Underestimating protection and overestimating risk: examining descriptive normative perceptions and their association with drinking and sexual behaviors

College men's use of protective behavioral strategies for sexual aggression, risky sexual behavior, and heavy episodic drinking

OBJECTIVE

Sexually aggressive behavior (SAB), risky sexual behavior (RSB), and heavy episodic drinking (HED) are serious behavioral health problems among college men. The present study substantially revises and validates protective behavioral strategies (PBS) measures in the SAB and RSB domains; evaluates the relations among PBS usage in the SAB, RSB, and HED domains; and determines whether college men with SAB, RSB, or HED histories report lower PBS usage.

METHOD

College students who identified as men (n = 1,121) completed measures of PBS, SAB, RSB, HED, rape-supportive attitudes, sociosexuality, and bar/party attendance.

RESULTS

Factor analyses resulted in three PBS scales (SAB, RSB-General, and RSB-Protection) that showed good fit and cross-validated well. Average scores for all four PBS measures converged moderately to strongly. Men reporting histories of SAB, RSB, or HED reported much lower domain-specific PBS use, and domain-specific PBS predicted concurrent SAB, RSB, or HED in the presence of other established predictors.

CONCLUSIONS

Four well-developed and validated PBS measures now provide an expanded set of potential harm-reduction strategies for college men who drink and engage in sexual activity. Given the strong concurrent associations between PBS use and problems, as well as the interrelatedness of PBS use across domains, future research should examine the impact of simultaneous personalized normative feedback on PBS use across alcohol and sexual domains. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Differential Role of Perceived Same-Gender and Gender-Neutral Norms in Emerging Adult Risk Behavior

Background: Normative perceptions are strongly related to risk behaviors among emerging adults but the role of gender-specific normative perceptions remain unclear. Objectives: The current study examined the differential effects of same-gender and gender-neutral normative perceptions on self-reported substance use and sexual risk behavior. College students (n = 389, ages 18-25) reported binge drinking, cannabis use and prescription drug misuse, sexual risk behavior, and the perceived frequency of these behaviors by both the average- and same-gender adult. Results: Binge drinking was positively associated with same-gender norms only, whereas cannabis use and sexual risk behavior were also positively associated with gender-neutral norms perceptions. For binge drinking only, same-gender norms explained more variance in behavior than gender-neutral norms. Conclusions: Findings indicate perceptions of same-gender norms play a particularly important role in binge drinking during this developmental period. Interventions targeting emerging adult risk behavior should include within-group normative perceptions related to demographic and social group characteristics.

An eHealth Prevention Program for Substance Use, Sexual Assault, and Sexual Risk Behaviors for Adolescents in Primary Care: Pilot Feasibility Randomized Controlled Trial of Teen Well Check

BACKGROUND

Substance use, sexual assault, and sexual risk behaviors are common among adolescents and are interrelated. Nearly 1 in 5 adolescents use substances before sexual encounters, placing these young people at risk for both sexual assault and sexual risk behaviors. Primary care visits present a unique opportunity to address multiple health risk behaviors.

OBJECTIVE

Teen Well Check is a web-based integrated prevention program for substance use, sexual assault, and sexual risk behaviors with demonstrated usability and acceptability among patients and providers. The aim of this study was to conduct a pilot randomized controlled trial to assess feasibility.

METHODS

Adolescents (n=123) aged 14 to 18 years from diverse backgrounds were recruited from primarily Medicaid-serving pediatric primary care clinics. Participants completed a baseline survey; were randomized to receive Teen Well Check or an assessment-only control; and completed 1-, 3-, and 6-month follow-up surveys. Feasibility was assessed in terms of recruitment and retention rates. Preliminary changes from baseline to follow-up periods were examined separately in the Teen Well Check and control conditions.

RESULTS

We recruited 123 participants (Teen Well Check: n=61, 49.6%; control: n=62, 50.4%). Of the 61 participants assigned to the Teen Well Check condition, 55 (90%) completed the full program and viewed all intervention content. Of the 123 participants, 105 (85.4%) were retained across at least 1 follow-up period, and there was no difference in follow-up rates between the conditions (χ21=0.6; P=.43). The completion of Teen Well Check took an average of 6.2 (SD 5.8) minutes. Preliminary analyses revealed that there were significant reductions in perceived peer norms (descriptive norms) for substance use before sex across follow-ups among participants in the Teen Well Check condition (P=.001 from baseline to 6 months), whereas there were significant increases among participants in the control condition (P=.003 from baseline to 6 months). In addition, there were nonsignificant reductions in substance misuse risk from baseline to the 6-month follow-up among participants in the Teen Well Check condition (P=.16).

CONCLUSIONS

These findings support the feasibility of Teen Well Check delivery within pediatric primary care clinics. A randomized clinical trial is needed to assess efficacy.

TRIAL REGISTRATION

ClinicalTrials.gov NCT3489434; https://www.clinicaltrials.gov/study/NCT03489434.

Short-term mating orientation as a predictor of alcohol use and risky sexual behavior

OBJECTIVES

Sexual Strategies Theory suggests people fall on a continuum between having short-term mating orientation (STMO) and long-term mating orientation. One way STMO individuals signal mating goals is via risky drinking. The current study therefore aims to investigate drinks per week (DPW) as a mediator between STMO and risky sexual behavior (RSB), with gender as a moderator between STMO and DPW.

PARTICIPANTS

Undergraduate students (N = 300) from a Midwestern university during Fall 2019.

METHOD

Participants completed questionnaires assessing STMO, DPW, and RSB frequency.

RESULTS

A moderated-mediation model indicated DPW significantly mediated the relationship between STMO and RSB. Positive associations were found among all three variables. Gender was not a moderator between STMO and DPW.

CONCLUSIONS

Mating orientation was a correlate of alcohol use and RSB for women and men, contributing to the literature identifying STMO as an indicator of those in need of substance use and RSB intervention.

