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College Women's Experiences with Physically Forced, Alcohol-

or Other Drug-Enabled, and Drug-Facilitated Sexual Assault
Before and Since Entering College
a a b c
Christopher P. Krebs PhD , Christine H. Lindquist PhD , Tara D. Warner MA , Bonnie S. Fisher PhD
d
& Sandra L. Martin PhD
a
RTI International in Research, Triangle Park, NC
b
Bowling Green State University
c
The University of Cincinnati, OH
d
The University of North Carolina, Chapel Hill
Published online: 07 Aug 2010.

To cite this article: Christopher P. Krebs PhD , Christine H. Lindquist PhD , Tara D. Warner MA , Bonnie S. Fisher PhD & Sandra L. Martin
PhD (2009) College Women's Experiences with Physically Forced, Alcohol- or Other Drug-Enabled, and Drug-Facilitated Sexual Assault
Before and Since Entering College, Journal of American College Health, 57:6, 639-649, DOI: 10.3200/JACH.57.6.639-649

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 JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 57, NO. 6

College Women’s Experiences with Physically

Forced, Alcohol- or Other Drug-Enabled, and
Drug-Facilitated Sexual Assault Before
and Since Entering College

Christopher P. Krebs, PhD; Christine H. Lindquist, PhD; Tara D. Warner, MA;

Bonnie S. Fisher, PhD; Sandra L. Martin, PhD
Downloaded by [University of Otago] at 03:36 25 July 2015

Abstract. Objective: Research has shown associations between
college women’s alcohol and/or drug consumption and the risk of
sexual assault, but few studies have measured the various means
by which sexual assault is achieved. Participants: The authors’
Campus Sexual Assault Study obtained self-report data from a
random sample of undergraduate women (N = 5,446). Methods:
The authors collected data on sexual assault victimization by
using a cross-sectional, Web-based survey, and they conducted
analyses assessing the role of substance use. The authors also
compared victimizations before and during college, and across
years of study. Results: Findings indicate that almost 20% of
undergraduate women experienced some type of completed sex-
ual assault since entering college. Most sexual assaults occurred
after women voluntarily consumed alcohol, whereas few occurred
after women had been given a drug without their knowledge
or consent. Conclusions: The authors discuss implications for
campus sexual assault prevention programs, including the need
for integrated substance use and sexual victimization prevention
programming.
Keywords: alcohol, drug facilitation, incapacitation, rape, sexual
assault, sexual battery
Some perpetrators physically force women, or threaten
them with physical force, to engage in sexual activity. This
type of assault is often termed physically forced sexual
assault. The term incapacitated sexual assault has been
used to refer to incidents in which victims are unable to
legally consent to sexual acts because of incapacitation.
Situations in which women are sexually assaulted when
they are incapacitated because of their voluntary and/or
excessive use of alcohol and/or drugs are referred to in the
present article as alcohol and/or other drug (AOD)-enabled
sexual assault. In another type of sexual assault, the perpe-
trator surreptitiously gives the victim a substance without
her knowledge or consent to incapacitate her; this type
of assault is often termed drug-facilitated sexual assault
(DFSA). The substances commonly reported in association
with DFSA (often called date rape drugs) include Rohypnol
(flunitrazepam), gamma hydroxybutyrate (GHB), Ketamine
(a general anesthetic), MDMA (ecstasy), and Soma (cari-
soprodol).6,7 Alcohol may also be administered without a
victim’s knowledge or consent, but this type of incapacita-

T
tion was neither measured in the present study nor included
here is mounting evidence that sexual assault is a
in the definition of DFSA.
common and reoccurring problem among college
There is growing evidence of links between victims’
women.1–5 Men are also sexually assaulted, but the
substance use and sexual assault.1,8 Data from the nationally
prevalence among women is believed to be considerably
administered 2005 Core Alcohol and Drug Survey showed
higher and is the focus of this study. Researchers have
that 82% of students who experienced unwanted sexual
reported that between one-fifth to one-quarter of college
intercourse during the current academic year were under the
women are raped during the course of their college careers.2,3
influence of AOD when they were victimized.9 The College
Moreover, during an academic year, approximately 2–3%
Alcohol Study (CAS) found that from 1997–2001, approxi-
of college women experience forcible rape.2,4
mately 3.4% of college women reported having been raped
when they were “so intoxicated that [they] were unable to
Drs Krebs and Lindquist are with RTI International in Research consent”4 since the beginning of the school year (p. 42).
Triangle Park, NC. Ms Warner is with Bowling Green State
University. Dr Fisher is with the University of Cincinnati, OH. Dr These studies are somewhat limited in that they did not
Martin is with the University of North Carolina, Chapel Hill. distinguish the means by which women became intoxi-
Copyright © 2009 Heldref Publications cated before being raped. That is, they did not distin-

