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. Author manuscript; available in PMC: 2022 Nov 1.
Published in final edited form as: Psychol Trauma. 2021 Sep 30;13(8):835–846. doi: 10.1037/tra0001130

The Differential Effects of Verbal Sexual Coercion and Forcible Sexual Assault on Alcohol Use and Consequence Trajectories in the First Year of College

Rachael Shaw 1, Jennifer P Read 1
PMCID: PMC9164101  NIHMSID: NIHMS1738576  PMID: 34591534

Abstract

Objective.

Verbal sexual coercion (VSC), is the most prevalent and pervasive form of sexual victimization that women experience, yet the long-term harmful effects of this type of experience are unknown. The current study examined the effects of verbal sexual coercion vs. forcible sexual assault (FSA) on alcohol use and alcohol consequences, two deleterious outcomes that have been linked to sexual victimization.

Method.

In a sample of college women (N = 649), lifetime history of VSC and FSA were examined as predictors of trajectories of alcohol outcomes with latent growth models. Participants were assessed at six time points over their first year of college, a critical transition period of increased risk for both alcohol use and trauma exposure. We also examined the influence of victimization characteristics, such as relationship to the perpetrator and re-victimization experiences in these associations.

Results.

VSC experiences were predictive of higher levels of alcohol use and alcohol-related consequences (i.e., intercept). This risk was sustained throughout the first year of college. VSC experiences did not predict changes (i.e., slope) in alcohol outcomes over this time. In contrast, FSA was not predictive of either initial level or change in alcohol use and consequences over time.

Conclusion.

Findings highlight the importance of distinguishing among types of coercive experiences, as they show unique associations with later harmful outcomes. Verbal sexual coercion, common in the lives of young women but often overlooked in the extant literature, is associated with substantial negative impact during the first year of college.

Keywords: sexual victimization, alcohol use and consequences, college women

Introduction

Sexual victimization is highly prevalent among young adult women, especially those in college (Abbey, 2002; Cantor et al., 2015; Muehlenhard et al., 2015; Testa & Livingston, 2009). Data suggest victimization rates in college samples to be as high as 20–25% (Mellins et al., 2017; Muehlenhard et al., 2015), a risk that is greatest during the first college year (Cranney, 2015). There has been a recent surge in public discourse and advocacy about sexual victimization, not only because of its ubiquity, but also because of its link to functional impairment in academic, interpersonal, and other domains (Kessler, 2000; Singer et al., 1995; Stepakoff, 1998), and to a myriad of negative psychological outcomes (e.g., anxiety, depression, posttraumatic stress).

Distinct Types of Sexual Victimization and Associated Outcomes: Unanswered Questions

The term sexual victimization encompasses a broad spectrum of coercive sexual experiences. One way that these experiences have been categorized is according to the tactics used by the perpetrator. Two salient examples are verbal sexual coercion and forcible sexual assault. Whereas forcible sexual assault (FSA) involves actual or threatened physical force (Griffin & Read, 2012), verbal sexual coercion (VSC) is defined as “behaviors in which nonphysical tactics (e.g., verbal pressure, lying, deceit, and continual arguments) are utilized to obtain sexual contact with an unwilling partner” (DeGue & DiLillo; 2005; Fossos et al., 2011, p. 1001). Though sometimes viewed as less impactful than forcible sexual assault on a number of dimensions (e.g., less injury, less victim struggle, less perpetrator force) (Gidycz et al., 1995; Gilmore et al., 2014; Messman-Moore et al., 2008; Testa et al., 2004), verbal sexual coercion is by far the more prevalent form of victimization. Indeed, twice as many women experience VSC than experience FSA (i.e., rape; Fedina et al., 2018; Humprey & White, 2000; Orchowski et al., 2012; Zweig, Barber, & Eccles, 1997).

Whereas there is a fairly robust literature on the deleterious effects of FSA (Abbey et al., 2004; Brown et al., 2009; Clum et al., 2002), there is to date, very little that is known about the potentially harmful effects of VSC. One reason for this is that studies of the longer-term consequences of sexual coercion have not delineated among different types of coercive sexual experiences – particularly those that use less forceful methods of coercion - and thus have not been able to isolate the unique effects of VSC. Instead, different methods of sexual assault have been studied in aggregate, under the broad rubric of “assault” or “victimization.” This is an important gap in the literature; the pervasiveness of verbal sexual coercion would suggest that harmful outcomes associated with it have a substantial societal impact by virtue of how many women are affected. A clearer understanding of outcomes associated with different types of coercive sexual experiences is needed, as this may have treatment and intervention implications. Tailored interventions geared toward specific types of coercive experiences may be best suited to prevent the harmful outcomes that are associated with them.

