The Effects of Childhood Sexual Abuse, Mental Health, and Motives for Sex on Sexual Risk-Taking Among United States Men Who Have Sex with Women.

This study assessed the role of mental health symptoms and motives for sex in the association between childhood sexual abuse (CSA) and sexual risk-taking among men who have sex with women (MSW). The sample consisted of young adult (ages 21 to 30), non-monogamous MSW (N = 532) who reported having condomless sex at least once in the past year. Due to alcohol-related aims from two larger studies from which the data were analyzed, participation was excluded to men who regularly consumed alcohol (3 to 35 weekly drinks) and reported no symptoms of alcohol use disorder. Participants answered background questionnaires in lab and then completed a six-week, follow-up survey assessing the number of sex partners and condom use during the prior six weeks. CSA survivors reported greater mental health symptoms and sex motives related to coping, self-affirmation, and partner approval relative to non-survivors. CSA, sex for partner approval, and sex to enhance motives were positively associated with the number of sex partners. Participants endorsing self-affirmation sex motives reported higher condom use than those who did not. CSA contributes to long-term mental and sexual health outcomes among MSW. Identifying and treating depressive and anxiety symptoms and motives for sex may improve sexual health among CSA survivors.

Young men's condom use resistance tactics: a latent profile analysis.

Research suggests that many men have used a variety of tactics to avoid using condoms when having sex with women. Guided by previous work demonstrating that men's use of coercive condom resistance tactics was predicted by negative attitudes toward women, inconsistent condom use, multiple partners, and sexual sensation seeking, the current study used latent profile analysis (LPA) to determine whether similar constructs were associated with a variety of resistance tactics. A community sample of 313 moderate-drinking men participated, of whom 80% reported employing at least one condom use resistance tactic since adolescence. The LPA revealed three classes of men. In general, men with the least negative beliefs about women, low levels of sexual sensation seeking and impulsivity, and positive beliefs about condoms (Condom Positive/Low Hostility) reported less use of resistance tactics than men with moderate sexual sensation seeking and impulsivity, negative beliefs about condoms, and moderate (Condom Negative/Moderate Hostility) or high (Condom Negative/High Hostility) negative attitudes about women. The classes also differed in terms of their sexual behaviors. This study demonstrated that sexual risk behavior interventions should not only address the tactics through which men resist using condoms but also tailor these efforts to men's individual characteristics.

A qualitative examination of men's condom use attitudes and resistance: "it's just part of the game".

The purpose of this study was to investigate the variability in young heterosexual men's perceptions of the advantages and disadvantages of condom use in their casual sexual relationships. Because men who perceive greater disadvantages of condom use may be more likely to resist using them, we also explored the tactics that men employ to avoid using condoms. Semi-structured focus groups were conducted with single men who have sex with women (n = 60), aged 21-35 years, all of whom reported using condoms inconsistently. Transcripts were analyzed using a framework analysis approach. As expected, participants reported advantages and disadvantages to condom use that pertained to the likelihood and quality of sex, physical sensations during intercourse, and the risk of sexually transmitted infections and unwanted pregnancies. Within each of these topics, however, participants' appraisals of the relative pros and cons of condom use varied considerably. Additionally, participants reported that men use a wide range of condom use resistance tactics, including seduction, deception, and condom sabotage, and that the use of these tactics was viewed as normative behavior for men their age. These findings suggest that the effectiveness of sexual health prevention efforts could be enhanced by increasing young men's motivations to use condoms and by targeting social norms regarding condom use resistance. Additionally, the issue of men's condom use resistance clearly merits increased empirical investigation and intervention attention.

Childhood Sexual Abuse and Acute Alcohol Effects on Men's Sexual Aggression Intentions.

OBJECTIVE: Although research has established childhood sexual abuse (CSA) as a risk factor for men's perpetration of sexual aggression, there has been little investigation of the factors undergirding this association. This study represents one of the first to use a laboratory-based sexual aggression analogue coupled with an alcohol administration protocol to investigate the pathways through which CSA and alcohol influence men's self-reported sexual aggression intentions. METHOD: After completing background questionnaires, male social drinkers (N = 220) were randomly assigned to a control, placebo, low alcohol dose or high alcohol dose condition. Following beverage consumption, participants read a sexual scenario in which the female partner refused to have unprotected sexual intercourse, after which they completed dependent measures. RESULTS: Path analysis indicated that men with a CSA history and intoxicated men perceived the female character as more sexually aroused and reported stronger sexual entitlement cognitions, both of which were in turn associated with greater condom use resistance and higher sexual aggression intentions. Exploratory analyses revealed that intoxication moderated the effects of CSA history on sexual entitlement cognitions, such that sexual entitlement cognitions were highest for men who had a CSA history and consumed alcohol. CONCLUSIONS: Findings suggest that CSA history may facilitate sexual assault perpetration through its effects on in-the-moment cognitions, and that these effects may be exacerbated by alcohol intoxication.

