Refinement and Pilot Testing of a Brief, Early Intervention for PTSD and Alcohol Use Following Sexual Assault.

Experiencing a sexual assault can have long-lasting negative consequences including development of posttraumatic stress disorder (PTSD) and alcohol misuse. Intervention provided in the initial weeks following assault can reduce the development of these chronic problems. This study describes the iterative treatment development process for refining a brief intervention targeting PTSD and alcohol misuse for women with recent sexual assault experiences. Experts, treatment providers, and patients provided feedback on the intervention materials and guided the refinement process. Based on principles of cognitive change, the final intervention consists of one in-person session and four coaching calls targeting beliefs about the assault and about drinking behavior. Initial feasibility and acceptability data are presented for patients enrolled in an open trial (N = 6). The intervention was rated as helpful, not distressing, and interesting by patients and all patients completed the entire treatment protocol. A large decrease in PTSD symptoms pre- to post-intervention was observed. A small effect on decreasing alcohol consequences also emerged, although drinks consumed per week showed a slight increase, not a decrease, over the course of the intervention. Applications of this intervention and next steps for testing efficacy are presented.

Partner Pressure, Victimization History, and Alcohol: Women's Condom-Decision Abdication Mediated by Mood and Anticipated Negative Partner Reaction.

Highly intoxicated versus sober women were evaluated using multi-group path analyses to test the hypothesis that sexual victimization history would interact with partner pressure to forgo condom use, resulting in greater condom-decision abdication-letting the man decide whether or not to use a condom. After beverage administration, community women (n = 408) projected themselves into a scenario depicting a male partner exerting high or low pressure for unprotected sex. Mood, anticipated negative reactions from the partner, and condom-decision abdication were assessed. In both control and alcohol models, high pressure increased anticipated negative partner reaction, and positive mood was associated with increased abdication. In the alcohol model, victimization predicted abdication via anticipated negative partner reaction, and pressure decreased positive mood and abdication. In the control model, under high pressure, victimization history severity was positively associated with abdication. Findings implicate condom-decision abdication as an important construct in understanding how women's sexual victimization histories may exert sustained impact on sexual interactions.

A Latent Class Analysis of Heterosexual Young Men's Masculinities.

Parallel bodies of research have described the diverse and complex ways that men understand and construct their masculine identities (often termed "masculinities") and, separately, how adherence to traditional notions of masculinity places men at risk for negative sexual and health outcomes. The goal of this analysis was to bring together these two streams of inquiry. Using data from a national, online sample of 555 heterosexually active young men, we employed latent class analysis (LCA) to detect patterns of masculine identities based on men's endorsement of behavioral and attitudinal indicators of "dominant" masculinity, including sexual attitudes and behaviors. LCA identified four conceptually distinct masculine identity profiles. Two groups, termed the Normative and Normative/Male Activities groups, respectively, constituted 88 % of the sample and were characterized by low levels of adherence to attitudes, sexual scripts, and behaviors consistent with "dominant" masculinity, but differed in their levels of engagement in male-oriented activities (e.g., sports teams). Only eight percent of the sample comprised a masculinity profile consistent with "traditional" ideas about masculinity; this group was labeled Misogynistic because of high levels of sexual assault and violence toward female partners. The remaining four percent constituted a Sex-Focused group, characterized by high numbers of sexual partners, but relatively low endorsement of other indicators of traditional masculinity. Follow-up analyses showed a small number of differences across groups on sexual and substance use health indicators. Findings have implications for sexual and behavioral health interventions and suggest that very few young men embody or endorse rigidly traditional forms of masculinity.

"He enjoys giving her pleasure": diversity and complexity in young men's sexual scripts.

Research on heterosexual men's sexual expectations has focused on self-described personal traits and culturally dominant models of masculinity. In a pair of studies, we used a sexual scripts perspective to explore the range and diversity of young men's thoughts about sex and relationships with women and to develop measures for assessing these scripts. In the first study, we conducted semi-structured interviews to elicit young men's accounts of their sexual relationships. We used these narratives to produce brief sexual script scenarios describing typical sexual situations, as well as conventional survey items assessing sexual behavior themes. In the second study, we administered the scenarios and theme items to an ethnically diverse, national sample of 648 heterosexually active young men in an online survey. Using exploratory factor analysis, we delineated sets of sexual scripts and sexual behavior themes. In the scenarios, we found both a traditional masculine "player" script and a script that emphasized mutual sexual pleasure. Analysis of theme items produced scales of Drinking and Courtship, Monogamy and Emotion, and Sexual Focus and Variety. We discuss the implications of these findings for understanding heterosexual men's thinking about sexuality and how cultural change in sexual thinking may arise. We also discuss the need for measures of sexual thinking that better integrate perceptions and expectations about the partner as well as the self in relation to the partner, rather than solely self-assessed traits.

