Development and validation of the C-SHADE Scale for measuring perpetration of common sexually harassing and aggressive behaviors in drinking environments

BACKGROUND

Sexual aggression (SA) is ubiquitous in drinking environments, often seen as normal and acceptable; yet, targets of SA experience many negative consequences. This research aimed to develop a valid measure of common acts of SA in drinking settings for estimating prevalence and evaluating prevention initiatives.

METHODS

We developed a questionnaire measure of common acts of sexual harassment and aggression in drinking environments (C-SHADE) based on descriptions of SA behavior from our own and others' research. The measure was validated in a cross-sectional survey of 335 men aged 19-25 using webpanels from an online survey company. Validation measures included: a modified version of the Sexual Experiences Survey (M-SES), measures of SA by peers in drinking environments, SA-related attitudes, expectancies about sexual effects of alcohol, and alcohol consumption.

RESULTS

The C-SHADE showed high internal consistency (alpha = .96) and was significantly correlated with M-SES (r = .52), SA by peers (r = .61 to .70), SA-related attitudes/expectations (r = .38 to .55), and measures of alcohol consumption (r = .22 to .36). Overall, 71.9% participants reported SA using the C-SHADE versus 24.7% with the M-SES. We compared the responses of participants who reported perpetration on both measures (N = 83), only the C-SHADE (N = 141), and non-perpetrators (N = 89) (excluding 4 participants who reported perpetration only on the M-SES). The M-SES/C-SHADE perpetrators scored significantly higher than C-SHADE-only perpetrators and non-perpetrators on most SA-related and drinking measures, while C-SHADE-only perpetrators scored significantly higher than non-perpetrators on peer SA and two attitude measures.

CONCLUSIONS

The C-SHADE is suitable for measuring prevalence and evaluating interventions in drinking settings. The C-SHADE confirmed high prevalence of SA in drinking settings and identified an important group of C-SHADE-only perpetrators for whom interventions that focus on situational precipitators of SA in drinking settings may be especially useful.

Navigating Paths to Wellness: A Strengths-Based Photovoice Study Conducted with One First Nation in Southern Ontario, Canada

Research on substance use challenges in First Nations communities is often deficit-focused and can reinforce paternalistic stereotypes that lead to further discrimination. In this article, we report on findings of a strengths-based Photovoice project done in collaboration with a First Nations' community in southern Ontario, Canada to better understand experiences with substance use challenges in the community. We analyzed interview data collected with seventeen individuals who have lived experience or are supporting a loved one with lived experience with a substance use challenge. Participants described sources of strength that characterized their path to wellness, including strong family and social connections, cultural practices, identity, spirituality, day-to-day activities, and helpful supports and services. Furthermore, participants made several suggestions for improving services, including the need for integrated and flexible systems of care and trustful client-provider relationships. At its core, nurturing wellness involved a transformative process involving social and/or cultural connections. The stories shared by participants demonstrate the unique and varied strengths drawn from by individuals dealing with a substance use challenge.

Children, Parental Alcohol Consumption, and Intimate Partner Violence: A Multicountry Analysis by Perpetration Versus Victimization and Sex

Both living with children and alcohol consumption are positively associated with intimate partner violence (IPV). We assessed their combined relationship with physical IPV (P-IPV) victimization and perpetration, and explored possible moderating roles of sex and culture. Data included 15 surveys of 13,716 men and 17,832 women in 14 countries from the GENACIS (Gender, Alcohol, and Culture: An International Study) collaboration. P-IPV was measured as victim of physical aggression by an intimate partner (Vic-Only), perpetrator of physical aggression toward a partner (Perp-Only), or both victim and perpetrator (i.e., bidirectional) (Bi-Dir). Participants reported whether they lived with children below 18 years of age, whether the participant was a drinker/abstainer, and, among drinkers, usual frequency and quantity of alcohol consumed. Multilevel multinomial logistic regression, controlling for age and nesting of data within countries, indicated that Vic-Only, Perp-Only, and Bi-Dir (compared with no P-IPV) were positively associated with living with children, being a drinker, and quantity/frequency of drinking among drinkers (especially higher quantity). The positive association of P-IPV with living with children and being a drinker was evident within most countries. Significant interactions with sex were found, with (a) living with children more strongly associated with Perp-Only for men and Vic-Only for women, and (b) Perp-Only and Bi-Dir more strongly associated with being a drinker for men but with quantity consumed for women. Also, alcohol consumption was more strongly related to Perp-Only and Bi-Dir than with Vic-Only. In conclusion, higher risk of P-IPV with alcohol consumption is compounded when living with children-putting children who live with drinkers, especially drinkers who consume large amounts per occasion, at special risk of exposure to P-IPV. This is an important area for future research and prevention.

Do gender differences in the relationship between living with children and alcohol consumption vary by societal gender inequality?

INTRODUCTION AND AIMS

To better understand the relationship between alcohol consumption and living with children, we assessed whether the association varied for men and women across diverse countries and whether this relationship was moderated by country-level gender inequality.

DESIGN AND METHODS

We used Hierarchical Linear Modelling to analyse data from 32 surveys conducted in 27 countries. Measures included whether the participant was a drinker versus abstainer in past 12 months, annual number of drinks consumed, whether the respondent lived with children, gender (male/female) and age of respondent, and country-level gender inequality measured using the Gender Inequality Index.

