Abstract
Objective
To examine the relation between interpersonal violence and substance use and to describe the role of victim and perpetrator substance use within such incidents among university students.
Methods
A random sample of students (N=1197) participating in this cross-sectional study completed an online survey. Logistic regression models assessed the relation between substance use and sexual and physical victimization. Victim and perpetrator substance use at the time of incident were described.
Results
Females were more likely to report sexual violence compared to males, whereas males were more likely to report physical victimization (p’s<0.05). In logistic regression models, all forms of substance use were significantly associated with physical victimization among males (OR’s=2.0–5.1). Among females, most forms of substance use were associated with sexual victimization (OR’s=2.4–4.7). Both males and females reported high rates of perpetrator and own substance use during victimization incidents.
Conclusions
Findings suggest that previous documentation among victimization studies of a relation between substance use and subsequent risk for victimization may also be attributable to the substance use behavior of the perpetrator.
Keywords: substance use, college students, violence perpetration, interpersonal violence
1. INTRODUCTION
Interpersonal victimization has been associated with increased risk of psychological, physical, and behavioral health problems including substance use (e.g. El-Bassel et al., 2003; Tjaden & Thoennes, 1998). While victimization has been linked to increased rates of subsequent substance use (e.g. Gidycz, Orchowski, King, & Rich, 2008; Grayson & Nolen-Hoeksema, 2005), studies have also indicated that substance use can increase victimization risk (Kaysen, et al., 2006; Testa, Livingston, & Leonard, 2003). However, less is known about the means by which substance use influences victimization risk. Many existing studies have alluded to alcohol’s effects on victim’s perceptions of and ability to respond to situations of violence (e.g. Davis, George, & Norris, 2004; Testa, Livingston, & Collins, 2000). However, data collected among perpetrators has highlighted the role of substance use in perpetration of both physical and sexual violence (e.g. Hingson, Heeren, & Zakocs, 2002; Testa, Vanzile-Tamsen, & Livingston, 2004).
Given high rates of substance use reported on many college campuses in the US (Hingson et al., 2002; Harford, Wechsler, & Seibring, 2002) and high rates of victimization between the ages of 16 and 26 (Tjaden & Thoennes, 1998) it is especially important to study the relation between interpersonal victimization and substance use among college students. The purpose of the current manuscript is: 1) to document the role of substance use in reports of sexual and physical violence among male and female university students, and 2) to describe study participant and perpetrator substance use at the time of victimization incident.
2. METHODS
2.1. Sample and procedure
This cross sectional research study was conducted among a representative and random sample of undergraduate students in a large urban university in Boston (N=2600) between January to March of 2006. Participants were recruited via email to complete an online survey. A total of 1381 (53%) participants completed the survey; participants missing data on sex (n=38) or sexual/physical victimization (n=71 males, n=75 women) were deleted from all current study analyses, with a resulting 513 males and 684 females (n=1197). Participants deleted from the analyses did not vary significantly on demographics or other relevant study variables (all p’s>0.05). All study procedures were approved by the university Human Subjects Review Board.
2.2 Measures
Sexual violence was measured using two items: 1) forced sexual touching/fondling within the last year (Core Alcohol and Drug Survey; Presley et al., 1994) and 2) being a victim of sexual assault or date rape in the past year (yes/no). The physical violence item asked participants whether (yes/no) s(he) had experienced actual physical violence in the past year (Core Alcohol and Drug Survey; Presley et al., 1994).
Alcohol, marijuana and cocaine use in the past 30 days was measured by asking participants how many days they drank alcohol or used marijuana or cocaine; each measure was dichotomized as any use versus no use (Core Alcohol and Drug Survey; Presley et al., 1994). Binge drinking was defined as having 5 or more drinks for males and 4 or more drinks for females, given biological differences in metabolism of alcohol (Wechsler, Dowdall, Davenport, & Rimm, 1995); participants were asked to report the number of drinks per day over a typical week during the past three months (Daily Drinking Questionnaire-DDQ; Collins et al., 1985) and classified as binge drinkers if they reported such drinking at least one day in a typical week. High number of alcoholic drinks per week was measured using the DDQ; a high level of alcohol consumption was considered to be 20 drinks for males and 16 drinks for females over a typical week during the past three months.
