Job authority and health: Unraveling the competing suppression and explanatory influences

Childhood emotional abuse and adult mental health at the intersection of social relationship and education

BACKGROUND

Previous research has established that childhood emotional abuse has long-term, negative consequences for adult mental health. Yet, less is known about the ways that social relationship and education intersect to shape the link between childhood emotional abuse and mental health in adulthood.

AIM

The current study aims to examine whether perceived quality of social relationships moderates the association between childhood emotional abuse and adult mental health. Moreover, it assesses how the moderating effect of perceived quality of social relationship differs across levels of education.

METHOD

The current study analyzes data from the 2012 Korean General Social Survey, a nationally representative sampling of Korean adults. It uses OLS regression models.

RESULTS

Childhood emotional abuse is positively associated with depression and psychological distress in adulthood. However, perceived quality of social relationships mitigates the positive association of childhood emotional abuse with depression and psychological distress. Further, this buffering effect of perceived quality of social relationships operates only for individuals with less than or equal to a high school education, but not for individuals with college education or more.

CONCLUSION

The results lend support to the resource substitution thesis, suggesting that positive perceptions of social relationship act as a protective factor against childhood emotional abuse for individuals with lower levels of education.

Maternal health, well-being, and employment transitions: A longitudinal comparison of partnered and single mothers in Germany

Balancing parenthood and employment can be challenging and distressing, particularly for single mothers. At the same time, transitioning to employment can improve the financial situations of single mothers and provide them with access to social networks, which can have beneficial effects on their health and well-being. Currently, however, it is not well understood whether the overall impact of employment on single mothers is positive or negative, and to what extent it differs from the impact of employment on partnered mothers. Building on the literature on work-family conflict, we investigate the differential effects of employment transitions on the health and well-being of single mothers and partnered mothers. Using longitudinal data from the German Socio-Economic Panel (1992-2016), we apply panel regression techniques that address the potential endogeneity of maternal employment, as well as the dynamic nature of the relationship between employment transitions and maternal health and well-being. We find that employment has a positive impact on single mothers, and that single mothers benefit from employment significantly more than partnered mothers. Surprisingly, income does not appear to be an important driver of these results. Overall, our findings suggest that employment plays a key role in the well-being of single mothers.

Testing the stress of higher status hypothesis. Variation of occupational stress among physicians and nurses at a German university hospital

Studies show especially for the UK and the US that physicians experience more occupational stress than nurses. It has also been shown that a higher status within the medical and nursing hierarchy is associated with less occupational stress. Our study's aim is to examine whether these results also can be found in the context of the German university hospital sector. Thus, we test the stress of higher status hypothesis in and between the occupational groups of nurses and physicians at a German university hospital. Based on two cross-section surveys in the years of 2016 and 2019 this paper compares the perceived level of occupational stress between physicians (n = 588) and nurses (n = 735). Perceived levels of occupational stress-measured via the effort-reward imbalance model and the job demand-control model-are differentiated by status positions within and between both occupational groups. Descriptive as well as inferential statistics (Mann-Whitney U test, Kruskal-Wallis H test) are used to test the stress of higher status hypothesis. Contrary to the stress of higher status hypothesis, our main result is that physicians and nurses perceive similar levels of occupational stress. Furthermore, within each hierarchy the perceived degree of work stress decreases with increasing status for both groups. Our main conclusion is that the stress of higher status hypothesis must be rejected in the German university hospital context and the competing resources of higher status hypothesis must be assumed. The findings can be explained by the unique relationship between physicians and nurses and the role of New Public Management in the German hospital sector.

The toxic gift: reciprocity and social capital in cigarette exchange in China

The widespread exchange of tobacco cigarettes as a gift in some societies normalises the symbolic desirability of tobacco products and promotes smoking. Little is known about how and why people exchange toxic substances as gifts. This study argues two key factors involved in social exchange processes - reciprocity and social capital - can explain gift cigarette circulation. We conducted a multistage survey among household heads from China and measured the quantity and monetary values of outgoing and incoming gift cigarettes circulated by each household and measured social capital in three dimensions: collective participation, social ties, and trust. Ordinary Least Square regressions showed that reciprocity is strongly and significantly associated with both the value and quantity of gift cigarettes. All three dimensions of social capital are varyingly associated with gifting cigarettes. Income and higher classes are also associated with greater quantity and value of received cigarettes. This study broadens the phenomenon of gifting cigarettes to the more universal patterns of reciprocity and social capital, wherein better social capital and socioeconomic position ironically lead to a higher risk of tobacco use and endanger health. We suggest policymakers target the endemic social need for gift exchange in China's informal economy.

