Examining within-person associations between alcohol and cannabis use and hooking up among adolescents and young adults in the United States.

OBJECTIVE: This study examined daily associations between alcohol use, cannabis use, and simultaneous alcohol and cannabis/marijuana (SAM) use with the likelihood of hooking up (uncommitted sexual encounter that may or may not include intercourse). METHOD: We used a longitudinal measurement burst ecological momentary assessment (EMA) design with 3-week EMA bursts with daily measurements repeated quarterly across 12 months. 1,009 (57 % female, Mean age = 20.00 [SD = 3.21]) Texan adolescents and young adults ages 15-25 participated in the study. Mixed effects logistic regression models were estimated using maximum likelihood estimation to evaluate the associations between substance use and hooking up. RESULTS: Within-person results indicated that participants were more likely to hook up on days with alcohol use and on days with cannabis use, but not on days with SAM use. Participants were also more likely to hook up on drinking days with higher-than-usual alcohol use. Between-person results indicated that participants who used alcohol more often or cannabis more often on average were more likely to hook up, and participants who tended to drink more on drinking days were more likely to hook up. CONCLUSIONS: Given the significant daily-level associations between alcohol and cannabis use and hooking up behavior, public health initiatives should focus on developing interventions to reduce alcohol and cannabis use and promote safer hooking up behavior among adolescents and young adults.

Polysubstance use among young adults and differences in negative alcohol-related sexual experiences.

This study aimed to compare negative alcohol-related sexual experiences among individuals who used (1) alcohol only, (2) alcohol plus marijuana, and (3) alcohol plus marijuana and stimulants. Participants in the analytic sample (N = 1,015; Mean age = 19.16 (SD = 0.79); 45.42% male) completed an online baseline survey as part of an intervention study. A hurdle negative binomial model examined the associations between polysubstance use and negative alcohol-related sexual experiences. Models examined if experiences varied by demographic factors. Compared to participants that only used alcohol, those who used alcohol plus marijuana and stimulants reported a higher likelihood and average number of negative alcohol-related sexual experiences in the past 3 months. Participants that used alcohol plus marijuana had a higher likelihood of having a negative alcohol-related sexual experience in the past 3 months compared to those who only used alcohol. These findings suggest the number and risk for negative alcohol-related sexual experiences increases with the number of substances being used.

The Role of Past and Current Medical Use on Nonmedical Use of Prescription Drugs among College Students: Exploring Same-Drug and Cross-Drug Class Associations.

Background: Understanding the role that medical use of prescription drugs plays in nonmedical use of prescription drugs can inform prevention efforts. In order to understand fully the potential risk that medical use of prescription drugs conveys for nonmedical use of prescription drugs, the current study explored (a) the simultaneous associations between the medical use of several classes of prescription drugs with current nonmedical use of the same and other prescription drug classes, and (b) whether the associations depended upon past or current medical use. Methods: Data came from a cross-sectional survey of 1686 college students, which assessed past and current medical use and current nonmedical use of stimulants, sedatives/anxiolytics, and opioid analgesics. Results: Logistic regression analyses revealed that both past and current medical use of sedatives/anxiolytics and opioid analgesics predicted the current nonmedical use of the same drug class, whereas past medical use of stimulants predicted the current nonmedical use of stimulants. In addition, current medical use of stimulants predicted current nonmedical use of sedatives/anxiolytics and past medical use of sedatives/anxiolytics predicted current nonmedical use of opioid analgesics. Conclusions: This study provides a broader examination than past research of simultaneous same-drug class and cross-drug class associations between medical and nonmedical prescription drug use, as well as the role of past and current medical use in these associations. Overall, the results suggest that efforts to prevent nonmedical use of a prescription drug class should move beyond targeting only those who have or who are using the same drug class medically.

University student perceptions about the motives for and consequences of nonmedical use of prescription drugs (NMUPD).