Teen Well Check: an e-health prevention program for substance use, sexual assault, and sexual risk behaviors for adolescents in primary care

Objective: Adolescents are at risk for substance use, sexual assault, and sexual risk behaviours; however, to date no integrated prevention programmes address all three risk behaviours. The goal of this study was to evaluate the usability and acceptability of Teen Well Check, an e-health prevention programme targeting substance use, sexual assault, and sexual risk among adolescents in primary care settings.Methods: The current study included content analysis of interviews with adolescents in primary care (aged 14-18; n = 25) in the intervention development process, followed by usability and acceptability testing with qualitative interviews among adolescents in primary care (aged 14-18; n = 10) and pediatric primary care providers (n = 11) in the intervention refinement process. All data were collected in the Southeastern U.S.Results: Feedback on Teen Well Check addressed content, engagement and interaction, language and tone, aesthetics, logistics, inclusivity, parent/guardian-related topics, and the application of personal stories. Overall, providers reported they would be likely to use this intervention (5.1 out of 7.0) and recommend it to adolescents (5.4 out of 7.0).Conclusions: These findings suggest preliminary usability and acceptability of Teen Well Check. A randomized clinical trial is needed to assess efficacy.

Does the Andersen Behavioral Model for health services use predict how health impacts college students' academic performance?

Objective: The purpose of this research study is to examine the use of the Andersen Behavioral Model of Health Services Use in predicting how health impacts the academic performance of college students through predisposing, enabling, and need factors. Participants: Data were collected from 428 college students attending a large university in the Southeast. Methods: Students answered questions about their demographic characteristics, health, healthcare use, and academics using a survey adapted from the 2018 National College Health Assessment (NCHA) II conducted by the American College Health Association (ACHA). Bivariate and multivariate statistical analyses were run on the data and summarized. Results: Enabling factors were more likely to predict health impact on academic performance, while predisposing factors were least likely to predict these impacts. Conclusion: Results indicate that the Andersen Model is a useful model for framing the relationship between health and academic performance among college students.

Narcissistic grandiosity and risky health behaviors in college students

Objective This study explored associations between narcissistic grandiosity (including its component traits) and reported risky health behaviors in college students. Participants: College men and women (N = 122) participated between December 2015 and January 2016. Methods: Participants completed self-report measures of grandiosity, alcohol consumption, number of sex partners, and condom use. Results: Grandiosity was positively associated with alcohol consumption. Gender interacted with grandiose traits, driving associations with reported sexual behaviors. College men high in entitlement/exploitativeness reported more sex partners. Grandiose exhibitionism was associated with condom use among women but not men, such that college women higher in grandiose exhibitionism were more likely to report not using a condom with their most recent partner. Conclusions: Grandiosity (and grandiose traits) may influence health behavior and/or the reporting of health behavior in college students, but associations may differ for men and women.

Association between relationship characteristics, sexual health attitudes, and dual contraceptive use among young adult college students aged 18-24

Objective Determine the relationship characteristics, sexual health attitudes, and demographic factors associated with dual contraceptive use among college students. Participants: September-October 2018 via campus email, we recruited College of Public Health students attending a large, urban, public university (N = 424). Methods: Respondents completed a cross-sectional, Web-based sexual health questionnaire. Descriptive statistics were calculated. Multiple logistic regression models were run to determine the association between relationship characteristics, pregnancy and condom attitudes, demographics, and dual use the last time having sex. Results: In independent models, one-unit increase in trust (aOR = 0.982; 95% CI: 0.966-0.998) and commitment score (aOR = 0.987, 95% CI: 0.976-0.999) was inversely associated with dual use while sex with a casual date/acquaintance (aOR = 3.149; 95% CI: 1.550-6.397) was positively associated. In a fully adjusted model for all correlates, only trust score was significant (aOR = 0.982; 95% CI: 0.966, 0.998). Conclusions: Emotion-based constructs may be more influential on dual use behaviors than discrete relationship factors.

Short-Term Consequences of Sex: Contextual Predictors and Change Across College

Although sexual experiences are normative by young adulthood, individuals continue to explore and develop their sexual behaviors and cognitions across the college years. Thus, perceived consequences of sexual experiences may change. Similarly, characteristics of sexual experiences such as partner type, alcohol use, and sexual behavior type predict perceived consequences, and these associations may change over time. In this study, we addressed links between characteristics of sexual experiences (casual vs. committed partner, heavy alcohol use on sex days, and kissing/touching only vs. oral/penetrative sex) and short-term perceived consequences of sexual experiences (physical satisfaction, emotional intimacy, not satisfied, guilt, not ready), using daily data collected longitudinally across seven college semesters. We also examined whether perceived consequences of sex change across college and whether within-person daily associations between sexual experience characteristics and perceived consequences of sex change across college. An ethnically and racially diverse sample of traditionally aged first year university students (N = 566; 54% female; 98% heterosexual) completed online surveys, yielding 8,838 daily reports about sexual behaviors. Multilevel models indicated that partner type, heavy alcohol use, and sexual behavior type predicted within-person differences in perceived consequences of sex. Interactions between characteristics of sexual experiences and college semester indicated that differences in perceived consequences of sexual experiences with casual versus committed partners lessened over time. The likelihood of reporting physical satisfaction and guilt after only kissing/touching (but not oral/penetrative sex) decreased across college semesters. Findings inform understanding of normative sexual development by demonstrating that perceived consequences and their predictors change across time.

Protective behavioral strategies for sexual aggression and risky sexual behavior

Sexual aggression (SA) is a serious public-health problem on college campuses, and there is a pressing need for basic research fostering the development of novel prevention strategies. The current study (a) developed measures of protective behavioral strategies (PBS) for sexual aggression (SA) and risky sex (RS); (b) characterized college men's PBS use; and (c) evaluated whether those who reported engaging in SA and RS showed lower PBS use. Undergraduate men from two universities (n = 567) who endorsed sexual attraction toward women completed measures of PBS, SA, RS, rape-supportive and sociosexual attitudes, and alcohol consumption. On average, participants reported using PBS for SA and RS fairly often, but a sizeable number indicated that they seldom or never used the strategies. Men who reported SA engagement in the last year, relative to their peers, endorsed sharply lower reliance on SA PBS and RS PBS. Men who reported at least one RS behavior in the last year used RS PBS far less often than their peers. The PBS measures converged as expected with other attitudinal and behavioral measures. The new PBS measures reference cognitive-behavioral approaches that a large percentage of college men use on a regular basis, making them potentially acceptable prevention targets. Further, men at greater risk of exhibiting SA are much less likely to take steps to reduce the risks associated with sexual behavior, in comparison with their peers. Thus, future work could evaluate the potential usefulness of incorporating PBS for SA and RS into primary prevention programming in both domains.

