Differences in psychological health and family dysfunction by sexual victimization type in a clinical sample of African American adolescent women.

According to the Federal Criminal Code, sexual victimization exists along a continuum that includes behaviors ranging from threats/pressures to engage in vaginal, anal, or oral sex to physical violence to force a woman or man to engage in sexual activity against her or his will (Kilpatrick, Whalley, & Edmunds, 2000). Since 1973, the U.S. Department of Justice has been collecting data on personal and household victimization from a nationally representative sample, which then is reported in the National Crime Victimization Survey (NCVS). Examination of the most recent trends for the NCVS from 1993 through 2001 reveals that, although the national crime rate has decreased substantially during this time period, the rate of rape and sexual assault has remained relatively unchanged (Rennison, 2001; 2002).

National survey data further reveal that the rate of sexual victimization is higher among youth as compared to adults (Bureau of Justice Statistics, 2001; Fisher, Cullen, & Turner, 2000; Hashima & Finkelhor, 1999; Kilpatrick, Edmunds, & Seymour, 1992; Kilpatrick & Saunders, 1997; Rennison 2001; 2002; Tjaden & Thoennes, 1998; 2000). For example, rates of sexual assault and verbal threat of rape/sexual assault were 2.0 and 3.3 times higher among youth between the ages of 12 to 17 years than among young adults 18 to 24 years of age (Hashima & Finkelhor). Similarly, data from the National Survey of Adolescents (NSA) indicate that although almost 30% of the youth surveyed reported that the assault occurred prior to age 11, the majority of cases (57.9%) occurred between the ages of 11 and 16 (Kilpatrick, 1996).

Closer inspection of sexual victimization data from national surveys indicates that the number of such cases are disproportionately high among adolescent women (Grunbaum et al., 2002; Rennison, 2001; 2002). Slightly more than half of all rape and sexual assault victims are women less than 25 years of age (Perkins, 1997). In the NSA, 13.1% of the adolescent women reported being sexually assaulted, as compared to 3.4% for adolescent men (Kilpatrick & Saunders, 1997). Comparable rates were reported by Boney-McCoy and Finkelhor (1995a), who found that among a nationally representative sample of 10-to 16-year-olds, 15.3% of the women and 5.9% of the men had experienced some form of sexual victimization. Moreover, adolescent women are more likely to be the targets of sexual victimization than are older women (Finkelhor & Hashima, 2001; Hashima & Finkelhor, 1999; Humphrey & White, 2000).

Although it is clear that adolescent women are more likely to be victims of sexual assault as compared to older women and their male counterparts, there is not a consensus as to how much rates vary by ethnicity. On the one hand, some studies find slightly higher sexual victimization rates among African Americans (Ackard & Neumark-Sztainer, 2002; Erickson & Rapkin, 1991; Hashima & Finkelhor, 1999). For example, in a large school-based sample of youth in grades 9 through 12, Ackard and Neumark-Sztainer found that 2.3% of African American adolescent women reported rape, as compared to 1.8% among White women. In contrast, other studies report very high rates among African Americans as compared to youth of different ethnicities (Kilpatrick & Saunders, 1997; Kilpatrick, Saunders, & Smith, 2003; Wordes & Nunez, 2002). The most recent data from the youth risk behavior surveillance (YRBS) (Grunbaum et al., 2002) reveal significantly higher rates of forced sex among African American women (9.6%) as compared to White women (6.9%). Similarly, in their study of dating violence among youth participating in a randomized controlled trial, Howard, Qiu, and Boekeloo (2003) found that reports of sexual victimization were significantly more likely among the African American adolescents as compared to the non-African American youth.

To be consistent with the federal Criminal Code, we defined sexual victimization as "the use of physical violence, threats of bodily harm, or psychological, economic, or evaluative pressure to force you, or to attempt to force you, into engaging in sexual intercourse, oral sex, or anal sex" (Allgeier, 1987, p. 13). This more inclusive definition was used to address the void identified by Fisher et al. (2000) and by Belknap, Fisher, and Cullen (1999), who noted that many of the measures of sexual victimization have been of limited value because they lacked detailed items that would more accurately measure the extent and type of sexual victimization. In other words, a major limitation of much existing research is the failure to measure the different ways in which a woman can be victimized. It has been suggested that in order to understand the impact of sexual victimization, as well as the likelihood of negative sequelae, one needs to know the severity of the sexual victimization experienced by the woman (Belknap et al.; Leidig, 1992; Maxwell, Robinson, & Post, 2003).

