Prevalence and psychosocial correlates of forced sexual intercourse among U.S. high school adolescents.

Howard, Donna E. ; Wang, Min Qi ; Yan, Fang 等

INTRODUCTION

Sexual violence, in its myriad forms, is recognized as an important public health problem for adolescents, especially girls (Howard & Wang, 2005; Irwin & Rickert, 2005; Raghavan, Bogart, Elliott, Vestal, & Schuster, 2004; Champion, Foley, DuRant, Hensberry, Altman, & Wolfson, 2004). Yet, the nature and full extent of their victimization remains unclear. While it has been argued that sexual violence unfolds along a continuum from minor physical or psychological acts to homicidal rape (Prospero, 2006; Jezl, Molidor, & Wright, 1996; Hickman, Jaycox, & Aronoff, 2004; Reiss & Roth, 1993), the sundry questions which gauge "coercive" "unwanted," or "forced" sexual experiences continues to add to the ambiguity, particularly when these terms are not accompanied by explicit language as to their behavior referents (CDC, 2001; Koss, 1985; Erickson & Rapkin, 1991; Sawyer, Howard, Brewster, Gavin, & Sherman, 2006; Raghavan et al., 2004). Furthermore, there is strong indication that its prevalence are underestimations of the actual extent of sexual violence, due to a number of methodological issues associated with sampling and measurement, such the self-report nature of much of the data and confidentiality issues (Kreiter, Krowchuk, Woods, Sinal, Lawless, & DuRant, 1999; Brener, Kann, McManus, Kinchen, Sundberg, & Ross, 2002). On a national level, information on forced sexual intercourse has been gathered by the National Longitudinal Study of Adolescent Health (Add Health) beginning in 1995 (Upchurch & Kusunoki, 2004) and by the Center for Disease Controls, Youth Risk Behavior Survey (YRBS) since 1999 (YRBS, 2006). These surveys, while not the only studies of sexual violence, provide the most representative data on victimization experiences among U.S. high school students.

Across a host of studies on sexual dating violence, adolescent female victimization rates reportedly range from 7-18% (Howard & Wang, 2005; Foshee, Benefield, Ennett, Bauman, & Suchindran, 2004; Raghavan et al., 2004; Silverman, Raj, Mucci, & Hathaway, 2001). While it appears that girls are more likely to be victims of sexual victimization (Foster, Hagan, & Brooks-Gunn, 2004; Foshee et al., 2004; Hickman, Jaycox, & Aronoff, 2004; Bennett & Fineran, 1998), adolescent boys do report sexual violence as well (Howard & Wang, 2005; Foshee, 1996; Bergman, 1992), estimates range from 5-14% (Howard, Wang, 2005; Coker, McKeown, Sanderson, Davis, Valois, & Huebner, 2000; Shrier, Pierce, Emans, & Durant, 1998). Indeed, data from the 2001 national YRBS indicated that female adolescents were twice as likely as males to report a history of forced sexual intercourse (lifetime prevalence of 10.2% and 5.1%, respectively), with higher prevalence among ethnic groups, compared to Whites (Howard & Wang, 2005). It has been suggested that boys, in particular, may be less inclined to report interactions as constituting sexual violence, and thus these figures may represent an underestimation of their experiences (Hyman, 1999; Wekerle & Wolfe, 1999).

Based on the national 1999 YRBS, associations between forced sexual intercourse and emotional states (sad/hopeless feelings and considered suicide), fighting, physical dating violence, heavy cigarette use, sexual risk behavior (unprotected sex, multiple partners, alcohol or drug use before sex) were found for both males and females (Howard, Wang, 2005). Important gender differences in the risk correlates emerged as well. Among females, having considered suicide, fighting, heavy cigarette smoking, and use of alcohol or drugs before sex were associated with forced sexual experiences. In contrast, among males, attempted suicide and gun carrying were important correlates. Ethnic males were also more likely than their White peers to have experienced forced sex.