Forms of Sexual Victimization and Hazardous Alcohol Involvement

Among the numerous deleterious psychological and behavioral outcomes that have been linked to sexual victimization (Kessler, 2000; Singer et al., 1995; Stepakoff, 1998), alcohol misuse is perhaps the most prominent. As such alcohol misuse in young adulthood has been associated with a higher risk of health problems, serious injury, and a variety of social and psychological problems (Mair et al., 2015; Prince et al., 2019; Read et al., 2007; Wechsler et al., 1995), and also with a risk for sexual assault re-victimization (Gidycz et al., 2007; Messman-Moore et al., 2015; Testa et al., 2010). The reasons for this link have been suggested by theories such as the Self-Medication theory (Khantzian, 1997; 2003). According to this theoretical formulation, after trauma, individuals may experience an onset or intensification of negative mood and associated cognitions, and may drink to relieve these symptoms as an effort to cope. Such self-medication drinking can occur following a range of types of traumas (e.g., Hawn et al., 2020; Miranda et al., 2002), and has been shown also to be more likely as trauma “dose” increases. That is, with more exposures, drinking risk becomes greater (Guinle & Sinha, 2020; Sinha, 2008). Several studies have found sexual victimization to be associated with increased alcohol involvement in college samples (Corbin et al., 2001; Griffin & Read 2012; Kaysen et al., 2006; Marx et al., 2000). Yet the evidence for this link has not been uniform, as some studies have not observed evidence for an increase in drinking after sexual victimization (Testa & Livingston, 2000; Testa et al., 2007). These inconsistent findings may be a function of the fact that studies have not delineated among victimization types. Though there is some research to suggest that verbal sexual coercion is linked to harmful alcohol use (Abbey et al., 1996; de Visser et al., 2003; Fossos et al., 2011; Gilmore et al., 2014), the contribution of these experiences relative to other types of victimization has not been examined.

Victimization Characteristics

In addition to the type of coercion, other characteristics of the sexual victimization experience also may exert an influence on drinking outcomes. Consideration of these factors is important to contextualize the unique risk processes associated with each type of sexually coercive experience. We outline some of the most critical of these characteristics below.

Newly Reported Victimization Experiences and Amount of Exposure.

Repeated victimizations are common (Blayney et al., 2016; Fisher et al., 2000; Griffin & Read, 2012; Humphrey & White, 2000; Messman-Moore et al., 2000), and have been linked to numerous harmful outcomes, including alcohol use and alcohol-related consequences (Filipas & Ullman, 2006; Humphrey et al., 2000; Messman-Moore et al., 2000; Najdowski & Ullman, 2009). In light of this, it is essential to model the effects of newly reported victimizations during the assessment periods when trying to understand the unique effect of VSC and FSA.

Relationship to the perpetrator.

The victim’s relationship to the perpetrator is another dimension of the victimization experience that may exert an influence on harmful behavioral outcomes such as drinking and should be accounted for. Previous research has indicated that the relationship with the perpetrator (e.g., the nature, degree, and extent of prior relationship) is linked to later outcomes. Specifically, closer relationships (e.g., perpetration by romantic partner or close friend) are associated with poorer post-assault adaptation (Cleere & Lynn, 2013; Littleton et al., 2006). However, no literature to our knowledge has considered whether and how relationship to the perpetrator may play a role in different types of coercive experiences.

Drinking Outcomes

Moreover, a substantial literature suggests that it is important to understand not only whether victimization experiences influence typical levels of alcohol use and problems, but also whether they influence persistent patterns, or changes in patterns of drinking (i.e., growth) over time, as these patterns may portend harmful longer-term outcomes (Schulenberg & Maggs, 2002; Vergés et al. 2013). This can help identify students who are on a course for distal consequences and misuse, allowing the opportunity to intervene before this course unfolds.

The Current Study

The literature on sexual assault outcomes has failed to delineate among the full range of coercive sexual experiences that may contribute to hazardous drinking and related outcomes in college women. Most crucially, outcomes that follow some of the less forceful or violent types of victimization (e.g., verbal coercion), but that are most common in this population have not been examined (Gidycz et al., 1995; Testa et al., 2004; Gilmore et al., 2014; Messman-Moore et al., 2008). Studies are needed to explicate the ways in which these high frequency, but often overlooked events, may contribute to drinking risk. Further, in light of dose-effects that have been documented previously in self-medication drinking (Guinle & Sinha, 2020; Harvey et al., 2016) understanding how these drinking patterns unfold over time in the wake of such lower-level but frequently occurring experiences can shed light on trajectories of drinking risk.

The current study seeks to address these gaps in the extant literature by examining two distinct types of assault experiences (verbal sexual coercion, forcible sexual assault) as prospective predictors of drinking and consequence trajectories in a sample of women over their first year of college. In a more exploratory aim, we also examined the role that relationship with the perpetrator, and later newly reported victimization experiences might play in these associations. The first college year is a crucial period, as it is a time of developmental transition and also a time of peak risk for sexual victimization (Arnett, 2000; Dodge et al., 2009; Griffin & Read, 2012; Kilpatrik et al., 2003).

