Using Experimental Paradigms to Examine Alcohol's Role in Men's Sexual Aggression: Opportunities and Challenges in Proxy Development

Impact of Acute Alcohol Consumption on Sexuality: A Look at Psychological Mechanisms

Alcohol's link with sexuality is long-standing and prominent. While research continues to document robust associations between drinking and sexual behavior, scientific attention now centers primarily on evaluating mechanisms and attendant theoretical frameworks to advance our understanding of how alcohol exerts a causal impact. We describe four domains with reliable evidence of alcohol effects: sexualized social perceptions, sexual arousal, sexual risk taking, and sexual assault. We consider three contextual frames: distal factors associated with encountering opportunities for alcohol-involved sex, proximal factors associated with alcohol's acute effects, and distal-proximal interactions. We then examine the empirical support for mechanisms embedded within four theoretical frameworks: alcohol disinhibition, alcohol expectancy, alcohol myopia, and emotion regulation. Support for disinhibition mechanisms is evident with sexual arousal only. Expectancy and myopia mechanisms enjoy support across domains and make up bases for integrative expectancy-myopia causal explanations. Emotion regulation mechanisms evidence preliminary support in risk taking and sexual assault. Implications and future directions are considered.

The Association of Acute Intoxication and Threats to Masculinity on Laboratory-Based Sexual Aggression

OBJECTIVE

Men's alcohol intoxication and perceptions of their masculinity as precarious (i.e., viewing masculinity as easily threatened) are independently related to men's perpetration of sexual aggression. Yet, the interactive effects of these constructs on sexual aggression are unclear. The goal of this study was to assess if precarious masculinity-measured as a static trait-and acute alcohol intoxication-measured in a laboratory setting-were positively associated with men's perpetration of laboratory-based sexual aggression after their masculinity is threatened.

METHOD

Cisgender heterosexual men (n = 120, ages 21-30 years) completed a self-report measure of precarious masculinity, were randomly assigned to consume an alcoholic or nonalcoholic beverage, and engaged in the Sexual Imposition Paradigm, which assessed laboratory-based sexual aggression perpetration toward a female confederate. Immediately before the Sexual Imposition Paradigm, all participants' masculinity was threatened via feedback from an ostensible personality test that indicated they are less masculine than other men.

RESULTS

Self-reported precarious masculinity and the Precarious Masculinity × Beverage Condition interaction were not associated with laboratory-based sexual aggression. However, intoxicated men showed higher levels of laboratory-based sexual aggression than sober men.

CONCLUSIONS

Acute alcohol intoxication facilitated men's sexually aggressive responding toward women when their masculinity was threatened. Consistent with pertinent theory and research, this effect suggests that acute intoxication facilitates men's focus on salient cues (i.e., threatened masculinity), which then may proximally motivate sexual aggression. Sexual aggression prevention programs should continue to address alcohol in their programming.

Power-Related Emotions, Alcohol Intoxication, and Nonconsensual Sex Intentions: The Role of Fear of Intimacy

The problem of alcohol-involved sexual assault against women highlights the need to identify how the presence of alcohol interacts with risk factors associated with sexual assault perpetration. One risk factor for sexual assault perpetration is fear of intimacy, the inhibited capacity to exchange vulnerable thoughts and emotions with a valued individual. Men who have perpetrated sexual violence report higher fear of intimacy and alcohol use than those who have not. However, little research has investigated how fear of intimacy may contribute to sexual assault perpetration in the context of alcohol intoxication. This study examined alcohol intoxication, fear of intimacy, proximal power-related emotions, and nonconsensual sex intentions. Non-monogamous, male social drinkers (N = 94) completed measures and were randomly assigned to an alcohol condition (alcohol [BrAC = .10%] versus control). Participants then read a sexual assault analogue scenario depicting sexual assault against a hypothetical woman and reported power-related emotions and nonconsensual sex intentions. Self-reported fear of intimacy differed across types of past perpetration. Results found that for intoxicated men only, fear of intimacy was positively associated with power-related emotions, and power-related emotions were positively associated with nonconsensual sex intentions. These associations were not observed for men in the control condition who did not consume alcohol. Future research should examine intimacy-related interventions for sexual assault prevention programming.

