Barriers to Condom Negotiation and Use Among Female Sex Workers in the United States and United States-Mexico Border Cities: A Systematic Review

Despite the effectiveness of male condoms, many Female Sex Workers (FSWs) report using condoms infrequently with multiple clients during sexual activity. As such, inconsistent condom use by FSWs is a public health concern as it can increase STI and HIV transmission. This systematic review synthesized extant evidence regarding barriers to condom use experienced by FSWs in the U.S and U.S. - Mexico border towns. The search was conducted through PubMed, CINAL, Cochrane, Medline, and PsychInfo. Studies were included if: they were conducted in the U.S. or U.S. - Mexico borders, their target population was FSWs, they examined condom use barriers experienced by FSWs, and they were published in English between 2011 and February 2021. Condom use barriers among FSWs were reported in all the articles including alcohol consumption and drug use before sex, venue stability, socio-economic status vulnerability, violence and gendered power dynamics, trust of regular clients, and age. The review findings indicate the need to develop interventions promoting condom use for both FSWs and their clients, as well as alternative interventions for HIV prevention such as pre-exposure prophylaxis (PrEP).

An event-level evaluation of women's self-medicated drinking: The role of sexual assault severity, affect, and drinking motives

OBJECTIVE

Women with sexual assault (SA) histories report heavier and more frequent drinking. Consistent with the motivational model of alcohol use, women with SA histories may consume alcohol to both downregulate negative emotions and upregulate positive ones. The present event-level study used a Bayesian multilevel moderated mediation approach to examine the extent to which women's alcohol use and intoxication was influenced by coping and enhancement drinking motives to downregulate or upregulate affect, respectively.

METHOD

Women ages 21-30 were recruited from the community to participate in a larger study that included a 32-day daily diary assessment of affect, drinking motives, and alcohol use.

RESULTS

We found consistent support for women's tendencies to be motivated to drink to cope or enhance negative or positive affect, respectively, and those drinking motives were associated with indicators of increased drinking. Becoming intoxicated to downregulate negative emotion was common and this pathway was particularly strong for women who reported more severe SA histories. Although women with more severe SA histories were generally more likely to drink more, they were not likely to do so as a way to enhance positive experiences.

CONCLUSIONS

Alcohol interventions that provide adaptive regulatory strategies are needed for women who experience increased negative or positive affect, with a particular focus on self-medication for young women with more severe SA histories. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Effects of Childhood Sexual Abuse, Mental Health, and Motives for Sex on Sexual Risk-Taking Among United States Men Who Have Sex with Women

This study assessed the role of mental health symptoms and motives for sex in the association between childhood sexual abuse (CSA) and sexual risk-taking among men who have sex with women (MSW). The sample consisted of young adult (ages 21 to 30), non-monogamous MSW (N = 532) who reported having condomless sex at least once in the past year. Due to alcohol-related aims from two larger studies from which the data were analyzed, participation was excluded to men who regularly consumed alcohol (3 to 35 weekly drinks) and reported no symptoms of alcohol use disorder. Participants answered background questionnaires in lab and then completed a six-week, follow-up survey assessing the number of sex partners and condom use during the prior six weeks. CSA survivors reported greater mental health symptoms and sex motives related to coping, self-affirmation, and partner approval relative to non-survivors. CSA, sex for partner approval, and sex to enhance motives were positively associated with the number of sex partners. Participants endorsing self-affirmation sex motives reported higher condom use than those who did not. CSA contributes to long-term mental and sexual health outcomes among MSW. Identifying and treating depressive and anxiety symptoms and motives for sex may improve sexual health among CSA survivors.