Method

Procedure.

Data for the current study are drawn from a larger longitudinal study of trauma, PTSD, and substance use in college students (Read et al., 2012). This study was conducted at two public universities in the north-and southeastern part of the U.S. At these universities, 3,991 students completed a screening survey for a $5 gift card. From the screening survey an enriched sample was selected to create a matched data set based on representation of DSM criterion A trauma exposure and PTSD symptoms. Those invited to continue in the study included 649 trauma-exposed students who endorsed at minimum one PTSD symptom and 585 randomly selected non-trauma exposed students. The total sample selected (N = 1,002; N = 649 female participants) completed an online survey and received a $25 gift card. This sample was then assessed 6 times over the 1st year of college (T1–4 each month during the fall semester, T5 and T6 bimonthly during the spring semester). Participants were compensated with gift cards for each survey completed; at every time point in the study, retention rates were >90%. All procedures were approved by the IRBs at the two universities.

Participants.

The sample used in the current study consisted of all 649 women from the parent study. The overwhelming majority (N = 611; 94%) of participants were 18 years old at the initial assessment (range: 18–20 yrs). The majority (N = 465; 72%) identified their ethnicity as non-Hispanic white, as well as African American (N = 73; 11%,), Asian (N = 62; 10.0%), Hispanic (N = 20; 3%), and Other (N = 24; 4%). About 44% of the sample (N = 284) reported a lifetime experience of verbal sexual coercion at the beginning of their freshman year of college and 15.19% (N = 99) reported a lifetime experience of forcible sexual assault. These numbers highlight how pervasive of a problem VSC is relative to FSA. Of note, it was common for women to have more than one experience with sexual victimization. Approximately 60% (n=171) of those who endorsed VSC reported more than one event and approximately 56% (n = 56) of those who endorsed FSA reported more than one event at the first assessment. At each assessment over the first year of college, past month victimization was assessed. Rates of newly reported victimization experiences (i.e., victimization that occurred after the T1 assessment) during any given assessment period ranged from 6.9%−13.5%.

Measures

In this study, we were interested in understanding the prospective influence of different types of coercive sexual experiences on drinking and consequence trajectories over the course of the first college year. Thus, our model included sexual victimization history prior to Time 1 assessment (Sept of 1st college year) of verbal sexual coercion, forcible sexual assault, and relationship to the perpetrator as predictor variables. Alcohol use and consequences, as well as newly reported victimization experiences were assessed at every time point.

Alcohol use (T1–6) and involvement was assessed with a modified version of the Daily Drinking Questionnaire (DDQ; Collins, Parks, & Marlatt, 1985). Participants reported on both the quantity and frequency of alcohol consumption for the past 30 days at every assessment point over the first year of college. A Quantity X Frequency index was created for each time point, representing overall alcohol use. The internal reliabilities for this measure ranged from .87-.90.

Alcohol Consequences (T1–6) were assessed with the Young Adult Consequences Questionnaire (YAACQ; Read et al., 2006). Participants reported ‘yes’ or ‘no’ to indicate whether they experienced any of the 48 possible alcohol consequences in the past 30 days. The YAACQ assesses 8 domains: interpersonal problems, impaired control, self-perception, self-care, risky behaviors, academic consequences, physiological dependence, or blackout drinking. For each time point a sum score was computed to reflect the number of consequences experienced over the past 30 days. Cronbach’s alpha for this measure across the six waves ranged from .92 to .95, indicating good internal reliability.

Lifetime History of Sexual victimization (T1) was assessed with a revised version of the Sexual Experiences Survey (SES; Koss et al., 1982; RSES: Testa et al., 2004). The measure assessed lifetime exposure to a variety of sexual victimization events (e.g., unwanted touching, attempted victimization, vaginal penetration, and oral and finger or object penetration), as well as the method of the assault. This measure was used to create the two predictor variables that differentiated the method of assault (verbal sexual coercion and forcible sexual assault). The forcible sexual assault variable was comprised of four, scored questions that began with the prompt “Has anyone threatened to physically harm you or used physical force (such as holding you down) to …”. Items were summed for a total score of forcible sexual assault experiences. Verbal sexual coercion was comprised of four items that began with the prompt “Has anyone overwhelmed you with arguments about sex or continual pressure for sex in order to…”. Scores were summed (possible range 0–4) with higher scores reflecting greater verbal coercion exposure.

Newly Reported Victimization Experiences (T2–6).

