551575
research-article2014
VAWXXX10.1177/1077801214551575Violence Against WomenWilliams et al.
Article
Victimization and Perpetration of Unwanted Sexual Activities Among High School Students: Frequency and Correlates
Violence Against Women 2014, Vol. 20(10) 1239–1257 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1077801214551575 vaw.sagepub.com
Corrine M. Williams1, Patricia G. Cook-Craig1, Heather M. Bush1, Emily R. Clear1, Alysha M. Lewis1, Lisandra S. Garcia1, Ann L. Coker1, and Bonnie S. Fisher2
Abstract The objective of this study was to report the frequency of perpetration and victimization of unwanted sexual activities (threatened to end relationship or other pressures to engage in sexual activities, threatened or actual physical force, and facilitated by drugs or alcohol) in a large, statewide sample of high school males and females. Among 18,030 students, 18.5% reported victimization and 8.0% perpetration in the past year. Although females were more likely to report unwanted sexual activities due to feeling pressured, there were no significant sex differences among those reporting physical force or unwanted sexual activities due to alcohol or drug use. Keywords adolescents, perpetration, sexual coercion, sexual violence, victimization Sexual violence among adolescents is increasingly being recognized as a public health problem (Centers for Disease Control and Prevention [CDC], 2004). Underscoring the importance of this research, sexual violence has significant consequences for
1University 2University
of Kentucky, Lexington, USA of Cincinnati, OH, USA
Corresponding Author: Corrine M. Williams, Department of Health Behavior, University of Kentucky, 151 Washington Avenue, Bowman Hall #353, Lexington, KY 40506-0059, USA. Email: [email protected]
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adolescents. For example, research shows that female adolescents with a history of forced sex are more likely to have had multiple sexual partners in the 3 months prior to interview and are less likely to have used a condom at last sexual encounter, implying a continuing effect on subsequent sexual behaviors (Bramsen, Lasgaard, Elklit, & Koss, 2011; Howard, Wang, & Yan, 2007). Increased alcohol use, depression, and suicide ideation and attempts have been associated with having experienced some form of sexual violence among adolescents (Asgeirsdottir, Sigfusdottir, Gudjonsson, & Sigurdsson, 2011; Buzi et al., 2003; Hanson, 2010; Olshen, McVeigh, WunschHitzig, & Rickert, 2007; Stappenbeck & Fromme, 2010). Unwanted sexual activities also contribute to unintended pregnancies, due to the decreased likelihood of using contraception, particularly condoms, effectively (Coggins & Bullock, 2003; Hathaway, Willis, Zimmer, & Silverman, 2005; Teitelman, Tennille, Bohinski, Jemmott, & Jemmott, 2011). Condom and contraceptive use at the last sexual encounter is lower among adolescent females who report either dating violence or forced sexual intercourse (Hanson, 2010). Adolescent males who experience forced sexual contact are also more likely to have impregnated a female (Pierre, Shrier, Emans, & DuRant, 1998), highlighting the importance of understanding the prevalence of unwanted sexual activities in both male and female adolescent populations. One critical issue in understanding and estimating the magnitude of sexual violence among adolescents is the multiple definitions and various terms used to describe these behaviors. Studies refer to sexual assaults, sexual abuse, sexual violence, sexual coercion, or sexual aggression, depending on the types of behaviors, amount of force, and an inability to consent to sexual activity. These terms incorporate different acts in their conceptualization, including both attempted, threatened, and completed sexual acts, such as ever having been pressured or forced into sexual touching; masturbation; oral, anal, or vaginal intercourse against the individual’s will; in addition to various levels of physical intimidation (Anderson, Reis, & Stephens, 1997; DeGue & DiLillo, 2005; Fisher, Cullen, & Turner, 2000; Fisher, Daigle, & Cullen, 2010; Lacasse & Mendelson, 2007; Lodico, Gruber, & DiClemente, 1996; Seto et al., 2010; Tjaden & Thoennes, 2000). The National Intimate Partner and Sexual Violence Survey (NISVS), the most recently conducted national survey of sexual violence victimization of women and men in the United States, included rape, being made to penetrate someone else, sexual coercion, unwanted sexual contact, and non-contact unwanted sexual experiences (Black et al., 2011). Rape was further categorized as forced penetration, attempted forced penetration, and alcohol or drug facilitated penetration on NISVS (Black et al., 2011). Sexual coercion has been defined as the use of force, authority, or alcohol or drugs to engage in some form of sexual activity (Morrison, McLeod, Morrison, & Anderson, 1997), whereas others define sexual aggression as unwanted sexual advances and forced intercourse (Stappenbeck & Fromme, 2010). In one consensus document issued by the CDC with specific definitions of sexual violence, the term sexual violence was defined to include a variety of behaviors including sexual abuse, sexual assault, and any other sexual violations such as sexual harassment and voyeurism (Corbett & Gentry, 1993).
