Comparing Drinking Game Motives, Behaviors, and Consequences Among Varsity Athletes, Recreational Athletes, and Non-Student-Athletes: A Multisite University Study

OBJECTIVE

Among college students, student-athletes are at increased risk for heavy alcohol consumption, participation in risky drinking practices (e.g., playing drinking games [DG]), and adverse alcohol-related consequences relative to non-student-athletes. Within the student-athlete population, level of sports participation (e.g., recreational or varsity sports) can affect alcohol use behaviors and consequences, but our understanding of the extent to which level of sports participation influences engagement in DG is limited. Thus, in the present study, we examined differences in frequency of participation in DG, typical drink consumption while playing DG, negative DG consequences, and motives for playing DG among varsity, recreational, and non-student-athletes.

METHOD

College students (n = 7,901 across 12 U.S. colleges/universities) completed questionnaires on alcohol use attitudes, behaviors, and consequences.

RESULTS

Student-athletes (recreational or varsity sports) were more likely to have participated in DG within the past month than non-student-athletes. Among students who reported past-month DG play, recreational athletes played more often and endorsed more enhancement/thrills motives for playing DG than non-student-athletes, and student-athletes (recreational or varsity) endorsed higher levels of competition motives for playing DG than non-student-athletes.

CONCLUSIONS

These findings shed light on some risky drinking patterns and motives of recreational athletes who are often overlooked and under-resourced in health research and clinical practice. Recreational and varsity student-athletes could benefit from alcohol screening and prevention efforts, which can include provision of competitive and alcohol-free social activities and promotion of alcohol protective behavioral strategies to help reduce recreational athletes' risk for harm while playing DG.

Neither a problem nor my problem: Risk factors for underage drinking disengagement among college students

OBJECTIVE

Underage drinking disengagement (UDD; cognitive restructuring/minimizing agency) measures attitudes about the acceptability and responsibility of drinking. We examined demographic correlates of UDD, as well as the moderating effects of legal drinking status on the association between UDD and drinking.

PARTICIPANTS

College student drinkers (n = 893; Mage = 19.48, range = 18-25; White = 74.1%; female = 68.1%) from a multi-site study.

METHODS

An online confidential survey included the UDD Scale for College Students and the AUDIT-C.

RESULTS

White and multiracial, underage students, or those living with others endorsed greater cognitive restructuring disengagement than Hispanic students, legal-age students, or those living alone or with parents, respectively. Greek membership and greater "party school" perceptions were related to more cognitive restructuring and minimizing agency. The associations between UDD and alcohol use were not moderated by legal drinking age status.

CONCLUSION

Identifying and educating students at risk for UDD on the ramifications associated with underage drinking could combat drinking.

A confirmatory factor analysis of a revised motives for playing drinking games (MPDG-33) scale among university students in the United States

AIM

Participating in a drinking game (DG) is common practice among university students and can increase students' risk for heavy drinking. Given the theoretical link between motivations to drink and alcohol use, careful consideration should be given to students' motivations to play DGs. In this study, we examined the factor structure, internal consistency, and concurrent validity of a revised version of the motives for playing drinking games (MPDG) scale, the MPDG-33.

METHODS

University students (n = 3345, Mage = 19.77 years, SDage = 1.53; 68.8% = women; 59.6% = White) from 12 U.S. universities completed a confidential online self-report survey that included the MPDG-33 and questions regarding their frequency of DG participation and typical drink consumption while playing DGs.

RESULTS

Confirmatory factor analysis indicated the 7-factor model fit the data adequately, and all items had statistically significant factor loadings on their predicted factor. All subscales had adequate to excellent internal consistency and were positively correlated with the frequency of DG participation and the typical number of drinks consumed while playing DGs (though the correlations were small).

CONCLUSION

Findings suggest that the MPDG-33 can be reliably used in research and clinical settings to assess U.S. university students' motives for playing DGs.

Gender Minority Stress and Resilience Measure: A Meta-Analysis of the Associations with Mental Health in Transgender and Gender Diverse Individuals

Transgender and gender diverse (TGD) individuals are more likely to experience mental health difficulties than cisgender individuals due to unique stressors related to their stigmatized gender identity and/or expression. This meta-analysis examined the associations between gender minority stressors and resilience factors, as measured by the Gender Minority Stress and Resilience Measure (GMSR; Testa et al., 2015), and two types of mental health symptoms (i.e., depression and anxiety). A comprehensive literature search and study inclusion process following PRISMA guidelines identified 69 sources, representing 47 unique samples. Mean effect sizes revealed significant positive associations between all GMSR minority stress subscales and anxiety and depression symptoms (rs = .22 to .40) with larger correlations for proximal stressors compared to distal stressors. The GMSR resilience subscales were significantly negatively correlated with anxiety and depression symptoms (rs = -.07 to -.16). These findings highlight the robust relationship between gender minority stressors and mental health symptoms among TGD individuals and indicate a need for addressing these stressors both by reducing exposure to external stressors and by addressing the internalization of those stressors in clinical settings. The small effects for the resilience subscales suggest a need to examine additional resilience factors that may be more pertinent to mental health among TGD individuals.

