Qualitative Analysis of Bystander Intervention Among Young Adult Male Soldiers Who Engage in At-Risk Drinking

Bystander intervention-when someone intervenes to help in situations that pose a risk for harm-is a promising strategy for sexual violence prevention. In the current study, a sample of U.S. Army male soldiers (N = 10; ages 18-24) who engaged in at-risk drinking completed a 90-min individual semi-structured interview to understand the ways in which soldiers intervene to address risk for sexual violence. Two independent raters coded soldier responses using thematic analysis and identified eight main themes: (a) recognizing risk for sexual violence; (b) labeling situations as problematic and taking responsibility; (c) facilitators of intervention; (d) barriers to intervention; (e) intervention strategies; (f) reactions and consequences to intervention; (g) alcohol's influence on intervention; and (h) using bystander intervention to shift cultural norms. As soldiers reported noticing more extreme risks for violence, prevention interventions may help service members identify situations earlier in the continuum of harm. Soldiers anticipated intervening in a way that was physical and aggressive, which could facilitate physical altercation and result in collateral misconduct. Results from the present study reveal ways that bystander intervention programs for civilians can be tailored to address the unique individual, situational, and contextual factors relevant to the military. These findings also highlight the importance of teaching soldiers indirect and nonaggressive strategies for intervention.

Preventing sexual violence in sexual orientation and gender diverse communities: A call to action

Background: Members of the lesbian, gay, bisexual, transgender, queer, and other sexual orientation and gender diverse (SOGD) communities are at disproportionately higher risk for sexual violence compared to cisgender heterosexual people. Despite this elevated risk, relatively few sexual violence prevention efforts effectively reduce these victimization disparities based on sexual orientation or gender identity.Objective: This narrative review provides an overview of the prevalence of sexual violence in the SOGD communities, delineates risk factors for sexual victimization among SOGD community members, and reviews and evaluates existing prevention efforts for the SOGD communities. We outline specific recommendations for ensuring that prevention efforts meet the needs of the SOGD communities.Method: Drawing on ecological systems theory and public health approaches to sexual violence prevention, we outline current approaches and opportunities for preventionists and scholars to push the field forward.Results: There have been promising prevention programmes designed to be implemented within SOGD communities specifically; however, it is important that general primary prevention programmes endeavour to specifically address sexual violence perpetrated against SOGD people. While many packaged programmes that endeavour to prevent sexual violence across all gender identities and sexual orientations are inclusive of SOGD participants, more programming is needed that integrates anti-oppression training to target social norms that perpetuate SOGD-specific rape myths and normalize sexual violence against SOGD community members.Conclusion: Ecological prevention strategies in line with a public health approach for primary prevention may be particularly valuable for reducing victimization disparities based on SOGD status and identity. Comprehensive sexual education and anti-discrimination policies should be considered front-line prevention programming. To assess if these strategies are effective, the implementation of large-scale surveillance surveys that use comprehensive assessments of sexual orientation, gender identity, and sexual violence are needed. Using theoretically grounded implementation strategies for prevention programmes can ensure effective programme delivery.

Integrated Alcohol Use and Sexual Assault Prevention Program for College Men Who Engage in Heavy Drinking: Randomized Pilot Study

BACKGROUND

Sexual assault is prevalent on college campuses and most commonly is perpetrated by men. Problematically, there is a dearth of evidence-based prevention programs targeting men as perpetrators of sexual aggression. The Sexual Assault and Alcohol Feedback and Education (SAFE) program is an integrated alcohol and sexual assault prevention intervention for college men who engage in heavy drinking that aims to address sexual aggression proclivity and alcohol use outcomes by incorporating social norms theory, bystander intervention, and motivational interviewing.

OBJECTIVE

This study aims to examine the initial feasibility-, acceptability-, and efficacy-related outcomes of a randomized pilot trial of an integrated alcohol and sexual assault prevention program for college men who engage in heavy drinking.

METHODS

This study included 115 college men who engaged in heavy drinking, who were randomly assigned to the SAFE program or a mindfulness-based control condition (MBCC). The feasibility of implementation, adequacy of participant retention, fidelity and competency of program administration, and satisfaction and utility of the intervention were evaluated. The primary outcomes of alcohol use and sexual aggression were evaluated at 2 and 6 months after baseline. The secondary outcomes of perceived peer norms, risks for sexual aggression, and bystander intervention were also assessed. The extent to which the motivational interviewing session with personalized normative feedback facilitated changes in the proximal outcomes of drinking intentions, motivation to change, and self-efficacy was also examined.