Individuals previously victimized are at a higher risk for re-victimization (Blayney et al., 2016; Humphrey & White, 2000), and this has been linked to greater risk for alcohol misuse (Testa et al., 2003). Thus, we modeled newly reported victimization experiences as a time-varying covariate, to examine whether these experiences that occurred over the assessment period contributed to or accounted for any observed effects of initial history of victimization. Newly reported victimization experiences were measured with the Traumatic Life Events Questionnaire (TLEQ) which assesses the presence of 22 types of potentially traumatic events (Kubany et al., 2000). At each time point, participants were asked whether they experienced forcible sexual assault (i.e., “Since the last survey, has anyone touched sexual parts of your body or made you touch sexual parts of his or her body against your will or without your consent?”) or verbal coercion (i.e., “Since the last survey, were you subjected to uninvited or unwanted sexual attention? (examples: touching, cornering, pressure for sexual favors, verbal remarks)”). Two dichotomous variables were created for the current study indicating whether participants did or did not experience a newly reported victimization event during that assessment period.

Relationship to the perpetrator was included in the study as a time invariant covariate to elucidate the role of this peritraumatic variable on associations of interest. In our study, the Trauma Life Events Questionnaire (TLEQ) was modified to query whether the perpetrator was a friend, stranger, intimate partner, acquaintance, or relative. Two variables were then created for each event, VSC and FSA (four in total), to represent whether the victim considered the perpetrator their friend or if there was no relationship with the perpetrator (e.g., a stranger). This resulted in four variables (1. VSC- friend, 2. VSC-stranger; 3. FSA-friend, 4. FSA-stranger) total regarding relationship with the perpetrator.

Data Analysis

To examine alcohol trajectories and alcohol consequences over the first year, two unconditional latent growth models were conducted. We then added verbal sexual coercion and forcible sexual assault as predictors of growth in alcohol and consequence outcomes, as well as the covariates perpetrator relationship and newly reported victimization experiences (see Figure 1). Latent growth models were used because they provide an analytic framework to describe sample average trajectories as well as individual differences in growth and predictors of individual differences in growth (Curran & Muthén, 1999).

Figure 1.

Figure 1.

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Conditional latent growth model of predictor variables (verbal sexual coercion and forcible sexual assault), time invariant covariates (VSC friend with perpetrator, VSC stranger with perpetrator, FSA friend with perpetrator, FSA stranger with perpetrator), and time variant covariates (newly reported VSC 2–6 and FSA 2–6 representing Time 2–6) predicting the intercept and slope of alcohol use 1–6 (representing Time 1–6) and then alcohol consequences (representing Time 1–6). Only significant predictor paths depicted.

* p < .05

** p < .01

Latent growth models.

Model Specification.

Intercept factors loadings were fixed to 1. The factor loading of alcohol use and alcohol consequences at each timepoint were freely estimated to allow the shape of change to be determined empirically. Covariances were specified for intercept and slope factors. The predictor variables (verbal sexual coercion and forcible sexual assault) are lifetime measurements surveyed at the beginning of college (Time 1). The predictor variables are regressed on the slope and intercept factors of the alcohol use and consequence trajectories over the first year of college. Relationship to the perpetrator at Time 1 is a time invariant covariate and therefore also regressed on the slope and intercept factors. The two newly reported victimization variables are considered to vary over time and therefore are regressed on the specific time points of alcohol use and consequence.

Model Estimation.

As is typical in college drinking data, examination of the distributions of model variables revealed that some of the consequence indicators and the newly reported victimization variables were quite skewed (skewness >2.00) and kurtotic (kurtosis > 3.00) (see Table 1; Table 2 for descriptive information of variables). In this dataset, missing data was minimal and showed no discernable pattern of missingness. We used Maximum Likelihood Robust (MLR) estimator because it helps correct for non-normality and is well suited to handle data that is missing at random. All structural equation models were analyzed using Mplus version 8 (Muthén & Muthén, 2014).

Table 1.

Descriptive statistics of variables used in analyses. T1-T6 refers to assessment from Time 1–6.

Variable Mean SD Skewness Kurtosis
Alcohol QxF T1 7.24 8.47 1.32 1.57
Alcohol QxF T2 6.49 7.89 1.18 0.68
Alcohol QxF T3 6.12 7.84 1.25 0.79
Alcohol QxF T4 5.58 7.28 1.45 1.84
Alcohol QxF T5 7.01 8.66 1.30 1.12
Alcohol QxF T6 6.83 8.70 1.45 1.85
Consequences T1 7.50 7.58 1.40 1.95
Consequences T2 6.87 7.35 1.58 3.05
Consequences T3 6.72 7.66 1.51 1.98
Consequences T4 5.95 7.45 1.82 3.43
Consequences T5 6.72 8.65 1.88 3.66
Consequences T6 6.44 7.50 1.68 2.89
Verbal Sexual Coercion 0.88 1.21 1.21 0.32
% yes % no
43.76 56.24
Freauencies: 0 events = 365, 1 event = 113, 2 events = 87, 3 events = 49, 4 events = 35
Forcible Sexual Assault 0.31 0.85 3.05 8.85
%yes % no
15.19 84.81
Frequencies: 0 events = 547, 1 event = 42, 2 events = 27, 3 events = 13, 4 events = 16
Newly Reported Victimization Experiences Yes (N =) Yes (%)
VSC T2 a 64 9.9%
FSA T2 a 23 3.5%
VSC T3 a 54 8.3%
FSA T3 a 21 3.2%
VSC T4 a 33 5.1%
FSA T4 a 12 1.8%
VSC T5 a 38 5.9%
FSA T5 a 15 2.3%
VSC T6 a 43 6.6%
FSA T6 a 16 2.5%
Relationship to the Perpetrator Yes (N =) Yes (%)
Friend with Perp. VSC a 183 28.2%
Stranger with Perp. VSC a 130 20%
Friend with Perp. FSA a 26 4.0%
Stranger with Perp. FSA a 4 0.6%
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a

Dichotomous Variable

Table 2.

