Predictors of mental health outcomes of three refugee groups in an advocacy-based intervention: A precision medicine perspective.

OBJECTIVE: Precision medicine is an area with great potential for mental health, but has made limited gains prognostically in predicting effective treatments. For refugees exposed to violence, culture may be a crucial factor in predicting treatment outcomes. METHOD: For this study, 290 participants from three regions (Afghanistan, the Great Lakes region of Africa, and Iraq and Syria) participated in a randomized controlled trial of an advocacy-based intervention. Emotional distress symptoms were measured prior to intervention, midintervention (3 months), postintervention (6 months), and follow-up (6 months after the end of intervention). Number of traumatic events, resource access, social support, and English proficiency were tested for potential predictive effects on intervention outcome. RESULTS: Multilevel generalized linear models revealed that Afghans' (B = -0.259, SE = 0.108, p = .013), and Great Lakes Africans' (B = -0.116, SE = 0.057, p = .042) emotional distress symptoms improved as a function of the intervention, while Iraqis and Syrians showed no intervention effects. For Afghans, English proficiency (B = -0.453, SE = 0.157, p < .01) and social support (B = -0.179, SE = 0.086, p = .037) were most strongly correlated to emotional distress, while for Africans, resource access (B = -0.483, SE = 0.082, p < .001) and social support (B = -0.100, SE = 0.048, p = .040) were the strongest predictors of emotional distress. CONCLUSIONS: Response to advocacy-based interventions and active ingredients may be influenced by culture; findings have implications for refugees and precision medicine. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Alcohol Use, Rape Myth Acceptance, Rape Empathy, and Sexual Assault History Influence the Believability of a Hypothetical Victim's Report of Sexual Assault.

College sexual assault is a common problem, and survivors often do not report their experience to college campus officials or law enforcement for fear of not being believed. This study examined how contextual factors such as alcohol use and whether the perpetrator was described as a student-athlete or student, and rater characteristics, such as the history of sexual assault and attitudes toward rape, influenced college students' perceptions of the believability of a hypothetical victim's sexual assault account. In all, 449 (N = 449) undergraduates read a vignette describing a hypothetical sexual assault and were assigned randomly to one of four conditions with varying contextual features: college athlete-no alcohol, college athlete-alcohol, college student-no alcohol, or college student-alcohol. They then rated how much they believed the victim in the vignette had been raped (0 [not at all] to 100 [completely]). The presence of alcohol use in the vignette was associated with lower ratings of believability, and participants who were higher in rape myth acceptance and lower in rape empathy rated the hypothetical victim's rape account as less believable. In addition, women who had been raped previously rated the victim in the vignette as more believable than women with no history of sexual assault. Implications for how college campuses might respond more effectively to reported sexual assaults are discussed.

Sexual Assaults, Bad Hookups, and Bad Dates: Comparisons of the Contextual Features Among College Women's Hypothetical and Real-Life Sexual and Dating Experiences.

Two hundred forty-seven (N = 247) undergraduate women at a medium-sized, Southwestern university provided written descriptions of a hypothetical sexual assault (SA). Women with a prior history of SA also described their actual SA experiences; women without a SA history provided a written description of a prior bad date or hookup. The contextual features of SA scripts were compared to those of actual SA experiences. Several characteristics of a stereotypical or "blitz rape" (e.g., physical force by a stranger) were more likely to be included in SA scripts relative to women's actual SA experiences. Victimized women were also more likely to include verbal coercion, a hangout/hookup context, and previous consensual kissing in their SA experiences, in comparison to their SA scripts. The contextual features of SA experiences were also compared to the contextual features of bad dates or bad hookups. SA experiences, relative to bad dates, were more likely to include alcohol use, physical and verbal coercion by the perpetrator, and passive resistance. SA experiences, relative to bad hookups, were more likely to include physical and verbal coercion by the perpetrator, and knowing the man for less than 1 week. Victimized participants SA experiences were also found to be less likely to include previous consensual kissing and consensual intercourse in comparison to bad hookup experiences of nonvictimized women. Overall, there was considerable overlap between the contextual features present across all experiences. The lack of differentiation among these events may explain why women experience difficulty acknowledging whether they have experienced SA.

