression analyses, recent bingers were more likely than non-bingers to consider themselves homeless, to have any income source, to have used crack longer, and to score higher on risk-taking and need for help with their drug problem. In multivariable ordinal and logistic regression analyses, recent bingers had more sex partners in the last six months and 30 days and were more likely to have never used a condom in the last 30 days. Among male users, recent bingers were more likely to report lifetime and recent exchange of money for sex and drugs for sex. Among both male and female users, recent bingers were more likely to report lifetime trading of sex for drugs. African-American, HIV-positive binge users of crack cocaine appear to be at increased risk for HIV transmission. Further investigations of binge crack use and sexual risk behaviors and interventions targeting and tailored to this group should be considered.
• Timpson, S., Ratliff, E., Ross, M., Williams, M., Atkinson, J., Bowen, A., & McCurdy, S. (2009). A Psychosocial Comparison of New Orleans and Houston Crack Smokers in the Wake of Hurricane Katrina. SUBSTANCE USE & MISUSE, 44(12), 1695-1710.
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  The purpose of this study was to compare psychological distress in a sample of African American crack cocaine users who relocated to Houston from New Orleans after Hurricane Katrina to African American drug users resident in Houston. Fifty-four African Americans from New Orleans were compared to a sample of 162 people in Houston. Data were collected between June 2002 and December 2005. There were no significant differences between the two groups on either depression or anxiety, but the New Orleans sample scored higher on the self-esteem scale and scored slightly lower on the risk-taking scale.
• Timpson, S., Ratliff, E., Ross, M., Williams, M., Atkinson, J., Bowen, A., & McCurdy, S. (2009). A psychosocial comparison of New Orleans and Houston crack smokers in the wake of Hurricane Katrina. Substance use & misuse, 44(12), 1695-710.
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  The purpose of this study was to compare psychological distress in a sample of African American crack cocaine users who relocated to Houston from New Orleans after Hurricane Katrina to African American drug users resident in Houston. Fifty-four African Americans from New Orleans were compared to a sample of 162 people in Houston. Data were collected between June 2002 and December 2005. There were no significant differences between the two groups on either depression or anxiety, but the New Orleans sample scored higher on the self-esteem scale and scored slightly lower on the risk-taking scale.
• Williams, M. L., Bowen, A. M., Timpson, S. C., Ross, M. W., & Atkinson, J. S. (2009). HIV prevention and street-based male sex workers: An evaluation of brief interventions. AIDS EDUCATION AND PREVENTION, 18(3), 204-215.
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  The purpose of this study was to evaluate the acceptability and the comparative efficacy of brief HIV risk reduction interventions to increase condom use during paid anal sex by street-based male sex workers (MSWs). Of the 399 street-based MSWs who participated in the evaluation of acceptability, 112 participated in the evaluation of efficacy. Acceptability was evaluated by assessing completion rates. Intervention efficacy was assessed across two brief interventions, a "standard" and a "standard-plus" interventions. The primary outcome of concern was condom use during paid anal sexual encounters. In addition to this variable, changes in drug use, needle use, condom use beliefs, and condom use intention were also assessed. Results showed that almost two thirds of MSWs enrolled in a brief intervention completed it. Completion rates varied by age, race/ethnicity, sexual orientation, and HIV status. Condom use during paid anal sex increased postintervention. In addition, condom use intentions, positive condom use outcome expectations, and condom use normative expectations increased preintervention to postintervention. However, there were no significant differences between the standard and the standard-plus brief interventions in any of the outcomes measured. Brief interventions to reduce the HIV risks are acceptable to MSWs and are efficacious for reducing unprotected anal sex during paid sexual encounters.
• Williams, M. L., McCurdy, S. A., Bowen, A. M., Kilonzo, G. P., Atkinson, J. S., Ross, M. W., & Leshabari, M. T. (2009). HIV seroprevalence in a sample of Tanzanian intravenous drug users. AIDS education and prevention : official publication of the International Society for AIDS Education, 21(5), 474-83.
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  Injection drug use has recently emerged in sub-Saharan Africa. The purpose of this study was to assess the factors associated with increased risk of testing HIV-positive in a sample of injection drug users (IDUs) in Dar es Salaam, Tanzania. Participants were recruited by a trained outreach worker or were referred by IDUs who had completed the study. Blood specimens and self-reported socioeconomic and behavioral data were collected from 315 male and 219 female IDUs. Data were analyzed using univariate odds ratios and multivariate logistic regression modeling. Forty-two percent of the sample tested HIV-positive. Several socioeconomic, injection, and sexual factors were found to be associated with increased odds of testing HIV-positive. Multivariate analysis showed that having had sex more than 81 times in past 30 days, earning less than 100,000 shillings (US$76) in the past month, residency in Dar es Salaam for less than 5 years, and injecting for 3 years were independently associated with the greatest risk of infection. The rate of HIV infection in this sample of IDUs was found to be very high, suggesting that injection drug use may be a factor in the continuing epidemic in sub-Saharan Africa. The factors associated with increased risk of HIV infection suggest further research is needed on the needle use and sexual networks of IDUs.
• Bowen, A. M., Daniel, C. M., Williams, M. L., & Baird, G. L. (2008). Identifying multiple submissions in Internet research: preserving data integrity. AIDS and behavior, 12(6), 964-73.
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  Internet-based sexuality research with hidden populations has become increasingly popular. Respondent anonymity may encourage participation and lower social desirability, but associated disinhibition may promote multiple submissions, especially when incentives are offered. The goal of this study was to identify the usefulness of different variables for detecting multiple submissions from repeat responders and to explore incentive effects. The data included 1,900 submissions from a three-session Internet intervention with a pretest and three post-test questionnaires. Participants were men who have sex with men and incentives were offered to rural participants for completing each questionnaire. The final number of submissions included 1,273 "unique", 132 first submissions by "repeat responders" and 495 additional submissions by the "repeat responders" (N = 1,900). Four categories of repeat responders were identified: "infrequent" (2-5 submissions), "persistent" (6-10 submissions), "very persistent" (11-30 submissions), and "hackers" (more than 30 submissions). Internet Provider (IP) addresses, user names, and passwords were the most useful for identifying "infrequent" repeat responders. "Hackers" often varied their IP address and identifying information to prevent easy identification, but investigating the data for small variations in IP, using reverse telephone look up, and patterns across usernames and passwords were helpful. Incentives appeared to play a role in stimulating multiple submissions, especially from the more sophisticated "hackers". Finally, the web is ever evolving and it will be necessary to have good programmers and staff who evolve as fast as "hackers".