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Furthermore, Basile et al. (2006) also highlighted the difference between an inability to consent because of age, illness, disability, being asleep, or the influence of alcohol or other drugs and an inability to refuse due to threat or use of physical violence, real or perceived coercion, intimidation or pressure, or misuse of authority. Given the variation in definitions, a wide range of measures have been used to estimate the prevalence of multiple forms of unwanted sexual activities, with the prevalence ranging from 1% to 52%. Using a definition of sexual aggression that included verbal coercion, use of drugs or alcohol by the victim, or the threat or use of physical force to obtain unwanted sexual contact with any part of the body, a prospective study of adolescents yielded a 4-year prevalence rate of sexual aggression of 46%, with approximately an equal number of adolescents reporting an incident each year (Year 1 = 16.2%; Year 2 = 20.1%; Year 3 = 16.6%; Year 4 = 18.3%). Another study that assessed being pressured to do something sexual against your will and attempted or completed rapes noted 22% of students had been victimized and 6% reported having perpetrated sexual violence (Bennett & Fineran, 1998). In a study of high school students, 52.5% of females and 26.3% of males reported ever experiencing any form of sexual assault; 50.7% of females and 25.9% of males reported unwanted kissing, hugging, or touching; 5.5% of females and 4.1% of males reported unwanted oral sex; 11.8% of females and 3.1% of males reported a completed rape; and 11.2% of females and 2.6% of males reported something else sexual (Young, Grey, & Boyd, 2009). A nationally representative study of adolescent females aged 12 to 17 identified 11.8% who had experienced any sexual assault; 2.1% of all females reported a sexual assault facilitated by drugs or alcohol. One study of students in an alternative high school found that 18.2% of female students and 6.7% of male students reported that they had ever been forced to have sex against their will (Buzi et al., 2003). Data from the Youth Risk Behavior Survey (YRBS), a nationally representative survey of adolescents enrolled in Grades 9 to 12 conducted by the CDC, have frequently been used to examine sexual violence among adolescents, both males and females (Basile et al., 2006; Behnken, Le, Temple, & Berenson, 2010; Howard & Wang, 2005; Howard et al., 2007). Since 1999, the biennially conducted national YRBS has included one yes/no item asking whether the respondent had ever been physically forced to have sexual intercourse when he or she did not want to. In 2009, 10.5% of female and 4.5% of male high school students in the United States reported ever having been physically forced to have sexual intercourse when they did not want to (Eaton et al., 2010). In 2011, these numbers remained virtually unchanged with 11.8% of female and 4.5% of male high school students reporting forced sexual intercourse (Eaton et al., 2012). Results of the above studies suggested that various forms of unwanted sexual activities were quite prevalent among all adolescents, and victimization rates appeared higher among females. Although a significant number of studies have examined victimization of female adolescents, fewer large studies have examined the experiences of male victims. In addition, perpetration among adolescents, both male and female, remained understudied (Abbey, McAuslan, & Ross, 1998; Seto et al., 2010). One study of college students
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reporting on their freshman year experience found that 5.6% of both males and females reported perpetrating either unwanted sexual advances or forced sexual intercourse (Stappenbeck & Fromme, 2010). Research on the correlates of unwanted sexual activities was primarily cross-sectional studies. Demographic correlates of unwanted sexual activities that have been previously identified included being female, non-intact family structure, self-identifying as a sexual minority, lower income, immigrant status, and dating history (Friedman et al., 2011; Testa, Hoffman, & Livingston, 2011). This large cross-sectional study of 18,030 high school students added to the existing literature by providing population-based estimates of both victimization and perpetration of unwanted sexual activities by specific tactic and sex, as well as an assessment of the overlap between reporting both victimization and perpetration. We also examined demographic correlates of reporting either victimization or perpetration of unwanted sexual activities. Throughout this study, we referred to the behaviors we were describing as unwanted sexual activities, which encompassed the range of behaviors from verbal pressure to physically forced intercourse.
Method Participants An inclusive sample of all high school students (freshmen-seniors) present and attending 1 of 26 participating high schools were asked to complete a self-administered survey. The survey was a 95-item paper-and-pencil anonymous questionnaire that took approximately 25 to 40 min to complete. Study personnel traveled to the high schools and administered surveys in one of two ways during school hours: (a) a class administration setting in the school during a selected class (e.g., English classes for the whole day), or (b) a school group administration during which, in one class period, the whole school was surveyed. The survey was conducted using the model familiar to schools in the YRBS (CDC, 2009). All surveys were administered between January and May 2010. At the end of the survey booklet, resources were included; websites and toll-free numbers for national agencies were available at all times to address domestic violence, sexual assaults, depression, or suicide ideation should this information be helpful for students. These resources were also provided on pencils the students used to complete the survey and were able to keep. The study protocol was approved by the University of Kentucky Institutional Review Board (#09-0680-F1V).