Correlation matrix not including the time variant covariates of newly reported victimization experiences during the assessment period.

Variable VSC FSA AU 1 AU 2 AU 3 AU 4 AU 5 AU 6 Con 1 Con 2 Con 3 Con 4 Con 5 Con 6 Friend VSC Stranger VSC Friend FSA Stranger FSA
VSC 1
FSA 0.59** 1
AU 1 0.14** 0.03 1
AU 2 0.16** 0.06 0.82** 1
AU 3 0.13** 0.02 0.75** 0.81** 1
AU 4 0.08 0.02 0.64** 0.70** 0.78** 1
AU 5 0.14** 0.04 0.71** 0.76** 0.77** 0.72** 1
AU 6 0.10* 0.01 0.69** 0.70** 0.72** 0.72** 0.77** 1
Con 1 0.31** 0.29** 0.54** 0.54** 0.51** 0.40** 0.49** 0.43** 1
Con 2 0.28**** 0.24** 0.46** 0.53** 0.47** 0.34** 0.41** 0.39** 0.75** 1
Con 3 0.29** 0.17** 0.40** 0.51** 0.59** 0.38** 0.49** 0.42** 0.67** 0.72** 1
Con 4 0.15** 0.13* 0.28** 0.41** 0.48** 0.50** 0.43** 0.34** 0.61** 0.64** 0.72** 1
Con 5 0.33** 0.24** 0.39** 0.47** 0.45** 0.41** 0.63** 0.43** 0.58** 0.65** 0.73** 0.66** 1
Con 6 0.25** 0.16** 0.44** 0.49** 0.46** 0.44** 0.54** 0.57** 0.61** 0.68** 0.71** 0.63** 0.72** 1
Friend VSC 0.39** 0.17** 0.08 0.06 0.03 −0.02 0.08 0.03 0.06 0.13* 0.11* 0.05 0.22** 0.17** 1
Stranger VSC 0.25** 0.17** 0.11** 0.15** 0.13** 0.11** 0.10* 0.10* 0.30** 0.29** 0.26** 0.25** 0.29** 0.24** 0.30** 1
Friend FSA 0.21** 0.11** 0.14** 0.14** 0.11** 0.03 0.14** 0.06 0.12* 0.09 0.07 0.04 0.13* 0.07 0.15** 0.09* 1
Stranger FSA 0.06 0.02 0.15** 0.09* 0.12** 0.09* 0.11** 0.17** 0.09 0.13* 0.15** 0.08 0.10 0.13* −0.01 0.16** −0.02 1
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AU 1–6 = Alcohol Use at Time 1–6, Con 1–6 = Alcohol Consequences at Time 1–6

*

significant at the .05 level

**

significant at the .01 level

Results

Unconditional Models of Alcohol Use and Consequences Across the First Year of College.

The freely estimated models for alcohol use and consequences met criteria for appropriate fit. Though the chi square for both were significant (alcohol use: χ2 = 89.85, df = 12 and alcohol consequences: χ2 = 33.55, df = 13), the CFI (use = 0.98; consequences = 0.99) and SRMR (use = 0.03; consequences = 0.04) values met criteria for good fit (CFI ≥ .95; SRMR ≤ .08; Hu & Bentler, 1999). The RMSEA value in the alcohol use model was 0.10 which meets the liberal criteria for acceptable fit (≤ .10); Browne & Cudek., 1992) and was 0.05 in the consequences model implying good fit. To interpret the latent growth model, the unstandardized solution is presented (see Table 3 & 4). The mean intercept and mean slope for both models were significantly greater than zero (p < .001) suggesting there is variability in these constructs to be accounted for.

Table 3.

Parameter estimates and results for both the unconditional latent growth model and conditional latent growth model for alcohol use. Unstandardized parameter estimates are used for interpreting the unconditional model whereas standardized parameter estimates are used for interpreting the effect of the predictor. T1-T6 refers to assessment at Time 1–6.