OBJECTIVE: The purpose of the current study was to increase qualitative understanding of student motives for and consequences associated with nonmedical use of prescription drugs. PARTICIPANTS: Sixty-one students participated in eight focus groups between April and November 2013. METHODS: Students described prescription drugs commonly used for nonmedical reasons, as well as the motives for and consequences associated with their use. Data were analyzed using thematic content analysis. RESULTS: Students reported stimulants as the most commonly used prescription drug for nonmedical reasons, least expensive, and easiest to obtain on campus, followed by benzodiazepines. Opioids were less commonly used, more expensive, and difficult to acquire. Motives and consequences varied by prescription drug class. CONCLUSIONS: Our qualitative findings extend previous research by suggesting differences in students' perceived motives for using and consequences associated with the different classes of prescription drugs. These findings provide implications for the development of preventive interventions.

Nonmedical use of prescription drugs and related negative sexual events: Prevalence estimates and correlates in college students.

The present study of college students investigated (a) the prevalence of nonmedical use of three classes of prescription drugs (stimulants, anxiolytics/sedatives, analgesics), (b) the prevalence of negative sexual events (NSE) associated with any nonmedical use of prescription drugs (NMUPD), and (c) a set of correlates of NSE. The specific NSE were sexual aggression victimization and perpetration, and regretted sex. The correlates of the NSE were sex, race/ethnicity, year in school, psychological symptoms, alcohol use, illegal drug use, and NMUPD. Participants were 509 (254 females, 255 males) randomly-selected college students who reported any NMUPD. The majority (76.2%) of the sample reported ever using stimulants, 38.9% reported ever using anxiolytics/sedatives, and 40.9% reported using analgesics. During NMUPD, 14.3% of the students reported regretted sex, 7.1% of female students reported sexual victimization, and 6.3% of male students reported perpetrating sexual aggression. Multiple logistic regression analyses indicated that anxiolytic/sedative use (Adj. OR=1.99; 95% CI=1.51-2.62) was positively associated with regretted sex, whereas anxiolytic/sedative use (Adj. OR=1.79; 95% CI=1.01-3.16) and psychological symptoms (Adj. OR=1.06; 95% CI=1.02-1.10) were positively associated with sexual victimization. Illegal drug use was positively associated with perpetrating sexual aggression (Adj. OR=4.10; 95% CI=1.21-13.86). These findings suggest that among these college students, NMUPD-associated NSE were not uncommon, and primarily associated with anxiolytic/sedative use. Given the academic, physical, and psychological implications associated with NSE, research needs to further explore the causal nature of these relations.

Development and Validation of a Video Measure for Assessing Women's Risk Perception for Alcohol-Related Sexual Assault.

OBJECTIVE: Using an iterative process, a series of three video scenarios were developed for use as a standardized measure for assessing women's perception of risks for alcohol-related sexual assault (SA). The videos included ambiguous and clear behavioral and environmental risk cues. METHOD: Focus group discussions with young, female heavy drinkers (N = 42) were used to develop three videos at different risk levels (low, moderate, and high) in Study 1. Realism, reliability, and validity of the videos were assessed using multiple methods in Studies 2 and 3. One hundred-four women were used to compare differences in risk perception across the video risk level in Study 2. In Study 3 (N = 60), we assessed women's perceptions of the low and high risk videos under conditions of no alcohol and alcohol. RESULTS: The realism and reliability of the videos were good. Women who viewed the low risk video compared to women who viewed the moderate and high risk videos perceived less risk for SA. We found an interaction between alcohol and risk perception such that, women in the alcohol condition were less likely to perceive risk when watching the high risk video. CONCLUSIONS: As the video risk level increased, women's perception of risk increased. These findings provide convergent evidence for the validity of the video measure. Given the limited number of standardized scenarios for assessing risk perception for sexual assault, our findings suggest that these videos may provide a needed standardized measure.

Perceived controllability of condom use shifts reliance on implicit versus explicit affect.