The question of whether or not there is a relationship between the type of sexual victimization and specific sequelae has not received much attention. The majority of research in this area has focused on documenting the negative consequences that may develop in diverse domains, ranging from psychological health to eating disorders and substance abuse problems. The general consensus is that adolescent women often experience adverse outcomes as a result of being sexually victimized (Boney-McCoy & Finkelhor, 1996; Finkelhor & Hashima, 2001; Kilpatrick et al., 1992; 2003). Some of these consequences are short-term, but others become lifelong problems. Commonly reported sequelae include psychiatric problems, homelessness, HIV, eating disorders, suicide, substance abuse, and unplanned pregnancies (Ackard & Neumark-Sztainer, 2002; Biglan, Noell, Ochs, Smolkowski, & Metzler, 1995; Boney-McCoy & Finkelhor, 1995a; Goodman, Koss, & Russo, 1993; Kaminer, Seedat, Lockhat, & Stein, 2000; Kilpatrick & Saunders, 1997; Kilpatrick et al., 2003; Messman-Moore, Long, & Siegfried, 2000).

A few studies have explored the relationship between the type of coercion used (e.g., physical, psychological, etc.) and the type and severity of the response. Some researchers have found that women who were forced to engage in unwanted sexual activity via psychological threats were more likely to experience adjustment difficulties such as depression and social anxiety (Mynatt & Allgeier, 1990; Zweig, Barber, & Eccles, 1997). However, Siegel, Golding, Stein, Burnam, and Sorenson (1990) found that adjustment problems were more likely to stem from the use of physical rather than psychological pressure.

Even though there is not agreement as to what type of force is related to poorer outcomes, these studies highlight the growing recognition that one needs to take into consideration the different types of sexual victimization (Belknap et al., 1999; Leidig, 1992). This study examined the prevalence of different types of sexual victimization among a sample of African American adolescent women. A main goal of this study was to examine the relationship between different types of victimization and well-being in three domains. In particular, we were interested in investigating whether more severe forms of sexual victimization are associated with poorer psychological adjustment, higher levels of family dysfunction, and greater substance use.

With respect to psychological health, elevated levels of depression and anxiety, along with lower levels of self-esteem, have been documented in both clinical and school samples of adolescent women who have a history of sexual victimization (Boney-McCoy & Finkelhor, 1995a; 1996; Gidycz & Koss, 1989; O'Keefe & Treister, 1998; Osborne & Rhodes, 2001). Thus, we postulated that adolescents who had experienced some form of sexual coercion (e.g., rape, attempted rape, sexual coercion) would report lower levels of self-esteem, higher levels of depression, and lower levels of mastery. To date, studies have not included the construct of mastery, which refers to the belief that one has control over one's life (Pearlin, Lieberman, Menaghan, & Mullan, 1981). If found to be of importance, this could explain why some adolescent women are reluctant to report sexual victimization experiences. Many cases of sexual victimization go unreported because the woman blames herself for the abuse (Allgeier, 1987; Fisher, Daigle, Cullen, & Turner, 2003; Koss, 1998; Koss & Cook, 1998). Possibly, these women have lower levels of mastery and feel that they have less control over their lives.

Ample evidence exists documenting a relationship between childhood sexual abuse and family dysfunction (Cecil & Matson, 2001; Draucker, 1996; Stevens-Simon & Reichert, 1992; Tyler, Hoyt, & Whitbeck, 2000). Retrospective studies of adult women suggest that high levels of family conflict predict a history of sexual abuse (Benedict & Zautra, 1993). Fewer studies have investigated the family environment and family relations characteristic of adolescent women who have been sexually victimized. The National Youth Victimization Prevention (NYVP) study revealed poor parent-child relations to be a risk factor for having experienced sexual victimization in the year prior to the survey among children and adolescents 10 to 16 years of age (Boney-McCoy & Finkelhor, 1995b). Similarly, Gruber (1983) identified several family characteristics, in particular an unstable family environment, that differentiated victims from nonvictims. In a survey of college women, those who had been sexually victimized repeatedly during adolescence characterized their families as displaying less cohesion, less expressiveness, more conflict, and more control (Long, 1991). Further, as compared to nonvictims, those women who had been victimized one or more times reported that their families were less organized (Long). These findings suggest that adolescents who have been sexually victimized will report higher levels of family conflict and lower levels of family cohesion.

Participants for this study were a group of African American adolescent women who received services from an adolescent health care facility. This study is part of a larger investigation of the factors predictive of engaging in unsafe sexual practices. We recruited only African American adolescent women for several reasons. First, recent statistics suggest that sexual victimization, excluding rape, may be more prevalent among African American women (Erickson & Rapkin, 1991; Howard et al., 2003; Kenney, Reinholtz, & Angelini, 1997; Merrill et al., 1999; Urquiza & Goodlin-Jones, 1994). Second, anecdotal evidence and observations of the second author at this particular health clinic suggested that more African American adolescent women were experiencing sexual victimization as compared to non-African American adolescent women. Third, many study samples have been primarily White adolescent women (e.g., Maxwell et al., 2003), with very few using ethnically diverse samples (Wyatt, Loeb, Solis, Carmona, & Romero, 1999). Studies comparing the experiences of sexual victimization among White and African American youth indicate that the experience and impact is different for African Americans (Hanson et al., 2003). Thus, studies are needed that examine the experience of sexual victimization among samples of African American youth only.