Drinking behavior at the time of the incident of sexual or physical violence was measured by asking participants reporting sexual assault/rape whether they were drinking, and whether the perpetrator was drinking shortly before these incidents (yes/no). For experiences of forced sexual touching/fondling and actual physical violence measures, only study participant substance use was examined (Core Alcohol and Drug Survey; Presley et al., 1994).
Demographics
Age was measured as a continuous variable and dichotomized as under 21 versus 21 and older, based on legal drinking age. Race/ethnicity was categorized as White, Asian, Hispanic, Black, or other. Year of study (freshman, sophomore, junior, senior, graduate student, other), student status (full time or part time), employment (full time, part time, none), hometown (urban, suburban, rural), US born (yes, no), and student residence type (off campus, residence hall, leased housing, or other) were also assessed.
2.3 Data Analysis
To assess sex differences across relevant study variables, chi-square tests were used to examine statistical significance. Crude and adjusted logistic regression models were used to assess the associations of substance use variables with variables measuring sexual and physical victimization. Demographic variables associated with any form of victimization in bivariate analyses (p<0.1) and which changed the magnitude of association by 10% or greater, were included in the adjusted regression analyses. Analyses were also age-adjusted due to the decision a priori to adjust for influence of being legal drinking age versus being underage. Frequencies described study participant and perpetrator substance use at the time of victimization incident.
3. Results
3.1. Participant demographics, victimization experiences, and substance use
Participant demographics are provided in Table 1. Sexual victimization was greater among females (7%; n=46/684) compared to males (3%; n=14/513) (χ2 = 9.8, df=2, p≤ 0.002). Physical victimization was more common among males (10%; n=51/513) compared to females (3%; n=21/684) (χ2 = 24.4, df=2, p≤ 0.0001). Males were more likely to report drinking 16–20 drinks per week, binge drinking, marijuana use, and cocaine use (all p’s <0.05).
Table 1.
Sample Demographics
| Male (n=513) | Female (n=684) | |
|---|---|---|
|
| ||
| Demographic Variable | % (n) | % (n) |
| Age | ||
| <21 | 52.0 (267) | 57.6 (394) |
| 21+ | 48.0 (246) | 42.4 (290) |
| Race/Ethnicity | ||
| White | 64.3 (330) | 61.9 (422) |
| Asian | 12.7 (65) | 11.4 (78) |
| Hispanic | 9.6 (49) | 10.4 (71) |
| Black | 7.8 (40) | 8.4 (57) |
| Other | 5.7 (29) | 7.9 (54) |
| US born | ||
| Yes | 87.5 (449) | 87.7 (600) |
| No | 12.5 (64) | 12.3 (84) |
| Year of Study | ||
| Freshman | 24.8 (127) | 21.8 (149) |
| Sophomore | 19.9 (102) | 25.3 (173) |
| Junior | 14.8 (76) | 15.4 (105) |
| Senior | 19.5 (100) | 14.8 (101) |
| Graduate level | 19.9 (102) | 21.2 (145) |
| Other | 1.2 (6) | 1.5 (10) |
| Student Status | ||
| Full time | 98.6 (506) | 98.1 (671) |
| Part time | 1.4 (7) | 1.9 (13) |
| Employment ± | ||
| Full time | 19.9 (102) | 18.7 (128) |
| Part time | 38.6 (198) | 51.2 (350) |
| None | 41.5 (213) | 30.1 (206) |
| Hometown | ||
| Suburban | 59.6 (305) | 60.1 (411) |
| Urban | 22.1 (113) | 19.9 (136) |
| Rural | 18.4 (94) | 20.0 (137) |
| Type of residence⊥ | ||
| Off campus | 48.5 (248) | 39.3 (269) |
| Residence Hall | 42.5 (217) | 51.2 (350) |
| Leased Housing | 5.7 (29) | 6.3 (43) |
| Other | 3.3 (17) | 3.2 (22) |
p<0.0001
p< 0.05
3.2. Substance use in relation to reports of victimization, & participant and perpetrator substance use
Findings from logistic regression models indicate that among males, the following were related to physical victimization: any alcohol use in the past 30 days (Odds Ratio (OR) = 3.0, 95% Confidence Interval (CI): 1.1–8.5), binge drinking at least once a week in the past 3 months (OR=4.1, 95% CI: 2.1–7.9), drinking 20 or more drinks per week in the past 3 months (OR=4.7, 95% CI: 2.5–8.7), using marijuana in the past 30 days (OR=2.0, 95% CI: 1.1–3.7), and using cocaine in the past 30 days (OR=5.1, 95% CI: 1.8–14.4). (Table 2) The following variables were associated with sexual victimization among females: any alcohol use in the past 30 days (OR=3.1, 95% CI: 1.1–8.8), binge drinking at least once a week in the past 3 months (OR=2.4, 95% CI: 1.3–4.4), drinking 16 or more drinks per week in the past 3 months (OR=3.0, 95% CI: 1.3–6.9), and using cocaine in the past 30 days (OR=4.7, 95% CI: 1.5–16.2). (Table 2).
