Young men's use of aggressive tactics to avoid condom use: A test of a theoretical model

A Scoping Review of Nonconsensual Condom Removal ("Stealthing") Research

Nonconsensual condom removal (NCCR; also known as "stealthing") involves the removal of a condom before or during sexual intercourse without a partner's sexual consent. Within the past several years, nations across the globe have codified NCCR as a form of sexual violence penalized by civil and/or criminal penalties. Given the recent legal attention to this behavior, we performed a scoping review of the peer-reviewed, empirical, English-language studies conducted on NCCR in order to summarize the current state of this field of research. Our scoping review yielded 27 articles meeting study inclusion criteria. Data on NCCR victimization and perpetration prevalence rates and correlates, as well as perceptions of NCCR, were extracted. The majority of the reviewed studies were conducted within the past 5 years and pertained to NCCR victimization. Rates of NCCR victimization ranged from 7.9% to 43.0% for women and 5.0% to 19.0% for men who have sex with men; rates of NCCR perpetration ranged from 5.1% to 9.8% for men and 0% for women. NCCR correlates included sociodemographic variables, relationship type, psychological factors, and sexual health concerns. Perceptions of NCCR were largely negative. The nascent field of NCCR research provides empirical evidence from several countries regarding concerning rates of NCCR. Building upon this foundation, continued research regarding NCCR is imperative. Studies that further delineate NCCR prevalence, risk factors, and outcomes would provide critical information beneficial to the development of evidence-based prevention and intervention programs targeting reductions in NCCR.

Components of Hostile Masculinity and Their Associations With Male-Perpetrated Sexual Aggression Toward Women: A Systematic Review

Hostile masculinity and its components (i.e., sexual dominance, hostility toward women, adversarial sexual beliefs, rape myth acceptance, and acceptance of interpersonal violence) have received considerable research attention as predictors of male-perpetrated sexual aggression toward women. The current systematic review sought to synthesize and organize the extant literature. Studies were included in the systematic review if they were published in a peer-reviewed journal between the years 1990 and 2020, contained a male sample within the United States, analyzed quantitative data, and examined at least one component of hostile masculinity and its association with sexual aggression. Literature searches were conducted in three academic databases, and additional records were identified through references sections from known hostile masculinity research. A total of 95 articles met inclusion criteria and were integrated into the overview of results. The reviewed literature provided broad support for the association between hostile masculinity and sexual aggression, including evidence for the theoretical framework posited by the confluence model of sexual aggression. Prevention efforts are likely to find success by modifying hostile masculine characteristics among men, particularly within problematic environmental contexts. However, the review also highlighted the need for a uniform conceptualization and operational definition of hostile masculinity. Additionally, empirical work with diverse samples is necessary to determine the scope of generalizability and potential subcultural distinctions. Future research that addresses these limitations will contribute to the understanding and prevention of sexual aggression beyond what is provided by the extant literature.

Relations Between Adolescent Sensation Seeking and Risky Sexual Behaviors Across Sex, Race, and Age: A Meta-Analysis

Sensation seeking (SS)-the seeking of novel and intense sensations or experiences and the willingness to take risks for the sake of such experiences-has been shown to be related to various risky sexual behaviors (RSBs) in areas such as multiple sexual partners, condom use, and sexual initiation. The aims of the current meta-analysis were to examine (1) how SS relates to specific RSBs in adolescents and (2) how the overall relationship between SS and RSB differs across sex, race, and age. Overall, a total of 40 studies met the inclusion criteria for our meta-analysis examining the relationship between SS and RSB, contributing 102 effect sizes. RSB variables included unprotected sex; multiple sexual partners; hazardous sexual activity; sexual initiation; virginity status; and history of sexually transmitted disease (STD) diagnosis. Moderating effects of sex, race, and age were also examined. The overall mean effect size of the correlational relationship between adolescent SS and RSB was statistically significant, as were the mean effect sizes of the relationships between SS and RSB subgroups, except for history of STD diagnosis. Race and age did not significantly moderate the overall relationship between SS and RSB; however, results indicated that SS and RSB relations were stronger in females compared to males. Our findings suggest that adolescents with elevations in SS tendencies tend to engage in more RSBs compared to their peers with lower levels of SS, increasing their risk of unplanned pregnancy and STD acquisition.

