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SexualViolenceVictimizationArticle1.docxSexual Violence Victimization and Associations with Health
in a Community Sample of African American Women
Kathleen C. Basile, Sharon G. Smith, Dawnovise N. Fowler, Mikel L. Walters,
and Merle E. Hamburger
Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
ABSTRACT
Limited information exists on the relationship between sexual
violence victimization and health among African American
women. Using data from a community sample of African
American women, we examine the association between current
health and lifetime experiences of sexual violence. Inperson
interviews were completed in 2010. Among interviewees,
53.7% of women reported rape victimization and 44.8%
reported sexual coercion in their lifetime. Victims of rape or
sexual coercion were significantly more likely to report depression
and posttraumatic stress disorder during their lifetime.
Among victims whose first unwanted sexual experience was
rape or sexual coercion, perpetrators were mostly acquaintances
and intimate partners, and over one third were injured
and needed services. More attention is needed on the health
needs of African American women and their association to
victimization status.
ARTICLE HISTORY
Received 15 September
2014
Revised 26 May 2015
Accepted 29 May 2015
KEYWORDS
Help-seeking; negative
health experiences; rape;
sexual coercion
Although sexual violence (SV) occurs across all ethnic and racial groups,
research has increasingly pointed to the prevalence and adverse health outcomes
of SV among specific groups, such as African American women and
other ethnic and racial minorities (Black et al., 2011; Bryant-Davis, Ullman,
Tsong, Tillman, & Smith, 2010; Lacey, McPherson, Samuel, Sears, & Head,
2013; Young & Boyd, 2000). Due to the limited number of studies and the
complex nature and consequences of SV victimization for African American
women, further research is needed.
There is a substantial literature focused on the health-related consequences
of SV (Lang et al., 2003; Smith & Breiding, 2011). Prior work has shown, for
example, that sexually victimized women are more likely to experience many
chronic health conditions, HIV risk factors, smoking, and excessive drinking
(Smith & Breiding, 2011). But most of the literature comes from population
samples that are not large enough to stratify by race or ethnicity. As a result,
less is known about the extent to which particular racial and ethnic groups,
CONTACT Kathleen C. Basile [email protected] Centers for Disease Control and Prevention, National Center
for Injury Prevention and Control, Division of Violence Prevention, Mailstop F64, 4770 Buford Highway, Atlanta, GA
30341-3724.
JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA
2016, VOL. 25, NO. 3, 231–253
http://dx.doi.org/10.1080/10926771.2015.1079283
This article not subject to US copyright law
including African American women SV survivors, experience these types of
negative health indicators. In this study, SV victimization status and specific
health associations are identified (e.g., mental, physical, and behavioral health
conditions, and postvictimization services received) in a community sample
of African American women.
Definitional components
The literature on SV uses various terms and definitions to examine this
public health problem, including sexual assault, sexual coercion, and rape.
These terms often overlap in definitions and are used interchangeably. For
the purpose of this study, SV includes physically forced nonconsensual
completed or attempted penetration, penetration when the victim was not
able to consent because she was passed out or asleep (rape), or unwanted
penetration that is not physically forced (sexual coercion; Basile, Smith,
Breiding, Black, & Mahendra, 2014).
The extent of SV among African American women
Despite the large body of literature examining SV, large nationally representative
studies focusing specifically on racial and ethnic minority women are limited.
Further, much of the previous scholarship that does exist on SV of African
American women is focused on rape and other penetrative SV acts (i.e., sexual
coercion), perhaps given the seriousness of these kinds of SV victimization and
their association with adverse health. Some national prevalence studies have
examined rape by racial and ethnic identity. For example, the National Violence
Against Women Survey (NVAWS) found that 18.8% of African American
women had experienced rape in their lifetime (Tjaden & Thoennes, 1998). A
study using data fromthe National Crime Victimization Survey found that from
2005 to 2010, approximately 3 African American women per 1,000 reported
experiencing sexual assault since age 12 (Planty, Langton, Krebs, Berzofsky, &
Smiley-McDonald, 2013). Kilpatrick, Resnick, Ruggiero, Conoscenti, and
McCauley (2007) conducted a national telephone study using both community
and college samples. These samples reported that African American women
reported higher rates of lifetime forcible rape than non-Hispanic White women,
Hispanic women, and Asian women. More recently, the National Intimate
Partner and Sexual Violence survey (NISVS) found that 13.6% of Hispanic
women, 21.2% of non-Hispanic Black women, 20.5% of non-Hispanic White
women, and 27.5% of American Indian/Alaska Natives reported experiencing
rape during their lifetime (Breiding et al., 2014). Several smaller studies have also
focused on the differences in SV by race or ethnicity. Molitor, Ruiz, Klausner,
and McFarland (2000) recruited young women from a community sample of
low-income neighborhoods in five counties in California. Of more than 2,500
232 K. C. BASILE ET AL.
young women, 24.0% reported they had experienced forced sex (30.0% of
African Americans, 32.0% of Whites, 14.4% of Hispanics, and 30.0% of multiracial
women). The aforementioned studies illustrate the range of SV prevalence
across samples of racial and ethnic minority women. Despite such variation,
findings consistently reveal a high burden of SV victimization among African
American women and other racial and ethnic minority groups. Given this
burden, it is imperative to explore the health of African American women SV
survivors as it can improve our understanding of the risks for this population,
and ultimately informthe development of effective interventions to address their
needs.