Men's alcohol intoxication and condom use during sexual assault perpetration.

We assessed the association between alcohol consumption and condom use during penetrative sexual assault acts perpetrated by young adult men. Men aged 21 to 35 who reported inconsistent condom use and heavy episodic drinking (N = 225) completed a questionnaire assessing their perpetration of sexual assault since the age of 15, their consumption of alcohol prior to these acts, and their use of condoms during acts involving penetration. Descriptive statistics and Pearson's chi-square tests were used to examine the simultaneous use of alcohol and condom nonuse during penetrative sexual assault acts. More than one third of respondents reported perpetrating at least one penetrative sexual assault 35.6% (n = 79). Condoms were not used in 70.0% of penetrative sexual assaults. When they had consumed alcohol, perpetrators were significantly less likely to use condoms. The sexual assaults reported by this sample typically consisted of perpetrator alcohol consumption and the nonuse of condoms. Programs targeting sexual health and assault risk reduction would be enhanced by addressing this interplay of alcohol, violence, and risk.

Childhood sexual abuse in males and subsequent risky sexual behavior: a potential alcohol-use pathway.

OBJECTIVE: Childhood sexual abuse (CSA) among boys has been associated with a variety of subsequent maladaptive behaviors. This study explored a potential connection between CSA and an increased likelihood of risky sexual behavior in adulthood. Further, the study examined whether or not alcohol use may contribute to this relationship. METHOD: As part of a study on alcohol and sexual decision-making, 280 heterosexual men completed multiple background questionnaires pertaining to past and current sexual experiences and patterns of alcohol use. CSA history was obtained and severity ratings were made based on type of contact reported. RESULTS: CSA was reported by 56 men (20%). Structural equation modeling revealed that CSA positively predicted number of sexual partners directly as well as indirectly, through its effect on alcohol use. Specifically, greater CSA severity predicted significantly lower age of first intoxication, which in turn predicted greater current alcohol consumption, followed by greater use of alcohol before sexual intercourse, leading to an increased number of reported sexual partners. The reported frequency of condom use was not predicted by CSA severity or the alcohol-use pathway. CONCLUSIONS: These findings suggest that CSA influences risky sexual behavior via multiple pathways and that more severe CSA may lead to elevated sexual risk indices. Moreover, these results suggest that men may elevate their risk of sexually transmitted infections via high numbers of sexual partners versus irregular condom use. PRACTICAL IMPLICATIONS: These results highlight the need for adequate assessment and early interventions in order to mitigate the effects CSA may have on subsequent alcohol use and risky sexual behavior. Secondly, ensuring that male CSA victims understand the inherent risks of high numbers of sexual partners may be an effective strategy to interrupt the path toward risk-taking.

Unmet need for mental health and addictions care in urban community health clinics: frontline provider accounts.

OBJECTIVE: To facilitate planning to improve care delivery in community health clinics, this study provides an in-depth description of the social, cultural, and organizational factors that create the context for mental health and addictions treatment delivery in this setting. METHODS: Seventeen community health clinic providers and personnel were interviewed for 45-90 minutes with open-ended questions to elicit the context of their frontline provider experiences. Major themes and subthemes of responses were identified with content analysis. RESULTS: Issues that create significant barriers to care included complex patient comorbidity and demographic characteristics; clinic organization, resources, and funding shortfalls; communication barriers with specialty mental health and addictions agencies; and stigmatizing aspects of mental health, addictions, and disadvantaged status. CONCLUSIONS: The unique barriers to care in the community health care setting, as well as the unique characteristics of patients served, are likely to require context-specific solutions. These solutions will determine the viability of existing chronic disease management models, such as collaborative care, when applied to this setting.

Later that night: descending alcohol intoxication and men's sexual arousal.

UNLABELLED: Although men often have sex when intoxicated, basic questions remain about how alcohol affects erection. It may depend on whether blood alcohol level is ascending or descending and whether the situation calls for maximizing or suppressing erection. OBJECTIVE: To evaluate whether descending intoxication affects erection when men are instructed to maximize or suppress arousal. METHOD: Seventy-eight heterosexual men were randomized to intoxication (descending from .08% vs. no alcohol) and arousal instruction (maximize vs. suppress) conditions. Response to erotica was examined using penile plethysmography. RESULTS: Compared to similarly instructed sober men, intoxicated men instructed to maximize exhibited less erection yet reported greater effort to maximize. Interestingly, intoxicated men instructed to suppress exhibited more erection than those instructed to maximize. In general, however, observed effects were modest. CONCLUSIONS: Findings suggest there is no simple answer regarding how alcohol affects sexual arousal. Descending intoxication, depending on context, appears to affect erection capacity and control.

