title: Momentary assessment of PTSD symptoms and sexual risk behavior in male OEF/OIF/OND Veterans.
abstract: BACKGROUND
  Post-traumatic stress disorder (PTSD) in Veterans is associated with increased sexual risk behaviors, but the nature of this association is not well understood. Typical PTSD measurement deriving a summary estimate of symptom severity over a period of time precludes inferences about symptom variability, and whether momentary changes in symptom severity predict risk behavior.
  
  
  METHODS
  We assessed the feasibility of measuring daily PTSD symptoms, substance use, and high-risk sexual behavior in Veterans using ecological momentary assessment (EMA). Feasibility indicators were survey completion, PTSD symptom variability, and variability in rates of substance use and sexual risk behavior. Nine male Veterans completed web-based questionnaires by cell phone three times per day for 28 days.
  
  
  RESULTS
  Median within-day survey completion rates maintained near 90%, and PTSD symptoms showed high within-person variability, ranging up to 59 points on the 80-point scale. Six Veterans reported alcohol or substance use, and substance users reported use of more than one drug. Eight Veterans reported 1 to 28 high-risk sexual events. Heightened PTSD-related negative affect and externalizing behaviors preceded high-risk sexual events. Greater PTSD symptom instability was associated with having multiple sexual partners in the 28-day period.
  
  
  CONCLUSIONS
  These results are preliminary, given this small sample size, and multiple comparisons, and should be verified with larger Veteran samples.
  
  
  CONCLUSIONS
  Results support the feasibility and utility of using of EMA to better understand the relationship between PTSD symptoms and sexual risk behavior in Veterans. Specific antecedent-risk behavior patterns provide promise for focused clinical interventions.
authors.affiliation: Yale School of Medicine, New Haven, CT 06519, USA; VA Connecticut Healthcare System, West Haven, CT 06516, USA. Electronic address: anne.black@yale.edu.
authors.forename: Anne C
authors.initials: AC
authors.lastname: Black
authors.affiliation: Yale School of Medicine, New Haven, CT 06519, USA; VA Connecticut Healthcare System, West Haven, CT 06516, USA. Electronic address: ned.cooney@va.gov.
authors.forename: Ned L
authors.initials: NL
authors.lastname: Cooney
authors.affiliation: Yale School of Medicine, New Haven, CT 06519, USA; Yale School of Public Health, New Haven, CT 06519, USA; VA Connecticut Healthcare System, West Haven, CT 06516, USA. Electronic address: amy.justice2@va.gov.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
authors.affiliation: Yale School of Medicine, New Haven, CT 06519, USA. Electronic address: lynn.fiellin@yale.edu.
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Fiellin
authors.affiliation: Yale School of Medicine, New Haven, CT 06519, USA; VA Connecticut Healthcare System, West Haven, CT 06516, USA; U.S. Department of Veterans Affairs National Center for PTSD, USA. Electronic address: robert.pietrzak@yale.edu.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pietrzak
authors.affiliation: Yale School of Medicine, New Haven, CT 06519, USA; VA Connecticut Healthcare System, West Haven, CT 06516, USA. Electronic address: christina.lazar@yale.edu.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Lazar
authors.affiliation: Yale School of Medicine, New Haven, CT 06519, USA; VA Connecticut Healthcare System, West Haven, CT 06516, USA. Electronic address: marc.rosen@yale.edu.
authors.forename: Marc I
authors.initials: MI
authors.lastname: Rosen
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000175:diagnosis* / Q000523:psychology*; D019966:Substance-Related Disorders / Q000150:complications; D011795:Surveys and Questionnaires; D013850:Thinking; D047568:Unsafe Sex / Q000523:psychology*; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: EMA; HIV; PTSD; Sexual risk; Substance use; Veterans