639
 Krebs et al
guish between women who voluntarily consumed AOD and
women who were administered a substance without their
knowledge or consent. Stories about college women who
were purposively drugged and then sexually assaulted (ie,
cases of DFSA) have led some people to believe or fear
that heinous acts such as these are commonplace during the
college years.10 It is therefore important to learn more about
how women become incapacitated prior to being sexually
assaulted, paying particular attention to the prevalence of
DFSA, as this information can inform the development of
sexual assault prevention programs.
A study by Testa, Livingston, et al8 was among the first of
few investigations that have identified the means by which
women became incapacitated and were subsequently raped.
They surveyed a community sample of 1,014 women in the
vicinity of Buffalo, New York, using a modified version of
the Sexual Experiences Survey (which was validated in a
follow-up study by Testa, VanZile-Tamsen, Livingston, and
Koss11) that distinguished between incapacitated and drug-
Downloaded by [University of Otago] at 03:36 25 July 2015
facilitated rapes. Results indicated that 9.8% of the women
had experienced physically forcible rape (ie, forced sexual
intercourse). Fewer women, 8.4%, experienced a rape when
they were “incapacitated due to alcohol or drugs,” and 3.1%
of the sample experienced alcohol or drug-facilitated rape,
which was defined by an affirmative response to a question
about experiencing sexual intercourse when “you didn’t
want to because a man made you intoxicated by giving you
alcohol or drugs without your knowledge or consent.”
Testa and her colleagues’ research added much needed
information to the scientific literature; however, the experi-
ences of this community sample of women may not be simi-
lar to those of undergraduate college women. For example,
the average age of the women in their sample was 24 years;
undergraduate women are typically younger, and as the
National Crime Victimization Survey (NCVS) has consis-
tently shown, being younger places them at increased risk
of sexual victimization.12 Also noteworthy is the evidence
from 1 campus to suggest that the risk of rape is greater
among women who recently entered college (eg, freshmen)
and that this risk decreases over the college tenure.5 More-
over, the college culture and its associated lifestyle, with
many students frequenting parties and/or bars and consum-
ing AOD, may place college women at greater risk of sexual
assault compared with women in the general population.
Given the serious consequences experienced by victims
of rape (ie, oral, anal, or vaginal penetration), it is not
surprising that it has received much more attention by
researchers than has sexual battery (ie, sexual assault that
involves no more than touching), even though some studies
suggest college women are more likely to experience sexual
battery than rape.13,14 For example, the National Sexual
Victimization of College Women study that surveyed 4,446
college women found that almost 9% of the women expe-
rienced unwanted sexual contact within an academic year,
whereas nearly 3% experienced rape.2
Even though less research has focused on sexual bat-
tery than rape, the little research that has been done on
640
this topic has found that the perpetrators of this type of
sexual assault also may use alcohol or drugs to incapacitate
women and assault them sexually. For example, in a sample
of undergraduate women from 1 university, Banyard and
colleagues14 found that 9% of unwanted sexual contact vic-
tims reported that the perpetrator used force, whereas 8%
reported that the perpetrator got them intoxicated by giving
them alcohol and/or drugs. To the best of our knowledge,
no previous studies have examined whether college women
who experience sexual battery while incapacitated were in
this state because of their voluntary use of substances or
because of someone giving them an intoxicating substance
without their knowledge or consent.
Seldom has a study simultaneously examined the preva-
lence of each of these types of sexual assault within a large
sample of college women. The present study, the Campus
Sexual Assault (CSA) study, analyzed results from a Web-
based survey administered to a probability-based sample
of 5,446 undergraduate women enrolled at 2 large public,
4-year universities. The CSA study builds on past research
in an effort to further the understanding of the prevalence
of different types of sexual assault experienced by college
women. Notable aspects of the CSA methodology are that
it examined both attempted and completed rape and sexual
battery, with attention paid to whether the assault occurred
through means of physical or threatened force or incapaci-
tation of the victim, including AOD-enabled sexual assault
and drug-facilitated sexual assault. Further, the CSA study
gathered data on sexual assaults that happened before enter-
ing college and those that occurred since entering college.
We first present data on the different types of sexual
assault experienced by the college women studied, with
attention paid to the prevalence of various types of complet-
ed sexual assault experienced before entering college and
the prevalence of various types of completed sexual assault
since entering college. In addition, to understand when
most undergraduate women experience sexual assault, the
prevalence data on the types of completed sexual assault
experienced since entering college were stratified by year of
study (eg, sophomore, junior). We discuss the implications
of these results for informing college-based prevention
efforts that target specific types of sexual assault.
METHODS
Recruitment of the Study Sample
Undergraduate students from 2 large public, 4-year uni-
versities—1 located in the southern United States and the
other in the Midwest—participated in the CSA study. The
Institutional Review Board (IRB) at the leading institution,
a nonprofit research organization, and the IRBs at both
participating universities reviewed and approved the CSA
study protocol. Registrars at both universities provided
demographic information on all undergraduates enrolled in
the 2005 fall term. The sampling frame was limited to tradi-
tional undergraduate students (ie, those between the ages of
18 and 25 who were enrolled at least three-quarters time). A
JOURNAL OF AMERICAN COLLEGE HEALTH
 College Women and Sexual Assault