Sexual assault characteristics and posttraumatic stress symptoms among collegiate women: The role of posttraumatic cognitions

Although it is well-established that sexual assault is a risk factor for posttraumatic stress symptoms (PTSS) and other negative mental health outcomes, research is needed to help identify which individuals are most likely to experience ongoing distress following sexual assault. Negative cognitions following trauma may be influenced by sexual assault characteristics and have been shown to be associated with PTSS. The present study examined whether sexual assault characteristics were associated with PTSS by way of posttraumatic cognitions in a sample of 475 female college students who had experienced a sexual assault since the age of 14 years. Participants completed an online survey that included questions about sexual assault characteristics (i.e., whether the perpetrator used force, whether they experienced a freeze response), posttraumatic cognitions, and PTSS. Path analysis revealed that survivors who indicated they froze during the assault reported higher levels of PTSS, total effect = .28, p < .001, direct effect = .19, p < .001; posttraumatic cognitions regarding others, indirect effect = .02, p = .047, and other-safety, indirect effect = .05, p = .003, partially accounted for this association. Only the direct effect of perpetrator use of force on PTSS was statistically significant, total effect = .23, p = .090, direct effect = .16, p = .009; none of the indirect effects were statistically significant, ps = .063-.669. The results support that assault characteristics are associated with postassault outcomes and are consistent with the cognitive model of posttraumatic stress disorder.

A national study on pregaming motives, frequency, consumption, and negative alcohol consequences among university students in the United States

BACKGROUND

Pregaming, or drinking before going out, is a commonly practiced risky behavior. Drinking motives are well-established predictors of alcohol use and negative alcohol consequences. Given the influence of context on drinking practices, motives specific to pregaming may affect pregaming behaviors and outcomes above and beyond general drinking motives. Thus, we examined how pregaming motives are related to pregaming behaviors and negative alcohol consequences.

METHODS

Using data from two national cross-sectional online studies, the current study included undergraduates who pregamed at least once in the past month (n=10,200, Mage=19.9, women=61%, white=73.6%; 119 U.S. universities). Participants completed assessments of demographics, general drinking motives, pregaming motives, pregaming frequency/consumption, and negative alcohol consequences. Data were analyzed using hierarchical linear models accounting for nesting of participants within sites.

RESULTS

When controlling for demographic factors and general drinking motives, interpersonal enhancement motives and intimate pursuit motives were positively associated with pregaming frequency, pregaming consumption, and negative alcohol consequences. Situational control motives were negatively associated with pregaming consumption and negative alcohol consequences. Barriers to consumption motives were negatively associated with pregaming frequency but positively associated with negative alcohol consequences.

CONCLUSIONS

Students who pregame to make the night more fun or to meet potential dating partners appear to be at particular risk for negative alcohol consequences. Motives may be modifiable, particularly via cognitive/behavioral strategies. Findings suggest that specific motives may be appropriate intervention targets when trying to reduce pregaming behaviors and negative alcohol consequences.

Going it alone: Examining interpersonal sensitivity and hostility as mediators of the link between perfectionism and social disconnection

OBJECTIVE

Perfectionism is linked to a variety of mental health conditions in university students. The Perfectionism Social Disconnection Model posits that perfectionistic individuals exhibit off-putting interpersonal behaviors (i.e., rejection sensitivity and hostility), which lead to social disconnection, and in turn contribute to psychological distress. Although several longitudinal studies have found that social disconnection mediates the link between perfectionistic traits and psychological distress, less is known about how perfectionism leads to social disconnection. The present study aimed to address this gap.

METHODS

A sample of 877 university students completed one survey a month for three consecutive months.

RESULTS

Our random-intercept cross-lagged panel model results showed significant positive associations between the random intercepts of socially prescribed and self-oriented perfectionism with rejection sensitivity, hostility, and loneliness, with stronger associations for socially prescribed perfectionism. In addition, the random intercept of other-oriented perfectionism showed positive associations with hostility but not rejection sensitivity or loneliness. Moreover, almost all cross-lagged paths were nonsignificant.

CONCLUSION

Collectively, these findings indicate that although perfectionistic traits may be associated with rejection sensitivity and hostility to varying degrees at the between-person level, these behaviors may not cause social disconnection at the within-person level.

Masculine Drinking Norms and Alcohol Use in a National Sample of NCAA Male Student-Athletes

Objectives

Participation in sports can increase young adults' risk for heavy alcohol use and related consequences. Among student-athletes, more men report heavy drinking than women. These gender differences may reflect men's expression of masculinity which can encompass excessive consumption. While a growing body of research indicates that general masculine norms are positively associated with alcohol use and consequences among men, the extent to which alcohol-specific masculine norms can increase student-athletes' risk for elevated drinking and related outcomes is not yet known. Thus, we examined how masculine drinking norms are associated with alcohol use and related consequences while accounting for demographics and multiple dimensions of general masculine norms.