Parameter Unstandardized (SE) Standardized (SE) Significance Estimate
Unconditional LGM Alcohol Use
Mean Structure
Intercept mean 6.89 (0.31) · 0.000
Slope mean −0.47 (0.14) · 0.001
Covariance Structure
Pattern Coefficients
Alcohol Use T1 0.00 (0.00) ·
Alcohol Use T2 0.22 (0.11) · 0.05
Alcohol Use T3 0.91 (0.14) · 0.00
Alcohol Use T4 2.64 (0.60) · 0.00
Alcohol Use T5 0.76 (0.14) · 0.00
Alcohol Use T6 1.00 (0.00) ·
Covariances & Variances
Intercept with Slope −6.19 (1.93) · 0.001
Intercept Variance 56.29 (3.68) · 0.00
Slope Variance 4.10 (1.60) · 0.01
Conditional LGM Alcohol Use
Covariance Structure
Direct Effects
a VSC → Intercept · 0.17 (0.08) 0.01
VSC → Slope · −0.10 (0.05) 0.25
b FSA → Intercept · −0.09 (0.06) 0.12
FSA → Slope · −0.01 (0.07) 0.90
Friend VSC → Intercept · −0.01 (0.06) 0.82
Friend VSC → Slope · −0.09 (0.06) 0.15
Stranger VSC → Intercept · 0.08 (0.06) 0.14
Stranger VSC → Slope · 0.05 (0.07) 0.48
Friend FSA → Intercept · 0.09 (0.07) 0.19
Friend FSA → Slope · −0.14 (0.08) 0.08
Stranger FSA → Intercept · 0.13 (0.10) 0.17
Stranger FSA → Slope · −0.09 (0.12) 0.45
R-Square
Intercept · 0.07 (0.06) 0.07
Slope · 0.06 (0.04) 0.10
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a

Verbal Sexual Coercion

b

Forcible Sexual Assault

Table 4.

Parameter estimates and results for both the unconditional latent growth model and conditional latent growth model for alcohol consequences. Unstandardized parameter estimates are used for interpreting the unconditional model whereas standardized parameter estimates are used for interpreting the effect of the predictor. T1-T6 refers to assessment at Time 1–6.

Parameter Unstandardized (SE) Standardized (SE) Significance Estimate
Unconditional LGM Consequences
Mean Structure
Intercept mean 7.04 (0.34) · 0.001
Slope mean −1.48 (0.28) · 0.001
Covariance Structure
Pattern Coefficients
Consequences T1 0.000 (0.00) · ·
Consequences T2 0.71 (0.06) · 0.00
Consequences T3 0.96 (0.07) · 0.00
Consequences T4 1.06 (0.08) · 0.00
Consequences T5 1.06 (0.08) · 0.00
Consequences T6 1.000 (0.00) ·
Covariances & Variances
Intercept with Slope −20.52 (2.45) · 0.001
Intercept Variance 54.59 (3.55) · 0.001
Slope Variance 25.22 (3.27) · 0.001
Conditional LGM Consequences
Covariance Structure
Direct Effects
a VSC → Intercept · 0.17 (0.07) 0.01
VSC → Slope · 0.01 (0.09) 0.90
b FSA → Intercept · 0.13 (0.08) 0.08
FSA → Slope · −0.16(0.11) 0.13
Friend VSC → Intercept · −0.08 (0.05) 0.14
Friend VSC → Slope · 0.13 (0.07) 0.05
Stranger VSC → Intercept · 0.24 (0.06) 0.001
Stranger VSC → Slope · −0.13 (0.07) 0.08
Friend FSA → Intercept · 0.06 (0.07) 0.41
Friend FSA → Slope · −0.13 (0.08) 0.11
Stranger FSA → Intercept · 0.05 (0.08) 0.55
Stranger FSA → Slope · 0.03 (0.05) 0.54
R-Square
Intercept · 0.17 (0.05) 0.001
Slope · 0.07 (0.05) 0.16
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a

Verbal Sexual Coercion

b

Forcible Sexual Assault

Next, we evaluated the random effects, which reflect individual variation of each participant around the group parameter (See Table 3 & 4). For both the intercepts and slopes of alcohol use and consequences this variation was significant (p < .05), suggesting significant heterogeneity in initial levels of drinking and consequences at college entry, significant variability in alcohol use and consequences change across time. The significant correlation between the intercept and slope of alcohol use and consequences (−6.19, p < .001; −20.52, p < .001) indicates those who start at higher initial levels of drinking and consequences tend to decrease more, likely reflecting a regression to the mean.

Main Aim:

Verbal Sexual Coercion & Forcible Sexual Assault as Unique Predictors of Alcohol Use and Alcohol Consequences. Following the unconditional latent growth models, we entered VSC and FSA as predictors of alcohol use and consequences intercept and slope factors. The chi square for the conditional models for alcohol use (χ2 = 137.05, df = 86) and for alcohol consequences (χ2 = 120.80, df = 87) both were significant. However, the values of the CFI (0.98; 0.97), the SRMR (0.03; 0.06), and RMSEA (0.03; 0.03) met criteria for good fit (CFI ≥ .95; SRMR ≤ .08; RMSEA ≤ .05; Hu & Bentler, 1999).