Consent All parents and guardians of enrolled students were mailed a parental information letter describing the study purpose and information on the study at least 2 weeks prior to surveying. Students with parents and guardians who responded via email or phone that they did not wish their child to participate were not approached to participate.
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Measures Unwanted sexual activities victimization or perpetration. The questions asked about unwanted sexual activities were prefaced with the following introduction: “The next questions are about sexual activities. Some of the questions might make you uncomfortable. Remember that this survey is anonymous. Your name will not be linked to your answers. You may also skip questions that make you uncomfortable.” Three items were used to measure victimization of unwanted sexual activities: (a) had sexual activities although you did not really want to because either they threatened to end your friendship or romantic relationship if you did not or you felt pressured by the other person’s constant arguments or begging; (b) had sexual activities when you did not want to because the other person threatened to use or used physical force (such as twisting your arm, holding you down) if you did not agree; and (c) had sexual activities when you did not want to because you were drunk or on drugs. Response options for all items ranged from never; 1 to 2 times; 3 to 5 times; 6 or more times; and yes, but not in the past 12 months. First, we created indicator variables for each item to represent the proportion reporting each tactic occurring 1 or more times in the past 12 months (all dichotomous yes/no variables). We then created a summary variable to measure whether a student reported any unwanted sexual activities victimization in the past 12 months (yes/no). The same three items were rephrased to determine the student’s perpetration of unwanted sexual activities: “In the last 12 months, how many times have YOU . . .” The ordinal response options for these items were similar to the victimization questions, with one additional option: never; 1 to 2 times; 3 to 5 times; 6 to 9 times; 10 or more times; and yes, but not in the past 12 months. We again created indicator variables for those who reported they had committed each tactic 1 or more times, and a separate indicator for having perpetrated any unwanted sexual activities in the past 12 months (all dichotomous yes/no variables). Finally, we measured the overlap between perpetration and victimization of unwanted sexual activities for each student as (a) both perpetration of and victimization by unwanted sexual activities, (b) perpetration of unwanted sexual activities alone, (c) victimization by unwanted sexual activities alone, and (d) the comparison group of no perpetration of or victimization by unwanted sexual activities. Demographics and other risk factors. Several demographic variables were included in the survey. Sex (male or female) and grade in school (9th-12th) were analyzed as asked. We used receipt of free/reduced meals as a proxy for socioeconomic status, which was ascertained with one yes/no question, “Do you receive a free or reduced price meal through your high school?” Race was asked using the question, “How would you describe yourself?” The response options were American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino/Latina, White, and Other. Students were allowed to select only one option, and we further recoded this variable to a dichotomous indicator of White compared with all other race categories.
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Sexual attraction was assessed with the following item: “People are different in their sexual attraction to other people. Which best describes your feelings?” The response options were as follows: (a) only attracted to females, (b) mostly attracted to females, (c) equally attracted to females and males, (d) mostly attracted to males, (e) only attracted to males, and (f) not sure. Students who reported that they were male and were only attracted to females and those who reported that they were female and were only attracted to males were coded as being exclusively attracted to the opposite sex. All others, including those who reported they were not sure, were coded as not exclusively attracted to the opposite sex. We assessed current dating relationship status with this question: During the past 12 months, have you been in a relationship with a boyfriend or girlfriend? By a relationship, we mean either having a partner for planned events like a school dance or going to the movies, having a sex partner, or hanging out in a group with a boyfriend or girlfriend.
Response options were (a) no, never been in a relationship; (b) no, not in the past 12 months; (c) not now, but have been in the past 12 months; (d) yes, in one relationship now; and (e) yes, in multiple relationships. From this, we created a dichotomous indicator of whether the student had been in a relationship in the past year. Finally, we measured the construct of having witnessed parent partner violence with the following item: “In your family, how often did you see or hear one of your parents or guardians being hit, slapped, punched, shoved, kicked, or otherwise physically hurt by their spouse or partner?” Response options ranged from never to more than 10 times, but were dichotomized as no or yes.
