Health risk behavior and sexual assault among ethnically diverse women

1. Health risk behavior and sexual assault among ethnically diverse women Supplemental to Heather Littleton, Amie Grills-Taquechel, Katherine Buck, Lindsey Rosman, and Julia Dodd 2013

2. The impact of sexual assault • Experiencing sexual assault is associated with greater risk for negative mental health outcomes including depression and posttraumatic stress disorder (PTSD) • Sexual assault victimization is also associated with health risk behaviors including alcohol use and sexual risk taking • Predominant hypothesis is that these health risk behaviors represent attempts to cope with psychological distress, including distress associated with victimization (self-medication hypothesis)

3. Sexual assault among college women • A total of 11 to 20% of college women have experienced sexual assault in adolescence or adulthood- sexual acts obtained by threat, force, or when the victim could not consent • Fairly comparable rates of sexual assault are found among European American, African American, and Latina college women (although research among ethnic minority women is less common) • Asian American college women report lower rates of sexual assault than other ethnicities

4. Health risk behaviors among Asian American women • Asian American women report lower rates of hazardous drinking than women of other ethnicities • Asian American women are more influenced by peer drinking norms than women of other ethnicities • Asian Americans tend to have less positive beliefs about drinking • Genetically mediated difficulties with metabolizing alcohol may result in unpleasant side effects of drinking among many Asian Americans • Little research on sexual risk taking among Asian American college women

5. Health risk behaviors among African American women • Overall African American college women engage in less hazardous drinking than women of other ethnicities • Contingent consistency peer influence model • College drinking behavior is influence by actual peer norms, perceived peer norms, and personal attitudes • African American women have lower actual and perceived peer drinking norms and hold less positive attitudes toward drinking • In contrast, African American women may be more likely to engage in sexual risk taking than European American college women

6. Health risk behaviors among Latinas • Latina college women report comparable rates of hazardous alcohol use as European American women- despite cultural norms against drinking among women • Acculturative stress model • Young adults in immigrant families are more acculturated to mainstream U.S. culture than parents/caregivers • May result in conflict between caregiver and child values • Stress of acculturation may also increase risk • Comparable rates of sexual risk taking have been found in Latina and European American college women

7. Goals of the current study • Examine the prevalence of sexual assault among college women of different ethnic backgrounds (adds to small extant literature in this area) • Examine the frequency of two health risk behaviors (hazardous drinking and using sex as an affect regulation strategy) among college women of different ethnic backgrounds (adds to small extant literature)

8. Goals of the current study continued • Evaluate whether women who have experienced sexual assault are more likely to engage in health risk behavior than non-victims (confirms some prior research) • Examine if psychological distress mediates the relationship between having a sexual assault history and engaging in health risk behavior (novel contribution) • Examine if there are ethnic differences in the strength of this mediated relationship (novel contribution)

9. Study procedures • 1,620 women attending three large universities completed an online survey for course credit about negative sexual experiences in college women • Completed self-report measures • Sexual assault since the age of 14 (Sexual Experiences Survey) • Hazardous past year drinking (AUDIT-5) • Measures of depression (CES-D) and anxiety (Four Dimensional Anxiety Scale) to assess psychological distress • Use of Sex to Regulate Negative Affect Scale (e.g., engaging in sex to feel better when feeling low)

10. Sexual assault and health risk behaviors among women of different ethnicities • Asian American women were less likely to have been sexually assaulted than women of the other ethnicities • African American women engaged in less hazardous drinking than Latina women; European American women engaged in more hazardous drinking than all the other groups of women • No differences in using sex to regulate negative affect among women of different ethnicities

11. Health risk behaviors among sexual assault victims • Sexual assault victims engaged in more hazardous drinking than non-victims • Sexual assault victims engaged in similar levels of using sex to regulate negative affect, as compared to non-victims

12. Mediation analyses Bootstrapping analyses supported that both anxiety and depression mediated the relationship between having a sexual assault history and engaging in more hazardous drinking Psychological distress Hazardous drinking Sexual assault history

13. Mediation analyses Bootstrapping analyses supported that both anxiety and depression mediated the relationship between having a sexual assault history and use of sex as a negative affect regulation strategy Psychological distress Use of sex as an affect regulation strategy Sexual assault history

14. Moderated mediation analyses • The mediated path from experiencing psychological distress to engaging in more hazardous drinking was significantly weaker in all groups of ethnic minority women than European American women • The mediated path from sexual assault to hazardous drinking through psychological distress was not statistically significant in any of the groups of ethnic minority women • In contrast, there were no significant ethnic differences in the mediated path in the use of negative affect as an affect regulation strategy mediated models

15. Conclusions • Sexual assault victimization remains a significant public health problem affecting all college women, although it may be less common among Asian American women • Hazardous drinking is common among college women, but varies among women of different ethnicities • Having a sexual assault history may be a risk factor for engaging in hazardous drinking

16. Conclusions continued • Consistent with the self-medication hypothesis, psychological distress mediated the relationship between having a sexual assault history and engaging in hazardous drinking and using sex as a negative affect regulation strategy • Hazardous drinking may be less strongly associated with psychological distress among ethnic minority women than European American women

17. Limitations • While overall sample was large, number of women in each ethnic minority group was modest • Reliance on self-report measures • Cross-sectional study design • Did not evaluate other potential predictors of risk behaviors, such as immigration stress, drinking motives, sexual attitudes • Important differences among women within ethnic groups were not evaluated

18. Research implications • There may be important differences in frequency of health risk behaviors among women of different ethnicities and in predictors of these behaviors • Models of risk behaviors following sexual assault developed among European American women may not apply to ethnic minority women • There is a need for future work examining factors that may uniquely relate to post-assault recovery among women of different ethnicities

19. Practice implications • Practitioners should routinely assess for sexual assault histories in women seeking services • It may be necessary to address women’s psychological distress to effectively reduce risk taking behavior, as these may represent attempts to manage this distress • Prevention and intervention programs addressing health risk behaviors may benefit from being targeted to address the specific needs of women of different cultural and ethnic backgrounds