Methods

1,825 NCAA student-athletes (White=79%, Mage=20.1/SDage=1.3; 50 colleges/universities) completed a confidential online survey which included questions regarding masculine drinking norms of excess and control and conformity to general masculine norms.

Results

We created latent constructs and tested a path model in SEM. Results indicated that, after accounting for demographics and multiple dimensions of general masculine norms, the masculine drinking norm of excess was positively associated with alcohol use and consequences. Conversely, control was negatively related to alcohol use but unrelated to consequences. Compared to control and other dimensions of general masculine norms, excess was most strongly related to alcohol use and consequences.

Conclusions

A move from assessing general masculine norms toward alcohol-specific masculine norms can further researchers' and practitioners' knowledge of masculine norms and their link to drinking behaviors, and enhance the application of masculine norms in alcohol intervention and prevention programs.

The Role of Gender, Sexual Assault History, and Sexism in Endorsement of Rape Myths Among College Students

The present study examined the roles of sexual victimization history, sexism toward women, and sexism toward men in the gender difference in rape myth acceptance. The data were obtained from 2,011 male and female college students who completed an online survey. The results suggested that gender had a significant indirect effect on rape myth acceptance via sexual assault history and several forms of sexist beliefs. The findings supported the importance of considering additional antecedents of rape myths in research, as well as in programming geared toward preventing sexual assault and improving support for survivors.

After the fall: Responding to the Champlain Towers building collapse

In June 2021, a condominium in Florida collapsed, with the loss of 98 lives. Search and rescue teams spent 2 weeks, recovering the victims. This study's objective was to assess the presence of psychological symptoms that might emerge in the following months, using the PTSD Checklist for DSM-5 (PCL-5), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder - 7 (GAD-7), Suicide Cognitions Scale-Short (SCS-S), and the Insomnia Severity Index (ISI). A monthly survey conducted for 3 months found that overall, mean scores on these measures did not indicate significant emotional distress. We then compared the scores when the group was divided into responders who recovered human remains and those who did not. Scores were significantly higher among the subgroup that recovered human remains. Fifty-three percent (53%) of this sub-group met the cut-off score for a provisional diagnosis of PTSD, depressive disorder or generalized anxiety disorder-15% met the cut-off score criteria on the PCL-5 for probable PTSD, 36.8% for probable depressive disorder on the PHQ-9, and 26.3% for probable generalized anxiety disorder on the GAD-7. The results are consistent with other investigations examining mental health after mass disasters. Specifically, not all first responders will develop emotional distress but certain recovery activities may put some responders at higher risk, with a percentage displaying psychological distress. The results emphasize the need to assess the impact of these events on the mental health of first responders and to consider strategies to prevent or mitigate the development of impairing psychopathology.

The Role of Social Reactions to Disclosures in the Relationship Between Sexual Assault Acknowledgment and Psychological Symptoms

Following a sexual assault, women experience a host of negative psychological consequences. While some survivors label their sexual assault experience as such (i.e., are acknowledged survivors), other survivors do not. The effect of acknowledgment of sexual assault on postassault outcomes has yielded mixed findings. It was hypothesized that social reactions may account for the relationship between acknowledgment status and psychological symptoms. Results indicated that acknowledged survivors reported more severe posttraumatic stress disorder symptoms, which were partially accounted for by turning against social reactions. Future studies should explore the mechanisms responsible for these relationships and analyze the individual social reactions.

Acceptance of rape myths and psychological symptoms: the indirect effect of self-blame

Objective: The current study examined the influence of rape myth acceptance on self-blame and psychological symptoms following a sexual assault. Participants: The sample included 280 female sexual assault survivors in college. Methods: In an online survey, participants completed the Sexual Experiences Survey - Short Form Victimization, Updated Illinois Rape Myth Acceptance Scale, Posttraumatic Cognitions Inventory, Patient Health Questionnaire - 9 item scale, and PTSD Checklist for DSM-5. Results: A significant indirect effect was found between acceptance of rape myths and PTSD symptoms via self-blame; acceptance of rape myths was positively associated with self-blame, which in turn was positively associated with PTSD symptoms. Conclusions: Clinicians working with survivors of sexual assault should assess for endorsement of rape myths and self-blame, as challenging posttraumatic cognitions has been shown to reduce symptoms of trauma.