External validity of analogue sexual risk laboratory data

This article presents data on the external validity of an alcohol administration study of sexual decision-making in men who have sex with men (MSM) ages 21-50. Men (N = 135) randomized to alcohol (blood alcohol concentration [BAC] = .075%) or water control conditions reported intentions to engage in condomless anal intercourse (CAI) in response to video vignettes. Following the experiment participants provided 6 weeks of experience sampling method (ESM) data assessing intoxication, sexual arousal, partner relationship, and sexual behavior. Laboratory CAI intentions were hypothesized to predict future CAI behavior, and associations were hypothesized to be conditional upon sexual arousal and intoxication contextual factors as well as laboratory beverage condition. The hypotheses were partially supported. CAI intentions were correlated with subject proportions of days engaging in CAI (r = .29). A multilevel analysis indicated, on average, CAI intention predicted increased probability of CAI versus anal intercourse with a condom (relative risk ratio [RRR] = 1.43). There was mixed evidence of CAI intentions effects being conditional upon laboratory condition as well as arousal and intoxication contextual factors. Graphs of conditional marginal effects identified regions of significance. Effects of CAI intention for men in the alcohol condition on the CAI versus No Sex contrast were significant when sexual arousal was elevated. CAI intentions for men in the water control condition predicted a higher probability of CAI versus anal intercourse with a condom when intoxication was moderately elevated and/or arousal moderately low. The results support the external validity of alcohol administration experiments of sexual decision-making among MSM and, reciprocally, provide support for the validity of ESM assessment of sexual behavior. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Patterns of University Students' Risky Sexual Experiences and Their Characteristics

In Poland, there is little research on university students' risky sexual behaviours. Additionally, existing studies analyse the behaviours selectively and do not group them into clusters. Hence, effective prevention is impossible. The research aims to gather information regarding the prevalence, forms and clusters of students' risky sexual experiences. In 2019, a cross-sectional study was conducted in 12 universities in south-eastern Poland on a random sample (n = 2764). Fifteen risky sexual experiences, both condom-protected and unprotected, were analysed; they were mainly unprotected vaginal, oral, anal contacts; protected and unprotected sexual experiences while intoxicated and with unknown persons. Thanks Ward's hierarchical method, four inseparable clusters of students with similar risky experiences were distinguished. Their dominant features were: (A) (24% of interviewees)-drunk partners, (B) (4.8%)-partners intoxicated with drugs, (C) (3.1%)-partner abuse and exceeding partner sexual norms, (D) (17.8%)-the anonymity of partners and going beyond the convention. It was stated that 60.3% of the respondents do not belong to any of the identified clusters. Sex education and the promotion of student sexual health should be intensified; the development of attitudes of avoiding risky sexual behaviours and dealing with their consequences should be considered.

Prevention of sexual violence among college students: Current challenges and future directions

Objective Preventing sexual violence among college students is a public health priority. This paper was catalyzed by a summit convened in 2018 to review the state of the science on campus sexual violence prevention. We summarize key risk and vulnerability factors and campus-based interventions, and provide directions for future research pertaining to campus sexual violence. Results and Conclusions: Although studies have identified risk factors for campus sexual violence, longitudinal research is needed to examine time-varying risk factors across social ecological levels (individual, relationship, campus context/broader community and culture) and data are particularly needed to identify protective factors. In terms of prevention, promising individual and relational level interventions exist, including active bystander, resistance, and gender transformative approaches; however, further evidence-based interventions are needed, particularly at the community-level, with attention to vulnerability factors and inclusion for marginalized students.

A laboratory study of the effects of men's acute alcohol intoxication, perceptions of women's intoxication, and masculine gender role stress on the perpetration of sexual aggression

BACKGROUND

Although research has established an association between alcohol use and sexual assault, few studies have examined how characteristics of the perpetrator may influence sexual aggression depending upon whether alcohol is consumed by the perpetrator and/or the victim. This laboratory-based investigation was designed to disentangle the effects of individual differences in masculine gender role stress (MGRS) and the perpetration of sexual aggression as a function of (1) men's acute alcohol intoxication and (2) whether a woman was consuming alcohol or not.