Sexual Assault, Psychological Distress, and Protective Factors in a Community Sample of Black, Latinx, and White Lesbian and Bisexual Women.

Intersectionality and minority stress frameworks were used to guide examination and comparisons of psychological distress (depression, anxiety, posttraumatic stress disorder symptoms) and protective factors (religiosity, spirituality, social support) among 673 Black, Latinx, and White lesbian and bisexual women with and without histories of sexual assault. Participants were from Wave 3 of the 21-year longitudinal Chicago Health and Life Experiences of Women (CHLEW) study. More than one-third (38%) of participants reported having experienced adolescent or adult sexual assault (i.e., rape or another form of sexual assault) since age 14. Confirmatory factor analysis, structural equation modeling, and multivariate analyses of covariance were used to analyze the data. Results revealed that levels of religiosity/spirituality and psychological distress varied by race/ethnicity and by sexual identity (i.e., Black lesbian, Black bisexual, Latinx lesbian, Latinx bisexual, White lesbian, White bisexual). Black lesbian women reported the highest level of religiosity/spirituality whereas White lesbian women reported the lowest level. White bisexual women reported the highest level of psychological distress whereas White lesbian women reported the lowest level. We found no significant differences in reports of sexual assault or in social support (i.e., significant other, family, friend, and total social support). However, White lesbian women had higher friend, significant other, and total social support relative to the other five groups of women with minoritized/marginalized sexual identities. Future work should examine whether religiosity, spirituality, and social support serve as protective factors that can be incorporated into mental health treatment for lesbian and bisexual who have experienced sexual assault to reduce psychological distress.

Occasions of Alcohol and Cannabis Use and Associated Risk for Sexual Assault Among College Women With Higher Sexual Risk Alcohol Expectancies.

OBJECTIVE: College women report high rates of sexual assault. Research focused on women's risk factors for sexual assault remains necessary to assist women in reducing their risk. Previous work has shown alcohol use and cannabis use to be associated with sexual assault. The current study examined whether individual difference variables moderated women's risk for sexual assault during occasions of alcohol use and cannabis use using ecological momentary assessment (EMA). METHOD: Participants were 18- to 24-year-old first-year undergraduate women (N = 101) who were unmarried and interested in dating men, consumed three or more alcoholic drinks on one occasion in the month before baseline, and engaged in sexual intercourse at least once. Baseline individual difference variables included sex-related alcohol expectancies, alcohol problems, decision skills, and sexual attitudes. EMA reports, collected three times per day over 42 days, included items regarding alcohol and cannabis use and sexual assault experiences. RESULTS: Among women who experienced sexual assault during the EMA period (n = 40), those with higher sexual risk expectancies had a higher probability of sexual assault during occasions when they were using alcohol or cannabis. CONCLUSIONS: Several modifiable risk factors for sexual assault and individual differences factors may exacerbate risk. Ecological momentary interventions may be useful to reduce sexual assault risk for women with high sexual risk expectancies who use alcohol or cannabis.

Substance Use, Risky Sex, and Peer Interactions Predict Sexual Assault Among College Women: An Ecological Momentary Assessment (EMA) Study.

Sexual assault is an unfortunately common experience among women in college campuses. This study used ecological momentary assessment (EMA) to gain a better understanding of the contextual determinants of sexual assault among college women. EMA reports inquired about sexual assault experiences, risky sex (sex without a condom and regretted hookups), and substance use (alcohol and cannabis use), as well as what activities participants were engaged in (e.g., pregaming, drinking with peers, and drinking with a casual sexual partner), and whether they experienced peer pressure to engage in casual sex. Participants were 103 freshman undergraduate women (18-24 years old) at a Southwestern university in the United States, who were unmarried, interested in dating opposite-sex partners, engaged in binge drinking (defined as having 3 or more drinks on one occasion) in the past month, and reported at least one experience of sexual intercourse in their lifetime. Participants completed reports (one random and two time-contingent) via EMA three times a day over a 42-day period. Compliance in completing EMA reports was good (84.2% of prompted reports were completed), and time-to-completion of reports once signaled was acceptable (mean = 26 minutes, median = 5.75 minutes). During the 42 days, 40 women (38.8%) reported 75 occasions of sexual assault. The odds of experiencing sexual assault were significantly greater during occasions of regretted hookups and unprotected sex. Additionally, drinking with peers and peer pressure to engage in casual sex were each associated significantly with occasions of sexual assault. Reducing risk for sexual assault among undergraduate women may be possible by targeting these behaviors and contextual features in near real-time via momentary intervention.