RESULTS

The study procedures resulted in high program completion and retention (>80%), high fidelity to the program manual (>80% of the content included), high competency in program administration, and high ratings of satisfaction and program utility in addressing sexual relationships and alcohol use. Both groups reported declines in the number of drinks per week and number of heavy drinking days. Compared with the MBCC participants, the SAFE participants reported higher motivation to change alcohol use after the program, as well as greater use of alcohol protective behavioral strategies at 6 months. Compared with the MBCC participants, the SAFE participants also reported lower perceived peer engagement in sexual coercion, perceived peer comfort with sexism, and peer drinking norms at 2 and 6 months. However, no group differences were observed in sexual aggression severity, rape myth acceptance, or the labeling of sexual consent. Results regarding bystander intervention intentions were mixed, with the MBCC group showing decreased intentions at 2 months and the SAFE group reporting increased intentions at both 2 and 6 months.

CONCLUSIONS

The findings provide promising evidence for the feasibility, acceptability, utility, and preliminary efficacy of the SAFE program in reducing alcohol use and positively influencing perceived peer norms and intentions for bystander intervention among college men who drink.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05773027; https://clinicaltrials.gov/study/NCT05773027.

Characteristics of Sexual Assault Among Men Receiving a Forensic Medical Examination

Sexual assault is a form of violence disproportionately perpetrated against women by men; however, men also experience high rates of sexual victimization. While recent research exploring victimization of sexual assault among men does exist, little is known about situational characteristics and consequences surrounding men's assault experiences. Therefore, the current study examines narratives of men's sexual assault to further understand the unique experiences of men receiving a sexual assault medical forensic examination. To accomplish this, we conducted a retrospective medical chart review of sexual assault narratives from N = 45 men receiving a sexual assault medical forensic examination at a large academic medical institution in the southeastern United States. Three general constructs were identified within the records: a) Perpetrator use of coercive tactics, b) Memory loss, and c) Contextual factors. Nested within these constructs, five specific themes emerged, including: a1) Use of weapons and physical force; a2) Tactical administration of alcohol and drugs; b1) Difficulties remembering assault; c1) Consensual sexual activity turned non-consensual; c2) Incarceration. Findings from the present study common identified characteristics of sexual assaults among men receiving a sexual assault medical forensic examination, including coercive tactics used by perpetrators, consequences of sexual assault, and high-risk settings for male victimization.

Bystander intervention to prevent firearm injury: A qualitative study of 4-H shooting sports participants

This qualitative study examines how youth and adult members of 4-H Shooting Sports clubs perceive firearm injury risk and risk reduction, and the applicability of a bystander intervention (BI) risk reduction framework in this community. Semistructured interviews were conducted with 11 youth and 13 adult members of 4-H Shooting Sports clubs across nine US states from March to December of 2021 until thematic saturation was reached. Deductive and inductive thematic qualitative analyses were performed. Six overarching themes emerged: (1) The tendency to view firearm injury as predominantly unintentional in nature; (2) Acknowledgment of a wide array of risks for firearm injury; (3) Perceived barriers to bystander action to prevent firearm injury including knowledge, confidence, and consequences of action; (4) Facilitators of bystander action including a sense of civic responsibility; (5) Direct and indirect strategies to address potential risks for firearm injury; and (6) Belief that BI skills training would be useful for 4-H Shooting Sports. Findings lay the groundwork for applying BI skills training as an approach to firearm injury prevention in 4-H Shooting Sports, similar to how BI has been applied to other types of injury (i.e., sexual assault). 4-H Shooting Sports club members' sense of civic responsibility is a key facilitator. Prevention efforts should attend to the broad array of ways in which firearm injury occurs, including suicide, mass shootings, homicide, and intimate partner violence, as well as unintentional injury.

