An examination of risky sexual behavior and HIV in victims of child abuse and neglect: A 30-year follow-up.

Objective: This article examined links between childhood maltreatment and risky sexual behavior (early sexual contact, promiscuity, prostitution) and HIV in adulthood. Design: Using a prospective cohort design, physically and sexually abused and neglected children (ages 0-11) with documented cases during 1967-1971 were matched with nonmaltreated children and followed into adulthood. Main Outcome Measures: Early sexual contact, promiscuity, and prostitution were assessed through in-person interviews and official records (prostitution) at approximate age 29 (N = 1196). HIV tests were conducted at approximate age 41 (N = 631). Results: Child maltreatment was associated with prostitution (OR = 2.47, 95% CI = 1.35-4.50) and early sexual contact (OR = 1.73, 95% CI = 1.24-2.40). Prevalence of HIV in the abuse/neglect group was twice that in controls (OR = 2.35, 95% CI = .64-8.62), although this difference did not reach conventional levels of statistical significance. SEM provided significant support for a model linking child abuse and neglect to prostitution through early sexual contact and a marginal link to HIV through prostitution. Conclusion: These findings provide prospective evidence that maltreated children are more likely to report sexual contact before age 15, engage in prostitution by young adulthood, and test positive for HIV in middle adulthood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding factors associated with early therapeutic alliance in PTSD treatment: Adherence, childhood sexual abuse history, and social support.

Objective: Therapeutic alliance has been associated with better treatment engagement, better adherence, and less dropout across various treatments and disorders. In treatment of posttraumatic stress disorder (PTSD), it may be particularly important to establish a strong early alliance to facilitate treatment adherence. However, factors such as childhood sexual abuse (CSA) history and poor social support may impede the development of early alliance in those receiving PTSD treatment. We sought to examine treatment adherence, CSA history, and social support as factors associated with early alliance in individuals with chronic PTSD who were receiving either prolonged exposure therapy (PE) or sertraline. Method: At pretreatment, participants (76.6% female; 64.9% Caucasian; mean age = 37.1 years, SD = 11.3) completed measures of trauma history, general support (Inventory of Socially Supportive Behaviors), and trauma-related social support (Social Reactions Questionnaire). Over the course of 10 weeks of PE or sertraline, they completed early therapeutic alliance (Working Alliance Inventory) and treatment adherence measures. Results: Early alliance was associated with PE adherence (r = .32, p     

5-HTTLPR status moderates the effect of early adolescent substance use on risky sexual behavior.

Objective: A longitudinal, prospective design was used to investigate a moderation effect in the association between early adolescent substance use and risky sexual behavior 2 years later. A genetic vulnerability factor, a variable nucleotide repeat polymorphism (VNTR) in the promoter region of the serotonin transporter gene SLC6A4, known as 5-HTTLPR, was hypothesized to moderate the link between substance use at age 14 and risky sexual behavior at age 16. This VNTR has been associated with risk-taking behavior. Design: African American youths in rural Georgia (N = 185) provided 2 waves of data on their substance use and sexual behavior. Genetic data were obtained via saliva samples. Main Outcome Measures: Substance use and sexual risk behavior were assessed using youth self-report items developed for this investigation. Results: Multiple regression analyses indicated that the presence of 1 or 2 copies of the short allele of the VNTR interacted with substance use to predict sexual behavior. Substance use had little effect on sexual behavior for youths without the short allele; this effect was greatly increased for youths with the short allele. Conclusion: Genetic vulnerability affected the implications of early onset substance use for later sexual behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pathways from childhood abuse and neglect to HIV-risk sexual behavior in middle adulthood.