total of 26,764 students met these criteria. From these stu-
dents, we randomly sampled a total of 7,200 women from
university 1 and 5,646 women from university 2, inviting
them to participate in the survey.
Sampled students were sent an initial recruitment e-mail
that described the study and were provided with a unique
CSA study identification number and a hyperlink to the
CSA study Web site. However, it is important to note that
because the survey was anonymous, students did not enter
their identification number on the study Web site. The iden-
tification number was only used to receive the incentive for
study participation (a gift code for an online store worth
$10), which was provided after the students entered the
CSA study identification number with a computer-gener-
ated survey completion code supplied after the last survey
question was answered. Two weeks after the initial e-mail-
ing, students who had not completed the survey were sent
a follow-up e-mail encouraging them to participate; after
3 weeks, nonrespondents were mailed a hard-copy recruit-
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nonresponse were developed using a generalized expo-
nential model15 to reduce nonresponse bias and increase
sample representativeness so that the sample would better
resemble the university populations. Once weights were
added for university, gender, year of study, and race/ethnic-
ity, the observable bias indicated by Cohen’s effect size was
reduced to negligible levels. All prevalence estimates and
multivariate models were computed using weighted data.
Assessment
The CSA Web-based survey was cross-sectional in nature
and collected a wide range of information from the stu-
dents, including data on demographics (eg, race/ethnicity,
age, year of study), school involvement, substance use, and
dating and sexual activity. Through separate series of ques-
tions, students were asked whether they had experienced
physically forced sexual assault (with attempted but not
completed incidents, and completed incidents recorded
separately) and sexual assault when they were incapaci-

ment letter. Two weeks after the mailing, nonrespondents
were sent a final recruitment e-mail.
The overall response rates for survey completion for the
undergraduate women sampled at the 2 universities were
42.2% and 42.8%, respectively. A nonresponse bias analy-
sis was conducted to create sample weights. We compared
respondents and nonrespondents on the administrative data
elements provided by the universities, which included age,
university, race/ethnicity, and year of study. Cohen’s effect
size was used as a measure of the magnitude of the bias.
The results indicated that a minimal amount of bias existed,
and the bias that was present was in the race/ethnicity
category. Nonwhite students (ie, those identified as black,
Hispanic, or other) were less likely to respond to the survey
than were their white counterparts. Weights adjusting for
tated and unable to provide consent (see the Figure 1 for
definitions and survey questions). Sexual assault involved
unwanted sexual contact that could include touching of
a sexual nature, oral sex, sexual intercourse, anal sex, or
sexual penetration with a finger or object. Several questions
focused on the students’ experiences with attempted (but
not completed) and completed sexual assault before enter-
ing college. The survey also gathered data in greater detail
on students’ experiences with sexual assault since entering
college. For both physically forced and incapacitated sexual
assaults, data were gathered about the nature of the sexual
contact that occurred, enabling us to classify the sexual
assault as rape or sexual battery.
Those who experienced an incapacitated sexual assault
since entering college were asked several questions about

Undergraduate
women
respondents
(n = 5,446)

1. Attempted or 6. Attempted or
completed SA before completed SA since
entering college entering college
(n = 819, 15.9%) (n = 1,073, 19%)

2. Attempted SA 3. Completed SA 7. Attempted SA 8. Completed SA

(n = 514, 10.1%) (n = 590, 11.3%) (n = 682, 12.6%) (n = 782, 13.7%)

4. Physically forced 5. Incapacitated SA 9. Physically forced 12. Incapacitated

SA (n = 322, 6.4%) (n = 377, 7.0%) SA (n = 256, 4.7%) SA (n = 651, 11.1%)

10. Sexual battery 11. Rape 13. Sexual battery 14. Rape
only (n = 75, 1.4%) (n = 181, 3.4%) only (n = 144, 2.6%) (n = 507, 8.5%)

15. AOD-enabled 16. Certain drug- 17. Suspected 18. Other

SA (n = 466, 7.8%) facilitated SA drug-facilitated SA incapacitated SA
(n = 31, 0.6%) (n = 103, 1.7%) (n = 48, 1.0%)

Figure 1. The prevalence of different types of sexual assault (SA) before and
since entering college (unweighted frequencies, weighted percentages).

