Prevalence and psychosocial correlates of alcohol-related sexual assault among university students.

Howard, Donna E. ; Griffin, Melinda A. ; Boekeloo, Bradley O. 等

INTRODUCTION

While there is a great deal of evidence linking personal alcohol use with negative psychosocial consequences among college students, the effect that others' heavy drinking has on non-drinkers or moderate drinkers has only recently been explored (Hingson, Heeren, Winter, & Wechsler, 2005; Perkins, 2002; Wechsler, Lee, Nelson, & Lee, 2001; Langley, Kypri, & Stephenson, 2003). Those negative experiences that students (whether drinking or abstaining) suffer which result from someone else's drinking are termed "secondhand effects" (Wechsler, Lee, Nelson, & Kuo, 2002; Wechsler et al., 2001; Langley et al., 2003). There is concern that these alcohol-related effects may be amplified on college campuses with high drinking rates and school policies that require undergraduates, especially freshmen, to reside in on-campus housing. One serious negative secondhand effect which warrants more attention is alcohol-related sexual assault.

As defined by the National Center for Victims of Crime, sexual assault takes many forms including attacks such as rape or attempted rape, as well as any unwanted sexual contact or threats (NIAAA, 2007). Integrating data from a number of national surveys of college students in 1998 and 2001, Hingson et al. documented that over 400,000 students (8%) reported unprotected intercourse as a result of their alcohol use, and almost 100,000 students annually reported being victims of date rape or sexual assault (Hingson et al., 2005). This figure may not include the over 100,000 students who reported having been too intoxicated to know if they consented to having sex (Hingson et al., 2005; Hingson, Heeren, Zakocs, Kopstein, & Wechsler, 2002). Thus, at least half of college students' sexual assaults may be associated with alcohol use (Abbey, Zawacki, Buck, Clinton, McAuslan, 2001; Collins & Messerschmidt, 1993; Crowe & George, 1989). More specifically, over one-half of all sexual assaults are committed by men who have been drinking alcohol, while approximately 50% of victims also report alcohol use at the time of the assault (Abbey et al., 2001). Furthermore, women in college who use drugs, attend a university with high drinking rates, belong to a sorority, and drank heavily in high school appear at greater risk for rape while intoxicated (Mohler-Kuo, Dowdall, Koss, & Wechsler, 2004). According to reports by the Centers for Disease Control, roughly 1 in 4 adolescents suffer from sexual abuse in a dating relationship (Choose Respect, 2007).

To compound the issue of alcohol-related sexual assault, in overwhelming numbers, college students (including those under the legal drinking age) report not only use of alcohol but binge drinking (Johnston, O'Malley, & Bachman, 1996; Shalala, 1995). Furthermore, despite numerous intervention efforts, recent trend data suggest that from 1999 to 2002 the proportion of college students who engaged in heavy episodic or binge drinking remained high and relatively constant, increasing from 41.7% to 43.2% (Hingson et al., 2005). Corroborating evidence of the persistently high prevalence of heavy alcohol use during a period of increased prevention efforts comes from the Harvard School of Public Health study of trends in binge drinking (Wechsler et al., 2002). The College Alcohol Study (CAS) surveyed students at 119 four-year colleges in 1993, 1997, 1999, and 2001. Little change in overall binge drinking was evidenced at the individual college level; interestingly, the percentages of both abstainers and frequent binge drinkers increased. Alcohol abuse thus remains a major health problem on college campuses with serious negative consequences for individual drinkers, and serious negative secondhand effects for those around them (Wechsler et al., 2002).

The role of alcohol both as a precipitating and explanatory factor for sexual aggression among males has been well-articulated, as has its role in increasing female vulnerability and risk of victimization, partially due to the lowered awareness of risky situations, impaired judgment, and/or ability to resist assault (Larimer, Lydum, Anderson, & Turner, 1999). Davis et al. found, in a study which used hypothetical dating situations to examine how alcohol consumption affects women's responses to unwanted sexual advances, that intoxicated women were more likely to consent to their dating partner's sexual advances and respond passively to such advances (Davis, George, Norris, 2004). Yet, while these women may be willing to consent to some sexual contact, their consent may be misinterpreted as indicating a desire for sexual intercourse, particularly among men who are intoxicated (Abbey et al., 2004).

Finally, at a time where heavy drinking seems to have become embedded in the cultural transition to college, some interventionists are advocating the adoption of a harm-reduction perspective. This approach centers on reducing alcohol-related negative consequences rather than stressing alcohol abstinence as the ultimate goal (Schulenberg & Maggs, 2002; Howard, Griffin, Boekeloo, Lake, & Bellows, 2007; Benton, Schmidt, Newton, Shin, Benton, & Newton, 2004; Delva, Smith, Howell, Harrison, Wilke, & Jackson, 2004; Martens, Taylor, Damann, Page, Mowry, & Cimini, 2004). That is, by adopting harm-reduction strategies, students may become empowered to drink more responsibly and minimize negative consequences of their alcohol-use decisions and enable them to protect themselves from others or in potentially dangerous situations (Graham, Tatterson, Roberts, & Johnston, 2004; McBride, Farringdon, Midford, Meuleners, & Phillips, 2003; Marlatt & Witkiewitz, 2002; Single, 1996; Marlatt, Somers, & Tapert, 1993; Marlatt, 1996). In recent years, documentation of the effectiveness of such protective behavioral strategies has been initiated; there is some support that it may decrease students' experiences with negative alcohol-related consequences. While the literature is scarce on the protective effect of such behavioral strategies, it is thought that they may also decrease students' experiences of alcohol-related sexual assault (Benton et al., 2004; Delva et al., 2004; Martens et al., 2004).