An Evaluation of the Methodological Underpinnings of a Laboratory Paradigm for the Study of Sexual Violence

Ethically constructed laboratory paradigms can provide behaviorally based opportunities to study sexual violence as an addition to questionnaires. One such paradigm invites male participants to watch and show sexual materials to a female confederate as an analog of sexual perpetration. However, there has been inconsistency in the confederate's presentation, such that she either expresses a dislike of sexual material or her preferences are omitted. Some researchers have also questioned whether an expressed dislike is analogous to an expressed nonconsent. As such, the primary goal of the current study was to determine whether confederate expressions of dislike, nonconsent, or the omission of a preference, differentially affect male participants' behavior within a well-established paradigm. That is, we attempted to clarify the appropriate methodology for future researchers (i.e., the validity of the paradigm) and determine the impact of such a situational manipulation on laboratory-based sexual violence. Participants were 276 adult men, who were randomly assigned to one of three conditions: (1) dislike, (2) nonconsent, or (3) said nothing (the omission of a preference) and then asked to show a brief video clip to the female confederate who expressed these preferences. Overall, exposure to experimental condition predicted sexual video-showing over and above that of social desirability, hostile sexism (HS), and sexual violence history, suggesting that situational variables can play a significant role in laboratory-based sexual violence. Greater HS was associated with greater likelihood of sexual video-showing in the nonconsent condition relative to the dislike condition. Sexual video-showing was most frequent in the said nothing condition. In sum, researchers should be mindful of the confederate expression (or lack thereof) of preferences for sexual materials when using the sexual imposition paradigm.

The Effect of State, Trait, and Situational Factors on Young Men's Coercive Condom Use Resistance

Coercive Condom Use Resistance (CUR) is a significant problem, associated with increases in STIs, unplanned pregnancy, feelings of betrayal, and a loss of sexual autonomy. Furthermore, young men are much more likely to perpetrate coercive CUR than young women. Thus, the present study sought to examine the past experiences, trait characteristics, and state emotions which may precede coercive CUR perpetration intentions, including alcohol intoxication, childhood emotional abuse, trait impulsivity, sexual sensation seeking, state impulsivity, and state anxiety, using an alcohol administration procedure. Young, single, non-problem drinking, and sexually active men who have sex with women from the United States (N = 297; 66% White, 9.4% Black, 10.7% Multi-racial, 5.1% Asian, 1.0% Native American, 1.0% Pacific Islander, and 10.4% Hispanic or Latino) were recruited for participation. They were randomly assigned to either receive alcohol or remain sober before projecting themselves into a hypothetical sexual scenario with a woman who asked to use a condom. Results showed that greater levels of childhood emotional abuse were associated with increased trait impulsivity and sexual sensation seeking, and that sexual sensation seeking was associated with increased state impulsivity and subsequent anxiety during the scenario. Finally, alcohol intoxication moderated the relationship between state anxiety and coercive CUR such that state anxiety was positively associated with coercive CUR among intoxicated men only. Findings suggest that interventions targeting coercive CUR behavior may be improved by focusing on men who have experienced childhood trauma, as well as their alcohol consumption and in-the-moment experiences of impulsivity and anxiety.

Alcohol intoxication and sexual risk intentions: Exploring cultural factors among heavy drinking women

INTRODUCTION

Sexually Transmitted Infections (STI) rates are the highest of the last 20 years, with people of color and women particularly affected. Ongoing research has identified risk factors (e.g., alcohol intoxication) and protective factors (e.g., risk perception) for sexual risk behaviors, such as inconsistent condom use. Depending on behavioral norms within a group, ethnic identity (EI) - the exploration and sense of belonging to one's ethnicity - may be a risk or protective factor. This study examined the relations between EI, alcohol intoxication, and STI risk perception on sexual risk intentions among women of color (WOC) and white women (WW).

METHODS

Cisgender women (N = 390; 35% WOC; 65% WW) completed measures and were randomly assigned to an alcohol condition (0.10% BrAC vs control). They projected themselves into an eroticized scenario and self-reported two aspects of STI risk perception (personal, partner) and two sexual risk behaviors (condomless sex intentions, condom decision abdication intentions).

RESULTS

Path analysis indicated that intoxicated women endorsed higher sexual risk intentions compared to women in the control group. Personal STI risk perception was negatively associated with sexual risk intentions. Indirect effects indicated that race was indirectly associated with both indicators of sexual risk, such that WOC reported higher perceived personal STI risk and subsequently endorsed lower sexual risk intentions compared to WW. Surprisingly, EI was associated with higher perceived partner risk for WW only.