Health risks and adverse conditions for African American women SV
survivors
A substantial body of literature documents the risks of SV victimization to
physical, mental, and behavioral health, indicating that SV survivors are more
likely to experience adverse health compared to non-SV victims (Koss, Koss, &
Woodruff, 1991; McFarlane et al., 2005; Pico-Alfonso et al., 2006; Rivara et al.,
2007). Moderate to high rates of SV (e.g., 22%–100%) are reported in various
samples of predominantly African American women, including substance abuse
treatment recipients (Young & Boyd, 2000), low-income samples (Boyd,
Henderson, Ross-Durow, & Aspen, 1997; Bryant-Davis et al., 2010; Dailey,
Humphreys, Rankin, & Lee, 2011; Kalichman, Williams, Cherry, Belcher, &
Nachimson, 1998), and military veterans (Campbell, Greeson, Bybee, & Raja,
2008).
Adverse mental and behavioral health
Depression, posttraumatic stress disorder (PTSD), substance use disorders
(SUDs), and suicidality are common mental and behavioral health problems
among SV survivors in general (Alim et al., 2006; Caetano & Cunradi, 2003;
Iverson et al., 2013; Ramos, Carlson, & McNutt, 2004). In a U.S. national
sample, a history of SV has been found to be associated with anxiety
disorders, mood disorders, PTSD, SUDs, and suicide attempts (Iverson
et al., 2013). Studies focusing on the mental and behavioral health of
African American female SV survivors in particular are limited, and the
studies that exist usually rely on urban, low socioeconomic status (SES), or
drug-abusing samples (Boyd et al., 1997; Bryant-Davis, Chung, & Tillman,
2009; Bryant-Davis et al., 2010; Campbell et al., 2008; Vaszari, Bradford,
CallahanO'Leary, Ben Abdallah, & Cottler, 2011). For example, in a community
sample of low-income, ethnically diverse women (N = 835), Temple and
colleagues (2007) found that sexual assault by current partners and nonpartners
was a significant predictor of PTSD symptoms for African American
JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 233
women. Depression is consistently found to be a health risk for African
American SV survivors (Alim et al., 2006; Ramos et al., 2004). Data from
462 women (87% African American) who were cocaine users showed that
43.3% reported sexual assault victimization. Among the African American
women in the sample, 85% reported suicidal ideation. Similarly, in terms of
comorbidity, in a sample of African American women recruited from an
urban hospital (n = 335), Thompson and colleagues (2000) found that
women with a history of child sexual abuse and current PTSD symptoms
were more likely than women without a child sexual abuse history or PTSD
to attempt suicide.
Although a concern for all survivors, adverse mental health and substance
use problems could be particularly problematic for African American women
SV survivors due to their risk for multiple, overlapping public health problems
and conditions (Bryant-Davis et al., 2010). For example, Bryant-Davis
and colleagues (2010) explored the relationship between poverty and mental
health outcomes in an urban community sample of African American female
SV survivors (N = 413). Positive relationships were found between poverty
and depression, PTSD, and illicit drug use in the sample.
Other adverse conditions and life consequences
A body of studies with samples of African American women either examined
the role of income or poverty as a correlate of SV (Bryant-Davis et al.,
2010; Ingram, Corning, & Schmidt, 1996), or included high numbers of
respondents with both low SES and high rates of SV victimization
(Kalichman et al., 1998; McFarlane et al., 2005; Temple et al., 2007;
Vaszari et al., 2011). Due to no or low income, African American women
with low SES are often resigned to homelessness or low-income housing in
communities where they are at increased risk for multiple violence exposures
(Abbey, Parkhill, Jacques-Tiura, & Saenz, 2009; Jenkins, 2002). In
addition to housing insecurity, food insecurity is another potentially related
adverse condition for impoverished African American women SV survivors.
Although food insecurity, as a factor of poverty, has not been directly
explored in the literature, it is related to women’s ability to meet their own
as well as their children’s basic needs. Overall, poverty and low SES are
associated with increased rates of SV among African American women
(Byrne, Resnick, Kilpatrick, Best, & Saunders, 1999; Honeycutt, Marshall,
& Weston, 2001; Kalichman et al., 1998).
Help-seeking and service needs
The help sources typically sought by SV survivors include reporting
assaults to police, obtaining protection orders (POs), receiving emergency
234 K. C. BASILE ET AL.
medical services (EMS) and emergency trauma department care, turning to
social support networks, and, in some cases, seeking mental health services
and victim shelter services (Bryant-Davis, Ullman, Tsong, & Gobin, 2011;
Kothari et al., 2012). Yet, the majority of all sexual assaults are not
reported or shared with social services or law enforcement (Hanson
et al., 2003), and often survivors who need medical care and counseling
do not receive it (Resnick et al., 2000). National data indicate that approximately
one fourth (26.2%) of adult rape survivors seek medical care after
the assault (Resnick et al., 2000). The National Crime Victimization Survey
(NCVS) estimates that in 2010 only 35% of the sexual assaults experienced
by women (regardless of their relationship to the perpetrator) were
reported to police (Planty et al., 2013).