From the Add Health wave 1 data (April-December 1995), forced sexual intercourse among adolescent girls was associated with having been in a recent romantic relationship, past-year exposure to violence, alcohol or marijuana use, and increased levels of emotional distress (Raghavan et al., 2004). These girls were also more likely to have multiple sexual partners, have initiated coitus at a younger age, have used alcohol or drugs before last sex and have a positive STD history (Upchurch & Kusunoki, 2004). Across waves 1 and 2 (April-December 1995 to January-December 1996), predictors of sexual victimization included having been sexually active at wave 1, alcohol or cocaine use, emotional distress, and sexual fondling within romantic relationships.

The present study aims to update prevalence estimates and examine the robustness of the risk profile of adolescents who report a history of forced sexual intercourse using the most current and representative data from the national 2005 YRBS of U.S. high school students.

METHOD

Sample

The 2005 national school-based YRBS data were used for this study, which is one component of the Youth Risk Behavior Surveillance System (YRBSS) established by the Centers for Disease Control and Prevention (CDC) to monitor the prevalence of youth behaviors that most influence health. Comprehensive design and sampling procedures are available from the CDC's Morbidity and Mortality Weekly Report series, and are excerpted here in condensed form (MMWR, 2006a). The YRBS survey used a three-stage cluster sample designed to produce a nationally representative sample of high school students in grades 912. The first stage contained 1,270 primary sampling units (PSUs), which consisted of large counties or groups of smaller, adjacent counties. From these, 52 were selected from 16 strata, formed on the basis of the degree of urbanization and the relative percentage of African American and Hispanic students in the PSU. Each PSU was selected with probability proportional to the size of the school enrollment. The second sampling stage selected 203 schools, also with probability proportional to school enrollment size. The third stage randomly selected one or two intact classes of a required subject (e.g., English or social studies) from the entire 9th-12th grades at the chosen school. All students in the selected classes were eligible participants. A total of 159 schools with 15,349 students completed survey questionnaires. The school response rate was 78%, and the student response rate was 86%; resulting in an overall response rate of 67%. For the purpose of this study, both male and female participants (N = 13,767) were selected for the analysis.

A weighting factor was applied to each participant to adjust for non-response and for the varying probabilities of selection, including those resulting from the oversampling of African-American and Hispanic students. The weights were scaled so that (a) the weighted count of students was equal to the total sample size, and (b) the weighted proportions of students in each grade matched national population proportions.

Survey Procedures and Measures

Surveys were administered anonymously in order to protect privacy, and participation was voluntary. Parental permission was obtained before survey administration. Students completed the self-administered questionnaire in their classrooms during a regular class period and recorded their responses on a scannable answer sheet.

The survey focused on priority health-risk behaviors that resulted in the most significant mortality, morbidity, disability, and social problems during both adolescence and adulthood. Monitoring progress in these areas was relevant in assessing how the national health objectives for the year 2010 were achieved. Results were also to be used to help focus programs and policies for comprehensive school health education on those behaviors that contribute most to the leading causes of mortality and morbidity.

The dependent variable was forced sexual dating violence, which was measured by the question: Have you ever been physically forced to have sexual intercourse when you did not want to? The response categories for this variable were yes or no.

The independent variables included four dimensions: violence, suicide, substance use, and sexual-risk behavior. Violence-related behavior encompassed three questions: (1) "During the past 30 days, on how many days did you carry a gun?" The response categories were coded as 0 days or 1 or more days. (2) "During the past 12 months, how many times were you in a physical fight?" The response categories were coded as 0 times, 1 time or 2 or more times. (3) "During the past 12 months, did your boyfriend or girlfriend ever hit, slap, or physically hurt you on purpose?" The response categories were yes or no.

Suicide consisted of two questions: (1) "During the past 12 months, did you ever seriously consider attempting suicide?" (2) During the past 12 months, how many times did you actually attempt suicide?" The response categories for both variables were yes or no. One additional question examined sad or hopeless feelings: "During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities?" The response categories were yes or no.

Substance use behavior consisted of four questions: (1) "During the past 30 days, on the days you smoked, how many cigarettes did you smoke per day?" The response categories were coded as 0, 1 or 2 or more cigarettes per day. (2) "During the past 30 days, on how many days did you have at least one drink of alcohol?" The response categories were coded as 0, 1-5 days or 6 or more days. (3) "During the past 30 days, on how many days did you have five or more drinks of alcohol in a row, that is, within a couple of hours?" The response categories were coded as 0 days, 1-5 days or 6 or more days. (3) "During the past 30 days, how many times did you use any form of cocaine, including powder, crack, or freebase, or sniff glue, or breathe the contents of aerosol spray cans, or inhale any paints or sprays to get high?" The response categories were coded as 0 or 1 or more times.