Statistical Analysis Demographic variables were described for the students overall and rates of unwanted sexual activities (victimization and perpetration) were provided for each demographic factor overall and by gender (Tables 1 and 2). Frequencies of the number of times for each unwanted sexual activity (victimization and perpetration) were also described for those who indicated an affirmative response (Figures 1 and 2). Comparisons were made using generalized estimating equations, which allow for the relaxation of independence conditions (students attending the same school) and for the control of potential confounding variables. Potential confounding variables include grade in school, receiving a free or reduced-price meal, race, sexual attraction, and a history of parental or guardian partner violence. Therefore, these models accounted for confounders and for the study design by incorporating the sampled high school (n = 26) in generalized estimating equations (link=log, distribution=binomial, exchangeable working correlation matrix). Multivariable logistic regression (PROC LOGISTIC, link=glogit) was used to determine sex differences in the overlap between victimization and perpetration, by analyzing the four-category variable for each tactic, and overall: perpetration alone, victimization alone, and both perpetration and victimization compared with no
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Williams et al. Table 1. Demographic Profile of High School Students Completing Baseline Survey, by Victimization of Unwanted Sexual Activities. Victimization of unwanted sexual activities prevalence rates (n)
All students (N = 18,030)
Grade 9th 30.5% (5,509) 10th 27.6% (4,981) 11th 25.7% (4,624) 16.2% (2,916) 12th Race Non-White 17.2% (3,106) White 82.8% (14,924) Free or reduced lunch Yes 43.4% (7,819) No 56.6% (10,211) Relationship status (past 12 months) In a 79.8% (14,394) relationship Not in a 20.2% (3,636) relationship Sexual attraction Exclusively 86.2% (15,537) heterosexual Not exclusively 13.8% (2,493) heterosexual Parental partner violence Yes 25.5% (4,595) No 74.5% (13,435)
All students (N = 18,030)
Females (n = 9,711)
Males (n = 8,319)
18.5% (3,331) = 20.0, p = .0002 16.6% (912) 19.0% (947) 19.6% (907) 19.4% (565) 2 χ1 = 4.0, p = .0465 19.7% (613) 18.2% (2,718) 2 χ1 = 22.9, p < .0001 20.1% (1,568) 17.3% (1,763) 2 χ1 = 489.8, p < .0001 21.7% (3,122)
22.6% (2,197) = 3.3, p < .0001 19.8% (587) 22.9% (623) 25.1% (616) 25.5% (371) 2 χ1 = 10.0, p = .0016 19.6% (319) 23.2% (1,878) 2 χ1 = 9.5, p = .0021 24.1% (1,048) 21.4% (1,149) 2 χ1 = 353.8, p < .0001 26.3% (2,103)
13.6% (1,134) = 3.4, p = .3347 12.8% (325) 14.3% (324) 13.4% (291) 14.5% (194) 2 χ1 = 59.2, p < .0001 19.9% (294) 12.3% (840) 2 χ1 = 9.5, p = .0021 15.0% (520) 12.7% (614) 2 χ1 = 122.0, p < .0001 15.9% (1,109)
χ32
χ32
5.8% (209)
χ
2 1
= 262.5, p < .0001 16.6% (2,579)
5.5% (94)
χ
2 1
30.2% (752)
χ12
= 601.8, p < .0001 30.6% (1,406) 14.3% (1,925)
χ32
= 80.1, p < .0001 20.86% (1,667)
6.0% (115)
χ
2 1
30.81% (530)
χ12
= 299.6, p < .0001 34.37% (939) 18.03% (1,258)
= 164.8, p < .0001 12.09% (912) 28.72% (222)
χ12
= 266.7, p < .0001 25.07% (467) 10.33% (667)
unwanted sexual victimization or perpetration, adjusting for other demographic factors. All analyses were conducted using SAS, Version 9.3.
Results Student Response Rates Of the 20,806 students enrolled in schools on the scheduled dates of surveying who completed a Scantron® form (>80% of all students in the 26 schools), 1,454 (7.0%) were student refusals and 82 (0.4%) were parental refusals. An additional 232 (1.1%) students started the survey but completed less than 30 of the 95 items (partial refusals), yielding an overall refusal rate of 8.5%. Of the remaining students, 369 (1.8%) did not answer one of the demographic questions and 639 (3.1%) did not complete all six items measuring victimization and perpetration of unwanted sexual activities, resulting in 18,030 students (86.6%) for the current analysis. There were no significant demographic differences between those who agreed and completed the survey and those
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Prevalence (n)
All students 8.0% (1,447) Grade 9th 8.0% (441) 8.9% (443) 10th 7.2% (332) 11th 12th 7.9% (231) Race Non-White 11.5% (357) White 7.3% (1,090) Free or reduced lunch Yes 8.6% (675) No 7.6% (772) Relationship status (past 12 months) In a relationship 9.1% (1,309) Not in a 3.8% (139) relationship Sexual attraction Exclusively 7.1% (1,107) heterosexual Not exclusively 13.7% (340) heterosexual Parental partner violence Yes 14.2% (654) No 5.9% (793)
Demographic factors
3
1
1
1
1
1
61.15
6.89
110.41
123.46
321.8
df
9.61
χ2
research-article2014
VAWXXX10.1177/1077801214551575Violence Against WomenWilliams et al.