Objective: This study examines the relationship between childhood abuse and neglect and sexual risk behavior in middle adulthood and whether psychosocial factors (risky romantic relationships, affective symptoms, drug and alcohol use, and delinquent and criminal behavior) mediate this relationship. Method: Children with documented cases of physical abuse, sexual abuse, and neglect (ages 0–11) processed during 1967–1971 were matched with nonmaltreated children and followed into middle adulthood (approximate age 41). Mediators were assessed in young adulthood (approximate age 29) through in-person interviews between 1989 and 1995 and official arrest records through 1994 (N = 1,196). Past year HIV-risk sexual behavior was assessed via self-reports during 2003–2004 (N = 800). Logistic regression was used to examine differences in sexual risk behavior between the abuse and neglect and control groups, and latent variable structural equation modeling was used to test mediator models. Results: Child abuse and neglect was associated with increased likelihood of risky sexual behavior in middle adulthood, odds ratio = 2.84, 95% CI [1.74, 4.64], p ≤ .001, and this relationship was mediated by risky romantic relationships in young adulthood. Conclusions: Results of this study draw attention to the potential long-term consequences of child abuse and neglect for physical health, in particular sexual risk, and point to romantic relationships as an important focus of intervention and prevention efforts. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Tests of the mediational role of preparatory safer sexual behavior in the context of the theory of planned behavior.

The present research details 2 empirical tests within the context of the theory of planned behavior (I. Ajzen & T. Madden, 1986) of the assumption that preparatory behaviors (e.g., discussing safer sex, obtaining condoms) play a mediational role in the relation between psychological variables (e.g., attitudes toward safer sex, social norms about safer sex) and condom use. The assumption of the mediational role of preparatory behaviors is examined in sexually experienced samples from 2 different populations: inner-city high school students (N=226) and college students (N=160). The results suggest that the mediational role of preparatory behaviors is a highly significant one. Results indicate no gender differences with regard to the main mediational hypotheses. The methodological, theoretical, and practical implications and importance of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social context and perceived effects of drugs on sexual behavior among individuals who use both heroin and cocaine.

Researchers have identified the association between the use of cocaine and sexual behavior as an important risk factor for HIV infection and have attempted to elucidate the nature of this association. Several lines of research have suggested that facilitation of sexual behavior during intoxication with cocaine may be because of the direct pharmacological effects of the drug (e.g., increase in sexual desire), whereas others have pointed to the importance of factors related to the context of drug use (e.g., opportunities for sexual behavior, expectations about the effects of the drug, social norms). The present study explored the perceived effects of cocaine and heroin on sexual behavior, as well as the social context of drug use as a function of drug type (cocaine vs. heroin), among 46 inner-city drug users who reported a history of regular use of both crack cocaine and heroin. Results indicated that compared to heroin, cocaine had deleterious effects on participants' perceived sexual desire and performance. Despite such deleterious effects on sexual behavior, cocaine was more frequently used with an intimate partner than heroin. Furthermore, participants did not differ in the extent to which they used the two drugs in other social contexts (e.g., with friends, family, or neighbors). These preliminary results suggest that the relationship between cocaine and sexual behavior, especially among long-term cocaine users, may be facilitated by opportunities for sex that exist in the context of cocaine use, rather than by the pharmacological effects of the drug. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social-cognitive theory mediators of behavior change in the National Institute of Mental Health Multisite HIV Prevention Trial.

The National Institute of Mental Health Multisite HIV Prevention Trial was a trial of an intervention to reduce sexual HIV risk behaviors among 3,706 low-income at-risk men and women at 7 U.S. research sites. The intervention, based on social- cognitive theory and designed to influence behavior change by improving expected outcomes of condom use and increasing knowledge, skills, and self-efficacy to execute safer sex behaviors, was effective relative to a control condition in reducing sexual risk behavior. At 3 months after completion of the intervention, measures of these potential mediators were higher in the intervention than in the control condition. Although the effect of the intervention on sexual risk behavior was significantly reduced when the variables were controlled statistically, supporting the hypothesis of their mediation of the intervention effect, most of the effect remained unexplained, indicating the influence of unmeasured factors on outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analytic complexities associated with group therapy in substance abuse treatment research: Problems, recommendations, and future directions.