Attitudes Toward Men and Rejection of Rape Myths: The Impact on Survivor Rape Acknowledgment

Because unacknowledged rape survivors (i.e., those who do not conceptualize their victimization as rape) are less likely to report the crime to police or seek formal services, a better understanding of factors that contribute to rape acknowledgment is a key step to improving access to care and assault reporting on college campuses. To contribute to this line of research, this study examined the indirect effect of sexist attitudes toward men on rape acknowledgment via rejection of rape myths among female rape survivors. The analyzed sample included 250 college female rape survivors (M age = 22.49 years, SD = 7.27) who completed measures of sexual assault history, sexist beliefs toward men, and rejection of rape myths. Among these women, 49.6% were classified as acknowledged rape survivors and 50.4% of the sample was classified as unacknowledged rape survivors. Indirect effects of sexist beliefs on rape acknowledgment via rape myth rejection were supported for four types of sexist beliefs, including resentment of paternalism, compensatory gender differentiation, maternalism, and complementary gender differentiation. Specifically, the findings supported that people with greater levels of these particular types of sexist beliefs toward men rejected rape myths less, and lower rejection of rape myths was associated with increased likelihood of unacknowledged rape. The indirect effects were not supported for the heterosexual hostility or heterosexual intimacy subscales of sexist beliefs. By identifying antecedents of rape acknowledgment, the findings from this study can be used to inform programming geared toward encouraging survivors to seek services, which ultimately improves survivor outcomes.

The Effect of Social Anxiety on the Risk of Sexual Victimization via Assertiveness in an Ethnically Diverse Sample

Preliminary evidence suggests social anxiety may increase the risk of sexual victimization via decreased sexual assertiveness. A sample of 2,043 undergraduate students completed an online survey. Analyses of moderated indirect effects examined whether gender or ethnicity moderated the indirect effect of social anxiety on sexual victimization via sexual assertiveness. No moderation effects were found, but the indirect effect of social anxiety on sexual victimization via sexual assertiveness was significant for all five types of sexual victimization. Clinically, the findings suggest that sexual assault risk reduction programs may be improved by including assertive resistance strategies and behavioral rehearsals.

A Brief Computer-Based Sexual Assault Risk Reduction Program: A Feasibility, Acceptability, and Preliminary Efficacy Pilot Study

Sexual victimization among college women is a common problem, necessitating the development of risk reduction programs that are both effective and acceptable to this population. Computer-based programs may be a cost- and time-effective option. This pilot study sought to examine the feasibility, acceptability, and preliminary efficacy of a computer-based risk reduction program. A total of 136 collegiate women were randomly assigned to receive either a computer-based risk reduction program or an educational program about campus resources (active control condition). Measures included predicted use of resistance techniques, risk detection, and acceptability of the program. No participants dropped out of the study, and acceptability ratings were generally high. Women reported learning new material from the program, preferring the computer-based program to large-group programs, and believing that other undergraduate women would benefit from the program. Furthermore, women reported they did not experience significant emotional disturbance due to the material. In addition, postintervention, the risk reduction program group had significantly better risk detection compared with the control group. The control group evidenced a reduction in predicted use of assertive resistance between pre- and postintervention assessments, while the risk reduction program group did not. Given preliminary support for the feasibility, acceptability, and preliminary efficacy of a brief, computerized risk reduction program, further research on computerized, online risk reduction programs, such as the one in this study, appears warranted.

What's in a Label? The Impact of Media and Sexual Assault Characteristics on Survivor Rape Acknowledgment

Media coverage of sexual assault has increased since 2017 due to high-profile cases and social media campaigns designed to increase awareness of sexual assault. The purpose of this study was to examine whether media coverage of the Harvey Weinstein allegations and the onset of the 2017 viral #MeToo movement impacted the likelihood of college women acknowledging their own victimization as rape. Participants were 207 female rape survivors who completed an online survey that included assessments of survivor acknowledgment and characteristics of the sexual assault. Some participants completed the study prior to the Harvey Weinstein allegations and onset of the #MeToo movement, and some participants completed the study after these events. The likelihood of survivors labeling their experience as rape did not differ based on when participants completed the study, odds ratios (ORs) = 0.61-3.92, ps = .127-.604. Use of both nonforceful verbal resistance, OR = 2.63, p = .001, and assertive resistance, OR = 3.05, p < .001, were positively associated with the likelihood of survivor acknowledgment. The effects of both perpetrators' use of force and experiencing immobility on survivor acknowledgment were moderated by the timing of study completion, ORs = 4.22 and 0.11, respectively, ps = .023-.040. These findings suggest that media coverage may impact how certain sexual assault characteristics influence how survivors label their victimization experiences.

A meta-analysis of drinking game participation and alcohol-related outcomes

OBJECTIVE

Research suggests that it is common for emerging adults in the U.S. and other countries to participate in a drinking game (DG). Playing DGs is associated with greater alcohol consumption and increased risk for experiencing alcohol-related harms. Gender differences in emerging adults' DG behavior and negative alcohol-related consequences have also been documented but the results have been mixed. We conducted the present meta-analysis in order to (a) quantify the association between DG participation and alcohol use and related consequences, and examine the moderating effect of gender and methodological factors on these associations, and (b) provide effect size estimates for power analyses for future DGs research.

METHOD

48 manuscripts, representing 31 independent samples, were included in the meta-analysis.

RESULTS

We found medium effect sizes between DG participation and frequency of alcohol use (r = .47) and binge drinking (r = .50), quantity of alcohol use (r = .38) and consumption while playing DGs (r = .45), alcohol use (frequency × consumption index; r = .49), and alcohol-related consequences (r = .38).

