Alcohol and sexual risk behaviors as mediators of the sexual victimization-revictimization relationship.

Numerous studies demonstrate a strong relationship between sexual victimization and revictimization. Women who are victimized sexually, whether in childhood (Merrill et al., 1999), adolescence (Hines, 2007; Humphrey & White, 2000) or adulthood (Kilpatrick, Acierno, Resnick, Saunders, & Best, 1997) are at elevated risk of being victimized again. Although several possible explanations for this persistent finding have been offered, there have been few prospective examinations of the proposed mediational mechanisms and hence limited support for any of these models. The current longitudinal study was designed to address this gap by examining the indirect effect of adolescent sexual victimization on later sexual victimization, specifically focusing on risky alcohol use and sexual behavior as potential mediating mechanisms. The empirical link between victimization and revictimization is robust and widely replicated across samples and ages but not well understood. Although empirical tests show a direct relationship, the actual relationship is much more likely to be indirect. That is, early victimization is likely to result in consequences for the woman that increase her vulnerability to later assault. Several integrative reviews have considered a variety of possibilities to explain the robust victimization – revictimization relationship (see Breitenbecher, 2001; Gold, Sinclair, & Balge, 1999; Messman-Moore & Long, 2003; Polusny & Follette, 1995). One explanation is that victims have difficulty assessing or responding to risky situations, and these impaired responses to risky situations increase vulnerability to sexual assault (see Gidycz, McNamara, & Edwards, 2006 for a review). Another explanation is that psychological trauma resulting from early victimization, such as post-traumatic stress, mediates the relationship between initial and later victimization (Hedtke et al., 2008; Risser, Hetzel-Riggin, Thomsen, & McCanne, 2006). Trauma symptoms, such as hyperarousal, may interfere with the ability to correctly recognize danger or may alert potential perpetrators to the woman's vulnerability (see Messman-Moore & Long, 2003). Another proposed mechanism involves self-medication of trauma symptoms through use of alcohol or drugs (see Stewart, Pihl, Conrod, & Dongier, 1998) or engaging in sexual activity as a way of regulating negative affect (Briere, 2005). Both substance use and elevated sexual activity may subsequently increase vulnerability to later victimization. It is this mechanism that is the focus of the current investigation. Numerous studies demonstrate that childhood and adolescent victimization are associated with increased substance use and abuse in adolescence and adulthood (Champion et al., 2004; Epstein, Saunders, Kilpatrick, & Resnick, 1998; Kendler et al., 2000; Kilpatrick, Acierno, Resnick, Best, & Schnurr, 2000; Nelson et al., 2002; Wilsnack, Vogeltanz, Klassen, & Harris, 1997; see Sartor, Agrawal, McCutcheon, Duncan, & Lynskey, 2008 for a review). In turn, women's substance use has been identified as a risk factor for subsequent sexual victimization (Mohler-Kuo, Dowdall, Koss, & Wechsler, 2004; Parks, Hsieh, Bradizza, & Romosz, 2008; Testa, VanZile-Tamsen, & Livingston, 2007). Increased vulnerability associated with alcohol use may stem from several potential mechanisms. First, acute intoxication impairs a women's ability to recognize sexual assault risk while increasing willingness to engage in risk-enhancing behaviors (e.g., Testa, VanZile-Tamsen, Livingston, & Buddie, 2006). At higher levels of intoxication, incapacitation or unconsciousness can result, leaving the woman unable to resist unwanted sexual advances (Kilpatrick, Resnick, Ruggierio, Conoscenti, & McCauley, 2007; Testa, Livingston, VanZile-Tamsen, & Frone, 2003). Among college students, rape while incapacitated is considerably more common than forcible rape (Mohler-Kuo et al, 2004). In addition, young people typically consume alcohol in social settings such as parties and bars where others are drinking (Single & Wortley, 1993). These settings, which include intoxicated males and females in a sexually-laden context (see Norris, Nurius, & Dimeff, 1996) pose risks for sexual victimization independent of alcohol consumption (Copenhaver & Grauerholz, 1991; Parks & Zetes-Zanatta, 1999). Another risk behavior that has been associated with sexual victimization is increased sexual activity. Numerous studies show that childhood sexual abuse (CSA) survivors initiate sex earlier and