639
 JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 57, NO. 6 
 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
here is mounting evidence that sexual assault is a common and reoccurring problem among college women.
1–5
 Men are also sexually assaulted, but the prevalence among women is believed to be considerably higher and is the focus of this study. Researchers have reported that between one-fifth to one-quarter of college women are raped during the course of their college careers.
2,3
 Moreover, during an academic year, approximately 2–3% of college women experience forcible rape.
2,4
 
 
T
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
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-tion was neither measured in the present study nor included in the definition of DFSA. There is growing evidence of links between victims’ substance use and sexual assault.
1,8
 Data from the nationally administered 2005 Core Alcohol and Drug Survey showed that 82% of students who experienced unwanted sexual intercourse during the current academic year were under the influence of AOD when they were victimized.
9
The College Alcohol Study (CAS) found that from 1997–2001, approxi-mately 3.4% of college women reported having been raped when they were “so intoxicated that [they] were unable to consent”
4
 since the beginning of the school year (p. 42). These studies are somewhat limited in that they did not distinguish the means by which women became intoxi-cated before being raped. That is, they did not distin-
 Drs Krebs
 and
 Lindquist
 are with RTI International in Research Triangle Park, NC.
 Ms Warner
 is with Bowling Green State University.
 Dr Fisher
 is with the University of Cincinnati, OH.
 Dr  Martin
 is with the University of North Carolina, Chapel Hill.Copyright © 2009 Heldref Publications
 
640 JOURNAL OF AMERICAN COLLEGE HEALTH
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 al
8
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 Koss
11
) that distinguished between incapacitated and drug-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 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 colleagues
14
 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.
METHODSRecruitment 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
 
VOL 57, MAY/JUNE 2009 641
 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-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 nonresponse were developed using a generalized expo-nential model
15
 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-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
Figure 1. The prevalence of different types of sexual assault (SA) before and since entering college (unweighted frequencies, weighted percentages).
12.
 IncapacitatedSA (
n
= 651, 11.1%)
14.
 Rape(
n
= 507, 8.5%)
13.
 Sexual batteryonly (
n
= 144, 2.6%)
11.
 Rape(
n
= 181, 3.4%)
15.
 AOD-enabledSA (
n
= 466, 7.8%)
10.
 Sexual batteryonly (
n
= 75, 1.4%)
18.
 Otherincapacitated SA(
n
= 48, 1.0%)
16.
 Certain drug-facilitated SA(
n
= 31, 0.6%)
17.
 Suspecteddrug-facilitated SA(
n
= 103, 1.7%)
8.
 Completed SA(
n
= 782, 13.7%)
7.
 Attempted SA(
n
= 682, 12.6%)Undergraduatewomenrespondents(
n
= 5,446)
9.
 Physically forced SA (
n
= 256, 4.7%)
5.
 Incapacitated SA(
n
= 377, 7.0%)
3.
 Completed SA(
n
= 590, 11.3%)
2.
 Attempted SA(
n
= 514, 10.1%)
4.
 Physically forcedSA (
n
= 322, 6.4%)
1.
 Attempted orcompleted SA beforeentering college(
n
= 819, 15.9%)
6.
 Attempted orcompleted SA sinceentering college(
n
= 1,073, 19%)
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