VOL 57, MAY/JUNE 2009 641

 Krebs et al
the means by which they became incapacitated. Specifi-
cally, victims were asked whether they had been drink-
ing alcohol or voluntarily using drugs other than alcohol
prior to the incident and whether they think they had been
given a drug other than alcohol without their knowledge or
consent. Depending on the means by which they became
incapacitated, sexual assault victims were classified into
the following sexual assault groups: (1) drug-facilitated
(women who indicated they had been given a drug other
than alcohol without their consent prior to being assaulted),
(2) suspected drug-facilitated (women who were not certain
whether or not they had been given a drug without their
consent prior to the assault), (3) AOD-enabled (women who
had been voluntarily consuming alcohol and/or drugs prior
to being assaulted), and (4) other incapacitated (women
who indicated they were victims of a sexual assault while
incapacitated but did not respond in a way that enabled us
to determine how they became incapacitated).
Downloaded by [University of Otago] at 03:36 25 July 2015
RESULTS
Description of the Sample
The majority (66.9%) of the women were white, although
a sizeable proportion of them were black (16.2%) or in the
other category (14.0%), which included Asians, Native
Hawaiians/Other Pacific Islanders, American Indians/Alas-
ka Natives, and respondents of multiple races. Only 3.0%
of the sample were Hispanic. The majority of the sample
(63%) was 18–20 years of age. There were larger percent-
ages of freshman (29.9%) and seniors (26.6%) than of
sophomores (22.8%) and juniors (20.7%). This distribution
reflected the distribution at the participating universities
because the data were weighted for year of study.
Prevalence Estimates of Sexual Assault Before and
Since Entering College
Of the 5,446 women, 28.5% reported having experienced
an attempted or completed sexual assault either before
or since entering college. Figure 1 presents the estimates
for the various types of sexual assault experienced by the
women. Nearly 16% of the 5,446 women experienced
attempted or completed sexual assault before entering col-
lege (see Figure 1, box 1). Almost equal percentages expe-
rienced attempted sexual assault before college (10.1%;
Figure 1, box 2) and completed sexual assault before
college (11.3%; Figure 1, box 3). Some women (5.5%)
experienced both attempted and completed sexual assault
before entering college (ie, the women represented in boxes
2 and 3 are not mutually exclusive). Similar percentages of
women experienced completed physically forced assault
(6.4%; Figure 1, box 4) and incapacitated sexual assault
(7.0%; Figure 1, box 5) before entering college. It should be
noted that 2.1% of the women in our study experienced both
physically forced and incapacitated sexual assault before
entering college (ie, the women represented in boxes 4 and
5 are not mutually exclusive).
Nineteen percent of the women reported experiencing
completed or attempted sexual assault since entering col-
642
lege (Figure 1, box 6), a slightly larger percentage than
those experiencing such incidents before entering college
(Figure 1, box 1). Since entering college, slightly more
women experienced completed sexual assault (13.7%; Fig-
ure 1, box 8) than attempted sexual assault (12.6%; Figure
1, box 7), with 7.2% of the women experiencing both com-
pleted sexual assault and attempted sexual assault during
college (ie, the women represented in boxes 7 and 8 are not
mutually exclusive).
Nearly 5% of the total sample were forcibly sexually
assaulted since college entry (4.7%; Figure 1, box 9). More
than 3% of the women (3.4%) experienced forced rape
since entering college (Figure 1, box 11) and 1.4% experi-
enced forced sexual battery since entering college (Figure
1, box 10). Approximately 11% of the women experienced
sexual assault while incapacitated since entering college
(Figure 1, box 12), with a higher percentage of women
being victims of incapacitated rape than incapacitated
sexual battery since entering college (8.5%; Figure 1, box
14, compared with 2.6%; Figure 1, box 13, respectively).
It is important to note that AOD-enabled sexual assault
was experienced by 7.8% of the women since entering
college (Figure 1, box 15). In contrast, smaller percent-
ages of women experienced drug-facilitated sexual assault
that they were certain happened (0.6%; Figure 1, box 16),
that they suspected happened (1.7%; Figure 1, box 17),
or some other type of incapacitated sexual assault (1.0%;
Figure 1, box 18).
Comparison of the Risk of Completed Sexual Assault
Before and Since Entering College
Figure 2 shows changes in the prevalence of completed
forced sexual assault and completed incapacitated sexual
assault before and since entering college. Similar percent-
ages of women experienced completed incapacitated sex-
ual assault (7.0%) and completed physically forced sexual
assault (6.4%) before entering college, McNemar χ2(1, N
= 5,466) = 1.698, p = .1925; however, the percentages of
victims of completed incapacitated sexual assault (11.1%)
and completed forced sexual assault (4.7%) differ greatly
for the since entering college time period, χ2(1, N = 5,446)
= 194.477, p < .0001. This is in part because during college,
the prevalence of completed incapacitated sexual assault is
considerably higher than for the prior to college time period
(7.0% before college compared with 11.1% during college,
χ2(1, N = 5,446) = 72.780, p < .0001). One hundred and
forty women (2.5%) were victims of completed incapaci-
tated sexual assault both before and since entering college,
whereas 68 women (1.4%) were victims of completed
physically forced sexual assault both before and since enter-
ing college.
Prevalence of Completed Sexual Assault During
College by the Women’s Year of Study
It is important to recognize that the window of time or
risk period during which undergraduate women can be sex-
ually assaulted varies by their year of study (eg, freshman in
the study had experienced less than 1 year of college, hence
JOURNAL OF AMERICAN COLLEGE HEALTH