Table 2.
Crude and age-adjusted logistic regression findings: Association between substance use variables & reports of sexual and physical violence victimization
| Substance Use Variable | % (n)◆ | Crude Odds Ratio (OR) | Adjusted OR* |
|---|---|---|---|
| Males (n=513) | |||
| Alcohol, past 30 days | 80.7 (414) | ||
| Sexual violence | 92.1 (13) | 3.2 (0.4–24.6) | 2.8 (0.4–21.9) |
| Physical violence | 92.2 (47) | 3.0 (1.1–8.7) † | 3.0 (1.1–8.5) † |
| Binge drank on average at least once a week, past 3 monthsΔ | 44.8 (230) | ||
| Sexual violence | 64.3 (9) | 2.3 (0.7–6.9) | 2.2 (0.7–6.8) |
| Physical violence | 74.5 (38) | 4.1 (2.1–7.9) ‡ | 4.1 (2.1–7.9) ‡ |
| Drank 20 or more drinks on average per week, past 3 months | 16.0 (82) | ||
| Sexual violence | 21.4 (3) | 1.5 (0.4–5.3) | 1.6 (0.4–5.5) |
| Physical violence | 41.2 (21) | 4.6 (2.5–8.5) ‡ | 4.7 (2.5–8.7) ‡ |
| Marijuana, past 30 days | 25.3 (130) | ||
| Sexual violence | 28.6 (4) | 1.2 (0.4–3.8 ) | 1.3 (0.4–4.4) |
| Physical violence | 37.3 (19) | 1.9 (1.1–3.4) † | 2.0 (1.1–3.7) † |
| Cocaine, past 30 days | 3.5 (18) | ||
| Sexual violence | 0 (0) | ** | ** |
| Physical violence | 11.8 (6) | 5.0 (1.8–14.0) † | 5.1 (1.8–14.4) † |
| Females (n=684) | |||
| Alcohol, past 30 days | 80.0 (547) | ||
| Sexual violence | 91.3 (42) | 2.8 (1.0–7.8) † | 3.1 (1.1–8.8) † |
| Physical violence | 95.2 (20) | 5.2 (0.7–38.3) | 5.9 (0.8–45.0) |
| Binge drank on average at least once a week, past 3 monthsΔ | 38.9 (266) | ||
| Sexual violence | 58.7 (27) | 2.4 (1.3–4.4) † | 2.4 (1.3–4.4) † |
| Physical violence | 42.9 (9) | 1.2 (0.5–2.9) | 1.2 (0.5–2.9) |
| Drank 16 or more drinks on average per week, past 3 months | 7.5 (51) | ||
| Sexual violence | 17.4 (8) | 2.9 (1.3–6.6) † | 3.0 (1.3–6.9) † |
| Physical violence | 23.8 (5) | 4.2 (1.5–12.0) † | 4.4 (1.5–12.7) † |
| Marijuana, past 30 days | 20.5 (140) | ||
| Sexual violence | 26.1 (12) | 1.4 (0.7–2.8) | 1.4 (0.7–2.7) |
| Physical violence | 33.3 (7) | 2.0 (0.8–5.0) | 1.9 (0.8–4.8) |
| Cocaine, past 30 days | 2.5 (17) | ||
| Sexual violence | 8.7 (4) | 4.6 (1.4–14.7) † | 4.7 (1.5–16.2) † |
| Physical violence | 4.8 (1) | 2.0 (0.3–16.0) | 2.1 (0.3–16.6) |
Frequencies indented represent reported sexual and physical violence among those reporting each type of substance use behavior
Adjusted for age (21 and older versus younger than 21)
defined as 5 or more drinks in one day for males and 4 or more drinks in one day for females
data not sufficient for this analysis
p<0.05
p<0.0001
Seventy percent (7/10) and 55% (28/51) of males reported they were drinking and/or using drugs at the time when they experienced forced sexual touching and physical violence respectively; 86% (6/7) reported they were drinking when they experienced sexual assault/rape. Among females, 39% (12/31) report such behavior during an incident of forced sexual touching, 70% (19/27) when sexually assaulted/raped, and 43% (9/21) when victimized physically. Both males (71%; n=5/7) and females (78%; n=21/27) report high rates of perpetrators’ drinking and/or drug use during incidents of sexual assault or rape.