"Everything feels risky now": Perceived "risky" sexual behavior during COVID-19 pandemic

Social distancing through the COVID-19 pandemic has impacted sexuality and relationships, which may also change risk perceptions beyond traditional definitions (e.g. sexually transmitted infections). This study examines risk perceptions related to sexuality during the pandemic. We present qualitative analyses of a survey of adults in the United States (N = 333) to identify impacts of COVID-19 on individuals’ risk perceptions. Risky sexual behavior definitions included: (1) COVID-19-related, (2) STI/pregnancy, (3) relationship-related, (4) physical boundaries, (5) drug or alcohol, and (6) multiple risks. Conventional public health messaging may need to incorporate changing risk definitions to address sexual health during the pandemic.

Correlates of STI Testing Among US Young Adults: Opportunities for Prevention

The purpose of this study was to examine sex cognitions and behavioral strategy correlates for chlamydia, gonorrhea, and HIV testing among a national sample of young adults ages 18-20. Young adults (18-20 years) were recruited nationally (n = 1144). The sample was restricted (n = 817) based on inclusion/exclusion criteria for analysis. The outcome variables were gonorrhea, chlamydia, and HIV testing, respectively, in the last 12 months. Covariates included demographic variables, alcohol use, perceived vulnerability, protective behavioral strategies, and sexual behavior in the last 3 months. Adjusted logistic regression models were estimated in SAS 9.4. Approximately 24% of respondents were tested for chlamydia and gonorrhea, and 21% were tested for HIV in the past year. Women were more likely than men to be tested for chlamydia (OR = 1.67, 95% CI 1.13, 2.46) and gonorrhea (OR = 1.55, 95% CI 1.05, 2.28). Persons who were worried about an STI after a sexual encounter and who engaged in casual sex were more than two times as likely to be tested for all three STIs. Similarly, persons who used more non-condom-related protective behavioral strategies were more likely to be tested. Future studies may consider these correlates as potential intervention points for promoting STI testing among young adults.

Meeting Kids Where They Are At-A Substance Use and Sexual Risk Prevention Program via Telemedicine for African American Girls: Usability and Acceptability Study

BACKGROUND

Rural African American youth lack access to drug and sexual risk-taking prevention programs available in more urban areas. Recent data indicate that rural youth now use substances at higher rates and at younger ages than their urban peers.

OBJECTIVE

This study aims to evaluate the initial usability and acceptability of a low-cost, technology-based approach to delivering effective, culturally tailored, integrated substance use disorder (SUD) and HIV risk behavior prevention programs to African American female youth to inform the use of this intervention via telemedicine for rural youth.

METHODS

Effective SUD prevention strategies and emotion regulation skills were integrated into an existing evidence-based HIV risk reduction program culturally tailored for African American female adolescents-Sisters Informing, Healing, Living, and Empowering (SIHLE)-and delivered to 39 African American female youth via group telehealth. The evaluation of the resulting program, 12-session SIHLEplus, was completed by 27 girls who also completed self-report measures that assessed sexual risk behaviors (eg, number of partners and age of sex initiation), substance use, exposure to traumatic events, and emotion regulation.

RESULTS

The descriptive and qualitative results of the pilot study demonstrate the initial usability and acceptability of delivering evidence-based prevention successfully via telehealth to help address health disparities in this vulnerable population.

CONCLUSIONS

Although more research is needed, the findings from this study suggest that SIHLEplus has demonstrated initial usability and acceptability.

Preventing College Sexual Victimization by Reducing Hookups: a Randomized Controlled Trial of a Personalized Normative Feedback Intervention

Sexual activity, including hooking up, increases college women's vulnerability to sexual victimization. Reducing hookups may reduce rates of sexual victimization among this vulnerable population. Because college students overestimate how frequently their peers hook up, correcting their misperceptions may lead to more accurate perceived social norms, and consequently, less hookup behavior. The study was designed as a randomized controlled trial of the efficacy of a brief, computer-administered personalized normative feedback (PNF) intervention regarding hookups during the first semester of college. We tested an indirect effects model in which PNF was hypothesized to predict perceiving fewer peer hookups, which were expected to predict fewer actual hookups and consequently, less sexual victimization during the first semester of college. Entering first-year women (N = 760) were randomly assigned to receive web-delivered PNF or no information. At the end of the semester, perceived number of hookups of others, number of hookups during the semester, and sexual victimization experiences were assessed. Women who received the intervention perceived that their peers engaged in significantly fewer hookups than did control women. Consistent with the proposed indirect effects model, intervention had a significant indirect effect on the odds of first-semester victimization via lower perceived descriptive norms, which in turn predicted fewer hookups. The study provides proof of concept for the importance of hookups as a risk factor for sexual victimization and provides novel, preliminary support for intervention to change descriptive norms as a way of reducing hookups and consequently, sexual vulnerability.

Social Norms: Are Sexually Aggressive Men More Likely to Misperceive Other Men's Sexual Desires and Behavior?

Separate lines of research show that men overestimate the extent of male peers' sexual activity, and independently, that sexually aggressive men believe that other men approve of coercive behavior. This study examined the intersection of these lines of inquiry, testing whether the degree of male participants' misperception of other men's sexual behavior differs as a function of perpetrator status. In a national sample, we presented heterosexually active men (n=497) with sexual scenarios varying in sexual acts, partner types, and circumstances. Results showed that participants significantly overestimated the typicality of all types of sexual situations for other men. Participants also misjudged the desirability of scenarios consistent with a traditional masculinity sexual script to other men; these scenarios reflected an adversarial perspective on relationships and an impersonal approach to sexuality - a known risk factor for sexual aggression. Further, sexually aggressive men overestimated the desirability of these traditional masculinity scenarios to a greater extent than non-aggressive peers. Findings suggest that interventions that provide accurate knowledge about social norms, or "typical" sexual desires and behaviors among other men, may reduce pressure to live up to perceived but perhaps inaccurate masculine ideals, as well as reduce social norm-related risks for sexually aggressive behavior.