We focused on adolescent women because most studies of prevalence or incidence of sexual victimization have neglected this age group, examining instead college-aged women (e.g., Brener, McMahon, Warren, & Douglas, 1999; Fisher & Cullen, 2000; Fisher et al., 2000; Muehlenhard, Harney, & Jones, 1992) or have focused solely on more severe levels of sexual victimization, such as rape or dating violence, among adolescent women (e.g., Bergman, 1992; Gray & Foshee, 1997; Hanson, 2002; Maxwell et al., 2003; Molinder & Tolman, 1998; O'Keefe & Treister, 1998). In addition, national statistics indicate that victimization rates are highest among adolescent women (Rennison, 2001; 2002; Tjaden & Thoennes, 2000), yet many prevention/intervention programs developed for adolescents are based on findings from adults (Maxwell et al.). Clearly, more research is needed that includes adolescent samples.

METHOD

Participants

Participants were 249 African American women, who ranged in age from 14 to 19 years (M = 16.43, SD = 1.47).

In order to be eligible for the study, participants had to have had vaginal intercourse. The study sample was recruited from the clinical population of the Milwaukee Adolescent Health Program (MAHP). MAHP provides primary and secondary care to approximately 4,000 adolescents each year. Patients attending the clinics are principally of lower socioeconomic status, African-American (81%), and more likely to be female (60%). The Institutional Review Board at the Medical College of Wisconsin approved this study.

Measures

Sexual coercion. Sexual coercion was assessed with the Sexual Experiences Survey (SES, Koss & Gidycz, 1985; Koss & Oros, 1982), a 13-item, true-false measure that was developed to assess sexual intercourse under various degrees of coercion, threat, and force and was designed for use in nonclinical populations. The survey examines whether a woman has ever experienced a continuum of unwanted sexual encounters from kissing to rape, associated with various degrees of coercion, threat, and violence. Thus, this instrument contains items tapping not only unwanted vaginal intercourse, but other forms of sexual contact as well, such as unwanted genital contact. As in other studies, respondents were classified according to the highest level of coercion that they reported having experienced (Alksnis, Desmarais, Sean, & Hunter, 2000; Humphrey & White, 2000; Koss, 1988; Koss & Gidycz, 1985; Koss, Gidycz, & Wisniewki, 1987).

The SES has high levels of reliability and validity among samples of adult women, with obtained values of Cronbach's alpha being consistently above .70 (Koss & Gidycz, 1985; Messman-Moore et al., 2000; Synovitz & Byrne, 1998). Repeated administrations of the SES have revealed high levels of test-retest reliability, including temporal stability of responses (Krahe, Reimer, Scheinberger-Olwig, & Fritsche, 1999; Koss & Gidycz; Synovitz & Byrne). Several recent studies have used this scale to assess levels of sexual victimization among adolescents, including African American youth (Kenney et al., 1997; Maxwell et al., 2003; Merrill et al., 1999). Moreover, a recent investigation found the survey to be psychometrically sound for use with African American adolescents (Cecil & Matson, in press). Cronbach's alpha was very good in our sample ([alpha] = .80).

Self-esteem. Rosenberg's Self-Esteem Scale (RSES, Rosenberg, 1965), a 10-item scale with 4-point Likert-type response choices, was used to assess feelings of global self-worth. For each item, respondents indicate their level of agreement/disagreement along a 4-point continuum. Total scores range from 10 to 40, with higher scores representing higher levels of global self-esteem. The RSES has been found to be psychometrically sound (Blascovich & Tomaka, 1991; Burns, 1979; Chiu, 1988; Crandall, 1973), with good levels of internal consistency (Hoge & McCarthy, 1983) and good test-retest reliability (Fleming & Courtney, 1984; Silber & Tippett, 1965). Numerous studies provide evidence for both convergent validity and discriminant validity (Demo, 1985; Fleming & Courtney; Hagborg, 1993; Lorr & Wunderlich, 1986; Reynolds, 1988; Savin-Williams & Jacquish, 1981). The RSES has been used with African American samples (Collins & Lightsey, 2001; Lockett & Harrell, 2003; Robinson, 2000) and has been found to be psychometrically sound for African American youth (Greenberger, Chen, Dmitrieva, & Farruggia, 2003; Owens & King, 2001; WhitesideMansell & Corwyn, 2003). Cronbach's alpha was .84 for our study sample.

Depression. Depression was measured by three true-false items constructed to assess whether adolescents are at risk for depression (Schubiner & Robin, 1990). Item responses were summed to produce a possible range of scores from 0 (no depression) to 3 (high level of depression). Using a sample of ethnically diverse adolescents, Schubiner and Robin found significant associations of all three items with scores on the Beck Depression Inventory. Moreover, these items accounted for a significant amount of the variance of the Beck Depression Inventory. Because they found that adolescents who scored high on the Beck Depression Inventory also scored high on these three items, they concluded that these three items are sensitive to the detection of abnormal levels of depression.