The use of alcohol and condoms during sexual assault.

Sexual assault remains an important public health issue due to the violence involved as well as the potential for health risks such as sexually transmitted infections. Alcohol has been associated with both violent and risky sexual behavior. This study assessed the frequency of sexual assault perpetration, alcohol use, and condom use during sexual assault in a community sample of young, heterosexual male social drinkers. Participants completed measures of their sexual assault perpetration. More than 50% reported sexual assault perpetration; 60% of these reported repeat perpetration. Almost one half of perpetrators reported alcohol consumption prior to every sexual assault incident. Never having used a condom during penetrative sexually aggressive acts was reported by 41.2% of perpetrators. Alcohol use and condom nonuse were positively correlated for acts of forcible rape. Findings provide information about the infrequent use of condoms during sexual assault incidents and support prior evidence of the association between alcohol and sexual assault.

Does occasional cannabis use impact anxiety and depression treatment outcomes?: Results from a randomized effectiveness trial.

This study investigated the extent to which occasional cannabis use moderated anxiety and depression outcomes in the Collaborative Care for Anxiety and Panic (CCAP) study, a combined cognitive-behavioral therapy (CBT) and pharmacotherapy randomized effectiveness trial. Participants were 232 adults from six university-based primary care outpatient clinics in three West Coast cities randomized to receive either the CCAP intervention or the usual care condition. Results showed significant (P<.01) evidence of an interaction between treatment group (CCAP vs. usual care) and cannabis use status (monthly vs. less than monthly) for depressive symptoms, but not for panic disorder or social phobia symptoms (all P>.05). Monthly cannabis users' depressive symptoms improved in the CCAP intervention just as much as those who used cannabis less than monthly, whereas monthly users receiving usual care had significantly more depressive symptoms than those using less than monthly. A combined CBT and medication treatment intervention may be a promising approach for the treatment of depression among occasional cannabis users.

Treating minority patients with depression and anxiety: what does the evidence tell us?

OBJECTIVE: The purpose of this study is to examine the current state of knowledge regarding treating ethnic/racial minority patients with mood and anxiety disorders, emphasizing data-based studies whenever possible. METHOD: This article reviews the evidence on poorer access and quality of care for minorities, the biological and cultural differences between minority and majority populations that may impact care and outcomes, and recent studies that address minority treatment response and outcomes both alone and in comparison to majority groups. RESULTS: Numerous impediments to appropriately treating anxious and depressed minority patients remain. Underutilization and poor quality of mental health care in minorities is due to less-than-favorable illness and treatment beliefs that affect adherence and outcome, stigma, clinician failure to engage the patient, poor patient activation and biological differences that may impact pharmacotherapy choice. However, though limited in number, some studies do indicate that when appropriate treatment is well-delivered to minorities, results are comparable to those seen among Caucasian patients. CONCLUSIONS: The clinician treating members of minority groups must consider differential personal elements, from the biological to the cultural, to achieve treatment success. The limited available data do suggest that minority patients can be successfully treated with available interventions. Of primary importance is for researchers to increase the number of carefully designed intervention studies that allow for ethnic/racial minority-specific analyses.

Understanding and treating panic disorder in the primary care setting.

According to studies, the median prevalence of panic disorder in the primary care setting is 4%. Rates are higher among certain patient populations, such as those with cardiac (20% to 50%) or gastrointestinal presentations (28% to 40%). Consequently, patients with panic disorder are high utilizers of medical services and are heavily represented among patients classified as high health care utilizers, compared with other psychiatric or non-psychiatric groups. Despite its frequency in the primary care setting, panic disorder is significantly under-recognized by medical providers. Corresponding with inadequate recognition is the substantial proportion of these patients who fail to receive appropriate treatment (pharmacotherapy and psychotherapy). Most experts have concluded that panic disorder is poorly managed in the primary care setting because of the process of care and patient engagement. In terms of process of care, primary care practice still operates on an acute disease model (leaving no time for initial patient education or follow-up), which is a poor fit for the management of chronic diseases. Insufficient patient engagement in treatment (i.e., being involved in the treatment process, "buying into" rationale for treatment, and being willing to collaborate with clinician and adhere to recommendations) is the second important contributor to inadequate treatment. Use of a chronic disease self-management approach would enhance treatment of panic disorder. This model requires that patients, in collaboration with the health care provider/system, take day-to-day responsibility for managing their illness by doing 3 things: adhering to recommended medical management, adopting improved health habits/coping skills, and assisting in ongoing monitoring of illness status/change. Future approaches to treating panic disorder in primary care would be enhanced by including assessments of patient beliefs and preferences, spending more time in preparing the patient for treatment, utilizing a simple pharmacotherapy algorithm, utilizing simple rating scales to monitor outcomes, and training providers in brief CBT interventions.