RESULTS

Annual drinks consumed was significantly lower for women living with children. Men living with children were generally more likely to be drinkers, and the relationship between annual consumption and living with children was moderated by cultural gender equality: specifically, men in countries with higher gender equality drank less if they lived with children while the association for men in lower equality countries was nonsignificant.

DISCUSSION AND CONCLUSIONS

Although lower alcohol consumption was found generally for women living with children, this relationship was found only for men in countries where there was more gender equality. Given the high risk of harm to children from heavy consumption by adults with whom they live, prevention efforts need to strengthen prevention of heavy consumption by parents and other who live with children, especially for men who live with children in low gender equality countries.

A community-driven and evidence-based approach to developing mental wellness strategies in First Nations: a program protocol

BACKGROUND

Mental health, substance use/addiction and violence (MSV) are important issues affecting the well-being of Indigenous People in Canada. This paper outlines the protocol for a research-to-action program called the Mental Wellness Program (MWP). The MWP aims to increase community capacity, promote relationship-building among communities, and close gaps in services through processes that place value on and supports Indigenous communities' rights to self-determination and control. The MWP involves collecting and using local data to develop and implement community-specific mental wellness strategies in five First Nations in Ontario.

METHODS

The MWP has four key phases. Phase 1 (data collection) includes a community-wide survey to understand MSV issues, service needs and community strengths; in-depth interviews with individuals with lived experiences with MSV issues to understand, health system strengths, service gaps and challenges, as well as individual and community resilience factors; and focus groups with service providers to improve understanding of system weaknesses and strengths in addressing MSV. Phase 2 (review and synthesis) involves analysis of results from these local data sources and knowledge-sharing events to identify a priority area for strategic development based on local strengths and need. Phase 3 (participatory action research approach) involves community members, including persons with lived experience, working with the community and local service providers to develop, implement, and evaluate the MWP to address the selected priority area. Phase 4 (share) is focused on developing and implementing effective knowledge-sharing initiatives. Guidelines and models for building the MWP are shared regionally and provincially through forums, webinars, and social media, as well as cross-community mentoring.

DISCUSSION

MWP uses local community data to address MSV challenges by building on community supports and resilience factors. Drawing on local data and each community's system of formal and informal supports, the program includes sharing exemplary knowledge-to-action models and wellness strategies developed by and for First Nations people that can be used by other First Nations to identify shared wellness priorities in each community, and determine and execute next steps in addressing areas of main concern.

Buffering effects of social support for Indigenous males and females living with historical trauma and loss in 2 First Nation communities

Globally, Indigenous mental health research has increasingly focused on strengths-based theory to understand how positive factors influence wellness. However, few studies have examined how social support buffers the effects of trauma and stress on the mental health of Indigenous people. Using survey data from 207 males and 279 females in 2 Ontario First Nations we examined whether social support diminished the negative effects of perceived racism, historical trauma and loss on depression and/or anxiety. Among females, having more social supports was significantly related to a lower likelihood of depression/anxiety, whereas greater perceived racism and historical losses were associated with a greater likelihood of depression/anxiety. For both males and females, childhood adversity was significantly related to a greater likelihood of depression/anxiety. Among females, a significant interaction was found between social support and childhood adversities. For females with low social support, depression/anxiety was significantly higher among those who had experienced childhood adversities versus those with none; however, for those with high level of social support, the association was not significant. The same relationships were not found for males. Possible reasons are that males and females might experience depression/anxiety differently, or the social support measure might not adequately capture social support for First Nations males.

How Much Do Mental Health and Substance Use/Addiction Affect Use of General Medical Services? Extent of Use, Reason for Use, and Associated Costs

OBJECTIVE

To measure service use and costs associated with health care for patients with mental health (MH) and substance use/addiction (SA) problems.

METHODS

A 5-year cross-sectional study (2007-2012) of administrative health care data was conducted (average annual sample size = 123,235 adults aged >18 years who had a valid Ontario health care number and used at least 1 service during the year; 55% female). We assessed average annual use of primary care, emergency departments and hospitals, and overall health care costs for patients identified as having MH only, SA only, co-occurring MH and SA problems (MH+SA), and no MH and/or SA (MH/SA) problems. Total visits/admissions and total non-MH/SA visits (i.e., excluding MH/SA visits) were regressed separately on MH, SA, and MH+SA cases compared to non-MH/SA cases using the 2011-2012 sample ( N = 123,331), controlling for age and sex.

RESULTS

Compared to non-MH/SA patients, MH/SA patients were significantly ( P < 0.001) more likely to visit primary care physicians (1.82 times as many visits for MH-only patients, 4.24 for SA, and 5.59 for MH+SA), use emergency departments (odds, 1.53 [MH], 3.79 [SA], 5.94 [MH+SA]), and be hospitalized (odds, 1.59 [MH], 4.10 [SA], 7.82 [MH+SA]). MH/SA patients were also significantly more likely than non-MH/SA patients to have non-MH/SA-related visits and accounted for 20% of the sample but over 30% of health care costs.

CONCLUSIONS

MH and SA are core issues for all health care settings. MH/SA patients use more services overall and for non-MH/SA issues, with especially high use and costs for MH+SA patients.

