College students’ experiences of sexual violence and reasons for seeking care in campus health and counseling centers

Abstract

Objective:

Examine associations between care seeking reasons in college health and counseling centers and sexual violence (SV).

Participants:

College students (n=2,084 baseline, n=1,170 one-year follow up) participating in a cluster randomized controlled trial of an SV reduction intervention on 28 campuses.

Methods:

Computer-based survey data gathered during students’ clinic visit and one-year follow up.

Results:

Despite high prevalence of SV, students almost never sought care specifically for SV (0.5% of reported visits). Gender differences emerged for reasons students sought care generally, but were not associated with differences in care seeking among those who experienced SV. At baseline and one-year, students who reported SV were more likely to state mental or sexual and reproductive health as their reason for care seeking.

Conclusion:

Many students seeking care have experienced SV yet present with other health needs. Providers need to recognize this and have a low threshold for providing SV resources routinely.

Introduction

Sexual violence (SV) is prevalent on college campuses with about 13% of students reporting some form of non-consensual sexual experience.¹ SV includes completed or attempted forceful sex, inappropriate touching, sexual coercion, as well as sexual harassment.² Recent studies show that more than one in ten students experience non-consensual sexual contact during their college career,¹ with 20–25% of women and 5–7% of men experiencing sexual contact involving force or incapacitation.^3,4 SV has myriad deleterious health consequences. Trauma from SV can lead to mental health conditions, such as depression and post-traumatic stress disorder (PTSD). It is also associated with an increase in unhealthy behaviors, such as heavy drinking, smoking, and disordered eating.^5,6 Revictimization is also extraordinarily common, with approximately two out of every three individuals who experience SV reporting revictimization,⁷ a pattern that is also documented among college students as well.⁸

Despite the high occurrence and substantial impact, many unwanted sexual experiences among college students go unreported and students often do not seek SV-specific care. Several factors impact care seeking following exposure to violence, as explained by Liang, Goodman, Narra and Weintraub in their conceptual framework for understanding how survivors of intimate partner violence (IPV) seek support. According to this framework, the internal and cognitive processes of the help-seeker are the focus of a psychological model of seeking help and change.⁹ The model consists of three stages: (a) problem recognition and definition, (b) the decision to seek help, and (c) the selection of a help provider.^9,10 Although the processes in the model are portrayed as separate steps, they are not sequential. The steps in the model are considered as a dialectical process with one step informing the other in a continuous feedback loop.¹⁰

While there are differences between IPV and SV, there is also substantial overlap, particularly among college students and young adults where up to 80% of sexual assaults are perpetrated by individuals known to the victim.¹¹ The first stage of the model, identifying and recognizing the problem refers to how the individual responds to the sexual assault based on the label they put on it and their perception of the severity of the incident.¹² The definition of the problem is highly influenced by sociocultural, individual, and relational factors, which can include various barriers such as fear and stigma.^10,13 The second stage of the model, the decision to seek help, results from the individual’s ability to define the problem themselves and their cognitive assessment of the problem together with a change in external conditions. The final stage of the model occurs after the individual recognizes a problem and then selecting a help provider after making a decision to seek help. Individual, interpersonal, and sociocultural factors all influence the stages in the model, which can include many, interacting cognitive and affective processes. Even though this study focuses on care seeking among college student survivors of sexual assault and not IPV specifically, the framework is beneficial in considering how and why some students may seek help following SV.

This complex process that impacts help seeking often leads to individuals who have experienced violence seeking care not for the acute incident of sexual assault, but for secondary concerns (e.g., mental health concerns, sexually transmitted infection (STI) or pregnancy testing, or somatic concerns). In the campus setting, students are likely to use services in college health and counseling centers for these services. Likely related to these secondary physical and mental health consequences of violence exposure, the prevalence of SV and related histories of interpersonal violence is higher in clinical settings (including college health and counseling centers) compared to the general population.¹⁴ Recognition of SV-related patterns in care seeking could help providers to better understand the ways in which the student population they are serving has been affected by SV and to ensure appropriate care for survivors.¹⁵ The aims of the present exploratory analyses were to 1) describe reasons for seeking care among students using college health and counseling centers, with the hypothesis that students would not report seeking care for SV directly – regardless of SV experiences; and 2) examine associations between reasons for care seeking at college health and counseling centers and SV experiences. We hypothesized that both prior to college and during college SV experiences would be associated with higher rates of reporting sexual and reproductive health, acute care, and mental health as a reason for care seeking. This study takes advantage of longitudinal data collected as part of an intervention study allowing for assessing changes in care seeking patterns from baseline to one-year later among students who experienced acute SV during this time period.