Relatively few studies have investigated post-SV help-seeking characteristics
and correlates specifically among African American women SV survivors
(Zinzow, Resnick, Barr, Danielson, & Kilpatrick, 2012). A small number of
researchers have focused on increasing the attention in the literature on what
Bryant-Davis and colleagues (2011) called the “cultural context of sexual
assault recovery” (p. 1602). For example, Flicker et al. (2011) investigated
the differential impact of concomitant forms of violence (sexual violence,
stalking, and psychological aggression) and ethnicity on help-seeking behaviors
of female partner abuse survivors. The authors found racial differences
related to specific help-seeking behaviors. For example, African American
women survivors were more likely to seek police help and orders of protection
compared to White women, which appears to be consistent with other
findings (Bachman & Coker, 1995; Lipsky, Caetano, & Roy-Byrne, 2009;
Pearlman, Zierler, Gjelsvik, & Verhoek-Oftedahl, 2003). Yet, Kothari et al.
(2012) found, in a sample of women survivors of partner violence (including
SV) for which the police were involved, that African American women
survivors were less likely to obtain protective orders than White women
survivors. Such inconsistencies suggest the influence of contextual and cultural
factors on the help-seeking behaviors of women survivors (Bent-
Goodley, 2007; Boykins et al., 2010).
In terms of contextual factors, the nature of the rape experience seems to
matter. Boykins and colleagues (2010) found that Black women SV survivors
were more likely to have reported weapons used in their assaults and use of
illicit drugs when compared to White women survivors. The context of the
rape incident and experience could affect African American women survivors’
propensity to seek help from the emergency department as a primary
source of care for this population (Boykins et al., 2010; Koss et al., 1991) over
other types of help sources, as well as the experience of weapon-inflicted
injuries requiring such specific care.
Similarly, cultural factors and values can also influence help-seeking.
Culturally preferred sources of help, for example, for African American
JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 235
women generally come from informal support networks of family and
friends, and faith-based resources and activities instead of more formal
help sources such as mental health counseling (Bent-Goodley & Fowler,
2006; Bryant-Davis et al., 2011; Henning & Klesges, 2002). Taken together,
more information is needed to better understand the victimization experiences,
related risks, and help-seeking characteristics (i.e., types of services
sought and obtained) for African American women SV survivors.
This study
The purpose of this study is to share findings from a community sample of
African American women about their rape and sexual coercion victimization
and its association with numerous negative mental and physical health
indicators as well as health-related behaviors. This study also builds on
previous studies that have addressed SV-related health risks in this population.
Findings from this study provide an in-depth examination of the health
burden associated with penetrative forms of SV victimization among a racial
and ethnic group of women for which little information is available on
health-related associations.
Methods
Participants
For this study, 168 African American women completed a face-to-face
paper-and-pencil interview. Eligibility requirements for this study were
being female, English-speaking, African American, and 18 years or older.
Descriptive analyses were conducted using the full sample. The women’s
ages ranged from 18 to 93 years old, with an average age of 48. Forty-two
percent (42.4%) of the sample was never married. Sixty-eight percent
(68.3%) completed high school or greater. The women’s total household
incomes varied, but tended to be low: 29.1% of participants reported an
annual income of less than $5,000; 12.7% reported an annual income of
$5,000 to $9,999; 12.1% reported annual income of $10,000 to $14,999,
17.6% reported earning between $15,000 and $24,999, 16.4% reported
annual income of $25,000 to $49,999, and 12.1% reported earnings of
$50,000 or greater.
Procedures
To ensure that interview questions were clearly interpreted and the instrument
was culturally appropriate, a pilot test of an African American sample
of women was conducted and the instrument was fine-tuned. To locate
236 K. C. BASILE ET AL.
African American women to complete the main study interviews, African
American urban neighborhoods in a Southeastern U.S. city and addresses
within those neighborhoods were randomly chosen and interviewers went
to those addresses to determine whether eligible women lived there. A total
of 322 women were screened for eligibility for the study, and 219 women
were deemed eligible. Of them, 168 women were interviewed for a completion
rate of 76.7%. Potential participants were initially told that the study
was about women’s health and well-being. As a safety precaution, interviewers
were instructed to reveal the specific nature of the survey—sexual
violence—only to the selected participant in a safe, private location.
Interviews were conducted between May and July 2010. The interviews
were conducted in person in a private location (most often at the participant’s
home) and lasted from 20 minutes to 2 hours, depending on the
participant’s experiences with SV. All women in the study received $20 as a
token of appreciation. Interviewers read the questions and response options
to participants or showed them a card with a list of the response options
pertaining to the question being asked.
Measures
Participants were asked a range of questions about their health and SV
victimization, including rape and sexual coercion. For all items, responses
of “don’t know” were recoded as missing.