Do managers sleep well? The role of gender, gender empowerment and economic development

Work demands often disrupt sleep. The stress of higher status theory posits that workers with greater resources often experience greater stress. We extend this theory to sleep and ask: do managers report more disrupted sleep and does this vary by gender and country context? Data come from the 2012 European Social Survey Programme and our sample comprised those currently employed in their prime working age (n = 27,616; age 25–64) in 29 countries. We include country level measures of the Gender Development Index (GDI) and gross domestic product (GDP). We find that workers sleep better, regardless of gender, in countries where women are empowered. For managers, women sleep better as GDI increases and men as GDP increases. Our results suggest that men experience a sleep premium from economic development and women from gender empowerment.

Does Positive Relational Management Benefit Managers Higher Up the Hierarchy? A Moderated Mediation Study of New Zealand Managers

Interpersonal relationships play an important role in work success, and this is especially so for managers. The present study tests the Positive Relational Management (PRM) Scale and its influence on organizational trust, with the effects potentially mediated by work-life balance. Hence, more positive relationships at work shape better management of work-life issues, and ultimately build trust perceptions. We test this on a sample of 600 New Zealand managers and include managerial hierarchy as a moderator to determine whether positive relationships become less important as management level increases. Ultimately, we test a moderated mediation model in PROCESS and confirm the dimensionality and reliability of the scale. We find PRM is positively related to work-life balance and organizational trust, while work-life balance partially mediates this effect. In addition to two significant two-way interactions, we find support for a moderated mediation effect, with the indirect effect of PRM being positive and strongest for low-level managers, but a reduction in the strength of the indirect effects for middle- and senior-managers. Hence, the importance of interpersonal relationships is especially powerful for low-level managers. The implications for understanding the importance of PRM for managers are discussed.

Occupational variation in burnout among medical staff: Evidence for the stress of higher status

Contemporary research highlights the serious mental health issues facing physicians and allied health professionals. Yet to date, much of this research has focused on these occupational groups in isolation. Drawing upon data collected from medical staff in a neonatal intensive care unit (N = 222), we address this gap by contrasting the mental health and workplace experiences of four groups of healthcare workers: physicians, nurse practitioners, registered nurses, and respiratory therapists. We find evidence that higher status healthcare workers-physicians and nurse practitioners-are more likely than their colleagues to report work-life conflict, irregular work hours, and heavy work pressure. These stressors explain an appreciable amount of the higher levels of burnout found among physicians and nurse practitioners. Collectively, results lend support to "the stress of higher status" hypothesis and provide insights into the job demands and mental health issues confronted by today's medical workforce.

Stress and neurocognitive efficiency in managerial contexts

Purpose

The purpose of this paper is to test the potential of an innovative technology-mediated mental training protocol for the empowerment of stress management and neurocognitive efficiency in highly stressful professional contexts, with people who occupy top management positions. The innovative protocol specifically combines mindfulness practice and a wearable neurofeedback system managed via smartphone.

Design/methodology/approach

The longitudinal research included pre- and post-training assessment steps in order to test training effects with respect to subjective level and physiological markers of stress, anxiety and mood profiles, cognitive abilities and markers of neurocognitive efficiency.

Findings

Results showed decreased stress, anxiety, anger and mental fatigue; increased participants’ information-processing efficiency; increased electrophysiological markers concerning the balance and reactivity of the mind-brain system; and improved physiological markers of vagal tone.

Research limitations/implications

Though further investigation and replication with larger samples would strengthen present findings, the authors suggest that observed outcomes, together with the limited duration of the overall protocol and of daily practices, make the training a potentially valuable tool especially for people whose professional position imposes time limitations and elevated job duties, thus increasing the risk of drop-out from traditional stress management programs.

Originality/value

The combination of mindfulness-based mental training with the advantages offered by a novel brain-sensing wearable technology allows for overcoming the weak points of traditional approaches (e.g. notable time expense) and optimizing training opportunities and outcomes. Furthermore, this is, to the authors’ best knowledge, the first systematic report of the application of such methodology in an organization and with top management professionals.

