The role of social drinking factors in the relationship between incapacitated sexual assault and drinking before sexual activity

Perceived Barriers and Facilitators to Treatment for Alcohol Misuse Among Survivors and Victim Service Professionals Following Sexual Assault and Intimate Partner Violence

Survivors of sexual assault (SA) and intimate partner violence (IPV) report high rates of alcohol misuse and often receive services from community agencies. We conducted a qualitative study to examine barriers and facilitators to treatment for alcohol misuse after experiences of SA/IPV among survivors (N = 13) and victim service professionals (VSPs; N = 22) at community-based agencies using semi-structured interviews and focus groups. Survivors discussed seeking treatment for alcohol misuse when alcohol is being used to cope with SA/IPV-related distress and when alcohol use becomes problematic. Survivors identified that stigma and acknowledgment of alcohol misuse are individual-level barriers and facilitators to treatment. System-level factors were also described including having access to treatment and sensitive providers. VSPs also discussed individual (e.g., stigma) and system (e.g., availability and quality of services) level barriers and facilitators to treatment for alcohol misuse. Results indicated several unique barriers and facilitators to treatment for alcohol misuse following SA/IPV.

A Web-Based Sexual Violence, Alcohol Misuse, and Bystander Intervention Program for College Women (RealConsent): Randomized Controlled Trial

BACKGROUND

Sexual violence (SV) incidence among college women has been invariant for the past 20 years. Innovative prevention strategies that are low resource and technology driven but demonstrate efficacy are greatly needed.

OBJECTIVE

The aim of this study was to determine the efficacy of a novel theoretically driven internet-based intervention for first-year college students who identify as women (RealConsent) in reducing their risk of exposure to SV and alcohol misuse as well as increasing alcohol protective and bystander behaviors.

METHODS

This randomized controlled trial involved first-year college students who identified as women (n=881) attending 1 of 3 universities in the southeastern United States. Participants aged 18 to 20 years were randomized to RealConsent (444/881, 50.4%) or to an attention-matched placebo control (437/881, 49.6%). RealConsent is fully automated and consists of four 45-minute modules that incorporate entertainment-education media and proven behavior change techniques. The primary outcome was exposure to SV; the secondary outcomes were alcohol protective behaviors, dating risk behaviors, alcohol misuse, and bystander behavior. Study outcomes were assessed at baseline and 6-month follow-up.

RESULTS

Among participants with some exposure to SV, those in the RealConsent group experienced less exposure to SV than the placebo group (adjusted incidence rate ratio 0.48, 95% CI 0.33-0.69; P=.002). Furthermore, participants in the RealConsent group engaged in more alcohol protective behaviors (adjusted odds ratio 1.17, 95% CI 0.12-2.22; P=.03) and were less likely to binge drink (adjusted incidence rate ratio 0.81, 95% CI 0.67-0.97; P=.003). Finally, participants in the RealConsent group who had 100% dosage were more likely to engage in bystander behavior than those with <100% dosage plus placebo group (adjusted odds ratio 1.72, 95% CI 1.17-2.55; P=.006).

CONCLUSIONS

A comprehensive exposure to SV, alcohol use, and bystander educational program was successful in decreasing the occurrence of exposure to SV among those most at risk and in increasing alcohol protective behaviors. Because of its web-based and mobile technologies, RealConsent can be easily disseminated and holds potential for reducing campus SV.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03726437; https://clinicaltrials.gov/ct2/show/NCT03726437.

Prepartying and incapacitated rape: Is drinking a risk factor or an outcome?

BACKGROUND

Incapacitated rape (IR) is common in college and has been linked to heavier post-assault drinking and consequences, including blackouts. Following IR, college students may adjust their drinking in ways meant to increase perceived safety, such as enhancing situational control over one's drinks through prepartying, which is drinking before going out to a main social event. Although it is possible that prepartying could influence risk related to IR, it is unclear whether or how prepartying and IR are associated.

METHODS

To address these gaps, we examined prepartying as both a risk factor and a consequence of IR, including the reasons for prepartying. Across two studies (Study 1 N = 1074; Study 2 N = 1753) of college women and men, we examined associations between IR and prepartying motives, alcohol consumption, and alcohol-related blackouts.