Article
Victimization and Perpetration of Unwanted Sexual Activities Among High School Students: Frequency and Correlates
Violence Against Women 2014, Vol. 20(10) 1239–1257 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1077801214551575 vaw.sagepub.com
Corrine M. Williams1, Patricia G. Cook-Craig1, Heather M. Bush1, Emily R. Clear1, Alysha M. Lewis1, Lisandra S. Garcia1, Ann L. Coker1, and Bonnie S. Fisher2
Abstract The objective of this study was to report the frequency of perpetration and victimization of unwanted sexual activities (threatened to end relationship or other pressures to engage in sexual activities, threatened or actual physical force, and facilitated by drugs or alcohol) in a large, statewide sample of high school males and females. Among 18,030 students, 18.5% reported victimization and 8.0% perpetration in the past year. Although females were more likely to report unwanted sexual activities due to feeling pressured, there were no significant sex differences among those reporting physical force or unwanted sexual activities due to alcohol or drug use. Keywords adolescents, perpetration, sexual coercion, sexual violence, victimization Sexual violence among adolescents is increasingly being recognized as a public health problem (Centers for Disease Control and Prevention [CDC], 2004). Underscoring the importance of this research, sexual violence has significant consequences for
1University 2University
of Kentucky, Lexington, USA of Cincinnati, OH, USA
Corresponding Author: Corrine M. Williams, Department of Health Behavior, University of Kentucky, 151 Washington Avenue, Bowman Hall #353, Lexington, KY 40506-0059, USA. Email: [email protected]
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Violence Against Women 20(10)
adolescents. For example, research shows that female adolescents with a history of forced sex are more likely to have had multiple sexual partners in the 3 months prior to interview and are less likely to have used a condom at last sexual encounter, implying a continuing effect on subsequent sexual behaviors (Bramsen, Lasgaard, Elklit, & Koss, 2011; Howard, Wang, & Yan, 2007). Increased alcohol use, depression, and suicide ideation and attempts have been associated with having experienced some form of sexual violence among adolescents (Asgeirsdottir, Sigfusdottir, Gudjonsson, & Sigurdsson, 2011; Buzi et al., 2003; Hanson, 2010; Olshen, McVeigh, WunschHitzig, & Rickert, 2007; Stappenbeck & Fromme, 2010). Unwanted sexual activities also contribute to unintended pregnancies, due to the decreased likelihood of using contraception, particularly condoms, effectively (Coggins & Bullock, 2003; Hathaway, Willis, Zimmer, & Silverman, 2005; Teitelman, Tennille, Bohinski, Jemmott, & Jemmott, 2011). Condom and contraceptive use at the last sexual encounter is lower among adolescent females who report either dating violence or forced sexual intercourse (Hanson, 2010). Adolescent males who experience forced sexual contact are also more likely to have impregnated a female (Pierre, Shrier, Emans, & DuRant, 1998), highlighting the importance of understanding the prevalence of unwanted sexual activities in both male and female adolescent populations. One critical issue in understanding and estimating the magnitude of sexual violence among adolescents is the multiple definitions and various terms used to describe these behaviors. Studies refer to sexual assaults, sexual abuse, sexual violence, sexual coercion, or sexual aggression, depending on the types of behaviors, amount of force, and an inability to consent to sexual activity. These terms incorporate different acts in their conceptualization, including both attempted, threatened, and completed sexual acts, such as ever having been pressured or forced into sexual touching; masturbation; oral, anal, or vaginal intercourse against the individual’s will; in addition to various levels of physical intimidation (Anderson, Reis, & Stephens, 1997; DeGue & DiLillo, 2005; Fisher, Cullen, & Turner, 2000; Fisher, Daigle, & Cullen, 2010; Lacasse & Mendelson, 2007; Lodico, Gruber, & DiClemente, 1996; Seto et al., 2010; Tjaden & Thoennes, 2000). The National Intimate Partner and Sexual Violence Survey (NISVS), the most recently conducted national survey of sexual violence victimization of women and men in the United States, included rape, being made to penetrate someone else, sexual coercion, unwanted sexual contact, and non-contact unwanted sexual experiences (Black et al., 2011). Rape was further categorized as forced penetration, attempted forced penetration, and alcohol or drug facilitated penetration on NISVS (Black et al., 2011). Sexual coercion has been defined as the use of force, authority, or alcohol or drugs to engage in some form of sexual activity (Morrison, McLeod, Morrison, & Anderson, 1997), whereas others define sexual aggression as unwanted sexual advances and forced intercourse (Stappenbeck & Fromme, 2010). In one consensus document issued by the CDC with specific definitions of sexual violence, the term sexual violence was defined to include a variety of behaviors including sexual abuse, sexual assault, and any other sexual violations such as sexual harassment and voyeurism (Corbett & Gentry, 1993).
