Alcohol Intoxication Impairs the Bystander Intervention Process in a Hypothetical Sexual Assault: A Field Investigation

Alcohol's Effects on the Bystander Decision-Making Model: A Systematic Literature Review

To decrease rates of sexual assault victimization, young people are encouraged to become involved when they see questionable sexual situations (i.e., be a prosocial bystander). Several factors can facilitate or inhibit intervention, including alcohol use. To inform bystander prevention programs that aim to address alcohol's impact on bystanders, the current study reviewed research focused on alcohol use and bystander decision making. In December 2022, the authors searched published studies from six major electronic databases. Empirical articles were deemed eligible if they examined alcohol and the bystander decision-making model within the context of sexual assault, were based in the United States or Canada, and not an intervention study; 32 studies were included in the final review. Across 32 studies published between 2015-2022, 12 assessed the proximal effects of alcohol on bystander constructs and the additional studies examined the distal effects of alcohol on bystander constructs. Alcohol use appeared to impede earlier steps of the bystander decision-making model; however, alcohol use was associated with impeding and facilitating bystander decision making at the latter half of the model. Overall, alcohol use appears to be negatively rather than positively associated with bystander constructs. Bystander intervention programs may want to move beyond the narrative of alcohol as a risk factor for sexual assault and discuss how alcohol impairs a bystanders' ability to recognize risk. More work is needed to ensure researchers assess alcohol consistently and with similar methods (number of drinks, subjective intoxication) to increase generalizability of findings to prevention programs.

Study protocol for a randomized controlled trial of RealConsent2.0: a web-based intervention to promote prosocial alcohol-involved bystander behavior in young men

BACKGROUND

Sexual violence (SV) is a significant, global public health problem, particularly among young adults. Promising interventions exist, including prosocial bystander intervention programs that train bystanders to intervene in situations at-risk for SV. However, these programs suffer from critical weaknesses: (1) they do not address the proximal effect of alcohol use on bystander decision-making and (2) they rely on self-report measures to evaluate outcomes. To overcome these limitations, we integrate new content specific to alcohol use within the context of prosocial bystander intervention into an existing, evidence-based program, RealConsent1.0. The resulting program, RealConsent2.0, aims to facilitate bystander behavior among sober and intoxicated bystanders and uses a virtual reality (VR) environment to assess bystander behavior in the context of acute alcohol use.

METHODS

This protocol paper presents the design of a randomized controlled trial (RCT) in which we evaluate RealConsent2.0 for efficacy in increasing alcohol- and non-alcohol-involved bystander behavior compared to RealConsent1.0 or to an attention-control program ("Taking Charge"). The RCT is being implemented in Atlanta, GA, and Lincoln, NE. Participants will be 605, healthy men aged 21-25 years recruited through social media, community-based flyers, and university email lists. Eligible participants who provide informed consent and complete the baseline survey, which includes self-reported bystander behavior, are then randomized to one of six conditions: RealConsent2.0/alcohol, RealConsent2.0/placebo, RealConsent1.0/alcohol, RealConsent1.0/placebo, Taking Charge/alcohol, or Taking Charge/placebo. After completing their assigned program, participants complete a laboratory session in which they consume an alcohol (target BrAC: .08%) or placebo beverage and then engage in the Bystanders in Sexual Assault Virtual Environments (BSAVE), a virtual house party comprising situations in which participants have opportunities to intervene. Self-reported bystander behavior across alcohol and non-alcohol contexts is also assessed at 6- and 12-months post-intervention. Secondary outcomes include attitudes toward, outcome expectancies for, and self-efficacy for bystander behavior via self-report.

DISCUSSION

RealConsent2.0 is the first web-based intervention for young men that encourages and teaches skills to engage in prosocial bystander behavior to prevent SV while intoxicated. This is also the first study to assess the proximal effect of alcohol on bystander behavior via a VR environment.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT04912492. Registered on 05 February 2021.

The bystander intervention for problematic alcohol use model (BIPAUM)

Objective: The study aimed to identify phases of bystander intervention (BI) for problematic alcohol use (PAU) among college students. Participants: Twenty focus groups and nine interviews were conducted. Methods: Transcripts were thematically analyzed. Results: The phases of the Bystander Intervention for Problematic Alcohol Use Model (BIPAUM) include: (1) plan in advance, (2) notice and interpret a sign, (3) decide (i.e., assume responsibility, assess support/feasibility to intervene, and identify intervention strategy), (4) intervene, and (5) assess outcomes. Assessing outcomes loops to influence future behavior and each phase is influenced by barriers and facilitators. Conclusions: These unique phases should be considered when designing and evaluating intervention programs for PAU to meet students' needs and better reduce PAU. Future research should empirically test the BIPAUM. The results of the current study demonstrate a promising opportunity for applying BI to PAU, with the goal of reducing risky drinking among college students.