have more sexual partners than non-survivors (see Arriola, Louden, Doldren, & Fortenberry, 2005; Senn, Carey, & Vanable, 2008 for reviews). Prospective studies have implicated higher levels of consensual sexual activity as a risk factor for later sexual victimization (Messman-Moore, Coates, Gaffey, & Johnson, 2008; Parks, Romosz, Bradizza, & Hsieh, 2008; Raghavan, Bogart, Elliott, Vestal, & Schuster, 2004). The increased vulnerability associated with having more sexual partners may reflect the fact that with exposure to more men, there is a statistically increased chance of encountering an aggressive man. However, it may also reflect greater exposure to parties and other locations that facilitate sexual activity or “hookups, ” just as the sexual vulnerability associated with drinking alcohol may reflect risk associated with the settings in which alcohol is consumed. Flack et al. (2007) found that hookups, that is, brief sexual encounters outside of intimate or dating relationships, were the most common context in which sexual victimization occurred in their sample of college women. Frequency of alcohol intoxication is strongly associated with hooking up (Paul, McManus, & Hayes, 2000). Although mediated models explaining the link between initial and later sexual victimization are often implied (see Filipas & Ullman, 2006; Siegel & Williams, 2003), there are few empirical tests of such models. Gidycz, Hanson and Layman (1995) tested, but failed to find that alcohol or sexual partners mediated the relationship between prior and subsequent victimization in a college sample. However, Orcutt, Cooper, and Garcia (2005) found that the strength of the relationship between prior and subsequent victimization in a community sample was reduced when sexual behavior was considered as a mediator. Substance use was not considered in this study. Thus, a primary goal of this study was to test a mediated model, whereby the relationship between adolescent sexual victimization and college victimization is presumed to be mediated via two types of risky behaviors: sexual and alcohol-related. The transition from high school to college is a particularly appropriate time to examine the mediating influences of risky behaviors on sexual victimization, given that the college setting, with its inherently greater freedoms, offers increased availability and opportunity to engage in risky behavior if one so desires (Fromme, Corbin, & Kruse, 2008). Accordingly, there are well-documented increases in alcohol consumption from high school to college (Schulenberg & Maggs, 2002; White et al., 2006) and some evidence that the likelihood of having sex with multiple partners increases during this transition as well (Fromme et al, 2008). Moreover, the first year of college is a particularly high risk time for sexual victimization relative to later college years (Humphrey & White, 2000). For college students, sexual and alcohol-related risk behaviors are likely to be particularly important (and related) predictors of sexual vulnerability given that heavy episodic drinking and “hookups” occur within the drinking contexts that also pose a risk for sexual victimization. Based on these research findings, we propose and test a prospective, mediated model of revictimization among first year college students (see Figure 1). Consistent with much prior research (e.g., Humphrey & White, 2000), we hypothesize that adolescent sexual victimization will increase risk of experiencing sexual victimization during the first year of college. However, we also expect the victimization-revictimization relationship to be at least partially mediated by alcohol-related and sexual risk behaviors in the first semester of college. Thus, we expect a significant path from high school victimization to college risk behaviors and a significant path from college risk behaviors to college victimization. The proposed model accounts for the expected positive association, at baseline, of adolescent victimization and drinking and sexual activity in the last year of high school. Moreover, the model accounts for the significant association of high school risk behaviors and college risk behaviors (e.g. Fromme et al, 2008; Sher & Rutledge, 2007), with high school HED and sexual activity as additional mediators of the effects of adolescent victimization on college risk exposure. Figure 1 Conceptual prospective model of first semester college risk behaviors as mediators of sexual revictimization during first year of college. T0 is the baseline at the end of senior year in high school; T1 is the end of the first fall semester in college; ...