J. DRUG EDUCATION, Vol. 43(4) 365-383, 2013

ALCOHOL CONSUMPTION AND NEGATIVE SEX-RELATED CONSEQUENCES AMONG COLLEGE WOMEN: THE MODERATING ROLE OF ALCOHOL PROTECTIVE BEHAVIORAL STRATEGIES

KAYLA D. MOORER, M.A. MICHAEL B. MADSON, PH.D. RICHARD S. MOHN, PH.D. BONNIE C. NICHOLSON, PH.D. The University of Southern Mississippi

ABSTRACT

Alcohol protective behavioral strategies (PBS) limit overall negative consequences; however, less is known about the relationship between PBS and negative sex-related consequences. The purpose of the current study was to examine the moderating effects of 2 distinct types of PBS—controlled consumption strategies and serious harm reduction strategies—on the relationship between alcohol consumption and alcohol-related risky sexual behavior and sexual victimization. Participants were 459 undergraduate women (ages 18-25) who had consumed alcohol within the past 30 days. Both types of PBS significantly qualified the alcohol-sexual victimization link, but neither type of PBS qualified the alcohol-risky sexual behavior link.

Increasing attention has focused on the rise in alcohol consumption among college women with recent findings indicating that women exceeded the National Institute on Alcohol Abuse and Alcoholism (NIAAA) weekly guidelines for safe drinking

365 Ó 2013, Baywood Publishing Co., Inc. doi: http://dx.doi.org/10.2190/DE.43.4.e http://baywood.com

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more frequently than men (Hoeppner, Paskausky, Jackson, & Barnett, 2013). Additionally, Johnston, O’Malley, Bachman, and Schulenberg (2013) found that 37% of college women report getting drunk at least once within the past month, and that nearly 10% report having 10 or more drinks in a row within the past 2 weeks. Associated with increased alcohol consumption among college women are increases in negative consequences (Hingson, Edwards, Heeren, & Rosenbloom, 2009; Norberg, Olivier, Alperstein, Zvolensky & Norton, 2011; Perkins, 2002), and negative sex-related consequences are among the most prevalent consequences experienced by college women (Abbey, Ross, & McDuffie, 1996; Smith & Berger, 2010). Examples of negative sex-related consequences include engaging in risky sexual behavior (e.g., having unprotected sex, having multiple or casual sexual partners) or experiencing sexual victimization (e.g., being verbally or physically coerced, threatened, or forced to engage in sexual activity) after consuming alcohol (Messman-Moore, Ward, & DeNardi, 2013; Sugarman, DeMartini, & Carey, 2009). Alcohol consumption is typically associated with greater levels of sexual activity, and the combination of alcohol and sex is associated with numerous risks for college women. For instance, college students who consume alcohol are more likely to engage in unprotected sex and to have sex with someone they would not ordinarily have sex with (i.e., casual sex) than are students who do not consume alcohol (Lewis, Granato, Blayney, Lostutter, & Kilmer, 2012; Patrick & Maggs, 2009; Patrick, O’Malley, Johnston, Terry-McElrtah, & Schulenber, 2012). In fact, nearly 10% of all college students report having had unprotected sex as a result of drinking alcohol at least once in the past academic year (Hingson, Heeren, Winter, & Wechsler, 2005), and college women are more likely to regret sexual behavior because they felt pressured by their partner (Oswalt, Cameron, & Koob, 2005). In addition to the increased likelihood of engaging in risky sexual behavior, Corbin, Bernat, Calhoun, McNair, and Seals (2001) highlight that prevalence rates of sexual victimization are three times higher for college women than they are for their same aged non-college peers, and each year an estimated 97,000 college students are victims of alcohol-involved sexual assault (Hingson & Zha, 2009; NIAAA, 2013). Overall, research has implicated alcohol consumption as a major risk factor for negative sex-related consequences, and alcohol-related risky sexual behavior and sexual victimization can lead to long-term consequences for college women. College women are biologically more vulnerable than college men are to the consequences of unprotected sex such as unplanned pregnancy or contracting sexually transmitted infections and diseases (CDC, 2011). The CDC estimates that there are approximately 20 million new sexually transmitted infections occurring each year in the United States, and that females ages 15 to 24 are most at risk, accounting for nearly half of all new sexually transmitted infections (CDC, 2013). During 2012, Chlamydia rates for females ages 15 to 24 were higher than the rates observed in any other age group (CDC, 2013). Additionally, the American College