Forced sexual assault
12.0%
12
10.0%
10
8.0%
8.0
7.0%
6.4%
6.0%
6.0
%
Percentage
4.0%
4.0
2.0%
2.0
0.0%
0.0
Before entering college
Before Entering College
Time Period
Time Period
Downloaded by [University of Otago] at 03:36 25 July 2015
Figure 2. The prevalence of physically forced and incapacitated sexual assault
Forced Sexual
before and since entering Assault
college.
they had less than 1 year at risk; sophomores experienced
more than 1 year but less than 2 years of college, hence they
had less than 2 years of risk). Table 1 presents prevalence
estimates of the types of completed sexual assault since
entering college, first examining the prevalence estimates
over the women’s entire college tenure (so women in differ-
ent years of study have different periods of risk) and then
examining the prevalence estimates for the past 12 months.
Table 1 shows that women surveyed in their senior year
of college (those having the longest risk period for sexual
assault since entering college) had the greatest cumulative
prevalence of each type of completed sexual assault. Almost
20% of the seniors experienced some type of sexual assault
since entering college, with 6.9% experiencing physically
forced sexual assault and 16.0% experiencing incapacitated
sexual assault. It is noteworthy that most of the incapacitated
sexual assaults (10.8%) were AOD-enabled. As expected, a
smaller percentage of freshman women experienced each
type of completed sexual assault since entering college
because of their reduced time at risk during college.
Table 1 also shows that when the women’s risk period
for sexual assault during college was taken into account (by
restricting the risk period to the past 12 months for sopho-
mores, juniors, and seniors), women who were sophomores
during the time of the survey had significantly higher past
12-month prevalence estimates of all types of completed
sexual assault (except for drug-facilitated sexual assault)
compared with women who were juniors or seniors. Fresh-
men were excluded from this analysis because they had not
experienced at least 12 months of college. Just over 9%
of women surveyed in their sophomore year experienced
some type of completed sexual assault during the past 12
months, compared with 7.2% of surveyed juniors and 6%
of surveyed seniors. In particular, women’s annual risk
VOL 57, MAY/JUNE 2009
College Women and Sexual Assault
Incapacitated sexual assault
11.1%
4.7%
After entering college
After Entering College
Incapacitated Sexual Assault
of incapacitated sexual assault decreased the longer they
were in college, with this pattern being primarily due to the
decrease in the annual prevalence of AOD-enabled sexual
assault with increasing years of college experience (5.9%
of sophomores, 3.6% of juniors, and 3.6% of seniors). Our
findings appear to support literature5 suggesting that women
are at the greatest risk of experiencing sexual assault early
in their college careers.
COMMENT
Echoing the findings of past national studies,2,3 the CSA
Study found that many undergraduate women were victims
of sexual assault during college, with almost 20% of the
women experiencing some type of completed sexual assault
by winter of their senior years. The CSA study is also con-
sistent with past research in finding positive associations
between women’s use of substances and their likelihood of
experiencing sexual assault.1,4,8,16 It is extremely important
to keep in mind, however, that even though many sexual
assaults involve substance use by the victim, this does not
imply that women are in any way responsible for their sex-
ual assault. Victimization is committed by the perpetrator,
and prevention programs targeting university men should
strongly emphasize that an intoxicated or incapacitated per-
son cannot legally or otherwise consent to sexual contact.
Supportive of White and Smith’s work,5 the CSA Study
found that women new to the college experience such as
freshmen and sophomores appeared to be at a particularly
high risk for sexual assault compared with women who had
more college experience (ie, juniors and seniors).
The CSA study extended prior research by clarifying the
means by which college women became incapacitated and
subsequently experienced sexual assault. The CSA study
results demonstrated that the majority of completed sexual
643
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644
Krebs et al