Psychometric properties and a latent class analysis of the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in a pooled dataset of community samples

The 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a brief measurement tool used cross-culturally to capture the multi-dimensional nature of disablement through six domains, including: understanding and interacting with the world; moving and getting around; self-care; getting on with people; life activities; and participation in society. Previous psychometric research supports that the WHODAS 2.0 functions as a general factor of disablement. In a pooled dataset from community samples of adults (N = 447) we used confirmatory factor analysis to confirm a one-factor structure. Latent class analysis was used to identify subgroups of individuals based on their patterns of responses. We identified four distinct classes, or patterns of disablement: (1) pervasive disability; (2) physical disability; (3) emotional, cognitive, or interpersonal disability; (4) no/low disability. Convergent validity of the latent class subgroups was found with respect to socio-demographic characteristics, number of days affected by disabilities, stress, mental health, and substance use. These classes offer a simple and meaningful way to classify people with disabilities based on the 12-item WHODAS 2.0. Focusing on individuals with a high probability of being in the first three classes may help guide interventions.

When Women Do Not Want It: Young Female Bargoers’ Experiences With and Responses to Sexual Harassment in Social Drinking Contexts

Women frequently experience unwanted sexual touching and persistent advances at bars and parties. This study explored women’s responses to these unwanted experiences through online surveys completed by 153 female bargoers (aged 19-29) randomly recruited from a bar district. More than 75% had experienced sexual touching or persistence (46% both). Most women used multiple deterrent strategies, including evasion, facial expressions, direct refusals, aggression, friends’ help, and leaving the premises. Women experienced negative feelings (disrespected, violated, disgusted, angry, embarrassed), especially from incidents involving touching. Cultural change is needed to reduce substantial negative impacts of sexual harassment on women in drinking and other settings.

Service user and family member perspectives on services for mental health, substance use/addiction, and violence: a qualitative study of their goals, experiences and recommendations

BACKGROUND

Mental health and substance use disorders (MSD) are significant public health concerns that often co-occur with violence. To improve services that address MSD and violence [MSD(V)], it is critical to understand the perspectives of those most affected, people who have sought help for MSD(V) (i.e., "service users"), especially those with co-occurring issues, as well as their family members.

METHODS

We conducted structured interviews with 73 service users and 41 family members of service users in two Ontario communities (one urban, one rural) regarding their goals related to help-seeking, positive and negative experiences, and recommendations for improving systems of care.

RESULTS

Overall, participants expressed a need for services that: (1) are respectful, nonjudgmental, and supportive, help service users to feel more 'normal' and include education to reduce stigma; (2) are accessible, varied and publicly funded, thereby meeting individual needs and addressing equity concerns at a systems level; and (3) are coordinated, holistic and inclusive of family members who often support service users.

CONCLUSIONS

The findings provide a rich understanding of how service users and their families perceive services for MSD(V) issues and identify key ways to better meet their needs.

Abstract POSTER-CTRL-1206: The mutational landscape of fallopian tube carcinoma

Fallopian tube (FT) carcinoma is a rare gynecological malignancy, whose incidence is most likely underestimated due to misdiagnoses as ovarian cancer. Recent advances in pathology with more thorough serial sectioning techniques have led to better identification. We undertook to define germline and somatic mutations in 98 FT carcinoma cases enrolled at diagnosis in IRB-approved studies at the University of Washington, excluding cases with carcinoma identified at the time of risk-reducing surgery. We sequenced DNA from blood and neoplastic tissue using BROCA, a targeted capture and massively parallel genomic sequencing approach that detects all classes of mutation in 64 genes. The fraction of all primary ovarian, peritoneal and FT carcinoma defined as a FT primary increased over time in our tissue bank: FT diagnoses accounted for 23% of cases in the past five years compared to 5% in the previous 10 years (p=0.002). Of 98 subjects with FT carcinoma, 32 (33%) had loss of function germline mutations in 9 genes. Mutations in BRCA1 were identified in 18 (19%), making up the largest number of germline mutations, and in BRCA2 in 4 (4%). Germline mutations were also identified in 6 other known breast and/or ovarian cancer susceptibility genes including 2 in BRIP1 (2%), 2 in CHECK2 (2%), and 1 each in BARD1, BLM, MRE11A, and ATM (1%). One mutation was found in the FA gene FANCL. Additionally, we found 1 mosaic mutations in TP53 (1%) and 2 in PPM1D (2%). Together germline and mosaic mutations were identified in 34 (35%) of cases. We sequenced neoplastic DNA with BROCA in 30 FT carcinomas and found 27 somatic mutations in TP53 (90%), 1 in PTEN (3%) and 1 in CHEK2 (3%). The germline mutation rate was higher in FT carcinoma compared to our previous studies in ovarian carcinoma (35% versus 22%), though the identified genes were similar. Recently identified ovarian cancer susceptibility genes such as BRIP1, BARD1, and PPM1D are also associated with hereditary fallopian tube cancer. Known breast cancer genes (i.e. CHEK2, MRE11A, ATM) and other cancer associated genes (BLM, FANCL) require further study to prove their association with FT or ovarian cancer risk. An increased pathological recognition of the FT as a primary site of disease is changing the relative distribution of FT, ovarian, and peritoneal carcinoma in some centers.