CONCLUSIONS

Playing DGs is associated with greater frequency of alcohol use, higher alcohol consumption, and more alcohol-related consequences. Findings also indicated that as the percentage of women in the sample increased, the association between DG participation and quantity of alcohol use strengthened. No gender moderation effect was found for the associations between DG participation and the other alcohol outcomes variables, which suggests that men and women who play DGs are equally at risk for experiencing alcohol-related consequences and may benefit from clinical attention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Coping Motivated Alcohol Use: The Role of Social Anxiety and Dissociation

Background: Social anxiety has been associated with higher rates of negative alcohol use consequences, and this relationship appears to be accounted for by coping drinking motives. Dissociation is commonly present in anxiety disorders, including social anxiety disorder, and may serve to unconsciously reduce negative emotions when more effortful coping strategies are not effective. Objectives: The present study examined whether the relationship between social anxiety, coping motives, and alcohol consequences was moderated by dissociative symptoms. It was hypothesized that coping motives would mediate the relationship between social anxiety and alcohol consequences, and that dissociation would moderate the relationship between social anxiety and coping motives. Undergraduate students who endorsed alcohol use within the past 30 days (n = 320) were recruited from a large public university. Participants completed measures of social anxiety, dissociation, alcohol motives, and alcohol consequences as part of a larger online questionnaire. Results: Coping motives were found to mediate the relationship between social anxiety and alcohol consequences. Dissociation did not moderate the relationship between social anxiety and coping motives. Dissociation was significantly associated with alcohol consequences via coping motives. Conclusions: Future research should include longitudinal research designs or ecological momentary assessment designs and should examine these relationships in clinical and community samples.

What about this time? Within- and between-person associations between drinking motives and alcohol outcomes

Alcohol use in college populations is highly prevalent. College students who consume alcohol can experience a variety of different alcohol-related consequences. Drinking motives, or reasons that individuals choose to consume alcohol, are proximal factors that affect alcohol use. Previous research has generally found that internal drinking motives (i.e., coping and enhancement motives) are particularly relevant in predicting alcohol-related consequences. However, most of this research has examined drinking motives as traits, rather than state (i.e., daily) motives. The present study sought to examine enhancement and coping motives as both distinct and combined predictors of alcohol-related consequences at the daily level, directly and via alcohol consumption. Multilevel analyses of a 30-day retrospective report of drinking behaviors showed that within-person enhancement motives increased alcohol-related consequences via increased alcohol use. In contrast, coping motives were directly associated with alcohol-related consequences at the between-person level. Implications of the findings are that clinicians should assess and discuss daily motives for alcohol use with patients presenting with problems related to alcohol use, as well as typical motives. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A randomized trial of a brief behavioral health lifestyle program for outpatient cardiology clinics

Research on lifestyle programs for patients with coronary artery disease (CAD) has largely recruited from hospitals and/or recruited following acute coronary syndrome. By contrast, this study evaluated a 3-session behavioral health program for patients with stable CAD treated in an outpatient cardiology clinic. Thirty-three patients were randomized to the behavioral lifestyle intervention or to Treatment as Usual (TAU). A priori feasibility and acceptability criteria were met, and reliable change analyses revealed that at post-treatment and 30-day follow-up, significantly more intervention participants than TAU participants exhibited increased self-efficacy compared with baseline.

Development and psychometric evaluation of the Caffeinated Alcoholic Beverages Motives Questionnaire

Caffeinated alcoholic beverage (CAB) consumption is a risky drinking practice for young people. The purpose of the current set of studies was to develop and psychometrically evaluate a theory-based CAB motives measure to understand what drives CAB consumption and its ensuing consequences. Using 4 different samples, we pilot tested the items of the Caffeinated Alcohol Beverages Motives Questionnaire (CABMQ) and then evaluated its factor structure and its convergent, concurrent, and discriminant validity. Factor analyses supported a 5-factor structure. The coping and conformity subscales assessed negative reinforcement from internal and external sources, respectively. The social subscale assessed positive reinforcement derived from external sources, whereas the intoxication and energy enhancement subscales assessed positive reinforcement derived from internal sources. Differential relationships between the intoxication and energy enhancement subscales and existing motives measures provided compelling support for their individual distinctiveness. Greater endorsement of all subscales was related to experiencing more adverse alcohol-related consequences, whereas all subscales but the conformity subscale were related to greater CAB consumption. After controlling for general drinking motives, coping motives, energy enhancement motives, intoxication enhancement motives, and social motives were significantly correlated with CAB use, whereas only energy enhancement motives were significantly correlated with alcohol-related consequences. In sum, these results show that the CABMQ helps us understand CAB use and its consequences, with the energy enhancement subscale being particularly helpful. Future research should examine if energy enhancement motives explain why CABs pose more risk than drinking alcohol on its own. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychological outcomes following sexual assault: Differences by sexual assault setting

