Abstract
Research suggests that students experience high levels of sexual assault, but studies addressing how they differ in their experiences from other sexual assault victims are virtually nonexistent. To address this gap, information was collected from consecutive individuals, aged 16 years or older, presenting to one of 7 hospital-based sexual assault treatment centers in Ontario from 2005 to 2007. Of the 882 victims seen during the study period, 32% were students. Relative to other sexual assault victims, students were more likely to be aged 16 to 18 years and 19 to 24 years versus 25 years and older. They were more likely to be living alone, with family of origin, a partner or spouse, or a nonrelative than on the street or in a shelter or institution. They were also more likely to report having consumed over-the-counter medication in the 72 hours prior to examination. Student victims were less likely than nonstudent victims to report having a disability and having used street drugs. Implications for research, education, and practice are discussed.
Sexual violence is a widespread social problem that overwhelmingly affects the lives of women (Du Mont & White, 2007). College/university and high school female student populations constitute a demographic subgroup that has been found to experience high levels of sexual assault (Fisher, Cullen, & Turner, 2000). Indeed, multiple studies indicate that prevalence of sexual violence against female students on college/university campuses has changed little since key research published in 1987 by Koss, Gidycz, and Wisniewski (1987), which revealed that 27.5% of undergraduates reported experiences of physically coercive sexual aggression (e.g., Brener, McMahon, Warren, & Douglas, 1999; Corbin, Bernat, Calhoun, McNair, & Seals, 2001; Fisher et al., 2000; Kalof, 2000; Krebs, Lindquist, Warner, Fisher, & Martin, 2009a). Brener et al. (1999) found that 55% of undergraduate students who had experienced forced sex were raped between the ages of 13 and 18 years. Bagley, Bolitho, and Bertrand (1997) surveyed 1,026 Canadian female adolescents in Grades 7 through 12 and reported that almost one fifth (19.6%) had experienced at least one event of sexual assault at school. Erickson and Rapkin (1991) similarly found that 15% of a large sample of Los Angeles students in grades 6 through 12 had experienced an unwanted sexual experience or sexual intercourse.
A few studies have compared students who have been sexually assaulted to students who have not and found significant differences between the two on sociodemographic and health-related factors. Cass (2007) reported that sexually assaulted college students were more likely to be female and single (see also Nagy, DiClemente, & Adcock, 1995). Decker, Raj, and Silverman (2007) reported that being an immigrant was associated with increased risk for experiencing recurring sexual assault among adolescent female high school students. Erickson and Rapkin (1991) found that those middle/high school students who experienced unwanted sex were more likely to report depression, stress, difficulty controlling anger, suicidal ideation, and weight problems (see also Nagy et al., 1995). Brener et al. (1999) similarly found that students who had been raped were more than twice as likely to have considered suicide. Although these findings are important, only one study, Gidycz, Orchowski, King, and Rich (2008) specifically queried preassault mental health difficulties. The authors indicated that women with feelings of suicidal ideation and who used diet pills and vomiting or laxatives to lose weight were more likely to be subsequently sexually victimized.
Several of these studies have also reported that sexually assaulted students were more likely than nonsexually assaulted students to have engaged in “risk taking” behaviors. Gidycz et al. (2008), as did Brener et al. (1999), found that students having experienced forced sexual intercourse were more likely to fight physically with their spouse or boyfriend, have two or more current sexual partners, have first sexual intercourse before the age of 15, smoke cigarettes, and use alcohol and marijuana. Erickson and Rapkin (1991) reported that those who had experienced unwanted sex were more likely to be sexually active and to use alcohol and drugs. Both Cass (2007) and Nagy et al. (1995) also reported that sexually assaulted students were more likely to have used illicit drugs. However, given the cross-sectional nature of these data, it was not possible to ascertain whether the substance use occurred in the context of being assaulted. Although there is some evidence for the multiplicative intoxicant effects of combining over-the-counter (OTC) and prescription drugs with alcohol and street drugs (Weathermon & Crab, 1999), these studies did not investigate rates of OTC or prescription medication use among students.