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Furthermore, Basile et al. (2006) also highlighted the difference between an inability to consent because of age, illness, disability, being asleep, or the influence of alcohol or other drugs and an inability to refuse due to threat or use of physical violence, real or perceived coercion, intimidation or pressure, or misuse of authority. Given the variation in definitions, a wide range of measures have been used to estimate the prevalence of multiple forms of unwanted sexual activities, with the prevalence ranging from 1% to 52%. Using a definition of sexual aggression that included verbal coercion, use of drugs or alcohol by the victim, or the threat or use of physical force to obtain unwanted sexual contact with any part of the body, a prospective study of adolescents yielded a 4-year prevalence rate of sexual aggression of 46%, with approximately an equal number of adolescents reporting an incident each year (Year 1 = 16.2%; Year 2 = 20.1%; Year 3 = 16.6%; Year 4 = 18.3%). Another study that assessed being pressured to do something sexual against your will and attempted or completed rapes noted 22% of students had been victimized and 6% reported having perpetrated sexual violence (Bennett & Fineran, 1998). In a study of high school students, 52.5% of females and 26.3% of males reported ever experiencing any form of sexual assault; 50.7% of females and 25.9% of males reported unwanted kissing, hugging, or touching; 5.5% of females and 4.1% of males reported unwanted oral sex; 11.8% of females and 3.1% of males reported a completed rape; and 11.2% of females and 2.6% of males reported something else sexual (Young, Grey, & Boyd, 2009). A nationally representative study of adolescent females aged 12 to 17 identified 11.8% who had experienced any sexual assault; 2.1% of all females reported a sexual assault facilitated by drugs or alcohol. One study of students in an alternative high school found that 18.2% of female students and 6.7% of male students reported that they had ever been forced to have sex against their will (Buzi et al., 2003). Data from the Youth Risk Behavior Survey (YRBS), a nationally representative survey of adolescents enrolled in Grades 9 to 12 conducted by the CDC, have frequently been used to examine sexual violence among adolescents, both males and females (Basile et al., 2006; Behnken, Le, Temple, & Berenson, 2010; Howard & Wang, 2005; Howard et al., 2007). Since 1999, the biennially conducted national YRBS has included one yes/no item asking whether the respondent had ever been physically forced to have sexual intercourse when he or she did not want to. In 2009, 10.5% of female and 4.5% of male high school students in the United States reported ever having been physically forced to have sexual intercourse when they did not want to (Eaton et al., 2010). In 2011, these numbers remained virtually unchanged with 11.8% of female and 4.5% of male high school students reporting forced sexual intercourse (Eaton et al., 2012). Results of the above studies suggested that various forms of unwanted sexual activities were quite prevalent among all adolescents, and victimization rates appeared higher among females. Although a significant number of studies have examined victimization of female adolescents, fewer large studies have examined the experiences of male victims. In addition, perpetration among adolescents, both male and female, remained understudied (Abbey, McAuslan, & Ross, 1998; Seto et al., 2010). One study of college students
Downloaded from vaw.sagepub.com at MICHIGAN STATE UNIV LIBRARIES on March 9, 2015
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Violence Against Women 20(10)
reporting on their freshman year experience found that 5.6% of both males and females reported perpetrating either unwanted sexual advances or forced sexual intercourse (Stappenbeck & Fromme, 2010). Research on the correlates of unwanted sexual activities was primarily cross-sectional studies. Demographic correlates of unwanted sexual activities that have been previously identified included being female, non-intact family structure, self-identifying as a sexual minority, lower income, immigrant status, and dating history (Friedman et al., 2011; Testa, Hoffman, & Livingston, 2011). This large cross-sectional study of 18,030 high school students added to the existing literature by providing population-based estimates of both victimization and perpetration of unwanted sexual activities by specific tactic and sex, as well as an assessment of the overlap between reporting both victimization and perpetration. We also examined demographic correlates of reporting either victimization or perpetration of unwanted sexual activities. Throughout this study, we referred to the behaviors we were describing as unwanted sexual activities, which encompassed the range of behaviors from verbal pressure to physically forced intercourse.
Method Participants An inclusive sample of all high school students (freshmen-seniors) present and attending 1 of 26 participating high schools were asked to complete a self-administered survey. The survey was a 95-item paper-and-pencil anonymous questionnaire that took approximately 25 to 40 min to complete. Study personnel traveled to the high schools and administered surveys in one of two ways during school hours: (a) a class administration setting in the school during a selected class (e.g., English classes for the whole day), or (b) a school group administration during which, in one class period, the whole school was surveyed. The survey was conducted using the model familiar to schools in the YRBS (CDC, 2009). All surveys were administered between January and May 2010. At the end of the survey booklet, resources were included; websites and toll-free numbers for national agencies were available at all times to address domestic violence, sexual assaults, depression, or suicide ideation should this information be helpful for students. These resources were also provided on pencils the students used to complete the survey and were able to keep. The study protocol was approved by the University of Kentucky Institutional Review Board (#09-0680-F1V).