Within this context, the aim of the present study was to estimate the prevalence and examine the correlates of alcohol-related sexual assault among predominately freshmen students attending a large public university in the mid-Atlantic region. We hypothesized that engagement in risk behaviors, i.e., use of various licit and illicit substances, exposure to violence, and being in situations where alcohol was present, including exposure to secondhand alcohol use, would be positively associated with reports of alcohol-related sexual assault. We further hypothesized that students who engaged in alcohol-related protective behaviors would be less likely to report alcohol-related sexual assault. To this end, we examined the extent to which personal alcohol use and contextual factors, such as being in alcohol-use situations, increased the odds of alcohol-related sexual assault and whether activation of alcohol-related protective strategies moderated this risk.

METHOD

Design and Sample

As part of a larger National Institute of Alcohol Abuse and Alcoholism (NIAAA) funded college alcohol intervention trial, "Peers as Family: Preventing Problem Drinking" (Boekeloo, 2005), a survey was administered to students living in predominantly freshmen residence halls at a large, mid-Atlantic university. This was a sub-study of a larger NIAAA-funded college alcohol problem prevention trial and was approved by the University's Institutional Review Board (IRB). The larger three-arm trial (comparing single gender, mixed gender, and control conditions) was conducted to determine whether a series of three educational workshops targeted at freshmen dormitory wings (wings were the unit of assignment) could effectively reduce quantity and frequency of alcohol use as well as problems associated with alcohol use.

The data for this study were obtained as part of the larger trial as follows: A purposive sampling frame was constructed from wings of students living in on-campus, traditional, high-rise, freshmen dormitories. Of the eight on-campus freshman high-rise dormitories, with wings supervised by a Resident Advisor, four dormitories had wings with a preponderance of incoming freshmen (rather than upperclassmen) and afforded balance across trial arms based on number of students per wing and number of wings by student gender. Of 64 wings in the four dormitories, 36 were chosen for the trial because they maximized the number of incoming freshmen per wing and balanced dormitory, student gender, and special wing-based learning programs across arms of the trial. Approximately two months after the beginning of the school year (Fall 2006) and 2 weeks after the final workshop in the trial, a web-based follow-up survey was conducted with all students in the 36 trial wings. This follow-up survey provided the data for the study described here.

Once the sampling frame was established and university IRB approval was received, students were recruited to complete an online consent form and a series of web-based surveys (baseline, two- and seven-month follow-ups) via personalized emails and flyers hung in residence halls. To minimize nonparticipation at the two-month follow-up, initial non-respondents were sent letters and a paper version of the survey. This study is based on a two-month follow-up wave of data collection which was conducted approximately 60 days into the start of the Fall 2006 semester and 2 weeks following the third and final workshop.

Of 1,269 students (634 males, 635 females) recruited, 551 (227 males and 324 females) students supplied reliable and valid data for a response rate of 43.4% (35.3% males, 51.0% females). Eleven paper surveys were received and the remaining 540 cases were obtained via the web-based survey. Among those students who completed surveys, the majority were recent drinkers (defined as self-reported alcohol use in prior 30 days (n = 333, 60.4%), white (n = 334, 60.6%), 18 years of age (n = 418, 75.9%), living-learning members (n = 363, 65.9%), and first-year freshmen (n = 509, 92.4%). Among the survey nonrespondents, the majority were male (n = 407, 56.7%), white (n = 396, 55.2%), 18 years of age (n = 534, 74.4%), non-living-learning members (n= 436, 60.7%), and first-year freshmen (n = 649, 90.4%). Proportionately fewer males, non-living-learning members, and black students completed the survey.

Survey Procedures and Measures

All survey procedures explained are consistent with the procedures of the parent study. As part of the personalized emails recruiting students to complete a survey about college peer experiences, a link to the web-based survey was included along with a unique study identification number. Once students were directed to the survey website, they were instructed to electronically sign a consent/assent form and respond to each item in a confidential manner. An assent form was included because 17-year-olds were permitted to participate in the study without parental notification and was required by the university IRB. Students were also assured that their responses would be linked only to their unique study identification number. While the primary focus of the survey was to assess alcohol-related behaviors, it addressed a number of other areas related to personal well-being and residence hall life.

The outcome variable for this study was alcohol-related sexual assault. Alcohol-related sexual assault was a composite of 2 items which measured how often within the 60 days prior to completing the survey, students "experienced an unwanted sexual advance" or "was the victim of sexual assault or date rape" due to the other person's alcohol use. The response options were 0 = none, 1 = 1 time, 2 = 2 times, and 3 = 3 or more times. For analysis, the two items were summed and recoded as a binary variable with 1 = ever experienced alcohol-related sexual assault (sum of at least one) or 0 = never experienced alcohol-related sexual assault. Independent variables included use of illicit substances, contextual factors such as drinking in social situations, secondhand interpersonal violence, alcohol-related protective behavioral strategies, as well as sociodemographics.