History and tactics of SV
To determine their history of SV victimization, women were asked how
many times in their life they experienced a form of completed or attempted
sex (vaginal, anal, or oral) that was unwanted. Rape items consisted of
completed or attempted sex after a perpetrator used physical force or
threats of physical harm; gave the victim drugs or alcohol; or when the
sex occurred when the victim was passed out, asleep, drunk, or high (and
unable to provide consent to sex). Sexual coercion items consisted of
completed sex after a perpetrator did any of the following: told lies, made
false promises about the future, or threatened to end a relationship or
spread rumors; wore down the victim by repeatedly asking for sex; or
used his or her influence or authority to make the victim engage in
unwanted sex.
For all SV items, response options were never, 1 time, 2 to 5 times, 6 to 10
times, and more than 10 times. Responses were recoded into dichotomous
responses to indicate whether the respondent was ever victimized: 0 = never;
1 = 1 time, 2 to 5 times, 6 to 10 times, or more than 10 times.
JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 237
Negative health behaviors and financial concerns
Alcohol and drug use. All participants were asked (a) how often they
engaged in binge drinking and (b) how often they used illegal drugs or
misused prescription drugs in the past 12 months. Response options for
each question were 0 = never, 1 = less than monthly, 1 = monthly,
2 = weekly, 3 = daily or almost daily and recoded into 1 = yes, any use
and 0 = no use.
Food and housing insecurity. All participants were asked questions
regarding how often they were worried or stressed about (a) their ability to
pay their rent or mortgage, and (b) to buy nutritious meals during the
previous 12 months. Response options for each question were always,
usually, sometimes, rarely, never, or don’t know and recoded into 1 = yes,
any worry and 0 = no worry.
Lifetime mental health conditions
Depression and suicidality. Participants were asked to indicate whether
they ever felt sad, down, or hopeless almost every day for 2 weeks or more,
had little interest or pleasure in doing things almost every day for 2 weeks or
more, seriously considered attempting suicide, or actually attempted suicide.
Response options were coded dichotomously: 1 = yes, 0 = no.
PTSD. Participants were asked to indicate whether they ever had an
experience that was so frightening, horrible, or upsetting that for at least
1 month they had nightmares about it or thought about it when they did not
want to; tried hard not to think about it or went out of their way to avoid
situations that reminded them of it; were constantly on guard, watchful, or
easily startled; or felt numb or distant from others, activities, or their
surroundings. Response options were coded dichotomously: 1 = yes, 0 = no.
First unwanted sexual experience was rape or sexual coercion
Among participants who endorsed any item of rape or sexual coercion
during their lifetime, we focused on those victims whose first unwanted
sexual experience was rape or sexual coercion. Several variables were analyzed
for this subset.
Age of victim. Age at first rape or sexual coercion was measured using the
following response options: 12 or younger, 13 to 17, 18 to 29, 30 to 44, 45 to
59, 60 to 64, 65 or older, and don’t know.
Age of perpetrator. Age of the perpetrator during the victim’s first rape or
sexual coercion was measured using the following response options: 12 or
238 K. C. BASILE ET AL.
younger, 13 to 17, 18 to 29, 30 to 44, 45 to 59, 60 to 64, 65 or older, and don’t
know.
Type of perpetrator. Participants were asked to indicate how they knew
the perpetrator. Four types of perpetrators were used to categorize responses:
(a) intimate partner: current or former boyfriend, girlfriend, romantic partner,
or significant other; current or former legal spouse, including common
law; or someone they were dating but who they would not label as a
boyfriend or girlfriend; (b) friend/acquaintance: friend; acquaintance; someone
they were on a first date with; someone in a position of power or trust
(e.g., employer, teacher, clergy, police officer); or someone else they knew; (c)
family member; and (d) stranger.
Physical health conditions and services related to their first unwanted sexual
experience which resulted in rape or sexual coercion
Injury. Participants were asked to indicate whether they experienced
injuries from the rape or sexual coercion that resulted from their first
unwanted sexual experience. Participants were specifically asked whether
they experienced minor bruises or scratches; cuts, major bruises, or black
eyes; broken bones or teeth; being knocked out after getting hit, slammed
against something, or choked; or other injuries. Response options for each
type of injury were coded dichotomously: 1 = yes, 0 = no.
STD/HIV. In separate questions, participants were asked to indicate
whether they contracted a sexually transmitted disease or whether they
contracted HIV from the rape or sexual coercion that resulted from their
first unwanted sexual experience. Response options were coded dichotomously:
1 = yes, 0 = no.
Pregnancy and outcome of pregnancy. Participants were asked to indicate
whether (yes–no) they got pregnant from the rape or sexual coercion that
resulted from their first unwanted sexual experience. If they answered yes,
they were asked what happened to the pregnancy. Response options were
birthed and kept the baby, birthed the baby and placed him or her for
adoption, had a miscarriage, had an abortion, or don’t know. In addition,
participants were asked whether they lost an existing pregnancy as a result of
their first experience of rape or sexual coercion; response options were coded
dichotomously: 1 = yes, 0 = no.
Rape kit exam. Participants were asked to indicate whether they underwent
a rape kit exam after the rape or sexual coercion that resulted from their
first unwanted sexual experience: Did a doctor or nurse take any physical
JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 239
evidence from you (for example, samples of bodily fluid for a “rape kit”)?
Response options were coded dichotomously: 1 = yes, 0 = no.