TABLE 1. Prevalence of Completed Sexual Assault Since Entering College and Prevalence of Completed Sexual Assault During the Past 12 Months,
Stratified by Women’s Year of Study During the Survey (Weighted Percentages)a

Freshman Sophomore Junior Senior All women

Variable (n = 1,297) (n = 1,354) (n = 1,390) (n = 1,402) (N = 5,466) pb

Types of completed sexual assaults experienced since entering college

Any completed sexual assault 7.5 12.6 15.8 19.8 13.7 < .001
Physically forced sexual assult 2.0 4.6 6.1 6.9 4.7 < .001
Incapacitated sexual assault 6.1 10.3 13.0 16.0 11.1 < .001
AOD-enabled sexual assault 4.6 7.6 8.7 10.8 7.8 < .001
DFSA 0.3 0.3 0.8 0.9 0.6 .0463
SDFSA 0.8 1.5 2.0 2.6 1.7 .0008
Otherwise incapacitated sexual assault 0.4 0.7 1.4 1.6 1.0 .0011
Types of completed sexual assaults experienced during the past 12 monthsc
Any completed sexual assault — 9.3 7.2 6.0 7.5 .0026
Physically forced sexual assult — 3.1 2.8 1.9 2.5 .1365
Incapacitated sexual assault — 7.6 5.4 4.9 6.0 .0048
AOD-enabled sexual assault — 5.9 3.6 3.6 4.3 .0032
DFSA — 0.2 0.5 0.3 0.3 .3464
SDFSA — 0.9 0.8 0.7 0.8 .8266
Otherwise incapacitated sexual assault — 0.7 0.5 0.3 0.5 .4250

Note. AOD = alcohol or drug; DFSA = drug-facilitated sexual assault; SDFSA = suspected drug-facilitated sexual assault.
a
Three women were missing college classification; they are excluded from this analyses.
b
Values based on the F test from analysis of variance.
c
Freshmen were not included in the presentation of past 12 months prevalence because they had not experienced 12 months of college at the time of the interview. The 12-month reference period
included their senior year in high school.

JOURNAL OF AMERICAN COLLEGE HEALTH


assaults of college women occurred while the victim was
incapacitated, with this incapacitation typically being due
to the women’s voluntary use of alcohol.
The CSA findings have implications for campus-based
sexual assault prevention policies and programs. Currently,
the Clery Act mandates that colleges and universities par-
ticipating in Federal student aid programs state their policy
“regarding [their] campus sexual assault program to pre-
vent sexual offenses” that must include a “description of
educational programs to promote the awareness” of sexual
violence.17 A review of these programs has found that they
seldom emphasize the important link between women’s
use of substances (in particular, women’s voluntary alcohol
or drug use) and becoming a victim of sexual assault.18
Neglecting to include this important information in college
sexual assault prevention programs is especially problem-
atic given that the college environment is often character-
ized as one in which it is common to experiment with, and
sometimes excessively use, alcohol and illicit drugs.
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Researchers have consistently reported that individuals
who consume alcohol to excess are less able to resist or
prevent victimization and are, therefore, more vulnerable
to victimization, including sexual assault.8 In light of the
CSA study findings and those of other researchers dem-
onstrating this strong link between alcohol use and sexual
assault, we encourage the development, implementation,
and evaluation of campus-based sexual violence preven-
tion programs that include a component educating students
about the link between substance use and sexual victimiza-
tion. Furthermore, such programs should teach students to
use various cognitive, behavioral, and social strategies to
monitor the amount of alcohol and/or drugs they consume
and to recognize when they, or their peers, are cognitively
and/or physically impaired (and therefore at increased risk
of sexual assault victimization). It is important to promote
the message that not drinking to excess (limiting intake) and
not taking drugs are important sexual assault self-protec-
tion strategies, especially within the context of the campus
social situations. When delivering this message, one must
be careful not to blame the victim because of substance
use, while clarifying that such substance use increases
one’s risk for sexual victimization. Such programs should
be delivered when women first enter college and throughout
the early college years because it appears that freshmen and
sophomore women are at the greatest risk of experiencing
sexual assault.
In addition, programs should be developed, implemented,
and evaluated that teach both women and men how they can
help protect their peers from sexual assault. For example,
male peer support programs that encourage men to get
proactively involved in efforts to reduce sexual assault
(eg, being involved in education programs and/or support
groups for abusive men) and intervene (eg, shaming men
who make sexist comments or engage in sexual abuse)
need to be expanded, enhanced, and evaluated.19 In addi-
tion, teaching college students how they might intervene to
help a peer who is obviously cognitively and/or physically
VOL 57, MAY/JUNE 2009
College Women and Sexual Assault
impaired because of AOD use and in a situation in which
an assault could easily occur may be helpful; this has been
suggested by the social guardianship work of Spano and
Nagy,20 whose findings imply that supportive peers can
serve as a protective factor against violent victimization.
Limitations
Caution is urged in interpreting the CSA study findings
because of the methodological limitations of this research.
First, because this study only examined the sexual assault
experiences of women from 2 large public, 4-year universi-
ties, it may be that the experiences of these women are not
representative of those of all college women, which limits
the generalizability of study findings. Another threat to the
representativeness of the sample is that this study had a
relatively modest response rate (approximately 42.5% of
all eligible women responded to the survey), even though
this level of response is viewed as “reasonable/acceptable”
for Web-administered surveys.21 In addition, weighting the
data to the true distribution of students in the study popula-
tion likely enhanced the representativeness of the sample
responses. In addition, the findings from the nonresponse
bias analyses were encouraging. A final limitation concerns
the types of incapacitated sexual assault measured in the
CSA study. Because we did not ask victims of incapacitated
sexual assault whether they had been given alcohol specifi-
cally (the question about the surreptitious administration of
substances was limited to drugs other than alcohol) without
their knowledge or consent, we are unable to estimate the
prevalence of this type of incapacitated sexual assault.
In closing, the CSA study findings brings researchers one
step closer to understanding the strong association between
college women’s substance use and their experiences with
sexual assault victimization. The findings provide insight
into the prevalence of different types of sexual assault and
clearly demonstrate that many women are incapacitated
(and thus unable to provide consent) at the time of their
sexual assault. It is important to note that this study shows
that the majority of this incapacitation is due to women’s
voluntary use of AOD, and that few women were sexually
assaulted after being given a drug (eg, GHB or Rohypnol)
without their knowledge or consent.
Taken together, these findings suggest the need for campus
sexual assault prevention programs that educate students not
only about the risks of forcible rape, which is less common,
but also about this well-established link between women’s
voluntary substance use and their risk for being a victim of
incapacitated sexual assault. Campus safety advocates and
sexual assault prevention providers should work with Con-
gress to amend the Clery Act requirements to mandate such
content in all campus sexual assault prevention programs.
ACKNOWLEDGMENTS
RTI International is an independent organization dedi-
cated to conducting innovative, multidisciplinary research
that improves the human condition.
645
 Krebs et al