Cronbach's alpha for the depression scale was .48. This scale is comprised of only 3 items, which may explain its low level of internal consistency, because test length influences a scale's reliability. Indeed, using Nunnally and Bernstein's formula (1994), increasing the number of scale items to 6 would result in an alpha of .65, which is acceptable. However, these items have not been validated using African American adolescents, which also could account for the low level of internal consistency observed with our sample.

Mastery. The Mastery Scale (Pearlin et al., 1981) is comprised of seven items that are answered along a 4-point agree-disagree continuum, with total scale scores ranging from 7 to 28. Pearlin and colleagues define mastery as an individual's belief that she can exercise control over her life. Persons with low levels of mastery hold the opposite belief, that their future is predestined and cannot be changed. Pearlin and colleagues established the unidimensionality of the instrument via factor analysis and demonstrated good test-retest reliability using longitudinal data. Convergent validity has been demonstrated with self-esteem and depression (Lawson, Gaushell, & Karst, 1996; Marshall & Lang, 1990), job goals (Finch, Shanahan, Mortimer, & Ryu, 1991), and feelings of control (Walford-Kraemer & Light, 1984). Furthermore, researchers have demonstrated the utility of this instrument for African American samples (Mizell, 1999; Petterson & Friel, 2001). A Cronbach's alpha of .74 was obtained with our sample, indicating an acceptable level of internal consistency.

Family interactions. The Cohesion and Conflict subscales from the Family Environment Scale--Real Form (FES-R; Moos & Moos, 1993) were used to assess family interactions. The Cohesion subscale taps the degree of commitment, help, and support that family members provide for each other, and the Conflict subscale assesses the extent of openly expressed anger, aggression, and conflict among family members. Each subscale comprises 9 items, scored using a true-false format. Items are coded such that a 1 is assigned to items that reflect cohesion and conflict. These items are then summed together. High scores on the Cohesion subscale indicate high levels of family support, while high scores on the Conflict subscale reveal high levels of conflict.

The Cohesion and Conflict factors of the FES have been replicated using samples of adolescents (Gondoli & Jacob, 1993; Kronenberger & Thompson, 1990; Oliver, Handal, Enos, & May, 1988; Oliver, May, & Handal, 1988). Moderate to high levels of internal consistency as well as test-retest reliability have been obtained using large samples of families that either were or were not distressed (Moos & Moos, 1993). Studies by other researchers also provide evidence of the reliability of these subscales (Boyd, Gullone, Needleman, & Burt, 1997; Sanford, Bingham, & Zucker, 1999).

In addition, studies have demonstrated construct validity with scores on the Cohesion and Conflict subscales correlating with perceived support from family members (Braungart-Reiker, Rende, Plomin, & DeFries, 1995; Sandier & Barrera, 1984; Tyerman & Humphrey, 1983), with other measures of family functioning (Gehring & Feldman, 1988; Perosa & Perosa, 1990; Russell, 1980; Schmid, Rosenthal, & Brown, 1988), and with the presence of dysfunctional family patterns (Bhatia, 1998; Ray, Jackson, & Townsley, 1991; Smith, Rivers, & Stahl, 1992). Discriminant validity also has been established (Sanford et al., 1999; Schmid et al.; Vostanis & Nicholls, 1995). Numerous studies have used this instrument to measure family dysfunction among African American families (Aktan, Kumpfer, & Turner, 1996; Clark & Armstead, 2000; Thompson et al., 1999). In addition, these two scales evidence reliability and validity for African American samples (Baer, 1999).

Adequate levels of internal consistency, as measured by Cronbach's alpha, were observed for each of these subscales: .74 for the Cohesion subscale and .72 for the Conflict subscale. However, examination of alpha values with the item, "We say anything we want to around home," removed indicated that inclusion of this item reduced the internal consistency of the Conflict subscale. As a result, this item was removed prior to subsequent analyses.

Demographics. Sociodemographics measured included age, grade level in school, grades typically received in school, and living arrangements.

Procedure

We conducted a pilot study to examine readability and comprehension of the survey packet by 19 adolescent women. The questionnaire was revised based on the feedback received from these women. The adolescent women who participated in the focus groups expressed concern about the ability of their peers to read and understand the survey items and suggested that it would be better to have someone interview each person, in spite of the sensitivity of some of the measures. The focus of their comments regarding comprehension centered on the meaning of certain sexual behavior terms and the inclusion of slang words for several of the items measuring sexual behavior.

Adolescents who agreed to be interviewed were administered an anonymous, 114-item questionnaire by one of two trained, female interviewers. Each participant received $15 for completing the survey.