Sexual victimization, alcohol intoxication, sexual-emotional responding, and sexual risk in heavy episodic drinking women.

This study used an experimental paradigm to investigate the roles of sexual victimization history and alcohol intoxication in young women's sexual-emotional responding and sexual risk taking. A nonclinical community sample of 436 young women, with both an instance of heavy episodic drinking and some HIV/STI risk exposure in the past year, completed childhood sexual abuse (CSA) and adolescent/adult sexual assault (ASA) measures. A majority of them reported CSA and/or ASA, including rape and attempted rape. After random assignment to a high alcohol dose (.10 %) or control condition, participants read and projected themselves into an eroticized scenario of a sexual encounter involving a new partner. As the story protagonist, each participant rated her positive mood and her sexual arousal, sensation, and desire, and then indicated her likelihood of engaging in unprotected sex. Structural equation modeling analyses revealed that ASA and alcohol were directly associated with heightened risk taking, and alcohol's effects were partially mediated by positive mood and sexual desire. ASA was associated with attenuated sexual-emotional responding and resulted in diminished risk taking via this suppression. These are the first findings indicating that, compared to non-victimized counterparts, sexually victimized women respond differently in alcohol-involved sexual encounters in terms of sexual-emotional responding and risk-taking intentions. Implications include assessing victimization history and drinking among women seeking treatment for either concern, particularly women at risk for HIV, and alerting them to ways their histories and behavior may combine to exacerbate their sexual risks.

Multidimensional characterization of sexual minority adolescents' sexual safety strategies.

Young adults have high rates of sexually transmitted infections (STIs). Sexual minority youths' risk for STIs, including HIV, is as high as or higher than sexual majority peers'. Sexual safety, while often treated as a single behavior such as condom use, can be best conceptualized as the result of multiple factors. We used latent class analysis to identify profiles based on ever-used sexual safety strategies and lifetime number of partners among 425 self-identified LGBTQ youth aged 14-19. Data collection took place anonymously online. We identified four specific subgroup profiles for males and three for females, with each subgroup representing a different level and type of sexual safety. Profiles differed from each other in terms of age and outness for males, and in outness, personal homonegativity, and amount of education received about sexual/romantic relationships for females. Youths' sexual safety profiles have practice implications for sexuality educators, health care professionals, and parents.

Social Norms: Are Sexually Aggressive Men More Likely to Misperceive Other Men's Sexual Desires and Behavior?

Separate lines of research show that men overestimate the extent of male peers' sexual activity, and independently, that sexually aggressive men believe that other men approve of coercive behavior. This study examined the intersection of these lines of inquiry, testing whether the degree of male participants' misperception of other men's sexual behavior differs as a function of perpetrator status. In a national sample, we presented heterosexually active men (n=497) with sexual scenarios varying in sexual acts, partner types, and circumstances. Results showed that participants significantly overestimated the typicality of all types of sexual situations for other men. Participants also misjudged the desirability of scenarios consistent with a traditional masculinity sexual script to other men; these scenarios reflected an adversarial perspective on relationships and an impersonal approach to sexuality - a known risk factor for sexual aggression. Further, sexually aggressive men overestimated the desirability of these traditional masculinity scenarios to a greater extent than non-aggressive peers. Findings suggest that interventions that provide accurate knowledge about social norms, or "typical" sexual desires and behaviors among other men, may reduce pressure to live up to perceived but perhaps inaccurate masculine ideals, as well as reduce social norm-related risks for sexually aggressive behavior.

Women's awareness of and discomfort with sexual assault cues: effects of alcohol consumption and relationship type.

Two studies examined the effects of alcohol and relationship type on women's sexual assault risk perception. Study 1 participants (N = 62) consumed a moderate alcohol dose or nonalcoholic beverage, then rated their awareness of and discomfort with sexual assault risk cues in a hypothetical encounter with a new or established dating partner. Study 2 (N = 351) compared control, placebo, low, and high alcohol dose conditions using a similar scenario. Intoxicated women reported decreased awareness of and discomfort with risk cues. An established relationship decreased discomfort ratings. Findings indicate that alcohol may increase women's sexual victimization likelihood through reduced sexual assault risk perception.