• Bowen, A., Williams, M., Dearing, E., Timpson, S., & Ross, M. (2008). Male heterosexual crack smokers with multiple sex partners: between- and within-person predictors of condom use intention. HEALTH EDUCATION RESEARCH, 21(4), 549-559.
• Horvath, K. J., Beadnell, B., & Bowen, A. M. (2008). A daily Web diary of the sexual experiences of men who have sex with men: Comparisons with a retrospective recall survey. AIDS AND BEHAVIOR, 11(4), 537-548.
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  The emergence of Internet technology provides a unique opportunity to collect real-time information on the sexual behaviors of persons at risk for HIV. However, relatively little is known of the utility and reliability of web diaries. To address this gap, 45 predominantly Caucasian and gay, Internet-using men who have sex with men completed a 4-week daily web diary of their sexual behaviors. Afterward, participants completed an online retrospective recall survey (RRS) of their sexual activities during the diary period and satisfaction ratings of the web diary method. Overall, web diary estimates of sexual behaviors differed from the RRS, with a tendency to over-report on the latter with the exception of insertive unprotected anal intercourse. Additionally, compliance rates were high and there was some evidence for reactivity. Participants evaluated the web diary method positively. Web diaries appear to be a promising tool for collecting information on health behaviors.
• Pallonen, U. E., Williams, M. L., Timpson, S. C., Bowen, A., & Ross, M. W. (2008). Personal and partner measures in stages of consistent condom use among African-American heterosexual crack cocaine smokers. AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV, 20(2), 212-220.
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  Participants' personal condom use measures and those of their last sex partner's were examined in five stages of change for consistent condom use among 449 urban sexually active, heterosexual, African-American crack smokers. The measures included participants' personal and their last sex partner's perceived responsibility, personal and perceived negative attitudes, and participants' self-efficacy to use condoms. The relationships between the measures and the stages were examined using analyses of variance and multivariate logistic regression. Over 90% of participants did not use condoms, consistently. Two-thirds of the inconsistent users were in the precontemplation stage. The rest were equally divided between the contemplation and preparation stages. Personal responsibility outperformed other measures in initial intention to become a regular condom user; partner's perceived responsibility dominated continued intention and actual consistent condom use. Negative attitudes and self-efficacies had strong relationships to the stages of consistent condom use in univariate analyses but these relationships became substantially weaker when the responsibility, attitude, and self-efficacy concepts were entered simultaneously into multivariate analyses.
• Ross, M. W., Timpson, S. C., Williams, M. L., Amos, C., Mccurdy, S., Bowen, A. M., & Kilonzo, G. P. (2008). Responsibility as a dimension of HIV prevention normative beliefs: measurement in three drug-using samples. AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV, 19(3), 403-409.
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  The concept of responsibility was derived originally from principles of morality, as part of a network of rights, duties and obligations. HIV risk-related studies have suggested that a sense of responsibility for condom use to protect a partner is a potentially important predictor of condom use in drug-using populations. We created a four-item scale measuring Self responsibility to use condoms and Partner's responsibility to use condoms. Data were collected from three drug-using samples: crack smokers, HIV seropositive crack smokers in an intervention study in Houston, Texas, and Tanzanian heroin users in Dar es Salaam. Data indicated that the four responsibility items had high alpha coefficients in each sample, and that there were moderate to high intercorrelations between equivalent self and partner responsibility items. There were significant differences in scale scores between the crack smokers and the HIV positive crack smokers and the Tanzanian samples, but no significant differences between the HIV positive and Tanzanian samples. Comparing within the first cracksmoker sample those who were HIV positive and negative showed significant differences in the direction of higher beliefs in responsibility to use condoms in the HIV positive group. These data suggest that responsibility is measurable, holds similar psychometric properties across three samples differing in culture and HIV serostatus, and that condom use responsibility is conceptualized as a measure of general responsibility rather than as a reciprocal self/partner responsibility.
• Schonnesson, L. N., Atkinson, J., Williams, M. L., Bowen, A., Ross, M. W., & Timpson, S. C. (2008). A cluster analysis of drug use and sexual HIV risks and their correlates in a sample of African-American crack cocaine smokers with HIV infection. DRUG AND ALCOHOL DEPENDENCE, 97(1-2), 44-53.
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  The purpose of this cross-sectional study was to classify a sample of HIV-seropositive African-American crack cocaine smokers into homogenous HIV drub use and sexual risk groups using a two step multivariate cluster analysis. Two hundred and fifty-eight crack cocaine smokers participated in the study. Cluster analysis revealed three distinct HIV risk groups. The highest risk group, the largest one, was characterized by frequent, daily crack use, multiple sex partners, trading sex, and inconsistent condom use. The consistent condom use group, the smallest group, was characterized by consistent condom use. The inconsistent condom use group, the second largest group, was distinguished by inconsistent condom use. Comparisons of the three HIV risk groups revealed that the highest risk group had a higher proportion of illegal sources of income, higher proportion of binged crack use, frequent, daily, alcohol use, same gender sex partners, and scored higher on depressive symptoms. Members of the consistent condom use group were more likely to have been HIV diagnosed for a shorter time, to have HIV serodiscordant casual sex partners, higher psychological motivation for condom use. and a lower frequency of vaginal sex. Members of the inconsistent condom use group were more likely to have a main sex partner, to be married. to be on public assistance, to know the HIV serostatus of their casual partner, and less likely to conceal their HIV serostatus. An alarming finding was that a large number of participants inconsistently used condoms with HIV serodiscordant sex partners. Interventions aiming to prevent the secondary spread of HIV infection in African-American crack cocaine smokers should take this variability in account and focus on the differences. (C) 2008 Elsevier Ireland Ltd. All rights reserved.
• Schönnesson, L. N., Atkinson, J., Williams, M. L., Bowen, A., Ross, M. W., & Timpson, S. C. (2008). A cluster analysis of drug use and sexual HIV risks and their correlates in a sample of African-American crack cocaine smokers with HIV infection. Drug and alcohol dependence, 97(1-2), 44-53.