Sexual assault is associated with increased psychological distress. It is possible that military sexual assault (MSA) is associated with heightened psychological distress compared to adult sexual assault that occurs pre- or postmilitary service due to the nature of the military setting. Veterans and service members (N = 3,114; 19.6% women) who participated in the Post-Deployment Mental Health Study completed self-report measures of sexual assault history, symptoms of posttraumatic stress disorder (PTSD), symptoms of depression, hazardous alcohol use, drug use, and suicidal ideation. Women who reported a history of MSA endorsed higher levels of all types of psychological distress than women who did not experience adult sexual assault. Women who reported a history of MSA also endorsed higher levels of PTSD and depression symptoms than women who experienced pre- or postmilitary adult sexual assault. Men who reported a history of adult sexual assault, regardless of setting, reported higher levels of PTSD and depression symptoms than individuals who did not experience adult sexual assault. MSA was associated with higher psychological distress than pre- or postmilitary adult sexual assault among women. Among men, distress associated with MSA was comparable to sexual assault outside the military. Women may face unique challenges when they experience sexual assault in the military, and men may face additional stigma (compared to women) when they experience sexual assault, regardless of setting. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Self- and Other-Directed Violence as Outcomes of Deployment-Based Military Sexual Assault in Iraq/Afghanistan-era Veteran Men and Women

Although military sexual assault (MSA) has been well-established as a risk factor for psychopathology (e.g., PTSD, depression), little research has examined the association between MSA and self- and other-directed violence. Furthermore, there has been a growing empirical focus on potential gender differences in the effects of MSA, but few of these studies have examined gender differences in self- and other-directed violence. In a sample of 1571 Iraq/Afghanistan-era veterans (21.0% women), we examined the effect of MSA on difficulty controlling violent behavior and attempting suicide among veteran men and women, above and beyond the influence of childhood sexual abuse, combat trauma, PTSD, and major depressive disorder. Results of a logistic regression revealed that MSA increased risk of attempting suicide and difficulty controlling violence among women but not men. Thus, the results suggest that MSA may be a risk factor for both types of violence in women. Furthermore, because PTSD was associated with both types of violence in both men and women, MSA may also confer risk of violence via PTSD.

When Traumatic Memories Affect Your Health: A Clinical Case Study

Obstructive sleep apnea hypopnea (OSA) is the most common breathing-related sleep disorder and affects more than 20% of older individuals. Furthermore, risk of OSA increases in postmenopausal women. OSA is effectively treated using continuous positive airway pressure (CPAP). However, Mary, a 74-year-old White woman with OSA, severe, refused to obtain a CPAP machine because the sound of the machine elicited memories of her late husband’s suicide. Intervention focused on reducing Mary’s fear of CPAP sounds. Treatment involved imaginal exposure, in vivo exposure, sleep hygiene strategies, and relaxation strategies. Although evidence-based treatments for OSA and trauma separately exist, there are no treatment protocols designed to address the specific combination of the conditions. Treatment gains included a reduction in trauma-related symptoms and an increase in CPAP compliance. Quantity and quality of patient’s sleep did not improve despite sleep hygiene and CPAP use. At 3-week follow-up, treatment gains and CPAP compliance were maintained.

Trauma Management Therapy and Prolonged Exposure Therapy for PTSD in an active duty sample: Design and methodology of a randomized clinical trial

Posttraumatic stress disorder (PTSD) resulting from military service is a common, yet often chronic condition. Treatment outcome often is attenuated by programs that are (a) lengthy in nature and (b) constricted in their target outcomes. These limitations leave much of the emotional and behavioral impairment that accompanies PTSD unaddressed and/or unassessed. Typical PTSD treatment programs are 3–4 months in length, which is challenging for the pace of the nation's military. In this investigation, we will compare two treatments, Trauma Management Therapy (TMT) and Prolonged Exposure (PE), both redesigned to address the needs of active duty personnel (300 participants at 3 military installations). Specifically, we will compare the TMT Intensive Outpatient Program (IOP; 3 weeks) to PE's compressed (2 week) format. Both interventions will be compared to a standard course of PE (12 weeks). In addition to PTSD symptomatology, outcome measurement includes other aspects of psychopathology as well as changes in social, occupational, and familial impairment. Potential negative outcomes of massed treatment, such as increased suicidal ideation or increased alcohol use, will be assessed, as will genetic predictors of PTSD subtype and treatment outcome. This study will inform the delivery of care for military-related PTSD and particularly the use of intensive or compressed treatments for active duty personnel.

Why are caffeinated alcoholic beverages especially risky?

PURPOSE

Evidence suggests that people drink more alcohol and experience more adverse alcohol-related consequences (ARCs) on occasions when they also consume caffeine. The current study examined whether this increase in risk is a result of caffeine attenuating the subjective effects of alcohol intoxication (i.e., the masking hypothesis).