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Health Association (ACHA) estimated that approximately 2.5% of college women reported having become unintentionally pregnant within the past academic year (ACHA, 2011). Sexually transmitted diseases and unintended pregnancies can inevitably change the lives of college women by creating increased risk of cervical cancer, increased susceptibility to HIV, and unexpected financial responsibilities (CDC, 2012, 2013). College women who report a history of negative sex-related consequences associated with their drinking are more likely than those who do not to also report increased levels of drinking (Bedard-Gilligan, Kaysen, Desai, & Lee, 2011), poorer mental health, and less use of protective drinking behaviors (Brahms, Ahl, Reed, & Amaro, 2011). This is particularly concerning because once a woman has been sexually victimized, a vicious cycle of revictimization exists (Abbey et al., 1996; Corbin et al., 2001), and the risk of revictimization is further exacerbated when a women engages in high-risk behaviors such as consuming alcohol. Researchers have examined proximal predictors of the alcohol consumption— negative sex-related consequences link (e.g., alcohol expectancies (BedardGilligan et al., 2011; Corbin et al., 2001); and drinking motives (Lindgren, Neighbors, Blayney, Mullins, & Kaysen, 2012);—however, there is still much to learn about the impact of college women’s use of safe drinking practices on the link between alcohol consumption and negative sex-related consequences (e.g., engaging in risky sexual behavior, experiencing sexual victimization). While prevention efforts aimed at reducing sexual victimization among college women have proven successful for women who report no previous experience of sexual victimization, prevention efforts have failed to curtail sexual victimization for women who have a previous history of sexual assault (Corbin et al., 2001). It may be that individual drinking practices influence the success of these prevention efforts and, therefore, it is critical to elucidate the role safe drinking practices may play in reducing the occurrence of alcohol-related risky sexual behavior and sexual victimization among college women. It is plausible that alcohol-specific self-regulatory behaviors (i.e., PBS) could be taught to women with (and without) a history of sexual victimization in an effort to interrupt or prevent the vicious cycle of revictimization. However, currently the research examining safe drinking practices and negative sex-related consequences is scarce. For these reasons, the purpose of this study was to evaluate the moderating effect of alcohol protective behavioral strategies (PBS) on the alcohol consumption–sex-related consequences link. Alcohol protective behavioral strategies (PBS) were advanced in an effort to decrease alcohol-related negative consequences, as they are active strategies that individuals can control (Martens, Taylor, Damann, Page, Mowry, & Cimini, 2004). Stemming from a harm-reduction approach, previous research has supported the use of PBS strategies in college students to limit both alcohol consumption and alcohol-related negative consequences (Borden, Martens, McBride, Sheline, Bloch,. & Dude, 2011; LaBrie, Lac, Kenney, & Mirza, 2011; Madson &