In community-based alcoholism and drug abuse treatment programs, the vast majority of interventions are delivered in a group therapy context. In turn, treatment providers and funding agencies have called for more research on interventions delivered in groups in an effort to make the emerging empirical literature on the treatment of substance abuse more ecologically valid. Unfortunately, the complexity of data structures derived from therapy groups (because of member interdependence and changing membership over time) and the present lack of statistically valid and generally accepted approaches to analyzing these data have had a significant stifling effect on group therapy research. This article (a) describes the analytic challenges inherent in data generated from therapy groups, (b) outlines common (but flawed) analytic and design approaches investigators often use to address these issues (e.g., ignoring group-level nesting, treating data from therapy groups with changing membership as fully hierarchical), and (c) provides recommendations for handling data from therapy groups using presently available methods. In addition, promising data-analytic frameworks that may eventually serve as foundations for the development of more appropriate analytic methods for data from group therapy research (i.e., nonhierarchical data modeling, pattern-mixture approaches) are also briefly described. Although there are other substantial obstacles that impede rigorous research on therapy groups (e.g., evaluation and measurement of group process, limited control over treatment delivery ingredients), addressing data-analytic problems is critical for improving the accuracy of statistical inferences made from research on ecologically valid group-based substance abuse interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Anger as a vehicle in the treatment of women who are sexual abuse survivors: Reattributing responsibility and accessing personal power.

Some clinicians view client anger as a problematic symptom to be reduced, whereas others view it as an opportunity for therapeutic development. The present authors describe how client anger, a fitting emotional response to abuse, can work as a vehicle to help sexual abuse survivors reattribute responsibility and develop personal efficacy. The role of anger in the healing process of the sexual abuse survivor is explored through 2 case studies. It is suggested that by reframing anger as a vehicle for recovery rather than a symptom, therapists can learn to effectively incorporate anger work (which involves successfully negotiating any dynamics that cause therapist discomfort) into the treatment of survivors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Misperceived risk among female adolescents: Social and psychological factors associated with sexual risk accuracy.

This study of 411 urban female adolescents had 3 objectives: (a) assess the relationship between perceived risk and sexual risk behavior (condom use, number of partners, partner risk, presence of STDs, and aggregate sexual risk), (b) assess the accuracy of risk perceptions, and (c) identify variables related to inaccurate sexual risk perceptions. Participants were classified as accurate or inaccurate risk perceivers on the basis of actual sexual behavior and perceived risk. Accurate versus inaccurate risk perceivers were compared on psychological maintenance variables (self-esteem, distress, and coping), relationship context variables (partnership duration and pressure to have unprotected sex), and risk knowledge at different levels of sexual risk. Approximately half of the participants underestimated the risk of their sexual behavior. Accurate and inaccurate risk perceivers differed on risk knowledge, partnership duration, and pressure to have unprotected sex. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special section on adult survivors of childhood sexual abuse.

Sexual abuse researchers need to use more complex models of abuse and more sophisticated research designs for studying long-term effects and for evaluating treatment programs. The articles that comprise this special section integrate the study of sexual abuse with perspectives on adult victimization, developmental psychopathology, and attachment theory and also offer specific methodological suggestions for improving research on long-term effects and therapy with the abuse survivor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of intention to use condoms among university women: An application and extension of the theory of planned behavior.

The purpose of the study was to identify the variables that best predict whether or not young women intend to use condoms during their sexual encounters with new partners. 187 heterosexually experienced undergraduate women (mean age 20.9 yrs) completed a questionnaire battery including variables to assess all components of the Theory of Planned Behaviour (T0PB). The TOPB was a useful model for predicting intention to use condoms with a new partner. Prediction was improved beyond the TOPB by including specific beliefs (condom use demonstrates responsible sexual activity, condom use does not destroy trust), group norms, and birth control use (mediated by attitudes toward condoms). The practical implications for AIDS prevention programs designed to promote condom use among women are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An evaluation of cognitive processing therapy for the treatment of posttraumatic stress disorder related to childhood sexual abuse.