Although female students have been declared to be “at greater risk for rape and other forms of sexual assault than women in the general population or in a comparable age group” (Fisher et al., 2000, p. iii), research that addresses how students may differ in these experiences from other sexual assault victims—information which could aid in tailoring educational initiatives as well as clinical services—could not be located. The objectives of our exploratory study were as follows: (a) to provide a profile of sexual assault victims who identified as students and (b) to compare student to nonstudent sexual assault victims in order to identify possible factors associated with student sexual assault. More specifically, we were interested in the relationship of student victimization to information not previously examined in sexual assault studies of student populations but deemed important in other sexual assault research (e.g., history of mental illness, presence of a physical disability, and consumption of OTC medications; Alempijevic, Savic, Pavlekic, & Jecmenica, 2007; Del Bove, Stermac, & Bainbridge, 2005; Du Mont et al., 2008; Eckert & Sugar, 2008; McNulty & Nelson, 2007; Rusnak, 2010; Stermac, Du Mont, & Dunn, 1998).
Method
Setting and Population
Seven of Ontario’s 35 hospital-based sexual assault treatment centers were enrolled in this study. These centers, which serve a geographically diverse and culturally representative population of Ontario, provide crisis intervention, physical assessment and treatment of injuries, collection of medicolegal evidence, prophylactic medication for pregnancy and sexually transmitted infections, and referral to counseling and community agencies for ongoing support to individuals reporting having experienced any form of sexual activity with another person without her or his consent, including forced kissing, grabbing, fondling, and attempted or completed rape. Centers are staffed by registered nurses who have undergone specialized sexual assault training (Du Mont & Parnis, 2002). Each consecutive sexual assault victim seen at a participating site, aged 16 years or older, was enrolled in the study between 2005 and 2007.
Measures
With the aid of an advisory committee of recognized experts in the field of sexual violence, the research team developed a data-collection form that included presentation characteristics (e.g., location of service, day of assault, time to presentation, alcohol used immediately before sexual assault, prescription medications used in 72 hours before examination, OTC medications used in 72 hours before examination, and street drugs used in 72 hours before examination); victim characteristics (student status, age, sex, ethnicity, living situation, employment status, mental health problems, and disability [physical, cognitive, or sensory]); and assault characteristics (kissing/fondling, cunnilingus/fellatio, oral/vaginal/anal penetration, injuries [genital and nongenital], and weapons). To ensure standardized administration across sites, attending sexual assault nurse examiners were trained to collect this information in person or using a video conferenced train-the-trainer model (Orfaly et al., 2005). Each completed form was reviewed by a member of the research team (NR) for completeness. Where possible, a designated nurse study coordinator at each of the seven sites filled in any missing information.
Analyses
Statistical Analysis System (SAS) software, Version 9.1.3 and Microsoft Excel were used to analyze the data. Characteristics of the student sample were summarized using frequency counts and proportions for categorical data and means and standard deviations for continuous data. Chi-square and cross-tabulation, or Fisher’s exact tests when cell sizes were small, were then used to compare student to nonstudent sexual assault victims. Finally, to determine what factors, if any, were associated with student sexual assault, all variables, except kissing/fondling for which there were substantial missing data, significant at p < .10 in the bivariate analyses were entered into a multivariate model using logistic regression (Hosmer & Lemeshow, 1989). All variables were examined for multicollinearity. The Hosmer and Lemeshow “goodness-of-fit” statistic was used to check the fit of the model (Lemeshow & Hosmer, 1982). A p value of .05 was considered statistically significant. Findings are reported as odds ratios (OR) with 95% confidence intervals (CI).
Results
A total of 882 individuals reporting sexual assault aged 16 years and older were seen during the study period, of whom 286 (32.4%) were students and 596 (67.6%) were nonstudents.
Profile of Student Sexual Assault Victims
Approximately, half of student sexual assault victims were assaulted between Monday and Thursday (n = 140, 48.9%) and presented within 24 hours of being victimized (n = 154, 53.9%). Immediately prior to the sexual assault, more than two thirds (n = 197, 68.9%) of student victims had been drinking alcohol and, in the 72 hours prior to examination, a substantial minority had consumed prescription medication (n = 69, 24.1%), most commonly antidepressants and benzodiazepines (e.g., Celexa, Ativan), OTC medication (n = 41, 14.3%), most commonly analgesics and cough and cold medicines (e.g., Tylenol, plain and with codeine; Nyquil; Benedryl; Gravol), and street drugs (n = 43, 15.0%), including marijuana, crack, and cocaine (see Table 1).
Presentation Characteristics
Large urban centre defined as city with population of more than 700,000.
Includes small city, town, suburb, or rural area.
Student victims were overwhelmingly women (n = 280, 97.9%) and ranged in age from 16 to 46 years (M = 20.9 years; SD = 5.1). Approximately, half were identified as White (n = 142, 49.6%) and were living with family members, including spouses/partners (n = 159, 55.6%). More than one in five (n = 59, 20.6%) reported histories of mental health problems, including depression and anxiety, and 4.5% (n = 13) reported a physical, sensory, and/or cognitive disability, including arthritis, deafness, learning disabilities, and fetal alcohol effects (see Table 2).
