Reducing Alcohol-Related Sexual Risk Behavior

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Abstract Despite increased attention to heavy episodic drinking (HED) and sexually aggressive behavior (SAB), high rates persist, and existing prevention programs are minimally effective. Programs that simultaneously target HED and SAB may be more effective as most sexual assaults occur when the perpetrator, victim, or both have been drinking. Such programs have shown some promise in college women but only one small open trial (n = 20) has been conducted with college men. Risky sexual behaviors (RSB) are also highly comorbid with HED and SAB. Although prevention programs targeting HED and RSB have demonstrated reductions in both behaviors, the proposed study will be the first to test the efficacy of an integrative prevention program that simultaneously targets SAB, HED, and RSB. The proposed study also breaks new ground by incorporating skills training derived from cutting-edge cognitive science methods. Our prior research shows that men at higher risk for SAB demonstrate performance-based deficits in perceptions of women’s sexual interest, and our preliminary data provide evidence for the efficacy of cognitive training, in which men receive trial-by-trial and block-by-block feedback on their ability to process cues relevant to women’s sexual interest. Incorporation of a cognitive training component may increase the efficacy of prevention approaches for SAB, which have typically focused on awareness or education rather than skill development. Personalized feedback approaches represent one of the most effective prevention approaches for HED and similar approaches have shown promise in addressing risk for SAB. By combining personalized feedback and cognitive skills training approaches, it is possible to target the key modifiable risk factors for SAB, including misperceptions of sexual interest, rape supportive attitudes, peer influence, HED, and RSB. To our knowledge, the proposed study will be the first to integrate personalized feedback and cognitive skills-training approaches to reduce men’s risk of perpetrating SAB. The proposed study will include three phases and involve a total of 190 sexually active and heavy drinking college men. Phase I will examine feasibility (n = 10), and Phase II will be an open trial (n = 40) examining the acceptability and efficacy of intervention components. Outcome and qualitative data from interviews in Phase II will be used to refine and streamline the intervention. Phase III will be a small (n = 140) randomized controlled trial (RCT) comparing this novel computer-administered program to services as usual (SAU). The prevention program will include two computer-administered sessions (60-90 minutes each) integrating personalized feedback and cognitive-training approaches. We hypothesize that, relative to SAU, the prevention program will lead to changes in personalized feedback and cognitive training targets (e.g., readiness to change and cognitive skills) and less engagement in and attitudes supportive of HED, SAB, and RSB. Findings of this preliminary study will support a larger clinical trial of a fully web-based program, an approach that could easily be implemented on a broad scale and is likely to be well received by young adults.