BYSTANDER INTERVENTION AMONG DRINKING GAMERS Bystander Intervention Among College Student Drinking Gamers: Sexual Assault Attitudes, Self-Efficacy, and Intent to Intervene

Heavy drinking and sexual assault warrant significant concern on U.S. college campuses as emerging evidence suggests that the risk for sexual victimization is amplified in the context of high-risk drinking behavior. Despite recent attention to sexual assault (e.g., MeToo Movement), rates of perpetration remain largely unchanged. In applying the bystander intervention framework, our understanding of the relation between key factors that may facilitate or prevent behavioral action, or when and how these factors are most salient, is limited. The present study examined whether bystander attitudes and bystander self-efficacy interact to predict bystander intent to intervene. Hypotheses were tested among college student drinking gamers, a group at particular risk for involvement in situations of sexual violence. Participants (N = 964) were traditional college-aged student drinking gamers recruited from three universities across the East and Southern Central United States. After controlling for Greek affiliation, prior intervention training and social desirability, hypotheses were partially supported. Higher rape supportive attitudes (rape myth acceptance) were negatively associated with bystander intent to intervene across all participants, but bystander self-efficacy significantly moderated the relation between bystander attitudes (rape myth acceptance) and bystander intent to intervene only among women college student drinking gamers. The interaction effect was not significant among men. For all participants, there was a significant relation between bystander self-efficacy and bystander intent to intervene such that as self-efficacy increases, bystander intent to intervene increases. The discussion addresses implications for sexual assault prevention programs on college campuses and directions for future research.

The Theory of Planned Behavior & Bystander Intention: Differences Based on Gender and Heavy Episodic Drinking

Research indicates that people who engage in heavy episodic drinking (HED) report less intention to intervene and intervention behavior to prevent sexual violence. Researchers have also found gender differences across bystander intention, bystander confidence, and intervention behavior. However, research in this area could benefit from use of an evidence-based health behavior theory. The theory of planned behavior (TPB) posits that personal attitudes, subjective norms, and perceived behavioral control (PBC) predict behavioral intention. Substantial evidence supports the utility of the TPB for predicting behavioral intention in a variety of health-related behaviors, yet few researchers have applied this theory when predicting bystander intention to prevent sexual violence. Undergraduate students (N = 395) from a southern university (77% female; 70% White, Non-Hispanic) completed a modified Sexual Assault Bystander Behavior Questionnaire and the Daily Drinking Questionnaire. Our findings did not reveal significant differences in attitudes, subjective norms, PBC, nor intention based on HED; however, there were significant differences based on gender, with women indicating more positive attitudes and supportive subjective norms regarding bystander intervention. Multiple regression analysis indicated that theoretical antecedents of intention positively predicted bystander intention, however, the relations were not moderated by prior engagement in HED. These findings support the utility of the TPB for predicting bystander intention to intervene; however, they do not support previous research examining how HED influences bystanders' intention to engage in prosocial actions.

Bystander Intoxication and Appraisal of Sexual Assault Risk: A Field Study of Emerging Adult Bargoers

Emerging adults are especially vulnerable to experiencing alcohol-related sexual assault. While bystanders play a critical role in preventing sexual assault, little is known about how bystander alcohol intoxication affects the intervention process-particularly in naturalistic settings. We recruited 315 emerging adult bargoers ages 21-29 (46% women; 28% non-college attending; 81% White) from a high-density bar area to provide responses to a sexual assault vignette and complete a breath alcohol concentration test. In this field-based study, we found a negative direct association between intoxication and appraisal of risk in the hypothetical sexual assault situation. We also found a negative indirect relation of intoxication on perceptions of personal responsibility to intervene and confidence in the ability to intervene, statistically mediated through reduced risk appraisal. Findings add to the limited literature in laboratory-based settings suggesting that bystander intoxication interferes with sexual assault intervention and help inform effective bystander intervention programming for emerging adults.

Bystander Intervention Behavior as Function of Victimization History, Opportunity, and Situational Context

Preliminary research has demonstrated the utility of bystander interventions in reducing sexual assault, and initial research has begun extending this type of intervention to intimate partner violence more broadly. However, the extant research is limited by methodological issues that fail to examine opportunity for intervention relative to intervention behaviors as well as a failure to examine intervention rates across differing risk situations. Further, there are many unexplored factors that may impact bystander intervention behavior, notably previous experiences with intimate partner violence and sexual assault. Thus, the current study examined bystander opportunities and intervention across situations of varying risk to the bystander, as well as the relationship of opportunity/intervention relative to victimization history. Given the rates of sexual assault and IPV on college and university campuses, the research examined the number of times college students (N = 393) encountered a range of situations in which bystander intervention may be indicated, and their intervention behavior across varying risk levels to the bystander. Results demonstrated that individuals with a history of psychological victimization were more likely to intervene across all situation types, but sexual and physical victimization provided mixed support for hypotheses. No differences in witnessing or intervening were found as a function of gender. These results replicate previous findings, and further provide evidence for a more nuanced approach to examine bystander behavior intervention. Implications and directions for future research are discussed.

Alcohol's Effects on Bystander Intervention Strategies to Prevent Sexual Assault

Alcohol's effects on bystander responses to potential sexual assault situations are understudied. In this mixed-methods study, we examined quality of bystander responses in intoxicated versus sober people. Participants were 121 young adults (ages 21-29, 50% female) randomly assigned to consume alcoholic beverages or soda water. After drinking, participants listened to a sexual assault vignette and completed a semistructured interview assessing how they would respond if they had witnessed the situation. Nearly all participants reported they would directly intervene if faced with the situation. Intoxicated participants and men were significantly less likely to use high-quality bystander intervention strategies than were sober participants and women. Results suggest that alcohol intoxication may negatively impact the likelihood that bystander intervention efforts will be helpful.