Victim Characteristics
Includes Aboriginal, Arab/West Asian, Black, Chinese, Filipino, Japanese, Korean, Latin American, South Asian, and Southeast Asian persons.
Includes in an institution, in a shelter, or homeless.
Although in a substantial number of cases victims could not recall all the specific types of sex acts perpetrated against them, kissing and/or fondling was reported to have taken place in 47.6% (n = 136; victim unsure in 38.1%) of cases, cunnilingus and/or fellatio in 16.4% (n = 47; victim unsure in 47.2%), and oral, vaginal, and/or anal penetration in 63.6% (n = 182; victim unsure in 32.5%). A handful (n = 5, 1.8%) of victims indicated that a weapon had been used in assaulting them, and more than a quarter stated that they had suffered injuries (n = 79, 27.6%; see Table 3).
Assault Characteristics
Includes clients who did not know or did not remember (unsure) or declined to give an answer (unknown).
Comparison of Student Sexual Assault Victims to Other Sexual Assault Victims
As seen in Tables 1 to 3, in the bivariate analyses, several factors differentiated cases of student sexual assault from cases involving other sexual assault victims at a p value less than .10. Not surprisingly, as compared to nonstudent victims, students were more likely to be younger (p < .001) and living with family, including partners/spouses, and nonrelatives (p < .001). They were also more likely to report having consumed alcohol (p = .004) and OTC medications (p = .06) prior to being assaulted and to have indicated that they had been kissed and/or fondled (p = .007). In contrast, they were less likely than other sexual assault victims to report mental health problems (p < .001), disabilities (p < .001), consumption of prescription medications (p = .005) and street drugs (p = .02), assailant use of weapons (p < .001), and injuries as a result of the assault (p = .007).
As seen in Table 4, several of these variables were significant in the multivariate model. Compared to nonstudent victims, sexually assaulted students were more likely to be aged 16 to 18 years (OR: 18.54; 95% CI: [11.23, 30.61]) and 19 to 24 years (OR: 4.57; 95% CI: [3.11, 6.70]) versus 25 years and older. They were also more likely to be living alone (OR: 2.09; 95% CI: [1.06, 4.10]), with family of origin, a partner or spouse (OR: 3.13; 95% CI: [1.82, 5.38]), or nonrelatives, including roommates in college/university residences (OR: 5.12; 95% CI: [2.77, 9.48]) than on the street or in a shelter or institution. They were less likely to have disabilities (OR: 0.42; 95% CI: [0.21, 0.84]) and to report having used street drugs in the previous 72 hours (OR: 0.51; 95% CI: [0.33, 0.80]). In contrast, student victims were more likely than other victims to report having used OTC medications in the 72 hours prior to being examined (OR: 1.96; 95% CI: [1.20, 3.20]).
Factors Associated With Student Sexual Assault
Note: N = 882; OR = odds ratio; CI = confidence interval; Hosmer and Lemeshow goodness-of-fit p value is .983.
Includes in an institution, in a shelter, or homeless.
Discussion
This exploratory study fills a significant gap in the sexual assault literature by comparing student to nonstudent sexual assault victims. Our findings indicate that one third of victims reporting sexual assault seen at hospital-based sexual assault treatment centers in Ontario were students. This group was mostly young, White women, living with family. Many students delayed in presenting for immediate care and reported that they had consumed alcohol prior to the assault. The effects of this alcohol consumption, along with the psychological trauma, which may have been incurred as a result of the assault, might have contributed to their inability to recall important details of what had happened to them (Gauntlett-Gilbert, Keegan, & Petrak, 2004; Russell & Curran, 2002). Student victims differed significantly from other sexual assault victims with regard to certain characteristics and activities prior to the assault.
Several demographic characteristics were associated with being a student victim of sexual assault. Not surprisingly, as student status is generally associated with youth, student victims were 18 years and four times more likely than other sexual assault victims to be aged 16 to 18 years and 19 to 24 years of age, respectively. Perhaps being able to learn and attend classes requires a certain degree of stability and support, as compared to nonstudents, student victims were also approximately two, three, and five times more likely to be living alone, with family, and nonrelatives, respectively, than on the streets, or in shelters, and other institutions. This finding supports those from an American study that found younger sexual assault victims were less likely to be homeless than those aged 40 to 55 years (Eckert & Sugar, 2008).