OBJECTIVES: This study integrated the framework of the behavioral affective associations model with dual process theories to investigate whether feelings about condoms operate at both implicit and explicit levels to influence condom use. We then tested whether 2 factors related to the perceived controllability of condom use (perceived behavioral control and past experience losing control in the heat of the moment) moderated the reliance on implicit versus explicit affect. METHOD: Sexually active young adults (N = 54) completed measures of implicit and explicit affect surrounding condoms, perceived behavioral control, and whether they attributed their prior unprotected sex to getting lost in the heat of the moment. They then completed 30 daily reports of their sexual activity and condom use. Multiple moderation analysis using generalized estimating equation (GEE) models tested the relative influence of implicit and explicit affect on condom use at varying levels of perceived controllability. RESULTS: Both perceived behavioral control and past unprotected sex because of getting lost in the heat of the moment moderated the effects of both implicit and explicit affect on behavior, ps < .05. Only implicit affect predicted condom use among participants who had gotten lost in the heat of the moment and who had low perceived behavioral control. Only explicit affect predicted condom use among participants without a history of getting lost in the heat of the moment and who had high perceived behavioral control. CONCLUSION: Feelings about condoms predicted condom use at either an implicit or explicit level, depending on perceived controllability, suggesting this is an important moderator of whether implicit processes drive condom use. (PsycINFO Database Record

Do Drinking Episodes Contribute to Sexual Aggression Perpetration in College Men?

OBJECTIVE: Survey and experimental analog studies suggest that alcohol consumption contributes to perpetration of sexual aggression. However, few studies have considered the temporal association between naturally occurring episodes of drinking and subsequent sexual aggression. This daily report study was designed to examine whether alcohol consumption increases the odds of aggressive sexual activity within the next 4 hours. METHOD: First-year male college students (N = 427) completed daily online reports of drinking and sexual activity for up to 56 days. Multilevel modeling was used to determine whether drinking episodes increased the odds of the following outcomes occurring within 4 hours: (a) aggressive sex with a new partner, (b) non-aggressive sex with a new partner, (c) aggressive sex with a previous partner, and (d) non-aggressive sex with a previous partner. RESULTS: Drinking episodes increased the odds of both aggressive and non-aggressive sex with a new partner. In contrast, drinking episodes did not predict aggression involving previous partners and decreased the odds of non-aggressive sex with a previous partner. Contrary to hypotheses, individual difference variables associated with propensity toward sexual aggression (sexual misperception, antisocial behavior, hostility toward women) did not interact with daily alcohol. CONCLUSIONS: The complex pattern of results is more consistent with situational as opposed to pharmacological effects of alcohol on sexual aggression and suggests that prevention efforts focus on drinking contexts known to facilitate sexual activity.

Increasing condom use by changing people's feelings about them: An experimental study.

OBJECTIVE: Given the well-documented efficacy of condoms as a means of preventing pregnancy and sexually transmitted infection transmission, the low rates of condom use among young adults necessitates a deeper understanding of the factors that influence condom use decision making. The central purpose of the current study was to examine how experimentally manipulated affective associations with condoms influence subsequent behavior in a condom selection task, thereby providing support for a causal relation of affective associations to behavior in this health domain. METHOD: Following a baseline assessment of cognitively based beliefs and affective associations, participants' (N = 171) affective associations with condoms were experimentally manipulated with an evaluative conditioning (EC) procedure. Images of condoms were paired repeatedly with positive or neutral affective stimuli. The key outcome measure was a behavioral choice task in which participants selected condoms upon completion of the experiment. RESULTS: Participants in the positive condition reported more positive affective associations post-EC compared with those in the neutral condition, ß = 0.33, p = .025, 95% CI (0.041, 0.63). For participants who regularly used condoms at baseline, those in the positive condition also selected significantly more condoms, RR = 1.39, p = .015, 95% CI (1.07, 1.83). This condition effect on behavior was partially mediated by the change in affective associations. There was no effect of condition on condom selection among participants who rarely used condoms at baseline. CONCLUSION: The current study extends our theoretical understanding of the affect-behavior relation in the realm of condom use, and provides preliminary support for interventions that target affective associations with condoms.

Sexual assault risks among gay and bisexual men.