METHOD

A community sample of 156 men participated in two laboratory sessions, during which they completed a self-report measure of MGRS (Session 1) and a modified version of the sexual imposition paradigm after consuming an alcoholic or non-alcoholic beverage (Session 2). In this paradigm, participants and a male friend were told that an ostensible female participant had consumed or not consumed alcohol. They were also told that she did not wish to view sexual content. Participants were then provided the opportunity to make the female confederate view a sexually or non-sexually explicit film. Sexual aggression was operationalized by selection of the sexually explicit film.

RESULTS

A hierarchical logistic regression showed that men higher in MGRS who were intoxicated were (1) more likely than sober men to select the sexually explicit film when the woman was intoxicated and (2) less likely than sober men to select the sexually explicit film when the woman was sober.

CONCLUSIONS

These findings suggest that the perpetration of sexual aggression is most likely among men with higher MGRS when there is concordance in drinking (i.e., when either the man and woman are both drinking or are both not drinking).

The Violent Behavior Vignette Questionnaire (VBVQ): A Measure of Violent Behavior for Research in Forensic and Non-Forensic Settings and Populations

The measurement of violent behavior presents serious challenges for research on violence. In the current article, we present initial tests of the construct validity of scores on the Violent Behavior Vignette Questionnaire (VBVQ), which consists of a series of interpersonal conflict vignettes with response options in a multiple-choice format designed to measure current violent behavior. Violent responses on the initial version of the VBVQ generally corresponded to independent indicators of physical aggressiveness and violent behavior among male university students, men in the community, and incarcerated male offenders. We then refined the VBVQ and again tested the validity of its scores in new samples of men in the community and incarcerated male offenders. In both samples, men who selected a violent response option on the VBVQ generally had much higher levels of physical aggressiveness and violent behavior than did men who selected non-violent response options. However, VBVQ responses were not associated with the number of violent offenses in offenders' official criminal records. Our findings provide some support for the use of the VBVQ in lab and correctional/forensic research, but further research is required to determine whether it offers advantages over other measures.

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.

Dangerous Liaisons: The Role of Hookups and Heavy Episodic Drinking in College Sexual Victimization

Heavy episodic drinking (HED) and hookups increase college women's vulnerability to sexual victimization. We examined whether the effect of HED on first year college sexual victimization severity was mediated via hookups, that is, casual sexual encounters between individuals not in a relationship. We also tested the hypothesis that greater sexual limit-setting would attenuate the positive effect of hookups on sexual victimization. Freshman women (N = 335) were recruited by e-mail to complete an online survey regarding their college drinking and sexual experiences. The effect of HED frequency on sexual victimization was completely mediated via hookups. There was a significant indirect path from HED to victimization via alcohol-involved hookups; the path through sober hookups was not significant. We found some support for the hypothesis that sexual limit-setting reduced the impact of hookups on sexual victimization severity. Findings suggest the importance of targeting sexual behavior, which frequently occurs in conjunction with drinking, as a way of preventing college sexual victimization.

Alcohol and Sexual Health Behavior: "What We Know and How We Know It"

Alcohol, despite salutary associations with sexuality, has been implicated in sexual health problems. This review examines the relationship between alcohol and outcomes related to sexual health. Methodological considerations limiting causal assertions permissible with nonexperimental data are discussed, as are advantages of experimental methods. Findings from laboratory experiments are reviewed evaluating causal effects of acute alcohol intoxication on a variety of outcomes, including sexual arousal, sexual desire, orgasm, and sexual risk behaviors related to sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). Several variables exerting mediating and moderating influences are identified. It is concluded that acute alcohol intoxication is capable of exerting a causal impact on multiple constituent components of sexual responding related to sexual health. Both alcohol expectancy and alcohol myopia theories have been supported as explanations for these causal effects. Furthermore, for sexual risk behavior, noteworthy recent developments include research highlighting the importance of women's sexual victimization history and men's condom use resistance. Limitations and implications associated with this body of research are also discussed.