Editor's Choice: Deliberative and non-deliberative effects of descriptive and injunctive norms on cancer screening behaviors among African Americans

Objective: Two longitudinal studies examined whether effects of subjective norms on secondary cancer prevention behaviors were stronger and more likely to non-deliberative (i.e., partially independent of behavioral intentions) for African Americans (AAs) compared to European Americans (EAs), and whether the effects were moderated by racial identity. Design: Study 1 examined between-race differences in predictors of physician communication following receipt of notifications about breast density. Study 2 examined predictors of prostate cancer screening among AA men who had not been previously screened.Main Outcome Measures: Participants' injunctive and descriptive normative perceptions; racial identity (Study 2); self-reported physician communication (Study 1) and PSA testing (Study 2) behaviors at follow up. Results: In Study 1, subjective norms were significantly associated with behaviors for AAs, but not for EAs. Moreover, there were significant non-deliberative effects of norms for AAs. In Study 2, there was further evidence of non-deliberative effects of subjective norms for AAs. Non-deliberative effects of descriptive norms were stronger for AAs who more strongly identified with their racial group. Conclusion: Subjective norms, effects of which are non-deliberative and heightened by racial identity, may be a uniquely robust predictor of secondary cancer prevention behaviors for AAs. Implications for targeted screening interventions are discussed.

Sextual Intercourse: Considering Social-Cognitive Predictors and Subsequent Outcomes of Sexting Behavior in Adulthood

The purpose of this study was to identify specific social-cognitive factors that may influence the likelihood of engaging in sexting, and potential positive and negative outcomes of such behaviors, in adults. We asked 244 adult participants (64.5% women) to complete a set of online measures reflecting sexting engagement, social-cognitive factors (definitions, differential association, differential reinforcement, and imitation), and outcomes of sexting behavior (risky sexual behavior appraisal, sexual satisfaction, and relationship satisfaction). Results showed that 77.6% of our sample had sexted. Sexting in the context of a romantic relationship was predicted by differential reinforcement and friend imitation, while positive definitions of sexting alone predicted sexting someone outside the context of a romantic relationship. This indicates that motivations for sexting engagement may be context specific in adulthood. Those who had sexted demonstrated significantly higher sexual satisfaction than those who had never sexted. However, sexting outside of a romantic relationship predicted reduced perceived risk and heightened perceived benefit of engaging in real-life risky sexual behaviors. This suggests there may be both positive and negative implications of sexting engagement in adulthood.

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.

A content analysis of sexual health and substance use information presented on study abroad websites: Findings and recommendations

Objective: Despite study abroad students frequently engaging in risky behaviors, there is a dearth of research exploring prevention efforts taken by study abroad programs. The goal of this project was to examine information presented on study abroad program websites regarding sexual assault, alcohol use, drug use, and risky sexual behavior. Participants: A total of 753 universities in the US were selected from the Carnegie Classification of Institutes database. Method: Coders evaluated the website of each institution's study abroad program for the presence of information about the four factors of interest. Results: Sixty-seven percent of the websites provided no information on any of these risk behaviors. Chi-square analyses revealed institutional demographic differences in the presentation of prevention information. We also identified three emerging themes about avenues for modifying website content. Conclusion: Study abroad programs can provide more detail and action oriented information on their websites for students.

Correcting for norm misperception of anti-bullying attitudes

Research has documented the presence of norm misperception in the context of school bullying, as children and adolescents typically underestimate the degree to which their peers disapprove of bullying behavior. Despite commonly held attitudes in opposition to bullies and in support of helping victims, widespread misperception of the norm makes students vulnerable to acting in a manner that reinforces bullying, as they aim to align themselves with perceived peer beliefs. This study investigated whether personalized normative feedback, a social norms intervention that juxtaposes individuals’ own perceptions of peer norms against their peers’ true normative values, could operate as a mechanism by which to reduce norm misperception of peer attitudes toward bullying. Whereas this type of intervention has shown promising effects in a variety of contexts, no study to date has examined its utility in the specific context of bullying. Baseline participants included 188 seventh grade students, 175 of whom were randomized into four study groups for follow-up data collection. Individuals in the experimental condition received personalized normative feedback on attitudes toward bullying. Control conditions were the following: general normative feedback on anti-bullying attitudes, the absence of normative feedback, and personalized normative feedback on a construct separate from bullying (i.e., antidrug use attitudes). Findings indicated that personalized normative feedback on bullying attitudes led to significant change in perceived peer attitudes in the direction of the group norm, with an effect size in the small-to-medium range. No intervention effects emerged on personal attitude change. Implications highlight strategies for improving the strength of similar interventions in future research as well as the positive clinical outcomes that could result from reduced norm misperception and increased engagement in prosocial bystander behavior.

Social norms, misperceptions, and mosquito net use: a population-based, cross-sectional study in rural Uganda

BACKGROUND

Mosquito net use is an essential part of malaria prevention. Although previous research has shown that many people sleep under a mosquito net in endemic areas, it is unknown whether people underestimate how common it is to sleep under a net every night. Furthermore, perceived social norms about whether most others sleep under a mosquito net every night may contribute to personally sleeping under a net, given decades of research showing that people often mimic others' behaviours.

METHODS

Population-based data were collected from 1669 adults across eight villages in one rural parish in southwestern Uganda. Individuals' perception about whether most adults in their community sleep under a mosquito net every night was compared with whether daily mosquito net use was the actual norm in their community to identify the extent of norm misperception. The association between whether an individual perceived daily mosquito net use to be the norm and personal mosquito net use was assessed while adjusting for the ratio of nets:people in the household and other factors.

RESULTS

Although the majority (65%) of participants reported sleeping under a mosquito net every night (and 75% did so among the 86% of people with at least one net), one-quarter of participants thought that most adults in their community did not sleep under a mosquito net every night. Another 8% were unsure how many nights per week most adults in their community sleep under a mosquito net. Participants who perceived that daily mosquito net use was the norm were 2.94 times more likely to report personally sleeping under a mosquito net every night (95% CI 2.09-4.14, p < 0.001) compared to participants who thought doing so was not normative, adjusting for other factors.