Materials and Methods

Study Overview

This analysis uses data from a 2-arm cluster-randomized controlled trial on 28 college campuses across western Pennsylvania and West Virginia which tested a brief intervention aimed at reducing alcohol-related SV. ¹⁶ Staff from college health and counseling centers receiving the intervention were trained to assess all patients for SV while patients at control sites received information about responsible drinking.⁴ Study sites were all located on co-ed campuses within a three to four hour radius of Pittsburgh, Pennsylvania. Eligibility for a college campus was based on having a student health or counseling center staffed by a health professional (i.e., counselor, nurse, nurse practitioner, physician’s assistant, or physician) who provided one-on-one services to students. Full protocol details are available in previously published materials.⁴ All study procedures were approved by the University of Pittsburgh and site Institutional Review Boards.

Recruitment and Data Collection

Students were recruited prior to seeing a health care provider using in-person and text message recruitment methods.⁴ Some clinics had pre-scheduled appointment systems that allowed students to be sent study recruitment materials via text message prior to their appointment, others were recruited in person by study or clinic staff using printed material.⁴ Interested students completed an in-person or online screening and consent process before completing an electronic survey prior to their clinic visit. Additional surveys were administered directly after their clinic visit (“exit survey”), four months later (“T2”) and one year later (“T3”). Surveys were administered on either a computer or iPad in a private setting with a research assistant, or on the participant’s personal phone, tablet, or computer. Eligibility criteria for the parent study included: 1) being between ages 18–24 years, 2) able to understand English, 3) seeking care at a college health center for any reason, and 4) having sufficient time to complete a 20-minute survey prior to seeing their provider.

Measures

Reason for seeking care at college health centers was collected through an exit survey after students completed a visit at the clinic and at the one-year follow up survey. Participants’ reasons for visit in the exit survey were elicited through a question that read “What was the main reason for your visit today? (check all that apply).” Table 1 lists all the options participants could choose from; a similar list was presented to participants who reported seeking any on-campus health care during the one-year follow up period. Survey items were study specific, modified from questions used in prior similar intervention studies, and modified between baseline and follow up to address feedback from sites, stakeholders, and the research team that the questions at baseline did not provide adequate depth of choices for mental health care seeking.^18,19

Table 1:

Reasons for visits to campus health and counseling centers at baseline and one-year follow up by gender