Occupational stress and risk for Parkinson's disease: A nationwide cohort study

Background: Stress has been suggested as a contributing factor in the etiology of Parkinson's Disease (PD), but epidemiological evidence is sparse.

Objective: The objective of this study was to explore the association between occupational stress according to the job demands‐control model and the risk for PD.

Methods: We conducted a population‐based cohort study with 2,544,748 Swedes born 1920 to 1950 who had an occupation reported in the population and housing censuses in 1980 or, if missing, in 1970. Job demands and control were measured using a job‐exposure matrix. Incident PD cases were identified using Swedish national health registers from 1987 to 2010. Data were analyzed with Cox regression with age as the underlying time scale, adjusting for sex, education, and chronic obstructive pulmonary disease as a proxy for smoking.

Results: During a mean follow‐up time of 21.3 years, 21,544 incident PD cases were identified. High demands were associated with increased PD risk among men, most evident in men with high education. High control was associated with increased PD risk among the low educated. This association was more pronounced in women. High‐strain jobs (high demands and low control) was only associated with increased PDrisk among men with high education, whereas active jobs (high demands and high control) were associated with increased PD risk among men with low education.

Interpretation: High job demands appear to increase PD risk in men, especially in men with high education, whereas high job control increases PD risk among low educated, more strongly in women. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

The Status-Health Paradox: Organizational Context, Stress Exposure, and Well-being in the Legal Profession

Prior research evaluates the health effects of higher status attainment by analyzing highly similar individuals whose circumstances differ after some experience a "status boost." Advancing that research, we assess health differences across organizational contexts among two national samples of lawyers who were admitted to the bar in the same year in their respective countries. We find that higher-status lawyers in large firms report more depression than lower-status lawyers, poorer health in the American survey, and no health advantage in Canada. Adjusting for income exacerbates these patterns-were it not for their higher incomes, large-firm lawyers would have a greater health disadvantage. Last, we identify two stressors in the legal profession, overwork and work-life conflict, that are more prevalent in the private sector and increase with firm size. Adjusting for these stressors explains well-being differences across organizational contexts. This study documents the role of countervailing mechanisms in health inequality research.

Improving Managers' Psychophysical Well-Being: Effectiveness of Respiratory Sinus Arrhythmia Biofeedback

High work stress has been consistently associated with disturbed autonomic balance, specifically, lowered vagal cardiac control and increased sympathetic activity, which may lead to increased cardiovascular risk. Stress management procedures have been proposed to reduce autonomic dysfunctions related to work stress in different categories of workers exposed to heightened work demands, while a limited number of studies addressed this issue in managers. The present study was aimed at evaluating the effectiveness of a respiratory sinus arrhythmia (RSA) biofeedback (BF) intervention on psychological and physiological outcomes, in managers with high-level work responsibilities. Thirty-one managers leading outstanding private or public companies were randomly assigned to either a RSA-BF training (RSA-BF; N = 16) or a control group (N = 15). The RSA-BF training consisted of five weekly 45 min sessions, designed to increase RSA, whereas controls had to provide a daily stress diary once a week. After the training, managers in both groups reported reduced heart rate at rest, lower anxiety levels and improvement in health-related quality of life. More importantly, managers in the RSA-BF group showed increased vagal control (as indexed by increased RSA), decreased sympathetic arousal (as indexed by reduced skin conductance and systolic blood pressure) and lower emotional interferences, compared to managers in the control group. Results from this study showed that RSA-BF training was effective in improving cardiac autonomic balance at rest. Moreover, findings from this study underline the effectiveness of biofeedback in reducing psychophysiological negative outcomes associated with stress in managers.

Job satisfaction developmental trajectories and health: A life course perspective

Understanding the health consequence of job dissatisfaction becomes increasingly important because job insecurity, stress and dissatisfaction have significantly increased in the United States in the last decade. Despite the extensive work in this area, prior studies nonetheless may underestimate the harmful effect of job dissatisfaction due to the cross-sectional nature of their data and sample selection bias. This study applies a life-course approach to more comprehensively examine the relationship between job satisfaction and health. Using data from the NLSY 1979 cohort, we estimate group based job satisfaction trajectories of respondents starting at age 25 and ending at age 39. Four job satisfaction trajectory groups are identified, a consistently high satisfaction group, a downward group, an upward group, and a lowest satisfaction group. We examine the effects of these trajectories on several physical and mental health outcomes of respondents in their early forties. We find membership in the lowest job satisfaction trajectory group to be negatively associated with all five mental health outcomes, supporting the accumulation of risks life course model. Those in the upward job satisfaction trajectory group have similar health outcomes to those in the high job satisfaction trajectory group, supporting the social mobility life course model. Overall, we find the relationship between job satisfaction trajectories and health to be stronger for mental health compared to physical health.