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

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

Sexual Coercion in the College Population: A Form of Risk-Taking Behavior

The purpose of this study was to examine whether a decision-making model of risk-taking behavior, specifically impulsivity, positive and negative outcome expectation, and sensation seeking, can be extended to motivation for perpetration of sexual coercion. Participants included 276 sexually active college students between the ages of 18 and 25 years old who completed a set of questionnaires: (a) Sexual Experiences Survey, (b) Sensation Seeking Scales, (c) Cognitive Appraisal of Risky Events, (d) Barratt Impulsiveness Scale, and (e) Reckless Behavior Questionnaire. Multiple regression analyses were utilized to examine the relationship between these decision-making models and sexually coercive behaviors. General risk-taking behaviors were positively correlated with acts of sexual coercion, r = .16, p < .01. The predictor variables accounted for a significant amount of the variance in sexual coercion, R² = .11, F(4, 246) = 7.57, p < .01. Only sensation seeking contributed unique variance to our model of sexual coercion, β = .27, t = 4.06, p < .01. Interventions to reduce sexual coercion may be more successful if they target those high in risk-taking. Similarly, prevention efforts informed by research on how to engage and hold the attention of sensation seeking youth may be more successful.

Intimate Partner Violence and Coerced Unprotected Sex Among Young Women Attending Community College

The present study examined the mediating role of sexual assertiveness in the relationship between psychological, physical, and sexual intimate partner violence (IPV) victimization and unprotected sex as a result of condom use resistance among sexually active young women attending community college. Women reported engagement in unprotected sex as a result of a partner's use of one of 32 forms of condom use resistance (e.g., physical force, deception, or other forms of coercion to avoid using a condom during intercourse). Women ages 18-24 years (N = 212) attending community college were recruited through paper advertisements to complete assessments of social and dating behavior in the campus computer laboratory. Only the women with a history of sexual intercourse (N = 178; 84% of the sample) were included in analyses. More frequent engagement in unprotected sex as a result of a partner's condom use resistance was associated with physical, psychological, and sexual IPV victimization. Sexual assertiveness mediated the relationship between physical IPV victimization and the frequency of unprotected sex as a result of condom use resistance. Efforts to prevent dating violence and enhance the sexual health of community college women may benefit from focusing on targeting sexual assertiveness as a protective factor.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Young Women's Experiences with Coercive and Noncoercive Condom Use Resistance: Examination of an Understudied Sexual Risk Behavior

OBJECTIVES

To investigate young women's engagement in and receipt of condom use resistance (CUR; attempts to avoid condom use with a partner who wants to use one), including nonconsensual condom removal ("stealthing"), with male partners.

METHODS

Participants were 503 women aged 21-30 years with increased sexual risk characteristics recruited from 2013 to 2017. Participants completed measures assessing sexual victimization history and CUR experiences.

RESULTS

Findings indicated that 87% of women experienced noncoercive CUR from a partner and 49% experienced coercive CUR. Of these women, 58% and 19% reported having engaged in noncoercive and coercive CUR, respectively. Twelve percent of women had a partner engage in stealthing; none of the women engaged in stealthing. The severity of sexual victimization history was positively associated with both use and receipt of coercive and noncoercive CUR. Diagnoses of sexually transmitted infections were positively associated with receipt of, but not engagement in, CUR.

CONCLUSIONS

Findings demonstrate that sexual victimization and both the use and receipt of CUR are positively related for young women, suggesting that prevention efforts focusing on women's sexual health would benefit from joint consideration of sexual violence and risk behaviors and that such efforts should target victims of sexual violence.

Male Partner Contraceptive Interference: Associations With Destructive Conflict and Women’s Relational Power

We explored the relational context of male partner contraceptive interference (CI), acts that impede women’s contraceptive use. Undergraduate women ( N = 213) who had previously been involved in a sexual relationship with a male partner provided self-report data on relational power and conflict within the relationship, including whether the past partner enacted CI. Relationships involving CI were characterized by greater conflict about whether to engage in sex, perceived infidelity, partner conflict engagement, and women’s withdrawal. These quantitative data suggest that, in heterosexual dyads, women who experience partner CI also experience disempowerment and multiple forms of destructive sexual and verbal conflict.

Men's Coercive Condom Use Resistance: The Roles of Sexual Aggression History, Alcohol Intoxication, and Partner Condom Negotiation

Condom use resistance (CUR) through coercive tactics is a significant public health concern. The present study investigated CUR risk factors through an alcohol administration experiment using a sexual risk analog with a community sample of male nonproblem drinkers ( N = 321). Utilizing a path analysis framework, results demonstrated that men with more severe sexual aggression histories displayed stronger in-the-moment power and control responses, which was associated with greater coercive CUR and unprotected sex intentions. A significant interaction between sexual aggression history, risk rationale, and alcohol condition also predicted coercive CUR intentions. These findings emphasize the relationship between sexual aggression and sexual risk behaviors and highlight the importance of targeting these constructs in intervention and prevention efforts.