Sexual-risk behavior consisted of three questions: (1) "During the past three months, with how many people did you have sexual intercourse?" The response categories were coded as never had sexual intercourse, none during past three months, 1 person or 2 or more people. (2) "Did you drink alcohol or use drugs before you had sexual intercourse the last time?" The response categories were coded as never had sexual intercourse, yes or no. (3) "The last time you had sexual intercourse, did you or your partner use a condom?" The response categories were coded as never had sexual intercourse, yes or no.

In addition, the demographic variables grade and ethnicity were included. Some of the above-mentioned variables were recoded, as necessary, based on the frequencies in response categories and the appropriateness for statistical analysis.

Data Analysis

All statistical analyses were performed using the Statistical Analysis System V 9.1 (SAS V9.1) survey procedures. These can account for a multistage sampling option by including the design factors (i.e., the stratum and PSU levels) into the analytical model. The data were first analyzed using univariate logistic models between the dependent variable (forced sexual intercourse) and each independent variable (substance use, suicide, violence, and sexual-risk behaviors) to examine their relationship. The unadjusted odds ratios (OR) and 95% confidence intervals (CI) as well as [chi square] tests were examined. To identify the most significant variables in relation to forced sexual dating violence, multivariate logistic regression was used to include all significant independent variables in the models. Adjusted OR and 95% CI were examined to assess the significance of the relationships.

RESULTS

Overall, 8.01% of high school adolescents reported a history of forced sexual intercourse. The lifetime prevalence for females (10.3%) was roughly twice that of the estimate for males (4.8%). As indicated in Table 1, prevalence estimates increased with grade and varied by ethnicity. Adolescent engagement in a host of risk behaviors was associated with a higher prevalence of forced sex. In fact, without exception, the greater the involvement in a particular risk behavior, the higher the prevalence of reported forced sexual experiences.

Bivariate relationships between forced sexual intercourse and risk factors. Table 2 displays the unadjusted odds ratios for the relationships between risk factors and forced sexual dating violence for the overall sample and by gender. Overall, sad or hopeless feelings, suicidal ideation and attempted suicide, violence-related behaviors, substance use, and risky sexual practices were associated with a history of forced sexual intercourse. Twelfth-grade girls were significantly more likely to have a history of forced sex and odds were greater for ethnic boys, compared to their white peers, to report forced sexual experiences.

Multivariate Relationships

To detect the most significant risk factors associated with forced sex, multivariate logistic regression analyses, which included all significant variables in the bivariate analysis, were conducted (see Table 3). Overall, forced sexual victimization was significantly associated with a having experienced a recent, prolonged episode where the teen felt sad or hopeless, suicidal ideation and attempted suicide. Recent physical dating violence victimization was associated with forced sexual experiences as was cigarette smoking and more regular alcohol use, but not binge drinking. Finally, being sexually active, including one or more recent sexual partners in the most recent 3-month period, and practicing unprotected sex were significantly associated with forced sexual dating violence.

Important differences in the risk profile associated with forced sexual intercourse were found by gender. Only female victims were likely to report feeling sad or hopeless, suicidal ideation and attempted suicide, engagement in physical fights, and cigarette smoking. In addition, being in the 12th grade, compared to 9th grade, increased the odds that females would have reported a history of forced sex. While a relationship between physical and forced sexual dating violence were seen for both females and males, male victims of physical dating violence were more than two times as likely as females to report a history of forced sex.

DISCUSSION

These findings provide the most current assessment of forced sexual dating violence against U.S. high school adolescents. The risk profile presented offers vital information for researchers and prevention planners.

First, a small but significant number of high school students continue to report a history of forced sexual intercourse. Approximately one in ten 9th- through 12th-grade female adolescents and one in twenty male high school students who participated in the 2005 YRBS reported being a victim of forced sexual intercourse. While the higher prevalence for females is not unexpected, our findings indicate that forced sexual intercourse touches the lives of numerous males as well.