The substance use items were continuous variables but recoded as binary "ever" versus "never" variables. Students were instructed to indicate how many days, in the previous 30 days, they used the following substances: beer, wine or wine coolers, liquor or spirits, prescription medication without a prescription (i.e., Vicodin, Percoset, Oxycontin, Ritalin), other nonprescription drugs (i.e., marijuana, cocaine, amphetamines, hallucinogens), and combined drinking alcohol with taking drugs. The alcohol-specific items were combined to create a general "drinker" variable. That is, students who responded positively to any of the alcohol use items were classified as a recent drinker. Students were also instructed to indicate how often, in the previous 30 days, they had engaged in a binge-drinking episode, defined as 5 or more drinks in a row within a couple of hours for males and 4 or more drinks for females. The binge-drinking item was also recoded as binary "ever" versus "never" variable. One additional item was included in the analysis which asked students to report, on average since arriving on campus for the semester, "how often were you in situations where there was alcohol?" The definition of an alcohol situation was not included in the wording of the survey. Therefore, the students would have had to subjectively define it on their own prior to responding to this specific item. Originally, this item was constructed as a continuous variable with response options of never, less than once a week, once or twice a week, three or four times a week, five or six times a week, and everyday. For this study, the item was also recoded as a binary "ever" versus "never" variable.

Drinking in social situations was included as a contextual measure to capture where and why students consume alcohol. These items were taken from the Social Facilitation sub-scale of the Social Context of Drinking Scale, college version (Thombs, Beck, & Mahoney, 1993). Students were instructed to indicate how often they drank alcohol in the following situations since arriving on campus for the semester (2 months): at a bar or club, at a party with friends, to get drunk, with wing-mates, as part of a drinking game, before "going out," and to make it easier to go to bed with someone. The original response options to these social context items were "never," "seldom," "occasionally," and "frequently." A "drank in social situations" variable was created as follows: Students were assigned to the "never" category if they responded "never" to drinking in each situation. Students were assigned to the "high frequency" category if they reported that they frequently drank in at least one social situation. Those students who did not report "never" to every item or "frequently" to at least one item, were assigned to the "some frequency" category. Thus, the three categories included in the logistic regression analysis were never, some frequency, and high frequency.

Secondhand consequences related to other types of violence were included as an independent variable. Secondhand interpersonal violence was defined as violence victimization experienced due to another's alcohol use. The four items were: "harassed, insulted, or humiliated"; "had a serious argument or quarrel"; "pushed, hit, or assaulted"; and, "had my property damaged." Response options were 0 = none, 1 = 1 time, 2 = 2 times, and 3 = 3 or more times. The students were directed to respond to each item based on how often they experienced the negative secondhand effect since arriving on campus for the semester (2 months). The four items were then summed and recoded with categories of never, once, and 2 or more times.

Alcohol-related protective behavioral strategies are those self-control or harm-reduction behaviors individuals practice prior to, during, or after drinking to either limit consumption or the negative consequences associated with alcohol use (Benton et al., 2004; Delva et al., 2004; Martens et al., 2004). Enactment of alcohol-related protective behavioral strategies was measured by having students respond to five items borrowed from previous studies (Benton et al., 2004; Delva et al., 2004; Martens et al., 2004). After factor analysis and reliability testing, the five items were divided into two sub-scales labeled "alcohol avoidance" and "alcohol resistance." The "alcohol avoidance" items included: "choose not to drink alcohol," "avoid situations where there was alcohol," and "participate in activities that did not include alcohol" (Cronbach's alpha coefficient of 0.80). The "alcohol resistance" items were: "drink an alcohol look-alike" and "carry around a cup but not drink any alcohol" (Cronbach's alpha coefficient of 0.73). The response options were "never," "rarely," "sometimes," "usually," and "always." The students were directed to respond to each item based on how often they engaged in the protective behaviors since arriving on campus for the semester (2 months). Each sub-scale was, however, recoded as a binary variable. One category included those that responded "usually" or "always" to each item; the other category included all other responses and was labeled "sometimes/never."

The sociodemographic items included age, ethnicity, living-learning membership, and a question on whether the student had passed a web-based alcohol education program; the latter two items were coded as "yes" or "no" binary items. Living-learning membership refers to university acceptance into one of several format programs which include students who have similar academic interests and was included as a demographic variable due to the parent study's sampling frame and the method with which the university assigns residential locations in dormitories. Age was originally coded as a continuous item but recoded as a categorical variable. The original ethnicity item allowed students to check all categories that applied to them from a list that included: White-not Hispanic, Hispanic-not White, Asian/Pacific Islander, and Black/African American; however, during recoding, students were placed into single-race categories based on the following rubric: If a student checked off only "Black" or "Latino" s/he was coded as such. If a student checked off "Black" or "Latino" and another category, s/he was coded as "Other."

Data Analysis

All data were analyzed using SPSS version 14.0. Cross-tabulations were computed to estimate the prevalence of alcohol-related sexual assault by each independent variable for the total sample and by gender. Univariate logistic regression models were run to identify the relationships between alcohol-related sexual assault and each independent variable. The unadjusted odds ratios (OR) and 95% confidence intervals were examined. Multivariate logistic regression analysis was conducted, including only the significant independent variables from the univariate models, to identify significant predictors of alcohol-related sexual assault. Adjusted odds ratios and 95% confidence intervals were again examined from the multivariate models.