METHODS

Undergraduate students (n = 148) reported their drinking patterns using a modified Timeline Followback approach. For each recalled drinking occasion, alcohol consumption, caffeine consumption, perceived blood alcohol concentration, and ARCs were assessed. Generalized linear mixed models were used to examine the influence that alcohol and caffeine consumption had on perceived intoxication and the experience of ARCs.

RESULTS

At the occasion level, greater caffeine consumption was associated with increased consumption of alcohol and increased ARCs. There was also a significant curvilinear relationship between the amount of alcohol consumed and perceived intoxication, such that the more alcohol was consumed on each occasion the less each additional drink increased perceived intoxication. Increased caffeine consumption weakened the association between alcohol consumption and perceived intoxication and it also weakened the association between alcohol consumption and ARCs. Specifically, the weakest relationship between ARCs and alcohol consumption existed at the highest level of caffeine consumption (240+ mg). Caffeine increased subjective intoxication.

CONCLUSIONS

These findings do not support the masking hypothesis. Caffeine was strongly associated with ARCs when consumed at high doses and this effect does not appear to be the result of drinking more alcohol or underestimating one's blood alcohol content. Efforts to reduce caffeinated alcohol beverage use are greatly needed.

Ethical considerations of compelled disclosure of sexual assault among college students: Comment on Holland, Cortina, and Freyd (2018)

The recent article "Compelled Disclosure of College Sexual Assault" (Holland, Cortina, & Freyd, 2018) documents the variability in how campuses define responsible employees, reviews the assumptions underlying compelled disclosure, and offers alternatives to compelled disclosure. Compelled disclosure conflicts with several of the general principles of the American Psychological Association's (2016) ethics code and, as a result, is likely to conflict with the values of many psychologists. In this response, the ethical conflicts are identified and recommendations to psychologists to address these conflicts are offered. Specifically, psychologists should take an active role in learning about their campus policy, identify methods to increase student knowledge of their disclosure requirements, consider ways of reminding students of their disclosure requirements if they believe a student is likely to make a disclosure, advocate to campus authorities to ensure appropriate roles are designated as confidential, and respond to the need for more research in this area to help inform policy change and increase student support. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Evidence for Multiple Classes of Sexually-Violent College Men

OBJECTIVE

Research on college sexual violence perpetration suggests there are multiple groups of male perpetrators. It is important to understand the distinctions between perpetrator subgroups to determine appropriate prevention strategies, as multiple strategies may be necessary to address multiple types of perpetrators. However, previous studies on subgroups of sexually-violent college men have relied on theoretically based distinctions, and there is currently no consensus on how to best classify perpetrators based on their sexually violent behaviors. The purpose of the current study was to take a data-driven approach to identifying subgroups of sexually-violent college men to help clarify: 1) the number and size of cohesive subgroups of sexually-violent college men, and 2) the types of behaviors that characterize each group.

METHODS

1,982 college men across five universities in the U.S. self-reported their past sexually-violent behaviors, using the Sexual Experiences Survey (SES; Koss et al., 2007).

RESULTS

Latent class analysis uncovered evidence for three groups: (1) a group unlikely to perpetrate any SV (88.6%); (2) a group likely to perpetrate SV using coercive tactics (verbal coercion or victim intoxication), but unlikely to use physical force (9.8%); and (3) a group likely to perpetrate the full range of SV (1.5%). Although the coercive tactics group was composed of men unlikely to use forceful tactics, it included the majority who attempted or completed rape based on legal definitions.

CONCLUSIONS

Our findings suggest that there are multiple, distinct perpetrator subgroups and signal the need for multiple prevention approaches, including approaches that address campus social norms.

Contingency Management Versus Psychotherapy for Prenatal Smoking Cessation: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVES

Prenatal smoking is the leading preventable cause of poor obstetric outcomes, yet treatment options are limited. Past reviews of prenatal smoking cessation have often grouped all counseling into a single category, which ignores the fact that psychotherapy is distinct from brief counseling. The objective of this study was to compare the effect sizes of two intensive interventions for prenatal smoking cessation: contingency management (i.e., financial incentives for abstinence) and psychotherapy.

METHODS

A systematic search for randomized controlled trials testing the efficacy of contingency management or psychotherapy was completed using PubMed, PsycINFO, Web of Science, the Cochrane Library, and EMBASE. Independent raters extracted data and assessed trials for risk of bias. Treatment effects were analyzed for three times points: late pregnancy, early postpartum, and late postpartum.

RESULTS

The search yielded 22 studies, and meta-analytic results indicated that interventions (compared with control groups) generally increased the odds of abstinence. Moderator analyses indicated that intervention type (contingency management vs. psychotherapy) accounted for variability in effect sizes. When comparing treatment type, effects of contingency management interventions were significantly greater than those of psychotherapeutic interventions. Although psychotherapy did not affect smoking abstinence, contingency management interventions had significant treatment effects at all three time points.

CONCLUSIONS

Contingency management seems to be a safe and efficacious prenatal smoking cessation treatment. Although psychotherapy alone did not show an effect on prenatal smoking abstinence, future research may seek to combine this approach with contingency management to promote prenatal smoking cessation.