For conditional latent growth models, the standardized results are interpreted (see Table 3 & 4). The experiences of verbal sexual coercion had a significant effect on the intercept of alcohol use (0.17, p < .05) and alcohol consequences (0.17, p < .05) while controlling for forcible sexual assault history, newly reported victimization, and the individual’s relationship to the perpetrator as demonstrated in Figure 1. A history of more verbally coercive experiences predicted higher levels of alcohol use and alcohol consequences at Time Point 1. Females with greater VSC exposure had higher intercepts or levels of alcohol use and consequences. The slope was not significantly predicted by VSC for either alcohol use or consequences (ps > .05). This means that individuals with a recurrent history of verbal sexual coercion are predicted to sustain higher levels of alcohol use and alcohol consequences over the first year of college.

In contrast, we observed no effect for FSA history on alcohol use (−0.09, p > .05) or consequence (0.13, p > .05) intercepts. We also did not observe effects for forcible sexual assault on the slopes of alcohol use or alcohol consequences (ps > .05). Including the effects of VSC and FSA contributed to the overall variance accounted for in the model (see Tables 3 and 4 for R2 values).

Victimization Characteristics:

When we entered newly reported victimization into the model as a time-varying covariate, we found that an increased history of VSC predicted higher levels of alcohol use and alcohol consequences at Time Point 1. The inclusion of the covariate of newly reported victimization experiences did not alter these findings. Of the time variant covariates included in the models, only past month VSC at Time 5 had a significant influence on alcohol use at that time (0.05, p < .05). For the consequence model, past month FSA at Time 2 and 3 (0.12, p < .05; 0.10, p < .05) and VSC at Timepoint 5 (0.18, p < .05) had a significant effect on the number of consequences experienced that assessment period. The perpetrator relationship also was modeled as a time invariant covariate and consisted of four dichotomous variables which indicated if the assailant was known or a stranger for each VSC and FSA. Interestingly, there was a significant direct effect found in relation to verbal sexual coercion, but not forcible sexual assault, on initial levels of the number of alcohol consequences; such that VSC perpetration by a stranger was associated with an increased number of consequences (0.24, p < .001).

Discussion

This study was the first to our knowledge to consider the unique effects of distinct sexually coercive experiences on alcohol use and alcohol-related consequences. We examined this question using a longitudinal design that spans a critical transition period, the first year of college. Our findings demonstrated that there are unique effects of verbal sexual coercion on alcohol use and consequences. Notably, the higher levels of alcohol use and consequences associated with VSC were sustained across the first college year, even when factors such as newly reported victimization experiences, and the relationship to the perpetrator were included in the prediction models. This highlights the lasting impact that such experiences can have. The effects of verbal sexual coercion, though modest, were observed above and beyond the effects of participants’ initial levels of drinking and consequences, demonstrating the robustness of these effects. In contrast, having a history of forcible sexual assault did not predict initial levels of alcohol use or consequences, nor did it predict the rate of change in drinking. Our findings highlight the importance of distinguishing among types of coercive experiences, as they reveal distinct differences in outcomes depending on the method of coercion.

Verbal Sexual Coercion (VSC) v Forcible Sexual Assault (FSA)

Prior literature has shown verbal sexual coercion occurs at a much higher rate than forcible sexual assault (Fedina et al., 2018; Orchowski et al., 2012) a pattern that was corroborated in the current study; Nearly half (n = 284) of the sample endorsed a verbally coercive event and 60% (n = 171) of those who endorsed such an event, endorsed more than one. In contrast, only 15% (n = 99) of our sample reported an experience of forcible sexual assault. Though, re-victimization were just as common for FSA (56%, n = 56 endorsed more than one event) as for VSC (60%, n = 171), the number of occurrences of VSC was greater. These findings indicate that women may get a larger “dose” of verbal sexual coercion, even though each individual occurrence involves less perpetrator force. A strength of our study is we modeled these multiple victimization experiences – and the potential for a dose effect - in our analyses. Our findings suggest that dose matters with regard to harmful outcomes; as these verbally coercive experiences may accumulate to have a larger effect including higher alcohol use and consequences which can be detrimental during the critical period of transitioning into college. Moreover, we controlled for the effects of newly reported victimization experiences during the assessment period that occurred specifically during the first year of college, isolating the unique effects of prior history of victimization.

Previous cross-sectional research has found verbal sexual coercion to be less likely than forcible sexual assault to be linked to outcomes such as physical injury or PTSD symptoms (Gidycz et al., 1995; Gilmore et al., 2014; Messman-Moore et al., 2008; Testa et al., 2004). Thus, it may seem surprising that in our longitudinal study, more exposure to VSC but not FSA predicted sustained elevations in alcohol use and related consequences. One explanation may be that traumas such as VSC, which occur with greater frequency, may actually result in more distress, and thus greater use of alcohol to manage this distress (Guinle & Sinha, 2020; Harvey et al., 2016). This is consistent with self-medication dose-response conceptualizations, and would underscore the importance of the ubiquity of VSC occurrences as important for conferring drinking risk. This is only one potential explanation to describe the results and there are likely a myriad of pathways that may lead to higher levels of drinking after repeated exposure to these events. Future research is needed to better elucidate the mechanisms by which VSC may be linked to drinking risk.