Consent All parents and guardians of enrolled students were mailed a parental information letter describing the study purpose and information on the study at least 2 weeks prior to surveying. Students with parents and guardians who responded via email or phone that they did not wish their child to participate were not approached to participate.
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Measures Unwanted sexual activities victimization or perpetration. The questions asked about unwanted sexual activities were prefaced with the following introduction: “The next questions are about sexual activities. Some of the questions might make you uncomfortable. Remember that this survey is anonymous. Your name will not be linked to your answers. You may also skip questions that make you uncomfortable.” Three items were used to measure victimization of unwanted sexual activities: (a) had sexual activities although you did not really want to because either they threatened to end your friendship or romantic relationship if you did not or you felt pressured by the other person’s constant arguments or begging; (b) had sexual activities when you did not want to because the other person threatened to use or used physical force (such as twisting your arm, holding you down) if you did not agree; and (c) had sexual activities when you did not want to because you were drunk or on drugs. Response options for all items ranged from never; 1 to 2 times; 3 to 5 times; 6 or more times; and yes, but not in the past 12 months. First, we created indicator variables for each item to represent the proportion reporting each tactic occurring 1 or more times in the past 12 months (all dichotomous yes/no variables). We then created a summary variable to measure whether a student reported any unwanted sexual activities victimization in the past 12 months (yes/no). The same three items were rephrased to determine the student’s perpetration of unwanted sexual activities: “In the last 12 months, how many times have YOU . . .” The ordinal response options for these items were similar to the victimization questions, with one additional option: never; 1 to 2 times; 3 to 5 times; 6 to 9 times; 10 or more times; and yes, but not in the past 12 months. We again created indicator variables for those who reported they had committed each tactic 1 or more times, and a separate indicator for having perpetrated any unwanted sexual activities in the past 12 months (all dichotomous yes/no variables). Finally, we measured the overlap between perpetration and victimization of unwanted sexual activities for each student as (a) both perpetration of and victimization by unwanted sexual activities, (b) perpetration of unwanted sexual activities alone, (c) victimization by unwanted sexual activities alone, and (d) the comparison group of no perpetration of or victimization by unwanted sexual activities. Demographics and other risk factors. Several demographic variables were included in the survey. Sex (male or female) and grade in school (9th-12th) were analyzed as asked. We used receipt of free/reduced meals as a proxy for socioeconomic status, which was ascertained with one yes/no question, “Do you receive a free or reduced price meal through your high school?” Race was asked using the question, “How would you describe yourself?” The response options were American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino/Latina, White, and Other. Students were allowed to select only one option, and we further recoded this variable to a dichotomous indicator of White compared with all other race categories.
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Violence Against Women 20(10)
Sexual attraction was assessed with the following item: “People are different in their sexual attraction to other people. Which best describes your feelings?” The response options were as follows: (a) only attracted to females, (b) mostly attracted to females, (c) equally attracted to females and males, (d) mostly attracted to males, (e) only attracted to males, and (f) not sure. Students who reported that they were male and were only attracted to females and those who reported that they were female and were only attracted to males were coded as being exclusively attracted to the opposite sex. All others, including those who reported they were not sure, were coded as not exclusively attracted to the opposite sex. We assessed current dating relationship status with this question: During the past 12 months, have you been in a relationship with a boyfriend or girlfriend? By a relationship, we mean either having a partner for planned events like a school dance or going to the movies, having a sex partner, or hanging out in a group with a boyfriend or girlfriend.
Response options were (a) no, never been in a relationship; (b) no, not in the past 12 months; (c) not now, but have been in the past 12 months; (d) yes, in one relationship now; and (e) yes, in multiple relationships. From this, we created a dichotomous indicator of whether the student had been in a relationship in the past year. Finally, we measured the construct of having witnessed parent partner violence with the following item: “In your family, how often did you see or hear one of your parents or guardians being hit, slapped, punched, shoved, kicked, or otherwise physically hurt by their spouse or partner?” Response options ranged from never to more than 10 times, but were dichotomized as no or yes.