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  The purpose of this cross-sectional study was to classify a sample of HIV-seropositive African-American crack cocaine smokers into homogenous HIV drug use and sexual risk groups using a two step multivariate cluster analysis. Two hundred and fifty-eight crack cocaine smokers participated in the study. Cluster analysis revealed three distinct HIV risk groups. The highest risk group, the largest one, was characterized by frequent, daily crack use, multiple sex partners, trading sex, and inconsistent condom use. The consistent condom use group, the smallest group, was characterized by consistent condom use. The inconsistent condom use group, the second largest group, was distinguished by inconsistent condom use. Comparisons of the three HIV risk groups revealed that the highest risk group had a higher proportion of illegal sources of income, higher proportion of binged crack use, frequent, daily, alcohol use, same gender sex partners, and scored higher on depressive symptoms. Members of the consistent condom use group were more likely to have been HIV diagnosed for a shorter time, to have HIV serodiscordant casual sex partners, higher psychological motivation for condom use, and a lower frequency of vaginal sex. Members of the inconsistent condom use group were more likely to have a main sex partner, to be married, to be on public assistance, to know the HIV serostatus of their casual partner, and less likely to conceal their HIV serostatus. An alarming finding was that a large number of participants inconsistently used condoms with HIV serodiscordant sex partners. Interventions aiming to prevent the secondary spread of HIV infection in African-American crack cocaine smokers should take this variability in account and focus on the differences.
• Williams, M., Bowen, A., Ross, M., Timpson, S., Pallonen, U., & Amos, C. (2008). An investigation of a personal norm of condom-use responsibility among African American crack cocaine smokers. AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV, 20(2), 225-234.
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  The purpose of this study was to investigate the unique contribution of a personal norm of condom-use responsibility to the formation of intentions to use male condoms during vaginal sex. Data were collected from 402 male and 157 female heterosexual African American crack cocaine smokers in Houston, Texas, US. Two structural equation models of the intention to use a condom with the last sex partner were estimated. One model included measures of condom-use attitudes, subjective norms and condom-use self-efficacy. A second model included these three measures and a fourth measure of a personal norm of condom-use responsibility. Separate models were estimated for men and women. The addition of a personal norm of condom-use responsibility provided a significantly better fit to the data than did models including only outcome expectations, subjective norms and self-efficacy. Results also showed distinctly different underlying cognitive structures of condom-use intention for men and women. A personal norm of condom-use responsibility had a strong direct effect on men's intentions to use condoms with the last sex partner. Other variables appeared to have no direct effect on men's intentions. Women's intentions were strongly influenced by a personal norm and social subjective norms. Situational self-efficacy and outcome expectations had weaker, yet significant, effects on women's intentions. Given the strong effect of personal norms on men's intentions to use condoms, further research should be undertaken.
• Bowen, A. M., Horvath, K., & Williams, M. L. (2007). A randomized control trial of Internet-delivered HIV prevention targeting rural MSM. Health education research, 22(1), 120-7.
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  The Internet may be important for delivering human immunodeficiency virus (HIV) risk reduction to men who have sex with men (MSM) in rural areas. This randomized control trial (RCT) tested the acceptability and efficacy of an Internet-delivered HIV risk-reduction intervention. Two modules include a conversation between an HIV-negative man and an HIV-positive man, with interactive graphics. Ninety men were randomly assigned to intervention or wait-list control and 79% completed the study. An 'intent-to-treat' model was used. HIV/acquired immune deficiency syndrome (AIDS) knowledge, self-efficacy and outcome expectancies increased after participating in the intervention, and changes were maintained at 1-week follow-up. Participants said they would participate again. This RCT provides support for the acceptability and efficacy of the Internet for delivering HIV prevention messages to rural MSM.
• Bowen, A., Williams, M., & Horvath, K. (2007). Using the Internet to recruit rural MSM for HIV risk assessment: Sampling issues. AIDS AND BEHAVIOR, 8(3), 311-319.
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  The Internet is an emerging research tool that may be useful for contacting and working with rural men who have sex with men (MSM). Little is known about HIV risks for rural men and Internet methodological issues are only beginning to be examined. Internet versus conventionally recruited samples have shown both similarities and differences in their demographic characteristics. In this study, rural MSM from three sizes of town were recruited by two methods: conventional ( e. g. face-to-face/snowball) or Internet. After stratifying for size of city, demographic characteristics of the two groups were similar. Both groups had ready access to the Internet. Patterns of sexual risk were similar across the city sizes but varied by recruitment approach, with the Internet group presenting a somewhat higher HIV sexual risk profile. Overall, these findings suggest the Internet provides a useful and low cost approach to recruiting and assessing HIV sexual risks for rural White MSM. Further research is needed on methods for recruiting rural minority MSM.
• Czuchry, M., Timpson, S., Williams, M. L., Bowen, A. M., & Ratliff, E. A. (2007). Improving condom self-efficacy and use among individuals living with HIV: The positive choices mapping intervention. JOURNAL OF SUBSTANCE USE, 14(3-4), 230-239.
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  Few interventions have been designed to improve behavioural outcomes and reduce risk of HIV transmission of individuals living with HIV, most focusing on preventative efforts directed at individuals who are HIV-negative. However, people living with HIV present individual and public health risks (infection with a different strain of HIV, health complications from contracting STD's, continued sexual activity with individuals with unknown HIV status) that have become the focus of intervention efforts. The current paper explores a promising new intervention, The Positive Choices Mapping (PCM) intervention, designed to increase condom self-efficacy and use among African American crack cocaine smokers who are living with HIV. The intervention was grounded in Social Cognitive Theory and incorporated an empirically backed visual representation strategy (node-link mapping). The focus of the current paper is on the main components of the intervention.
• Horvath, K. J., Beadnell, B., & Bowen, A. M. (2007). A daily web diary of the sexual experiences of men who have sex with men: comparisons with a retrospective recall survey. AIDS and behavior, 11(4), 537-48.