One health characteristic was negatively associated with student sexual assault. Although a small minority of students disclosed having a disability, overall, students were almost 60% less likely than nonstudent victims to report histories of cognitive, physical, and/or sensory impairments. As compared to other sexual assault victims, there is a dearth of published studies on the experiences of sexual assault among students with disabilities. The fact that students in our study were less likely than nonstudent victims to report a history of disabilities may suggest that they are less common in this group, perhaps due to their younger age or that persons with disabilities are less likely to be attending high school or college/university (Del Bove et al., 2005; Eckert & Sugar, 2008).
Two substance use variables were also associated with the sexual assault of students. Student victims were about 50% less likely than nonstudent victims to report having used street drugs prior to the assault. This is somewhat unexpected given the focus of much violence research on the consumption of illegal drugs by students (e.g., Krebs et al., 2009a; Krebs, Lindquist, Warner, Fisher, & Martin, 2009b). Studies have typically shown higher levels of street drug use among students who are sexually assaulted compared with students who are not (e.g., Cass, 2007; Nagy et al., 1995). In contrast, OTC medications such as cough and cold and pain relief medicines were almost twice as likely to have been used by students. These medications, which can have sedating effects, may have enhanced the effects of any alcohol consumed increasing students’ vulnerability to being victimized (Jenkins & Stillwell, 2010; Weathermon & Crab, 1999). Recall that more than two thirds of students had drunk alcohol immediately prior to being assaulted, a proportion that was higher in the bivariate analyses than for nonstudent victims. Differences from other sexual assault victims regarding student use of OTC medications points to the need for further research in this area.
Several limitations of our study warrant discussion, some of which are common to other sexual assault research and could be addressed in future studies (Eckert & Sugar, 2008). These include the reliance for some variables on self-reported data (e.g., mental health problems, injuries). For instance, as victims may not have known that they had sustained physical trauma, particularly in the anogenital region, the proportion experiencing injuries may have been underestimated. There were also substantial missing data on all the specific types of sex acts perpetrated against victims and several variables that might have further helped contextualize the experiences of student sexual assault victims were not examined. These included the level of schooling, relationship to offender, and amount of alcohol consumed prior to the assault (Del Bove et al., 2005; Eckert & Sugar, 2008; Mohler-Kuo, Dowdall, Koss, & Wechsler, 2004; Saewyc et al., 2009; Stermac et al., 1998). Finally, because this research draws on data from individuals presenting to hospital-based treatment centers, the findings may not be fully generalizable to other student sexual assault victims, who do not seek care following their assault.
Conclusion
The findings have important implications for educational initiatives and clinical practice. The substantial proportion of students among victims seeking sexual assault care and forensic evaluation in the community should be of concern to school/college/university administrators in terms of program planning and policies. Given the gendered nature of sexual violence and the fact that almost 98% of students victims were female (Du Mont & White, 2007), male peer-based programming focused on violence in the behaviors and belief systems of men and boys should be enhanced and expanded (Foubert, Godin, & Tatum, 2010; Schwartz, DeKeseredy, Tait, & Alvi, 2001). Traditionally, sexual assault educational campaigns for college and university students have focused on risk reduction through cautionary messages regarding alcohol and illicit drug consumption (e.g., Hensley, 2002; Krebs et al., 2009b; UCLA Counseling and Psychological Services, 2010). Our results, however, indicate a need for prevention and educational interventions that also address the possible interactive effects of consuming alcohol with other types of substances such as OTC medications. With regard to students’ younger age, addressing their particular needs for medical care and counseling should be an integral part of sexual assault services and should include a health education and healthy relationships component. Most students are sexually active by college/university (Boynton Health Service, 2007), and, compared to older adults, they may be more likely to engage in unprotected intercourse, experience sexually transmitted infections and unintended pregnancies, and perceive controlling behaviors and intense jealousy as “attentive” or “caring” behaviors, the latter of which can put them at risk for subsequent physical aggression in dating relationships (Centers for Disease Control and Prevention, 2009; Eaton et al., 2010; Murphy & Smith, 2010; Trussell & Wynn, 2008).
Footnotes
Acknowledgements
The authors are indebted to the sexual assault nurses, physicians, and program coordinators and the women and men who participated in this study.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded by a peer-reviewed grant from the Ontario Women’s Health Council (now ECHO, An Agency of the Ministry of Health and Long-Term Care). J. Du Mont is supported by the Atkinson Foundation.