	Baseline (n=2,084)				One-year Follow Up (n=1,170)
Reason for visit	Cisgender Men n=545	Cisgender Women n=1510	Gender minority n=29	p-value*	Cisgender Men n=252	Cisgender Women n=903	Gender minority n=15	p-value*
ACUTE CARE
Any of the following	213 (35.3)	461 (27.9)	5 (15.6)	<0.001	83 (32.9)	389 (43.1)	4 (26.7)	0.008
Cold/flu/cough/allergy/breathing or throat problems	177 (29.4)	392 (23.7)	5 (15.6)		81 (32.1)	369 (40.9)	3 (20.0)
Gastrointestinal issues	18 (3.0)	38 (2.3)	0 (0.0)		7 (2.8)	56 (6.2)	0 (0.0)
Fatigue, fever, or other pain	48 (8.0)	110 (6.7)	1 (3.1)		6 (2.4)	84 (9.3)	1 (6.7)
SEXUAL AND REPRODUCTIVE HEALTH
Any of the following	39 (6.5)	239 (14.5)	2 (6.3)	<0.001	17 (6.7)	190 (21.0)	1 (6.7)	<0.001
Birth control other than condoms	1 (0.2)	92 (5.6)	0 (0.0)		0 (0.0)	89 (9.9)	1 (6.7)
Emergency contraceptive	0 (0.0)	5 (0.3)	0 (0.0)		0 (0.0)	11 (1.2)	0 (0.0)
Pregnancy test	0 (0.0)	15 (0.9)	0 (0.0)		0 (0.0)	18 (2.0)	0 (0.0)
STD test or treatment	28 (4.6)	54 (3.3)	54 (3.3)		12 (4.8)	61 (6.8)	0 (0.0)
Gyno exam	0 (0.0)	56 (3.4)	0 (0.0)		0 (0.0)	70 (7.8)	0 (0.0)
Pain around genitals, urination	5 (0.8)	44 (2.7)	0 (0.0)		0 (0.0)	24 (2.7)	0 (0.0)
Sexual assault	5 (0.8)	6 (0.4)	1 (3.1)		0 (0.0)	4 (0.4)	0 (0.0)
Condoms	4 (0.7)	7 (0.4)	1 (3.1)		7 (2.8)	10 (1.1)	0 (0.0)
ROUTINE CARE
Any of the following	91 (15.1)	322 (19.5)	4 (12.5)	0.048	30 (11.9)	172 (19.0)	2 (13.3)	0.022
TB test	27 (4.5)	183 (11.1)	4 (12.5)		8 (3.2)	92 (10.2)	1 (6.7)
Immunization	46 (7.6)	96 (5.8)	0 (0.0)		18 (7.1)	80 (8.9)	0 (0.0)
INJURY
Injury	53 (8.8)	50 (3.0)	4 (12.5)	<0.001	20 (7.9)	46 (5.1)	0 (0.0)	0.106
OTHER
Any of the following	133 (22.1)	389 (23.5)	11 (34.4)	0.253	29 (11.5)	73 (8.1)	3 (20.0)	0.108
Other	133 (22.1)	389 (23.5)	10 (31.3)		29 (11.5)	73 (8.1)	3 (20.0)
Transgender care	0 (0.0)	0 (0.0)	1 (3.1)		0 (0.0)	0 (0.0)	0 (0.0)
MENTAL HEALTH
Any of the following	46 (7.6)	142 (8.6)	7 (21.9)	0.050	50 (19.8)	235 (26.0)	9 (60.0)	0.002
Alcohol or drug counseling	16 (2.7)	16 (1.0)	1 (3.1)		4 (1.6)	7 (0.8)	0 (0.0)
Mental health	32 (5.3)	127 (7.7)	6 (18.8)		18 (7.1)	114 (12.6)	3 (20.0)
Academic issues					13 (5.2)	70 (7.8)	2 (13.3)
Anxiety and/or depression					37 (14.7)	171 (18.9)	8 (53.3)
Crisis intervention					1 (0.4)	11 (1.2)	0 (0.0)
Drug/alcohol problems					7 (2.8)	9 (1.0)	0 (0.0)
Eating disorder or excessive exercise concerns					3 (1.2)	13 (1.4)	0 (0.0)
Grief/loss					2 (0.8)	23 (2.5)	2 (13.3)
Relationship and intimacy					9 (3.6)	52 (5.8)	1 (6.7)
Social/interpersonal issues					13 (5.2)	60 (6.6)	4 (26.7)
Sexuality					1 (0.4)	9 (1.0)	1 (6.7)
Trauma/PTSD					3 (1.2)	19 (2.1)	2 (13.3)
Family problems					9 (3.6)	54 (6.0)	4 (26.7)
Difficulties adjusting to college					4 (1.6)	12 (1.3)	1 (6.7)
Suicidal thoughts/urges					5 (2.0)	29 (3.2)	4 (26.7)
Self-injury behaviors/urges					1 (0.4)	20 (2.2)	0 (0.0)
Problems related to a disability					4 (1.6)	8 (0.9)	2 (13.3)
Psychiatric medication issue					6 (2.4)	27 (3.0)	5 (33.3)
Other - counseling reason					5 (2.0)	11 (1.2)	0 (0.0)

Notes: Reason for visit categories are not mutually exclusive. List of mental health reasons for care options were expanded between baseline and one-year follow up.