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  The emergence of Internet technology provides a unique opportunity to collect real-time information on the sexual behaviors of persons at risk for HIV. However, relatively little is known of the utility and reliability of web diaries. To address this gap, 45 predominantly Caucasian and gay, Internet-using men who have sex with men completed a 4-week daily web diary of their sexual behaviors. Afterward, participants completed an online retrospective recall survey (RRS) of their sexual activities during the diary period and satisfaction ratings of the web diary method. Overall, web diary estimates of sexual behaviors differed from the RRS, with a tendency to over-report on the latter with the exception of insertive unprotected anal intercourse. Additionally, compliance rates were high and there was some evidence for reactivity. Participants evaluated the web diary method positively. Web diaries appear to be a promising tool for collecting information on health behaviors.
• Pequegnat, W., Rosser, B. R., Bowen, A. M., Bull, S. S., DiClemente, R. J., Bockting, W. O., Elford, J., Fishbein, M., Gurak, L., Horvath, K., Konstan, J., Noar, S. M., Ross, M. W., Sherr, L., Spiegel, D., & Zimmerman, R. (2007). Conducting Internet-based HIV/STD prevention survey research: considerations in design and evaluation. AIDS and behavior, 11(4), 505-21.
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  The aim of this paper is to advance rigorous Internet-based HIV/STD Prevention quantitative research by providing guidance to fellow researchers, faculty supervising graduates, human subjects' committees, and review groups about some of the most common and challenging questions about Internet-based HIV prevention quantitative research. The authors represent several research groups who have gained experience conducting some of the first Internet-based HIV/STD prevention quantitative surveys in the US and elsewhere. Sixteen questions specific to Internet-based HIV prevention survey research are identified. To aid rigorous development and review of applications, these questions are organized around six common criteria used in federal review groups in the US: significance, innovation, approach (broken down further by research design, formative development, procedures, sampling considerations, and data collection); investigator, environment and human subjects' issues. Strategies promoting minority participant recruitment, minimizing attrition, validating participants, and compensating participants are discussed. Throughout, the implications on budget and realistic timetabling are identified.
• Bowen, A. M., Horvath, K., & Williams, M. L. (2006). A randomized control trial of Internet-delivered HIV prevention targeting rural MSM. HEALTH EDUCATION RESEARCH, 22(1), 120-127.
• Bowen, A., Williams, M., Dearing, E., Timpson, S., & Ross, M. (2006). Male heterosexual crack smokers with multiple sex partners: between- and within-person predictors of condom use intention. Health education research, 21(4), 549-59.
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  Little research has examined predictors of condom intention within concurrent partnerships. This study examined predictors of intention among 259 male African-American crack smokers with multiple partners. Each participant reported personal condom intention at next sex, condom use self-efficacy, responsibility and outcome expectances for himself and his perceptions for his last two sex partners. Stepwise logistic regressions showed that for both partners one and two, condom use at last sex and personal responsibility for condom use were predictors of intention to use condoms at next sex. Perceived partner responsibility was an additional positive predictor with Partner 2. Hierarchical generalized linear model analyses showed that positive intention was associated negatively with perceived partner responsibility and intimacy, while positively related to situational self-efficacy. Personal responsibility interacted with intimacy such that only men who indicated the highest levels of intimacy were more likely to intend to use condoms. Overall, the findings in this study support the need for examining additional social cognitive constructs that capture the interpersonal aspects of sexual relationships such as personal and perceived responsibility, intimacy and how beliefs may change between multiple partners and across time. Finally, the differences in the valence of perceived partner responsibility across analyses and the interaction of personal responsibility with intimacy suggest the need for studies that include measure of power within the relationship.
• Horvath, K. J., Bowen, A. M., & Williams, M. L. (2006). Virtual and physical venues as contexts for HIV risk among rural men who have sex with men. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 25(2), 237-42.
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  Rural men who have sex with men (MSM) have few identifiable venues in which to congregate and meet potential sex partners. The Internet provides a venue for rural MSM to meet, and this is potentially troubling because studies of urban MSM suggest that HIV risk is higher for men who date online. The goals of this study were to identify venues where rural MSM meet their sexual partners and to examine their association with high-risk sexual practices. Six hundred sixty-three predominantly single, gay, Caucasian MSM completed an online survey of their sexual activities. Results showed that the Internet and bars were the most popular venues for meeting sex partners. Highest rates of risk behaviors were associated with Internet dating and venues in which immediate sexual encounters typically occur, suggesting that prevention in rural areas should target multiple-risk environments.
• Horvath, K., Bowen, A., & Williams, M. (2006). Virtual and physical venues as contexts for HIV risk among rural men who have sex with men. HEALTH PSYCHOLOGY, 25(2), 237-242.
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  Rural men who have sex with men (MSM) have few identifiable venues in which to congregate and meet potential sex partners. The Internet provides a venue for rural MSM to meet, and this is potentially troubling because studies of urban MSM suggest that HIV risk is higher for men who date online. The goals of this study were to identify venues where rural MSM meet their sexual partners and to examine their association with high-risk sexual practices. Six hundred sixty-three predominantly single, gay, Caucasian MSM completed an online survey of their sexual activities. Results showed that the Internet and bars were the most popular venues for meeting sex partners. Highest rates of risk behaviors were associated with Internet dating and venues in which immediate sexual encounters typically occur, suggesting that prevention in rural areas should target multiple-risk environments.
• Williams, M. L., Bowen, A. M., Timpson, S. C., Ross, M. W., & Atkinson, J. S. (2006). HIV prevention and street-based male sex workers: an evaluation of brief interventions. AIDS education and prevention : official publication of the International Society for AIDS Education, 18(3), 204-15.
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  The purpose of this study was to evaluate the acceptability and the comparative efficacy of brief HIV risk reduction interventions to increase condom use during paid anal sex by street-based male sex workers (MSWs). Of the 399 street-based MSWs who participated in the evaluation of acceptability, 112 participated in the evaluation of efficacy. Acceptability was evaluated by assessing completion rates. Intervention efficacy was assessed across two brief interventions, a "standard" and a "standard-plus" interventions. The primary outcome of concern was condom use during paid anal sexual encounters. In addition to this variable, changes in drug use, needle use, condom use beliefs, and condom use intention were also assessed. Results showed that almost two thirds of MSWs enrolled in a brief intervention completed it. Completion rates varied by age, race/ethnicity, sexual orientation, and HIV status. Condom use during paid anal sex increased postintervention. In addition, condom use intentions, positive condom use outcome expectations, and condom use normative expectations increased preintervention to postintervention. However, there were no significant differences between the standard and the standard-plus brief interventions in any of the outcomes measured. Brief interventions to reduce the HIV risks are acceptable to MSWs and are efficacious for reducing unprotected anal sex during paid sexual encounters.