CONCLUSIONS

Prevention initiatives that address STI risk perception, condom assertion behaviors, and alcohol may be effective for mitigating women's sexual risk behaviors.

Web-Based Alcohol and Sexual Assault Prevention Program With Tailored Content Based on Gender and Sexual Orientation: Preliminary Outcomes and Usability Study of Positive Change (+Change)

Background

Alcohol use and sexual assault are common on college campuses in the United States, and the rates of occurrence differ based on gender identity and sexual orientation.

Objective

We aimed to provide an assessment of the usability and preliminary outcomes of Positive Change (+Change), a program that provides integrated personalized feedback to target alcohol use, sexual assault victimization, sexual assault perpetration, and bystander intervention among cisgender heterosexual men, cisgender heterosexual women, and sexual minority men and women.

Methods

Participants included 24 undergraduate students from a large university in the Southwestern United States aged between 18 and 25 years who engaged in heavy episodic drinking in the past month. All procedures were conducted on the web, and participants completed a baseline survey, +Change, and a follow-up survey immediately after completing +Change.

Results

Our findings indicated that +Change was acceptable and usable among all participants, despite gender identity or sexual orientation. Furthermore, there were preliminary outcomes indicating the benefit for efficacy testing of +Change.

Conclusions

Importantly, +Change is the first program to target alcohol use, sexual assault victimization, sexual assault perpetration, and bystander intervention within the same program and to provide personalized content based on gender identity and sexual orientation.

Trial Registration

ClinicalTrials.gov NCT04089137; https://clinicaltrials.gov/ct2/show/NCT04089137

Sexual Assault Victimization: Latinx Identity as a Protective Factor for Sexual Minorities

Sexual assault victimization is an experience that impacts many college students, and rates differ based on ethnicity and sexual minority status. However, little is known about the impact of the intersectionality of Latinx and sexual minority identities on sexual assault severity among college students. The current study examined past year sexual assault victimization severity based on sexual orientation and Latinx identities among a random sample of college students (n = 506). Further, factors associated with past year sexual assault victimization severity were examined among sexual minority participants (n = 170). Among all college students, identifying as a cisgender woman, sexual minority, or having a more severe sexual assault history was associated with higher past year sexual assault victimization severity. Further, among sexual minorities, identifying as Latinx or having fewer drinks per week were associated with less severe past year sexual assault victimization. Although preliminary, this finding suggests a need for future research to examine potential cultural factors associated with Latinx populations that may serve as protective factors for sexual assault victimization among college students.

Greater Perceptions of Economic Deprivation in Childhood are Associated with More Sexual Risk Behaviors in Adulthood via Younger Age of Sexual Initiation

Introduction

Sexual risk behaviors are a public health concern. Although sexual risk behaviors are overrepresented among economically disadvantaged individuals, the mechanisms underlying the link from economic deprivation to sexual risk behaviors are not well understood.

Aim

The purpose of this study was to investigate whether one of the earliest indicators of sexual risk, age of sexual initiation, mediates the link between young men's perceptions of economic deprivation while growing up and sexual risk behaviors in adulthood.

Method

Six-hundred twenty-four men provided data on background variables and risk. Path analyses were conducted in Mplus Version 8.

Results

Perceptions of economic deprivation while growing up were related to younger age of sexual initiation, which in turn was related to higher risk for sex earlier in a relationship, condomless sex, STIs, unintended pregnancy, and condom use resistance.

Conclusion

These findings highlight important avenues for sexual health and health equity promotion.