^*p-values are listed for Pearson Chi² tests or Likelihood Ratio Chi² based on expected cell counts

A modified version of the six item Sexual Experiences Survey (SES), was used to assess sexual violence ¹⁷ at baseline (before and since college), in the past four months (baseline, T2, and T3), and in the past 12 months (T3).⁴ Unwanted SV experiences included items such as someone “has fondled, kissed, or touched you sexually when you indicated that you didn’t want to?” and “has anyone made you have vaginal sex when you indicated you didn’t want to?” Participants were asked to indicate the number times each SV type occurred (0, 1, 2, 3, or 4 or more times) within the specified time frame.^4,8

For these analyses, responses were re-coded into dichotomous variables for having experienced or not experienced any SV at three time points: 1) prior to starting college, 2) since starting college (reported at baseline), 3) between baseline and one-year follow up. The measure demonstrated adequate reliability in our sample at baseline, with a Cronbach alpha of 0.78, for the “prior to college” timeframe.⁴

Demographic items were also included in the baseline survey including: 1) gender (cisgender male, cisgender female, gender minority [inclusive of transgender men, women, nonbinary and genderqueer individuals, and individuals who selected “other”]; 2) year in school (first year undergraduate, second year undergraduate, third year undergraduate, fourth year undergraduate, fifth year+ undergraduate/graduate student 3) baseline residence (campus related housing [including dormitories, Greek life housing, other campus housing] and non-campus housing [including parent/guardian’s home, off campus apartment, and “other” responses], and 4) race (Asian, Black/African American, White, more than one/other)

Data Analysis

Descriptive statistics were used to characterize the sample. Bivariate analysis comparing students’ reason for visit by gender were examined using Pearson Chi² or Fisher’s Exact tests. Generalized linear mixed modelling with a random effect to account for clustering of participants within schools was used to examine differences in the reason for visit outcome. Separate multivariable models were built for each visit category (e.g., sexual and reproductive health, acute care, etc.) at each time point (baseline data from the exit survey and one-year follow up). Because of the known differences between SV reporting and care seeking by gender, models at each time point were also run for cisgender men and women separately. Multivariate analysis was not used for gender minority students because of the small sample size (n=29). In addition to parent study exclusion criteria above, we excluded students (n=204) at both timepoints who did not complete the questionnaire items for gender (n=3), reason for visit (n=201). For the one year follow up models, we additionally excluded students who: 1) did not complete the one-year follow up (n= 470), 2) indicated that they had graduated or took leave of absence during the past 12 months of study participation (n=426). or 3) did not provide responses to key variables in the one-year follow up survey (n= 396) (i.e., SV since baseline, reasons for seeking care since baseline). As assessing reason for visit was not the parent study’s primary aim, power calculations for sample size were not conducted for this analysis prior to data collection.¹⁸ Significance levels were set at 0.05 a priori and no correction for multiple tests was completed in this secondary analysis of the parent study data. Data were analyzed using SPSS Version 25.¹⁹

Results

Demographics

Our final sample for these analyses included 2,084 students at baseline, and 1,170 at one-year follow up. At baseline, the sample was primarily female (72%) and White (68%), with an even split between on and off campus living. SV was prevalent in this sample, with just over a third of participants (36%) reporting SV since starting college at baseline, more than 40% reporting SV prior to starting college, and 30% reporting additional SV experiences during the one-year study follow up period, with an overall 60% total lifetime prevalence of SV in the sample.

Reasons for visiting student health and counseling centers

At baseline and one-year follow up students sought care most often for respiratory symptoms (e.g., cough, allergies, etc.) – 15–29% students across all gender categories at baseline and 27–43% of students at follow up (Table 1). At baseline, approximately one in four students also reported seeking care for an “other” reason. When additional categories choices were added for students who sought counseling services at one-year follow up, “anxiety and/or depression” were endorsed as a reason for seeking care by 18% of students overall, with just over half of gender minority students indicating this as a reason they had sought care in the past year. Less than 1% of the sample reported seeking care directly related to sexual assault, despite 36% having experienced SV since starting college and more than 60% having experienced lifetime SV.