Citation Format: M.I. Harrell, T. Walshb, K.J. Agnew, B. Norquist, M.K. Lee, S. Bernards, K.P. Pennington, E.M. Swisher. The mutational landscape of fallopian tube carcinoma [abstract]. In: Proceedings of the 10th Biennial Ovarian Cancer Research Symposium; Sep 8-9, 2014; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2015;21(16 Suppl):Abstract nr POSTER-CTRL-1206.

Abstract AS09: Germline mutations in cancer susceptibility genes in BRCA1 and BRCA2 negative families with ovarian and breast cancer

Objectives: Germline mutations in cancer susceptibility genes other than BRCA1 and BRCA2 (BRCA1/2) are found in approximately 6% of women with ovarian, fallopian tube, or primary peritoneal cancer. Our objective was to sequence BRCA1/2-negative ovarian cancer patients with a family history of ovarian or breast cancer to identify inherited mutations that may explain the familial risk.

Methods: We used a targeted capture, massively parallel sequencing test called BROCA on ovarian cancer probands with a family history of ovarian or breast cancer, or a personal history of breast cancer. BROCA testing included all known breast and ovarian cancer genes. Only clear loss of function mutations were included. 118 probands were ascertained from a gynecologic oncology tissue bank or outside referrals and provided informed consent. A family history of ovarian cancer was defined as having a first or second degree relative with ovarian cancer. A family history of breast cancer was defined as having a first or second degree relative with pre-menopausal breast cancer, or 2 or more regardless of menopausal status. Subjects were only included in one category.

Results: Of 118 ovarian cancer probands, 22 (18.6%) were found to carry deleterious mutations in non-BRCA1/2 cancer susceptibility genes. 8/29 (27.6%) ovarian cancer patients with a personal history of breast cancer had mutations in 7 genes (2 CHEK2, 2 RAD51D, 1 BRIP1, 1 TP53, 1 ATM, and one with both PALB2 and PMS2). This included mutations found in 2/5 (40%) who also had a family history of ovarian cancer and 4/10 (40%) who also had a family history of breast cancer. 38 patients had a family history of ovarian cancer with no personal history of breast cancer; 9/38 (23.7%) had mutations in 5 genes (3 BRIP1, 3 RAD51C, 1 RAD51D, 1 TP53, and 1 ATM). Finally, 5/51 (9.8%) ovarian cancer patients with a family history of breast cancer and no personal history of breast cancer had mutations in 5 genes (1 MSH6, 1 FAM175A, 1 NBN, 1 PALB2, and 1 CHEK2).

Conclusions: Germline mutations in DNA-repair genes are present in a substantial fraction of BRCA1/2-negative ovarian cancer patients with a personal or family history suggestive of inherited disease. These women may benefit from multiplex gene testing. The detection of inherited mutations in these women may be useful to identify the risk of other cancers, to inform family members of possible risk, and to direct therapy by suggesting candidates for PARP inhibitor therapy.

Citation Format: B. Norquist, M. Harrell, T. Walsh, J. Mandell, S. Bernards, K. Agnew, M. Lee, K. Pennington, M.C. King, E. Swisher. Germline mutations in cancer susceptibility genes in BRCA1 and BRCA2 negative families with ovarian and breast cancer [abstract]. In: Proceedings of the 10th Biennial Ovarian Cancer Research Symposium; Sep 8-9, 2014; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2015;21(16 Suppl):Abstract nr AS09.

Predrinking, alcohol use, and breath alcohol concentration: A study of young adult bargoers

Predrinking (preloading, pregaming) has been found to be related to alcohol use and intoxication. However, most research relies on estimates of blood alcohol concentration and does not control for usual drinking pattern. We assessed whether predrinking was associated with subsequent alcohol consumption and breath alcohol concentration (BrAC) among 287 young adult bargoers (173 men [60.3%], Mage = 21.86 years, SD = 2.55 years) who were recruited in groups in an entertainment district of a midsized city in Ontario, Canada. We also examined whether predrinking by other group members interacted with individual predrinking in relation to amount consumed/BrAC. Adjusting for nesting of individuals within groups in hierarchical linear models, predrinkers were found to consume more drinks in the bar district and over the entire night compared to nonpredrinkers and had higher BrACs at the end of the night controlling for drinking pattern. A group- by individual-level interaction revealed that individual predrinking predicted higher BrACs for members of groups in which at least half of the group had been predrinking but not for members of groups in which less than half had been predrinking. This study confirms a direct link of predrinking with greater alcohol consumption and higher intoxication levels. Group- by individual-level effects suggest that group dynamics may have an important impact on individual drinking. Given that predrinking is associated with heavier consumption rather than reduced consumption at the bar, initiatives to address predrinking should include more effective policies to prevent intoxicated people from entering bars and being served once admitted.

Drinking to reach the top: Young adults' drinking patterns as a predictor of status within natural drinking groups

In this study we examined associations between young adults' drinking patterns and social status within their natural drinking groups (NDGs) and assessed gender differences in these relationships. Same-sex NDGs (n=104) on route to a bar district were recruited and completed a peer-nominated measure of within-NDG status. In a follow-up online survey, participants (n=293; 174 men and 119 women) reported their usual drinking pattern within the past year. Hierarchical Linear Modeling revealed that men who engaged in more frequent heavy episodic drinking (HED) (both for 5+ and 8+ drinks in one sitting) and women who drank more frequently were nominated as occupying higher-status positions within their NDGs compared to their peers who drank less. Further, for both men and women, drinking more than one's peers during one's heaviest drinking occasion in the past year was also associated with higher within-NDG status. These findings suggest that higher social status is associated with riskier drinking patterns and have important implications for prevention programming.