Data Analysis

We used summary statistics to describe the study population. Pearson product moment correlations assessed bivariate associations between continuous variables, and Spearman's Rho was used when one variable was continuous and the other variable was ordinal. Cramer's V is reported when both variables were nominal. We conducted a MANCOVA to examine whether or not there were group differences for the psychological health constructs of self-worth, depression, and mastery, while controlling for grades received in school. Last, a MANOVA assessed whether there were group differences for family dysfunction (i.e., family cohesion and conflict). We used Tukey post-hoc analyses when significant univariates were obtained. The analyses were performed using SPSS.

RESULTS

Socio-Demographic Characteristics

As shown in Table 1, the majority of respondents were in 8th, 9th, and 10th grades. This variable was recoded into 5 groups to reflect the highest level of education reported. The new groups are middle school (15.3%), high school (68.3%), high school graduate/GED (11.6%), not enrolled in school (3.6%), and some college (1.2%). Reported grades received in school ranged from "mostly As" to "mostly Fs," with the majority reporting that they received mostly Bs (see Table 1).

Examination of with whom youth lived revealed many different living arrangements. Thus, we collapsed responses to make groups when possible. Although these youth reported diverse living arrangements, many reported living with their mothers (47.8%), whereas few reported living with their fathers only (2%). Only 6.4% reported that they lived with both parents. Slightly less than 10 percent (9.2%) reported living with their mothers and another person (e.g., stepfather), and very few reported living with their fathers and another person (1.2%). The remaining 33.4% endorsed an array of responses, with no category having more than 5 persons. Some of these categories included living with aunts, sisters, or boyfriends. Because the living arrangements reported were very diversified, we were not able to collapse any of the other responses into meaningful categories.

Levels of Sexual Coercion

We classified participants according to the most severe level of coercion they had experienced. The four groups developed included nonvictimization/consensual sex, sexual coercion, attempted rape, and completed rape (see Appendix). Approximately one third of the sample reported being raped (32.1%), and one third reported sexual coercion (33.7%). A small minority of respondents reported an attempted rape (10.8%). Only a quarter of the sample (23.4%) reported never having been victimized.

Preliminary Analyses

We assessed bivariate relationships to determine whether any of the socio-demographic variables (age, grade, grades received, and living arrangement) were related to each other and to any of the dependent measures. Not surprisingly, age was significantly and positively correlated with grade level (rho = .71, p = .000). In addition, age was positively correlated with reported grades (rho = .13, p = .038), indicating that older age was associated with poorer grades. No other significant correlations were obtained.

We conducted additional analyses to assess the relationships between the socio-demographic variables (age, grades received in school, grade in school, living arrangement) with each of the outcome variables (self-esteem, depression, mastery, family cohesion and conflict), as well as with level of sexual victimization. Age was uncorrelated with the total scale scores for self-esteem, depression, mastery, and the cohesion and conflict scales (all r < .09, p = not significant). Age also was unrelated to the levels of sexual victimization (rho = .005, p = .94). None of the socio-demographics correlated with scores on the depression scale, the conflict scale, or the cohesion scale. Grades received in school were correlated with mastery (rho = -. 14, p = .025) and self-esteem (rho = -. 17, p = .008). Thus, higher grades, which are indicated with lower values, were associated with higher levels of self-esteem and mastery, although the obtained associations are modest in size. No other significant bivariate relationships emerged. Finally, no significant associations between any of the socio-demographic variables and level of sexual victimization were obtained.

We examined the bivariate relationships between the dependent measures (self-esteem, depression, mastery, cohesion and conflict) using Pearson correlations. Persons scoring high on the RSES had lower levels of depression (r = -.47, p = .01), higher levels of mastery (r = .55, p = .01), higher levels of family cohesion (r = .25, p = .01), and lower levels of family conflict (r = -.22, p = .01). Respondents with higher levels of depression reported lower levels of mastery (r = -.42, p = .01) and family cohesion (r = -.30, p = .01) and higher levels of family conflict (r = .37, p = .01). Mastery scores were positively correlated with levels of family cohesion (r = .26, p = .01) and negatively correlated with levels of family conflict (r = -.25, p = .01). Lastly, family cohesion scores were negatively correlated with family conflict scores (r = -.60, p = .01).

Finally, we conducted one-way ANOVAs to determine whether scores on the measures of psychological well-being and family dysfunction varied as a function of any of the socio-demographic variables (grade level, grades received in school, and living arrangement). There were no differences in levels of depression and mastery as a function of grade level, grades received in school, or living arrangement, with one exception: grades received in school was significantly associated with self-esteem, F (4, 244) = 3.53, p = .008. Tukey post-hoc analyses revealed that adolescent women who received mostly As had higher levels of self-esteem (M = 35.96, SD = 4.30) as compared to those who received mostly Bs (M = 32.76, SD = 4.82), Cs (M = 32.03, SD = 5.92), or Ds (M = 30.54, SD = 6.05). No other significant pairwise comparisons were obtained. No differences in levels of self-esteem were found for the variables grade in school and living arrangement.