Second, high school juniors and seniors, and particularly female seniors, were more likely to report forced sexual dating violence than their 9th-grade peers. The data does not permit an assessment as to whether the sexual violence occurred during the high school period or rather, reflects a greater likelihood for older adolescents to report lifetime victimization experiences. Either way, such findings make clear that prevention and intervention efforts should be initiated early, preferably, before entrance to high school.

Third, ethnicity was associated with increased odds of a history of forced sexual intercourse. For the overall sample, Black adolescents were significantly more likely than Whites to report victimization; among males, Black and Hispanics appeared at significant risk. It is unclear whether these ethnic differences are artifactual or reflect significant differences in exposure; what is unambiguous is the need to investigate these differences and clarify their meaning and significance (Blum, Gallagher, Resnick, & Tolman, 1999).

Fourth, regardless of gender, youth who had been victims of sexual violence report an almost identical risk profile. Emotionally, they are more likely to report feeling sad or hopeless and to have considered or attempted suicide. Elsewhere, a relationship has also been found between attempted suicide and forced sexual intercourse (Coker et al., 2000).

These youth appear more likely to have been exposed to other violence including fighting, gun carrying, and physicality in dating relationships. Additionally, victims of forced sex are apt to use a variety of substances such as tobacco, alcohol, cocaine, and inhalants, and use them regularly. Finally, engagement in at-risk sexual behavior (unprotected sexual intercourse, recent and multiple sexual partners) was associated with forced sex.

The co-occurrence of these factors strongly underscores the notion of an at-risk profile for adolescents and reinforces the concept of problem behavior in that adolescents who engage in one risk behavior are likely to be involved in other risk behaviors (Jessor, 1982; Jessor, 1991; Dryfoos, 1900; Diclemente, Hansen, & Ponton, 1996; Resnick et al., 1997). Thus, factors which influence engagement in risk behavior, including personality dispositions, may place youth in vulnerable situations where they are more likely to be victimized (Blum et al., 1999; Harvey & Spiguer, 1995). Alternatively, the risk engagement may be a form of coping, albeit maladaptive, with the physical and/or psychological harm these youth have suffered. Unfortunately, the cross-sectional nature of the data preclude our ability to disentangle antecedents from consequences or correlates.

While recent sexual engagement was associated with forced sex, the odds of having a history of sexual victimization were higher if the adolescent had multiple sexual partners. Little can be surmised about the nature of adolescent sexual relations from the YRBS but is seems apparent that as the number of partners increases, there are increased opportunities for sexual victimization. Similarly, having been in a dating relationship that involved physical violence was associated with an increased risk of sexual violence as well. Clearly, violence in dating relationships and sexual violence must be addressed at early ages through school- and community-based programs. Development of tailored interventions for adolescents who are at risk for physical and/or forced sexual dating violence may decrease the potential for victimization and enhance the prospects for respectful intimate partner relations as these adolescents mature into adulthood.

Finally, a history of forced sex was associated with unprotected sexual behavior among adolescents. Not only have these youth been harmed, but they are placing themselves in harms way through such risky sexual practice.

Limitations

As noted, the cross-sectional nature of the study design does afford an opportunity to examine prevalence and correlates of forced sexual intercourse but it precludes examination of temporal relationships. There is some concern that students may have variable understandings of what constitutes forced sexual intercourse, i.e., does it capture, in addition to rape, perceptions of psychological pressure that are more ambiguous to define and interpret? Indeed, while this question assesses lifetime prevalence, it leaves vague the context in which victimization occurred, the age of victimization, and the relationship of perpetrator to victim.

Furthermore, while this study focused on teens as victims of forced sexual intercourse it only superficially addresses the relationship between forced sex victimization and physical dating victimization. Further, it does not provide insight into whether these experiences occur equally in same-gender or heterosexual adolescent relationships.

While sampling for the national YRBS aimed to provide the most representative data, those students who, for a variety of reasons, were not present on the day of the survey administration may be systematically different from attendees, limiting the external generalizability of the findings. This may be important if those who are not in school are more likely to engage in risk behavior and/or be vulnerable to sexual harm. The possibility of the reported prevalence being underestimations of actual experiences is further suggested, for boys in particular, as was previously noted.