This project was supported by Grant Number 2004-WG-
BX-0010, awarded by the National Institute of Justice, Office
of Justice Programs, US Department of Justice. Points of view
are those of the authors and do not necessarily represent the
official position or policies of the US Department of Justice.
NOTE
For comments and further information, address corre-
spondence to Dr Christopher P. Krebs, RTI International,
3040 Cornwallis Rd., Research Triangle Park, NC 27709-
2194, USA (e-mail: krebs@rti.org).
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of College Women. Washington, DC: US Department of Justice,
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3. Koss MP, Gidycz CA, Wisniewski N. The scope of rape:
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Springfield, IL: Thomas; 2007:167–187.
10. Zorza J. Drug-faciliated rape. In: Ottens AJ, Hotelling K,
eds. Sexual Violence on Campus: Policies, Programs and Perspec-
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11. Testa M, Vanzile-Tamsen C, Livingston J, Koss MP. Assess-
ing women’s experiences of sexual aggression using the sexual
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research. Psychol Women Q. 2004;28:256–265.
12. Catalano SM. National Crime Victimization Survey: Crimi-
nal Victimization, 2005. Washington, DC: US Department of Jus-
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13. Adams-Curtis LE, Forbes GB. College women’s experienc-
es of sexual coercion. Trauma, Violence Abuse. 2004;5:91–122.
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Walsh W. Unwanted sexual contact on campus: a comparison of
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Psychol. 1987;55:162–170.
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relates of rape while intoxicated in a national sample of college
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8. Testa M, Livingston J, Vanzile-Tamsen C, Frone MR. The
role of women’s substance use in vulnerability to forcible and
incapacitated rape. J Stud Alcohol. 2003;64:756–764.
9. Dowdall GW. The role of alcohol abuse in college student
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13-17, 2000; Indianapolis, IN.
16. Testa M, Vanzile-Tamsen C, Livingston J. The role of victim
and perpetrator intoxication on sexual assault outcomes. J Stud
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17. Security on Campus Inc. Web site. http://www.securityon-
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2000;60:821–836.