RESULTS

Within the cross-sectional Study 1, negative binomial regressions revealed that having a history of IR was associated with more alcohol consumption and blackouts when prepartying. In a multivariate model, past-year IR was associated with preparty motives related to interpersonal enhancement, intimate pursuit, and barriers to consumption, but not situational control. Within the prospective Study 2, a path model revealed that preparty drinking was a prospective predictor of IR in the following year, but past-year IR did not predict subsequent prepartying.

CONCLUSIONS

Findings revealed a robust link between recent history of IR and prepartying regardless of gender. Prepartying was a prospective risk factor for subsequent IR. Although more research in this area is needed, addressing prepartying in alcohol interventions may contribute to the prevention of negative outcomes, including sexual assault.

A Behavioral Science Framework for Understanding College Campus Sexual Assault

We propose a behavioral-science approach to sexual assault on college campuses. In this framework, people commit assault when aspects of the immediate situation trigger certain psychological states. No set of mental processes or situational configurations is a precise predictor of assault. Instead, the interaction between mental processes and situational configurations predicts when sexual assault is more or less likely to occur. We begin with an illustrative story to show how a behavioral-science approach is relevant to sexual assault. Next, we map out a framework that suggests how behavioral theories of situations and mental processes have been or could be used to describe, predict, and develop ideas for the reduction of sexual assault. Relevant situational configurations include geographical configurations, local situational and informational cues, and situation-based power. Theories of mental processes include person perception, social norms, moral reasoning, and goals. Our framework can be used to demonstrate how "good" people can commit assault and how individuals can and will refrain from assault within institutions with a "bad" record. Compared with previous theories of sexual assault, a behavioral-science framework offers unique understanding and generative methods for addressing sexual assault on college campuses.

Scoping Review of Access to Emergency Contraception for Sexual Assault Victims in Emergency Departments in the United States

OBJECTIVE

We conducted a scoping review of the literature to assess the prevalence of hospital policies regarding emergency contraception (EC) and the frequency that U.S. emergency departments (EDs) provide EC to sexual assault survivors.

STUDY DESIGN

We searched PubMed, Embase, the Cochrane Library, and CINAHL from inception to January 2019 for studies that assessed access to EC for sexual assault survivors in EDs. We included English-language studies that surveyed ED staff at U.S. hospitals and reported the weighted mean of the percentage of hospitals with an EC policy for sexual assault survivors and the percentage that provided EC counseling, offered or dispensed EC onsite. Secondary outcomes were rates of testing and prophylaxis for sexually transmitted infections (STIs) and HIV.

RESULTS

From 390 articles retrieved, 14 studies met the inclusion criteria; all studies were published between 2000 and 2013. Eligible studies surveyed staff at 3,314 hospitals. Overall, 60% (weighted mean) of hospitals had a policy on EC, 75% provided EC counseling, 44% offered EC, and 62% had EC available to dispense onsite. Four studies reported secondary outcomes: 81% of hospitals provided STI testing, 84% provided STI prophylaxis, 64% provided HIV testing, and 53% provided HIV prophylaxis.

CONCLUSION

Existing literature demonstrates significant variability in EC policies and practices for sexual assault survivors in U.S. hospital EDs. Future research should assess whether EC access for survivors has improved in ED settings as well as evaluate persistent or new barriers to access.

Prospective Risk for Incapacitated Rape Among Sexual Minority Women: Hookups and Drinking

Sexual minority women (SMW), including lesbian and bisexual women, are at greater risk for heavy drinking and sexual victimization than heterosexual women. Risk factors for alcohol-related sexual victimization, such as incapacitated rape (IR), include frequent heavy drinking and hookups among heterosexual women, but it is less clear whether these risk factors extend to SMW. This current study was designed to address this gap. In a national sample of SMW (N = 1,057), logistic regressions were used to test whether heavy drinking and hookups in the first year of the study were risk factors for IR during the second year. After controlling for history of prior sexual victimization, subsequent IR was predicted by an interaction between heavy drinking and the number of male hookup partners. Specifically, more frequent heavy drinking was associated with increased risk for subsequent IR, but only among SMW who reported more than one male hookup partner, indicating exposure to more potential perpetrators. When examined separately, this finding held for bisexual women, but was not significant for lesbian women, likely because they reported fewer male hookup partners. Overall, findings from this longitudinal study highlight that in combination, heavy drinking and hookups with multiple men elevate risk for IR.