School partner perspectives on the implementation of the Your Voice Your View sexual assault prevention program for high school students

Despite the high risk for sexual assault among adolescents, few sexual assault prevention programs designed for implementation in high schools have sustained rigorous evaluation. The present study sought to better understand the factors that influenced the implementation of Your Voice Your View (YVYV), a four-session sexual assault prevention program for 10th grade students, which includes a teacher "Lunch and Learn" training as well as a 4-week school-specific social norms poster campaign. Following program implementation, eight school partners (i.e., health teachers, guidance counselors, teachers, and principals) participated in an interview to provide feedback on the process of program implementation. The Consolidated Framework for Implementation Research was utilized to examine site-specific determinants of program implementation. Participants discussed the importance of the design quality and packaging of the program, as well as the relative advantage of offering students a violence prevention program led by an outside team, as opposed to teachers in the school. School partners highlighted the importance of intensive preplanning before implementation, clear communication between staff, the utility of engaging a specific champion to coordinate programming, and the utility of offering incentives for participation. Having resources to support implementation, a desire to address sexual violence in the school, and a positive classroom climate in which to administer the small-group sessions were seen as school-specific facilitators of program implementation. These findings can help to support the subsequent implementation of the YVYV program, as well as other sexual assault prevention programs in high schools.

Impulsivity and Reactive-Proactive Aggression as Mechanisms of Alcohol-Related Sexual Intimate Partner Violence Perpetration among Romantic Partners

Background: Sexual intimate partner violence (S-IPV) commonly occurs within the contexts of committed romantic relationshops. Prior research has demonstrated the existence of a robust link between alcohol use and S-IPV. Despite this, few research studies have explored the etiological underpinnings of alcohol-related S-IPV perpetration, specifically. The present study examines the role of several key factors (i.e., problematic drinking, negative and positive urgency, proactive and reactive aggression) on S-IPV perpetration. Methods: Participants were 337 heavy drinking men and women in intimate relatinships who reported perpetrating some form of IPV toward their current partner within the past-year. A moderated-mediation model was used to determine how the key study variables interacted to predict S-IPV perpetration. Results: Results indicated that problematic drinking was positively correlated with both negative urgency and positive uregency. Findings also revealed that negative urgency, positive urgency, proactive aggression, and reactive aggression were all positively related to S-IPV perpetration. The indirect relationship between problematic drinking and S-IPV perpetration was mediated by positive urgency. Additionally, a significant main effect of proactive aggression on S-IPV perpetration was also detected. Conclusions: These findings suggest that impulsivity, specifically positive urgency, and proactive aggression may be under-appreciated constructs within the existing sexual aggression literature, and future research examining these variables as mechanisms explaining the association between the alcohol and S-IPV is warranted.

An Application of the Confluence Model of Sexual Aggression Among Young Adult Male Soldiers

Sexual violence in the U.S. military is a serious concern. Whereas numerous studies document the prevalence of sexual violence among service members, far less research has examined etiological risk factors for sexual aggression perpetration among service members. The present study sought to evaluate the applicability of the Confluence Model of Sexual Aggression among a sample of young adult men engaged in active-duty military service within the U.S. Army. Anonymous surveys were completed by 326 male soldiers between the ages of 18 and 24 at a large military installation in the Southeastern region of the United tStates. Men's likelihood to engage in sexual aggression was operationalized as men's perceived likelihood to persist with sexual activity despite a partner's resistance. Aligning with the Confluence Model of Sexual Aggression, two composite variables reflecting hostile masculinity and tendency toward impersonal sex were created. A linear regression indicated that the main effects of hostile masculinity and impersonal sex were significantly associated with greater perceived likelihood of sexual aggression perpetration. Results also revealed that while the interaction term between hostile masculinity and impersonal sex was significant, the direction of the relationship suggests that the effect of impersonal sex is weaker at higher levels of hostile masculinity. These findings lend evidence to help identify those at elevated risk for perpetrating sexual aggression, as well as informing programmatic efforts to prevent sexual assault within the military.

Implementing school-wide sexual assault prevention in middle schools: A qualitative analysis of school stakeholder perspectives

Sexual assault and harassment are significant problems that begin early in the lifespan. The current study sought to understand the contextual factors that influence the implementation of school-wide sexual assault prevention programs in middle schools that focus on fostering community norms change. The Consolidated Framework for Implementation Research (CFIR) is a menu of constructs arranged across 5 domains that assists stakeholders in assessing and identifying site-specific determinants of successful intervention implementation. In the present study, researchers conducted a series of 10 interviews with middle school stakeholders (i.e., principals, guidance counselors, teachers) to document characteristics inside and outside of the school environment (i.e., cultural norms, relative priority, prior interventions, implementation climate) relevant to the implementation of prevention programming, using the CFIR as a guiding framework for analysis. Whereas schools recognized the importance of implementing violence prevention programming, stakeholders reported several other competing demands (i.e., time, resources) that make it difficult to implement rigorous programming without support from an outside agency/team. Community agencies and research teams hoping to implement violence prevention in middle schools can benefit from using stakeholder interviews grounded in the CFIR model to gain a better awareness of the school- and community-specific factors that are likely to influence successful implementation of violence prevention programs in middle schools.