Future Directions for Research

Prevalence data indicate that youth in all grades, from 9th through 12th, report a history of forced sexual intercourse. Indeed, the prevalence rates across high school are cause for alarm. Due to the serious and injurious nature of these events, future research should consider investigation of sexual victimization among younger adolescents.

Psychological risk factors in our study (i.e., feeling sad/hopeless, suicide ideation, and attempted suicide) were strongly associated with an increased risk of being the victim of forced sex. While this cross-sectional study cannot identify causal relationships between these depressive symptoms, related risk factors, and sexual victimization, from a medical perspective, prevention, identification, and treatment of depressive symptomatology among adolescents may help reduce the likelihood of subsequent victimization or other forms of harm.

Furthermore, a better understanding of the antecedents of forced sex may allow prevention efforts to focus on those who may be at high risk for victimization and, potentially, prevent its occurrence. Unless more specific questions are asked of victims, i.e., the nature of the sexual violence, researchers, program planners and health care providers will be stymied in their efforts to intervene appropriately.

CONCLUSION

A history of forced sexual intercourse among our nation's youth is a persistent and alarming public health problem. The risk profiles of females and males who report such victimization suggests the need for early prevention programming and tailoring of gender-specific interventions.

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Min Qi Wang and Fang Yan, Department of Public and Community Health, University of Maryland.

Reprint requests should be sent to Donna E. Howard, Dr.PH, Department of Public and Community Health, CHHP, 2387 Valley Drive, University of Maryland, College Park, MD 20742.

Table 1. Prevalence of Personal, Psychological and Behavioral Risk
Factors Among Adolescents who reported a History of Forced Sexual
Intercourse

Risk Factors Total Sample Females Males

Grade
 12th Grade 9.13 12.15 5.84
 11th Grade 8.09 10.99 4.94
 10th Grade 7.52 10.70 4.20
 9th Grade 7.21 9.78 4.31
Ethnicity
 Black 10.07 12.38 7.51
 Hispanic 7.28 9.06 5.19
 Other 8.88 11.54 6.00
 White 7.29 11.18 3.29
Feel Sad/Hopeless
 Yes 15.64 18.72 9.66
 No 4.74 6.14 3.55
Consider Suicide
 Yes 19.85 22.38 14.58
 No 5.58 7.71 3.53
Attempted Suicide
 Yes 26.23 28.07 22.58
 No 6.02 8.68 3.23
Physical Fight
 2+ Time 13.64 22.03 9.09
 1 Time 9.54 15.06 4.64
 0 Times 5.68 8.02 2.38
Physical Dating Violence
 l+ Time 27.41 32.10 22.06
 0 Times 5.83 8.56 2.92
Gun Carrying
 1+ Days 16.64 34.25 14.55
 0 Days 7.33 10.62 3.32
Days Smoked Cigarettes
 2+ Cigarettes 15.76 22.26 10.15
 1 Or Less Cigs 9.89 15.12 4.96
 0 Cigarettes 5.73 7.91 3.19
Days Drank Alcohol
 6+ Days 15.37 22.46 10.45
 1-5 Days 9.04 13.45 3.80
 0 Days 5.06 7.36 2.36
Had 5+ Drinks Alcohol
 6+ Days 20.23 30.22 15.04
 1-5 Days 10.53 15.50 5.67
 0 Days 6.13 8.62 3.13
Used Cocaine or Glue
 Yes 16.90 22.01 11.56
 No 6.29 8.85 3.50
Multiple Sex Partners
 2+ People 16.97 23.42 13.16
 1 Person 11.98 16.64 5.04
 None/Never had sex 3.73 5.55 1.71
Alcohol/Drugs Before Sex
 Yes 18.52 26.16 12.94
 Not Never had sex 6.80 18.07 5.58
You/Partner Used Condoms
 No 18.84 24.98 9.63
 Yes 10.52 15.46 6.51
 Never had sex 1.51 2.24 0.62

Table 2. Unadjusted Odds Ratios for Relationships between Forced
Sexual Intercourse and Personal, Psychological and Behavioral Risk
Factors among Adolescents Participating in the 2005 National Youth
Risk Behavior Survey (95 % Confidence Intervals)