RESULTS

Prevalence

Demographic information regarding the sample has been provided. The overall prevalence of alcohol-related sexual assault was 14.7% (n = 81); however, there was a marked difference across gender with females more than 3 times as likely as males to report alcohol-related sexual assault (n = 66, 20.4% versus n = 15, 6.6%, respectively) (see Table 1). Being 17 years of age, a recent drinker and a binge drinker, using other substances, being in and drinking in alcohol situations, experiencing secondhand interpersonal violence, and rarely using protective behavioral strategies were all associated with a higher prevalence of alcohol-related sexual assault.

Bivariate Odds Ratios between Alcohol-related Sexual Assault and Psychosocial Risk Factors

Table 2 presents the unadjusted odds ratios for relationships between psychosocial factors and alcohol-related sexual assault. Among females, alcohol and illicit drug use, alone or in combination, and binge drinking were all significantly associated with alcohol-related sexual assault. The odds of being a victim of alcohol-related sexual assault were roughly three times greater if the female was a recent drinker (OR = 2.94), four and one-half times greater if she used illicit drugs (OR = 4.50), and somewhere in-between if she reported combining alcohol with taking drugs (OR = 3.51). Binge drinking, however, was associated with much greater odds of alcohol-related sexual assault (OR = 6.04). Those females who were in alcohol situations and drank more frequently in social situations were also more likely to experience alcohol-related sexual assault (OR = 4.49 and 5.72, respectively). Males who drank more frequently in social situations were more likely to experience alcohol-related sexual assault (OR = 4.36). Being a victim of other alcohol-related violence was associated with alcohol-related sexual assault for both males and females; however, the magnitude of the relationship was strikingly different. Reporting a single episode of violence victimization was significantly related to alcohol-related sexual assault for males, but not females, and the odds of alcohol-related sexual assault were 7 times as great for males who reported two or more violence experiences compared to females with similar reports (OR = 49.84 and 6.94, respectively.

Use of alcohol avoidance protective strategies appeared protective for females only. Specifically, women who infrequently or never used alcohol-avoidance behavioral strategies were at least two and one-half times more likely to experience alcohol-related sexual assault (OR = 2.64). Age, race, living-learning membership, online alcohol education, using prescription medication without a prescription, and alcohol resistance protective behavioral strategies were not significantly related to experiencing alcohol-related sexual assault.

Multivariate Relationship between Alcohol-related Sexual Assault and Psychosocial Risk Factors

All variables that were significant in the univariate logistic models were entered into a multivariate logistic model. Table 3 presents the adjusted odds ratios from the multivariate logistic model. For females, the odds of being a victim of alcohol-related sexual assault were seven times greater if they reported recent binge drinking and five times greater if they had two or more other violence victimization experiences (OR = 7.74 and 5.03, respectively). For males, the only significant predictor of alcohol-related sexual assault was having reported other violence victimization; there, a dose response relationship was evident. That is, the odds of being a victim of alcohol-related sexual assault were 12 times greater if the male had one violence-related experience but 43 times greater if he had two or more such experiences (OR = 12.58 and 43.45, respectively).

DISCUSSION

Alcohol-related sexual assault, defined as alcohol-related unwanted sexual advances and/or sexual assault or date rape, appeared prevalent among this sample of predominantly freshmen university students. That is, almost 1 in 7 students reported having such experiences. Not unexpectedly, females were much more likely to report alcohol-related sexual assault than were males. Indeed, the experience of alcohol-related sexual assault appeared almost commonplace among females, with approximately 1 out of every 5 reporting such victimization. Clearly, the scope of such experiences is alarmingly high.

Our hypothesis that engagement in risk behaviors, i.e., use of various licit and illicit substances, being in situations where alcohol was present, and being a victim of secondhand alcohol-related effects would be positively associated with reports of alcohol-related sexual assault was only partially supported. Independently, substance use and being in situations where alcohol was present was associated with alcohol-related sexual assault; however, these findings were significant only among females. The cross-sectional nature of the present data, however, precludes our ability to determine whether drug use increases females' vulnerability to alcohol-related sexual assault, represents a coping mechanism, albeit maladaptive, to assuage the physical and psychological effects of victimization, or whether some additional factor or set of factors account for this observed relationship.

We further hypothesized that students who engaged in alcohol-related protective behaviors would be less likely to report alcohol-related sexual assault. Again, for females, when examined independent of other risk and protective factors, enactment of alcohol avoidance strategies significantly decreased their risk of being sexually victimized; however, this finding did not hold upon further investigation. This lack of finding in the multivariate analysis may be due to multi-collinearity among the predictor variables. That is, a number of independent variables were significantly correlated and their individual effects may have been washed out.