"I Know Correlation Doesn't Prove Causation, but . . .": Are We Jumping to Unfounded Conclusions About the Causes of Sexual Offending?

Identifying causes of sexual offending is the foundation of effective and efficient assessment, intervention, and policy aimed at reducing sexual offending. However, studies vary in methodological rigor and the inferences they support, and there are differences of opinion about the conclusions that can be drawn from ambiguous evidence. To explore how researchers in this area interpret the available empirical evidence, we asked authors of articles published in relevant specialized journals to identify (a) an important factor that may lead to sexual offending, (b) a study providing evidence of a relationship between that factor and sexual offending, and (c) the inferences supported by that study. Many participants seemed to endorse causal interpretations and conclusions that went beyond the methodological rigor of the study they identified. Our findings suggest that some researchers may not be adequately considering methodological issues when making inferences about the causes of sexual offending. Although it is difficult to conduct research in this area and all research designs can provide valuable information, sensitivity to the limits methodology places on inferences is important for the sake of accuracy and integrity, and to stimulate more informative research. We propose that increasing attention to methodology in the research community through better training and standards will advance scientific knowledge about the causes of sexual offending, and improve the effectiveness and efficiency of practice and policy.

Emergency Department Visits for Sexual Assault by Emerging Adults: Is Alcohol a Factor?

INTRODUCTION

Emerging adults (18-25 years of age) are at increased risk for sexual assault. There is little Emergency Department (ED) data on sexual assaults that involve alcohol among this population. The purpose of this study was to analyze ED visits for sexual assault and determine if alcohol consumption by the patient was noted.

METHODS

This study was a retrospective chart review of patients aged 18-25 presenting to an ED in a college town over a four-year period. Extracted variables included age, gender, delay in seeking care, sexual assault nurse examiner (SANE) evaluation, and alcohol consumption by the patient. For analysis of alcohol use, cases were categorized as ages < 21 and ≥ 21.

RESULTS

There were 118 patients who presented to the ED from 2012 to 2015. The mean age of the cohort was 20 years, and almost 70% of visits were among those < 21. Of those aged < 21, 74% reported alcohol consumption, in contrast to 48% of those ≥ 21 (p = 0.055). Of those reporting alcohol use, 36% were evaluated on the day of the assault compared to 61% of those not reporting alcohol (p=0.035).

CONCLUSION

This study found that ED visits for sexual assault in emerging adults were more common in younger patients. Alcohol use occurred more frequently with patients under the legal drinking age, and presentation was also more likely to be delayed. The relationship between sexual assault and alcohol use should underscore primary prevention efforts in emerging adult populations.

The effects of alcohol intoxication and sexual interest on men's sexual persistence and hostility in a dating simulation

Perpetrators of sexual assault are often intoxicated; however, few experimental studies evaluate alcohol's "in the moment" effects on sexual aggression. This study extends past theory and research by examining the acute effects of alcohol on men's decisions about how to respond to sexual refusals in a dating simulation. Men (N = 62) ages 21-29 were randomly assigned to consume alcohol (target breath alcohol level 0.080%) or no alcohol. Participants were encouraged to talk to a simulated woman and act as they would on an actual date. They made choices from a list which included nonsexual and sexual options. The female agent was programmed to engage in some sexual activities but refuse others. Refusals became more intense if participants persisted. Negative binomial regression analysis was used to test a path analytic model. As predicted, participants' self-reported desire to have sex was positively associated with choosing more consensual sexual activities during the simulation (i.e., activities in which the woman willingly engaged). Consensual sexual activities were positively associated with the number of times participants persisted after the woman refused. Alcohol moderated this relationship such that it was stronger for intoxicated men than sober men. The more sexual refusals participants received, the more hostile verbal comments they made to the woman. Contrary to our predictions, this relationship was not moderated by alcohol condition. Because participants had multiple opportunities to escalate their aggression or desist, this paradigm provides new insights into the mechanisms through which intoxication enhances the likelihood of sexual aggression in dating situations.

Alcohol retail sales licenses and sexually transmitted infections in Texas counties, 2008-2015

BACKGROUND

Research suggests that reduced retail alcohol outlet density may be associated with lower prevalence of HIV and other sexually transmitted infections (STIs). On-premise sale of alcohol for immediate consumption is theorized as increasing social interactions that can lead to sexual encounters.