CONCLUSIONS

Results suggest an opportunity for anti-malarial interventions to reduce misperceptions about mosquito net use norms and emphasize the commonness of daily mosquito net use in malaria-endemic regions. If people correctly perceive most others to sleep under a net every night, then they may personally do so when possible and support others to do so too.

Attitudes toward protective behavioral strategies: Do they predict use of strategies and alcohol outcomes over time?

Whereas past research among young adults has established that the use of protective behavioral strategies (PBS) is negatively related to alcohol outcomes, fewer studies have examined constructs related to PBS use. This study aimed to examine longitudinally the associations of attitudes toward PBS with PBS use and alcohol outcomes, as well as between PBS use and attitudes toward PBS. It also aimed to examine biological sex as a moderator of these associations. Participants (N = 248) were young adults participating in a longitudinal study in the US. Measures of attitudes toward PBS, PBS use, alcohol use and related consequences at 18, 24 and 30-months were included in the analyses. Results indicated that attitudes toward PBS were positively related to subsequent PBS use when prior PBS use was not controlled for; similarly, PBS use was positively related to attitudes toward PBS when prior attitudes were not taken into account. Both associations did not remain significant after controlling for prior PBS use and attitudes. These associations were not significantly moderated by biological sex. There was, however, a significant interaction between attitudes toward PBS and biological sex in predicting alcohol use, such that positive attitudes toward PBS were significantly related to fewer drinks over time among males but not among females, even after controlling for prior PBS use and alcohol use. Finally, after controlling for prior PBS use and consequences, attitudes toward PBS were not significantly related to consequences over time. Implications of these findings for prevention among young adults are discussed.

Risky sex behaviours among college students: The psychosocial profile

AIMS

Risky sex behaviours among college students are a growing public health concern. However, few studies have profiled these behaviours using a large range of psychosocial correlates.

METHODS

Participants were 6874 undergraduate and postgraduate students (64.7% female, age range 17-25 years, M = 20.43 years, SD = 1.86 years) drawn from 13 higher-level institutions in Ireland.

RESULTS

Regarding prevalence, 75% of the sample report that they have been, or are currently sexually active. Of this sexually active cohort (n = 5111), 27.2% report early sexual initiation, 29.5% report 5 or more lifetime sexual partners and 12.1% report 2 or more sexual partners in the past 3 months. In addition, 47.7% of students report inconsistent condom use and 39.5% report inconsistent use of other contraceptive methods in the past 3 months. Using multivariate logistic regression analyses, significant correlates of risky sex behaviour are identified across 5 groups of psychosocial predictors (demographic, sexuality and relationships, substance use, mental well-being and personal resources). Differences between males and females and between different sexual orientations are highlighted.

CONCLUSIONS

Suggestions are made for sexual education and intervention programs to specifically target subgroups of the student population.

Misperceived norms and personal sugar-sweetened beverage consumption and fruit and vegetable intake among students in the United States

Perceptions of peer food and beverage consumption norms may predict personal consumption. Yet actual peer norms may be misperceived. Data were collected from adolescents in grades 6-12 (n = 5841) in 13 schools across six regionally diverse states via an anonymous online survey. The male and female averages for the number of sugar-sweetened beverages (SSBs) personally consumed per day were significantly lower than average perceptions of the typical number of SSBs consumed by peers. Inversely, the male and female averages for the number of fruit and vegetable (FV) servings personally consumed per day were significantly higher than average perceptions of typical FVs consumed by peers. Among the majority of male and female grade cohorts, the median SSB consumption was 1 drink per day and the median FV intake was 3 servings per day. Regression analyses found a strong relationship between personal consumption and perceived peer norms about male and female consumption (β  = 0.56, p < .001 for perceived male norm among male students and β  = 0.52, p < .001 for perceived female norm among female students about SSB consumption, for example), adjusting for sociodemographic characteristics and actual consumption norms. Overall, 65% and 67% of students overestimated average SSB consumption among males and females in their grade cohort, respectively, while less than 5% underestimated these norms. In addition, 49% and 52% of students underestimated average FV intake among males and females in their grade cohort, respectively, while only about 25-30% overestimated the norm. There was little difference in male and female students' estimations of peer norms. Unhealthy misperceptions of SSB norms and FV norms existed across all student categories and grade cohorts, which may contribute to unhealthy personal dietary patterns.

Accuracy of HIV Risk Perceptions Among Episodic Substance-Using Men Who Have Sex with Men

Using the HIV Incident Risk Index for men who have sex with men-an objective and validated measure of risk for HIV acquisition, and self-perceptions of belief and worry about acquiring HIV, we identified individuals who underestimated substantial risk for HIV. Data from a racially/ethnically diverse cohort of 324 HIV-negative episodic substance-using men who have sex with men (SUMSM) enrolled in a behavioral risk reduction intervention (2010-2012) were analyzed. Two hundred and fourteen (66%) SUMSM at substantial risk for HIV were identified, of whom 147 (69%, or 45% of the total sample) underestimated their risk. In multivariable regression analyses, compared to others in the cohort, SUMSM who underestimated their substantial risk were more likely to report: a recent sexually transmitted infection diagnosis, experiencing greater social isolation, and exchanging sex for drugs, money, or other goods. An objective risk screener can be valuable to providers in identifying and discussing with SUMSM factors associated with substantial HIV risk, particularly those who may not recognize their risk.

Eating for Two? Protocol of an Exploratory Survey and Experimental Study on Social Norms and Norm-Based Messages Influencing European Pregnant and Non-pregnant Women's Eating Behavior

The social context is an important factor underlying unhealthy eating behavior and the development of inappropriate weight gain. Evidence is accumulating that powerful social influences can also be used as a tool to impact people's eating behavior in a positive manner. Social norm-based messages have potential to steer people in making healthier food choices. The research field on nutritional social norms is still emerging and more research is needed to gain insights into why some people adhere to social norms whereas others do not. There are indications stemming from empirical studies on social eating behavior that this may be due to ingratiation purposes and uncertainty reduction. That is, people match their eating behavior to that of the norm set by their eating companion(s) in order to blend in and be part of the group. In this project, we explore nutritional social norms among pregnant women. This population is particularly interesting because they are often subject to unsolicited advice and experience social pressure from their environment. In addition, their pregnancy affects their body composition, eating pattern, and psychosocial status. Pregnancy provides an important window of opportunity to impact health of pregnant women and their child. Nevertheless, the field of nutritional social norms among pregnant women is understudied and more knowledge is needed on whether pregnant women use guidelines from their social environment for their own eating behavior. In this project we aim to fill this research gap by means of an exploratory survey (Study 1) assessing information about social expectations, (mis)perceived social norms and the role of different reference groups such as other pregnant women, family, and friends. In addition, we conduct an online experiment (Study 2) testing to what extent pregnant women are susceptible to social norm-based messages compared to non-pregnant women. Moreover, possible moderators are explored which might impact women's susceptibility to social norms as well as cultural aspects that co-determine which social norms and guidelines exist. The project's findings could help design effective intervention messages in promoting healthy eating behavior specifically targeted to European pregnant women.