Medical services, care, and hospitalization. Participants were asked to
indicate whether they needed medical care from a doctor or nurse due to
the rape or sexual coercion that resulted from their first unwanted sexual
experience. If they indicated yes, then they were asked if they were able to get
the medical care they needed. In addition, participants were asked to indicate
whether they have to stay at a hospital or get other inpatient medical care as a
result of their experience of rape or sexual coercion. Response options for all
questions were coded dichotomously: 1 = yes, 0 = no.
Mental health services. Participants were asked to indicate whether they
needed mental health care from a therapist, counselor, or other mental health
care provider due to the rape or sexual coercion that resulted from their first
unwanted sexual experience. If they indicated yes, then they were asked if
they were able to get the mental health services they needed. Response
options for all questions were coded dichotomously: 1 = yes, 0 = no.
Other services. Participants were asked to indicate whether they needed
housing services, community services, victim’s advocate services, and
whether someone contacted the police due to the rape or sexual coercion
that resulted from their first unwanted sexual experience. Response options
were coded dichotomously: 1 = yes, 0 = no.
Other consequences of the first unwanted sexual experience which was rape
or sexual coercion
Participants were asked to indicate whether they felt safe in the neighborhood
where they lived, whether they missed work, whether they stayed with
family members or friends, and whether they relocated from the area in
which they lived due to the rape or sexual coercion that resulted from their
first unwanted sexual experience. Response options were coded dichotomously:
1 = yes, 0 = no.
Analyses
First, we conducted descriptive analyses to verify racial identification. Three
participants were removed from the analysis sample because they did not
identify as African American, bringing the final sample to 165. Next, we
conducted analyses to determine the percentage of women from this community
sample who experienced rape, sexual coercion, or both in their
lifetime. Next, we performed chi-square analyses to test for a relationship
among mental health experiences, alcohol and drug use, and financial
240 K. C. BASILE ET AL.
concerns and lifetime rape or sexual coercion victim status. Second, we
examined more closely the use of alcohol and drugs, and financial concerns
among lifetime victims of rape or sexual coercion. Finally, we provide
descriptive statistics regarding the characteristics and outcomes of women’s
first unwanted sexual experience that was rape or sexual coercion.
Results
Lifetime experiences of rape or sexual coercion in full sample
In the full sample, over half of participants indicated they were victims of
rape, sexual coercion, or both. More specifically, 53.7% of women reported
rape victimization and 44.8% reported sexual coercion in their lifetime.
About 42% (42.3%) of the full sample experienced both rape and sexual
coercion in their lifetime.
Mental health experiences
Overall, 63.8% of the full sample experienced at least one symptom of PTSD,
and 50.0% experienced at least one symptom of depression during their lifetime.
Chi-square tests were performed, which revealed statistically significant
relationships between victimization status of lifetime experience of rape or
sexual coercion and individual symptoms of PTSD and depression (see
Table 1); lifetime experience of rape or sexual coercion and any symptom of
PTSD, χ2(1, N = 163) = 13.7986, p = .001; and lifetime experience of rape or
sexual coercion and any symptom of depression, χ2(1, N = 164) = 22.2826,
p = .001.
In addition, 20.9% of women in the full sample seriously considered
suicide during their lifetime; among those women, 88.2% also had a history
Table 1. Lifetime Mental Health Experiences by Victim Status of Rape or Sexual Coercion.
Participant has experienced
Victim Nonvictim Total
% n % n N Chi-square
PTSD symptoms (any) 67.31% 70 32.69% 34 104 13.7986*
Nightmares 72.41% 42 27.59% 16 58 9.3428**
Avoided situations that reminded her 68.67% 57 31.33% 26 83 9.7904**
Constantly on guard or easily startled 71.64% 48 28.36% 19 67 11.5359*
Felt numb or distant from others or activities 75.00% 45 25.00% 15 60 14.1523*
Depression symptoms (any) 74.39% 61 25.61% 21 82 22.2826*
Felt sad, down, or hopeless for 2 weeks or more 76.81% 53 23.19% 16 69 20.7523*
Little interest or pleasure in doing things for 2 weeks or
more
75.71% 53 24.29% 17 70 18.5358*
Note: Percentages represent proportion of victims or nonvictims of rape or sexual coercion who endorsed
the mental health experience. PTSD = posttraumatic stress disorder.
*p < .001. **p < .01.
JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 241
of rape or sexual coercion in their lifetime. Among only the women who
seriously considered suicide, 41.2% actually attempted suicide. Among
women who both seriously considered and attempted suicide, 92.9% were
also victims of rape or sexual coercion in their lifetime.
Negative health behaviors and financial concerns in previous 12 months
Food and housing insecurity
In the full sample, 55.2% and 73.9% of participants indicated that they
worried about their ability to buy nutritious meals and pay their rent or
mortgage during the past 12 months, respectively. Chi-square tests revealed
significant relationships between rape or sexual coercion victimization
status and both food and housing insecurity: 66.3% of victims and 40.3%
of nonvictims were concerned about their ability to buy nutritious meals
during the previous year, χ2(1, N = 164) = 11.0490, p = .001. In addition, the
chi-square analysis indicated that 81.5% of victims and 63.9% of nonvictims
worried about their ability to pay their rent or mortgage during the
previous year, χ2(1, N = 164) = 6.4917, p = .011.