OBJECTIVE

We examined associations between on- and off-premise retail alcohol sales licenses and number of newly diagnosed HIV and STI cases in Texas counties.

METHODS

Retail alcohol sales license data were obtained from the Texas Alcoholic Beverage Commission. HIV and bacterial STI data were obtained from the Texas Department of State Health Services. Associations between retail alcohol sales licenses and STIs were estimated using spatial linear models and Poisson mixed effects models for over-dispersed count data.

RESULTS

Adjusting for county-specific confounders, there was no evidence of residual spatial correlation. In Poisson models, each additional on-premise (e.g., bar and restaurant) alcohol license per 10,000 population in a county was associated with a 1.5% increase (95% CI: 0.4%, 2.6%) in the rate of HIV and a 2.4% increase (95% CI: 1.9%, 3.0%) in the rate of bacterial STIs, adjusting for potential confounders. In contrast, number of off-premise licenses (e.g., take-out stores) was inversely associated with the incidence of STI and HIV, although the association with HIV was not statistically significant.

CONCLUSIONS

This study adds to the limited literature on the association between retail alcohol availability and STIs. Additional research is needed on the role of alcohol availability (and policies affecting availability) in the spread of HIV and other STIs.

Further Validation of a Laboratory Analog Sexual Aggression Task: Associations With Novel Risk Factors for Sexual Violence

Official crime statistics and self-reports of sexual aggression perpetration are limited by various factors (e.g., lack of reporting, social desirability bias), as well as an inability to use these measures in experimental studies of sexual aggression. To address these issues, Nagayama Hall et al. (1994) developed a laboratory analog measure of sexual aggression, which has received empirical support as a valid measure of sexual aggression proclivity. Here, we seek to replicate these findings and further validate the paradigm by examining sexually aggressive responses in relation to a range of recently emerging predictors of sexual aggression (e.g., sexual objectification, sexual narcissism) as well as participants' perceptions of a female confederate serving as the target of sexual aggression. A sample of 49 undergraduate men completed questionnaires and participated in the sexual aggression analog task. Results of logistic regression analyses supported both criterion and construct validity of the analog task; men who chose the sexually explicit video were more likely to report prior sexual aggression, greater sexual objectification of women, higher sexual narcissism, greater hostile sexism, and higher impersonal dating. These men were also more likely to express dehumanizing beliefs about the female confederate, consider her less intelligent, and believe she was more distressed by the video. These results replicate and extend prior research supporting this paradigm as a valid laboratory-based measure of sexual aggression proclivity that can be used in tandem with validated self-report measures.

Predicting Men's Immediate Reactions to a Simulated Date's Sexual Rejection: The Effects of Hostile Masculinity, Impersonal Sex, and Hostile Perceptions of the Woman

OBJECTIVE

Aggression is a common response to many types of social rejection. Men who respond aggressively to a woman's sexual rejection are likely to score high on risk factors associated with sexual aggression and to convince themselves that she is at fault. This study investigated how sexual dominance motivation and casual sex attitudes interact with "in the moment" hostile perceptions of the woman to predict the likelihood of an aggressive response.

METHOD

Male participants (N = 77) completed an online survey including self-report measures of sexual dominance motivation and casual sex attitudes. In a separate session, participants completed a laboratory study in which they interacted with a female agent in a dating simulation, allowing them to make nonsexual choices, sexual choices that were accepted, and sexual choices that were rejected. Immediate responses to sexual rejection were categorized as aggressive (n = 25) or nonaggressive (n = 52). After the simulation ended, participants answered questions about their perceptions of the situation and the woman. Moderated multiple logistic regression analyses were used to test the hypotheses.

RESULTS

The hypothesized interactions were found such that men with high scores on sexual dominance motivation and positive attitudes about casual sex had a greater probability of responding aggressively when they formed extremely hostile perceptions of the woman who rejected them.

CONCLUSIONS

These findings provide insight into the processes by which men respond aggressively to women's refusals, and highlight the need for training that encourages benevolent attributions and nonviolent strategies to deal with sexual rejection.

