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

Risk factors of sexual violence perpetration and victimization among adolescents: A study of Norwegian high school students

Sexual violence among adolescents represents a significant problem in society. In this study, we aimed to examine risk factors for sexual violence perpetration in adolescent men and victimization in adolescent women among a community sample of Norwegian high school students. The participants (560 men and 751 women, aged between 16 and 21 years) responded to online questionnaires covering physical and non-physical forms of sexual harassment and possible risk factors identified in the literature. Last year's prevalence rate of physical sexual perpetration reported by adolescent men was 7%. Comparably, the prevalence of physical sexual victimization reported by adolescent women was 30%. Path analyses suggest that sociosexuality was associated with adolescent men's sexual perpetration indirectly through sexual risk taking, alcohol intoxication, porn exposure, and sexual underperception that in turn was positively associated with undesirable non-physical solicitation from and toward women. In addition, rape stereotypes were associated with perpetration behavior in adolescent men. For adolescent women, sociosexuality was associated with being sexually victimized primarily through sexual risk behavior, alcohol intoxication, and sexual overperception. These factors were again positively associated with sexual derogation from adolescent women and solicitation from adolescent men. Prior sexual abuse victimization was only indirectly associated with victimization. The factors associated with adolescent men's perpetration and adolescent women's victimization were highly similar. Future work aimed at reducing sexual violence in adolescence within the educational context might find it more effective to specifically target non-physical forms of sexual harassment.

Coerced Condomless Sex: A Scoping Review of Qualitative Studies

Coerced condomless sex is a prevalent form of sexual coercion that is associated with severe negative health consequences. This scoping review addresses the current lack of synthesized qualitative evidence on coerced condomless sex. Our systematic literature search yielded 21 articles that met review eligibility criteria. Themes of coerced condomless sex were organized into three categories (tactics, motives, and sequelae) and presented separately for studies based on whether researchers stipulated pregnancy promotion intent as underlying the behavior. Coerced condomless sex perpetration tactics ranged from verbal pressure to physical assault. Besides pregnancy promotion, perpetration motives included control, dominance, entrapment, enhancing sexual experiences, and avoiding conflict. Following coerced condomless sex, victims reported developing protective strategies. They also reported experiencing various negative emotional, relational, and physical health effects. Interventions that specifically address coerced condomless sex perpetration and provide supportive programs for those who have experienced coercive condomless sex may be beneficial.

Coercive Condom Use Resistance: A Scoping Review

Objective

Sexual aggression research has recently expanded to include empirical investigations of coercion during condom negotiation and use. This scoping review presents and discusses peer-reviewed, quantitative, English-language studies conducted on coercive condom use resistance (CUR) behavior and intentions.

Method

Our systematic literature search yielded 20 articles that assessed coercive CUR perpetration behaviors or intentions and met other inclusion criteria. Data on rates and correlates of coercive CUR behavior and intentions were extracted.

Results

Identified studies used varied methods including cross-sectional surveys, 3-month longitudinal studies, and alcohol administration experiments, primarily with young adult samples. Overall, results indicated that a substantial minority (up to 42.6%) of sampled individuals endorsed lifetime perpetration of coercive CUR, with men reporting higher prevalence of coercive CUR perpetration than women. The majority of studies (70%) assessed coercive CUR through the Condom Use Resistance Tactics Scale (Davis et al., 2014). Although correlates largely differed by gender, alcohol-related variables emerged as risk factors for both men and women.

Conclusions

Burgeoning evidence indicates that coercive CUR is relatively common, and, particularly for men, risk factors are similar to those associated with sexual aggression more generally. Review findings demonstrate that continued research in this area is warranted and should expand to include more diverse populations, to consider other risk factors and sequelae, and to utilize novel methodological approaches.

Discriminating between consensual intercourse and sexual assault: Genital-anal injury pattern in females

BACKGROUND

Assessment of genital-anal (GA) injuries following sexual assault promotes health and assists prosecutors to build a case. The pattern of injuries may help differentiate between consensual and non-consensual intercourse, bolster the survivors' credibility, and increase prosecutions in sexual assault cases.

OBJECTIVES

To identify the constellation of G-A injury-related characteristics that most effectively discriminated between consensual sexual intercourse and sexual assault in females when controlling for intercourse-related variables.

METHODS

We employed a comparative study with two groups: a prospective cohort group with consensual participants and a group derived from an existing sexual assault registry. In the prospective cohort, we performed a sexual assault forensic examination at baseline and following consensual sexual intercourse with females ≥21 years. We compared their injury patterns to the injury records of females ≥21 years who were sexual assaulted.