Repeated Measures Analysis of Alcohol Patterns among Gay and Bisexual Men in the Momentum Health Study

BACKGROUND

This study analyzed repeated study visits (n = 2,624) of 693 gay and bisexual men (GBM) in the Momentum Health Study from July, 2012 to June, 2015. Based on recent cross-sectional analyses, we hypothesized that over the study period: (1) hazardous drinking levels would remain high, (2) GBM classified as Hazardous Drinkers will be consistently associated with high risk sex, and (3) GBM classified as Always Hazardous Drinkers differ significantly from Sometimes Hazardous Drinkers.

METHODS

AUDIT classified participants as Non-Hazardous Drinkers or Hazardous Drinkers, the Cochran-Mantel-Haenszel Test assessed hazardous drinking trends, and Generalized Estimating Equations (GEE) analysis identified Hazardous Drinking covariates. Logistic regression analysis of participants with at least two study visits (575) compared those who were Sometimes Hazardous Drinkers (n = 171) with Always Hazardous Drinkers (n = 129).

RESULTS

At baseline 40% of participants were Hazardous Drinkers, but there was a significant decline in hazardous drinking by visit and Hazardous Drinkers were not significantly associated with high risk sex. Always Hazardous Drinkers had significantly more high risk sex and gay bar attendance, but less often sought Internet sex partners compared to Sometimes Hazardous Drinkers.

CONCLUSIONS

Analyses did not support the first two hypotheses, but distinguishing between Always and Sometimes Hazardous drinkers identified a young GBM subgroup associated with significantly higher levels of high risk sex and social support measures. These results suggest interventions programs based on Social Norms Theory, which predicts peer norms among youth are important factors in regulating drinking patterns, may be effective for these men.

Prototype Willingness Model Drinking Cognitions Mediate Personalized Normative Feedback Efficacy

Personalized normative feedback (PNF) interventions have been shown to be efficacious at reducing college student drinking. Because descriptive norms have been shown to mediate PNF efficacy, the current study focused on examining additional prototype willingness model social reaction cognitions, namely, prototypes and willingness, as mediators of intervention efficacy. We expected the PNF interventions to be associated with increased prototype favorability of students who do not drink, which would in turn be associated with decreased willingness to drink and subsequently, less drinking. The current study included 622 college students (53.2% women; 62% Caucasian) who reported one or more heavy drinking episodes in the past month and completed baseline and three-month follow-up assessments. As posited by the framework of the prototype willingness model, sequential mediation analyses were conducted to evaluate increases in abstainer prototype favorability on willingness on drinking, and subsequently willingness to drink on drinking behavior. Mediation results revealed significant indirect effects of PNF on three-month drinking through three-month prototypes and willingness, indicating that the social reaction pathway of the prototype willingness model was supported. Findings have important implications for PNF interventions aiming to reduce high-risk drinking among college students. Study findings suggest that we should consider looking at additional socially-based mediators of PNF efficacy in addition to perceived descriptive norms.

Actual Versus Perceived HIV Testing Norms, and Personal HIV Testing Uptake: A Cross-Sectional, Population-Based Study in Rural Uganda

HIV testing is an essential part of treatment and prevention. Using population-based data from 1664 adults across eight villages in rural Uganda, we assessed individuals' perception of the norm for HIV testing uptake in their village and compared it to the actual uptake norm. In addition, we examined how perception of the norm was associated with personal testing while adjusting for other factors. Although the majority of people had been tested for HIV across all villages, slightly more than half of men and women erroneously thought that the majority in their village had never been tested. They underestimated the prevalence of HIV testing uptake by 42 percentage points (s.d. = 17 percentage points), on average. Among men, perceiving that HIV testing was not normative was associated with never testing for HIV (AOR = 2.6; 95% CI 1.7-4.0, p < 0.001). Results suggest an opportunity for interventions to emphasize the commonness of HIV testing uptake.

Sex Differences in Contraception Non-Use Among Urban Adolescents: Risk Factors for Unintended Pregnancy

BACKGROUND

Contraception non-use among sexually active adolescents is a major cause of unintended pregnancy (UP).

METHODS

In this cross-sectional study we sought to identify overall and sex-specific correlates of contraception non-use using the 2015 Philadelphia Youth Risk Behavior Survey (YRBS) (N = 9540). Multivariate regression models were used to examine mental health, sexual activity, substance use, and violence indicators on reported contraception non-use among sexually active youth.

RESULTS

Marijuana use among boys and girls was a statistically significant risk factor for contraception non-use. Availability of illegal drugs on school property in the past year was also significantly related to contraception non-use among boys.

CONCLUSIONS

These results may inform overall and sex-specific adolescent programs to promote consistent contraception use among urban youth within school-based communities.