This study compared the effectiveness of cognitive processing therapy for sexual abuse survivors (CPT-SA) with that of the minimal attention (MA) given to a wait-listed control group. Seventy-one women were randomly assigned to 1 of the 2 groups. Participants were assessed at pretreatment and 3 times during posttreatment: immediately after treatment and at 3-month and 1-year follow-up, using the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale (D. Blake et al., 1995), the Beck Depression Inventory (A. T. Beck, R. A. Steer, & G. K. Brown, 1996), the Structured Clinical Interview for the DSM-IV (R. L. Spitzer, J. B. W. Williams, & M. Gibbon, 1995; M. B. First et al., 1995), the Dissociative Experiences Scale-II (E. M. Bernstein & F. W. Putnam, 1986), and the Modified PTSD Symptom Scale (S. A. Falsetti, H. S. Resnick, P. A. Resick, & D. G. Kilpatrick, 1993). Analyses suggested that CPT-SA is more effective for reducing trauma-related symptoms than is MA, and the results were maintained for at least 1 year. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing the effectiveness of cognitive-behavioral treatment for substance abuse in a community setting: Within treatment and posttreatment findings.

This study evaluated the short-term effectiveness of cognitive- behavioral treatment (CBT) for substance abuse delivered in a community setting. At entry into outpatient community substance abuse treatment, participants (N=252) were randomly assigned to 3 conditions: high-standardization CBT, low-standardization CBT, and treatment as usual. Treatment consisted of 12 weekly individual therapy sessions. There was a significant decrease in substance use from baseline, with participants reporting being abstinent on 90% of within-treatment days and 85% of days during the 6 months posttreatment. However, there were no significant differences in outcomes across conditions. Findings do not support the hypothesis that disseminating CBT to community settings will improve outcomes and suggest that standard substance abuse counseling may be more effective than previously thought. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of the MMPI-2 restructured clinical (RC) and clinical scales in a substance abuse treatment sample.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) restructured clinical (RC) scales were designed to assess the underlying distinctive core components of the MMPI-2 clinical scales in order to enhance discriminant and convergent validity. Analyses utilizing inpatient and outpatient mental health treatment samples (Tellegen et al., 2003) have demonstrated improvements in the psychometric functioning of the RC scales in comparison with the original clinical scales. The current study extends these analyses by comparing the RC and original clinical scales in a sample of 1,284 men assessed at intake to a substance abuse treatment program in a VA setting. Results indicate that the RC scales demonstrate a general improvement in psychometric properties, with some increases in convergent and discriminant validity compared to their clinical scale counterparts. These results replicate Tellegen et al.'s (2003) findings in a different type of treatment setting and with different criteria, and complement their report by examining the validity of scales RC3 and RC9, for which Tellegen et al. (2003) did not have appropriate criteria. Implications for deliverers of psychological services in public sector settings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"About last night": the social ecology of sexual behavior relative to alcohol use among adolescents and young adults in substance abuse treatment

Data were collected in face-to-face interviews from 120 substance-abusing adolescents and young adults (87 men, 33 women; M age = 17.2 years old) recruited from residential and nonresidential treatment facilities in South Florida. Participants described two recent sexual events, one with and one without concurrent alcohol use. Participants described social aspects of these sexual events, actual and intended behaviors, and their feelings about sex in the two alcohol-use contexts. High levels of discrete, risky behaviors occurred in both contexts. Event analysis produced only limited evidence suggesting a higher level of risk in the alcohol-use context. Participants reported less positive feelings about sex when alcohol was used.     

Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse.

Fifty-eight women with posttraumatic stress disorder (PTSD) related to childhood abuse were randomly assigned to a 2-phase cognitive-behavioral treatment or a minimal attention wait list. Phase 1 of treatment included 8 weekly sessions of skills training in affect and interpersonal regulation; Phase 2 included 8 sessions of modified prolonged exposure. Compared with those on wait list, participants in active treatment showed significant improvement in affect regulation problems, interpersonal skills deficits, and PTSD symptoms. Gains were maintained at 3- and 9-month follow-up. Phase 1 therapeutic alliance and negative mood regulation skills predicted Phase 2 exposure success in reducing PTSD, suggesting the value of establishing a strong therapeutic relationship and emotion regulation skills before exposure work among chronic PTSD populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)