Risk Factors Total sample

Grade
 12th grade 1.53(1.21-1.93) ***
 11th grade 1.32(1.05-1.68) *
 10th grade 1.18(0.96-1.46)
 9th grade 1.00
Ethnicity
 Black 1.39(1.20-1.61) ***
 Hispanic 1.11(0.90-1.37)
 Other 1.25(0.98-1.59)
 White 1.00
Feel Sad/Hopeless
 Yes 4.07(3.43-4.82) ***
 No 1.00
Consider Suicide
 Yes 4.37(3.61-5.29) ***
 No 1.00
Attempted Suicide
 Yes 5.57(4.28-7.25) ***
 No 1.00
Gun Carrying
l+ days 2.21(1.65-2.97) ***
0 Days 1.00
Physical Fight
 2+ Times 2.76(2.18-3.48) ***
 1 Time 1.74(1.30-2.31) ***
 0 Times 1.00
Physical Dating Violence
 Yes 6.79(5.75-8.02) ***
 No 1.00
Days Smoked Cigarettes
 2+ Cigarettes 3.58(3.01-4.25) ***
 1OrLess Cigs 1.88(1.40-2.53) ***
 0 Cigarettes 1.00
Days Drank Alcohol
 6+ Days 4.18(3.32-5.27) ***
1-5 Days 2.01(1.63-2.48) ***
 0 Days 1.00
Had 5+ Drinks Alcohol
 6+ Days 4.64(3.37-6.40) ***
 1-5 Days 1.99(1.59-2.48) ***
 0 Days 1.00
Used Cocaine or Glue
 1+ Times 3.24(2.69-3.91) ***
 0 Times 1.00
Multiple Sex Partners
 2+ People 5.62(4.43-7.14) ***
 1 Person 3.84(3.16-4.68) ***
 None/ Never Had Sex 1.00
Alcohol/Drugs Before Sex
 Yes 15.24(10.96-21.19) ***
 No 9.61(7.07-13.05)***
 Never Had Sex 1.00
You/Partner Used Condoms
 No 17.60(12.76-24.29) ***
 Yes 7.60(5.59-10.34) ***
 Never had sex 1.00

Risk Factors Females

Grade
 12th grade 1.53(1.10-2.14) *
 11th grade 1.37(0.98-1.92)
 10th grade 1.26(0.92-1.72)
 9th grade 1.00
Ethnicity
 Black 1.07(0.85-1.34)
 Hispanic 0.86(0.65-1.14)
 Other 1.18(0.91-1.53)
 White 1.00
Feel Sad/Hopeless
 Yes 3.84(3.10-4.76) ***
 No 1.00
Consider Suicide
 Yes 3.74(2.94-4.76) ***
 No 1.00
Attempted Suicide
 Yes 4.31(3.30-5.63) ***
 No 1.00
Gun Carrying
l+ days 3.69(2.06-6.63) ***
0 Days 1.00
Physical Fight
 2+ Times 3.51(2.60-4.74) ***
 1 Time 1.97(1.43-2.73) ***
 0 Times 1.00
Physical Dating Violence
 Yes 5.44(4.45-6.66) ***
 No 1.00
Days Smoked Cigarettes
 2+ Cigarettes 3.97(3.16-5.00) ***
 1OrLess Cigs 2.06(1.46-2.89) ***
 0 Cigarettes 1.00
Days Drank Alcohol
 6+ Days 4.48(3.23-6.22) ***
1-5 Days 2.11(1.63-2.73) ***
 0 Days 1.00
Had 5+ Drinks Alcohol
 6+ Days 33.52(2.66-4.67) ****
 1-5 Days 2.20(1.73-2.81) ***
 0 Days 1.00
Used Cocaine or Glue
 1+ Times 3.12(2.50-3.89) ***
 0 Times 1.00
Multiple Sex Partners
 2+ People 5.44(3.93-7.53) ***
 1 Person 3.73(3.00-4.64) ***
 None/ Never Had Sex 1.00
Alcohol/Drugs Before Sex
 Yes 15.75(10.71-23.17) ***
 No 10.16(7.35-14.05) ***
 Never Had Sex 1.00
You/Partner Used Condoms
 No 16.64(11.63-23.81) ***
 Yes 7.81(5.61-10.86) ***
 Never had sex 1.00