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Zeigler-Hill, 2013; Zeigler-Hill, Madson & Ricedorf, 2012). However, the majority of these studies have looked at overall negative consequences without independently examining the specific types of consequences, and in some cases only a single item assessed sexual consequences (Delva, Smith, Howell, Harrison, Wilke, & Jackson, 2004; Haines, Barker, & Rice, 2006; LaBrie, Kenney, Lac, Garcia, & Ferraiolo, 2009). Lewis, Rees, Logan, Kaysen, and Kilmer (2010) examined the relationship of alcohol consumption, use of PBS, and consensual sex-related consequences among college students and found that college women who reported using PBS while drinking also reported fewer consensual sex-related consequences. This work represented an important step in better understanding the role of PBS in linking alcohol consumption and sex-related consequences. Because each year over 100,000 college students report being too intoxicated to remember consenting to sex (NIAAA, 2013), it is important to also examine the role of PBS outside the context of consensual sexual experiences. Further, prevention efforts would benefit from identifying what specific types of strategies might qualify the relationship between alcohol consumption and risky sexual behavior and sexual victimization; however, these links are not currently known. At least three randomized controlled trials with college students support the use of PBS as a mechanism of change in alcohol use and related outcomes (for a review see Pearson, 2013), and the value of PBS in moderating the link between alcohol consumption and negative consequences has been well established. For instance, Benton et al. (2004) found that increased alcohol consumption most strongly predicted negative consequences for individuals who used the fewest PBS, and Borden et al. (2011) found that the link between binge drinking and alcohol-related problems was stronger for students who used the fewest PBS. Additionally, there is evidence to suggest that PBS may be most effective at reducing negative consequences for college students with lower levels of selfregulation, as PBS are considered drinking specific self-regulatory behaviors (D’Lima, Pearson, & Kelley, 2012). Closely related to low self-regulation, women with a history of sexual victimization have demonstrated high levels of cognitive emotion dysregulation, which can promote sexual compliance through decreased sexual assertiveness (Zerubavel & Messman-Moore, 2013). Given that PBS appear to be particularly useful for the “impaired” (D’Lima et al., 2012), it seems that college women with a history of sexual victimization may benefit most from the use of PBS. More recently, PBS research has focused on uncovering the differential effects of PBS on alcohol consumption and alcohol-related negative consequences depending on the type of strategies used (Martens, Martin, Littlefield, Murphy, & Cimini, 2011; Pearson, D’Lima, & Kelley, 2013; Prince, Carey, & Maisto, 2013). There is mounting evidence for two distinct types of PBS—strategies that are directly related to controlling or limiting consumption, and strategies that are indirectly related to consumption and aimed at reducing serious harm (DeMartini,

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Palmer, Leeman, Corbin, Toll, Fucito, et al., 2013; Madson, Arnau, & Lambert, 2013; Pearson, 2013). In light of these findings, the current study sought to extend the role of PBS in the association between alcohol consumption and negative sex-related consequences by examining that the degree to which different types of PBS—controlled consumption and serious harm reduction strategies— would differentially qualify the associations between alcohol consumption and risky sexual behavior and between alcohol consumption and sexual victimization. Accordingly, we independently assessed whether controlled consumption strategies and serious harm reduction strategies would moderate the associations between alcohol consumption and alcohol-related risky sexual behavior, and between alcohol consumption and alcohol-related sexual victimization. We anticipated that serious harm reduction strategies would significantly moderate the relationships between alcohol consumption and both alcohol-related risky sexual behavior and sexual victimization. Our rationale for this hypothesis is threefold. First, college women who regularly consume alcohol (i.e., monthly) tend to rely more on serious harm reduction strategies than any other type of protective behavioral strategy (Benton et al., 2004; Madson & Zeigler-Hill, 2013). Next, the nature of serious harm reduction strategies (e.g., going home with a friend, knowing where your drink is at all times) appear to be imperative for reducing the likelihood of negative sex-related consequences. Finally, controlled consumption strategies may be ineffective in reducing alcohol-related harm (Frank, Thake, & Davis, 2012; Martens et al., 2011); therefore, we anticipated that controlled consumption strategies would not significantly moderate the relationships between alcohol consumption and alcohol-related risky sexual behavior and sexual coercion/ victimization.

METHOD

Participants and Procedures Participants for this study were 495 traditional age (18-25) undergraduate female drinkers from a mid-sized southern university recruited through class credit opportunities. After completing an online informed consent, participants completed the study questionnaires. In order to control for fatigue effects, all measures were accessed online using a secure website that automatically randomized the presentation order of measures. To qualify for participation, participants must have been between the ages of 18 and 25 and reported drinking alcohol in the past 30 days. The majority of participants identified as White, Non-Hispanic (54%), or African American (42%). The average age was 19.83 (SD = 1.67), and 43% were classified as freshmen, 24% as sophomore, 22% as junior, and 11% as senior.