Occasions of Alcohol and Cannabis Use and Associated Risk for Sexual Assault among College Women with Higher Sexual Risk Alcohol Expectancies.

OBJECTIVE: College women report high rates of sexual assault (SA). Research focused on women's risk factors for SA remains necessary to assist women in reducing their risk. Previous work has shown alcohol and cannabis use to be associated with SA. The current study examined whether individual difference variables moderated women's risk for SA during occasions of alcohol and cannabis use using ecological momentary assessment (EMA). METHOD: Participants were 18-24-year-old first-year undergraduate women (N=101), who were unmarried and interested in dating men, consumed three or more alcoholic drinks on one occasion in the month before baseline, and engaged in sexual intercourse at least once. Baseline individual difference variables included sex-related alcohol expectancies, alcohol problems, decision skills, and sexual attitudes. EMA reports, collected three times per day over 42 days, included items regarding alcohol and cannabis use and SA experiences. RESULTS: Among women who experienced SA during the EMA period (n=40), those with higher sexual risk expectancies had a higher probability of SA during occasions when they were using alcohol or cannabis. CONCLUSIONS: Several modifiable risk factors for SA and individual differences factors may exacerbate risk. Ecological momentary interventions may be useful to reduce SA risk for women with high sexual risk expectancies who use alcohol or cannabis.

Measurement Invariance of the Sexual Assault Script Scale (SASS): An Examination Among Hispanic and Non-Hispanic White College Women.

Rates of sexual victimization have remained steady over several decades, and preventative interventions to reduce men's sexually aggressive behavior have been largely ineffective. As such, research has endeavored to find novel approaches to identify women at increased risk for sexual victimization. Sexual assault scripts, or "cognitive models" that women adhere to that guide their beliefs about sexual assault are posited to influence their victimization risk. Prior studies on sexual assault scripts primarily have been qualitative in nature; however, recent work yielded a 27-item measure of putative risk for sexual victimization called the Sexual Assault Script Scale (SASS). The SASS has four subscales called Stereotypical Assault Scripts, Acquaintance Assault Scripts, Assault Resistance Scripts, and Date/Friend Assault Scripts, which were found in prior work to be internally consistent and associated with putative risk factors for sexual victimization. The focus of the current study was to test the measurement invariance of the SASS among Hispanic and non-Hispanic White college women who were recruited in the prior study. Four hundred sixty-nine (N = 469) Hispanic and 415 non-Hispanic White US undergraduate heterosexual or bisexual women from a Southwestern university in the United States completed the SASS. Confirmatory factor analysis (CFA) replicated the prior four-factor model with an acceptable fit to the data, and tests of measurement invariance revealed the SASS to be invariant across Hispanic and non-Hispanic White college women, suggesting that the SASS is measuring a similar construct in these groups.

Women's Response Performance in Sexually Risky Situations: Associations With Disinhibited Sex-Related Alcohol Expectancies.

This study evaluated the effects of sexual victimization history, alcohol-related problems, psychological distress, and disinhibited sex-related alcohol expectancies on the effectiveness of women's response performance in hypothetical social situations depicting risk for sexual victimization. Two hundred and forty-five undergraduate women first listened to audiotaped descriptions of the hypothetical social situations and imagined that they were the woman depicted in each scenario. They then were given a response to each situation deemed in prior work by experts in the sexual victimization research area to be effective at reducing risk for sexual victimization and asked to provide each response verbally while being videotaped. Participants then completed measures assessing prior victimization history, alcohol-related problems, psychological distress, and disinhibited sex-related alcohol expectancies. Experts in the sexual violence research area rated participants' responses with respect to how effective each response was in decreasing their risk for having an unwanted sexual experience, defined as an experience in which the woman may be verbally or physically coerced into having a sexual contact of any kind with a man. Structural equation modeling analyses revealed that disinhibited sex-related alcohol expectancies were associated positively with women's response performance, indicating that women who endorsed greater disinhibited sex-related alcohol expectancies provided more effective responses to risky hypothetical situations. Findings suggest possible interventions aimed at reducing women's risk of sexual victimization.