The Impact of Drinking Age Laws on Perpetration of Sexual Assault Crimes in Canada, 2009-2013

PURPOSE

Sexual-assault crimes, primarily perpetrated by males against female victims, impose a substantial burden on societies worldwide, especially on youth. Given that approximately half of all sexual assaults involve alcohol consumption by the perpetrator or victim, it is reasonable to expect that minimum legal drinking age (MLDA) restrictions might have an effect on sexual-assault patterns. Canadian MLDA laws are 18 years in Quebec, Alberta, and Manitoba (MLDA-18), and 19 years in the rest of the country (MLDA-19). The present study assesses whether MLDA laws might have an impact on sexual-assault crimes.

METHODS

A regression-discontinuity design was applied to sexual-assault crime data (n = 12,980 incidents) from the national Uniform Crime Reporting survey 2009-2013, a population-level registry of all police-reported crimes in Canada. Uniform Crime Reporting data does not include an explicit alcohol involvement indicator.

RESULTS

Nationally, in comparison to males slightly younger than the MLDA, those just older had significant and immediate increases in sexual-assault perpetration of 31.9% (95% confidence interval: 8.7%-54.5%, p = .007). In MLDA-19 provinces, there was an immediate post-MLDA increase of 56.0% (95% confidence interval: 18.9%-90.8%, p = .004) in sexual-assault crimes by males just older than 19 years, whereas in MLDA-18 provinces no significant effect was found. For females, there was no evidence of MLDA effects on sexual-assault crimes.

CONCLUSIONS

Release from Canadian MLDA law restrictions was strongly associated with increases in sexual-assault perpetration by young men. These findings lend support to the potential effectiveness of population-level alcohol control policies for sexual-assault prevention among youth.

Men's Responses to Women's Sexual Refusals: Development and Construct Validity of a Virtual Dating Simulation of Sexual Aggression

OBJECTIVE

To provide evidence regarding the construct validity of a sexual aggression proxy in which male participants go on multiple virtual dates with a woman. A unique strength of this proxy is participants' opportunity to make choices throughout the simulation about how they interact with their virtual date. These decisions determine their exposure to the female agent's sexual refusals.

METHOD

Piloting included focus groups (n = 82), surveys (n = 95), and cognitive interviews (n = 32). To establish construct validity, 87 male participants completed two separate sessions: 1) an online survey with measures of discriminant and convergent validity; and 2) a lab session in which they went on multiple dates that included nonsexual options, sexual options which the female agent accepted, and sexual options she refused. Sexual aggression was operationalized as the total number of sexual refusals that participants' received.

RESULTS

There was strong correlational evidence for discriminant and convergent validity. As hypothesized, there were some differences in the risk factors associated with refusals received on casual as compared to steady dates. Additionally, the number of refusals received was associated with the types of thoughts and actions commonly reported by perpetrators.

CONCLUSIONS

This simulation provides a new approach for examining sexual aggression in controlled experiments that vary factors within the simulation such as the man's and woman's intoxication and past sexual history. Because what happens is based on each individual's responses, it could be adapted for use in prevention and treatment programs.

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.

Review of survey and experimental research that examines the relationship between alcohol consumption and men's sexual aggression perpetration

This article systematically reviews empirical studies that examine associations between alcohol consumption and men's sexual aggression with the goal of identifying major findings; gaps in current knowledge; and directions for future research, practice, and policy. We identified 25 cross-sectional surveys, 6 prospective studies, and 12 alcohol administration experiments published between 1993 and August 2013 with male college students and young adult (nonincarcerated) samples. Many cross-sectional surveys have demonstrated that distal and proximal measures of men's alcohol consumption are positively associated with sexual assault perpetration, although very few of these studies evaluated how alcohol interacts with other risk and protective factors to exacerbate or inhibit sexual aggression. There are surprisingly few surveys that examine alcohol's effects at the event level and over short-time intervals to identify how changes in alcohol consumption are associated with changes in perpetration status. Alcohol administration studies suggest some important mechanisms that warrant additional investigation.