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Measures Alcohol Consumption

The Daily Drinking Questionnaire (DDQ; Collins, Parks, & Marlatt, 1985) was used to measure alcohol consumption. Participants estimated how many standard alcoholic drinks they consume on each day of a typical week. Total drinks per week were calculated by summing each amount reported for a typical week. Reliability of the DDQ has been supported by evidence that self-report measures are accurate depictions of alcohol consumption (Sobell & Sobell, 1995). Convergent validity has been established by comparing results from the DDQ to results from the Drinking Practices Questionnaire (DPQ; Cahalan, Cisin, & Crossley, 1969). Alcohol-Related Risky Sexual Behavior

Following the procedure outlined by Lewis et al. (2010), four questions from the Young Adult Alcohol Problems Screening Test (YAAPST; Hurlbut & Sher, 1992) were used to assess engagement in risky sexual behavior resulting from alcohol consumption. Items were: “Has drinking ever gotten you into sexual situations which you later regretted,” “because you had been drinking, have you ever had sex when you really didn’t want to,” “because you had been drinking, have you ever had sex with someone you wouldn’t ordinarily have sex with,” and “because you have been drinking, have you neglected to use birth control or neglected to protect yourself from sexually transmitted diseases?” Participants respond using a 4-point Likert-type scale that ranges from 0 (No, Never) to 4 (3 or more times in the past 3 months). Higher scores indicate more frequent engagement in risky sexual behavior following the consumption of alcohol. Internal consistency among the current sample was adequate (“ = .82). Alcohol-Related Sexual Victimization

The Sexual Experiences Survey (SES; Koss & Oros, 1982) contains 12 yes-no questions that assessed various levels of sexual victimization (e.g., verbal and/or physical coercion, threat, or force) occurring within the past year. In order to include only alcohol-related sexual victimization, both the instructions and items were modified. Modified example items include: “As a result of consuming alcohol, have you ever had a man misinterpret the level of sexual intimacy you desired” and “as a result of consuming alcohol, have you ever had sexual intercourse with a man when you didn’t want to because he used some degree of physical force (twisting your arm, holding you down, etc.)?” Total scores can range from 0 to 12, with higher scores indicating more experiences of alcoholrelated sexual victimization, but not necessarily more severe, or more aggressive experiences. Internal consistency among the current sample was good (a = .91).

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Protective Behavioral Strategies

The Protective Behavioral Strategies Scale-Revised (PBSS-R; Madson, Arnau, & Lambert, 2013) was used to assess participants’ use of protective strategies while drinking alcohol. The PBSS-R is an 18-item, self-report questionnaire. All items are scored on a 6-point Likert-type scale that ranges from 1 (Never) to 6 (Always), and item responses are added to obtain a total and two subscale scores (controlled consumption, CC, and serious harm reduction, SHR). Participants responded to various behaviors by indicating how often they engage in the said behavior. There are 12 items that assess the controlled consumption subscale (e.g., “determine not to exceed a set number of drinks” and “drink slowly, rather than gulp or chug”), and 6 items that assess the serious harm reduction subscale (e.g., “use a designated driver” or “know where your drink is at all times”). Total scores range from 18-108, controlled consumption subscale scores can range from 12-72, and serious harm reduction subscale scores can range from 6-36. Higher scores indicate more utilization of protective behavioral strategies. Internal consistency for the total PBSS-R score was good for the current sample (“ = .94) and subscales were .94 for CC and .90 for SHR. Data Analytic Approach A series of simple moderation analyses were conducted in order to determine the extent to which two distinct types of alcohol protective behavioral strategies— controlled consumption and serious harm reduction—qualified the relationship between alcohol consumption and alcohol-related risky sexual behavior, as well as to determine the extent to which controlled consumption and serious harm reduction strategies qualified the relationship between alcohol consumption and alcohol-related sexual victimization. According to Hayes (2013), moderation analysis (i.e., conditional effects) is typically performed when one variable’s (X) effect on another (Y) is dependent on the magnitude of a third variable. Moderation analyses were conducted using the SPSS PROCESS macro (Hayes, 2013). Additionally, simple slopes were conducted following each analysis in order to interpret the interactions (Aiken & West, 1991). High and low values for all variables of interest were computed by adding and subtracting one standard deviation from the mean of the respective variable. Results of these analyses are presented in Table 1. Prior to conducting analyses, all data underwent a cleaning process that screened for outliers and missing items. Truncation was used to correct for outliers on the DDQ, and linear trend at point imputation was used to correct for missing values on items pertaining to PBS use. However, due to the dichotomous nature of the Sexual Experiences Survey (SES; Koss & Oros, 1982), a more conservative approach was utilized to correct for missing values on items pertaining to alcohol-related sexual victimization. Specifically, participants who omitted more than three items on the SES were removed from analyses; this eliminated seven participants and the sample decreased from 502 to a final size of 495. Additionally,