Differences in Levels of Psychological Well-Being and Family Dysfunction as a Function of Sexual Victimization Category

To determine whether current levels of psychological well-being (self-esteem, depression, and mastery) differed as a function of level of sexual victimization (nonvictimization/consensual sex, sexual coercion, attempted rape, and completed rape), we conducted a MANCOVA controlling for grades received in school. The overall model was significant, F (9, 584.25) = 3.15, p = .001, partial [eta.sup.2] = .04, power = .98. Each of the univariates was significant, self-esteem (F [3, 242] = 4.32, p = .005, partial [eta.sup.2] = .05, power = .87), depression (F [3,242] = 4.16, p = .007, partial [eta.sup.2] = .05, power = .87), and mastery (F [3, 242] =- 5.57, p =.001, partial [eta.sup.2] = .065, power = .94), indicating that scores were not equivalent across the four groups of sexual victimization.

We performed post-hoc Tukey analyses for each univariate. Girls who reported rape had significantly lower levels of self-esteem (M = 31.264, SE = .58) compared to girls who had never been sexually coerced (M = 33.91, SE = .69) and those who reported an attempted rape (M = 34.75, SE = 1.00). A trend was observed wherein girls who reported rape had lower levels of self-esteem as compared to girls who had experienced sexual coercion (M = 32.75, SE = .58, p = .075). No other significant group differences were found.

Significantly higher levels of depression were reported by girls who had been raped (M = 1.47, SE = .10) in comparison to girls who never experienced any form of sexual coercion (M = .95, SE = .12) and in comparison to girls who reported sexual coercion (M = 1.12, SE = . 12). No other significant group differences emerged.

Lastly, girls who had been raped reported significantly lower levels of mastery (M = 20.47, SE = .41) than did girls who reported consensual sex only (M = 22.95, SE = .49) and girls who reported a sexually coercive event (M = 22.18, SE = .41). A trend (p = .075) was observed in which scores on the mastery scale were higher among girls reporting an attempted rape (M = 21.95, SE = .71) as compared to the girls who had been raped. None of the remaining pairwise comparisons were significant.

We performed a one-way MANOVA to determine whether levels of reported family conflict or family cohesion differed by reported levels of coercion experienced. The overall model was significant, F (6, 490) = 5.05, p = .000, partial [eta.sup.2] = .059, power = .99. Examination of the univariate ANOVAs revealed significant differences as a function of coercion level experienced on both the Cohesion (F [3, 245] = 4.30, p = .006, partial [eta.sup.2]= .05, power = .86) and Conflict (F [3,245] = 7.96, p = .000, partial [eta.sup.2]= .089, power = .99) subscales of the FES.

Post-hoc Tukey analyses revealed that women who reported only consensual sex had higher levels of family cohesion (M = 6.86, SD = 2.15) than did the girls who reported having been raped (M = 5.61, SD = 2.34). Similarly, girls who reported consensual sex only had significantly lower levels of family conflict (M = 3.19, SD = 2.27) as compared to girls who had been raped (M = 4.87, SD = 2.06) and as compared to girls who reported an attempted rape (M = 4.63, SD = 2.20). No other significant group differences emerged.

DISCUSSION

This study examined types of sexual victimization experienced by a clinical sample of adolescent African American women and investigated whether levels of psychological adjustment or family dysfunction differed as a function of the type of sexual victimization. In our investigation, 32.1% of the participants reported having been raped, which is higher than rates reported in national studies (13.1%, NSA, Kilpatrick, 1996; 15.3%, Boney-McCoy & Finkelhor, 1995a; 9.6%, YRBS, Grunbaum et al., 2002) and other studies that used the SES to measure sexual victimization. In general, studies using the SES to assess the rate of rape among young adults have found a range of approximately 15% to 30% (23% and 31%, Alksnis et al., 2000; 13%, Humphrey & White, 2000; 15%, Koss et al., 1987; 29%, Krahe, Scheinberger-Olwig, et al., 1999) with one exception (Forbes & Adams-Curtis, 2001). In a sample of primarily White college students, Forbes and Adams-Curtis reported that 2.8% of the women had been raped. However, unlike other studies, Forbes and Adams-Curtis did not classify students according to their level of sexual victimization. Instead, they used a summary score, and based on this total scale score, they determined a cutoff value to indicate rape. Thus, the low rate of reported rape most likely reflects the fact that they did not develop sexual victimization groups. It is important to note that the samples were comprised of almost all White students for each of these investigations.