Stress at work: Differential experiences of high versus low SES workers

This paper asks whether workers with higher socioeconomic status (SES) experience different levels of stress at work than workers with lower SES and, if so, what might explain these differences. We collected innovative assessments of immediate objective and subjective measures of stress at multiple time points across consecutive days from 122 employed men and women. We find that in comparison to higher SES individuals, those with lower SES reported greater happiness at work, less self-reported stress, and less perceived stress; cortisol, a biological marker of stress, was unrelated to SES. Worker's momentary perceptions of the workplace were predicted by SES, with higher SES individuals more commonly reporting feeling unable to meet work demands, fewer work resources, and less positive work appraisals. In turn, perceptions of the workplace had a generally consistent and robust effect on positive mood, subjective stress, and cortisol.

Bidirectional relations between work-related stress, sleep quality and perseverative cognition

OBJECTIVE

In this longitudinal two-wave study, bidirectional relations between work-related stress and sleep quality were examined. Moreover, it was investigated whether perseverative cognition is a potential underlying mechanism in this association, related to both work-related stress and sleep quality.

METHODS

A randomly selected sample of Dutch employees received an online survey in 2012 and 2013. Of all invited employees, 877 participated in both waves. Structural equation modeling was performed to analyze the data.

RESULTS

We found evidence for reversed relations between work-related stress and sleep quality. Specifically, when controlling for perseverative cognition, work-related stress was not directly related to subsequent sleep quality, but low sleep quality was associated with an increase in work-related stress over time. Moreover, negative bidirectional associations over time were found between perseverative cognition and sleep quality, and positive bidirectional associations were found between work-related stress and perseverative cognition. Lastly, a mediation analysis showed that perseverative cognition fully mediated the relationship between work-related stress and sleep quality.

CONCLUSION

The study findings suggest that perseverative cognition could be an important underlying mechanism in the association between work-related stress and sleep quality. The bidirectionality of the studied relationships could be an indication of a vicious cycle, in which work-related stress, perseverative cognition, and sleep quality mutually influence each other over time.

Job Pressure and SES-contingent Buffering: Resource Reinforcement, Substitution, or the Stress of Higher Status?

Analyses of the 2008 National Study of the Changing Workforce demonstrate that job pressure is associated with greater anxiety and job dissatisfaction. In this paper we ask, What conditions protect workers? The conventional buffering hypothesis in the Job-Demands Resource (JD-R) model predicts that job resources should attenuate the relationship. We test whether the conventional buffering hypothesis depends on socioeconomic status (SES). Support for conventional buffering is evident only for job dissatisfaction--and that generalizes across SES. When anxiety is assessed, however, we observe an SES contingency: Job resources attenuate the positive association between job pressure and anxiety among workers with lower SES, but exacerbate it among those with higher SES. We discuss the implications of this SES-contingent pattern for theoretical scenarios about "resource reinforcement," "resource substitution," and the "stress of higher status." Future research should consider SES indicators as potential contingencies in the relationship between job conditions and mental health.

Gender, job authority, and depression

Using the 1957-2004 data from the Wisconsin Longitudinal Study, we explore the effect of job authority in 1993 (at age 54) on the change in depressive symptoms between 1993 and 2004 (age 65) among white men and women. Within-gender comparisons indicate that women with job authority (defined as control over others' work) exhibit more depressive symptoms than women without job authority, whereas men in authority positions are overall less depressed than men without job authority. Between-gender comparisons reveal that although women have higher depression than men, women's disadvantage in depression is significantly greater among individuals with job authority than without job authority. We argue that macro- and meso-processes of gender stratification create a workplace in which exercising job authority exposes women to interpersonal stressors that undermine health benefits of job authority. Our study highlights how the cultural meanings of masculinities and femininities attenuate or amplify health-promoting resources of socioeconomic advantage.