Statistical Analysis Demographic variables were described for the students overall and rates of unwanted sexual activities (victimization and perpetration) were provided for each demographic factor overall and by gender (Tables 1 and 2). Frequencies of the number of times for each unwanted sexual activity (victimization and perpetration) were also described for those who indicated an affirmative response (Figures 1 and 2). Comparisons were made using generalized estimating equations, which allow for the relaxation of independence conditions (students attending the same school) and for the control of potential confounding variables. Potential confounding variables include grade in school, receiving a free or reduced-price meal, race, sexual attraction, and a history of parental or guardian partner violence. Therefore, these models accounted for confounders and for the study design by incorporating the sampled high school (n = 26) in generalized estimating equations (link=log, distribution=binomial, exchangeable working correlation matrix). Multivariable logistic regression (PROC LOGISTIC, link=glogit) was used to determine sex differences in the overlap between victimization and perpetration, by analyzing the four-category variable for each tactic, and overall: perpetration alone, victimization alone, and both perpetration and victimization compared with no
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Williams et al. Table 1. Demographic Profile of High School Students Completing Baseline Survey, by Victimization of Unwanted Sexual Activities. Victimization of unwanted sexual activities prevalence rates (n)
All students (N = 18,030)
Grade 9th 30.5% (5,509) 10th 27.6% (4,981) 11th 25.7% (4,624) 16.2% (2,916) 12th Race Non-White 17.2% (3,106) White 82.8% (14,924) Free or reduced lunch Yes 43.4% (7,819) No 56.6% (10,211) Relationship status (past 12 months) In a 79.8% (14,394) relationship Not in a 20.2% (3,636) relationship Sexual attraction Exclusively 86.2% (15,537) heterosexual Not exclusively 13.8% (2,493) heterosexual Parental partner violence Yes 25.5% (4,595) No 74.5% (13,435)
All students (N = 18,030)
Females (n = 9,711)
Males (n = 8,319)
18.5% (3,331) = 20.0, p = .0002 16.6% (912) 19.0% (947) 19.6% (907) 19.4% (565) 2 χ1 = 4.0, p = .0465 19.7% (613) 18.2% (2,718) 2 χ1 = 22.9, p < .0001 20.1% (1,568) 17.3% (1,763) 2 χ1 = 489.8, p < .0001 21.7% (3,122)
22.6% (2,197) = 3.3, p < .0001 19.8% (587) 22.9% (623) 25.1% (616) 25.5% (371) 2 χ1 = 10.0, p = .0016 19.6% (319) 23.2% (1,878) 2 χ1 = 9.5, p = .0021 24.1% (1,048) 21.4% (1,149) 2 χ1 = 353.8, p < .0001 26.3% (2,103)
13.6% (1,134) = 3.4, p = .3347 12.8% (325) 14.3% (324) 13.4% (291) 14.5% (194) 2 χ1 = 59.2, p < .0001 19.9% (294) 12.3% (840) 2 χ1 = 9.5, p = .0021 15.0% (520) 12.7% (614) 2 χ1 = 122.0, p < .0001 15.9% (1,109)
χ32
χ32
5.8% (209)
χ
2 1
= 262.5, p < .0001 16.6% (2,579)
5.5% (94)
χ
2 1
30.2% (752)
χ12
= 601.8, p < .0001 30.6% (1,406) 14.3% (1,925)
χ32
= 80.1, p < .0001 20.86% (1,667)
6.0% (115)
χ
2 1
30.81% (530)
χ12
= 299.6, p < .0001 34.37% (939) 18.03% (1,258)
= 164.8, p < .0001 12.09% (912) 28.72% (222)
χ12
= 266.7, p < .0001 25.07% (467) 10.33% (667)
unwanted sexual victimization or perpetration, adjusting for other demographic factors. All analyses were conducted using SAS, Version 9.3.
Results Student Response Rates Of the 20,806 students enrolled in schools on the scheduled dates of surveying who completed a Scantron® form (>80% of all students in the 26 schools), 1,454 (7.0%) were student refusals and 82 (0.4%) were parental refusals. An additional 232 (1.1%) students started the survey but completed less than 30 of the 95 items (partial refusals), yielding an overall refusal rate of 8.5%. Of the remaining students, 369 (1.8%) did not answer one of the demographic questions and 639 (3.1%) did not complete all six items measuring victimization and perpetration of unwanted sexual activities, resulting in 18,030 students (86.6%) for the current analysis. There were no significant demographic differences between those who agreed and completed the survey and those
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Prevalence (n)
All students 8.0% (1,447) Grade 9th 8.0% (441) 8.9% (443) 10th 7.2% (332) 11th 12th 7.9% (231) Race Non-White 11.5% (357) White 7.3% (1,090) Free or reduced lunch Yes 8.6% (675) No 7.6% (772) Relationship status (past 12 months) In a relationship 9.1% (1,309) Not in a 3.8% (139) relationship Sexual attraction Exclusively 7.1% (1,107) heterosexual Not exclusively 13.7% (340) heterosexual Parental partner violence Yes 14.2% (654) No 5.9% (793)
Demographic factors
3
1
1
1
1
1
61.15
6.89
110.41
123.46
321.8
df
9.61
χ2