"Blurred lines?" Sexual aggression and barroom culture

BACKGROUND

Meeting potential sexual/romantic partners for mutual pleasure is one of the main reasons young adults go to bars. However, not all sexual contacts are positive and consensual, and aggression related to sexual advances is a common experience. Sometimes such aggression is related to misperceptions in making and receiving sexual advances while other times aggression reflects intentional harassment or other sexually aggressive acts. This study uses objective observational research to assess quantitatively gender of initiators and targets and the extent that sexual aggression involves intentional aggression by the initiator, the nature of responses by targets, and the role of third parties and intoxication.

METHODS

We analyzed 258 aggressive incidents involving sexual advances observed as part of a larger study on aggression in large capacity bars and clubs, using variables collected as part of the original research (gender, intoxication, intent) and variables coded from narrative descriptions (invasiveness, persistence, targets' responses, role of third parties). Hierarchical linear modeling analyses were used to account for nesting of incidents in evening and bars.

RESULTS

Ninety percent of incidents involved male initiators and female targets, with almost all incidents involving intentional or probably intentional aggression. Targets mostly responded nonaggressively, usually using evasion. Staff rarely intervened; patron third parties intervened in 21% of incidents, usually to help the target but sometimes to encourage the initiator. initiators' level of invasiveness was related to intoxication of the targets, but not their own intoxication, suggesting intoxicated women were being targeted.

CONCLUSIONS

Sexual aggression is a major problem in bars often reflecting intentional sexual invasiveness and unwanted persistence rather than misperceptions in sexual advances. Prevention needs to focus on addressing masculinity norms of male patrons and staff who support sexual aggression and better management of the highly sexualized and sexist environments of most bars.

Apparent Motives for Aggression in the Social Context of the Bar

OBJECTIVE

Little systematic research has focused on motivations for aggression and most of the existing research is qualitative and atheoretical. This study increases existing knowledge by using the theory of coercive actions to quantify the apparent motives of individuals involved in barroom aggression. Objectives were to examine: gender differences in the use of compliance, grievance, social identity, and excitement motives; how motives change during an aggressive encounter; and the relationship of motives to aggression severity.

METHOD

We analyzed 844 narrative descriptions of aggressive incidents observed in large late-night drinking venues as part of the Safer Bars evaluation. Trained coders rated each type of motive for the 1,507 bar patrons who engaged in aggressive acts.

RESULTS

Women were more likely to be motivated by compliance and grievance, many in relation to unwanted sexual overtures from men; whereas men were more likely to be motivated by social identity concerns and excitement. Aggressive acts that escalated tended to be motivated by identity or grievance, with identity motivation especially associated with more severe aggression.

CONCLUSIONS

A key factor in preventing serious aggression is to develop approaches that focus on addressing identity concerns in the escalation of aggression and defusing incidents involving grievance and identity motives before they escalate. In bars, this might include training staff to recognize and defuse identity motives and eliminating grievance-provoking situations such as crowd bottlenecks and poorly managed queues. Preventive interventions generally need to more directly address the role of identity motives, especially among men.

The Cross-Cultural Association Between Marital Status and Physical Aggression Between Intimate Partners

Some research suggests that the risk of physical aggression by an intimate partner is related to marital status, but this relationship may vary across cultures and by gender. In the present study, we systematically examine the relationship between marital status and physical partner aggression by gender across 19 countries. Logistic and multilevel regression confirmed previous findings of lower rates of physical aggression for legally married versus cohabiting and separated/divorced women and men across most, but notably, not all countries. Single status was associated with higher risk in some countries and lower in others reflecting possible cultural differences in risk for different marital statuses. For example, single women had significantly lower rates of victimization than did married women in India where violence against wives is often accepted. The variation in the cross-cultural findings highlights the importance of examining both men and women and considering the cultural context when interpreting the relationship between partner aggression and marital status.

Behavioural indicators of motives for barroom aggression: implications for preventing bar violence

INTRODUCTION AND AIMS

To develop new strategies for preventing violence in high-risk licensed premises, we identify behavioural indicators of apparent motives for aggression in these settings and outline the implications of different motivations for prevention.

DESIGN AND METHODS

The four types of motives for aggressive or coercive acts defined by the theory of coercive actions framed the research: gaining compliance, expressing grievances/restoring justice, attaining a favourable social identity and pursuing fun/excitement. Incidents of aggression from the Safer Bars evaluation research were analysed to identify behavioural indicators of each motivation.

RESULTS

Compliance-motivated aggression typically takes the form of unwanted social overtures, third party intervention to stop conflicts or staff rule enforcement. Prevention strategies include keeping the aggressor's focus on compliance to avoid provoking grievance and identity motives that are likely to escalate aggression. Grievance motives are typically elicited by perceived wrongdoing and therefore prevention should focus on eliminating sources of grievances and adopting policies/practices to resolve grievances peacefully. Social identity motives are endemic to many drinking establishments especially among male patrons and staff. Prevention involves reducing identity cues in the environment, hiring staff who do not have identity concerns, and training staff to avoid provoking identity concerns. Aggression motivated by fun/excitement often involves low-level aggression where escalation can be prevented by avoiding grievances and attacks on identity.