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Table 1. Regression of Alcohol Consumption, Controlled Consumption Strategies, and Serious Harm Reduction Strategies, on Alcohol-Related Sexual Victimization R2

Predictor variable Controlled Consumption Strategies Step 1: Alcohol Consumption CC Strategies Step 2: Alcohol ´ CC Serious Harm Reduction Strategies Step 1: Alcohol Consumption SHR Strategies Step 2: Alcohol ´ SHR

DR2

b

t

.13*

.17*

.24* –.00

5.61* –.03

–.004*

–4.29*

.21* –.08*

5.26* –3.46*

–.01*

–4.27*

.04*

.21*

.24*

.03*

Note: CC = Controlled Consumption Strategies; SHR = Serious Harm Reduction Strategies. *p < .001.

missing values on the SES were coded as “No” in cases where participants omitted three or less items on the SES. RESULTS Means, standard deviations and intercorrelations of all variables of interest are found in Table 2. Greater use of controlled consumption strategies was associated with less alcohol consumption (r = –.34, p < .001), fewer reports of alcohol-related risky sexual behavior (r = –.26, p < .001), and less endorsement of alcohol-related sexual victimization (r = –.24, p < .001). Serious harm reduction strategies were negatively associated with alcohol consumption (r = –.29, p < .001), alcoholrelated risky sexual behavior (r = –.30, p < .001), and alcohol-related sexual victimization (r = –.40, p < .001). The top three most frequently endorsed alcoholrelated risky sexual behaviors were “Has drinking ever gotten you into a sexual situation you later regretted” (n = 173, 35%), “Because you had been drinking, have you ever neglected to use birth control or neglected to protect yourself from sexually transmitted diseases” (n = 114, 23%), and “Because you had been drinking, have you ever had sex with someone you wouldn’t ordinarily have sex with” (n = 108, 22%). Additionally, the three most commonly reported experiences of alcohol-related sexual victimization were “Had a man misinterpret the level of sexual intimacy you desired” (n = 148, 30%), “Been in a situation where a man

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Table 2. Means, Standard Deviations, and Intercorrelations of Measures

1. 2. 3. 4. 5.

SES YAAPST DDQ CC SHR Mean SD

1

2

3

— .39* .25* –.24* –.40*

— — .27* –.26* –.30*

— — — –.34* –.29*

1.33 2.62

1.62 2.64

7.90 7.30

4

5

— — — — .63*

— — — — —

48.29 16.08

30.55 7.09

Note: SES = Sexual Experiences Survey; YAAPST = Modified Young Adult Alcohol Problems Screening Test; DDQ = Daily Drinking Questionnaire; CC = Controlled Consumption Strategies; SHR = Serious Harm Reduction Strategies. *p < .01.