APPENDIX
Definitions of Sexual Assault Used in the Campus Sexual Assault (CSA) Study

The CSA Web-based survey collected a wide range of information from students. The survey included questions concerning the
characteristics of the respondents (eg, age, race, years in college), their substance use, dating experiences, and many aspects of their
experiences with sexual assault prior to and since entering college. The sexual assault experiences portion of the CSA survey was
prefaced with the following information:
This section of the interview asks about nonconsensual or unwanted sexual contact you may have experienced. When you are asked about
whether something happened since you began college, please think about what has happened since you entered any college or university.
The person with whom you had the unwanted sexual contact could have been a stranger or someone you know, such as a family member or
someone you were dating or going out with.
These questions ask about 5 types of unwanted sexual contact:
• Forced touching of a sexual nature (forced kissing, touching of private parts, grabbing, fondling, rubbing up against you in a sexual way,
even if it is over your clothes)
• Oral sex (someone’s mouth or tongue making contact with your genitals or your mouth or tongue making contact with someone else’s
genitals)
• Sexual intercourse (someone’s penis being put in your vagina)
• Anal sex (someone’s penis being put in your anus)
• Sexual penetration with a finger or object (someone putting their finger or an object like a bottle or a candle in your vagina or anus)

(appendix continues)

646 JOURNAL OF AMERICAN COLLEGE HEALTH

 College Women and Sexual Assault

APPENDIX (continued)

Respondents were then asked about the following 2 general types of sexual assault: (a) physically forced sexual assault and (b)
sexual assault when they were incapacitated and unable to provide consent. Each type was described with introductory text. The
following is an example:
The questions below ask about unwanted sexual contact that involved force or threats of force against you. Force could include someone hold-
ing you down with his or her body weight, pinning your arms, hitting or kicking you, or using or threatening to use a weapon against you.

Respondents were then asked the following:

Since you entered college, has anyone had sexual contact with you by using physical force or threatening to physically harm you?

To capture instances in which physically forced sexual assault was attempted but not completed, women were asked the following:
Has anyone attempted but not succeeded in having sexual contact with you by using or threatening to use physical force against you?

The same 2 questions were asked about victimizations occurring before entering college. The following text prefaced questions about
sexual assault when the victim was incapacitated and unable to provide consent:
The next set of questions asks about your experiences with unwanted sexual contact while you were unable to provide consent or stop what
was happening because you were passed out, drugged, drunk, incapacitated, or asleep. These situations might include times that you voluntarily
consumed alcohol or drugs and times that you were given drugs without your knowledge or consent.

Respondents were then asked the following:

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Since you entered college, has someone had sexual contact with you when you were unable to provide consent or stop what was happening
because you were passed out, drugged, drunk, incapacitated, or asleep? This question asks about incidents that you are certain happened.

Women were also asked about sexual assaults that they suspected had happened while they were incapacitated. These 2 questions
were also asked about incapacitated sexual assaults occurring before entering college. Please note that because a primary focus of
this paper was completed sexual assaults, women classified as victims of suspected drug-facilitated sexual assault (Figure 1, box 17)
were those who experienced a completed assault (an incident they were certain had happened) but were uncertain whether they had
been given a drug without their consent prior to the assault.
Separate survey modules then asked contextual questions about each type of sexual assault and responses were used to further classify
sexual assault types and victims. Regarding any of their physically forced or incapacitated sexual assault victimizations, women were
asked which of the following happened: (a) forced touching of a sexual nature, (b) oral sex, (c) sexual intercourse, (d) anal sex, or (e)
sexual penetration with a finger or object. Respondents were allowed to check off all behaviors that applied. Women were classified as
victims of rape if they selected any of the following: oral sex, sexual intercourse, anal sex, or sexual penetration with a finger or object.
Those who selected forced touching but no other behavior were coded as victims of sexual battery.
To further an understanding of incapacitated sexual assault, the type of incapacitation was used to classify victims of incapacitated
sexual assaults. Women who experienced sexual assault when they were incapacitated and unable to provide consent were asked the
following:
1. Just prior to the incident/any of the incidents had you been drinking alcohol?
2. Just prior to the incident/any of the incidents had you been given a drug without your knowledge or consent?

On the basis of their responses, we classified the victims into the following four mutually exclusive categories: (a) victims of drug-
facilitated sexual assault (DFSA; victims who were sexually assaulted when they were incapacitated after they had been given a drug
without their knowledge), (b) victims of suspected drug-facilitated sexual assault (SDFSA; victims who were sexually assaulted while
incapacitated but were uncertain whether they had been given a drug without their knowledge), (c) victims of alcohol and/or other drug-
enabled sexual assault (AOD; victims who were sexually assaulted when they were incapacitated after voluntarily consuming drugs or
alcohol), and (d) victims who were sexually assaulted when they were otherwise incapacitated (victims who were asleep or unconscious
when they were assaulted but who were not incapacitated due to voluntary or involuntary drug or alcohol consumption).

VOL 57, MAY/JUNE 2009 647

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