Impact of Sexual Violence on Reason for Seeking Care

At baseline, students who reported SV prior to entering college were more likely to report seeking care for mental health (OR: 1.708, 95%CI: 1.246–2.342) or sexual and reproductive health reasons (OR: 1.329, 95%CI: 1.011–1.747). These same students were less likely to endorse seeking care for a routine care visit type (OR: 0.761, 95%CI: 0.597–0.969). In our baseline data, no relationships were noted between reason for seeking care and SV experience since starting college. At one-year follow-up, students who reported SV exposure since baseline were more likely to report seeking care for mental health (OR: 1.411, 95%CI: 1.022–1.949) and sexual and reproductive health (OR: 1.803, 95% CI: 1.256–2.588) reasons compared to students without SV exposure during the year of study follow up.

Gender differences in seeking care

At the baseline visit, there were gender differences for all types of visits, with cisgender women reporting more sexual and reproductive health care and routine care visits, cisgender men reporting the highest frequency of visits for acute care (i.e., illness), and gender minority students reporting the highest frequency of mental health and injury visits (Table 1). At one-year follow up (in which all visit types in the past year could be included), fewer differences remained, with women continuing to report the highest rates of sexual and reproductive health, acute care, and routine care seeking, gender minority students reporting the highest rates of mental health care seeking, and no differences by gender in reporting of injury or “other” reasons. As gender difference were noted in bivariate analysis of reasons students reported seeking care, gender specific models were run when examining the impact of SV on care seeking. Models at each time point were run for cisgender men and women separately, producing results that are interpreted similarly to the combined gender model (Online Supplemental Material). Demonstrating that in our sample gender did not appear to impact the relationship between reason for care seeking and SV.

Discussion

The study aimed to describe reasons college students seek care at college health and counseling centers and examined the association between these reasons and students’ SV experiences. As anticipated, most students were not seeking care specifically for SV but rather, were seeking care for other reasons. Additionally, although there were differences by gender in reasons for care seeking, we found no differences by gender on the impact of SV on care seeking patterns. That is, for all genders, those students exposed to SV were more likely to present to college health and counseling centers for sexual and reproductive health and mental health concerns.

Despite 36% of students in the sample reporting SV during college and 30% of students reporting SV during the year of study follow up, less than 1% of students reported seeking care specifically for sexual assault care. This finding is consistent with literature that suggest that individuals who have experienced SV do not seek healthcare because of the barriers associated with seeking care for SV. ^20–23 Based on the results, providers on college campuses must be prepared to provide trauma-informed care to survivors of SV despite the lack of direct care seeking and disclosures. An analysis of care seeking among college students revealed that the majority of the students who had experienced any form of SV did not report because they did not perceive the victimization as a serious offense while others indicated that they felt it was a personal issue making them not report the incidence.¹³ Further, those who sought help were more likely to seek help from off-campus rather than on-campus providers. ²⁴ This can be related to the first stage of the framework which speaks to recognizing and identifying violence as a problem. Students who do not perceive SV as a serious problem would therefore not likely report it or seek help to deal with it.¹⁰

While exploratory, our results in the context of others are also consistent with Liang and colleagues’ framework in that students do not consistently decide to seek care for SV specific reasons. They do, however, appear to seek care more often than peers who have not experienced SV for reasons that are linked to known SV sequelae – e.g. sexual health and mental health. These findings suggest health care providers must be cognizant of the frequency with which their patients likely have experienced SV, but may not be disclosing this directly.

Sabina and Ho found that most college students who experienced SV preferred informal disclosure to peers than reporting to formal service providers such as healthcare professionals. ²⁵ Due to the uneasiness, fear, and mistrust experienced by people who have experienced SV about reporting SV incidents, ²⁶ it is important that college health providers examine the best possible ways to make their clinics inclusive, welcoming, and safe for students to seek care following such incidents. Creating an environment in which students feel comfortable seeking care can be one important step in the process of allowing students to confidentially connect with resources (e.g. mental health providers, SV advocates), receive needed health services (e.g. STI testing, pregnancy prophylaxis), and perhaps ultimately disclose SV to trusted care providers.