The Interplay of Sexual Arousal and Power-Related Emotions in Men's Alcohol-Involved Sexual Aggression Intentions

Research has identified power/dominance and sexual arousal as key motivators of men's sexual aggression; however, little research has examined the interplay of these two factors in alcohol-involved sexual aggression. Two alcohol administration experiments investigated the roles of power-related sex motives and power- and sexual arousal-related emotions on men's sexual aggression intentions. In Study 1, participants (N = 96) read a sexual aggression scenario after random assignment to consume either an alcoholic (target peak BrAC = .10%) or nonalcoholic beverage. Results indicated that power-related sex motives indirectly predicted stronger sexual aggression intentions through greater in-the-moment power-related emotions but not through sexual arousal-related emotions. Intoxicated men with more severe perpetration histories reported stronger sexual aggression intentions. In Study 2, participants (N = 203) completed similar measures after random assignment to receive either a brief emotion regulation-focused intervention (cognitive restructuring or mindfulness) or a control, followed by either alcohol (target peak BrAC = .08%) or nonalcoholic beverage consumption. Results demonstrated that greater power-related sex motives indirectly predicted stronger sexual aggression intentions through greater feelings of power and sexual arousal. Additionally, findings suggest that cognitive restructuring approaches may mitigate these relationships in sober men, while mindfulness approaches may exacerbate these relationships in intoxicated men.

The Roles of Emotion Regulation, Alcohol Consumption, and Women's Condom Request Style in Men's Coercive Condom Use Resistance Intentions

Condom use resistance (CUR) remains a significant problem, and many men employ coercive CUR strategies to avoid using condoms with partners who do not consent to unprotected sex. To assess the decision-making process underlying men's coercive CUR, the present study administered alcohol to assess the effects of alcohol intoxication, condom request style, and emotion regulation (ER) strategies (i.e., cognitive reappraisal, expressive suppression) on intentions to use coercive CUR to have unprotected sex during a hypothetical sexual scenario. Sexually active, male social drinkers (N = 297) were randomly assigned to either consume alcohol or remain sober, and to project themselves into a hypothetical sexual scenario during which they received either indirect, direct, or insistent condom requests. Results showed that, although cognitive reappraisal had no relationship with coercive CUR or unprotected sex intentions, expressive suppression's relationship with intentions to have unprotected sex was mediated by coercive CUR and moderated by alcohol intoxication and condom request. Specifically, suppression was positively associated with coercive CUR among sober individuals who received an indirect condom request only. Such results suggest that sober men with suppressive tendencies may use coercive CUR to regulate negative emotions, such as frustration at not being able to have unprotected sex.

Acute Alcohol Intoxication, State Anger, and Sexual Assault Perpetration: The Role of State Emotion Regulation

OBJECTIVE

Alcohol-involved sexual assault remains a pervasive problem, with extensive individual- and societal-level costs. Emotion regulation (ER), the process through which an individual modulates emotional states, remains an understudied predictor of sexual assault perpetration, with past research focusing on general ER tendencies (e.g., trait ER) as predictors of sexual assault perpetration. This study sought to examine the associations between state ER on sexual assault perpetration in the context of state anger and acute alcohol intoxication.

METHOD

Single, male social drinkers aged 21-30 with a history of sexual risk-taking (N = 92) participated in an alcohol administration paradigm and were randomly assigned to an alcohol condition [sober control vs. intoxicated (BrAC = .10%)]. Intoxicated and sober participants completed a sexual assault analogue that assessed state anger, state ER, and sexual assault perpetration intentions against a hypothetical female partner.

RESULTS

Path analysis demonstrated interactive effects of state ER and state anger on sexual assault perpetration intentions. Relative to men with low and moderate levels of anger, state ER was associated with lower intentions to perpetrate sexual assault for men with high levels of anger. Alcohol intoxication did not directly predict state ER, state anger, or sexual assault perpetration intentions.

CONCLUSIONS

The results suggested that state ER may be protective against sexual assault perpetration for men who experience anger in response to a partner's expression of non-consent. Because replication is necessary, the results carry tentative implications for state ER as an intervention target for sexual assault prevention programming.