• Williams, M. L., Ross, M. W., Atkinson, J., Bowen, A., Klovdahl, A., & Timpson, S. C. (2006). An investigation of concurrent sex partnering in two samples of drug users having large numbers of sex partners. International journal of STD & AIDS, 17(5), 309-14.
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  The objective of this study was to quantitatively measure the nature of concurrent sex partnering in two samples of drug users having large numbers of sex partners. The purpose of this study was to measure concurrent sex partnering and overlap in concurrent sex partners in two samples of drug users in which some or all participants were trading sex-for-money. Two samples having large numbers of sex partners were used to conduct the analyses: drug-using male sex workers (MSW) and male and female crack cocaine smokers (CS) having vaginal sex. To reflect the quality of concurrent partnering, three measures were used: the proportion of the samples having concurrent partners; the proportions of the samples having intimate, casual, and sex-for-money of partners; and overlap in concurrent partners. Proportions of each sample having concurrent partners were essentially the same. However, the kinds of concurrent partners and overlap in concurrent partners were significantly different. Concurrent partners in the MSW sample were mostly sex-for-money or sex-for-drugs partners. Most concurrent partners in the CS sample were initimate or casual sex partners. Overlap in concurrent partners was also significantly different. The measure of overlap for the CS sample was three times higher than that of the MSW sample. These data suggest that concurrent sex partnering in the two samples, beyond the proportion having concurrent partners, was different. The patterns of concurrent sex partners in each sample may reflect different reasons for engaging in concurrent partnering. Different reasons for engaging in concurrent partnering may also be reflected in different overlap scores between the two samples. Efforts should be made in future studies to better capture the complexities of concurrent partnering and to examine the implications of these for disease spread and control.
• Williams, M., Freeman, R., Bowen, A., Zhao, Z., Elwood, W., Gordon, C., Young, P., Rusek, R., & Signes, C. (2006). A comparison of the reliability of self-reported drug use and sexual behaviors using computer-assisted versus face-to-face interviewing. AIDS EDUCATION AND PREVENTION, 12(3), 199-213.
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  sThe purpose of this study was to assess the reliability of responses to HIV risk behavior questions obtained using a voice-enhanced, computer-administered self-interview (audio-CASI) system with touch-screen response compared with those obtained via face-to-face interviews administered by trained and experienced interviewers. Additionally, the study assessed bias that may be attributable to an audio-CASI data collection format The design of the study was a four-group crossover design with random assignment to one of four study conditions: (a) audio-CASI interview at both intake and retest, (b) face-to-face interview at both intake and retest, (c) audio-CASI interview at intake and face-to-face interview at retest, and (d) face-to-face interview at intake and audio-CASI interview at retest The study was conducted with a sample of drug users at risk for HIV infection interviewed in nonclinical settings. Data were collected at intake and 48 hours after intake. Analyses show that data obtained using voice-enhanced computer interviewing with touch-screen response are reliable and are comparable to data obtained using interviewer administered face-to-face interviews. However, bias was found to be associated with data collection format and maybe partially attributable to the complexity of the questionnaire.
• Bowen, A. (2005). Internet sexuality research with rural men who have sex with men: can we recruit and retain them?. Journal of sex research, 42(4), 317-23.
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  This study examines the utility of internet banner ads for recruiting rural MSM and identifies correlates of internet HIV risk survey initiation and completion. Banner ads were shown on a popular internet dating site for one month and resulted in 1,045 rural MSM, from 49 States, Canada, Australia/New Zealand, and 5 from other countries initiating the questionnaire. Logistic regression indicated that progression beyond screening questions was negatively related to "expecting pay, but not being paid" and positively related to "using chat rooms to find friends" and identifying as gay. Linear regression indicated that the absolute number of responses by consenting participants was positively correlated with reimbursement, number of sexual partners, motivated by money, and having been HIV tested. Overall, this sample represents one of the largest rural MSM samples; survey completion was high and strengthened by reimbursement and possibly by awareness of HIV risk. Generalizability was limited by low participation of minority and non-gay identified MSM.
• Williams, M. L., Bowen, A. M., & Horvath, K. J. (2005). The social/sexual environment of gay men residing in a rural frontier state: implications for the development of HIV prevention programs. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 21(1), 48-55.
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  The incidence and prevalence of HIV/AIDS is increasing among rural men who have sex with men (MSM). Yet little is known about the social/ sexual environment of rural frontier areas.
• Williams, M., Bowen, A., & Horvath, K. (2005). The Social/Sexual environment of gay men residing in a rural frontier state: Implications for the development of HIV prevention programs. JOURNAL OF RURAL HEALTH, 21(1), 48-55.
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  Context: The incidence and prevalence of HIV/AIDS is increasing among rural men who have sex with men (MSM). Yet little is known about the social/ sexual environment of rural frontier areas. Purpose: The purpose of this study was to assess the social/sexual environment of gay men living in rural areas and how this environment contributes to the development of HIV/AIDS prevention programs. Methods: A qualitative study was conducted in Wyoming. In-depth guided interviews were conducted with 39 self-identified gay men. Data were analyzed for emergent themes using constant comparative analysis. Findings: Four broadly related themes emerged. Participants perceive that they live in a hostile social environment in which the potential for becoming a target of violence is present. In order to cope with this social reality, men adopt strategies to assimilate into the predominant heterosexual culture and to look for sex partners. These, in turn, are related to their attitudes about HIV/AIDS and prevention activities. Notably, the Internet was discussed by participants as a means for men to connect to a larger gay society and look for sex partners and as a potential venue to HIV/AIDS prevention programs. Conclusions: Data provided a number of implications for developing HIV/AIDS prevention programs targeting rural MSM. Especially apparent was the need for programs to be mindful of the desire to keep one's sexual preferences shielded from public knowledge and the effect this may have on recruiting rural MSM to participate in prevention activities. The Internet, because men can access it privately, might provide a venue for prevention projects.