Risk Factors Males

Grade
 12th grade 1.53(0.98-2.38)
 11th grade 1.18(0.73-1.91)
 10th grade 1.05(0.76-1.47)
 9th grade 1.00
Ethnicity
 Black 2.41(1.52-3.81) ***
 Hispanic 1.94(1.29-2.93) **
 Other 1.54(0.96-2.49)
 White 1.00
Feel Sad/Hopeless
 Yes 2.86(2.01-4.08) ***
 No 1.00
Consider Suicide
 Yes 4.18(3.07-5.68) ***
 No 1.00
Attempted Suicide
 Yes 7.53(4.76-11.92) ***
 No 1.00
Gun Carrying
l+ days 4.82(3.22-7.21) ***
0 Days 1.00
Physical Fight
 2+ Times 4.40(3.25-5.96) ***
 1 Time 2.23(1.40-3.56) ***
 0 Times 1.00
Physical Dating Violence
 Yes 11.76(8.78-15.75) ***
 No 1.00
Days Smoked Cigarettes
 2+ Cigarettes 3.19(2.29-4.45) ***
 1OrLess Cigs 1.66(1.01-2.71) *
 0 Cigarettes 1.00
Days Drank Alcohol
 6+ Days 5.51(3.97-7.67) ***
1-5 Days 1.60(1.14-2.25) **
 0 Days 1.00
Had 5+ Drinks Alcohol
 6+ Days 5.15(2.98-8.91) ***
 1-5 Days 1.78(1.21-2.62) **
 0 Days 1.00
Used Cocaine or Glue
 1+ Times 3.44(2.44-4.86) ***
 0 Times 1.00
Multiple Sex Partners
 2+ People 9.58(5.87-15.62) ***
 1 Person 3.38(2.19-5.21) ***
 None/ Never Had Sex 1.00
Alcohol/Drugs Before Sex
 Yes 23.11(10.84-49.28) ***
 No 9.86(5.03-19.34) ***
 Never Had Sex 1.00
You/Partner Used Condoms
 No 19.35(9.56-39.16) ***
 Yes 10.67(5.20-21.92)***
 Never had sex 1.00

Note. The last category was used as the reference.

* P <05, ** p <.01, *** p <.001

Table 3. Adjusted Odds Ratios for Relationships Between Forced
Sexual Intercourse and Personal, Psychological and Behavioral
Risk Factors among Adolescents Participating in the 2001 National
Youth
Risk Behavior Survey (95 % Confidence Intervals)

Risk Factors Total sample

Grade
 12th grade 1.23(0.87-1.74)
 11th grade 1.13(0.80-1.58)
 10th grade 1.27(0-91-1-77)
 9th grade 1.00
Ethnicity
 Black 1.21(0.96-1.53)
 Hispanic 0.86(0.70-1.07)
 Other 0.91(0.65-1.25)
 White 1.00
Feel Sad/Hopeless
 Yes 2.10(l.66-2.65) ***
 No 1.00
Consider Suicide
 Yes 1.71(1.32-2.22) ***
 No 1.00
Attempted Suicide
 Yes 1.60(1.18-2.17) **
 No 1.00
Gun Carrying
 I+ days 0.78(0.48-1.25)
 0 Days 1.00
Physical Fight
 2+ Times 1.13(0.82-1.56)
 Time 0.93(0.64-1.36)
 0 Times 1.00
Physical Dating Violence
 Yes 3.01(2.34-3.87) ***
 No 1.00
Days Smoked Cigarettes
 2+ Cigarettes 1.47(1.l3-1.92) **
 1 Or Less Cigs 1.16(0.76-1.80)
 0 Cigarettes 1.00
Days Drank Alcohol
 6+ Days 1.50(1.06-2.12) *
 1-5 Days 1.28(0.99-1.65)
 0 Days 1.00
Had 5+ Drinks Alcohol
 6+ Days 0.93(0.55-1.55)
 1-5 Days 0.73(0.50-1.05)
 0 Days 1.00
Used Cocaine or Glue
 1+ Times 1.26(0.93-1.70)
 0 Times 1.00
Multiple Sex Partners
 2+ People 2.71(2.10-3.49) ***
 1 Person 1.91(1.50-2.43) ***
 Never Had Sex /Note 1.00
Alcohol/Drugs Before Sex
 yes 1.2((0.88-1.64)
 Never Had Sex/No 1.00
You/Partner Used Condoms
 No 2.49(1.95-3.20) ***
 Never Had Sex /Yes 1.00