As noted, earlier, a number of researchers (ourselves included) have argued that since heavy drinking seems to be embedded in the cultural transition to college, a harm-reduction perspective, which centers on decreasing the negative consequences of heavy drinking, should be adopted (Schulenberg & Maggs, 2002; Howard et al., 2007; Benton et al., 2004; Delva et al., 2004; Clapp, Shillington, & Segars, 2000). That recommendation is based on findings from a growing body of research that suggests college students have a repertoire of coping strategies they employ in an attempt to safeguard themselves and their friends from harm when consuming alcohol. These strategies encompass preparatory planning to ensure a safe context for drinking, safety measures to minimize harm when out drinking, and caretaking strategies for when they or their friends have had too much to drink. Clearly, more attention needs to be focused on the success or failure of various initiatives in relation to different kinds of harm. A serious concern is that while some protection may be afforded students, they may develop a false sense of security and not objectively gauge their potential vulnerability for certain types of harm, such as alcohol-related sexual assault. We did examine whether activation of alcohol-related protective strategies moderated the risk of alcohol-related sexual assault violence among binge drinkers, but results were not significant, possibly due to the students' lack of control over others' behaviors.

Our findings offer further corroboration that alcohol may be at the fulcrum of risk for female college students who report being victims of alcohol-related sexual assault. Recent binge drinking was the most potent predictor of victimization for females, and one of only two factors that remained significant when a host of risk factors where examined simultaneously. What is not evident is the motivation behind binge drinking and whether these young women are aware of the increased risk of victimization associated with this behavior.

Whether the sample consists of students in the mid-Atlantic region of the U.S. or those attending a university in New Zealand, research findings suggest that students who drink heavily experience more unwanted sexual advances than those who do not. In the latter study, a linear relationship was evidenced such that the risk of unwanted sexual advances increased as drinking behavior changed to greater frequency (Langley et al., 2003). This association may be due to a host of factors that come into play in the context of heavy drinking. Research on the ways in which alcohol distorts perceptions and alters refusal communications is widely available; as an example, the alcohol myopia theory which suggests that compared to sober persons, drinkers may attend to a restricted range of cues, and take longer to understand and put them together in a cohesive way (Lannutti & Monahan, 2004).

Across gender, a strong significant relationship was evidenced between the experience of interpersonal violence in the context of another person's drinking, i.e., having had one's person or property assaulted, fighting or harassment, and being a victim of alcohol-related sexual assault. That is, there appears to be a generalized risk of multiple victimization experiences and this was markedly evident for the male college students. Males who reported a single violent episode involving another's alcohol use were twelve times as likely to report alcohol-related sexual assault whereas if they experienced multiple violent episodes, their risk of alcohol-related sexual assault increased almost four-fold. These males may represent a subset of highly at-risk young adults who, for various reasons, find themselves in social and relational contexts where Violence is prevalent and victimization takes multiple forms, including sexual. Without examination of contextual or developmental factors, it is difficult to determine the origins or temporal relations of these findings. It can be stated, however, that too little attention has been paid to identifying and understanding the risks and consequences for these vulnerable young men.

Limitations

The use of a purposive sampling frame to assure balance across gender and living-learning membership limits the ability to generalize to other college students. Students were recruited heavily to complete the survey but still may have self-selected into survey participation. Thus, despite efforts to recruit a diverse sample of students that reflected the socio-demographic and academic make-up of the freshman class, logistical and selection factors affected the selection process. Furthermore, the demographic information presented on the eligible but nonparticipating students study sample was based on administrative data received from the Department of Resident Life and thus cannot be directly compared with the self-reported demographic information presented for the survey respondents.

The reliance on self-report data is also an issue in that students may have subjectively defined the outcome variables of interest of "unwanted sexual advance" and "victim of sexual assault or date rape" and reported frequency based on the subjective interpretations of their meaning. Therefore, an under/over reporting of experiences of alcohol-related sexual assault may have resulted. Furthermore, lack of power might have made it difficult to find significant relationships between risk factors and alcohol-related sexual assault among the males.

CONCLUSIONS

Study findings suggest that alcohol-related sexual assault affects a small, but significant number of college students, particularly females. The experience of alcohol-related sexual assault is associated with engagement in risky substance use and experiencing other secondhand interpersonal violence. These individual and interpersonal factors and the psychosocial sequelae of alcohol-related sexual assault deserve further attention through longitudinal research and intervention efforts, especially in the context of alcohol use prevention and harm-reduction efforts.

REFERENCES

Abbey, A., & McAuslan, P. (2004). A longitudinal examination of male college students' perpetration of sexual assault. Journal of Consulting and Clinical Psychology, 72(5), 747-756.

Abbey, A., Zawacki, T., Buck, P. O., Clinton, M. A., & McAuslan, P. (2001). Alcohol and sexual assault. Alcohol Health Research World, NIAAAA, 25(1).

Benton, S. L., Schmidt, J. L., Newton, F. B., Shin, K., Benton, S. A., & Newton, D. W. (2004). College student protective strategies and drinking consequences. Journal of Studies on Alcohol, 65, 115-121.

Boekeloo, BO. (2005). Principal Investigator: Peers as family: Preventing problem drinking. Funded by National Institutes of Alcohol Abuse and Alcoholism. Grant #R01AA015139-01A1.

Choose Respect: Centers for Disease Control and Prevention. Available at: http://www.chooserespect.org/scripts/teens/statistics.asp. Accessed March 17, 2007.

Clapp, J. D., Shillington, A. M., & Segars, I. B. (2000). Deconstructing contexts of binge drinking among college students. American Journal of Drug and Alcohol Abuse, 26, 139-154.

Collins, J. J., & Messerschmidt, P. M. (1993). Epidemiology of alcohol-related violence. Alcohol Health Research World, NIAAA, 17, 93-100.