Randomized Trial to Reduce Risky Sexual Behavior Among Justice-Involved Adolescents.

INTRODUCTION: Justice-involved adolescents are at high risk for sexually transmitted infections; one primary reason is co-occurring substance use. This study investigates the additive benefit of including alcohol and cannabis use content in a theory-based sexual risk reduction intervention, delivered using group-based motivational enhancement therapy. STUDY DESIGN: This study had a cluster randomized design, with randomization of single-sex clusters to 1 of 3 interventions. SETTING/PARTICIPANTS: Participants were male and female justice-involved adolescents (N=460) residing in youth detention facilities. Data were collected from 2010 to 2014; analyses were completed in 2018-2019. INTERVENTION: Adolescents were randomized to 1 of 3 motivational enhancement therapy interventions: sexual risk reduction intervention, sexual risk reduction intervention with alcohol content, or sexual risk reduction intervention with alcohol and cannabis content. MAIN OUTCOME MEASURES: The primary outcome was risky sexual behavior (aggregation of condom use and frequency of intercourse), measured every 3 months for 1 year. Secondary outcomes were theoretical mechanisms on which the intervention was based (condom use attitudes, self-efficacy, peer norms, and behavioral intentions), collected at baseline and post-test. RESULTS: Risky sexual behavior significantly decreased from baseline to 3-month follow-up (t=10.59, p<0.001) and this decrease was maintained 1 year later (t=9.04, p<0.001). Intervention was associated with improved values on all theoretical mechanisms. Although all outcomes improved over time, changes did not differ by intervention condition (p>0.29 for all). Comparisons to a historical, information-only, sexual risk reduction control arm conducted with a similar juvenile justice sample confirm the effectiveness of all 3 motivational enhancement therapy-based interventions. CONCLUSIONS: All 3 interventions were associated with decreased sexual risk up to 1 year later, suggesting that the intervention modality (motivational enhancement therapy) may resonate with this population beyond the specific substance use content. This single-session manualized intervention can be readily disseminated to juvenile justice settings. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT01170260.

Comparisons of Sexual Victimization Experiences among Sexual Minority and Heterosexual Women.

This study examined the associations among heterosexual women (HW) and sexual minority women (SMW; for example, lesbian and bisexual), adolescent and adult sexual victimization experiences, childhood experiences of abuse, coping strategies, and mental health symptoms. Participants were 177 women recruited across the United States via the Internet to complete an online survey. Participants first completed the Sexual Experiences Survey and then described qualitatively their most distressing and/or severe sexual victimization experience. They were asked to include situational (e.g., location, alcohol, and drug use) and interpersonal features (e.g., relationship to perpetrator) of their experience. They then completed self-report questionnaires on childhood sexual abuse, coping with substances, coping through self-blame, social reactions to their assault disclosure, and symptoms of anxiety, depression, and somatization. Nonparametric tests were used to examine associations among the variables. There were no significant differences between SMW and HW in terms of the contextual features (i.e., situational, interpersonal) of their most distressing (i.e., severe) sexual victimization experiences or their postassault experiences. However, results revealed significant associations between sexual minority status and both victimization severity and sexual revictimization, with SMW reporting more severe victimization histories and higher rates of sexual revictimization relative to HW. In addition, there was a significant difference between SMW and HW with respect to coping through substances, with SMW reporting more substance use relative to HW. Future work should endeavor to identify the reasons for these important differences and seek to develop appropriate interventions for SMW who have experienced sexual violence.

Sexual Attitudes, Perceptions of Attractiveness, and Level of Coercion Affect Undergraduate Men's Judgments of Women's Responses to Sexual and Nonsexual Social Situations.