The goal of this study was to examine lifetime patterns of sexual assault and associated risks among a purposive sample of gay and bisexual men (N = 183; 18 to 35 years old, M = 24.3). Cross-sectional data were collected via written, self-administered questionnaires and face-to-face, event-based qualitative interviews. Alcohol severity scores indicated high rates of hazardous drinking (53.0%) and possible dependence (14.2%) among participants. One-half of men (50.8%) reported childhood sexual abuse (CSA), and 67.2% reported adult sexual assault (ASA). Average age at most recent ASA was 21 years. Most perpetrators (83.9%) of recent ASA incidents were male; 67.0% of participants reported consuming alcohol and/or drugs prior to the most recent incident. Regression findings indicated more severe CSA experiences and past alcohol-related problems predicted recent severe ASA. Although we found similarities between gay and bisexual men in lifetime sexual assault history, we found some distinct differences in ASA risk factors. Bisexual men reported higher alcohol severity scores, more female ASA perpetrators, higher internalized homophobia scores, and fewer male sexual partners than gay men. Findings suggest the need for interventions that reduce ASA risk among sexual minority men-and the potential benefits of focusing on alcohol consumption in risk reduction efforts.

A longitudinal analysis of drinking and victimization in college women: is there a reciprocal relationship?

The purpose of the current study was to assess the relationship between drinking and severe physical and sexual victimization in a sample of 989 college women over 5 years. Participants completed a Web-based survey each fall semester, beginning as first-time incoming freshman, and continuing each year for 5 years. The survey was comprehensive in assessing drinking, victimization, and relevant covariates. Women were followed whether they remained at university or not. Prior year same type of severe victimization predicted current year victimization, both severe physical and sexual. However, prior year drinking did not predict current year severe victimization. Prior year severe sexual victimization predicted current year drinking. Our findings of a longitudinal relationship between severe sexual victimization and subsequent increases in drinking suggests that college women may be drinking to cope with negative sequelae that they experience as a result of the victimization. We did not find the same longitudinal relationship between drinking and severe physical or sexual victimization, suggesting that a reciprocal relationship does not exist between drinking and victimization among college women. We did find that severe sexual victimization decreased across college, suggesting that the year prior to and the first year of college may be a critical period for intervening to reduce risk for severe victimization.

Sexual victimization and associated risks among lesbian and bisexual women.

This study examines relationships among childhood sexual abuse (CSA), risky alcohol use, and adult sexual victimization among bisexual and lesbian women. Half (51.2%) of women reported CSA and 71.2% reported adult sexual victimization. Perpetrators were generally male, and 56.4% of women's most recent adult sexual victimization incidents occurred after coming out. Regression results indicated that adult sexual victimization severity was associated with a bisexual identity, more severe CSA history, more lifetime sexual partners, and higher alcohol severity scores. Compared to lesbians, bisexual women reported more severe adult sexual victimization experiences, greater revictimization, riskier drinking patterns, and more lifetime male sexual partners.

The influence of marijuana and alcohol use on condom use behavior: findings from a sample of young adult female bar drinkers.

Prevalence data indicate that alcohol and marijuana are frequently used intoxicants among young adults in the United States. In a number of studies, both alcohol use and marijuana use have been associated with failure to use condoms, a high-risk sexual behavior. The purpose of the current study was to assess the individual and additive effects of alcohol and marijuana use on this risky sexual behavior among 251 young adult, female bar drinkers. Multilevel modeling was used to assess the likelihood of condom use during sexual events that occurred as a function of substance use (none, only alcohol, only marijuana, or both) prior to and partner type (known or casual) during the event, as well as individual differences in sexual assertiveness. Initial model testing (Levels 1 and 2) revealed that there were significant main effects for partner type (known), substance use (alcohol and marijuana) and sexual assertiveness (refusal, pregnancy/STI prevention) on risky sex. Final model testing indicated that sexual assertiveness interacted with substance use to influence risky sex. Women who were low in sexual assertiveness refusal were more likely to engage in risky sex on days when they had consumed both alcohol and marijuana prior to the sexual activity. These findings highlight the complex nature of the relationship between substance use and risky sex.

Women bar drinkers' discussions about birth control and risky sexual behavior.