What Stops Unwanted Sexual and Social Advances Made by Heavy Drinking College Men?

Although rates of sexual aggression are high among college men who engage in heavy drinking, little is known regarding how often heavy drinking college men initiate unwanted sexual advances towards women that could lead to a potential sexual assault or the reasons why these advances stop or proceed. The present study describes heavy drinking college men's (N = 210) initiation of unwanted sexual and social advances towards women, as well as outcomes of these interactions, including how often these behaviors continue, and men's perception of what stopped the behavior over a 3-month period. Men indicated whether they were in a situation where a sexual partner noted that she does not want sexual activity to proceed further, initiated unwanted sexual contact, initiated unwanted sexual intercourse, attempted to give a woman alcohol when she did not appear to want to drink, or attempted to take a woman to an isolated location when she did not appear to want to go. These unwanted sexual and social advances most often stopped because of women's verbal resistance (i.e., saying "stop" or "no"), or because men engaged in a discussion regarding the women's limits or choices. Given that none of the unwanted sexual or social advances stopped because of bystander intervention, the present study highlights the importance of raising awareness of the effectiveness of women's resistance tactics and continuing to train bystanders to notice and take action to address risky situations.

Sexual Re-Assault among College Women Differs Based on Sexual Refusal Assertiveness and Assertive Resistance Strategy Intentions

Sexual assault and sexual re-assault are common problems on college campuses for women, and experiencing an initial assault dramatically increases risk for experiencing sexual re-assault. Low use of sexual refusal assertiveness and assertive resistance strategy intentions has been found to predict initial victimization, yet few studies to date look collectively at the associations of sexual refusal assertiveness and assertive resistance strategy intentions to sexual re-assault. The current study examined both sexual refusal assertiveness and assertive resistance strategy intentions as potential moderators of sexual re-assault among college women. It was hypothesized that the association between sexual assault severity before college and sexual assault severity since college would be stronger among those with low sexual refusal assertiveness compared to those with high sexual refusal assertiveness (Hypothesis 1). it was also hypothesized that the association between sexual assault severity before college and sexual assault severity since college would be stronger among those who endorsed assertive resistance strategy intentions (Hypothesis 2). Participants (N = 623) included college women at a large, public university within the northwestern region of the United States, who completed a web-based survey. Results revealed that the association between sexual assault severity before college and sexual assault severity since college was significant among those with lower levels of sexual refusal assertiveness (t = 91.42, p < 0 .001). Results also revealed that the association between sexual assault severity before college and sexual assault severity since college was stronger among those who endorsed non-assertive resistance strategy intentions to a potential sexual assault scenario (t = 25.09, p < 0.001). These findings provide insight into risk for sexual re-assault, wherein risk reduction programmatic efforts may be targeted towards women entering college with a sexual assault history to increase their use of sexual refusal assertiveness and assertive resistance strategy intentions.

Medications at the Emergency Department After Recent Rape

Rape is associated with myriad negative physical and mental health effects, yet little is known about medical prescribing following rape-related emergency room visits. The goal of this study was to examine factors associated with medications prescribed the same day as a sexual assault medical forensic examination (SAMFE). A total of 939 medical records (93.9% female) of a medical university in the Southeastern United States between July 1, 2014, and May 15, 2019, were paired with Sexual Assault Nurse Exam records. Demographic and assault characteristics were examined as correlates of medications prescribed at the emergency department within the same day of a SAMFE. All individuals were offered medications within the national guidelines. Intimate partner violence (IPV) was negatively associated with antibiotic prescriptions and with emergency contraception prescriptions. Genital injury and male gender of victim were positively associated with antiviral prescriptions. Non-genital injury was positively associated with both over-the-counter and prescription pain medication prescriptions. Report of strangulation was positively associated with accepting over-the-counter but not prescription pain medication. IPV and strangulation were positively associated with psychotropic prescriptions. Although specific medications were offered to individuals during the SAMFE, demographic and assault characteristics were associated with medication acceptability.