The aims of this study were to (a) evaluate undergraduate men's (N = 108) judgments of the effectiveness of women's responses to increasingly coercive sexual victimization risk and nonsexual social situations and (b) examine whether individual difference factors (e.g., perceptions of attractiveness, rape empathy) influenced these judgments. As part of a larger study, undergraduate women were video recorded responding to a series of vignettes depicting increasingly coercive sexual and nonsexual social situations. Undergraduate men then rated the effectiveness of these responses in either decreasing risk for sexual victimization (for the sexual victimization risk situations) or increasing the likelihood of achieving a social goal (for the nonsexual social situations), as well as each woman's physical attractiveness. Multilevel modeling results revealed that both situational-level (i.e., level of coercion) and individual-level factors (i.e., rape empathy, perceived attractiveness of the women, and rape myth acceptance) were associated with men's judgments of the effectiveness of women's responses in sexually risky situations. Specifically, responses were rated as less effective in decreasing victimization risk as the level of coercion increased, and men who reported lower rape empathy, lower perceived attractiveness of the woman, and higher rape myth acceptance judged women's responses as less effective than men who reported higher rape empathy, higher perceived attractiveness, and lower rape myth acceptance. Attractiveness was the only significant predictor of men's judgments of women's responses to nonsexual situations, with more attractive women being perceived as more effective. The findings of the current study highlight the importance of understanding the interaction between individual difference variables and situational features in understanding men's judgments of women's responses.

The Association Between a History of Sexual Violence and Romantic Relationship Functioning: A Systematic Review.

The consequences of sexual violence are substantial and include both intra- and interpersonal problems. Notably, sexual violence has been associated with difficulties in interpersonal relationships including intimate relationships. While there have been prior reviews considering various interpersonal and dyadic consequences associated with sexual violence, there has not been a comprehensive review considering the various aspects of adult dyadic functioning including intimacy, relationship conflict, and satisfaction satisfaction among both child and adult victims of sexual violence. The databases PsycINFO and PubMed were searched for terms related to sexual victimization (e.g., sexual assault, sexual victimization, sexual abuse, rape, revictimization), terms related to relationships (e.g., romantic relationship, intimate relationship), and terms related to relationship functioning (e.g., satisfaction, relationship quality, conflict, communication, intimacy, sexual functioning). Eligible studies for this review were required to (1) be an original study, (2) be written in English, (3) identify a sample or subsample consisting of women reporting a history of sexual violence in either childhood or adulthood, and (4) measure at least one of the following relationship areas: intimacy, relationship conflict, or relationship satisfaction in heterosexual adult romantic relationships. A total of 20 articles met inclusion criteria and were included in this review. Results demonstrated mixed findings on the association between sexual violence and relationship functioning, with some studies demonstrating an association between sexual violence and relationship functioning, and others failing to find such associations. These findings are discussed within the context of gaps in the extant literature and future research directions.

The Indirect Relationship Between Interpersonal Trauma History and Alcohol Use via Negative Cognitions in a Multisite Alcohol Treatment Sample.

Although interpersonal trauma history (ITH) is frequently associated with alcohol use disorder (AUD), little is known about specific psychological constructs that may indirectly link these phenomena. This study hypothesized that one such construct may be negative cognitive schemas that often emerge in the aftermath of trauma. Secondary latent variable modeling was conducted using the Project MATCH sample of adults receiving treatment for AUD (N = 1726; 24.3% women; 38.63% ITH). The negative cognitions latent variable provided an excellent fit to the data and showed evidence of strong measurement invariance. As hypothesized, negative cognitions mediated the inverse association between ITH at baseline and percent days abstinent from alcohol 12 weeks later. Findings suggest that negative cognitions may be a specific underlying mechanism and potential treatment target for individuals with ITH and AUD.

Type of Judge Influences Judgments of College Women's Responses to Increasingly Coercive Sexual and Nonsexual Social Situations.

Research examining women's ability to respond to sexually risky situations has relied on trait-based measures or experts' judgments to determine the effectiveness of women's responses. To date, no work has examined whether there are differences among relevant judges with respect to these evaluations. As part of a larger study, 100 undergraduate women listened to descriptions of sexual and nonsexual social situations, viewed clips of a male actor making increasingly coercive verbal requests to each situation, provided a videotaped response to each request, and evaluated the effectiveness of their own responses in decreasing risk for sexual victimization. Women's responses were provided to experts in sexual violence research (n = 8) and undergraduate men (n = 107) who also rated their effectiveness. All raters were asked to attend to both verbal and nonverbal behaviors when providing their ratings. As verbal coercion increased across both types of situations, responses were rated by undergraduate women and undergraduate men as more effective, suggesting that responses become more effective as risk increases for a negative outcome. Experts rated women's responses to moderate coercion as being more effective than responses to low coercion but rated responses to high coercion as less effective than responses to moderate coercion. Additionally, experts and undergraduate women rated women's responses to the sexual victimization risk vignettes as more effective than responses to the nonsexual social situation vignettes. In most cases, experts and undergraduate women's ratings were not statistically different from one another; however, undergraduate men rated undergraduate women's responses to both the sexual victimization risk and the nonsexual social situation vignettes as less effective than experts or undergraduate women. This article discusses applications of these findings for future prevention efforts focused on maximizing the effectiveness of women's responses in sexually risky situations.