Gender's role in misperceptions of peers' sexual motives

The sexual double standard influences men's and women's sexual attitudes and behavior, leading men and women to consider distinct sexual motives, or reasons whether or not to engage in sexual intercourse (Crawford & Popp 2003; Reiss 1964). The goal of the present paper was to document how the sexual double standard shapes perceptions of peers' sexual motives. We build on past research by using open-ended questions and measuring perceptions of both same-gender and other-gender peers. The sample included 154 heterosexual college students (50% female, 49% European American, 25% Latino American, 26% African American) recruited via probability sampling. When we compared perceptions of men's and women's sexual motives, we found that participants seemed to rely on the sexual double standard. Participants were more likely to attribute a female-stereotyped motive (e.g., romantic relationship characteristics, feeling "ready", emotional investment) and less likely to attribute a male-stereotyped motive ("easy", arousal, physical appearance) to female peers than to male peers. However, when we compared participants' own motives to perceptions of their peers' motives, participants overestimated male-stereotyped motives and underestimated female-stereotyped motives in peers, regardless of peer gender, possibly in congruence with stereotypes of hookup culture. These findings demonstrate that, although individuals sometimes rely on the sexual double standard to attribute sexual motives to others, misperceptions of peers' sexual motives may also be influenced by stereotypes of hookup culture. These misperceptions contribute to pluralistic ignorance that may influence college students' sexual behaviors.

Alcohol use, risky sexual behavior, and condom possession among bar patrons

PURPOSE

The current study seeks to: 1) assess the relationship between alcohol consumption and intentions to engage in unprotected sex in an uncontrolled environment, and 2) to identify if covariates (race, age, sex, breath alcohol content (BrAC), intentions to engage in sex, hazardous drinking rates) are significant predictors of condom possession during time of uncontrolled alcohol consumption.

METHODS

Data were collected from 917 bar patrons to assess alcohol use using the Alcohol Use Disorders Identification Test (AUDIT-C), BrAC levels, intentions to engage in risky sex, and condom possession. Correlational analysis and hierarchical binary logistic regression was conducted using SPSS.

RESULTS

Correlational analyses indicated a negative relationship between AUDIT-C scores (r=-0.115, p=0.001), BrAC (r=-0.08, p=0.015), and intentions to use a condom. Over 70% of participants intended to use a condom if they engaged in sex; however, only 28.4% had a condom to use. The regression analysis indicated the predictive model (χ(2)=114.5, df=8, p<0.001) was statistically significant, and correctly classified 72.9% of those in possession of a condom.

CONCLUSIONS

Alcohol consumption was associated with intentions to have unprotected sex; however, intentions to engage in protected sex and condom possession were higher for males and those with higher BrAC levels.

Using a pattern-centered approach to assess sexual risk-taking in study abroad students

OBJECTIVES

The purpose of this study was to examine the impact of several potential factors related to sexually risky behaviors in study abroad students. The authors utilized a pattern-centered analysis to identify specific groups that can be targeted for intervention.

PARTICIPANTS

The sample consisted of 173 students who studied abroad in a variety of international locations for an average of 4 months.

METHODS

Participants completed questionnaires informed by the Triandis Theory of Interpersonal Behavior that have been predictive of risky sex in traditional traveling environments.

RESULTS

The analyses revealed 3 different pathways for risky sexual behavior: Environmental involvement, historical condom use, and intentions to engage in risky sex.

CONCLUSION

These findings can be used for identification of specific high-risk groups of students who can be targeted for predeparture prevention programs.

Man Up Monday: An integrated public health approach to increase sexually transmitted infection awareness and testing among male students at a midwest university

OBJECTIVE

This campaign sought to (a) increase awareness of sexual health and chlamydia testing; (b) motivate students, particularly sexually active men who do not pursue regular sexually transmitted infection (STI) testing, to get tested; and (c) improve the capacity of the student health center to provide free chlamydia testing and treatment for all students.

PARTICIPANTS

Students enrolled at a 4-year public research university (N = 333).

METHODS

Collaborative partnerships formed the foundation of a campus marketing and testing campaign, with treatment for students testing positive for chlamydia.

RESULTS

A total of 333 students were tested over 5 consecutive Mondays, showing a chlamydia incidence of 9.6%. The incidence for females and males were 8.6% and 10.8%, respectively.

CONCLUSIONS

The campaign was effective in reaching men, an at-risk population not traditionally emphasized in STI testing.

College Students' Perceptions of Depressed Mood: Exploring Accuracy and Associations

College is a time of high risk for depressed mood. Theories about depression (i.e. Cognitive Theory and Depressive Realism theory) are well researched, but suggest different venues of understanding the cognitive underpinnings of mood. In addition, much research is available about normative perceptions around substance use and how those perceptions relate to behaviors. However, there are no studies examining normative perceptions around depressed mood nor how these perceptions may relate to students' own well-being. Undergraduates (N=1577) ages 18-24 responded to an online survey as part of a larger study on drinking and depressed mood. The survey assessed symptoms of depression and feelings of sadness, depression and suicidal ideation experienced in the past 2 weeks, as well as students' perceptions of the prevalence of these feelings among other students. Rates of sadness and depression reported in the sample were relatively high; whereas rates of reported suicidal ideation were low. Most students under-estimated the prevalence of sadness and depression experienced by other students; a finding that was especially true for male students. Conversely, most students over-estimated the prevalence of suicidal ideation. Students who reported experiencing a given feeling in the past two weeks perceived greater rates of the feeling among other students. Depression symptoms were associated with both greater perceived prevalence of sadness, depression and suicidal ideation, as well as correct and over-estimates of the prevalence of sadness and depression. Implications for future directions in prevention and interventions efforts are discussed.

The association between alcohol use and engagement in casual sexual relationships and experiences: a meta-analytic review of non-experimental studies

The present study provides a meta-analytic review of the association between alcohol use and engagement in casual sexual relationships and experiences (CSREs). Specifically, the meta-analysis focused on non-experimental studies of community and college samples. Results from the meta-analysis, which included 29 relevant studies (34 effect sizes), indicated that alcohol use was significantly associated with engaging in CSREs, r = .34, 95 % CI [.29-.38], but that this link showed considerable variability. Subsequent analyses examined moderators that may explain this heterogeneity. Results revealed that age and method of assessment significantly moderated the effect of alcohol use on CSRE engagement such that the association was greater for emerging adults (18-24 year olds) than older adults and online assessments produced greater effect sizes than paper-and-pencil assessments. These results have implications for future research and intervention development. In particular, this meta-analysis emphasizes the need for studies that utilize consistent measurements of CSRE engagement, include diverse methodology, and expand upon sampling.