RESULTS

We enrolled a sample of 834 females: 528 consensual (63.3%) participants and 306 non-consensual (36.7%) registry cases. After controlling for race/ethnicity, age, and time between intercourse and examination, logistic regression analyses showed that the presence of an external genital tear increased the odds of non-consensual intercourse more than two times (adjusted odds ratio [AOR] = 2.70, 95% CI = 1.28-5.56). Logistic regression analyses also showed that the odds of non-consensual sexual intercourse were significantly greater with a lower prevalence and frequency of external and internal genital redness, lack of condom use and lubrication, and presence of anal penetration. Latent class analysis identified high and low G-A injury prevalence subgroups among both consensual and non-consensual samples. One subset of results emerged that may be indicative of non-consensual as compared to consensual intercourse: a higher prevalence of external genital and anal tears.

CONCLUSION

External genital tears occurred more frequently in the non-consensual sample and increased the odds of non-consensual intercourse more than two times. Anal tears, swelling, and ecchymosis and anal penetration were markers for non-consensual intercourse and should increase suspicion for lack of consent.

Predicting rape events: The influence of intimate partner violence history, condom use resistance, and heavy drinking

Sexual aggression perpetration is a public health epidemic, and burgeoning research aims to delineate risk factors for individuals who perpetrate completed rape. The current study investigated physical and psychological intimate partner violence (IPV) history, coercive condom use resistance (CUR), and heavy episodic drinking (HED) as prospective risk factors for rape perpetration. Young adult men (N = 430) ages 21-30 completed background measures as well as follow-up assessments regarding rape events perpetrated over the course of 3 months. Negative binomial regression with log link function was utilized to examine whether these risk factors interacted to prospectively predict completed rape. There was a significant interaction between physical IPV and HED predicting completed rape; men with high HED and greater physical IPV histories perpetrated more completed rapes during follow-up than men with low HED at the same level of physical IPV. Moreover, psychological IPV and coercive CUR interacted to predict completed rape such that men with high coercive CUR and greater psychological IPV histories perpetrated more completed rapes throughout the follow-up period than men with low coercive CUR at the same level of psychological IPV. Findings suggest targets for intervention efforts and highlight the need to understand the topography of different forms of aggression perpetration.

Sexual Aggression Analogues Used in Alcohol Administration Research: Critical Review of Their Correspondence to Alcohol-Involved Sexual Assaults

BACKGROUND

Alcohol administration studies are crucial because causal questions about alcohol's role in human behavior can only be answered through experimental research that randomly assigns participants to drink conditions. The primary goal of this review was to catalogue the characteristics of experimental analogues used in alcohol administration research to assess men's sexual aggression proclivity and evaluate the extent to which they represent the scope of alcohol-involved sexual aggression. Although this review focuses on sexual aggression analogues, the identified methodological issues are relevant to a wide range of alcohol administration studies.

METHODS

Online databases were searched for published studies that randomly assigned participants to drink conditions and assessed participants' sexual aggression proclivity with an experimental analogue. Characteristics of the analogues were coded by both authors.

RESULTS

Seventeen studies were identified that used 12 unique experimental analogues. All of the analogues depicted a completed or potential sexual assault in an apartment between a male perpetrator and female victim who did not know each other well. This information was presented in written (n = 7), audio (n = 1), video (n = 3), or virtual simulation (n = 1) format. Sexual aggression proclivity was measured through participants' self-reports (n = 10) and behavioral responses (n = 2). Perpetrators primarily used physical force which the woman verbally and physically resisted. Only one analogue depicted behavioral signs of the woman's alcohol impairment; none included signs of the man's alcohol impairment.

CONCLUSIONS

These analogues were designed to address important theoretical questions; however, they do not represent the full range of alcohol-involved sexual assaults. This hampers the development of evidence-based prevention and treatment programs because we do not know whether these findings generalize to other types of sexual assaults (e.g., with incapacitated victims, within serious relationships, with sexual and other gender minorities). Funding agencies need to support more alcohol administration research in order to provide a strong foundation for the development of effective interventions.

Data driven optimization of sexual assault case processing

In recent years, several forensic laboratories have noted an increase in the number of sexual assault cases submitted for testing, often leading to longer turnaround times. In that context, forensic laboratories may be interested in reviewing their procedures to increase productivity. Here, we present two different strategies that were put in place in our laboratory. First, we changed the way sexual assault evidence kits (SAEK) are processed by implementing an optimized workflow that prioritizes the internal samples (vaginal, anal, and oral). This new procedure allowed for a drastic decrease in turnaround time, while maintaining a similar investigative power.

