Supplemental to Heather Littleton, Amie Grills- Taquechel, Katherine Buck, Lindsey Rosman, and Julia Dodd 2013

 Experiencing sexual assault is associated with greater risk for negative mental health outcomes including depression and posttraumatic stress disorder (PTSD)  Sexual assault victimization is also associated with health risk behaviors including alcohol use and sexual risk taking  Predominant hypothesis is that these health risk behaviors represent attempts to cope with psychological distress, including distress associated with victimization (self-medication hypothesis)

 A total of 11 to 20% of college women have experienced sexual assault in adolescence or adulthood- sexual acts obtained by threat, force, or when the victim could not consent  Fairly comparable rates of sexual assault are found among European American, African American, and Latina college women (although research among ethnic minority women is less common)  Asian American college women report lower rates of sexual assault than other ethnicities

 Asian American women report lower rates of hazardous drinking than women of other ethnicities ◦ Asian American women are more influenced by peer drinking norms than women of other ethnicities ◦ Asian Americans tend to have less positive beliefs about drinking ◦ Genetically mediated difficulties with metabolizing alcohol may result in unpleasant side effects of drinking among many Asian Americans  Little research on sexual risk taking among Asian American college women

 Overall African American college women engage in less hazardous drinking than women of other ethnicities  Contingent consistency peer influence model ◦ College drinking behavior is influence by actual peer norms, perceived peer norms, and personal attitudes ◦ African American women have lower actual and perceived peer drinking norms and hold less positive attitudes toward drinking  In contrast, African American women may be more likely to engage in sexual risk taking than European American college women

 Latina college women report comparable rates of hazardous alcohol use as European American women- despite cultural norms against drinking among women  Acculturative stress model ◦ Young adults in immigrant families are more acculturated to mainstream U.S. culture than parents/caregivers ◦ May result in conflict between caregiver and child values ◦ Stress of acculturation may also increase risk  Comparable rates of sexual risk taking have been found in Latina and European American college women

 Examine the prevalence of sexual assault among college women of different ethnic backgrounds (adds to small extant literature in this area)  Examine the frequency of two health risk behaviors (hazardous drinking and using sex as an affect regulation strategy) among college women of different ethnic backgrounds (adds to small extant literature)

 Evaluate whether women who have experienced sexual assault are more likely to engage in health risk behavior than non- victims (confirms some prior research)  Examine if psychological distress mediates the relationship between having a sexual assault history and engaging in health risk behavior (novel contribution)  Examine if there are ethnic differences in the strength of this mediated relationship (novel contribution)

 1,620 women attending three large universities completed an online survey for course credit about negative sexual experiences in college women  Completed self-report measures ◦ Sexual assault since the age of 14 (Sexual Experiences Survey) ◦ Hazardous past year drinking (AUDIT-5) ◦ Measures of depression (CES-D) and anxiety (Four Dimensional Anxiety Scale) to assess psychological distress ◦ Use of Sex to Regulate Negative Affect Scale (e.g., engaging in sex to feel better when feeling low)

 Asian American women were less likely to have been sexually assaulted than women of the other ethnicities  African American women engaged in less hazardous drinking than Latina women; European American women engaged in more hazardous drinking than all the other groups of women  No differences in using sex to regulate negative affect among women of different ethnicities

 Sexual assault victims engaged in more hazardous drinking than non-victims  Sexual assault victims engaged in similar levels of using sex to regulate negative affect, as compared to non-victims

Bootstrapping analyses supported that both anxiety and depression mediated the relationship between having a sexual assault history and engaging in more hazardous drinking Sexual assault history Psychological distress Hazardous drinking

Bootstrapping analyses supported that both anxiety and depression mediated the relationship between having a sexual assault history and use of sex as a negative affect regulation strategy Sexual assault history Psychological distress Use of sex as an affect regulation strategy

 The mediated path from experiencing psychological distress to engaging in more hazardous drinking was significantly weaker in all groups of ethnic minority women than European American women  The mediated path from sexual assault to hazardous drinking through psychological distress was not statistically significant in any of the groups of ethnic minority women  In contrast, there were no significant ethnic differences in the mediated path in the use of negative affect as an affect regulation strategy mediated models

 Sexual assault victimization remains a significant public health problem affecting all college women, although it may be less common among Asian American women  Hazardous drinking is common among college women, but varies among women of different ethnicities  Having a sexual assault history may be a risk factor for engaging in hazardous drinking

 Consistent with the self-medication hypothesis, psychological distress mediated the relationship between having a sexual assault history and engaging in hazardous drinking and using sex as a negative affect regulation strategy  Hazardous drinking may be less strongly associated with psychological distress among ethnic minority women than European American women

 While overall sample was large, number of women in each ethnic minority group was modest  Reliance on self-report measures  Cross-sectional study design  Did not evaluate other potential predictors of risk behaviors, such as immigration stress, drinking motives, sexual attitudes  Important differences among women within ethnic groups were not evaluated

 There may be important differences in frequency of health risk behaviors among women of different ethnicities and in predictors of these behaviors  Models of risk behaviors following sexual assault developed among European American women may not apply to ethnic minority women  There is a need for future work examining factors that may uniquely relate to post- assault recovery among women of different ethnicities

 Practitioners should routinely assess for sexual assault histories in women seeking services  It may be necessary to address women’s psychological distress to effectively reduce risk taking behavior, as these may represent attempts to manage this distress  Prevention and intervention programs addressing health risk behaviors may benefit from being targeted to address the specific needs of women of different cultural and ethnic backgrounds