In control or fatalistically ruled? The sense of mastery among working Canadians

Using data from a 2011 nationally representative sample of Canadian workers (N = 5,576), the present study evaluates the social-structural determinants of the sense of mastery. Three main contributions emerge. First, we document that each of the main components of socioeconomic status--education, income, occupation, and economic hardship--have distinct total, indirect, and net associations with mastery. The well-educated report more mastery because of their higher earnings--but exposure to more role blurring and work-family conflict offset what would otherwise be their even higher levels of mastery. Second, job-related demands and resources have largely independent associations with mastery, but our analyses also reveal some key areas of overlap. Third, role-blurring activities--and their connections with work-to-family conflict and family-to-work conflict--offer unique expansions to the overall narrative of mastery, with unexpected explanatory and suppression effects. We interpret each of these observations in an effort to advance recent theoretical perspectives about mastery.

Has work replaced home as a haven? Re-examining Arlie Hochschild's Time Bind proposition with objective stress data

Using innovative data with objective and subjective measures of stress collected from 122 employed men and women, this paper tests the thesis of the Time Bind by asking whether people report lower stress levels at work than at home. The study finds consistent support for the Time Bind hypothesis when examining objective stress data: when participants were at work they had lower values of the stress hormone cortisol than when they were at home. Two variables moderated this association - income and children at home - such that the work as haven effect was stronger for those with lower incomes and no children living at home. Participants also, however, consistently reported higher subjective stress levels on work days than on non-work days, which is in direct contrast to the Time Bind hypothesis. Although our overall findings support Hochschild's hypothesis that stress levels are lower at work, it appears that combining work and home increases people's subjective experience of daily stress.

Is Insecurity Worse for Well-Being in Turbulent Times? Mental Health in Context

Using General Social Survey data, we examine whether any association between job insecurity and well-being is contingent on economic climate (comparing those interviewed in turbulent 2010 vs. pre-recessionary 2006), as well as income and gender. We find respondents with higher levels of job insecurity in 2010 reported lower levels of happiness compared to those similarly insecure in 2006. The positive relationship between job insecurity and days of poor mental health becomes more pronounced for those in the 3^rd quartile of personal income in 2010, suggesting middle-class vulnerability during the economic downturn. Men (but not women) with higher insecurity report more days of poor mental health in both 2006 and 2010. These findings reinforce a "cycles of control" theoretical approach, given the mental health-job insecurity relationship is heightened for workers in turbulent times.

Professional women's well-being: the role of discrimination and occupational characteristics

This study examined the association between perceived discrimination, workplace racial composition, and three outcomes-psychological distress, life dissatisfaction, and job dissatisfaction-among a sample of Black (n = 72) and White (n = 74) professional women. As a comparison, these relationships were analyzed to determine if they varied from those observed in more traditionally studied populations: Whites and non-professional Blacks, using data from a population of working women in the 1995 Detroit Area Study (N = 533). Perceived discrimination was associated with differences in psychological distress and job dissatisfaction but not with life dissatisfaction. The correlation between perceived discrimination and psychological distress was larger for White professional women than for Black professional women (White women odds ratio [OR]: 1.99; Black women OR: 0.80). A larger correlation between race and job dissatisfaction was observed for Black professional women than for Black non-professional women. The racial composition of the workplace was unrelated to any of the outcomes. Study results emphasized the importance of decreasing the frequency of discrimination for positive mental health and underscored the need for more systematic research on discrimination and health among Black women of higher socioeconomic status, a growing sub-population in the United States.

Higher-status occupations and breast cancer: a life-course stress approach

Using the 1957-2011 data from 3682 White non-Hispanic women (297 incident breast cancer cases) in the Wisconsin Longitudinal Study, United States, we explore the effect of occupation in 1975 (at age 36) on breast cancer incidence up to age 72. Our study is motivated by the paradoxical association between higher-status occupations and elevated breast cancer risk, which presents a challenge to the consistent health advantage of higher social class. We found that women in professional occupations had 72122% and women in managerial occupations had 57-89% higher risk of a breast cancer diagnosis than housewives and women in lower-status occupations. We explored an estrogen-related pathway (reproductive history, health behaviors, and life-course estrogen cycle) as well as a social stress pathway (occupational experiences) as potential explanations for the effect of higher-status occupations. The elevated risk of breast cancer among professional women was partly explained by estrogen-related variables but remained large and statistically significant. The association between managerial occupations and breast cancer incidence was fully explained by job authority defined as control over others' work. Exercising job authority was related to higher breast cancer risk (HR = 1.57, 95% CI: 1.12, 2.18), especially with longer duration of holding the professional/managerial job. We suggest that the assertion of job authority by women in the 1970s involved stressful interpersonal experiences that may have promoted breast cancer development via prolonged dysregulation of the glucocorticoid system and exposure of the breast tissue to adverse effects of chronically elevated cortisol. Our study emphasizes complex biosocial pathways through which women's gendered occupational experiences become embodied and drive forward physiological repercussions.