became so sexually aroused that you felt it was useless to stop him even though you did not want to have sexual intercourse” (n = 80, 16%), and “Found out that a man had obtained sexual intercourse with you by saying things he really didn’t mean” (n = 75, 15%). The top three most commonly endorsed PBS—all serious harm reduction strategies—were, “Know where your drink has been at all times” (n = 376, 76%), “Know what you are drinking” (n = 381, 77%), and “Avoid getting into a car with someone who has been drinking” (n = 376, 76%). A paired samples t-test revealed that participants used significantly more serious harm reduction strategies than controlled consumption strategies (t(458) = 26.61, p = < .001). Alcohol-Related Risky Sexual Behavior The first moderation analysis examined whether controlled consumption strategies would qualify the association between alcohol consumption and risky sexual behavior. Main effects emerged for alcohol consumption ($ = .11, t = 2.47, p = .01) and controlled consumption strategies ($ = –.03, t = –2.52, p = .01), such that higher rates of risky sexual behavior were observed for women who reported higher levels of alcohol consumption and those who reported using relatively few controlled consumption strategies. The two-way interaction of alcohol consumption and controlled consumption strategies that emerged from this analysis was not significant ($ = –.00, t = –.73, p = .47, ns). The second moderation analysis was used to determine the extent to which serious harm reduction strategies qualified the association between alcohol consumption and risky sexual behavior. Main effects emerged for alcohol consumption ($ = .09, t = 2.01, p = .05) and serious harm reduction strategies ($ = –.09, t = –3.78, p < .001), such that higher rates of risky sexual behavior were observed for women who reported higher levels of alcohol consumption and those who reported using the least amount of serious harm reduction strategies. The

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interaction of alcohol consumption and serious harm reduction strategies on risky sexual behavior was non-significant ($ = –.00, t = –.28, p = .78, ns). Alcohol-Related Sexual Victimization The third moderation analysis was used to determine the extent to which controlled consumption strategies qualified the association between alcohol consumption and alcohol-related sexual victimization. The only main effect that emerged was for alcohol consumption ($ = .24, t = 5.61, p < .001), such that women who reported higher levels of alcohol consumption also endorsed higher rates of alcohol-related sexual victimization. This main effect was qualified by the interaction of alcohol consumption and controlled consumption strategies ($ = –.004, t = –4.29, p < .001; see Table 1). Simple slopes tests were then conducted which found the slope of the line representing the association between controlled consumption strategies and alcohol-related sexual victimization to be negative for students with high ($ = –.004, t = –3.83, p < .001) and low alcohol consumption ($ = –.003, t = –5.27, p < .001). The simple slopes graph illustrates that controlled consumption strategies appear to be especially useful in reducing alcohol-related sexual victimization for college women who consume more alcohol during a typical week (operationalized as 1SD + M for the current sample; $10 drinks per week), as compared to college women who typically consume less alcohol (see Figure 1).

Figure 1. Results of the interaction between alcohol consumption and controlled consumption strategies (CC) on experiences of alcohol-related sexual victimization.

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Finally, a fourth moderation analysis was conducted to determine the extent to which serious harm reduction strategies qualified the association between alcohol consumption and alcohol-related sexual victimization. Main effects emerged for alcohol consumption ($ = .21, t = 5.26, p < .001), such that increased alcohol consumption was associated with increased alcohol-related sexual victimization, and for serious harm reduction strategies ($ = –.08, t = –3.46, p < .001), such that less use of serious harm reduction strategies was associated with higher alcoholrelated sexual victimization. Additionally, a significant interaction was observed between alcohol consumption and serious harm reduction strategies ($ = –.01, t = –4.27, p < .001; see Table 1). Simple slopes tests were then conducted which found the slope of the line representing the association between serious harm reduction strategies and alcohol-related sexual victimization to be negative for students with high ($ = –.01, t = –5.53, p < .001) and low alcohol consumption ($ = –.01, t = –9.24, p < .001), with a steeper slope for high alcohol consumption (see Figure 2). The simple slopes graph illustrates that serious harm reduction strategies appear to be beneficial in reducing alcohol-related sexual victimization for college women, regardless of their typical alcohol consumption. Additionally, the graph illustrates that serious harm reduction strategies may have a more prominent impact on reducing experiences of alcohol-related sexual victimization for college women who consume more alcohol during a typical week (operationalized as 1SD + M for the current sample; $10 drinks per week), as compared to college women who typically consume less alcohol.

