Why is this study important?
Decades of research document the pervasiveness of sexual assault against women. Once victimized, a woman is at increased risk for future victimizations, and victimization is associated with unemployment, transiency, lower socioeconomic status and psychological problems. A 1993 study also found that rape prevention programs were not effective in reducing the incidence of future sexual assault among women who already had a history of sexual assault. Such findings compel investigators to explore deeper into the factors that contribute to a woman's risk for sexual victimization in the hopes of discovering effective preventative measures.

What is the purpose of this study?
The authors of this study previously discovered significant relationships between a woman's risk for being sexually victimized, her history of sexual victimization (childhood and adolescent), and current mental health. The short time period (9 weeks) of the earlier study limited the strength of its findings. The present study is a prospective analysis of the problem. It assesses participants' psychological functioning and histories of sexual assault at the beginning of the study, then follows study participants over a period of time, assessing at 3-month intervals participants' experiences of sexual assault that occurred since the last assessment and current psychological functioning. The goal of the present study is to improve upon the earlier study by Expanding assessment of psychological functioning to include not only measures of depression and anxiety, but also interpersonal functioning, alcohol use, family functioning and sexual behaviors (number of sexual partners) Following study participants over a longer period of time (9 months).

How did the study differentiate between the effects of different sexual assault experiences and different kinds of psychological adjustment on a woman’s risk for future sexual assault?

Statistical techniques known as loglinear analysis and path analysis were used to determine which aspects of study participants' sexual assault histories or psychological adjustment best predicted outcomes (i.e., a recent sexual assault). Data consisted of responses to sexual assault history and psychological functioning surveys. Subjects were young, 18 or 19 year old, female college psychology students (only about 15% of study participants were over 20 years old). The initial assessment determined sexual victimization histories and overall psychological functioning. 796 women began the study. At the end of each 3-month interval, surveys asked participants about sexual victimizations experienced since the last assessment, sexual behavior, anxiety, depression and interpersonal problems. 677 participants attended the second assessment. 16.7% to 18.6% of study participants reported that they had been sexually assaulted between the first and second assessments. All victims and an equal number of non-victims were called back for two more assessments at 6 and 9 months since initial assessment. As the study progressed some participants dropped out, reducing the sample size. 178 women completed surveys 6 and 9 months after the initial assessment.

How did researchers define childhood, adolescent and adult sexual victimization?
Many studies vary with regard to what constitutes childhood, adolescent and adult sexual abuse and levels of severity of abuse. The following distinctions were used in this study: Childhood sexual abuse was defined as sexual victimization that occurred before age 14. To determine degree of severity of childhood sexual abuse, participants responded to nine items developed by Finkelhor (1979). Three levels of victimization were defined: 1) no victimization; 2) moderate victimization (e.g., experienced fondling or exposure of either their own sexual organs or those of another person); 3) severe victimization (e.g., rape or attempted rape). Adolescent sexual victimization was defined as those experiences that occurred after age 14 but prior to participation in the study. The Sexual Experience Survey (SES) was used to screen for frequency and severity of adolescent sexual victimization. Three levels of severity were defined: 1) no victimization; 2) moderate victimization (e.g., fondling or kissing in response to menacing verbal pressure, threats or actual physical harm or force, or sexual intercourse in response to similar threats, harm, misuse of authority, etc.); 3) severe victimization (i.e., rape or attempted rape). Adult sexual victimization was not part of the initial assessment; instead it was assessed at the three-month and six-month follow-ups and defined as sexual victimizations that occurred during these three-month periods of participation in the study. The same three levels of severity as for adolescent sexual victimization were defined for adult sexual victimization.

What are the study's findings?
Sexual victimization directly affected both a woman's psychological adjustment and her risk for future sexual victimization. Study participants had high rates of previous sexual victimization according to initial assessment results: 47% had experienced moderate child sexual abuse (CSA); 12%, severe CSA; 26%, moderate adolescent sexual victimization; 33%, severe adolescent victimization. The severity of a sexual victimization directly affected the victim's risk of being sexually assaulted again. The more severe the assault, the more likely it was that she would be assaulted again during the study. Severity of subsequent victimzations adhered to a pattern: subsequent victimizations were likely to be as severe and violent as previous victimizations. History of sexual victimization significantly correlated with subsequent victimizations. CSA correlated with adolescent sexual victimization, and adolescent sexual victimization correlated with adult sexual victimization. A history of sexual victimization doubled a woman's risk of being sexually victimized during the first three months of the study. Sexual victimization during any 3-month interval of the study correlated with a sexual victimization during the next three months. Women who were sexually assaulted or victimized during the first 3 months of the study were three times more likely to be victimized again during the next three months than women who had not been sexually assaulted. A sexual assault during the second three months of the study increased a woman's risk for being victimized again in the succeeding three months by more than twenty times. Adolescent sexual victimization correlated with maladaptive psychological adjustment at the initial assessment. In particular, it affected interpersonal problems, numbers of sex partners and alcohol use. Psychological adjustment: Psychological adjustment at the 6-month follow-up predicted sexual assault in the following three months. Poor psychological adjustment at the initial assessment had a significant relationship with victimization during the first 3-month period. Repeated victimization. Many women in the study (25% of victims at the 6-month assessment and 17% at the 9-month assessment) were repeatedly sexually assaulted. Acquaintance rape accounted for more than 75% of sexual assaults reported during the study.

What are the study's implications?
Preventative efforts and policies are needed that address the sexual assault and, more specifically, acquaintance rape of women on college campuses. Women are no safer from sexual assault today than twenty years ago despite legal innovations and policy changes aimed at preventing such violence. Mental health outreach initiatives are needed to intervene in the cycle of victimization of women with sexual assault histories. Because males are the perpetrators of sexual violence, male-targeted interventions should be considered.

Reviewed by Priscilla Schulz, October 1999