This study evaluated how birth control discussions prior to sexual activity affected condom use in a sample of 225 young women bar drinkers. The use of alcohol and other drugs (AOD) and partner type also were assessed. Data were collected through daily reports and qualitative interviews over 12 weeks. A total of 1671 sexual events were reported (M = 7.4 events per participant), of which 64.7% (n = 1081) did not involve condom use. Discussions of birth control occurred prior to 10.9% (n = 183) of all sexual events. These discussions were more likely to be initiated by the woman and to occur when AOD had been used. Thematic analysis revealed four common themes: confirmation of the need to use condoms, confirmation of oral/hormonal contraceptive use, use of sufficient birth control, and discrepant condom use. The discussions reduced rates of risky sex when the sexual partner was more intimate (i.e., boyfriend/dating partner), regardless of AOD use and when the sexual partner was a friend or ex-partner and no AOD were used. The thematic analysis suggested that pregnancy prevention was a stronger motivation for discussing condom use, rather than risk of contracting an STI. Given the substantial rate of high risk partners, history of STIs, and limited amount of time women reported knowing "regular" partners, we suggest that interventions designed to reduce risky sex should be tailored to increase women's awareness of STI and pregnancy risk when under the influence of AOD, and promote condom use regardless of partner type.

Daily assessment of alcohol consumption and condom use with known and casual partners among young female bar drinkers.

The relationship between alcohol and condom use has been studied extensively over the past several decades. Reviews of event-level studies suggest that alcohol's effect on risky sexual behavior are not due to simple main effects, but appear to be dependent upon individual characteristics, and situational or contextual factors. In the current study, we assessed the temporal relationship between daily alcohol consumption and unprotected sexual behavior, taking into account sexual partner type (casual or known) as well as individual and situational characteristics among a group of young female bar drinkers. Greater alcohol consumption was not associated with unprotected sex. However, greater alcohol consumption was associated with an increase in sex (protected and unprotected) with casual partners. Having less HIV knowledge was associated with increased unprotected sex, while greater frequency of drinking in bars was associated with increased protected sex with casual partners. These findings are discussed in terms of possible prevention programs that increase HIV knowledge and decrease alcohol consumption to reduce young women's risky sexual behavior.

Predictors of risky sexual behavior with new and regular partners in a sample of women bar drinkers.

OBJECTIVE: We designed the current study to assess the rates of risky sexual behavior among women bar drinkers, as well as differences in predictors of risky sexual behavior, based on partner type-new or regular. METHOD: We conducted comprehensive, in-person interviews with 241 young women who reported weekly drinking in bars. Several constructs (e.g., individual characteristics, social and sexual behavior, substance use) that we hypothesized would predict risky sexual behavior were assessed in two separate hierarchical regression models for new and regular sexual partners. RESULTS: Rates of risky sexual behavior were significantly higher with regular partners compared with new partners. Increased risky sexual behavior with new partners was significantly associated with having had a riskier regular partner in the past 6 months, lower sexually transmitted disease (STD)/pregnancy prevention assertiveness, increased expectations of sexual disinhibition when drinking, a greater history of prior sexual risk taking, and more frequent drinking in bars. Increased risky sexual behavior with a regular partner was significantly associated with being older, the use of oral contraceptives, lower assertiveness for STD/pregnancy prevention, a greater history of prior sexual risk taking, and increased drug use. CONCLUSIONS: Among young women who regularly drink in bars, sexual risk taking was significantly higher with regular partners than with new partners. The predictors of risky sexual behavior differed based on partner type. These findings have implications for including information about the role of alcohol, drinking context, and drug use, as well as individual difference characteristics and partner type in targeted prevention strategies to reduce sexual risk taking.

WOMEN'S SOCIAL BEHAVIOR WHEN MEETING NEW MEN: THE INFLUENCE OF ALCOHOL AND CHILDHOOD SEXUAL ABUSE.

Heavy alcohol consumption (Testa & Parks, 1996) and childhood sexual abuse (CSA; Messman-Moore & Long, 2003) have been associated with adult sexual victimization. We examined the social behavior of 42 women under two alcohol conditions (high dose and low dose) in a bar laboratory. Women were videotaped interacting with a man they had just met. Women in the higher dose condition engaged in more open body position and talked, stood, and walked more than women in the lower dose condition. These behaviors are consistent with signs of intoxication or romantic interest. The women in the high-dose condition also frowned more than women in the low-dose condition. An increase in frowning could indicate less comfort or may be considered consistent with an increase in animation during the social interaction given the concomitant increase in other behaviors. Thus, the nonverbal behavior of women in the high-dose condition could be interpreted as mixed signals. CSA victims exhibited fewer head movements (e.g., nods), were less animated, and frowned more than non-CSA victims. These behaviors convey reticence or possibly even anxiety or discomfort during the social interaction. Thus, the nonverbal behavior of women with a history of CSA may convey an unease that could be viewed by a potential perpetrator as vulnerability. Our findings suggest that both acute alcohol consumption and history of CSA may influence nonverbal social behavior and may influence risk for sexual assault by sending mixed cues of romantic interest or signs of vulnerability to potential perpetrators.