The Role of Alcohol-Related Behavioral Risk in the Design of HIV Prevention Interventions in the Era of Antiretrovirals: Alcohol Challenge Studies and Research Agenda

HIV/AIDS remains a significant health threat and alcohol is a robust contributing factor. After 25 years of alcohol challenge studies investigating alcohol-related behavioral risk (ARBR), much has been learned delineating how drinking influences sexual transmission. We examine this research and consider its relevance for interventions in the era of antiretrovirals. We consider prototypic alcohol challenge methods, illustrative findings, and prevention/intervention implications, noting three perspectives: (a) scale up/extend existing interventions, including identifying under-targeted risk groups and intersecting with PrEP/PEP interventions; (b) modify existing interventions by cultivating psychoeducational content related to alcohol expectancies, alcohol myopia, sexual arousal, risk perception, sexual abdication, and condom use resistance; and (c) innovate new interventions through Science of Behavior Change approaches and repurposing ARBR paradigms. Finally, we suggest research directions concluding that until HIV incidence diminishes significantly, psychosocial interventions addressing the nexus of alcohol use, sexual transmission, and adherence to biomedical protocols will be an important priority.

Recruitment and retention of underrepresented and vulnerable populations to research

Per principles outlined in the Belmont Report, research involving human subjects should minimize risks to participants and maximize benefits to participants and society. Recruitment of participants should be equitable. Once enrolled, participants have the right to withdraw at any point. Researchers must balance these principles with pressures to meet enrollment goals and, in the context of repeated-measures designs, retain participants across time. The purpose of this perspective is to describe the approach and corresponding activities for recruiting and retaining underrepresented and vulnerable populations that are the focus of a transdisciplinary academic research center. To this effort, we offer diverse disciplinary backgrounds, experience working with a wide range of populations (from infants to older adults and across multiple health conditions), and spanning a variety of research designs. Effective strategies offered include partnering with community entities, approaching potential participants where they are and at a time of readiness, using population-appropriate modes of communication and data collection, conducting study activities in familiar settings and at convenient times, maintaining frequent contact, and offering meaningful incentives. These strategies are consistent with population-specific reports found in the extant literature and underscore their cross-cutting nature, with adaptations based on participant and community partner needs and preferences.

Alcohol-involved sexual aggression: Emotion regulation as a mechanism of behavior change

OBJECTIVE

Sexual aggression remains a significant public health problem, with the majority of sexual assaults involving alcohol. Founded upon an experimental medicine approach to behavior change, the current study used a proximal change experiment to target and test emotion regulation (ER) as a mechanism underlying alcohol-involved sexual aggression.

METHOD

Heavy episodic drinking men aged 21-30 with a sexual assault perpetration history (N = 209) were randomly assigned to a brief, online, ER-focused cognitive restructuring or mindfulness intervention or to control. Intervention effects were evaluated during sober and intoxicated states through laboratory-based alcohol administration (target BrAC = .08%). Intoxicated and sober participants completed a proximal change protocol that included implementing ER skills during a sexual aggression analogue that assessed relevant emotions and intentions.

RESULTS

Path analysis demonstrated that relative to control, the cognitive restructuring intervention improved emotional modulation and emotional clarity, resulting in lower sexual arousal and anger, respectively, followed by decreased sexual coercion intentions. The mindfulness intervention yielded mixed results, predicting decreased sexual aggression intentions compared to control but also predicting stronger coercive tactic intentions in intoxicated men with more severe sexual aggression histories. Both interventions improved emotional acceptance relative to control, but only for sober men.

CONCLUSIONS

Overall, the current study demonstrated that ER-focused interventions improved proximal ER skills associated with reduced sexual aggression intentions, signifying ER as an important mechanism for changing sexually aggressive behavior. Because intervention efficacy varied by intoxication state, further research is needed to assess the effectiveness of ER interventions targeting real-world alcohol-involved sexual aggression. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

How Men's Sexual Assault Victimization Experiences Differ Based on Their Sexual History