Alcohol and drug use
In the full sample, 42.9% and 14.0% of participants engaged in binge
drinking and illegal drug use or prescription drug misuse during the past
12 months, respectively. A chi-square test revealed a significant association
between rape or sexual coercion victimization status and binge drinking in
the past 12 months: 49.5% of victims and 33.8% of nonvictims engaged in
binge drinking during the previous 12 months, χ2(1, N = 162) = 3.9938,
p = .046. Chi-square tests were not performed on drug use due to low cell
sizes.
Experiences among victims of lifetime rape or sexual coercion
In this section the findings presented are among lifetime victims of rape or
sexual coercion only (n = 92).
Negative health behaviors and financial concerns in previous 12 months
among lifetime victims of rape or sexual coercion
Alcohol and drug use. Among lifetime victims of rape or sexual coercion,
a total of 49.5% indicated that they engaged in binge drinking (i.e., drank 4 or
more alcoholic beverages on one occasion) at some point in the previous
12 months on a monthly, weekly, or daily basis. Additionally, 10.9% reported
that they engaged in illegal drug use/prescription drug misuse on a daily or
almost daily basis in the last 12 months (see Figure 1).
242 K. C. BASILE ET AL.
Food and housing insecurity. Among lifetime victims of rape or sexual
coercion, 81.5% were concerned about paying their rent or mortgage, and
66.3% were concerned about their ability to pay for nutritious meals during
the previous 12 months (see Figure 2).
Characteristics of victims whose first unwanted sexual experience was rape
or sexual coercion
Victims were asked a series of questions about their first unwanted sexual
experience, such as their age when it happened and the person who victimized
them. Here, we focus on those whose first unwanted sexual experience
was rape or sexual coercion (n = 80).
Of the 80 women who reported that rape or sexual coercion occurred
during their first unwanted sexual experience, 73.4% (n = 58) reported that
0%
10%
20%
30%
40%
50%
60%
70%
Never Sometimes or
rarely
Always or usually
Rent
Meals
Figure 2. Financial concerns among lifetime victims of rape or sexual coercion, previous 12
months (N = 92).
0%
10%
20%
30%
40%
50%
60%
70%
80%
Never Monthly or less Weekly Daily or almost
daily
Binge drinking
Drug use
Figure 1. Alcohol and drug use among lifetime victims of rape or sexual coercion, previous 12
months (N = 92).
JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 243
the violence occurred when they were under the age of 18. In Figure 3 we
present the women’s ages at their first unwanted sexual experience resulting
in rape or sexual coercion.
Age and type of perpetrator. Among the women who reported a rape or
sexual coercion as their first unwanted sexual experience, perpetrators were
male (98.8%), the same race (96.3%), and known (90.0%) to the women in
some capacity. We examined the victims’ age and type of perpetrator
during their first unwanted sexual experience resulting in rape or sexual
coercion. Among victims who were 12 and younger, perpetrators were
mostly friends or acquaintances (46.2%) or family members (42.3%). Of
victims who were 13 to 17, perpetrators were mostly friends or acquaintances
(53.1%) or intimate partners (28.1%). Among those who were 18 to
29, perpetrators were mostly intimate partners (47.1%) or friends or
acquaintances (41.2%). Finally, among victims who were 30 to 44, perpetrators
were split between intimate partners (50.0%) and friends or
acquaintances (50.0%). See Table 2.
Consequences experienced by women whose first unwanted sexual
experience resulted in rape or sexual coercion
Physical health outcomes. Among women whose first unwanted sexual
experience resulted in rape or sexual coercion, 39.7% of victims suffered
injuries (ranging from minor cuts to being knocked out). Approximately 4%
(3.8%) and 8% (7.8%) reported contracting HIV or a sexually transmitted
disease, respectively. In addition, 17.9% of victims became pregnant as a
result of this experience (see Table 3).
32.9%
40.5%
21.5%
5.1%
12 & younger
13-17
18-29
30-44
Figure 3. Age at victim’s first unwanted sexual experience: Victims of rape or sexual coercion
(N = 79). One participant was excluded because she could not recall her age at the time of her
first unwanted sexual experience.
244 K. C. BASILE ET AL.
Table 3. Consequences of First Unwanted Sexual Experience (Rape or Sexual Coercion).