Figure 1. Results of the interaction between alcohol consumption and controlled consumption strategies (CC) on experiences of alcohol-related sexual victimization.

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DISCUSSION The purpose of this study was to examine the moderating effects of two distinct types of alcohol protective behavioral strategies—controlled consumption strategies and serious harm reduction strategies—on the relationship between alcohol consumption and alcohol-related risky sexual behavior and sexual victimization. Consistent with previous findings (e.g., Benton et al., 2004; Madson & Zeigler-Hill, 2013), we found that college women tend to use serious harm reduction strategies more often than controlled consumption strategies. This finding suggests that the current sample did not favor abstaining or controlling their drinking behavior, but that they were more willing to control other behaviors, such as going home with a friend or knowing where their drink was at all times. Additionally, the current sample reported sex-related consequences at rates comparable to previous studies (e.g., Corbin et al., 2001; Lewis et al., 2010). Our results lend some support to our initial hypotheses. As anticipated, serious harm reduction strategies moderated the relationship between alcohol consumption and alcohol-related experiences of sexual victimization. This supports our previous claim that the nature of serious harm reduction strategies appear to make them uniquely qualified for reducing alcohol-related sexual victimization among college women. In contrast to what was hypothesized, controlled consumption strategies also moderated the relationship between alcohol consumption and alcohol-related experiences of sexual victimization. Considering that a paired sample t-tests revealed that our sample relied more on serious harm reduction strategies than on controlled consumption strategies, these findings may demonstrate an acute awareness among our participants of the importance of protecting themselves against serious harm (e.g., negative sex-related consequences) when they choose to drink. Delva and colleagues (2004) suggested that women tend to socialize in groups that promote the use of protective strategies, and that women have more of a need to specifically protect themselves from unwanted sexual behavior (Lewis, Rees, & Lee, 2009; Lewis et al., 2010). It is possible then, that women are socialized to not just protect themselves in the general sense (e.g., to avoid academic or legal repercussions from drinking, or to avoid a hangover), but to specifically protect themselves from alcohol-related sexual victimization (e.g., verbal or physical threat, coercion, or force), which may contribute to more effective use of serious harm reduction and controlled consumption strategies. However, the value college women place on protecting themselves against sex-related consequences has yet to be empirically explored, and the same explanations likely would not translate from alcohol-related sexual victimization to alcohol-related risky sexual behavior. Current results support our prediction that controlled consumption strategies would not qualify the link between alcohol consumption and alcohol-related risky sexual behavior; however, in contrast to our initial hypothesis, serious harm reduction strategies did not qualify the alcohol consumption—alcohol-related risky