Crowe, L. C., & George, W. H. (1989). Alcohol and human sexuality: Review and integration. Psychological Bulletin, 105, 374-386.

Davis, K. C., George, W. H., & Norris, J. (2004). Women's responses to unwanted sexual advances: The role of alcohol and inhibition conflict. Psychology of Women Quarterly, 28, 333-343.

Delva, J., Smith, M. P., Howell, R. L., Harrison, D. F., Wilke, D., & Jackson, D. L. (2004). A study of the relationship between protective behaviors and drinking consequences among undergraduate college students. Journal of American College Health, 53, 19-27.

Graham, J. W., Tatterson, J. W., Roberts, M. M., & Johnston, S. E. (2004). Preventing alcohol-related harm in college students: Alcohol-related Harm Prevention program effects on hypothesized mediating variables. Health Education Research, 19(1), 71-84.

Hingson, R., Heeren, T., Winter, M., & Wechsler, H. (2005). Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18-24: Changes from 1998 to 2001. Annual Review of Public Health, 26, 259-79.

Hingson, R. W., Heeren, T., Zakocs, R. C., Kopstein, A., & Wechsler, H. (2002). Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18-24. Journal of Studies on Alcohol, 63, 136-44.

Howard, D. E., Griffin, M., Boekeloo, B., Lake, K., & Bellows, D. (2007). Staying safe while consuming alcohol: A qualitative study of the protective strategies and informational needs of college freshmen. Journal of American College Health, 56(3), 247-54.

Johnston, L. D., O'Malley, P. M., & Bachman, J. G. (1996). National Survey Results on Drug Use from the Monitoring the Future Study, 1975-1994: College Students and Young Adults. Rockville, MD: National Institute on Drug Abuse.

Langley, J. D., Kypri, K., & Stephenson, S. C. (2003). Secondhand effects of alcohol use among university students: Computerized survey. British Medical Journal, 327, 1023-24.

Lannutti, P. J., & Monahan, J. L. (2004). "Not now, maybe later": The influence of relationship type, request and persistence, and alcohol consumption on women's refusal strategies. Communication Studies, 55, 362-378.

Larimer, M. E., Lydum, A. R., Anderson, B. K., & Turner, A. P. (1999). Male and female recipients of unwanted sexual contact in a college student sample: Prevalence rates, alcohol use, and depression symptoms. Sex Roles, 40, 295.

Marlatt, G. A., & Witkiewitz, K. (2002). Harm reducation approaches to alcohol use: Health promotion, prevention and treatment. Addictive Behavior, 27, 867-86.

Marlatt, G. A. (1996). Harm reduction. Come as you are. Addictive Behavior, 21(6), 779-88.25.

Marlatt, G. A., Somers, J. M., & Tapert, S. F. (1994). Harm reduction: Application to alcohol abuse problems. NIDA Research Monograph, 137, 147-166.

Martens, M. P., Taylor, K. K., Damann, K. M., Page, J. C., Mowry, E. S., & Cimini, M. D. (2004). Protective behavioral strategies when drinking alcohol and their relationship to negative alcohol-related consequences in college students. Psychology of Addictive Behavior, 18(4), 390-393.

McBride, N., Farringdon, F., Midford, R., Meuleners, L., & Phillips, M. (2003). Early unsupervised drinking: Reducing the risks. The School Health and Alcohol Harm Reduction Project. Drug and Alcohol Review, 22(3), 263-276.

Mohler-Kuo, M., Dowdall, G. W., Koss, M. P., & Wechsler, H. (2004). Correlates of rape while intoxicated in a national sample of college women. Journal of Studies on Alcohol, 65(1), 37-45.

NIAAA: National Center for Victims of Crime. The Sexual Assault. Available at: http://www.neve.org/neve/main.aspx?dbName=DocumentViewer&DocumentID=32369#1. Accessed March 15, 2007.

Perkins, H. W. (2002). Surveying the damage: A review of research on consequences of alcohol misuse in college populations. Journal of Studies on Alcohol, 14, 91-100.

Schulenberg, J. E., & Maggs, J. L. (2002). A developmental perspective on alcohol use and heavy drinking during adolescence and the transition to young adulthood. Journal of Studies on Alcohol, 14, 54-70.

Shalala, D. E. NIAAA, Alcohol Alert, No. 29 PH 357 July 1995.

Single, E. (1996). Harm reduction as alcohol-prevention strategy. Alcohol Health Research World, 20(4), 239.

Thombs, D. L., Beck, K. H., & Mahoney, C. A. (1993). Effects of social context and gender on drinking patterns of young adults. Journal of Counseling Psychology, 40(1), 115-119.

Wechsler, H., Lee, J. E., Nelson, T. F., & Kuo, M. (2002). Underage college students' drinking behavior, access to alcohol, and the influence of deterence policies: Findings from the Harvard School of Public Health College Alcohol Study. Journal of American College Health, 50(5), 203-217.

Wechsler, H., Lee, J. E., Nelson, T. F., & Lee, H. (2001). Drinking levels, alcohol problems and secondhand effects in substance-free college residences: Results of a national study. Journal of Studies on Alcohol, 62(1), 23-31.

This study was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism, Grant #R01AA015139-01A1, to Bradley O. Boekeloo Investigator.