Yes No
Consequences % n % n
Physical
Injured 39.7% 31 60.3% 47
Minor bruises or scratches 93.6% 29 6.4% 2
Cuts, major bruises or black eyes, knocked out 40.0% 12 60.0% 18
Contracted HIV 3.8% 3 96.2% 76
Contracted a sexually transmitted disease 7.8% 6 92.2% 71
Lost existing pregnancy 3.0% 2 97.0% 65
Became pregnant 17.9% 12 82.1% 55
Birthed and kept the baby 58.3% 7 41.7% 5
Miscarriage 25.0% 3 75.0% 9
Abortion 16.7% 2 83.3% 10
Services
Needed medical services 35.1% 27 64.9% 50
Able to get medical services 55.6% 15 44.4% 12
Hospital stay 5.1% 4 94.9% 74
Rape kit exam was performed 15.4% 12 84.6% 66
Needed mental health services 36.2% 29 63.8% 51
Able to get mental health services 51.7% 15 48.3% 14
Needed community services 13.9% 11 86.1% 68
Needed housing services 12.8% 10 87.2% 68
Needed victim advocacy services 12.8% 10 87.2% 68
Police were contacted 26.3% 21 73.7% 59
Daily life
Stayed with family or friends afterward 38.0% 30 62.0% 49
Relocated or changed residence afterward 32.5% 26 67.5% 54
Missed work afterward 6.3% 5 93.7% 75
Felt unsafe in neighborhood afterward 42.3% 33 57.7% 45
Table 2. Victim Age and Perpetrator Type Among Those Whose First Unwanted Sexual
Experience was Rape or Sexual Coercion.
Intimate
partner Family
Friend or
acquaintance Stranger
n % n % n % n % Total N
12 and younger 1 3.9 11 42.3 12 46.2 2 7.7 26
13–17 9 28.1 2 6.3 17 53.1 4 12.5 32
18–29 8 47.1 0 0.0 7 41.2 2 11.8 17
30–44 2 50.0 0 0.0 2 50.0 0 0.0 4
Note: N = 79. One participant was excluded because she could not recall her age at the time of her first
unwanted sexual experience.
JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 245
Services sought and obtained. The women whose first unwanted sexual
experience resulted in rape or sexual coercion sought a variety of services,
including medical care, mental health care, community services, housing,
victim advocacy, and police assistance. Findings revealed that 35.1% of
victims needed medical services, and of them, 55.6% were able to obtain
those services; 15.4% of all victims underwent a rape kit exam. Over one
quarter of victims (26.3%) stated that the police were contacted after the
incident. Moreover, 36.2% reported that they needed mental health services,
and about half (51.7%) of those were able to obtain them. Approximately
13% to 14% needed services provided by the community (13.9%), housing
(12.8%), or victim advocacy (12.8%; see Table 3).
Other consequences. Women whose first unwanted sexual experience
resulted in rape or sexual coercion were asked about other consequences
that affected their daily lives after this first unwanted experience. About 6%
(6.3%) of victims missed work because of the incident. Additionally, 42.3%
stated that they felt unsafe in their neighborhood afterward. Thirty-eight
percent of victims reported that they stayed with family or friends, and 32.5%
decided to relocate or move from their residence.
Discussion
African American women are victims of SV at high rates, as consistently
evidenced by previous national prevalence studies (Black et al., 2011;
Breiding et al., 2014; Tjaden & Thoennes, 1998). There is less information
available about the health associations linked to SV victimization for African
American women in particular. Understanding the physical and mental
health correlates and impact of SV among specific segments of the population
at high risk (i.e., African American women) is important to (a) better
contextualize the SV victimization experience, and (b) help inform and tailor
prevention efforts. Although the focus of this study is on a relatively small
community sample that is not representative of all African American women
in the United States, this sample is important because it provides a fuller
picture of the context and circumstances around SV victimization of a highrisk
urban sample of women. The findings help to highlight the high prevalence
of SV victimization and its health consequences for some racial and
ethnic minority women.
Findings from this study reveal a high prevalence of rape and sexual
coercion victimization among this community sample of African American
women (53.7% experienced rape and 44.8% experienced sexual coercion at
some point in their lives). These prevalence estimates are higher than previous
national survey estimates (Black et al., 2011; Breiding et al., 2014;
Tjaden & Thoennes, 1998), but are consistent with other community-based
246 K. C. BASILE ET AL.
studies of African American women (Bryant-Davis et al., 2010; Kalichman
et al., 1998). In addition, the face-to-face nature of data collection in this
study could have also increased disclosure (Tillman, Bryant-Davis, Smith, &
Marks, 2010). Results reveal that mental health conditions, alcohol use, and
financial concerns are associated with previous SV victimization. For example,
being a victim of rape or sexual coercion was associated with endorsing
at least one PTSD symptom and symptoms of depression in their lifetime. In
other findings, a high percentage of lifetime victims of rape or sexual coercion
engaged in binge drinking during the previous year, and over 10%
reported that they abused prescription drugs or used illegal drugs on a
daily or almost daily basis in the last 12 months.
Of those whose first unwanted sexual experience resulted in rape or sexual
coercion, the majority of victims were younger than 18 years of age, were the
same race as their perpetrator, and knew their perpetrators (intimate partners,
family members, or acquaintances) at the time of their assault. These
findings are consistent with results from previous studies of African
American women (Avegno, Mills, & Mills, 2009; Weist et al., 2007). The
consequences experienced by victims whose first unwanted sexual experience
resulted in rape or sexual coercion (e.g., physical consequences, service needs,
and impacts on daily living) are consistent with previous literature (Avegno
et al., 2009; Weist et al., 2007). Regarding the impact of rape or sexual
coercion on a victim’s daily life, many women no longer felt safe in their
neighborhood as a result of their assault. Others chose to stay with family or
friends after their attack and some chose to relocate or change residence
afterward. These findings are consistent with the work of Frazier and colleagues,
who found in their study of 171 sexual assault survivors that after their
assault women believed their world was no longer safe and they held negative
attitudes regarding fairness of life and goodness of people (Frazier, Conlon, &
Glaser, 2001).