4. DISCUSSION
Study findings indicate that substance use is associated with increased reports of physical victimization among college males and increased risk for sexual victimization among college females, and are in congruence with findings from previous studies (e.g. Grayson & Nolen-Hoeksema, 2005; Kaysen et al., 2006; Meade, Kershaw, Hansen, & Sikkema, 2007). While based on a small sample size, analyses from the current study extend previous sexual victimization research by describing participant and perpetrator substance use, suggesting that substance use is common among the victim, perpetrator, and both. Previous studies assessing risk for victimization have often posited that substance use increases vulnerability for victimization; however, current study findings highlight the need for future physical and sexual victimization studies to further consider the influence of the perpetrator’s substance use behavior within the context of victimization incidents.
The findings of the current study should be considered with recognition of several study limitations. The self-reported nature of the study as well as the stigma associated with substance use and victimization may result in underreporting; however, computer based surveys often reduce reporting biases of stigmatized behaviors, including victimization (Abbey, 2005). Small numbers reporting victimization and lack of information on perpetrator substance use during physical victimization incidents limited the assessment related to substance use behaviors in the context of victimization. The cross-sectional nature of the study limited ability to identify temporal sequencing and study findings are most generalizable to university populations with similar demographic profiles.
In conclusion, given the high proportion of substance use among both perpetrator and victim reported in the current study, findings suggest that previous documentation among victimization studies of a relation between substance use and subsequent risk for victimization may also be attributable to the substance use behavior of the perpetrator. However, future research is needed on both physical and sexual victimization with larger samples to further investigate the influence of perpetrator’s substance use during incidents of victimization. Such findings will be necessary in order to develop appropriate prevention efforts.
Acknowledgments
This work was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism, Grant # 1U18AA015671 – Rapid Response to College Drinking Problems, with Dr. Philomena Mantella as the Principal Investigator.
Footnotes
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Contributor Information
Elizabeth Reed, Email: ereed@hsph.harvard.edu.
Hortensia Amaro, Email: h.amaro@neu.edu.
Atsushi Matsumoto, Email: matsumoto.a@neu.edu.
Debra Kaysen, Email: dkaysen@u.washington.edu.