To date, only four studies have used the SES to assess sexual victimization among adolescents (Gidycz & Koss, 1989; Maxwell et al., 2003; Noell, Rohde, Seeley, & Ochs, 2001; Osborne & Rhodes, 2001), of which only two reported the rate of rape (Gidycz & Koss; Noell et al.) and thus can be used as a comparison. Gidycz and Koss, who studied a small sample of adolescents (n = 67), 61% of whom were African American, reported that 2.8% had experienced rape due to a threat of being hurt and 22% experienced a rape because of pressure. Noell et al. found that, among a sample of 216 homeless, primarily White, adolescent women, 8% reported having been raped. It is possible that the lower rate of rape reported by Noell and his colleagues stems from the ethnic composition of the sample. This is speculated because national statistics suggest that sexual victimization rates are higher among African American women as compared to women of other ethnic groups (Ackard & Neumark-Sztainer, 2002; Boney-McCoy & Finkelhor, 1996; Grunbaum et al., 2002; Hashima & Finkelhor, 1999; Kilpatrick et al., 2003; Kilpatrick & Saunders, 1997).

Our higher rate of reported rape could also reflect the narrow age range of the participants in our study. For example, the age of participants in the study by Noel et al. ranged from 11 to 19 years of age. In our study the range was 14 to 19 years of age, with the majority of the sample (95%) falling between the ages of approximately 15 to 18 years of age. National samples, as well as investigations including nonrepresentative adolescent samples, provide evidence that rates of sexual victimization among adolescents increase with age (e.g., Kilpatrick, 1996). For example, Maxwell and his colleagues (2003) found that among 15-year-old adolescent women, 53% reported a form of sexual victimization. This rate increased to 74% for 18-year-olds.

Another explanation for the higher rate of sexual victimization herein relates to the study composition. Participants were recruited from an urban adolescent health clinic. Youth attending clinics may not be representative of the general adolescent population. Although sexual victimization is present in the general population, rates of sexual victimization are often higher in clinical/psychiatric or medical settings (Kimerling & Calhoun, 1994; Koss, 1993; Koss, Koss, & Woodruff, 1991; Whitfield, 1998). Indeed, Whitfield (1997a, b) reported that between 50-70% of clients in clinical/psychiatric settings have survived some kind of trauma, including sexual victimization. Furthermore, it has been shown that there is an increase in health care usage after the woman has been sexually victimized (Beeb, Gulledge, Lee, & Replogle, 1994).

However, it has also been suggested that adolescents may be less likely to seek medical services as compared to adults due to concerns such as confidentially, being blamed for the assault, and feeling ashamed (Arata, 1998; Foshee, Linder, Bauman, & Langwick, 1996; Roesler & Wind, 1994). Although these findings suggest that persons attending a clinic are different from those choosing not to seek treatment at a clinic, the negative sequelae associated with sexual victimization has been reported in nonclinical samples, such as community samples and samples of college students (Banyard, Plante, & Maynihan, 2004). Nonetheless, future studies using a matched group design need to be conducted to examine the impact of seeking medical care among persons who have experienced some form of sexual victimization. Using a matched group design would help answer the question regarding the generalizability of our findings to nonclinical samples.

Rates reported for attempted rape vary substantially, from as low as 7% (Humphrey & White, 2000) to a high of 26% (Krahe, Scheinberger-Olwig, et al., 1999). In our study, approximately 11% of the African American women surveyed reported an attempted rape experience. This is much lower than the rate reported by Gidycz and Koss (22%, 1989) and by Krahe, Scheinberger-Olwig, et al. (26%, 1999). In the study by Krahe and colleagues, participants were German women between the ages of 17 and 20 years. Thus, one reason for the higher rates may be that the sample was non-U.S. based and comprised of older adolescents. In general, however, the percentage of girls reporting attempted rape in our study is similar to the rates noted in other studies of adolescent women (10.8%, Noell et al., 2001) and female college students (10%, Alksnis et al., 2000; 12%, Koss et al., 1987).

We found that many adolescent women (34%) had experienced some form of sexual coercion. In general, this rate is substantially higher than rates reported by researchers in other studies who used the SES to assess sexual coercion (10-19%, Alksnis et al., 2000; 15%, Humphrey & White, 2000; 12-14%, Koss et al., 1987; 22%, Krahe, Scheinberger-Olwig, et al., 1999; 26%, Noell et al., 2001), although higher rates have been reported (53%, Forbes & Adams-Curtis, 2001). There is a fair amount of variation in published investigations regarding the rate of sexual victimization. We speculate that the wide range in levels of sexual coercion found in the literature reflects two important limitations. First, few studies have used the exact same SES items. Indeed, it is not uncommon for researchers to modify the questions used (Forbes & Adams-Curtis; Maxwell et al., 2003; Messman-More et al., 2000; Osborne & Rhodes, 2001). In some studies, researchers use a subset of the original survey items (e.g., Koss & Gidycz, 1985), whereas in other studies, additional items have been added to the survey (e.g., Krahe, Reimer, et al., 1999; Larimer, Lydum, Anderson, & Turner, 1999).