Web-Based Alcohol and Sexual Assault Prevention Program With Tailored Content Based on Gender and Sexual Orientation: Preliminary Outcomes and Usability Study of Positive Change (+Change)

Background

Alcohol use and sexual assault are common on college campuses in the United States, and the rates of occurrence differ based on gender identity and sexual orientation.

Objective

We aimed to provide an assessment of the usability and preliminary outcomes of Positive Change (+Change), a program that provides integrated personalized feedback to target alcohol use, sexual assault victimization, sexual assault perpetration, and bystander intervention among cisgender heterosexual men, cisgender heterosexual women, and sexual minority men and women.

Methods

Participants included 24 undergraduate students from a large university in the Southwestern United States aged between 18 and 25 years who engaged in heavy episodic drinking in the past month. All procedures were conducted on the web, and participants completed a baseline survey, +Change, and a follow-up survey immediately after completing +Change.

Results

Our findings indicated that +Change was acceptable and usable among all participants, despite gender identity or sexual orientation. Furthermore, there were preliminary outcomes indicating the benefit for efficacy testing of +Change.

Conclusions

Importantly, +Change is the first program to target alcohol use, sexual assault victimization, sexual assault perpetration, and bystander intervention within the same program and to provide personalized content based on gender identity and sexual orientation.

Trial Registration

ClinicalTrials.gov NCT04089137; https://clinicaltrials.gov/ct2/show/NCT04089137

Sexual Assault Victimization: Latinx Identity as a Protective Factor for Sexual Minorities

Sexual assault victimization is an experience that impacts many college students, and rates differ based on ethnicity and sexual minority status. However, little is known about the impact of the intersectionality of Latinx and sexual minority identities on sexual assault severity among college students. The current study examined past year sexual assault victimization severity based on sexual orientation and Latinx identities among a random sample of college students (n = 506). Further, factors associated with past year sexual assault victimization severity were examined among sexual minority participants (n = 170). Among all college students, identifying as a cisgender woman, sexual minority, or having a more severe sexual assault history was associated with higher past year sexual assault victimization severity. Further, among sexual minorities, identifying as Latinx or having fewer drinks per week were associated with less severe past year sexual assault victimization. Although preliminary, this finding suggests a need for future research to examine potential cultural factors associated with Latinx populations that may serve as protective factors for sexual assault victimization among college students.

New Perspectives on Risk Factors for Non-fatal Strangulation and Post-assault Imaging

Strangulation has long been associated with death in the context of sexual assault and intimate partner violence (IPV). Non-fatal strangulation (NFS) during sexual assault, which refers to strangulation or choking that does not result in death, is common and has been associated with IPV and with bodily injury; however, other factors associated with NFS are unknown. The current study examined demographic and sexual assault characteristics associated with NFS among women who received a sexual assault medical forensic exam (SAMFE). A second purpose of this study was to explore factors associated with receiving follow-up imaging orders after NFS was identified during a SAMFE. Participants (N = 882) ranged in age from 18 to 81 (M = 28.85), with the majority identifying as non-Hispanic White (70.4%) or Black/African American (23.4%). A total of 75 women (8.5%) experienced NFS during the sexual assault. Of these, only 13 (17.3%) received follow-up imaging orders for relevant scans. Results from a logistic regression analysis demonstrated that NFS was positively associated with report of anal penetration, intimate partner perpetration, non-genital injury, and weapon use during the assault. Results from chi-square analysis showed that among sexual assaults involving women who experienced NFS, those whose assaults involved weapon use were over four times more likely to receive imaging orders compared to assaults without weapon use. These findings have implications for criminal justice, and if incorporated into danger assessments, could potentially reduce fatalities linked to sexual assault and/or IPV. Additional work is needed to ensure that all assaults with NFS trigger a referral for imaging regardless of other assault characteristics.

Alcohol use and alcohol-related consequences based on gender and sexual orientation among college students

BACKGROUND AND OBJECTIVES

Research has not yet investigated how the association between alcohol and alcohol-related consequences differs across cisgender heterosexual women (CHW), cisgender heterosexual men (CHM), and sexual and gender minority (SGM) college students.

METHODS

Participants were N = 754 college students (34.5% CHW [n = 260]; 34.5% CHM [n = 260]; 31.0% SGM [n = 234]) between the ages 18 and 25 who completed a survey on sexual orientation, gender identity, alcohol use (i.e., average drinks per week), and alcohol-related consequences.