Factors influencing the temporal relationship between alcohol consumption and experiences with aggression among college women.

The authors assessed temporal relationships among alcohol use, aggression, and mood using daily data from 179 college women. Participants called an interactive voice response system over an 8-week period. The odds of experiencing verbal, sexual, and physical aggression (odd ratios = 2.25, 19.44, and 11.84, respectively) were significantly higher on heavy drinking days (M = 7.46 drinks) compared to nondrinking days. Both a history of victimization and greater psychological symptom severity influenced the odds of involvement in verbal aggression. The odds of alcohol consumption were 3 times higher during the 24 hr following verbal aggression compared with days in which verbal aggression did not occur. On the day immediately following involvement in either verbal or physical aggression, positive mood decreased and negative mood increased. During the week (2-7 days) following sexual aggression, women's positive mood was decreased. These findings reinforce the need for interventions aimed at reducing heavy episodic drinking on college campuses.

A dangerous transition: women's drinking and related victimization from high school to the first year at college.

OBJECTIVE: The current study assessed women's risk for victimization during the first year at college, based on changes in drinking during the transition from high school to college. We were specifically interested in differential risk for victimization based on women's change in drinking status over the transition to college. We compared continued abstainers with women who began drinking ("new" drinkers) and women who continued drinking but either decreased, increased, or did not change their level of weekly drinking. METHOD: Data were collected using a Web-based survey each fall for the first 2 years at college with one cohort (N = 886) of incoming freshmen women at a large state university in New York. Women reported on their alcohol and other drug use, psychological symptoms, number of sexual partners, and experiences with physical and sexual victimization for the year before entering college (Year 1 survey) and for the first year at college (Year 2 survey). RESULTS: Abstainers were significantly less likely to experience physical or sexual victimization during the first year at college, compared with drinkers. Logistic regression indicated that there were differences in the predictors of physical and sexual victimization during the first year at college. These differences included history of victimization, psychological symptoms, and number of sexual partners, as well as the type of change in drinking over the transition. CONCLUSIONS: In comparison with abstainers, having a history of physical victimization, greater psychological symptoms, and being a "new" drinker increased the odds of physical victimization, whereas having a greater number of current psychological symptoms, sexual partners, and increasing weekly drinking increased the odds of sexual victimization during the first year at college. These findings have implications for prevention efforts targeting young women entering college.

Collecting data on alcohol use and alcohol-related victimization: a comparison of telephone and Web-based survey methods.

OBJECTIVE: Traditionally, personal contact with an experienced interviewer has been thought to facilitate collection of data on alcohol use and victimization experiences. Recent studies indicate that Web-based surveys may be an efficient alternative for gathering these sensitive data. To date, telephone interviewing and Web-based collection of data on alcohol-related negative consequences, particularly victimization, have not been compared. This study was designed to compare data from an interviewer-administered and Web-based survey on alcohol use and alcohol-related negative consequences in a sample of college women. METHOD: Seven hundred women from a second semester freshmen college class were randomly selected to participate in either the telephone interview or Web-based modes of survey administration. RESULTS: Fifty-three percent of invited women (N = 370) completed the survey. Completion rates were higher, and estimated dollar costs were significantly lower, for the Web-based survey. There were no differences in reported rates of alcohol or drug use by survey method; however, there were differences in several specific alcohol-related negative consequences. CONCLUSIONS: These findings suggest that, for college women, Web-based surveys versus telephone interviews can be an effective and more cost-efficient means for collecting data on alcohol use and related negative consequences, particularly victimization. In addition, we found some evidence that women may be more forthcoming when responding to a Web-based survey as compared with an interviewer-administered telephone survey.