DISCUSSION AND CONCLUSIONS

Knowledge of behavioural indicators of motives can be used to enhance staff hiring and training practices, reduce environmental triggers for aggression, and develop policies to reduce motivation for aggression.

Does the relationship between depression and intimate partner aggression vary by gender, victim-perpetrator role, and aggression severity?

Research has shown a consistent link between intimate partner violence (IPV) and depression, although this association may vary by gender, role in IPV (victim, perpetrator, or bidirectional), and aggression severity. We evaluated these factors in a telephone survey of 14,063 Canadians. All three factors were found to affect the association of depression with IPV. Specifically, depression was more strongly associated with IPV by a partner (i.e., victimization) for women but with aggression toward a partner (i.e., perpetration) for men. Severity of aggression was associated with increased risk of depression for both one-sided and bidirectional aggression by a partner but more strongly for one-sided aggression toward a partner. These findings suggest that research, prevention, and treatment should focus on all roles in IPV, not just male-to-female aggression.

'Hotspots' for aggression in licensed drinking venues

INTRODUCTION AND AIMS

In order to better understand the social context of barroom aggression, the aim was to identify common locations ('hotspots') for aggression in bars and examine the association of hotspots with aggression severity and environmental characteristics.

DESIGN AND METHODS

Aggression hotspots were identified using narrative descriptions and data recorded on premises' floor plans for 1057 incidents of aggression collected in the Safer Bars evaluation. Hierarchical Linear Modelling was used to identify bar-level and night-level characteristics associated with each hotspot.

RESULTS

The most common location for aggression was the dance floor (20.0% of incidents) or near the dance floor (11.5%), followed by near the serving bar (15.7%), at tables (13.1%), aisles, hallways and other areas of movement (6.2%), entrance (4.5%) and the pool playing area (4.1%). Hotspots were predicted mainly by bar-level characteristics, with dance floor aggression associated with crowded bars, a high proportion of female and young patrons, lots of sexual activity, a large number of patrons and staff, security staff present, better monitoring and coordination by staff, and people hanging around at closing. Incidents at tables and pool tables tended to occur in bars with the opposite characteristics. Nightly variations in patron intoxication and rowdiness were associated with aggression at tables while variations in crowding and sexual activity were associated with aggression in areas of movement. Incidents outside tended to be more severe.

DISCUSSION AND CONCLUSIONS

Each aggression location and their associated environments have somewhat different implications for staff training, premises design, policy and prevention.

Alcohol-related negative consequences among drinkers around the world

AIMS

This paper examines (i) gender and country differences in negative consequences related to drinking; (ii) relative rates of different consequences; and (iii) country-level predictors of consequences.

DESIGN SETTING AND PARTICIPANTS

Multi-level analyses used survey data from the Gender, Alcohol, and Culture: An International Study (GENACIS) collaboration.

MEASUREMENTS

Measures included 17 negative consequences grouped into (i) high endorsement acute, (ii) personal and (iii) social. Country-level measures included average frequency and quantity of drinking, percentage who were current drinkers, gross domestic product (GDP) and Human Development Index (HDI).

FINDINGS

Overall, the three groupings of consequences were reported by 44%, 12% and 7% of men and by 31%, 6% and 3% of women, respectively. More men than women endorsed all consequences, but gender differences were greatest for consequences associated with chronic drinking and social consequences related to male roles. The highest prevalence of consequences was in Uganda and lowest in Uruguay. Personal and social consequences were more likely in countries with higher usual quantity, fewer current drinkers and lower scores on GDP and HDI. However, significant interactions with individual-level quantity indicated a stronger relationship between consequences and usual quantity among drinkers in countries with lower quantity, more current drinkers and higher scores on GDP and HDI.

CONCLUSIONS

Both gender and country need to be taken into consideration when assessing adverse drinking consequences. Individual measures of alcohol consumption and country-level variables are associated with experiencing such consequences. Additionally, country-level variables affect the strength of the relationship between usual quantity consumed by individuals and adverse consequences.

Alcohol may not cause partner violence but it seems to make it worse: a cross national comparison of the relationship between alcohol and severity of partner violence

This study assesses whether severity of physical partner aggression is associated with alcohol consumption at the time of the incident, and whether the relationship between drinking and aggression severity is the same for men and women and across different countries. National or large regional general population surveys were conducted in 13 countries as part of the GENACIS collaboration. Respondents described the most physically aggressive act done to them by a partner in the past 2 years, rated the severity of aggression on a scale of 1 to 10, and reported whether either partner had been drinking when the incident occurred. Severity ratings were significantly higher for incidents in which one or both partners had been drinking compared to incidents in which neither partner had been drinking. The relationship did not differ significantly for men and women or by country. We conclude that alcohol consumption may serve to potentiate violence when it occurs, and this pattern holds across a diverse set of cultures. Further research is needed that focuses explicitly on the nature of alcohol's contribution to intimate partner aggression. Prevention needs to address the possibility of enhanced dangers of intimate partner violence when the partners have been drinking and eliminate any systemic factors that permit alcohol to be used as an excuse. Clinical services for perpetrators and victims of partner violence need to address the role of drinking practices, including the dynamics and process of aggressive incidents that occur when one or both partners have been drinking.