Latent Profile Analysis of Alcohol Consumption and Sexual Attitudes Among College Women: Associations With Sexual Victimization Risk.

This study used latent profile analysis (LPA) to identify at-risk profiles of college freshman women ( n = 481) using self-reports of alcohol consumption and sociosexuality. Analyses resulted in three profiles labeled low alcohol use-low sociosexuality, high alcohol use-medium sociosexuality, and high alcohol use-high sociosexuality. Baseline victimization predicted latent profile membership. More severely victimized women were more likely to be in the high alcohol-high sociosexuality profile than the high alcohol-medium sociosexuality and low alcohol-low sociosexuality profiles. At follow-up, the high alcohol-high sociosexuality profile had higher mean levels of victimization severity, relative to those in the high alcohol-medium sociosexuality and low alcohol-low sociosexuality profiles.

Confirmatory factor analysis and measurement invariance of the Eating Disorder Examination Questionnaire (EDE-Q) in a non-clinical sample of non-Hispanic White and Hispanic women.

OBJECTIVE: Body dissatisfaction and eating disorder rates have increased in racial and ethnic minority groups, yet the validity of various commonly-used eating disorder instruments has not been established in these populations. One way to establish validity is to test for measurement invariance; namely, that the same constructs are being measured across groups. This study tested the measurement invariance of the Eating Disorder Examination Questionnaire (EDE-Q) across non-Hispanic White and Hispanic women. METHOD: Female undergraduates (n = 561) were recruited from a southwestern U.S. university. Confirmatory factor analysis (CFA) and measurement invariance of the EDE-Q were tested in non-Hispanic White and Hispanic samples. RESULTS: CFA analyses revealed that the original four-factor structure did not fit the data in either group. Only a modified 7-item, three-factor structure of the EDE-Q provided an acceptable fit in both non-Hispanic White and Hispanic women. Thus, this modified EDE-Q factor structure was used to test the equivalence of the measure between groups. Results found that the factor structure was similar across groups, but the factor loadings and intercepts differed across non-Hispanic White and Hispanic women. DISCUSSION: A modified 7-item, three-factor structure of the EDE-Q provided an acceptable fit of the data, which is supported by previous research. However, the lack of measurement invariance suggests that researchers should be cautious when using this modified EDE-Q to make explicit comparisons between non-Hispanic White and Hispanic women. Future research should further examine the psychometric properties of the EDE-Q in ethnically diverse groups, specifically the role of dietary restraint among Hispanic women.

Effect of Including Alcohol and Cannabis Content in a Sexual Risk-Reduction Intervention on the Incidence of Sexually Transmitted Infections in Adolescents: A Cluster Randomized Clinical Trial.