The Intersection of Men's Sexual Violence Perpetration and Sexual Risk Behavior: A Literature Review

According to the Confluence Model of Sexual Violence, men with a strong impersonal sex orientation (i.e., greater engagement in sexual activities with more casual sexual partners) are at increased risk of perpetrating sexual violence. Research from a variety of countries and samples has supported this proposition, finding that men who perpetrate sexual violence are also more likely to engage in risky sexual behavior. The present article reviews this literature, synthesizing research findings from both psychology and public health domains utilizing both domestic and international samples. In particular, this review focuses on the associations between men's perpetration of sexual violence and their sexual partners, condom use, and sexually transmitted infection status, as well as provides recommendations for future research directions and prevention and intervention programming.

The Effects of Men's Hostility Toward Women, Acute Alcohol Intoxication, and Women's Condom Request Style on Men's Condom Use Resistance Tactics

OBJECTIVE

To extend previous research demonstrating that intoxicated men high in hostility toward women report stronger intentions to use coercive condom use resistance (CUR) tactics to have unprotected sex by examining the role of women's condom request style.

METHODS

Community, non-problem drinking men, ages 21-30 (N = 296) completed standard alcohol administration procedures and read an eroticized story of a casual sexual interaction. Following the woman's request to use a condom, intentions to engage in coercive CUR tactics were assessed. Generalized linear models with gamma distributions assessed the 3-way interaction of men's hostility toward women, beverage condition (alcohol or sober), and the woman's condom request style (indirect, direct, or insistent).

RESULTS

The 3-way interaction between hostility toward women, beverage condition, and indirect condom request (vs. direct) significantly predicted men's coercive CUR intentions. Men high in hostility toward women reported stronger CUR intentions after experiencing an indirect condom request, when sober or intoxicated, and after a direct condom request when intoxicated. Men high in hostility toward women reported the weakest CUR intentions when sober following an insistent or direct condom request.

CONCLUSIONS

Men high in hostility toward women pose a threat to women's sexual safety, particularly when intoxicated or following an indirect condom request. Hostility toward women and alcohol consumption should be addressed in sexual risk prevention programs. Pending further replication, women should be informed of the relative effectiveness of using insistent condom requests.

Triangular relationship among risky sexual behavior, addiction, and aggression: A systematic review

Background

Risky sexual behavior (RSB), addiction, and aggression are three important personal and social factors which influence each other.

Objective

To overview the potential relationship among RSB, addiction, and aggression to conduct an interactive model for the pathology and management of human behavior.

Methods

This review article was carried out by searching studies in PubMed, Medline, Web of Science, Ebsco, IEEE, Scopus, Springer, MagIran, and IranMedex databases from the year 1993 to 2013. The search terms were violence, aggression, drug abuse, substance abuse, illicit drug, psychoactive drug, intravenous drug users, addiction and high-risk sexual relationships, unprotected sex, high risk sexual behavior, and sexual risk-taking. In this study, forty-nine studies were accepted for further screening, and met all our inclusion criteria (in English or Persian, full text, and included the search terms).

Results

Forty-nine articles were included; 17 out of 26 studies showed a significant correlation between addiction and risky sexual behavior, 15 out of 19 articles indicated a statistically significant correlation between aggression and addiction, and 9 out of 10 articles reported significant correlation between aggression and risky sexual behavior.

Conclusion

According to the results, the triangle hypothesis of sex, addiction, and aggression led to the definition of the relationship among the variables of the hypothetical triangle based on the reviewed studies; and the proposed dual and triple relationship based on the conducted literature review was confirmed. This is not a meta-analysis, and there is no analysis of publication bias.

Depressive Symptoms, Acute Alcohol Intoxication, and Risk Rationale Effects on Men's Condom Use Resistance

This study examined the role of depressive symptoms, acute intoxication, and risk rationale in men's use of condom use resistance (CUR) tactics in an experimental study. Participants included 313 heterosexual male, nonproblem drinkers, ages 21 to 30. Participants were randomized to one of four beverage conditions: no alcohol, placebo, low (.04%) alcohol dose, or high (.08%) alcohol dose. They read an eroticized scenario depicting a consensual sexual encounter with a female partner who requested a condom to prevent either pregnancy or sexually transmitted infections (STIs) (risk rationale) and then indicated their intentions to use 10 different CUR tactics. Hypotheses related to the pharmacological, dosage, and expectancy effects of alcohol were tested in a generalized linear model. In intoxicated (.04% and .08%) men who were given a pregnancy risk rationale, depressive symptoms were associated with stronger intentions to use CUR tactics than in sober (control and placebo) men. Men who received a high alcohol dose (.08%) and who were given a pregnancy risk rationale reported higher intentions to use CUR tactics than those who received a lower alcohol dose (.04%). Findings suggest that the pharmacological effects of alcohol on men's likelihood to resist condoms vary by the saliency of the risk rationale and mood-related variables.