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sexual behavior link either. Thus, it appears that PBS function differently for alcohol-related risky sexual behavior and alcohol-related sexual victimization. This may be related to college women’s beliefs about the interaction between alcohol consumption and sexual behavior, or their sex-related alcohol expectancies (Abbey, McAuslan, Ross, & Zawacki, 1999; Benson, Gohm, & Gross, 2007). For instance, women have reported that alcohol allows them to avoid negative social perceptions and gender-related sanctions for sexual behavior (Peralta, 2010; Smith, Toadvine, & Kennedy, 2009); thus, if college women believe that consuming alcohol lowers their sexual inhibition and enhances their sexual risk taking (Benson et al., 2007; Messman-Moore et al., 2013), they may feel that drinking affords them social permission to engage in risky sexual behavior that would not be socially acceptable without the influence of alcohol. In addition, college students tend to overestimate how often their same-sex peers engage in risky sexual behavior, and norm perceptions have been positively correlated with actual behavior (Lewis, Lee, Patrick, & Fossos, 2007; Lewis, Litt, Cronce, Blayney, & Gilmore, 2014). Thus, college women may form the belief that alcohol consumption is a socially acceptable way for them to engage in otherwise unacceptable sexual behavior. In other words, college women may intentionally engage in alcohol-related risky sexual behavior despite the potential health risks (e.g., unplanned pregnancy, sexually transmitted diseases), in which case PBS may seem irrelevant to their drinking goals. Other researchers have also suggested that college students may use being intoxicated as a way to justify their sexual behavior and avoid feelings of shame or guilt (Massie, 2013; Ven & Beck, 2009). Therefore, it would be beneficial for future research to assess individual drinking goals and perceived positive and negative consequences of engaging in alcoholrelated risky sexual behavior. The results from the current study provide implications for clinical interventions for college women. Tailoring interventions according to the type(s) of consequences students experience more often or desire to prevent may enhance the efficacy of brief alcohol interventions. Current harm reduction approaches such as the Brief Alcohol Screening and Intervention for College Students programs (BASICS) operate from a skills-based curriculum that provides specific cognitivebehavioral strategies to college student drinkers (Dimeff, Baer, Kivlahan, & Marlatt, 1999) and could be tailored in such a way. Since gender differences are linked to alcohol-related consequences (Ham & Hope, 2003; Hingson et al., 2005; Sugarman et al., 2009), it would be beneficial for BASICS counselors to be familiar with the types of consequences commonly experienced by male and female college drinkers as well as the specific PBS shown to impact such consequences. Additionally, utilizing a motivational interviewing approach in individualized brief alcohol interventions can provide an empirically supported framework for effectively promoting risk-reduction behaviors among college students (Miller & Rollnick, 2013). In fact, Carey, Scott-Sheldon, Carey, and DeMartini (2007) found that screening and brief interventions that emphasized a motivational interviewing approach performed better than those not including this

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element. Thus, utilizing a motivational interviewing framework for brief alcohol interventions would provide a practical and proven way to tailor interventions to specific negative consequences as identified by the student drinker. In addition to the clinical implications, our findings uncovered several important considerations for continued research. For instance, the results from this study highlight the need to extend PBS research by exploring which types of strategies are beneficial in moderating the relationship between alcohol consumption and other specific types of negative consequences (e.g., academic, public, physical, legal). It is possible that different types of PBS may qualify the associations between alcohol consumption and other specific types of negative consequences; however, these associations have not yet been examined. Research examining the role of contextual factors often predictive of college student drinking behaviors and in better understanding the relationships among consumption, PBS, and sexrelated consequences is needed. Examining the influence of alcohol expectancies or drinking motives on PBS and sex-related consequences would help to better understand these links. Alcohol expectancies are strong predictors of drinking behaviors (Labbe & Maisto, 2011; Thompson, Spitler, McCoy, Marra, Sutfin, Rhodes, et al., 2009), and positive expectancies are predictive of less use of PBS (Madson, Moorer, Zeigler-Hill, Bonnell, & Villarosa, 2013). Further, positive alcohol expectancies may limit one’s attention to environmental cues that are salient to that expectancy (LaBrie, Grant, & Hummer, 2011). For instance, college students endorse more positive alcohol expectancies when they drink compared to when they are sober, and it has been suggested that the college social environment may activate alcohol expectancies related to sexual risk taking (LaBrie, Grant, & Hummer, 2011a). Additionally, Lindgren et al. (2012) found that coping motives partially explain the association between sexual assault and subsequent problem drinking. Better understanding the conditions under which the effects of PBS operate will better inform prevention and intervention efforts aimed at reducing alcohol-related risky sexual behavior and sexual victimization among college women. While the current findings are promising and informative, study limitations must be considered when interpreting these results. Importantly, the current study surveyed only risky sexual behavior and sexual victimization that occurred in the context of alcohol consumption; thus, it is important that these findings not be interpreted to extend to non-alcohol related sexual experiences. Additionally, the current study relied on a convenience sample and retrospective self-report, and when considering the sensitive nature of survey items regarding alcohol and sex, the potential for socially desirable responding should be taken into account when interpreting the current findings. Caution should also be exercised when generalizing these results to the larger college population because the current sample was collected from a single university in the southern United States. An additional limitation is the cross-sectional design, which prevents causal inferences from being made regarding the current results. Future research should incorporate longitudinal designs such as daily diary designs to account for this limitation (Pearson et al., 2013).

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