Risk Factors Females

Grade
 12th grade 1.24(0.86-1.77)
 11th grade 1.12 (0.79-1.58)
 10th grade 1.16(0.80-1.53)
 9th grade 1.00
Ethnicity
 Black NS
 Hispanic
 Other
 White
Feel Sad/Hopeless
 Yes 2.03(1.49-2.77) ***
 No 1.00
Consider Suicide
 Yes 1.57(1.16-2.11) **
 No 1.00
Attempted Suicide
 Yes 1.40(1.01-1.94) *
 No 1.00
Gun Carrying
 I+ days 1.08(0.40-2.93)
 0 Days 1.00
Physical Fight
 2+ Times 1.54(1.03-2.30) *
 Time 0.98(0.62-1.55)
 0 Times 1.00
Physical Dating Violence
 Yes 2.42(1.87-3.12) ***
 No 1.00
Days Smoked Cigarettes
 2+ Cigarettes 1.69(1.22-2.35) **
 1 Or Less Cigs 1.26(0.76-2.10)
 0 Cigarettes 1.00
Days Drank Alcohol
 6+ Days 1.30(0.80-2.10)
 1-5 Days 1.20(0.87-1.65)
 0 Days 1.00
Had 5+ Drinks Alcohol
 6+ Days 1.07
 1-5 Days 0.81(0.55-1.20)
 0 Days 1.00
Used Cocaine or Glue
 1+ Times 1.29(0.92-1.82)
 0 Times 1.00
Multiple Sex Partners
 2+ People 2.67(2.03-3.50) ***
 1 Person 1.80(1.35-2.40) ***
 Never Had Sex /Note 1.00
Alcohol/Drugs Before Sex
 yes 1.21(0.82-1.78)
 Never Had Sex/No 1.00
You/Partner Used Condoms
 No 2.58(1.90-3.50) ***
 Never Had Sex /Yes 1.00

Risk Factors Males

Grade
 12th grade NS
 11th grade
 10th grade
 9th grade
Ethnicity
 Black 1.72(0.89-3.29)
 Hispanic 1.51(0.80-2.88)
 Other 1.00(0.51-1.95)
 White 1.00
Feel Sad/Hopeless
 Yes 0.82(0.52-1.30)
 No 1.00
Consider Suicide
 Yes 1.77(0.88-3.55)
 No 1.00
Attempted Suicide
 Yes 2.05(0.90-4.66)
 No 1.00
Gun Carrying
 I+ days 1.57(0.91-2.70)
 0 Days 1.00
Physical Fight
 2+ Times 1.28(0.74-2.19)
 Time 1.31(0.77-2.23)
 0 Times 1.00
Physical Dating Violence
 Yes 6.25(3.86-10.12) ****
 No 1.00
Days Smoked Cigarettes
 2+ Cigarettes 0.66(0.35-1.26)
 1 Or Less Cigs 0.72(0.37-1.40)
 0 Cigarettes 1.00
Days Drank Alcohol
 6+ Days 1.90(0.80-4.50)
 1-5 Days 1.16(0.68-2.01)
 0 Days 1.00
Had 5+ Drinks Alcohol
 6+ Days 1.29(0.35-4.53)
 1-5 Days 0.85(0.33-2.19)
 0 Days 1.00
Used Cocaine or Glue
 1+ Times 1.15(0.66-2.02)
 0 Times 1.00
Multiple Sex Partners
 2+ People 3.47(1.80-6.69) ***
 1 Person 1.89(1.03-3.45) *
 Never Had Sex /Note 1.00
Alcohol/Drugs Before Sex
 yes 1.19(0.72-1.98)
 Never Had Sex/No 1.00
You/Partner Used Condoms
 No 1.94(1.24-3.03) **
 Never Had Sex /Yes 1.00

Note. The last category was used as the reference.

NS indicates non-significant in the univariate logistic model.

* p<.05, ** p<. 01, *** p<.001