Given the many barriers to care seeking following SV on college campuses, there are also larger structural concerns that clinicians can advocate for with campus administrators. These include but are not limited to: ensuring that information regarding confidential and non-confidential help seeking options are widely available and publicly searchable on campus websites;²⁷ ensuring that professional confidential and non-confidential help seeking options are available to students 24 hours a day; creating financial options to assist students who may need to cover costs of medical, housing, or lost work due to SV; providing access to a wide range of academic accommodations; partnering with SV advocates to ensure students have access to professional community-based services in addition to those offered through campuses.²⁸ Despite the informal and limited help seeking, the psychological effects of SV are well documented; lack of disclosure and poor social support following SV have been associated with poor mental health.²⁹ Thus, mental health consultation appears to be common among SV victims.³⁰ In other studies, up to 90% of the respondents sought help for mental health after experiencing sexual violence.³⁴ Individuals who experienced SV have sought help months or even years after the incident and sought general support services during which SV may or may not come up.³¹ This is consistent with our finding that students who reported SV prior to entering college were more likely to be seeking care for mental health concerns. If the recent SV histories (36% of our sample reported SV during college) is not addressed, however, these visits become missed opportunities to provide resources, support, or referrals as appropriate to SV advocates, legal services, or mental health providers to perhaps begin to limit the long-term negative consequences we know are prevalent following an experience of SV.

While differences between cisgender men and cisgender women were not identified when examining the relationship between SV and care seeking reasons, gender differences were observed between the reasons college students reported care seeking at college health and counseling centers in general. Our finding that cisgender women had the highest proportion of visits at baseline and also at one-year follow-up for routine care is not new or unusual.³² Among the reasons given by students for seeking healthcare, mental health and injury visits were more common among gender minority students. This is consistent with a previous study, where gender minorities were more likely to seek mental health services compared to cisgender students.³³ This finding was expected given that the prevalence of psychological issues is higher among gender minorities.³⁴ The reasons for this may include the high rates of discrimination³⁵ and victimization among gender minority students.^36,37

Implications for College Health Providers

Among our care seeking sample, students reported high levels of SV and its sequelae. Students reported SV both prior to and since entering college, and both exposures increased likelihood of seeking care for mental health or sexual and reproductive health concerns. Providers working in campus settings must be aware not only of the acute impacts of violence, but also their long-term impacts and how they are likely to present among the patients they serve.

Providers should be offered training, resources, and support in providing universal trauma-informed care. As students did not present seeking SV or trauma specific care, many students in the study (58% in the intervention arm, which investigated a universal SV intervention) reported not having a conversation or being offered resources with their provider about violence. ¹⁶ These conversations act as an important step in demonstrating to students that campus health settings are safe spaces to turn to for help and that campus-based providers are competent and willing to provide SV resources, support, and treatment.

The specific models (CUES) used for these conversations in this study followed a model developed in partnership by the non-profit Futures Without Violence and utilized in a variety of clinical settings. It includes key steps 1) discuss the limits of Confidentiality such as what topics may trigger mandatory reporting, 2) Universal Education regarding the health impacts of violence, 3) Empowerment for patients to encourage sharing information with friends and others in their networks, and 4) Support for patients who disclose violence in their lives or those of friends and families. The focus of support is on a supported handoff to a trained violence advocate in the community for further assessment and follow up if the patient consents. Given that SV increased care seeking for sexual and mental health reasons across the gender spectrum, it is important for providers to note the biases that may be present in their practices around discussing or sharing SV related resources. Providers must also understand the important role they play as confidential holders of information on campuses. College campuses are a unique environment in that Title IX policies limit students’ options for privacy and confidentiality when asking for help related to SV. As students are often not able to seek confidential help or guidance for SV from the trusted adults in their life while on campus due to their mandated reporter status, healthcare providers play an even more important role in recognizing students’ needs and connecting them to appropriate, confidential resources. Coordination with other individuals on campus to ensure smooth handoffs of care and services are necessary, while also recognizing that students are often hesitant to engage in formal reporting procedures. Ensuring that support systems within the student health, counseling, and wellness community exist to meet the sexual, reproductive, and mental health needs of these students during this time is critical.