“Yes, I Do but Not with You”: Qualitative Analyses of Sexual/romantic Overture-Related Aggression in Bars and Clubs

Assaultive and aggressive behaviors related to sexual overtures are common in commercial drinking establishments (bars, pubs, and clubs). In this article, we examined the thematic content of 251 incidents of verbal and physical aggression related to sexual/romantic overtures documented by researcher-observers in a study of Toronto bars and clubs. Aggression was examined as it emerged in the following stages of the social interaction process: (a) sexual/romantic overtures that began aggressively; (b) initiators of sexual/romantic overtures who became aggressive later in the social interaction process; (c) aggression by targets of overtures; and (d) aggression by third parties. From these thematic analyses we identify the distinctions between predatory and genuine overtures and explore the potential role of the effects of alcohol.

In these social overtures aggression occurred as part of the initial overture, during the interaction following the overture (i.e., aggression by the person who made the initial overture, by the target or third parties), and in response to rejection by the target. Targets of overtures responded aggressively to perceived inappropriate overtures; third parties played important aggressive and nonaggressive roles; and alcohol intoxication was identified as contributing to aggression in a number of ways. The theoretical significance and practical implications for prevention of the findings are discussed.

"Yes, I Do But Not With You"-Qualitative Analyses of Sexual/Romantic Overture-related Aggression in Bars and Clubs

Assaultive and aggressive behaviors related to sexual overtures are common in commercial drinking establishments (bars, pubs and clubs). In this paper, we examined the thematic content of 251 incidents of verbal and physical aggression related to sexual/romantic overtures documented by researcher-observers in a study of Toronto bar and clubs. Aggression was examined as it emerged in the following stages of the social interaction process: (a) sexual/romantic overtures that began aggressively; (b) initiators of sexual/romantic overtures who became aggressive later in the social interaction process; (c) aggression by targets of overtures; and (d) aggression by third parties. From these thematic analyses, we identify the distinctions between predatory and genuine overtures and explore the potential role of the effects of alcohol.In these social overtures, aggression occurred as part of the initial overture, during the interaction following the overture (i.e., aggression by the person who made the initial overture, by the target or third parties) and in response to rejection by the target. Targets of overtures responded aggressively to perceived inappropriate overtures; third parties played important aggressive and nonaggressive roles; and alcohol intoxication was identified as contributing to aggression in a number of ways. The theoretical significance and practical implications for prevention of the findings are discussed.

'I have no interest in drinking': a cross-national comparison of reasons why men and women abstain from alcohol use

AIMS

To examine country differences in reasons for abstaining including the association of reasons with country abstaining rate and drinking pattern.

PARTICIPANTS

Samples of men and women from eight countries participating in the GENACIS (Gender Alcohol and Culture: an International Study) project.

METHODS

Surveys were conducted with 3338 life-time abstainers and 3105 former drinkers. Respondents selected all applicable reasons for not drinking from a provided list. Analyses included two-level hierarchical linear modelling (HLM) regression.

FINDINGS

Reasons for abstaining differed significantly for life-time abstainers compared to former drinkers, by gender and age, and by country-level abstaining rate and frequency of drinking. Life-time abstainers were more likely than former drinkers to endorse 'no interest', 'religion' and 'upbringing' and more reasons overall. Gender differences, especially among former drinkers, suggested that norms restricting drinking may influence reasons that women abstain ('no interest', 'not liking taste') while drinking experiences may be more important considerations for men ('afraid of alcohol problems', 'bad effect on activities'). Younger age was associated with normative reasons ('no interest', 'taste', 'waste of money') and possibly bad experiences ('afraid of problems'). Reasons such as 'religion', 'waste of money' and 'afraid of alcohol problems' were associated with higher country-level rates of abstaining. Higher endorsement of 'drinking is bad for health' and 'taste' were associated with a country pattern of less frequent drinking while 'not liking effects' was associated with higher drinking frequency.

CONCLUSIONS

Reasons for abstaining depend on type of abstainer, gender, age and country drinking norms and patterns.

Gender and the assessment of at-risk drinking: evidence from the GENACIS Canada (2004-2005) telephone survey version of the AUDIT

The alcohol use disorders identification test (AUDIT) is widely used in general population surveys as a method of determining prevalence of hazardous drinking. However, its interpretation has been questioned particularly regarding the unequal contribution of the items to the total score, specifically, that the drinking frequency item contributes disproportionately to the score and may lead to inappropriate identification of some drinkers as hazardous drinkers. To explore these issues further as well as possible gender differences in the applicability of the AUDIT, we conducted analyses using a modified version of the AUDIT (AUDIT(M)) as part of a general population survey that used random digit dialing and computer-assisted telephone interviewing. Item and factor analyses were performed separately for men and women, and the impacts of excluding the frequency of drinking item in the measurement of mean scores, percentages and types of problems for men and women were examined. We found that the AUDIT(M) items loaded onto three distinct dimensions for both men and women: frequency of drinking; usual quantity and frequency of heavy-episodic drinking; problem consequences from drinking. In addition, we found that excluding the frequency question may give a more meaningful estimate of the percent of drinkers actually at risk of experiencing problems from drinking for both men and women. Finally, although our analyses identified only minor gender differences in the structure of the AUDIT and good sensitivity for identifying problem drinkers among both men and women, significant gender differences in the types of problems experienced suggest that use and interpretation of the AUDIT should routinely take gender into consideration.