Donna E. Howard, Melinda A. Griffin, and Bradley O. Bockeloo, Department of Public and Community Health, University of Maryland College Park School of Public Health.

Requests for reprints should be sent to Donna E. Howard, DrPH, Department of Public and Community Health, UMCPSPH, 2387 Valley Drive, University of Maryland, College Park, MD 20742. E-mail: dhowardl@umd.edu

Table 1. Prevalence of Recent Alcohol-related sexual assault Violence
among College Students Residing in Freshmen Dormitories by Personal
and Behavioral Risk Factors

 Total
 Sample Females Males
Risk Factors N=551 N=324 N=227

Age
 19 or older 16.92 26.67 8.57
 18 14.11 18.88 7.10
 17 22.45 30.56 0.00
Ethnicity
 Black 11.90 15.63 0.00
 Asian/PI 15.45 19.72 7.69
 Hispanic 18.75 20.00 16.67
 White 14.93 21.84 6.51
Part of Living-Learning Community
 Yes 14.71 20.11 4.30
 No 15.19 21.58 8.40
Passed Online Alcohol Education
 Yes 15.05 21.36 6.02
 No 13.33 0.00 25.00
Recent Drinker
 Yes 19.22 26.53 8.76
 No 7.80 10.94 3.33
Rx without Prescription
 Yes 21.43 25.00 16.67
 No 14.67 20.19 6.57
Illicit Drug Use
 Yes 32.81 47.37 11.54
 No 12.42 16.67 6.22
Combined Alcohol and Drug Use
 Yes 31.82 44.00 15.79
 No 13.36 18.31 6.03
Recent Binge Drinking
 Yes 24.89 38.52 9.35
 No 7.45 9.41 4.17
Been in Alcohol Situations
 Yes 16.63 22.46 7.89
 No 3.08 6.06 0.00
Drank in Social Situations
 High Frequency 29.71 39.53 13.46
 Some Frequency 11.96 16.53 5.68
 Never 7.35 10.26 3.45
Secondhand Interpersonal Violence
 [greater than or equal to] 2 Times 38.83 48.33 25.58
 1 Time 16.00 20.97 7.89
 Never 7.18 11.88 0.68
Protective Behavioral Strategies
 Alcohol Avoidance
 Usually/Always 7.84 10.99 3.23
 Sometimes/Never 17.69 24.56 8.02
 Alcohol Resistance
 Usually/Always 7.69 10.26 0.00
 Sometimes/Never 15.68 22.14 7.11

Table 2. Unadjusted Odds Ratios for Relationships between Recent
Alcohol-related sexual assault Violence and Personal and Behavioral
Risk Factors among College Students Residing in Freshmen
Dormitories (95% Confidence Intervals)

Risk Factors Total Sample

Age
 19 or older 0.70 (.28-1.79)
 18 0.57 (.28-1.17)
 17 1.00
Race
 Black 0.81 (.30-2.15)
 Asian/PI 1.09 (.60-1.99)
 Hispanic 1.38 (.38-5.01)
 White 1.00
Part of Living-Leaming Community
 No 1.04 (.65-1.67)
 Yes 1.00
Passed Online Alcohol Education
 No 0.87 (.19-3.92)
 Yes 1.00
Recent Drinker
 Yes 2.81 (1.60-4.95) ***
 No 1.00
Rx without Prescription
 Yes 1.59 (.43-5.82)
 No 1.00
Illicit Drug Use
 Yes 3.44 (1.91-6.20) ***
 No 1.00
Combined Alcohol and Drug Use
 Yes 3.03 (1.53-6.01) **
 No 1.00
Recent Binge Drinking
 Yes 4.12 (2.47-6.87) ***
 No 1.00
Been in Alcohol Situations
 Yes 6.28 (1.51-26.22) *
 No 1.00
Drank in Social Situations
 High Frequency 5.33 (2.81-10.10) ***
 Some Frequency 1.71 (.88-3.35)
 Never 1.00
Secondhand Interpersonal Violence
 [greater than or equal to] 2 Times 8.20 (4.65-14.48) ***
 1 Time 2.46 (1.26-4.82) **
 Never 1.00
Protective Behavioral Strategies
Alcohol Avoidance
 Usually/Always 0.40 (.21-.75) **
 Sometimes/Never 1.00
Resistance
 Usually/Always 0.45 (.16-1.28)
 Sometimes/Never 1.00

Risk Factors Females

Age
 19 or older 0.83 (.28-2.42)
 18 0.53 (.24-1.15)
 17 1.00
Race
 Black 0.67 (.24-1.85)
 Asian/PI 0.89 (.45-1.76)
 Hispanic 0.90 (.18-4.43)
 White 1.00
Part of Living-Leaming Community
 No 1.09 (.63-1.89)
 Yes 1.00
Passed Online Alcohol Education
 No 0.00 (.00-)
 Yes 1.00
Recent Drinker
 Yes 2.94 (1.55-5.57) **
 No 1.00
Rx without Prescription
 Yes 1.32 (.26-6.68)
 No 1.00
Illicit Drug Use
 Yes 4.50 (2.21-9.15) ***
 No 1.00
Combined Alcohol and Drug Use
 Yes 3.51 (1.51-8.15) **
 No 1.00
Recent Binge Drinking
 Yes 6.04 (3.23-10.96) ***
 No 1.00
Been in Alcohol Situations
 Yes 4.49 (1.05-19.27) *
 No 1.00
Drank in Social Situations
 High Frequency 5.72 (2.74-1 1.96) ***
 Some Frequency 1.73 (.81-3.73)
 Never 1.00
Secondhand Interpersonal Violence
 [greater than or equal to] 2 Times 6.94 (3.58-13.45) ***
 1 Time 1.97 (.93-4.15)
 Never 1.00
Protective Behavioral Strategies
Alcohol Avoidance
 Usually/Always 0.38 (.18-.78) **
 Sometimes/Never 1.00
Resistance
 Usually/Always 0.40 (.14-1.17)
 Sometimes/Never 1.00