Secondly, we used data from casework to target cases and samples that were likely to yield biological material from the perpetrator, in an attempt to avoid dedicating time and effort to cases for which there is a very low probability of obtaining foreign DNA evidence. Among other things, we looked at the likelihood of obtaining DNA from the perpetrator when the complainant reported the use of a condom, has showered after the assault or when the complainant has no memory of the assault. Results show that those circumstances do not dramatically decrease the probability of finding DNA from the perpetrator.

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.

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.

Child Sexual Abuse and Negative Affect as Shared Risk Factors for Sexual Aggression and Sexual HIV Risk Behavior in Heterosexual Men

Previous research has suggested that sexually aggressive behavior and sexual HIV risk behavior are associated. Childhood sexual abuse (CSA) is a well-established risk factor for both types of problematic sexual behavior. Negative affect (i.e., anxiety, depression, and anger) is a less well-studied risk factor, but it has been theorized to relate to both sexual aggression and HIV risk behavior. Thus, this study sought to (1) confirm the relationship between sexual aggression and HIV risk behavior, (2) establish CSA and negative affect as shared risk factors for sexual aggression and HIV risk behavior, and (3) evaluate whether negative affect mediates the relationship between CSA and sexual aggression and between CSA and HIV sexual risk in a sample of heterosexual men. We recruited 18- to 30-year-old heterosexual men (N = 377) from urban sexually transmitted infection clinics. Men completed measures of sexual HIV risk history (number of partners and condom use), sexual aggression history, CSA history, and trait negative affect (anger, anxiety, and depression). Structural equation modeling was used to examine hypothesized direct and indirect relationships. In the final SEM model, sexual aggression history and sexual HIV risk behavior were correlated. CSA was associated with both types of problematic sexual behavior. Anxiety significantly mediated the relationship between CSA and sexual aggression and between CSA and sexual HIV risk behavior (χ ²[1300] = 2121.79, p < .001; CFI = 0.905; RMSEA [90% CI] = .044 [.041-.047]). Sexual aggression appears to be part of a constellation of sexual risk behaviors; thus, it may be possible to develop prevention programs that target both sexual HIV risk and sexual aggression. CSA is a shared risk factor for sexual aggression and HIV risk behavior through the pathway of anxiety. Thus, anxiety might be one promising target for intervention.

Toward Development of Enhanced Preventive Interventions for HIV Sexual Risk among Alcohol-Using Populations: Confronting the 'Mere Pause from Thinking'

The papers in this issue detail state-of-the science knowledge regarding the role of alcohol use in HIV/AIDS risk, as well as offer suggestions for ways forward for behavioral HIV prevention for at-risk alcohol-using populations. In light of recent evidence suggesting that the anticipated uptake of the newer biomedical HIV prevention approaches, prominently including pre-exposure prophylaxis, has been stalled owing to a host of barriers, it has become ever more clear that behavioral prevention avenues must continue to receive due consideration as a viable HIV/AIDS prevention approach. The papers collected here make a valuable contribution to "combination prevention" efforts to curb HIV spread.

Sexual Assault Perpetrators' Justifications for Their Actions: Relationships to Rape Supportive Attitudes, Incident Characteristics, and Future Perpetration

Perpetrators use rape supportive attitudes and sexual assault incident characteristics to justify forcing sex on their victims. Perpetrators who can justify their behaviors are at increased risk for future perpetration. This study examined the relationships between rape supportive attitudes, sexual assault incident characteristics, and the post-assault justifications of 183 men sampled from the community who self-reported committing at least one act of sexual aggression. Hierarchical multiple regression analyses indicated that rape supportive attitudes, expectations for having sex, misperceptions of sexual intent, victims' alcohol consumption, attempts to be alone with her, and the number of consensual sexual activities prior to the unwanted sex were significant predictors of perpetrators' post-assault use of justifications. Greater use of justifications was a significant predictor of sexual aggression over a 1-year follow-up interval. These findings demonstrate the need for further research exploring when and why perpetrators use post-assault justifications and whether they are amenable to change.

Background Predictors and Event-Specific Characteristics of Sexual Aggression Incidents: The Roles of Alcohol and Other Factors

Sexual assault in the United States is an important public health concern. Using prospective longitudinal methods and responses from 217 community men, we examined whether background characteristics predicted subsequent sexual aggression (SA) perpetration during a 3-month follow-up period. We also examined event-specific characteristics of reported SA occurrences. Consistent with predictions, SA perpetration history, aggressive and impulsive personality traits, rape myth attitudes, and alcohol expectancies predicted SA (both non- and alcohol-involved) at follow-up. In addition, alcohol-involved assaults occurred more often with casual (vs. steady) partners but were more likely to involve condom use with casual (vs. steady) partners. Results suggest important avenues for future research and SA prevention efforts.

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.