Objective: Sexual aggression remains a significant public health problem, with the majority of sexual assaults involving alcohol. Founded upon an experimental medicine approach to behavior change, the current study used a proximal change experiment to target and test emotion regulation (ER) as a mechanism underlying alcohol-involved sexual aggression. Method: Heavy episodic drinking men aged 21–30 with a sexual assault perpetration history (N = 209) were randomly assigned to a brief, online, ER-focused cognitive restructuring or mindfulness intervention or to control. Intervention effects were evaluated during sober and intoxicated states through laboratory-based alcohol administration (target BrAC = .08%). Intoxicated and sober participants completed a proximal change protocol that included implementing ER skills during a sexual aggression analogue that assessed relevant emotions and intentions. Results: Path analysis demonstrated that relative to control, the cognitive restructuring intervention improved emotional modulation and emotional clarity, resulting in lower sexual arousal and anger, respectively, followed by decreased sexual coercion intentions. The mindfulness intervention yielded mixed results, predicting decreased sexual aggression intentions compared to control but also predicting stronger coercive tactic intentions in intoxicated men with more severe sexual aggression histories. Both interventions improved emotional acceptance relative to control, but only for sober men. Conclusions: Overall, the current study demonstrated that ER-focused interventions improved proximal ER skills associated with reduced sexual aggression intentions, signifying ER as an important mechanism for changing sexually aggressive behavior. Because intervention efficacy varied by intoxication state, further research is needed to assess the effectiveness of ER interventions targeting real-world alcohol-involved sexual aggression.

Objective: Despite condoms' effectiveness at preventing sexually transmitted infections (STIs) and unplanned pregnancy, coercive condom use resistance (CUR; i.e., using coercive tactics to resist condom use with a partner who wants to use one) is relatively common. However, research has not examined how risk factors, including alcohol use, alcohol expectancies related to sexual coercion, and sensation seeking, may interact to predict coercive CUR. The present study used an alcohol administration experiment to assess sensation seeking and alcohol expectancies as moderators of the relationship between acute alcohol intoxication and intentions to perpetrate coercive CUR during a hypothetical scenario. Method: Single, young, heterosexual men (N = 313) were randomly assigned to a control, placebo, low (BrAC = .04%), or high dose alcohol condition (BrAC = .08%). Participants then read and projected themselves into a sexually explicit stimulus story and indicated the likelihood that they would perpetrate coercive CUR. Results: Findings indicated that intoxication interacted with expectancies and sensation seeking to predict coercive CUR intentions, such that alcohol intoxication was associated with greater coercive CUR intentions only among participants who reported greater sensation seeking and stronger alcohol expectancies. Conclusions: Both alcohol expectancies and myopia play a key role in coercive CUR intentions, especially among sensation seeking individuals. Thus, intervention programs should evaluate men's alcohol use, alcohol expectancies, and sensation seeking behaviors as possible targets to reduce the perpetration of coercive CUR. Public Health Significance StatementThis study found that alcohol intoxication increases young men's intentions to use coercion to resist condom use when those men also engage in more sensation seeking behaviors and expect that alcohol will make them behave in a more sexually coercive manner.

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Although condoms are effective at preventing sexually transmitted infections (STIs) and unwanted pregnancies, condom use resistance (CUR) remains prominent. In particular, coercive CUR, or the use of coercive tactics to resist condom use with a partner who wants to use one, comprises a unique combination of sexual aggression and risky sexual behaviors, making it especially problematic. The present study sought to examine the relationship between coercive CUR and a variety of factors associated with both sexual aggression and risky sexual behaviors (e.g., typical alcohol consumption, alcohol expectancies regarding sexual aggression, and sensation seeking) to determine whether such factors may also contribute to the etiology of coercive CUR. To do so, a nationwide study of 102 young, heterosexual men who had previously perpetrated coercive CUR were recruited to complete an online, cross-sectional survey. Data were analyzed using a hierarchical linear regression model, which showed that alcohol expectancies regarding sexual coercion and sensation seeking moderated the relationship between typical drinking quantity and previous coercive CUR perpetration, such that typical drinking was positively associated with coercive CUR among men who reported greater sensation seeking and alcohol expectancies regarding sexual coercion. However, among men who were low in one or both of these factors, typical drinking was not associated with coercive CUR. These results suggest that typical drinking, alcohol expectancies, and sensation seeking may all be important to the etiology of coercive CUR, and that a reduction in one or more may be sufficient to reduce the likelihood of coercive CUR perpetration. Future research should confirm these findings using experimental and/or longitudinal methodologies and seek to develop intervention programs targeting typical alcohol use, alcohol expectancies related to sexual coercion, and sensation seeking in young men.

Nonconsensual condom removal (NCCR) is a form of sexual violence that a significant minority of men use to obtain unprotected sex. Experiencing NCCR is associated with serious physical and mental health consequences, such as sexually transmitted infections, unplanned pregnancies, anxiety, and depression. Alcohol use is known to be associated with sexual violence in general; however, limited research has been done on the association between alcohol-related factors and NCCR specifically. Thus, the present study examined the associations between event-level drinking, daily drinking, drinking motives, alcohol expectancies, and NCCR. Young, single, heterosexually active men ( N = 96) completed cross-sectional measures of their NCCR behavior, event-level drinking, drinking motives, and alcohol expectancies. A total of 19 (19.8%) participants reported successfully engaging in NCCR at least once since age 14. Results showed that consuming more alcohol during the event, having more highly intoxicated partners, drinking to enhance sex, and holding more negative alcohol expectancies were associated with increased likelihood of NCCR. To effectively decrease the rates of NCCR, prevention efforts could aim to decrease event-level alcohol consumption for both men and their partners and to challenge men’s beliefs regarding alcohol’s role in sexual behavior. Given the current study’s limitations, future studies should consider employing an ecological momentary assessment design to avoid recall bias and include more diverse samples to increase the generalizability of findings.