RESULTS

Among individuals who reported alcohol use, CHM reported significantly more drinks per week compared to CHW and SGM. The logistic model of a zero-inflated negative binomial regression indicated that excess zeros in the alcohol-related consequences were more likely among (1) nondrinkers and (2) SGM compared to CHM. The count portion of the model indicated that, among drinkers, there was a positive association between drinks per week and alcohol-related consequences. Estimated alcohol-related consequences per drink were 1.90% higher among CHW than CHM and 2.76% higher among SGM than CHM. Exploratory analyses did not find significant differences in outcomes between cisgender female and male sexual minority students.

DISCUSSION AND CONCLUSION

Findings suggest that although CHW and SGM students consume less alcohol than CHM, these students experience more alcohol-related consequences per drink.

SCIENTIFIC SIGNIFICANCE

This study advances the field's knowledge of alcohol use patterns and consequences among SGM college students. There is a need for alcohol education programming that is tailored to the unique experiences, identities, and minority stressors of SGM college students.

A Qualitative Analysis of Sexual Consent among Heavy-drinking College Men

The current study sought to examine how heavy-drinking college men describe communication of sexual interest and sexual consent. Thematic analysis of semi-structured interviews with 12 heavy-drinking college men identified three themes. Themes included: (a) expectations about parties and sexual activity, (b) observing and communicating sexual interest, and (c) communication of sexual consent. Men reported visiting drinking environments to locate women who they assumed would be open to sexual advances. In these environments, sexual interest was inferred indirectly through shared alcohol use. Anticipating token resistance men reported "trying and trying again" to pursue escalating types of sexual activity. Consent was inferred when participants did not hear "no" from a sexual partner, highlighting the importance of continued education on verbal consent in the context of sexual assault prevention programs.

The instigating effects of isolation on substance-related intimate partner violence: A review

In this article, we examine the empirical and theoretical support for the idea that experiences of isolation can intensify substance use, even among those in committed close relationships, and can increase the likelihood of negative conflict behaviors, including intimate partner violence (IPV). Cross-sectional, longitudinal, and laboratory-based research suggest that individuals and couples who report experiences of social exclusion and have fewer social supports experience more mental health problems, more negative emotional experiences, and higher levels of stress. These negative outcomes spur coping efforts to reduce these distressing states, which often involve pain-relieving substances such as alcohol. We describe how dynamic models of relationship conflict and IPV can integrate alcohol and substance use patterns among both individuals and couples to understand and predict contexts leading to conflict escalation and IPV perpetration.

Alcohol Use and Risk Factors for Sexual Aggression: Differences According to Relationship Status

The present study examined the ways alcohol use and risk factors for sexual assault perpetration vary by relationship status. Participants included 242 college men (age = 18-22 years) from a northeastern university who identified as being single or in a casual or committed dating relationship with a female partner. ANCOVAs and paired t tests compared individuals who were single, casually dating, and in committed relationships on self-reported alcohol use during sexual situations, beliefs about sexual communication, behavior associated with sexual aggression, and peer approval of sexual aggression. Differences in alcohol use during sexual situations and behavior associated with sexual aggression according to relationship status emerged. Post hoc analyses examining whether alcohol use during sexual situations moderated significant associations between relationship status and behavior associated with sexual aggression suggested that men in committed relationships who endorsed more frequent alcohol use during sexual situations also endorsed more behavior associated with sexual aggression. Findings suggest that individuals in committed relationships who often use alcohol during sexual situations may be at increased risk of sexually aggressive behavior.

Effects of couple conflict on alcohol craving: Does intimate partner violence play a role?

OBJECTIVE

Social stress in the form of maladaptive relationship conflict is a common precipitant to alcohol misuse and problems. Research has also established a clear causal association between alcohol misuse and relationship conflict in the form of intimate partner violence (IPV). Despite the robust literature linking relationship conflict and problematic drinking using survey methodology, no laboratory studies have examined the proximal association between relationship conflict and alcohol craving among couples, or the influence of IPV perpetration and victimization on this association.

METHOD

As part of a larger randomized controlled trial, 30 different-sex community couples with substance misuse completed a laboratory conflict resolution task. Participants reported subjective alcohol craving on a Likert-type scale immediately, before, and after the task. Conflict behaviors were coded by trained observers. Analyses were conducted using a multilevel modeling framework to account for the dyadic nature of the data.