Risk Factors Males

Age
 19 or older 0.00 (.00-)
 18 0.00 (.00-)
 17 1.00
Race
 Black 0.00 (.00-)
 Asian/PI 1.34 (.35-5.21)
 Hispanic 3.22 (.34-30.58)
 White 1.00
Part of Living-Leaming Community
 No 2.04 (.63-6.62)
 Yes 1.00
Passed Online Alcohol Education
 No 5.21 (.96-28.37)
 Yes 1.00
Recent Drinker
 Yes 2.78 (.76-10.16)
 No 1.00
Rx without Prescription
 Yes 2.84 (.31-26.03)
 No 1.00
Illicit Drug Use
 Yes 1.97 (.52-7.50)
 No 1.00
Combined Alcohol and Drug Use
 Yes 2.92 (.75-11.43)
 No 1.00
Recent Binge Drinking
 Yes 2.37 (.78-7.17)
 No 1.00
Been in Alcohol Situations
 Yes 0.00 (.00-)
 No 1.00
Drank in Social Situations
 High Frequency 4.36 (1.07-17.67) *
 Some Frequency 1.69 (.39-7.29)
 Never 1.00
Secondhand Interpersonal Violence
 [greater than or equal to] 2 Times 49.84 (6.21-400.01) ***
 1 Time 12.43 (1.26-123.11) *
 Never 1.00
Protective Behavioral Strategies
Alcohol Avoidance
 Usually/Always 0.38 (.08-1.74)
 Sometimes/Never 1.00
Resistance
 Usually/Always 0.00 (.00-)
 Sometimes/Never 1.00

* p <0.05, ** p <0.01, *** p <0.0001

Table 3. Adjusted Odds Ratios for Relationships between Recent
Alcohol-related sexual assault and Personal and Behavioral Risk
Factors among College Students Residing in Freshmen Dormitories
(95 % Confidence Intervals)

Risk Factors Total Sample

Recent Drinker
 Yes 54 (.15-2.03)
 No 1.00
Illicit Drug Use
 Yes 1.49 (.55-4.02)
 No 1.00
Combined Alcohol and Drug Use
 Yes 0.67 (.22-2.10)
 No 1.00
Recent Binge Drinking
 Yes 3.29 (1.28-8.47) *
 No 1.00
Been in Alcohol Situations
 Yes 3.11 (.67-14.52)
 No 1.00
Drank in Social Situations
 High Frequency 1.97 (.52-7.40)
 Some Frequency 1.10 (.34-3.61)
 Never 1.00
Secondhand Interpersonal Violence
 [greater than or equal to] 2 Times 5.66 (3.08-10.41) ***
 1 Time 2.06 (1.02-4.14) *
 Never 1.00
Protective Behavioral Strategies
Alcohol Avoidance
 Usually/Always 1.15 (.50-2.65)
 Sometimes/Never 1.00

Risk Factors Females

Recent Drinker
 Yes 0.37 (.08-1.70)
 No 1.00
Illicit Drug Use
 Yes 2.14 (.67-6.86)
 No 1.00
Combined Alcohol and Drug Use
 Yes 0.51 (.13-2.02)
 No 1.00
Recent Binge Drinking
 Yes 7.74 (2.41-24.86) **
 No 1.00
Been in Alcohol
 Yes 2.37 (.47-12.01)
 No 1.00
Drank in Social Situations
 High Frequency 1.75 (.41-7.49)
 Some Frequency 1.22 (.34-4.37)
 Never 1.00
Secondhand Interpersonal
 [greater than or equal to] 2 Times 5.03 (2.39-10.63) ***
 1 Time 1.53 (.69-3.44)
 Never 1.00
Protective Behavioral
Alcohol Avoidance
 Usually/Always 1.26 (.48-3.32)
 Sometimes/Never 1.00

Risk Factors Males

Recent Drinker
 Yes N/S
 No
Illicit Drug Use
 Yes N/S
 No
Combined Alcohol and Drug Use
 Yes N/S
 No
Recent Binge Drinking
 Yes N/S
 No
Been in Alcohol
 Yes N/S
 No
Drank in Social Situations
 High Frequency 1.82 (.39-8.44)
 Some Frequency 0.97 (.20-4.63)
 Never 1.00
Secondhand Interpersonal
 [greater than or equal to] 2 Times 43.75 (5.30-361.36) ***
 1 Time 12.58 (1.25-127.03) *
 Never 1.00
Protective Behavioral
Alcohol Avoidance
 Usually/Always N/S
 Sometimes/Never

Note. The last category was used as the reference.

N/S indicates non-significance in the univariate logistic model.

* p <.05, ** p < .01, *** p < .001