Young adults aged 18-24 who abuse alcohol are at heightened risk for contracting human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs). However, the factors and mechanisms underlying alcohol abuse and HIV/STI risk behaviors in young adults are not well understood, and most existing efforts to promote safer sex behaviors have not been tailored to this unique population. Thus, there continues to be a need for research that focuses on an improved understanding of the factors that are most likely to translate into more effective, empirically-supported interventions for HIV/STI risk behavior reduction in young adults who abuse alcohol. One such factor, and especially promising target for intervention, involves the concept of self-regulation, or the capacity to override desires, thoughts, emotions, and behavior patterns that otherwise might lead to potentially undesirable outcomes. Indeed, poor self-regulation in the heat of the moment has been found to lead to risky sexual decision making in laboratory studies and is generally associated with HIV/STI risk behavior. However, while some initial studies suggest an important role for these processes, to date no research has systematically tested 1) whether specific self-regulatory deficiencies contribute to HIV/STI risk behavior and 2) whether interventions that target changes in these self-regulatory mechanisms may have the potential to reduce HIV/STI risk behavior in young adults. The following hypotheses will be tested in the proposed research: 1) Attentional processes underlie failures in self-regulatory mechanisms in the context of HIV/STI risk behavior and alcohol abuse, and 2) the modification of attentional processing of cues indicative of safe vs. risky sex decrease HIV/STI risk behaviors in sexually active young drinkers. The proposed research tests these hypotheses in two ways. First, a laboratory study will be conducted to elucidate the attentional processes that have been implicated in failures to self-regulate in addictive and impulse control behaviors, but which have, to date, not been explicitly addressed in terms of their potential role in the regulation of HIV/STI risk behavior. To do so, eye-tracking software will measure visual attention to risk- related information (e.g., frequency of past condom use, # of previous sexual partners) of high and low risk hypothetical sexual partners depicted on a computerized sexual decision making task. Second, the study will examine whether an experimentally-adopted safe-sex schema - an attention-regulation strategy adapted from cognitive therapy - influences participants' sexual decision making and attention patterns to risk-related information on the task. The long-term goals of the proposed research are 1) to contribute to a promising, emerging literature on the role of cognitive processes in sexual decision making, and 2) to lay the groundwork for more empirically-based interventions for HIV/STI risk behavior reduction, particularly in individuals who abuse alcohol. PUBLIC HEALTH RELEVANCE: While young adults who abuse alcohol are at increased risk for contracting human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), the mechanisms underlying sexual risk behavior are not well understood, and HIV/STI risk behavior reduction interventions do not always address mechanisms that may be crucial for eliciting behavior change. The proposed study hypothesizes that attentional processes contribute to failures to inhibit HIV/STI risk behaviors, and that modifying attention to sexual risk and reward cues can decrease sexual risk taking in sexually active young drinkers. This project has the potential to further our understanding of basic cognitive processes that underlie sexual risk behavior, as well as to provide a springboard for development of empirically-based HIV/STI risk behavior reduction interventions.