Due to findings demonstrating gender minority students often face increased need for and use of mental health resources,³⁵ campuses must ensure that there is improved access and services for mental health on college campuses that are inclusive and competent to address the specific psychological needs of gender minority students.

Limitations

The current study had limitations in addition to those identified in the parent study. There was limited racial and ethnic diversity in the sample due to the geographic area used during sampling.⁴ The study did not assess the meanings college students attached to SV and how their definition influenced their decision to either seek or not seek care for SV. Instead, the reason for visit item used a predetermined list of options which did not always provide us with a complete understanding of the specific reasons why students visited college health and counseling centers (for example: students did not have the option of providing further details when they selected ‘other’ under the options for seeking care). Furthermore, while only 0.5% students reported seeking care from a campus health or counseling provider directly for SV, we did not assess whether students sought care off campus for these specific services. Further research is therefore needed to understand college students’ definition of SV, as well as the barriers and facilitators of care seeking to implement strategies that meet their needs.

Despite these limitations, the study adds to the literature on SV among college students. A major strength of this study is how SV was broadly measured incorporating all forms of sexual assault, rape, unwanted sexual contact and non-contact experiences. While other studies have focused specifically on sexual assault involving contact or solely on forced sexual intercourse^38,39, it was relevant to include several types of SV rather than only rape or sexual assault as defined in criminal law because all forms of violence can have traumatic effects and long-term consequences on victims.^40–42 However, it is important to acknowledge that using a broader definition can make it difficult to compare to other study findings due to varying definitions.

Conclusion

This paper highlights that most students who experience SV do not seek on-campus care specifically for SV, but do regularly seek services for sexual and reproductive health and mental health concerns. While gender largely did not impact the relationship between SV and care seeking reasons, gender differences were observed for the overall reasons college students reported visiting the college health and counseling centers. Providers working in campus health settings should know how to provide care for patients who have experienced SV – regardless of disclosures.

Table 2:

Results from generalized mixed models for reasons for visit to campus health or counseling center.

Reason for Visit	Sexual Violence	Baseline (n=2,084)	One-Year Follow Up (n=1,170)
Sexual and reproductive health	SV Before College	1.329 (1.011, 1.747)*	1.261 (0.883,1.800)
	SV During College	1.221 (0.923,1.615)	1.803 (1.256, 2.588)*
	SV Since Baseline	-	1.337 (0.917,1.950)
Mental health	SV Before College	1.708 (1.246, 2.342)*	1.248 (0.912,1.709)
	SV During College	1.339 (0.972,1.844)	1.411 (1.022,1.949)*
	SV Since Baseline	-	1.322 (0.941,1.856)
Acute care	SV Before College	0.880 (0.720,1.075)	1.261 (0.883,1.800)
	SV During College	0.936 (0.760,1.152)	1.803 (1.256, 2.588)*
	SV Since Baseline	-	1.337 (0.917,1.950)
Injury	SV Before College	0.988 (0.645,1.513)	1.217 (0.700–2.116)
	SV During College	1.297 (0.838,2.005)	1.412 (0.803–2.485)
	SV Since Baseline	-	0.637(0.335–1.213)
Routine care	SV Before College	0.761 (0.597, 0.969)*	0.762 (0.533,1.088)
	SV During College	0.965 (0.754,1.234)	0.918 (0.636,1.325)
	SV Since Baseline	-	1.130 (0.764,1.672)
Other	SV Before College	1.129 (0.912,1.397)	0.890 (0.561,1.413)
	SV During College	0.872 (0.698,1.090)	0.614 (0.370,1.018)
	SV Since Baseline	-	1.092 (0.650,1.835)

Notes: Each model controls for effects of year in school, baseline residence, and race in addition to sexual violence at prior timepoints.

^*Denotes values which were statistically significant at p<0.05.