This study examined the differences in men's sexual assault victimization experiences based on their history of only having sex with women (MSW) or having sex with women and men (MSW/M). Based on the previous research, we expected that MSW/M would be more likely to report a sexual assault history, experience a significantly greater number of sexual assault acts, experience more severe levels of unwanted sexual activity and tactics (i.e., physically forced attempted or completed rape), and report both male and female perpetrators, compared with MSW. Community, nonproblem drinking men, ages 21 to 30 (N = 311), reported on their sexual assault victimization experiences since age 14 using a modified version of the Sexual Experiences Survey. Six items were used to assess participants' number of unwanted sexual experiences (i.e., unwanted sexual contact, attempted and completed rape) that included the use of intoxication, physical force, both, or neither. For each item, participants indicated if the perpetrator(s) was/were male, female, or both male and female. Two fifths of men reported experiencing sexual assault, the majority of which involved attempted or completed rape. Replicating and extending previous research, MSW/M were significantly more likely to be victims (65% vs. 39%), experienced a significantly greater number of sexual assault acts since age 14, were more likely to have experienced attempted or completed rape through the use of physical force, and were more likely to report male only or both male and female perpetrators across their victimization experiences, as compared with MSW. Results indicate a clear need for additional research on the unique victimization experiences of MSW/M. Additionally, sexual assault prevention programming needs to provide men with the skills to identify and negotiate unwanted sexual advances made by men and women and to promote healthy sexual relationship behaviors.

An Event-Level Investigation of Factors Associated With Young Women's Experiences of Coerced Consensual Sex

Little is known about instances of coerced consensual sex in which women report both that they consented to have sex and that their partner used coercive tactics (e.g., made threats) to get them to have sex when they did not want to. Yet, these experiences are frequently reported by young sexually active women. We examined the relationship between sexual victimization history and the woman's level of alcohol intoxication in the likelihood of experiencing coerced consensual sex using event-level data collected over a 1-year period from 548 young adult nonproblem drinking women who engaged in sexual activity with men. Twenty percent (n = 112) reported at least one incident of coerced consensual sex. A generalized estimating equation model revealed main effects of daily estimated blood alcohol content (eBAC) and sexual victimization severity. The more women increased their alcohol consumption above their own average and the more severe their sexual victimization history, the more likely they were to experience coerced consensual sex. Our findings highlight the fact that coercion and consent are not mutually exclusive in some situations and shed light on this important yet understudied coercive sexual experience.

A Prospective Examination of Men's Condom Use Resistance: Event-Level Associations with Sexual Aggression, Alcohol Consumption, and Trait Anger

Burgeoning research suggests that men engage in a variety of coercive and non-coercive tactics to avoid condom use (condom use resistance; CUR), suggesting a risk nexus regarding sexual risk and sexual aggression (SA). Laboratory-based research has found that acute alcohol intoxication is associated with CUR; however, no study has examined event-level associations among alcohol consumption, SA history, and CUR or the moderating effects of trait anger. Non-problem drinking young adult men who have sex with women (N = 430) completed a background survey and follow-up assessments regarding their sex events and alcohol consumption over three months. CUR was reported in 113 sex events; 6.2% of these involved SA and 40.7% involved alcohol consumption. Generalized estimating equations demonstrated that men with more severe SA histories were more likely to perpetrate CUR. Men lower in trait anger were more likely to perpetrate CUR the more they increased above their typical level of alcohol consumption, whereas men higher in trait anger were similarly likely to perpetrate CUR regardless of their alcohol consumption. Results suggest that men with greater SA histories and high trait anger are at increased risk of perpetrating CUR, and that risk of CUR increases among other men the more they increase their alcohol consumption beyond their average.

Growing Up, Hooking Up, and Drinking: A Review of Uncommitted Sexual Behavior and Its Association With Alcohol Use and Related Consequences Among Adolescents and Young Adults in the United States

Hookups are uncommitted sexual encounters that range from kissing to intercourse and occur between individuals in whom there is no current dating relationship and no expressed or acknowledged expectations of a relationship following the hookup. Research over the last decade has begun to focus on hooking up among adolescents and young adults with significant research demonstrating how alcohol is often involved in hooking up. Given alcohol’s involvement with hooking up behavior, the array of health consequences associated with this relationship, as well as its increasing prevalence from adolescence to young adulthood, it is important to determine the predictors and consequences associated with alcohol-related hooking up. The current review extends prior reviews by adding more recent research, including both qualitative and experimental studies (i.e., expanding to review more diverse methods), research that focuses on the use of technology in alcohol-related hookups (i.e., emerging issues), further develops prevention and intervention potentials and directions, and also offers a broader discussion of hooking up outside of college student populations (i.e., expanding generalization). This article will review the operationalization and ambiguity of the phrase hooking up, the relationship between hooking up and alcohol use at both the global and event levels, predictors of alcohol-related hooking up, and both positive and negative consequences, including sexual victimization, associated with alcohol-related hookups. Throughout, commentary is provided on the methodological issues present in the field, as well as limitations of the existing research. Future directions for research that could significantly advance our understanding of hookups and alcohol use are provided.