Bad nights or bad bars? Multi-level analysis of environmental predictors of aggression in late-night large-capacity bars and clubs

AIMS

To clarify environmental predictors of bar-room aggression by differentiating relationships due to nightly variations versus across bar variations, frequency versus severity of aggression and patron versus staff aggression.

DESIGN, SETTING AND PARTICIPANTS

Male-female pairs of researcher-observers conducted 1334 observations in 118 large capacity (> 300) bars and clubs in Toronto, Canada.

MEASUREMENTS

Observers independently rated aspects of the environment (e.g. crowding) at every visit and wrote detailed narratives of each incident of aggression that occurred. Measures of severity of aggression for the visit were calculated by aggregating ratings for each person in aggressive incidents.

FINDINGS

Although bivariate analyses confirmed the significance of most environmental predictors of aggression identified in previous research, multivariate analyses identified the following key visit-level predictors (controlling for bar-level relationships): rowdiness/permissive environment and people hanging around after closing predicted both frequency and severity of aggression; sexual activity, contact and competition and people with two or more drinks at closing predicted frequency but not severity of aggression; lack of staff monitoring predicted more severe patron aggression, while having more and better coordinated staff predicted more severe staff aggression. Intoxication of patrons was significantly associated with more frequent and severe patron aggression at the bar level (but not at the visit level) in the multivariate analyses and negatively associated with severity of staff aggression at the visit level.

CONCLUSIONS

The results demonstrate clearly the importance of the immediate environment (not just the type of bar or characteristics of usual patrons) and the importance of specific environmental factors, including staff behaviour, in predicting both frequency and severity of aggression.

Guardians and handlers: the role of bar staff in preventing and managing aggression

AIMS

To identify good and bad behaviors by bar staff in aggressive incidents, the extent these behaviors apparently reflect aggressive intent, and the association of aggressive staff behavior with level of aggression by patrons.

DESIGN, SETTING AND PARTICIPANTS

Data on staff behavior in incidents of aggression were collected by 148 trained observers in bars and clubs on Friday and Saturday night between midnight and 2 a.m. in Toronto, Canada. Behaviors of 809 staff involved in 417 incidents at 74 different bars/clubs were analysed using descriptive statistics and three-level hierarchical linear modeling (HLM) analyses.

MEASUREMENTS

Observers' ratings of 28 staff behaviors were used to construct two scales that measured escalating/aggressive aspects of staff behavior. Apparent intent level for bar staff was dichotomized into (1) no aggressive intent versus (2) probable or definite aggressive intent. Five levels of patron aggression were defined: no aggression, non-physical, minor physical, moderate physical and severe physical.

FINDINGS

The most common aggressive behaviors of staff were identified. Staff were most aggressive when patrons were either non-aggressive or highly aggressive and staff were least aggressive when patrons exhibited non-physical aggression or minor physical aggression. Taking apparent intent into consideration decreased staff aggression scores for incidents in which patrons were highly aggressive indicating that some aggression by staff in these instances had non-aggressive intent (e.g. to prevent injury); however, apparent intent had little effect on staff aggression scores in incidents with non-aggressive patrons.

CONCLUSION

Although there is potential for staff to act as guardians or handlers, they often themselves became offenders when they responded to barroom problems. The practical implications are different for staff aggression with nonaggressive patrons versus with aggressive patrons.

Triple therapy with ranitidine, clarithromycin, and metronidazole in the treatment of Helicobacter pylori

BACKGROUND

To determine whether a triple therapy regimen for the treatment of Helicobacter pylori infection, consisting of ranitidine 300 mg q.i.d., clarithromycin 500 mg t.i.d., and metronidazole 500 mg t.i.d. would provide a safe and effective treatment regimen, we performed an open prospective study in 20 consecutive patients with proven H. pylori-associated non-ulcer dyspepsia or peptic ulcer disease.

METHODS

The percentage of patients in whom eradication of H. pylori succeeded was determined. A semiquantitative assessment of histology was performed, and the results were analysed using Wilcoxon's matched-pairs ranks tests; side effects were noted and graded.

RESULTS

Eradication was achieved in 19 of 20 patients, i.e. in 95% (confidence interval 85-100%). Eradication of the bacterium led to a significant improvement in semiquantitative histology scores; active antral inflammation decreased from (mean +/- SEM) 1.84 +/- 0.19 to 0.21 +/- 0.16 (p = 0.0004) and chronic antral inflammation from 2.47 +/- 0.14 to 1.16 +/- 0.14 (p = 0.0002); active gastric body inflammation decreased from 0.95 +/- 0.19 to 0.00 +/- 0.00 (p = 0.0015) and chronic inflammation from 1.68 +/- 0.17 to 0.32 +/- 0.11 (p = 0.0007). Side effects occurred in 45% of patients, but in over half of these patients only mild side effects occurred. Severe side effects did not occur, none of the patients discontinued the triple therapy.

CONCLUSIONS

Triple therapy with ranitidine, clarithromycin, and metronidazole provides a safe and effective treatment of H. pylori infection, resulting in a high eradication rate, and in significant decrease in semiquantitative histology scores. Further prospective studies are warranted.