Importance: Adolescents in the juvenile justice system are at high risk for sexually transmitted infections (STIs). Concurrent use of alcohol and cannabis increase this risk. Objective: To determine whether a theory-based sexual risk-reduction intervention that included alcohol- and cannabis-focused content resulted in greater reductions in STIs than an intervention that included alcohol-related content only and an intervention that did not include substance use content. Design, Setting, and Participants: Cluster randomized clinical trial with 3 conditions. Between July 1, 2010, and December 10, 2014, adolescents living at a juvenile detention facility in the southwestern United States were tested and treated for STI before randomization and again 12 months after the intervention. Data analyses were conducted in July and August 2017. Eligibility criteria included (1) being aged 14 to 18 years, (2) able to speak English, (3) having a remaining detention term of less than 1 month, and (4) signing a release granting access to STI results if tested at intake. Six hundred ninety-three adolescents were assessed for eligibility. Of these, 460 completed baseline assessments and were randomized to 1 of 3 intervention conditions. Data analysis was by intent-to-treat. Interventions: There were 3 intervention conditions: sexual risk reduction intervention (SRRI); SRRI plus alcohol content (SRRI + ETOH); and SRRI + ETOH plus cannabis content (SRRI + ETOH + THC). Interventions were conducted in same-sex groups by trained clinicians and included video presentations with discussion, group activities, and active feedback by participants, consistent with the principles of motivational enhancement therapy. Main Outcomes and Measures: Although not the outcome on which the study was originally powered, the main outcome variable presented herein is STI incidence (Chlamydia trachomatis and/or Neisseria gonorrhoeae) 12 months after the intervention. Results: Of the 460 participants randomized, mean (SD) age was 15.8 (1.1) years, 347 participants (75.4%) were male, and 57.0% were of Hispanic ethnicity. Among the participants, 143 were randomized to SSRI, 155 to SRRI + ETOH, and 162 to SRRI + ETOH + THC. Attrition at 12-month follow-up was 99 (21.5%) for the STI outcome variable. Participants in the SRRI + ETOH + THC intervention had lower incidence of STI at follow-up (3.9%) than those in either the SRRI (12.4%; odds ratio, 0.29; 95% CI, 0.10-0.84) or the SRRI + ETOH (10.2%; odds ratio, 0.36; 95% CI, 0.12-1.05) interventions. Conclusions and Relevance: An intervention delivered in a motivational enhancement therapy format that includes theory-based sexual risk reduction combined with alcohol- and cannabis-focused elements is effective at reducing STI incidence among justice-involved adolescents. This 1-session manualized intervention can be delivered in the context of short-term detention and is easily disseminated to juvenile justice agencies. Trial Registration: clinicaltrials.gov Identifier: NCT01170260.

Risky Sex in High-Risk Adolescents: Associations with Alcohol Use, Marijuana Use, and Co-Occurring Use.

Risky sexual behavior and substance use appear to be interconnected behaviors among adolescents, but data are scarce regarding the extent to which sexual risk behavior is associated with high levels of marijuana and alcohol use, both separately and in combination. 301 adolescents were recruited from a short-term detention facility, and substance use and risky sexual behavior were assessed. We found that adolescents who frequently used marijuana, but not alcohol, reported significantly less risky sex as well as greater intentions to use condoms than either adolescents who frequently used alcohol, but not marijuana, or adolescents who frequently used both substances. Substance use status as a predictor of future risky sexual behavior followed a similar pattern. When designing interventions to reduce substance use in the context of risky sex, it might be especially effective to target efforts toward reducing harm associated with alcohol use, either alone or in combination with marijuana use.

Sexual Attitudes Moderate the Effects of Alcohol Intoxication on Women's Risk Judgments.

This study evaluated the effects of alcohol intoxication, sexual attitudes, and sexual victimization history on the cognitive processes underlying undergraduate women's risk judgments. Participants were 116 unmarried, undergraduate women between the ages of 21 and 29. The sample was diverse ethnically and composed primarily of heterosexual women. Stimuli were written vignettes describing social situations that varied on dimensions of sexual victimization risk and potential impact on women's popularity. Participants were assigned randomly to an alcohol or a no-alcohol condition, and completed an explicit classification task in which they rated how risky each situation was in terms of their having an unwanted sexual experience. They then completed the Sexual Experiences Survey (SES) and the Sociosexuality Scale (SS); SES responses were used to quantify the severity of victimization experiences, and SS responses were used to measure endorsement of positive attitudes toward casual, impersonal sex. Although there was no main effect for condition, higher sociosexuality predicted use of higher thresholds for judging situations as risky. Importantly, sociosexuality interacted with condition such that higher sociosexuality predicted lower sensitivity to risk information in the alcohol condition but not in the no-alcohol condition. More severe victimization history predicted increased use of popularity impactwhen judging risk. This study emphasizes the importance of identifying specific cognitive processes affected by alcohol that may explain why women have difficulty processing contextual cues signaling risk in social situations. It demonstrates also the relevance of examining individual difference factors that may exacerbate the relationship between intoxication and cognitive processing of risk-relevant information.