• Alexander, E. N., & Bowen, A. M. (2004). Excessive drinking in college: behavioral outcome, not binge, as a basis for prevention. Addictive behaviors, 29(6), 1199-205.
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  The dichotomous variable "binge drinking" and its associated outcomes may be insufficient for understanding the drinking phenomenon on college campuses. The current study examined the behavioral outcomes associated with different drinking nights (light, typical, and heavy) in an effort to more closely examine collegiate drinking behavior. Data were collected from 236 university students, including hourly drinking rate, estimated blood alcohol concentration (BAC) was computed, and outcomes for each drinking night. Students reported drinking behavior that ranged from weekly "light night" drinking (average: 2.85 drinks, 3.34 h, end of night BAC = 0.04%) to biweekly "heavy nights" (average: 9.91 drinks, 4.93 h, end of night BAC = 0.25%). Students report encountering the greatest number of negative outcomes during heavy drinking nights, while light nights were found to have the fewest associated negative outcomes. Positive outcomes were highest on "typical" nights, although effect sizes were small. These data suggest that prevention efforts may be more successful if types of drinking night and positive outcomes become a stronger focus. Limitations and directions for future programming and research are discussed.
• Bowen, A. M., Daniel, C. M., Williams, M. L., & Baird, G. L. (2004). Identifying Multiple Submissions in Internet Research: Preserving Data Integrity. AIDS AND BEHAVIOR, 12(6), 964-973.
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  Internet-based sexuality research with hidden populations has become increasingly popular. Respondent anonymity may encourage participation and lower social desirability, but associated disinhibition may promote multiple submissions, especially when incentives are offered. The goal of this study was to identify the usefulness of different variables for detecting multiple submissions from repeat responders and to explore incentive effects. The data included 1,900 submissions from a three-session Internet intervention with a pretest and three post-test questionnaires. Participants were men who have sex with men and incentives were offered to rural participants for completing each questionnaire. The final number of submissions included 1,273 "unique", 132 first submissions by "repeat responders" and 495 additional submissions by the "repeat responders" (N = 1,900). Four categories of repeat responders were identified: "infrequent" (2-5 submissions), "persistent" (6-10 submissions), "very persistent" (11-30 submissions), and "hackers" (more than 30 submissions). Internet Provider (IP) addresses, user names, and passwords were the most useful for identifying "infrequent" repeat responders. "Hackers" often varied their IP address and identifying information to prevent easy identification, but investigating the data for small variations in IP, using reverse telephone look up, and patterns across usernames and passwords were helpful. Incentives appeared to play a role in stimulating multiple submissions, especially from the more sophisticated "hackers". Finally, the web is ever evolving and it will be necessary to have good programmers and staff who evolve as fast as "hackers".
• Ross, M. W., Timpson, S. C., Williams, M. L., & Bowen, A. M. (2003). Situational correlates of condom use in a sample of African-American drug users who are primarily crack cocaine users. AIDS and behavior, 7(1), 55-60.
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  We studied the situational determinants of condom use for vaginal sex in 151 African-American crack cocaine users in Houston, Texas, using situational presentation (Sitpres) methodology, which uses hypothetical scenarios with randomly generated levels of eight variables across 10 scenarios that may impact the decision to use a condom. Multiple regression showed that variables associated with a high probability of using a condom were older age, how badly the partner wants to use a condom, and how badly the respondent wants vaginal sex. Crack craving or level of intoxication were not correlates. The Sitpres methodology was successfully used by these crack users and data indicated that it was sexual variables, rather than drug-associated variables, that were significantly associated with condom use.
• Ross, M., Timpson, S., Williams, M., & Bowen, A. (2003). Situational correlates of condom use in a sample of African-American drug users who are primarily crack cocaine users. AIDS AND BEHAVIOR, 7(1), 55-60.
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  We studied the situational determinants of condom use for vaginal sex in 151 African-American crack cocaine users in Houston, Texas, using situational presentation (Sitpres) methodology, which uses hypothetical scenarios with randomly generated levels of eight variables across 10 scenarios that may impact the decision to use a condom. Multiple regression showed that variables associated with a high probability of using a condom were older age, how badly the partner wants to use a condom, and how badly the respondent wants vaginal sex. Crack craving or level of intoxication were not correlates. The Sitpres methodology was successfully used by these crack users and data indicated that it was sexual variables, rather than drug-associated variables, that were significantly associated with condom use.
• Timpson, S. C., Williams, M. L., Bowen, A. M., & Keel, K. B. (2003). Condom use behaviors in HIV-infected African American crack cocaine users. Substance abuse, 24(4), 211-20.
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  The purpose of this study was to investigate sexual risk behaviors and factors associated with consistent condom use of HIV+ African Americans receiving HAART who smoke crack. Participants were African Americans in Houston, Texas and over 18, being treated for HIV, and reported currently using crack. Measures included demographic variables, sexual behaviors, drug use, and nine psychosocial scales and seven escape scales. One hundred thirty seven participated in the study. Condom use was low across all partner types. Regression analyses revealed two demographic variables, and two psychosocial and one escape scale were significantly associated with intention to use condoms. One of the more alarming findings of this study concerns the large number of individuals who know they are HIV positive yet continue to have unprotected sex. The inconsistent condom use by these HIV+ individuals threatens the progress that has been made to stem the epidemic.
• Williams, M. L., Bowen, A. M., Timpson, S., & Blair Keel, K. (2003). Drug injection and sexual mixing patterns of drug-using male sex workers. Sexually transmitted diseases, 30(7), 571-4.
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  Drug-using male sex workers (DUMSWs) are known to have large numbers of drug injection and sex partners.
• Williams, M. L., Timpson, S., Klovdal, A., Bowen, A. M., Ross, M. W., & Keel, K. B. (2003). HIV risk among a sample of drug using male sex workers. AIDS (London, England), 17(9), 1402-4.
• Bourgeois, M., & Bowen, A. (2001). Self-organization of alcohol-related attitudes and beliefs in a campus housing complex: An initial investigation. HEALTH PSYCHOLOGY, 20(6), 434-437.