"Bend a fish when the fish is not yet dry": adolescent boys' perceptions of sexual risk in Tanzania

Despite decades of effort, the spread of HIV/AIDS continues among many African young people. A key contributor is unsafe sexual behavior that is desired, persuaded, or coerced. We explored the masculinity norms shaping pubescent boys' perceptions of and engagement in (unsafe) sexual behaviors in Tanzania. Through a comparative case study in rural and urban Tanzania, qualitative and participatory methods were used with 160 adolescent boys in and out of school to better understand the social and contextual factors promoting unsafe sexual behaviors. Adolescent boys in both the rural and urban sites reported struggling with intense sexual desires, strong peer pressures to have sex, and social norms dissuading condom use. A growing "normalization" of AIDS suggests messages promoting the dangers of HIV infection may be less effective. Findings reinforce the need for interventions with very young adolescents. Research is needed to identify more effective approaches for promoting safer sexual practices among boys in sub-Saharan Africa. Harm reduction approaches and gender transformative approaches might prove more effective than current HIV prevention efforts focused on youth.

Sex on the beach: the influence of social norms and trip companion on spring break sexual behavior

Spring Break trips are associated with heavy drinking and with risky sexual behavior (e.g., unprotected sex, multiple partners, unwanted sexual contact), especially for those students who go on trips with friends. The present study adds to this growing event-specific risk literature by examining Spring Break-specific normative perceptions of sexual risk behavior and the role that these perceptions and taking a trip with a friend or with a romantic partner have on Spring Break sexual behavior. College students (N = 1,540; 53.9 % female) were asked to report descriptive normative perceptions of sex with casual partners, drinking prior to sex, number of drinks prior to sex, and condom use as well as their own Spring Break drinking and sexual behaviors. Students perceived the typical same-sex student to have engaged in more frequent sexual behavior for all outcomes than students' own self-reported sexual behavior. Furthermore, results revealed that these perceptions were positively associated with behavior. The choice of travel companion (friend(s) versus romantic partner) also differentially predicted sexual behaviors. Results suggested that intervention efforts aimed at reducing risks for Spring Break trip-takers may be strongest when they incorporate corrective normative information and target those traveling with friends.

Web-based intervention to change perceived norms of college student alcohol use and sexual behavior on spring break

The purpose of the present study was to evaluate an adapted web-based multi-component personalized feedback intervention to reduce college student alcohol use and risky sexual behavior during Spring Break. This is one of the first interventions focused on Spring Break alcohol use and related sexual behavior. Personalized feedback intervention components addressed intentions, expected consequences, norms, motivations, protective behavioral strategies, and pacts with friends. Participants were college students (N=263; 55% women) between the ages of 18 and 21 who planned to go on a Spring Break trip with their friends. Effects were not significant in reducing alcohol use or sexual behavior during Spring Break or some of the proposed intervention mechanisms. However, consistent results showed that the intervention succeeded in reducing perceived social norms for Spring Break drinking and sexual behavior. Findings suggest that changing norms alone is not sufficient for changing risk behavior during this event and alternative strategies are needed to impact other putative mediators.

Randomized controlled trial of a web-delivered personalized normative feedback intervention to reduce alcohol-related risky sexual behavior among college students

OBJECTIVE

The purpose of this study was to evaluate the efficacy of personalized normative feedback (PNF) on college student alcohol-related risky sexual behavior (RSB).

METHOD

In a randomized controlled trial, 480 (57.6% female) sexually active college students were stratified by gender and level of drinking and randomly assigned to an alcohol-only intervention, an alcohol-related RSB-only intervention, a combined alcohol and alcohol-related RSB intervention, or control. All assessment and intervention procedures were Web-based.

RESULTS

Results indicated a significant reduction in drinking outcomes for the alcohol only and the combined alcohol and alcohol-related RSB interventions relative to control. Findings further demonstrated a significant reduction in alcohol-related RSB outcomes for the alcohol-related RSB only and the combined alcohol and alcohol-related RSB interventions relative to control. There were no significant intervention effects on alcohol-related negative consequences. These findings demonstrate that the combined alcohol and alcohol-related RSB intervention was the only intervention successful at reducing both drinking and alcohol-related RSB outcomes relative to control. There were no significant differences when comparing the combined alcohol and alcohol-related RSB intervention to the alcohol-only intervention or the alcohol-related RSB-only intervention. Finally, results suggested that the intervention effects on high-risk behaviors were mediated by reductions in descriptive normative perceptions.

CONCLUSIONS

These findings demonstrate that PNF specific to drinking in sexual situations was needed to reduce alcohol-related RSB. Furthermore, this study highlights the potential utility of a brief intervention that can be delivered via the Internet to reduce high-risk drinking and alcohol-related RSB among college students.

Normative misperceptions of peer seat belt use among high school students and their relationship to personal seat belt use

OBJECTIVES

This research examined gender-specific perceptions of peer seat belt use norms among high school students and their relationship with one's own seat belt use. We expected that students would underestimate the seat belt use of their peers and that these perceptions would be positively associated with their own seat belt use.

METHODS

High school students from 4 schools (N = 3348; 52% male) completed measures assessing perceived seat belt use and personal seat belt use.

RESULTS

Findings demonstrated that students perceived that others engaged in less seat belt use than they do and that perceived norms were positively associated with one's own seat belt use.

CONCLUSIONS

Peer influences are a strong predictor of behavior, especially among adolescents. Ironically, adolescents' behaviors are often influenced by inaccurate perceptions of their peers. This research establishes the presence of a misperception related to seat belt use and suggests that misperception is associated with own behaviors. This research provides a foundation for social norms-based interventions designed to increase seat belt use by correcting normative misperceptions among adolescents.

Alcohol consumption and negative sex-related consequences among college women: the moderating role of alcohol protective behavioral strategies

Alcohol protective behavioral strategies (PBS) limit overall negative consequences; however, less is known about the relationship between PBS and negative sex-related consequences. The purpose of the current study was to examine the moderating effects of 2 distinct types of PBS-controlled consumption strategies and serious harm reduction strategies-on the relationship between alcohol consumption and alcohol-related risky sexual behavior and sexual victimization. Participants were 459 undergraduate women (ages 18-25) who had consumed alcohol within the past 30 days. Both types of PBS significantly qualified the alcohol-sexual victimization link, but neither type of PBS qualified the alcohol-risky sexual behavior link.