Young Women's Experiences with Coercive and Noncoercive Condom Use Resistance: Examination of an Understudied Sexual Risk Behavior.

OBJECTIVES: To investigate young women's engagement in and receipt of condom use resistance (CUR; attempts to avoid condom use with a partner who wants to use one), including nonconsensual condom removal ("stealthing"), with male partners. METHODS: Participants were 503 women aged 21-30 years with increased sexual risk characteristics recruited from 2013 to 2017. Participants completed measures assessing sexual victimization history and CUR experiences. RESULTS: Findings indicated that 87% of women experienced noncoercive CUR from a partner and 49% experienced coercive CUR. Of these women, 58% and 19% reported having engaged in noncoercive and coercive CUR, respectively. Twelve percent of women had a partner engage in stealthing; none of the women engaged in stealthing. The severity of sexual victimization history was positively associated with both use and receipt of coercive and noncoercive CUR. Diagnoses of sexually transmitted infections were positively associated with receipt of, but not engagement in, CUR. CONCLUSIONS: Findings demonstrate that sexual victimization and both the use and receipt of CUR are positively related for young women, suggesting that prevention efforts focusing on women's sexual health would benefit from joint consideration of sexual violence and risk behaviors and that such efforts should target victims of sexual violence.

The opposite of sex? Adolescents' thoughts about abstinence and sex, and their sexual behavior.

CONTEXT: Little research has explored how teenagers think about abstinence and how it functions in their lives. These questions are particularly salient in light of widespread funding of abstinence-only programs in the United States. METHODS: Data on attitudes and intentions related to abstinence and sex were collected from 365 adolescents aged 12-15 who participated in an HIV risk reduction program in Seattle in 2001-2003. Logistic regression analyses assessed associations between these cognitions, as measured six months after the program, and teenagers' likelihood of having vaginal or anal sex in the subsequent six months. RESULTS: Adolescents who had positive attitudes and intentions about abstinence had a reduced likelihood of subsequently engaging in sex (odds ratio, 0.6 for each), whereas those with positive attitudes and intentions about having sex had an elevated likelihood of engaging in sex (2.2 and 3.5, respectively). A regression model including only sex cognitions accounted for substantially more variation in sexual activity than did one including only abstinence cognitions (15-26% vs. 6-8%). Significant interaction effects were also seen: Among teenagers with low levels of sex intention, greater abstinence intention had little relationship to the predicted probability of having sex, but among teenagers with high levels of sex intention, greater abstinence intention was associated with increases in the predicted probability of having sex. CONCLUSIONS: Youth do not consider abstinence and sexual activity opposing constructs, and solely instilling positive abstinence attitudes and intentions in youth may not have robust effects in preventing sexual activity.

How Childhood Maltreatment Profiles of Male Victims Predict Adult Perpetration and Psychosocial Functioning.

This study used latent class analysis to empirically identify subgroups of men based on their exposure to childhood maltreatment (i.e., emotional neglect and abuse, physical neglect and abuse, and sexual abuse). It then examined subgroups' differential perpetration of adult intimate partner violence (IPV; both psychological and physical), violence against peers, and sexual assault. Finally, we compared sociodemographic variables and psychosocial functioning across profiles to characterize the adult experiences of men in different maltreatment groups. The community sample consisted of 626 heterosexually active 21- to 30-year-old men. We identified four subgroups: Low Maltreatment (80% of the sample), Emotional and Physical Maltreatment (12%), Emotional and Sexual Maltreatment (4%), and Poly-Victimized (4%). The Low Maltreatment group had significantly lower IPV perpetration rates than the Emotional and Physical Maltreatment group, but groups did not significantly differ on peer violence or sexual assault perpetration rates. Overall, Poly-Victimized men were significantly worse off than the Low Maltreatment group regarding income, education level, and incarceration history. Their rates of recent anxiety and depression symptoms were also higher than those of Low Maltreatment men. Findings support the use of person-oriented techniques for deriving patterns of childhood maltreatment and how these patterns relate to psychological, behavioral, and social factors in adulthood.

Predicting Sexual Assault Perpetration Among Heterosexually Active Young Men.

Data from an online community sample of young men were analyzed to test predictors of sexual assault perpetration. We used structural equation modeling to test the relative contributions of specific sub-types of childhood adversity to subsequent sexual aggression. Mediators included hostile masculinity, impersonal sexual behavior and attitudes, and substance use variables. Findings suggested that childhood sexual abuse had direct and mediated effects on sexual assault perpetration, but hostile masculinity was the only proximal factor significantly related to aggression. Childhood polytrauma was also associated with increased perpetration risk, suggesting that prevention efforts may be aided by increased attention to childhood maltreatment.