Fatores de risco associados à exposição de adolescentes à violência sexual

Objetivo: analisar as evidências científicas sobre os fatores de risco associados à exposição de adolescentes à violência sexual.Síntese de conteúdo: revisão integrativa da literatura, realizada em quatro bases de dados e duas bibliotecas virtuais, sem limites do ano de publicação, utilizando-seos descritores: “delitos sexuais”, “adolescentes” e “fatores de risco”. Utilizou-se, também, a palavra-chave “violência sexual” e equivalentes, no idioma inglês. Na análise dos 22 artigos incluídos, os fatores associados à exposição dos adolescentes à violência sexual foram classificados em “abuso sexual” e “exploração sexual”. O consumo de álcool e/ou drogas foi o fator mais evidente, seguido do sexo casual, dabaixa escolaridade, da baixa renda, da violência familiar, dos relacionamentos em ambientes virtuais, da estigmatização do trabalho sexual e falta de moradia.Conclusão: os fatores apresentados devem ser considerados pela enfermagem para o reconhecimento de adolescentes vítimas de violência sexual, além de contribuir na prevenção de novos casos e na minimização dos efeitos que tal ato pode causar na vida desse público.

Situational Contexts and Risk Factors Associated with Incapacitated and Nonincapacitated Sexual Assaults Among College Women

BACKGROUND

Research has documented multilevel risk factors associated with experiencing incapacitated sexual assault among undergraduate women. Less is known about multilevel risk factors associated with nonincapacitated sexual assault. This study examines and compares the different settings, coercion methods, and relationships in which incapacitated and nonincapacitated sexual assaults occur among undergraduate women.

MATERIALS AND METHODS

Our sample included 253 undergraduate women who reported experiencing sexual assault during college on a population-based survey of randomly selected students at two colleges in New York City in 2016 (N = 1671, response rate = 67%). We examined event-level data on their most significant sexual assault incident since entering college. Using multivariable statistical analysis, we identified situational contexts associated with incapacitated and nonincapacitated assault incidents adjusting for binge drinking, illicit drug use, and other confounding sociodemographic and psychosocial variables.

RESULTS

Almost half (47%) of women who experienced sexual assault reported being incapacitated due to alcohol or drugs during the most significant incident. Being at a party before the event and "acquaintance" perpetrators were associated with incapacitated sexual assault after adjusting for binge drinking and other confounders. Meeting a perpetrator through an Internet dating app or indicating the perpetrator was an intimate partner were each associated with nonincapacitated assault incidents. Perpetrator use of physical force and verbal coercion were also associated with nonincapacitated assault incident.

CONCLUSIONS

The different situational contexts associated with incapacitated and nonincapacitated sexual assaults have important implications for the design of prevention strategies that will effectively target the diverse risk environments in which campus sexual assault occurs.

Examining the influence of gender and sexual motivation in college hookups

OBJECTIVE

Hooking up is common in college, and has been linked to heavy drinking. Hookups have positive as well as negative consequences, and thus the motivations for hooking up are complex. Yet, little research has focused on these motivations. The present study examined the role that gender and drinking patterns play in the relationship between sexual motivation and penetrative hookups.

PARTICIPANTS

Heavy drinking college students (N = 396) completed online surveys between September/October 2009.

METHOD

Sexual motivation, alcohol, and hooking up were assessed.

RESULTS

Enhancement motives and drinking frequency predicted more frequent oral and vaginal sex when hooking up, while peer and partner motives predicted anal sex. Men endorsed greater enhancement motives, peer motives, and hookup oral and vaginal sex. For men, coping motives predicted oral and vaginal sex and peer motives predicted anal sex.