References
- Abbey A. Lessons learned and unanswered questions about sexual assault perpetration. J Interpers Violence. 2005;20(1):39–42. doi: 10.1177/0886260504268117. [DOI] [PubMed] [Google Scholar]
- Collins RL, Parks GA, Marlatt GA. Social determinants of alcohol consumption: the effects of socials interaction and model status on the self-administration of alcohol. Journal of Consulting and Clinical Psychology. 1985;53:189–200. doi: 10.1037//0022-006x.53.2.189. [DOI] [PubMed] [Google Scholar]
- Davis KC, George WH, Norris J. Women’s responses to unwanted sexual advances: The role of alcohol and inhibition conflict. Psychology of Women Quarterly. 2004;28(4):333–343. [Google Scholar]
- El-Bassel N, Gilbert L, Witte S, Wu E, Gaeta T, Schilling R, Wada T. Intimate partner violence and substance abuse among minority women receiving care from an inner-city emergency department. Women’s Health Issues. 2003;13:16–22. doi: 10.1016/s1049-3867(02)00142-1. [DOI] [PubMed] [Google Scholar]
- Gidycz CA, Orchowski LM, King CR, Rich CL. Sexual Victimization and Health-Risk Behaviors: A Prospective Analysis of College Women. J Interpers Violence. 2008 doi: 10.1177/0886260507313944. (In Press) [DOI] [PubMed] [Google Scholar]
- Grayson CE, Nolen-Hoeksema S. Motives to drink as mediators between childhood sexual assault and alcohol problems in adult women. Journal of Traumatic Stress. 2005;18(2) doi: 10.1002/jts.20021. [DOI] [PubMed] [Google Scholar]
- Harford TC, Wechsler H, Seibring M. Attendance and alcohol use at parties and bars in college: a national survey of current drinkers. J Stud Alcohol. 2002;63(6):726–33. doi: 10.15288/jsa.2002.63.726. [DOI] [PubMed] [Google Scholar]
- Hingson RW, Heeren T, Zakocs RC. Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18–24. Journal of Studies on Alcohol. 2002;63(2):136–144. doi: 10.15288/jsa.2002.63.136. [DOI] [PubMed] [Google Scholar]
- Kaysen D, Neighbors C, Martell J, Fossos N, Larimer ME. Incapacitated rape and alcohol use: A prospective analysis. Addictive Behaviors. 2006;31:1820–1832. doi: 10.1016/j.addbeh.2005.12.025. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Meade CS, Kershaw TS, Hansen NB, Sikkema KJ. Long-Term Correlates of Childhood Abuse among Adults with Severe Mental Illness: Adult Victimization, Substance Abuse, and HIV Sexual Risk Behavior. AIDS Behav. 2007 doi: 10.1007/s10461-007-9326-4. (In Press) [DOI] [PMC free article] [PubMed] [Google Scholar]
- Presley CA, Meilman PW, Lyerla R. Development of the Core Alcohol and Drug Survey: Initial findings and future directions. Journal of American College Health. 1994;42:248–255. doi: 10.1080/07448481.1994.9936356. [DOI] [PubMed] [Google Scholar]
- Testa M, Livingston JA, Collins RL. The role of women’s alcohol consumption in evaluation of vulnerability to sexual aggression. Experimental and Clinical Psychopharmacology. 2000;8(2):185–191. doi: 10.1037//1064-1297.8.2.185. [DOI] [PubMed] [Google Scholar]
- Testa M, Livingston JA, Leonard KE. Women’s substance use and experiences of intimate partner violence: a longitudinal investigation among a community sample. Addict Behav. 2003;28(9):1649–64. doi: 10.1016/j.addbeh.2003.08.040. [DOI] [PubMed] [Google Scholar]
- Testa M, Vanzile-Tamsen C, Livingston JA. The role of victim and perpetrator intoxication on sexual assault outcomes. Journal of Studies on Alcohol. 2004;65(3):320–330. doi: 10.15288/jsa.2004.65.320. [DOI] [PubMed] [Google Scholar]
- Tjaden P, Thoennes N. Prevalence, incidence, and consequences of violence against women: Findings from the National Violence Against Women Survey. Washington, DC: U.S. Department of Justice, National Institute of Justice; 1998. [Google Scholar]
- Wechsler H, Dowdall GW, Davenport A, Rimm EB. A gender-specific measure of binge drinking among college students. American Journal of Public Health. 1995;85(7):982–984. doi: 10.2105/ajph.85.7.982. [DOI] [PMC free article] [PubMed] [Google Scholar]