Correlates of Young Men's Intention to Discuss Birth Control with Female Partners.

CONTEXT: Heterosexually active men who wish to prevent conception, but are not willing to use condoms consistently, need to discuss birth control with female partners. Improving the understanding of correlates of men's intention to have such discussions is one step toward supporting this health-facilitating behavior. METHODS: A sample of 372 heterosexually active men aged 18-25 were recruited and surveyed online between December 2010 and June 2011. Men answered questions on attitudes toward, norms regarding and self-efficacy about discussing birth control, and about endorsement of two sexual scripts. Multiple regression analyses tested these measures' associations with intention to discuss birth control, controlling for age and relationship status. RESULTS: Attitudes, norms and self-efficacy were each positively associated with men's intention to discuss birth control, accounting for 34% of variance. The more strongly men endorsed a traditional masculinity sexual script, the less likely they were to intend to discuss birth control (coefficient, -0.2). Endorsement of an alternative, gender-equitable "sex-positive woman" script, which emphasizes sexual pleasure and emotional connection as goals for both partners, had no association with intention. CONCLUSION: Strategies that merit further exploration as potential supports for men's intention to discuss birth control include improving men's self-efficacy and positive attitudes and norms pertaining to such discussions, and reducing belief in traditionally masculine sexual scripts or transforming them to include discussing birth control. Future research should work both experimentally and longitudinally to document each element of the process that ends with men's full participation in effective contraceptive use.

Women's responses to sexual aggression: the effects of childhood trauma, alcohol, and prior relationship.

This study examined effects of alcohol consumption (control, moderate dose, high dose) and type of relationship (new, established) on women's responses to escalating male sexual aggression. The role of childhood trauma was also examined. After consuming a beverage, participants (N=220) projected themselves into a story portraying a social interaction with a man that depicted escalating sexual aggression. The story was paused 3 times to assess assertive, polite, and passive resistance as well as consent. Alcohol consumption increased consent and interacted with type of relationship to increase passive resistance and with level of sexual aggression to increase polite resistance. Assertive resistance increased and other responses decreased as the man's sexual aggression escalated. Childhood trauma lowered consent initially and increased passive resistance when rape was threatened.

Patterns of Intimate Partner Violence and Sexual Risk Behavior among Young Heterosexually Active Men.

Intimate partner violence (IPV) victimization is linked to sexual risk exposure among women. However, less is known about the intersection of IPV perpetration and sexual risk behavior among men. This study used data from a diverse, community sample of 334 heterosexually active young men, aged 18 to 25, across the United States to examine whether and how men with distinct IPV-related behavior patterns differed in sexual risk-related behavior and attitudes. Participants were recruited and surveyed online, and grouped conceptually based on the types of IPV perpetration behavior(s) used in a current or recent romantic relationship. Groups were then compared on relevant sexual risk variables. Men reporting both physical abuse and sexual coercion against intimate partners reported significantly higher numbers of lifetime partners, higher rates of nonmonogamy, greater endorsement of nonmonogamy, and less frequent condom use relative to nonabusive men or those reporting controlling behavior only. This group also had higher sexually transmitted infection (STI) exposure compared to men who used controlling behavior only and men who used sexual coercion only. Findings suggest that interventions with men who use physical and sexual violence need to account for not only the physical and psychological harm of this behavior but also the sexual risk to which men may expose their partners.

In-The-Moment Dissociation, Emotional Numbing, and Sexual Risk: The Influence of Sexual Trauma History, Trauma Symptoms, and Alcohol Intoxication.

OBJECTIVE: Prior research on the effects of sexual trauma has examined dissociation but not emotional numbing during sex and has relied exclusively on retrospective surveys. The present experiment examined associations among distal factors of childhood sexual abuse (CSA), adolescent/adult sexual assault (ASA), and trauma symptoms and the proximal factor of acute alcohol intoxication on in-the-moment dissociation, emotional numbing, and sexual risk intentions. METHOD: Young adult female drinkers (N = 436) at elevated sexual risk were randomized to receive alcohol (target peak breath alcohol concentration = .10%) or no alcohol. They then read an eroticized sexual scenario and reported on their dissociation and emotional numbing experiences, unprotected sex refusal self-efficacy, and unprotected sex intentions. RESULTS: Path analysis revealed that CSA was indirectly associated with increased unprotected sex intentions through increased ASA severity, increased trauma-related symptoms, increased emotional numbing, and decreased unprotected sex refusal self-efficacy. Further, alcohol intoxication was indirectly associated with increased unprotected sex intentions through increased emotional numbing and decreased unprotected sex refusal self-efficacy. CONCLUSIONS: Emotional numbing, but not dissociation, was associated with unprotected sex intentions and may be one potential target for interventions aimed at reducing HIV/STI-related risk among women with a history of sexual trauma.