Relationship to the Perpetrator

In our exploratory analysis, we also found relationship to the perpetrator to be predictive of alcohol consequences in verbally coercive experiences. Specifically, VSC perpetrated by a stranger was associated with higher levels of alcohol consequences. This finding is inconsistent with at least some previous studies that have found that having a prior relationship (e.g., friend, romantic partner, ex-romantic partner) with the perpetrator is associated with poorer post-assault adaptation (Cleere & Lynn 2013; Cole & Lynn, 2011; Littleton et al., 2006). Yet, as we have noted, prior studies have not differentiated among event type with regard to perpetration tactics. The findings we observed here may suggest that the full impact of perpetrator relationship comes into relief only when specific types of coercive experiences (e.g., physical versus verbal) are delineated. For example, methods such as verbal pressure for sex may be particularly distressing or even threatening when coming from a stranger whereas more aggressive methods of coercion (e.g., threats of force or force) may be more distressing when perpetrated by a trusted friend or romantic partner (Edwards et al., 2012). Though an intriguing possibility, replication will be important to corroborate this finding.

Clinical Implications

Our findings also have clinical implications. Prior research has demonstrated that women who experience VSC are unlikely to report the event and seek help (Fisher et al., 2003; Zinzow & Thompson, 2011). In light of this, our data suggest that these women, though less likely to seek help, are in fact at a higher risk for sustained alcohol use and consequences (de Visser et al., 2003; Gilmore et al., 2014). As such, individuals who may benefit most from intervention may not be getting the support that they need. Such intervention will be facilitated by assessments that explicitly inquire about women’s exposure to the full range of coercive experiences, including verbal sexual coercion. In terms of treatment, helping women to identify and name their experiences can foster greater understanding of how these less physically forceful events may still place them at risk for experiencing consequences (e.g., higher levels of alcohol use and negative experiences related to drinking).

Limitations and Future Directions

Sexual victimization occurs along a spectrum, and here we modeled only events that occurred at the two ends of this spectrum (VSC and FSA). It will be important for future work to advance the present findings by further distinguishing among other methods of assault. This will help to further inform treatment and intervention methods. The inclusion of peritraumatic factors including, but not limited to the relationship of the perpetrator, is also important to disentangle the impact of sexual victimization. However, these factors are complex and the current study’s evaluation of perpetrator relationship allowed participants to endorse more than one category (i.e., VSC/FSA by a friend and/or stranger) making it difficult to identify the unique effects of each category. Additionally, alcohol use and its consequences have been implicated as a risk factor for sexual assault and have been found to be a mechanism through which re-victimization occurs (Gidycz et al., 2007; Norris et al., 1998; Testa et al., 2003; Testa et al., 2010). In this study, we examined only unidirectional paths from different types of victimization to drinking outcomes. An important next step for future research will be to clarify how the trajectories that we observed here may set the course for later victimization and re-victimization, differentiating among pathways to and from different types of victimization experiences. It is important to note that our sample was predominantly non-Hispanic white women (72%). The research on the impact of sexual victimization in minority women has been historically underdeveloped (Littleton et al., 2013) and therefore it is unknown whether the research on consequences following victimization experiences will generalize to minority women. Finally, in this study we focused on the first college year. As we have described, this first year is important because of its developmental significance, and also because it is a peak period of victimization risk. Still, it will be interesting to examine how far victimization risks may extend, and whether these effects may be observable throughout the college experience, or even beyond the college years.

Verbal sexual coercion is highly prevalent on college campuses (Fedina et al., 2018; Orchowski et al., 2012) yet until now, little has been known about how this form of victimization may impact women in the long-term. This study is a first step toward distinguishing verbal coercion as a problem that requires specific attention in order to address future risk of increased alcohol use and consequences. These findings highlight a need for more attention to lower-level but higher frequency victimization experiences, and for interventions that may help to decrease the occurrence of verbal sexual coercion specifically but also to target its deleterious effects.

Clinical Impact Statement:

Women who have experienced Verbal Sexual Coercion are at a higher risk for alcohol use and alcohol-related consequences. This elevated risk is sustained across the first college year. Identification of and intervention for those at greatest risk will be facilitated by assessments that explicitly inquire about women’s exposure to the full range of coercive experiences. Helping women to identify and name their experiences can foster greater understanding of how these common types of events- sometimes overlooked - may still place them at risk for experiencing consequences.

Funding:

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by a grant from NIDA (R01 DA018993) to Dr. Jennifer Read.

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