Job-related resources and the pressures of working life

Data from a 2011 representative sample of Canadian workers are used to test the resource versus the stress of higher status hypotheses. Drawing on the Job Demands-Resources model (JD-R), the resource hypothesis predicts that job-related resources reduce job pressure. The stress of higher status hypothesis predicts that job-related resources increase job pressure. Findings tend to favor the resource hypothesis for job autonomy and schedule control, while supporting the stress of higher status for job authority and challenging work. These findings help elaborate on the "resource" concept in the JD-R model and identify unique ways that such resources might contribute to the pressures of working life.

The inconsistent mediating effects of psychosocial work characteristics on the education-health relationship

This study examined the relationship between psychosocial work characteristics and educational disparities in health. Informed by the evidence on the relationship between work pressure and higher education, we suggested reframing the distribution of psychosocial work characteristics in the context of education. We differentiated psychosocial work resources from demands and hypothesized that the inconsistent mediation effects of psychosocial resources and demands are associated with educational status. Using data from the 2008 National Study of Changing Workforce (NSCW), we found that psychosocial work resources and demands had inconsistent mediating effects on the education-health relationship. Higher educated employees were more likely to report autonomy, challenge and schedule control, but they were also more likely to experience overtime hours, job overload and work-family conflict. Work resources appeared to protect higher-educated workers from stress and health problems while work demands put them at risk of less favorable health outcomes. In addition we found that the 'costs' of psychosocial work demands were stronger among women, particularly those who were highly educated, suggesting that highly educated women did not reap the full health benefit of high educational attainment. Our findings illustrate that the observed positive associations between education and health mask important heterogeneity in the effects of psychosocial work characteristics. We discuss the implications of this study for health and family-based work policies.

Examining factors associated with the length of short-term disability-free days among workers with previous short-term disability episodes

OBJECTIVE

The purpose of this study is to examine the timing of short-term disability recurrence among workers who have previously experienced a short-term disability episode.

METHODS

The dataset comes from a Canadian resource sector company's 2003 to 2006 short-term disability leave and human resource datasets. The multi-year dataset consists of the records of 3593 employees who experienced at least on short-term disability episode between 2003 and 2006.

RESULTS

The overall 1-year disability-free rate was 72.1% ± 1.6%. About half of workers with previous disability episodes for mental/behavioral disorders were disability free for more than 800 days. In contrast, about 50% of workers with previous disability episodes for physical disorders were disability free for more than 1300 days.

CONCLUSIONS

These findings suggest the majority of workers with previous short-term disability episodes for mental/behavioral disorders remain disability free for more than 2 years. However, the duration of disability free days for these workers is half that of other workers with previous episodes.

Direct and indirect associations between internalized homonegativity and high-risk sex

Recent meta-analytic work has endorsed a lack of any meaningful, direct relationship between internalized homonegativity (IH) and high-risk sex. It may not be possible to observe a direct association, however, if heterogeneity in response to IH is considered. This investigation used data from 1,669 men who have sex with men who completed an online survey of sexual behavior in 2005 to consider two potential intermediate variables (compulsive sexual behavior [CSB] and the frequency of sexual partnering) that could increase (CSB) and decrease (frequency of sexual partnering) the probability of having unprotected anal sexual intercourse. We used Mplus (Version 5.1) to estimate confirmatory factor analysis and structural models. Statistical mediation models identified indirect associations through both CSB (positive association) and the number of male sexual partners (negative association). The different directions of association, when combined, cancelled out one another. This contributed to the observed lack of association between IH and high-risk sexual behavior. Future work on risk behavior that incorporates IH will need to consider heterogeneity in how individuals respond to the construct and how these different processes are associated with risk behavior.