"Stealthing": Factors associated with young men's nonconsensual condom removal

OBJECTIVE

The purpose of this study was to investigate the rates, predictors, and associated sexual risk indices of young men's nonconsensual condom removal (also known as stealthing).

METHODS

Participants were 626 male inconsistent condom users aged 21-30 years recruited from an urban area in the Pacific Northwest. Participants completed survey measures assessing sexual aggression history, sexual aggression-related attitudes, sexually transmitted infection history, unplanned pregnancies, and nonconsensual condom removal experiences.

RESULTS

Almost 10% of the participants (n = 61) reported engaging in nonconsensual condom removal since the age of 14 years, with an average of 3.62 times (SD = 3.87) and range of 1-21 times (maximum possible). After controlling for condom use self-efficacy, men with greater hostility toward women (odds ratio = 1.47) and more severe sexual aggression history (odds ratio = 1.06) had significantly higher odds of engaging in nonconsensual condom removal behavior. χ2 analyses demonstrated that men who had a history of nonconsensual condom removal were significantly more likely to have had a sexually transmitted infection diagnosis (29.5% vs. 15.1%) or have had a partner who experienced an unplanned pregnancy (46.7% vs. 25.8%).

CONCLUSIONS

Nonconsensual condom removal, which involves elements of both sexual risk and sexual aggression, confers multiple sexual risks to its recipients, thus meriting increased clinical and research attention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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.

Sexual Victimization and Sex-Related Drinking Motives: How Protective is Emotion Regulation?

One in five college women experience sexual victimization (SV), and SV severity is associated with subsequent psychological distress, including sex-related distress. SV severity may also be associated with drinking motives to cope with sex-related distress and to enhance sex (sex-related drinking motives [SRDMs]), particularly if individuals suffer from emotion regulation (ER) difficulties. College women (N = 151) completed a survey assessment of ER, SV history, childhood sexual abuse (CSA), and SRDMs. Twelve regression models assessed six facets of ER as moderators between SV severity and SRDMs. Among women with no or low levels of prior SV severity, women with greater access to ER strategies were less likely to endorse drinking to cope SRDMs. At higher levels of SV severity, women at all levels of access to ER strategies were equally likely to endorse drinking to cope SRDMs, suggesting that access to ER strategies did not mitigate motivations to drink to cope with sex-related distress for these women. Women with severe SV histories may benefit from interventions that build on existing ER strengths or address other factors. However, greater access to ER strategies may serve as a protective factor against SRDMs when SV severity is low.

Tactics Young Women Use to Resist Condom Use When a Partner Wants to Use a Condom

Although there is a growing literature on men's condom use resistance (CUR) tactics (e.g., direct requests, deception), little research exists on women's CUR tactics. This study investigated young women's (ages 18 to 21) self-reported use of CUR tactics since age 14 and related individual difference factors. Participants included 235 sexually active heterosexual women from a nationwide convenience survey sample who completed a newly adapted women's version of the Condom Use Resistance Survey. Consistent with the limited previous research, women were most likely to use risk-level reassurance (37.9%) and seduction (33.2%) tactics. A higher frequency and quantity of alcohol consumption, particularly prior to sex, lower perceived risk of sexually transmitted infections (STIs), and a history of STI diagnosis were associated with having previously used a greater number and variety of CUR tactics. This highlights the need for CUR prevention and intervention programming for women. Future research should specifically examine women's rationale for using CUR tactics and utilize longitudinal and experimental methods to further elucidate directional and causal relationships among individual-level risk factors, CUR, and negative sexual health outcomes.