A qualitative examination of men's condom use attitudes and resistance: "it's just part of the game"

The purpose of this study was to investigate the variability in young heterosexual men's perceptions of the advantages and disadvantages of condom use in their casual sexual relationships. Because men who perceive greater disadvantages of condom use may be more likely to resist using them, we also explored the tactics that men employ to avoid using condoms. Semi-structured focus groups were conducted with single men who have sex with women (n = 60), aged 21-35 years, all of whom reported using condoms inconsistently. Transcripts were analyzed using a framework analysis approach. As expected, participants reported advantages and disadvantages to condom use that pertained to the likelihood and quality of sex, physical sensations during intercourse, and the risk of sexually transmitted infections and unwanted pregnancies. Within each of these topics, however, participants' appraisals of the relative pros and cons of condom use varied considerably. Additionally, participants reported that men use a wide range of condom use resistance tactics, including seduction, deception, and condom sabotage, and that the use of these tactics was viewed as normative behavior for men their age. These findings suggest that the effectiveness of sexual health prevention efforts could be enhanced by increasing young men's motivations to use condoms and by targeting social norms regarding condom use resistance. Additionally, the issue of men's condom use resistance clearly merits increased empirical investigation and intervention attention.

Young men's condom use resistance tactics: a latent profile analysis

Research suggests that many men have used a variety of tactics to avoid using condoms when having sex with women. Guided by previous work demonstrating that men's use of coercive condom resistance tactics was predicted by negative attitudes toward women, inconsistent condom use, multiple partners, and sexual sensation seeking, the current study used latent profile analysis (LPA) to determine whether similar constructs were associated with a variety of resistance tactics. A community sample of 313 moderate-drinking men participated, of whom 80% reported employing at least one condom use resistance tactic since adolescence. The LPA revealed three classes of men. In general, men with the least negative beliefs about women, low levels of sexual sensation seeking and impulsivity, and positive beliefs about condoms (Condom Positive/Low Hostility) reported less use of resistance tactics than men with moderate sexual sensation seeking and impulsivity, negative beliefs about condoms, and moderate (Condom Negative/Moderate Hostility) or high (Condom Negative/High Hostility) negative attitudes about women. The classes also differed in terms of their sexual behaviors. This study demonstrated that sexual risk behavior interventions should not only address the tactics through which men resist using condoms but also tailor these efforts to men's individual characteristics.

Men's alcohol intoxication and condom use during sexual assault perpetration

We assessed the association between alcohol consumption and condom use during penetrative sexual assault acts perpetrated by young adult men. Men aged 21 to 35 who reported inconsistent condom use and heavy episodic drinking (N = 225) completed a questionnaire assessing their perpetration of sexual assault since the age of 15, their consumption of alcohol prior to these acts, and their use of condoms during acts involving penetration. Descriptive statistics and Pearson's chi-square tests were used to examine the simultaneous use of alcohol and condom nonuse during penetrative sexual assault acts. More than one third of respondents reported perpetrating at least one penetrative sexual assault 35.6% (n = 79). Condoms were not used in 70.0% of penetrative sexual assaults. When they had consumed alcohol, perpetrators were significantly less likely to use condoms. The sexual assaults reported by this sample typically consisted of perpetrator alcohol consumption and the nonuse of condoms. Programs targeting sexual health and assault risk reduction would be enhanced by addressing this interplay of alcohol, violence, and risk.

Childhood Sexual Abuse and Acute Alcohol Effects on Men's Sexual Aggression Intentions

OBJECTIVE: Although research has established childhood sexual abuse (CSA) as a risk factor for men's perpetration of sexual aggression, there has been little investigation of the factors undergirding this association. This study represents one of the first to use a laboratory-based sexual aggression analogue coupled with an alcohol administration protocol to investigate the pathways through which CSA and alcohol influence men's self-reported sexual aggression intentions. METHOD: After completing background questionnaires, male social drinkers (N = 220) were randomly assigned to a control, placebo, low alcohol dose or high alcohol dose condition. Following beverage consumption, participants read a sexual scenario in which the female partner refused to have unprotected sexual intercourse, after which they completed dependent measures. RESULTS: Path analysis indicated that men with a CSA history and intoxicated men perceived the female character as more sexually aroused and reported stronger sexual entitlement cognitions, both of which were in turn associated with greater condom use resistance and higher sexual aggression intentions. Exploratory analyses revealed that intoxication moderated the effects of CSA history on sexual entitlement cognitions, such that sexual entitlement cognitions were highest for men who had a CSA history and consumed alcohol. CONCLUSIONS: Findings suggest that CSA history may facilitate sexual assault perpetration through its effects on in-the-moment cognitions, and that these effects may be exacerbated by alcohol intoxication.