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  The, self-organization of college students' alcohol-related attitudes and their beliefs about other students' attitudes were assessed within a. campus housing complex. Pluralistic ignorance was widespread, in that, compared with their own self-ratings, students rated their friends and the "typical" student as being more in, favor of alcohol and more Tax in the number of drinks per hour that were acceptable and the number of drinks that were acceptable before driving. They also perceived typical students as more risky than their friends. Dynamic social impact theory was. also supported, as students' dormitory building and floor of residence reliably predicted both their personal drinking attitudes and their beliefs about the drinking attitudes of other students.
• Bowen, A., Williams, M., McCoy, H., & McCoy, C. (2001). Crack smokers' intention to use condoms with loved partners: intervention development using the theory of reasoned action, condom beliefs, and processes of change. AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV, 13(5), 579-594.
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  Prevalence rates of HIV infection acquired through heterosexual contacts have risen steadily since 1982. Crack cocaine smokers are at particular risk of HIV infection due to heterosexual exposure. HIV risk reduction interventions seeking to increase condom use among drug users have met with minimal success, and there is a need for interventions to be strongly grounded in psychosocial models of behaviour change. This study presents the results of an investigation of Predictors of intention to use condoms and related therapy processes among heterosexual drug users. Data were analyzed from 586 crack smokers recruited in Washington, DC, Miami, Florida, and Collier County, Florida who reported having both primary and casual sex partners. Participants responded to items derived from the theory of reasoned action, the theory of planned behaviour and the transtheoretical model of change. Condom use beliefs and therapy processes used to initiate and maintain condom use were assessed. Outcome expectancies and normative beliefs were the strongest predictors of intention to use condoms with a primary sexual partner. In turn, beliefs that condoms inhibit sexual romance and decrease sexual pleasure strongly predicted outcome expectancies. Therapy processes found to be associated with these constructs included: self-liberation, counter conditioning and stimulus control/reinforcement. Results suggest that HIV risk reduction interventions using a group format and targeting condom beliefs related to sexual romance and pleasure will decrease negative outcome expectancies about condom use. Also, reinforcing attempts to use condoms with intimate partners should increase positive outcome expectancies and intention to initiate or maintain condoms with a primary sexual partner.
• Ross, L. L., & Bowen, A. M. (2001). Sexual Decision Making for the oBetter Than Averageo College Student. JOURNAL OF AMERICAN COLLEGE HEALTH, 59(3), 211-216.
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  Objectives: To examine the impact of downward social comparison and the oknown partner is a safe partnero heuristic on college students' sexual decisions. Participants: One hundred-eighty heterosexual or bisexual undergraduate college students. Methods: Participants read dating vignettes that varied on perspective and familiarity and then rated the likelihood the couple would engage in sexual intercourse and use a condom. Results: There were no differences in rated likelihood based on familiarity, suggesting that the students did not view the 2 partner types as significantly different. Students rated the likelihood of sexual intercourse lower and condom use higher when the vignette was presented from the second person perspective. Conclusions: The students' use of downward social comparison is consistent with the obetter than average effect,o suggesting that the students perceive their own behavior as safe. The implication is that safer sex messages might be most effective if they focus on what students will gain by practicing safer sex behaviors, not just avoidance of a risk behavior.
• Stark, L., Jelalian, E., Powers, S., Mulvihill, M., Opipari, L., Bowen, A., Harwood, ., Passero, M., Lapey, A., Light, M., & Hovell, M. (2000). Parent and child mealtime behavior in families of children with cystic fibrosis. JOURNAL OF PEDIATRICS, 136(2), 195-200.
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  Objectives: We investigated the hypothesis thai children with cystic fibrosis (CF) and their parents would show more maladaptive behaviors during dinner than children without CF and their parents.
• Williams, M. L., McCurdy, S. A., Bowen, A. M., Kilonzo, G. P., Atkinson, J. S., Ross, M. W., & Leshabari, M. T. (2000). HIV SEROPREVALENCE IN A SAMPLE OF TANZANIAN INTRAVENOUS DRUG USERS. AIDS EDUCATION AND PREVENTION, 21(5), 474-483.
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  Injection drug use has recently emerged in sub-Saharan Africa. The purpose of this study was to assess the factors associated with increased risk of testing HIV-positive in a sample of injection drug users (IDUs) in Dar es Salaam, Tanzania. Participants were recruited by a trained outreach worker or were referred by IDUs who had completed the study. Blood specimens and self-reported socioeconomic and behavioral data were collected from 315 male and 219 female IDUs. Data were analyzed using univariate odds ratios and multivariate logistic regression modeling. Forty-two percent of the sample tested HIV-positive. Several socioeconomic, injection, and sexual factors were found to be associated with increased odds of testing HIV-positive. Multivariate analysis showed that having had sex more than 81 times in past 30 days, earning less than 100,000 shillings (US$76) in the past month, residency in Dar es Salaam for less than 5 years, and injecting for 3 years were independently associated with the greatest risk of infection. The rate of HIV infection in this sample of IDUs was found to be very high, suggesting that injection drug use may be a factor in the continuing epidemic in sub-Saharan Africa. The factors associated with increased risk of HIV infection suggest further research is needed on the needle use and sexual networks of IDUs.
• Williams, M., Elwood, W., Weatherby, N., Bowen, A., Zhao, Z., Saunders, L., & Montoya, I. (1998). An assessment of the risks of syphilis and HIV infection among a sample of not-in-treatment drug users in Houston, Texas. AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV, 8(6), 671-682.
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  The research presented in this paper details the results of an assessment of the risk factors associated with having a positive syphilis or HIV serology. The study was conducted using a sample of not-in-treatment drug users volunteering to participate in an HIV risk reduction intervention. The sample was composed of individuals who had injected drugs within 30 days or smoked crack cocaine 48 hours prior to participation in the study. Study participants were approximately 75% male and 66% African-American. All participants provided a blood sample to be tested for HIV and syphilis. Analysis of risk was conducted using univariate and multivariate statistical methods. Multivariate analysis of blood results showed that women, African-Americans, and those having a positive blood test for HIV were at higher odds of having a positive syphilis test. Analysis also showed that being a gay or bisexual male, having a history of drug injection, having less than a high-school education, having a history of trading sex for money, being African-American, and having a positive blood test for syphilis significantly increased the odds of a positive HIV test. Implications for HIV and STD prevention are discussed.