CONCLUSIONS

Results provide greater insight into the reasons why college students engage in penetrative hookups.

Drinking to Cope Motivations as a Mediator of the Relationship Between Sexual Coercion Victimization and Alcohol Use Among College Women: The Role of Depressive Symptoms

This cross-sectional study examined whether depressive symptoms strengthened the relationship between different forms of sexual coercion victimization and drinking to cope motivations, which was hypothesized to influence alcohol use. Participants were 214 female undergraduates who completed an online survey. Participants who experienced any lifetime sexual coercion and reported higher depressive symptoms were the most likely to report drinking to cope motivations, which in turn were associated with alcohol use. Depressive symptoms did not strengthen the relationship between specific forms of sexual coercion, drinking to cope, and alcohol use. Increasing emotion regulation strategies among sexual coercion victims may reduce drinking.

The Role of Sex-Related Alcohol Expectancies in Alcohol-Involved Consensual and Nonconsensual Sex Among Women of Asian/Pacific Islander and Women of European Race/Ethnicity

Alcohol-involved sexual experiences, including incapacitated sexual assault and alcohol-involved sex, are major public health concerns among college women. Further, racial/ethnic diversity among college students is increasing, particularly with regard to increases in college students of Asian/Pacific Islander (API) race/ethnicity. Of relevance, evidence suggests differences in sexual assault rates across ethnicities and cultures; however, no known study to date has examined differences by ethnicity and first language in expectancies and experiences specifically surrounding alcohol and sex. The current study sought to examine differences in incapacitated sexual assault, alcohol-involved sex, and heavy episodic drinking, as well as differences in sex-related alcohol expectancies among native English-speaking college women of European (EU) race/ethnicity, native English-speaking women of API race/ethnicity, and non-native English-speaking women of API race/ethnicity (NNES-API). EU reported higher frequency of heavy episodic drinking, alcohol-involved sex, and incapacitated sexual assault compared to API and NNES-API. In addition, API reported more frequent alcohol-involved sex and incapacitated sexual assault compared to NNES-API, in part due to API's stronger endorsement of sexual disinhibition-related alcohol expectancies (indirect effects: β = -.04, p = .04, and β = -.07, p = .04, respectively). Findings highlight the important role of expectancies in acculturation and influence on actual alcohol-involved sex and sexual assault.

Relacionamento entre pai e mãe e consumo de álcool segundo relato de escolares de 12 a 14 anos do sul do Brasil

RESUMO Objetivo Investigar a relação entre uma avaliação negativa do relacionamento entre pai e mãe e seu consumo de álcool segundo o relato de escolares de 12 a 14 anos do sul do Brasil. Métodos Estudo transversal de base escolar, no qual foram visitadas todas as escolas dos municípios de Lajeado e Sapiranga, no interior do Rio Grande do Sul, em 2012, com amostragem aleatória, estratificada por sexo, idade, município e rede de ensino (pública estadual, pública municipal ou privada). Os dados foram submetidos a análise descritiva e a regressão de Poisson, com controle de efeito de delineamento para a variável escola. Resultados A amostra foi composta por 2.189 escolares, sendo 1.351 (61,7%) da cidade de Lajeado e 838 (38,3%) de Sapiranga. Não se identificou associação estatisticamente significativa entre consumo de álcool da mãe e relacionamento entre pai e mãe percebido como negativo. Já o consumo de álcool do pai reduziu a probabilidade de a relação entre ele e a mãe do escolar ser referida de modo negativo, na análise bruta [RP = 0,857 (IC95%: 0,744-0,988)]. Essa associação também desaparece na análise ajustada para sexo, idade e escolaridade do principal responsável. Conclusão Do conjunto dos relatos dos escolares, não se mantém qualquer associação entre o consumo de álcool dos adultos e relacionamentos avaliados pelos jovens como negativos. Há risco de haver dissonância entre essas evidências e as que embasam discursos que indicam riscos decorrentes do consumo de álcool para as relações familiares. Aprofundar estudos como esse pode ser oportuno para qualificar políticas públicas na área.