In addition, various services were needed and sought by victims in this
sample whose first unwanted sexual experience was rape or sexual coercion.
These included medical care, mental health care, community services, housing,
victim advocacy services, and assistance from the police. Approximately
one third of victims needed either medical or mental health services.
However, only about half of those who required these services were able to
obtain the help they needed. In addition, only one quarter of victims whose
first unwanted sexual experience was rape or sexual coercion contacted the
police after their experience. These findings suggest the disinclination of
African American women to seek help from mental health services
(Henning & Klesges, 2002; Snowden, 2001) and, in some cases, from law
enforcement and the criminal justice system, which might reflect a cultural
tendency among this population to distrust helping professionals due to
historical mistreatment, and a lack of culturally competent services (Flicker
JOURNAL OF AGGRESSION, MALTREATMENT & TRAUMA 247
et al., 2011; Raj et al., 1999; Tillman et al., 2010). Compounded by increased
exposure to SV, racial and structural inequities, including the experience of
discrimination, might increase African American women survivors’ risk for
poor outcomes.
These findings as a whole support previous research suggesting the multiple
sociocultural hardships faced by African American women might be
exacerbated by SV victimization or might, in some cases, lead to SV victimization.
For example, the majority of the participants in our sample fell below
the poverty threshold for a family of two adults without children. In addition,
the majority of lifetime rape or sexual coercion victims expressed they had
financial concerns within the 12 months prior to the survey and they were
significantly more likely to have these concerns than nonvictims. These
included concerns about being able to pay their rent or mortgage and their
ability to afford healthy meals. Previous research has shown that women are
at increased risk of victimization when their income is below the poverty line,
and conversely, victimization increases women’s likelihood of unemployment
and reduced income (Byrne et al., 1999). In 2010, 46.6% of African American
female, single-parent households were impoverished (Entmacher, Robbins, &
Vogtman, 2014). African Americans live at disproportionately lower socioeconomic
levels with less access to resources than their White counterparts
(DeNavas-Walt, Proctor, & Smith, 2013). The added burden of traumatic SV
victimization for women living in poverty potentially exacerbates the need
for multiple services and resources to address various intersecting problems
(i.e., poverty, victimization, mental and physical health; Bryant-Davis et al.,
2009).
This study is a contribution to the literature on the impact of SV victimization
of African American women because it included many health associations
and circumstances of the violence, which enabled a well-rounded
picture of the SV experience. In addition, the measurement of SV victimization
included in this study was very detailed, including numerous tactics,
which likely improved disclosure. However, this study has some limitations.
First, the sample is from an urban neighborhood in a Southeastern U.S. city,
so the findings might not be generalizable to all African American women.
Second, the sample is relatively small, which limited our ability to conduct
more complex statistical testing. Also, the study only included one racial and
ethnic group of women so it did not enable comparisons to other groups. In
addition, the analyses conducted in this study only focused on rape and
sexual coercion, and other types of SV such as unwanted sexual contact are
not represented. The main SV variable used in this study combined rape and
sexual coercion. Ideally, we would have examined rape experiences and
sexual coercion victimization experiences separately so that we could determine
if there were differences in the health associations linked to these two
forms of sexual violence. However, the experiences of the women in our
248 K. C. BASILE ET AL.
sample did not enable us to examine rape and sexual coercion separately
because a relatively large subset of the women in our sample experienced
both rape and sexual coercion.
Overall, the findings from this study have important implications for
prevention, practice, and service response to African American victims of
SV. Given the alarming numbers of women in this study who experienced
rape and sexual coercion that caused injuries and other physical and
mental health problems, primary prevention of SV has the potential to
prevent numerous adverse health experiences and the costs associated with
them. In addition, the high rates of adverse physical and mental health
experiences among victims of SV in this sample suggest that African
American women are in particular need of ongoing health-related services,
whether or not they disclose their victimization status. Although our
findings suggest a need for these types of services, only a little more
than 50% of women in our sample were able to get the physical and
mental health services they needed.
Some have suggested that African American women’s SV-related health
risks, adverse conditions, and challenges with regard to seeking services are
intricately linked to race or ethnicity and culture (Bent-Goodley, 2007;
Boykins et al., 2010; Flicker et al., 2011; Tillman et al., 2010). This study
supports prior research suggesting an association between SV victimization
and numerous physical and mental health risks and behaviors. More scholarship
in this area with representative samples of African American women
and other racial and ethnic minority women are important to inform prevention
practice. Larger and more representative samples are needed for
future research on the health associations linked to SV victimization, and
to enable comparisons across different racial and ethnic groups. Further, the
important connections among adverse health, SV, and cultural differences
need further exploration to inform practice.
Acknowledgments
The findings and conclusions in this report are those of the authors and do not necessarily
represent the official position of the Centers for Disease Control and Prevention. The authors
acknowledge the passing of their coauthor, Dr. Merle E. Hamburger, before this article was
completed. This article is dedicated to his memory for his commitment and contributions to
youth violence and sexual violence research and prevention.
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