• Ross, M. W., Timpson, S. C., Williams, M. L., & Bowen, A. (1996). The impact of HIV-related interventions on HIV risk behavior in a community sample of African American crack cocaine users. AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV, 19(5), 608-616.
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  While there are reports of the impact of specific interventions designed to reduce HIV drug and sexual risk behaviors, there are few reports of the impact of HIV interventions in a community-based sample. We report on baseline data from a sample of African American crack smokers who were about to participate in an intervention designed to reduce HIV-related risk behaviors. The majority were male ( 80%), single ( 70%) and homeless ( 52%). Data indicated that 29% of the sample had been in a previous HIV intervention in the past 12 months, the majority in a correctional setting or CBO program. There were few systematic demographic differences between the two groups. Those who had been in an intervention reported using male and female condoms significantly more frequently on all measures of condom use, had positive condom use outcome expectations for male condoms and higher affective and situational condom-related self-efficacy beliefs. These data suggest that, at a community level, the spectrum of HIV risk-reduction programs does produce a significant improvement in condom use and related cognitions, although there is a need to cover a greater proportion of the population. Previous exposure to interventions must be a critical covariate in assessing the impact of future interventions.

Poster Presentations

• Bowen, A., Angiola, J., Aldrich, L., Moring, J., & Ross-Bailey, L. (2014, April). Smart Girls may Carry Condoms but they are Judged Promiscuous. Do Public Service Announcements reduce stigma?. Poster presentation at Society for Behavioral Medicine. Philadelphia.
• Bowen, A., Kitchen-Andren, ., & MacLean, . (2014, April). Health Disparities for Rural People with Intellectual and Developmental Disability. Poster Presentation for the Society of Behavioral Medicine.
• Kitchen-Andren, ., Bowen, A., & MacLean, . (2014, April). Health Care Access for People with Developmental Disability: Perspectives from Health care Coordinators. Poster Presentation for the Society of Behavioral Medicine.

Reviews

• Pequegnat, W., Rosser, B. R., Bowen, A. M., Bull, S. S., DiClemente, R. J., Bockting, W. O., Elford, J., Fishbein, M., Gurak, L., Horvath, K., Konstan, J., Noar, S. M., Ross, M. W., Sherr, L., Spiegel, D., & Zimmerman, R. (2007. Conducting Internet-based HIV/STD prevention survey research: Considerations in design and evaluation(pp 505-521).
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  The aim of this paper is to advance rigorous Internet-based HIV/STD Prevention quantitative research by providing guidance to fellow researchers, faculty supervising graduates, human subjects' committees, and review groups about some of the most common and challenging questions about Internet-based HIV prevention quantitative research. The authors represent several research groups who have gained experience conducting some of the first Internet-based HIV/STD prevention quantitative surveys in the US and elsewhere. Sixteen questions specific to Internet-based HIV prevention survey research are identified. To aid rigorous development and review of applications, these questions are organized around six common criteria used in federal review groups in the US: significance, innovation, approach (broken down further by research design, formative development, procedures, sampling considerations, and data collection); investigator, environment and human subjects' issues. Strategies promoting minority participant recruitment, minimizing attrition, validating participants, and compensating participants are discussed. Throughout, the implications on budget and realistic timetabling are identified.

Others

• Bowen, A. M. (2013, March). The importance of Family quality time for families and children with special health care needs. Wyoming Family to Family Health Information Center, Wyoming Institute for Disabilities, University of Wyoming, Laramie. http://www.uwyo.edu/wind/f2f/
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  Fact sheet for families with children diagnosed with chronic health problems
• Bowen, A. M. (2013, March). The importance of socializing with peers for you and your child with special health care needs. Wyoming Family to Family Health Information Center, Wyoming Institute for Disabilities, University of Wyoming, Laramie. http://www.uwyo.edu/wind/f2f/
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  Fact sheet for families with children with special needs.
• Bowen, A. M. (2013, March). The importance of well-being and mental health for you and your child with special health care needs. Wyoming Family to Family Health Information Center, Wyoming Institute for Disabilities, University of Wyoming, Laramie. http://www.uwyo.edu/wind/f2f/
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  fact sheet for families with children with special needs
• Moring, J., Tsega, T., Bowen, A. M., Angiola, J., & Burman, M. (2012, APR). MENTAL HEALTH NEEDS OF LOW INCOME INDIVIDUALS ATTENDING A RURAL FREE CLINIC. ANNALS OF BEHAVIORAL MEDICINE.
• Bowen, A., Angiola, J., Aldrich, L., Moring, J., & Ross-Baily, L. (2010, APR). SMART GIRLS MAY CARRY CONDOMS BUT THEY ARE JUDGED PROMISCUOUS. DO PUBLIC SERVICE ANNOUNCEMENTS REDUCE STIGMA?. ANNALS OF BEHAVIORAL MEDICINE.
• Ross, L. L., Angiola, J., Moring, J., & Bowen, A. (2010, APR). CONDOM RESPONSIBILITY: WHO'S THE BOSS?. ANNALS OF BEHAVIORAL MEDICINE.
• Williams, M., Bowen, A., & Ei, S. (2010). An evaluation of the experiences of rural MSM who accessed an online HIV/AIDS health promotion intervention. Health promotion practice.
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  The purpose of this study was to assess rural MSM's satisfaction with an Internet-delivered HIV/AIDS intervention. Objectives were to evaluate if completion rates varied by characteristics, if completion varied by computer issues, if satisfaction changed from first to last modules, and if satisfaction was associated with module order. Data were collected from 300 rural MSM. Results showed few differences between men who completed the intervention and those who dropped out. Completion was associated with income, accessing the intervention at home, time to load screens, and finding navigation easy. For those completing the intervention, interest in and perceived usefulness of the information increased from first to the last module. Module order was associated with the knowledge module. Interest in the module was greatest if it was encountered last. Results indicate that rural MSM are willing to enroll in and complete an Internet-delivered HIV/AIDS risk reduction intervention.
• Moring, J., Thomas, J., & Bowen, A. (2007, APR). IMPLICIT ATTITUDES ABOUT SOUND AND THEIR EFFECTS ON TINNITUS MAINTENANCE. ANNALS OF BEHAVIORAL MEDICINE.