Condoms and Contexts: Profiles of Sexual Risk and Safety Among Young Heterosexually Active Men.

Heterosexual men's sexual safety behavior is important to controlling the U.S. epidemic of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). While sexual safety is often treated as a single behavior, such as condom use, it can also be conceptualized as resulting from multiple factors. Doing so can help us achieve more nuanced understandings of sexual risk and safety within partner-related contexts. We used latent class analysis with data collected online from 18- to 25-year-old heterosexually active U.S. men (n = 432) to empirically derive a typology of the patterns of sexual safety strategies they employed. Indicators were sexual risk-reduction strategies used in the past year with the most recent female sex partner: condom use, discussing sexual histories, STI testing, agreeing to be monogamous, and discussing birth control. We identified four subgroups: Risk Takers (12%), Condom Reliers (25%), Multistrategists (28%), and Relationship Reliers (35%). Partner-related context factors--number of past-year sex partners, relationship commitment, and sexual concurrency--predicted subgroup membership. Findings support tailoring STI prevention to men's sexual risk-safety subgroups. Interventions should certainly continue to encourage condom use but should also include information on how partner-related context factors and alternate sexual safety strategies can help men reduce risk for themselves and their partners.

A person-centered approach to examining heterogeneity and subgroups among survivors of sexual assault.

This study identified subgroups of female sexual assault survivors based on characteristics of their victimization experiences, validated the subgroup structure in a second cohort of women recruited identically to the first, and examined subgroups' differential associations with sexual risk/safety behavior, heavy episodic drinking (HED), psychological distress symptomatology, incarceration, transactional sex, and experiences with controlling and violent partners. The community sample consisted of 667 female survivors of adolescent or adult sexual assault who were 21 to 30 years old (M = 24.78, SD = 2.66). Eligibility criteria included having unprotected sex within the past year, other HIV/STI risk factors, and some experience with HED, but without alcohol problems or dependence. Latent class analyses (LCA) were used to identify subgroups of women with similar victimization experiences. Three groups were identified and validated across 2 cohorts of women using multiple-group LCA: contact or attempted assault (17% of the sample), incapacitated assault (52%), and forceful severe assault (31%). Groups did not differ in their sexual risk/safety behavior. Women in the forceful severe category had higher levels of anxiety, depression, and trauma symptoms; higher proportions of incarceration and transactional sex; and more experiences with controlling and violent partners than did women in the other 2 groups. Women in the forceful severe category also reported a higher frequency of HED than women in the incapacitated category. Different types of assault experiences appear to be differentially associated with negative outcomes. Understanding heterogeneity and subgroups among sexual assault survivors has implications for improving clinical care and contributing to recovery.

Cognitive mediation of women's sexual decision making: the influence of alcohol, contextual factors, and background variables.

As a result of the current STI epidemic, women are at particularly high risk. Sexual relations with men are the greatest source of risk for women in contracting HIV or other STIs. Because the male condom is still the most effective means of protection against these diseases, prevention efforts for women need to concentrate on the ability to effectively negotiate condom use. To date, research has primarily addressed the role of knowledge, attitudes, and beliefs about condoms in predicting their use rather than the situation within which individuals make sexual decisions. Our first goal is to present a theoretical model focusing on the situational influences and cognitive processes occurring at the time of a woman's sexual interaction with a man. The underlying premise for this model is that sexual decision making is mediated by a series of primary and secondary appraisals during the sexual encounter. Our second goal is to discuss specific contextual influences on women's cognitions during the process leading to sexual decision making. We review the literature on the effects of alcohol consumption, relationship status, and sexual arousal on the cognitive appraisal process, as well as on sexual decision making. Finally, although our main interest is the specific situation and context, we also review the influence of background factors and experiences that are especially relevant to the cognitive appraisal process, including alcohol expectancies, sexual victimization, sexuality-related characteristics, relationship-related characteristics, and other personality traits. Examining women's cognitive processes at the time of a sexual encounter can yield information that will enhance women's power to protect themselves against HIV and other STIs.