Published online May 2, 2005
PEDIATRICS Vol. 115 No. 5 May 2005, pp. e573-e581 (doi:10.1542/peds.2004-2073)
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ELECTRONIC ARTICLE

Affect and Sexual Behavior in Adolescents: A Review of the Literature and Comparison of Momentary Sampling With Diary and Retrospective Self-Report Methods of Measurement

Lydia A. Shrier, MD, MPH*, Mei-Chiung Shih, PhD{ddagger} and William R. Beardslee, MD§

* Division of Adolescent/Young Adult Medicine
{ddagger} Clinical Research Program
§ Department of Psychiatry, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts

Objective. Assessment of mental health is important in understanding sexual risk behavior in adolescents, yet few studies have examined how affect is directly related to sexual behavior. Momentary sampling (MS) methods permit real-time assessment of affect in relation to specific events and embed the collected data in the context of the respondent's moment-to-moment life. The objectives of this study were to review the literature on affect and sexual behavior and to compare the feasibility and acceptability of MS with diaries and retrospective self-report as a means of collecting temporally relevant data on affect and sexual behavior in adolescents.

Methods. Sexually active, nondepressed adolescent outpatients who were aged 15 to 18 years were randomly assigned to a schedule of the 3 methods of data collection for 2 weeks each. All participants completed a retrospective self-report by interview at the end of each 2-week period. In the diary arm, participants completed twice-daily paper-and-pencil diary cards, which were returned by mail. In the MS arm, participants used 2-way pagers to respond to several random pages per day. Primary outcomes included rates of completion (diaries vs MS reports) and the participants' tolerance of and preferences for the methods. A secondary outcome was the agreement in means for positive and negative affect and in report of days on which substance use and sexual activity occurred. Associations of affect with contextual factors and with sexual activity were also explored in the MS arm.

Results. Ten youths completed 30 of 30 retrospective self-reports (100%, 3 per participant, by design), 254 of 280 diaries (91%; mean: 25.4 per participant), and 442 of 600 MS reports (74%; mean: 44.2 per participant). Most participants preferred the MS method to the diaries or retrospective self-report. Affect scores and reports of sexual activity and substance use were correlated among the methods. Measured with MS, affect was found to differ by location, companionship, and thoughts when paged; notably, positive affect was highest when participants reported thoughts about sex. There was no difference in affect before versus after coitus.

Conclusions. The results of this study suggest that MS in adolescents is feasible and preferred and provides contextual, temporally relevant, event-level data on affect and sexual activity that are not readily measured with traditional methods. Future research using MS methods will be important in increasing our understanding of the link between affect and sexual behavior and inform the development of improved risk reduction interventions for adolescents.

Key Words: affect • sexual behavior • substance use • momentary sampling • diary • retrospective self-report

Abbreviations: STI, sexually transmitted infection • MS, momentary sampling • BDI, Beck Depression Inventory • NA negative affect • PA, positive affect • ESM, Experience-Sampling Method • EMA, Ecological Momentary Assessment • PANAS, Positive Affect-Negative Affect Schedule

Accepted Nov 23, 2004.