The Indirect Effect of Child Maltreatment Severity on Adult PTSD Symptoms through Anxiety Sensitivity

Although the rate of posttraumatic stress disorder (PTSD) among survivors of child maltreatment is high, individuals differ in symptom severity and many do not experience clinically significant levels of psychopathology. The present study tested the indirect effects of child maltreatment severity on adult PTSD, suicidal ideations, and alcohol dependence via anxiety sensitivity. A sample of 336 participants (mean age of 22.81 years, SD = 8.93; 70.2% female) completed an online survey of child abuse and neglect, anxiety sensitivity, PTSD symptom severity, suicidal ideation severity, and alcohol dependence severity. The results revealed significant indirect effects of child maltreatment on PTSD symptom severity through cognitive and social concerns, but not physical concerns. No direct or indirect effects were demonstrated for suicidal ideations or alcohol dependence severity. These findings elucidate mechanisms in the robust relationship between child maltreatment and adult PTSD symptoms and can potentially inform future research on mechanisms of change in psychotherapy.

The Association Between Alcohol Consumption, Lifetime Alcohol Use Disorder, and Psychiatric Distress Among Male and Female Veterans

OBJECTIVE

This study aimed to examine among veterans (a) whether alcohol consumption patterns are associated with probability of psychiatric symptoms and (b) whether an alcohol use disorder (AUD) history explains psychiatric symptoms among nondrinkers.

METHOD

Data were collected from 3,003 veterans (20.5% women). Gender-stratified logistic models examined the association between alcohol consumption pattern and the odds of symptoms of posttraumatic stress disorder (PTSD), depression, and suicidality. Two types of models were tested: four-group models comparing moderate drinkers to nondrinkers, light, and heavy drinkers; and five-group models separating nondrinkers by AUD history.

RESULTS

In four-group models for both genders, compared with moderate drinkers, hazardous drinkers were more likely to have psychiatric symptoms. Among men, nondrinkers were more likely to have symptoms of depression and suicidality but not PTSD. Among women, nondrinkers and light drinkers were more likely to have PTSD symptoms. In the five-group model for men, odds of symptoms were higher for nondrinkers with an AUD history and hazardous drinkers. Compared to nondrinkers without an AUD history and light drinkers, male nondrinkers with an AUD history had higher odds of psychiatric symptoms. In the five-group model for women, the odds of symptoms were higher for hazardous drinkers. Female nondrinkers with an AUD history had higher odds of a positive depression screen. Odds of a positive PTSD screen were higher for female nondrinkers (with and without an AUD history) and light drinkers.

CONCLUSIONS

For male veterans, there was a protective effect of moderate drinking (compared with abstinence) that disappeared when nondrinkers without an AUD history were separated. However, results for women showed a protective effect of moderate drinking with regard to PTSD that persisted even when an AUD history was taken into account.

Rape myth acceptance and rape acknowledgment: The mediating role of sexual refusal assertiveness

Unacknowledged rape, defined as when an individual experiences an event that meets a legal or empirical definition of rape but the individual does not label it as such, is prevalent. Research examining predictors of rape acknowledgment is needed. Sexual assertiveness may be an important variable to consider, as an individual's typical behavior during sexual situations may influence rape acknowledgment. To assess the indirect effect of rape myth acceptance on rape acknowledgment through sexual refusal assertiveness, an online survey of 181 female rape survivors was conducted. The indirect effects of two types of rape myths (He didn't mean to and Rape is a deviant event) were significant and positive. Specifically, acceptance of these two rape myths was negatively related to sexual refusal assertiveness, which was negatively associated with likelihood of rape acknowledgment. The results of this study indicate that sexual refusal assertiveness is associated with lower likelihood of rape acknowledgment among rape survivors. As a result, it appears that, under certain circumstances, women high in rape myth acceptance may be more likely to acknowledge rape when it results in decreased sexual refusal assertiveness.

Cannabis use disorder and suicide attempts in Iraq/Afghanistan-era veterans

The objective of the present research was to examine the association between lifetime cannabis use disorder (CUD), current suicidal ideation, and lifetime history of suicide attempts in a large and diverse sample of Iraq/Afghanistan-era veterans (N = 3233) using a battery of well-validated instruments. As expected, CUD was associated with both current suicidal ideation (OR = 1.683, p = 0.008) and lifetime suicide attempts (OR = 2.306, p < 0.0001), even after accounting for the effects of sex, posttraumatic stress disorder, depression, alcohol use disorder, non-cannabis drug use disorder, history of childhood sexual abuse, and combat exposure. Thus, the findings from the present study suggest that CUD may be a unique predictor of suicide attempts among Iraq/Afghanistan-era veterans; however, a significant limitation of the present study was its cross-sectional design. Prospective research aimed at understanding the complex relationship between CUD, mental health problems, and suicidal behavior among veterans is clearly needed at the present time.