RESULTS

Findings indicate that psychological and physical IPV perpetration and victimization strengthened the associations between negative and positive conflict behaviors and alcohol craving among men only. Contrary to our hypotheses, no main or moderating effects of conflict behaviors, IPV perpetration, or IPV victimization were found for women.

CONCLUSIONS

Findings from this exploratory study suggest that in this sample, relationship conflict and IPV in one's current relationship played a more impactful role on acute alcohol craving among men compared to women. Future studies should examine the role of specific conflict behaviors on alcohol craving and relapse risk, and patterns of communication that might increase or reduce risk for exacerbated alcohol craving.

Emotion Dysregulation Predicts Dropout from Prolonged Exposure Treatment among Women Veterans with Military Sexual Trauma-Related Posttraumatic Stress Disorder

BACKGROUND

Military sexual trauma (MST) is notably prevalent among military personnel and can result in mental and physical health problems, including post-traumatic stress disorder (PTSD). Although there are several evidence-based treatments for MST-related PTSD, including prolonged exposure (PE) therapy, it is unclear what factors are associated with premature termination (i.e., dropout) from this treatment. Given the popularity of PE as an evidence-based treatment for PTSD, the examination of variables that influence dropout from PE among women veterans with MST is warranted. Identification of these specific factors may assist clinicians in addressing the unique symptom profiles and potential barriers to treatment access for individual MST survivors.

METHODS

The current study presents secondary data analyses from an ongoing randomized clinical trial that compared the effectiveness of PE delivered in person to delivery via telemedicine for women veterans with MST-related PTSD (n = 136).

RESULTS

A total of 50% of participants dropped out from the study (n = 68). Difficulties with emotion regulation at baseline were associated with treatment dropout (odds ratio, 1.03; p < .01), whereas baseline PTSD and demographic factors were not.

CONCLUSIONS

Findings from the current study indicate that emotion regulation skills deficits contribute to PE dropout and may be an appropriate target to address in future clinical trials for PTSD treatment.

Usability Testing of a Mobile Health Intervention to Address Acute Care Needs after Sexual Assault

Sexual assault is associated with a range of poor mental health outcomes. To enhance access to care by this population, technology-based mental health interventions have been implemented in the emergency room; however, more accessible and easily disseminated interventions are needed. The aim of the present study was to test the usability of a mobile health intervention targeting alcohol and drug misuse, suicide prevention, posttraumatic stress symptoms, coping skills, and referral to formal assistance for individuals who have experienced sexual assault. Feedback on the usability of the intervention was collected from individuals who received a sexual assault medical forensic examination (n = 13), and feedback on the usability and likelihood of recommending the application was collected from community providers (n = 25). Thematic analysis was used to describe qualitative data. Content themes related to aesthetics, usability, barriers to resources, and likes/dislikes about the intervention arose from interviews following the intervention. Participants found the intervention to be user friendly and endorsed more likes than dislikes. Providers rated the intervention as being helpful and would recommend it to survivors of sexual assault. Findings suggest that the intervention is usable and fit for future effectiveness testing, filling an important gap in treatment for individuals who experience sexual assault.

A Qualitative Analysis of Bystander Intervention Among Heavy-Drinking College Men

This study qualitatively examines how heavy-drinking college men conceptualize bystander intervention. Twelve semi-structured individual interviews were conducted with college men reporting past-month heavy drinking and sexual activity within the past 2 months. NVivo software was used to conduct a thematic analysis. Following the stage model of bystander intervention, men in this sample described situations-predominantly in drinking contexts-when other men made sexual advances toward women who were not interested or who were intoxicated as opportunities for intervention. Men reported relying on women's expression of verbal and nonverbal cues as a sign that a situation was problematic, and warranting intervention. Men reported a desire to protect women from experiencing a sexual assault, or to protect a peer from being accused of rape. Men perceived themselves to be more likely to assume responsibility for intervening when the situation involved someone they knew, especially a female friend. A variety of intervention strategies were also reported. Preliminary support was offered for considering alcohol myopia as a barrier to intervention. The interviews also provided preliminary support for further investigation into the role of alcohol expectancies regarding "liquid courage" and "aggression" as factors that can influence bystander intervention when intoxicated. Implications for future research and the development of tailored sexual assault prevention efforts for heavy-drinking men are discussed.