Forced Sexual Intercourse and Associated Health Risk Behaviors Among Female College Students in the United States
Brener, N.D., McMahon, P.M., Warren, C.W., and Douglas, K.A. (1999). Journal of Consulting and Clinical Psychology, 67, 252-259.

A Review of Literature
By: Karen J. Bachar MA
University of Arizona

This article explores the relationship between rape prevalence and health risk behaviors among a national sample of college students (ages 18 and above), using data from the 1995 National College Health Risk Behavior Survey (NCHRBS).
■A representative sample of college students from 148 institutions were mailed a 96-item questionnaire.
■In all 4609 undergraduate students completed the questionnaire (a response rate of 60%).

The questionnaire included:
■Demographic items (age, race/ethnicity, parent's educational level…)
■Questions related to risk taking behaviors (physical fighting, cigarette smoking, marijuana use, episodic heavy drinking, driving under the influence of alcohol, multiple concurrent sexual partners, and suicidal ideation) …AND
■The question: "During your life, have you ever been forced to have sexual intercourse against your will?”

In all, twenty percent of female respondents reported ever having been forced to have sexual intercourse against their will (four percent of male respondents reported having been forced to have sexual intercourse against their will and were dropped from further analysis).

■Of females reporting the occurrence of unwanted sexual intercourse 71% indicated they were raped before the age of 18 with the majority of experiences happening during the teen years (see Table 2 page 254).
■The study found a prevalence rate of 15% when they restricted their estimate to women who had been raped since the age of 15 *(incidents that occur below age 15 are considered child abuse by some).
■These results are virtually identical to the findings of a study by Koss et al. (1987), which indicated that 15% of a national sample of college women had been raped since age 14.
■When viewed together these results suggest that there has been no decline in the lifetime prevalence of rape over the past 12 years.
■The authors point out that the results obtained in this study differ from those found by two other national studies (Kilpatrick et al., 1992., Moore et al., 1989).
■Those studies found that a higher percentage of women experienced rape at younger ages than reported here.

The reasons for the difference in results include:
■It is possible that women affected by rape at an early age are less likely to attend college.
■It is also possible that college women may differ from their non-college counterparts on a number of dimensions.
■How rape was defined and the questions used to assess the age at which rape occurred varied between studies (which can effect whether a someone identifies an experience as rape).

Health Risk Behaviors:
■In addition to Rape Prevalence this study also examined Health Risk Behaviors including:
–Physical fighting (a physical fight with a spouse or boyfriend at least once 12 months prior to the survey)
–Smoking (at least once 30 days prior to the survey)
–Marijuana use (at least once within 30 days of the survey)
–Episodic heavy drinking(5 or more drinks at least once within 30 days of the survey)
–Driving under the influence of alcohol (at least once within 30 days of the survey)
–Multiple sexual partners(3 months before the survey)
–Alcohol or drug use during last sexual intercourse
–Suicidal ideation (at least once 12 months prior to the survey)

A Statistical Aside
■Controlling for demographics is a statistical method used to measure the likelihood that someone who has been raped engages in the health risk behaviors when differences in age, parents education, race/ethnicity, and sorority membership are eliminated.
■Odds Ratios (OR) are a measure of association between two things. An OR of 1.0 means that there is no relationship between variables (temperature and a height would have an OR of 1.0). The size of a relationship is measured by the difference (in either direction) from 1.0. An OR of less than 1.0 indicates a negative relationship between 2 variables. An OR of greater than 1.0 indicates a direct, positive relationship.

The results of this study indicate that:
■Women who had experienced forced sexual intercourse engaged in the above mentioned health-risk behaviors at a significantly higher rate than those women who had not reported forced sexual intercourse, except for episodic heavy drinking and marijuana use (see Table 3 pg. 255).
■When demographic characteristics were controlled for the results also indicate that women who experienced forced sexual intercourse had significant odds ratio for engaging in all of the health-risk behaviors (Table 4 pgs. 256-257).
■The authors did not comment on another finding related to episodic heavy drinking, namely that being a sorority member had a higher odds ratio (2.5) than experiencing forced sexual intercourse (1.6).


There are at least two explanations for these findings:
■After women are raped they are more likely to engage in health-risk behaviors.
■Engaging in health-risk behaviors may increase women's vulnerability to forced sexual intercourse.
■It is also possible that the association between health-risk behaviors and forced sexual intercourse operates in both directions.

Limitations of the study:
■The present study has several limitations including
–Retrospective, cross-sectional design (the data was all gathered at one point in time)
–Only one question was used to screen for forced sexual intercourse
–No information was collected regarding the nature of forced sexual experiences.

■Despite the limitations, this study highlights several important findings:
–Up to 1 in 5 college women experience forced sexual intercourse in their lifetime
–Most rapes happen before the age of 18
–Women who have experienced forced sexual intercourse are more likely to engage in a number of health-risk behaviors.

Author’s Conclusions:
■Given these results prevention efforts must target adolescents before they reach 18 (the earlier the better)
■Treatment programs should be developed to ameliorate the long-term emotional and health related impact of rape.

Notes:
■This study reports that 1 in 5 women experience rape in their lifetime. Previous studies have quoted a figure of 1 in 4. The 1 in 4 figure includes attempted and completed rapes.

References:

■Kilpatrick, D.G., Acierno, R., Resnick, H.S., Saunders, B.E., & Best, C.L. (1997). A two-year longitudinal analysis of the relationships between violent assault and substance abuse in women. Journal of Consulting and Clinical Psychology, 65, 834-847.

■Koss, M.P., Gidycz, C.A., & Wisniewski, N. (1987). The scope of rape: Incidence and prevalence of sexual aggression and victimization in a national sample of higher education students.Journal of Consulting and Clinical Psychology, 55, 162-170.

■Moore, K.A., Nord, C.W., & Peterson, J.L. (1989). Nonvoluntary sexual activity among adolescents. Family Planning Perspectives, 21, 110-114.