A second difficulty with attempts to compare rates across studies is that there is not a consensus as to which items should be included in each victimization level and which terms should be used to represent each category. In existing studies, adult and adolescent levels of victimization have been classified into four groups (Koss & Gidycz, 1985; Krahe, Scheinberger-Olwig, et al., 1999; Noell et al., 2001), five or six groups (Alksnis et al., 2000; Kenney et al., 1997; Koss et al., 1987; Larimer et al., 1999; Humphrey & White, 2000), whereas in other studies, responses have been collapsed to indicate whether or not participants had experienced any form of sexual coercion (e.g., victims vs. nonvictims: Field et al., 2001; Gidycz & Koss, 1989; Osborne & Rhodes, 2001; Synovitz & Byrne, 1998; e.g., no victimization vs. psychological victimization vs. criminal victimization: Maxwell et al., 2003). Moreover, in some instances, the researchers do not indicate which items they used to create the various categories of coercion (Alksnis et al., 2000; Humphrey & White, 2000; Kenney et al.; Koss & Gidycz, 1985; Messman-Moore et al.).

With regard to terminology, most researchers use the terms rape and attempted rape. However, a variety of terms appear to reflect other levels of sexual victimization, such as sexual coercion, sexual contact, victimization, sexual assault, unwanted contact, and verbal coercion. Future studies should examine how best to create categories of abuse. One suggestion would be to develop categories based on the legal definitions of rape, attempted rape, and sexual coercion provided by the federal government, while taking into account that definitions vary by state. Another possibility would be to develop groups based on the definitions of victimization used in national surveys. To summarize, reported rates of sexual victimization vary substantially due to methodological differences (Fisher et al., 2000; Hilton, Harris, & Rice, 1998; Koss, 1993). In particular, the definition and measurement of sexual victimization, the number of items used to assess the sexual victimization, and the characteristics of the questionnaire not only influence the rate of reported sexual victimization for any given study (Hamby & Koss, 2003), but also make cross-sample comparisons problematic.

As we had expected based on prior research, levels of self-esteem, depression, and mastery were not the same across the types of victimization. For the three psychological variables, controlling for grades received in school, girls who had been raped had significantly lower levels of self-esteem, higher levels of depression, and lower levels of mastery than did the girls who reported no sexual victimization. These findings are in line with studies wherein elevated levels of depression and lower levels of self-esteem have been found among girls who have been sexually victimized (Gidycz & Koss, 1989; O'Keefe & Treister, 1998; Osborne & Rhodes, 2001). We also found that girls who had been raped had significantly lower levels of self-esteem and mastery as compared to girls who had experienced an attempted rate (trend). Furthermore, levels of self-esteem (trend), depression, and mastery were significantly lower for girls who had been raped compared to girls who had experienced some form of sexual coercion. These findings provide preliminary support for the hypothesis that levels of psychological adjustment may vary as a function of the level of coercion experienced. Girls who had been raped, overall, had worse psychological health than girls who were never victimized, who reported an attempted rape, and who had experienced sexual coercion.

As hypothesized, family functioning varied according to the type of victimization experienced. Levels of family cohesion were significantly lower and levels of conflict were significantly higher among girls who had been raped as compared to girls reporting no victimization. Interestingly, levels of family conflict were also higher among women who had reported an attempted rape versus women who had no history of victimization. Although studies of victimization typically have not examined relationships among family members, studies of childhood abuse have. Numerous studies document more negative family dynamics among youth with a history of physical or sexual abuse (Benedict & Zautra, 1993; Cecil & Matson, 2001). Prospective studies are needed to elucidate the temporal sequence of family dysfunction and sexual victimization among adolescents.

Limitations

The results of this study have limited generalizability to populations other than African American adolescent women attending an urban, adolescent health clinic. Investigations are needed that examine sexual victimization levels of adolescent women who attend health clinics in other cities to find out whether or not similar rates of sexual victimization would be found. Secondly, not all of our study participants had experienced sexual victimization. As a result, we cannot determine how representative our sample is of all African American adolescent women who have experienced sexual victimization. Additional studies are needed to replicate our findings using samples of adolescent boys as well as to include participants with diverse ethnic backgrounds. Furthermore, participants need to be recruited from a variety of sources, not just adolescent health clinics.

In addition, because of the cross-sectional design used, we were unable to make any causal inferences between sexual victimization and psychological functioning or family dysfunction. However, the findings obtained herein provide guidance in the development of future research questions. Longitudinal studies are needed to examine whether adolescent women with mental health problems are more likely to be sexually victimized, or whether mental health problems arise after the occurrence of the victimization. The role of the family should also be studied.

Conclusion

Despite these limitations, this study is a starting point for future research to examine the impact of sexual victimization types on various domains of functioning. This study is the first to demonstrate a relationship between the type of sexual victimization and African American adolescent women's mental health and level of family dysfunction. Prior studies have either not taken into consideration the type of victimization or have only included one domain (e.g., psychological functioning). The significant intercorrelations among the mental health and family variables suggest that sexual victimization does not occur in a vacuum. These findings also lend support to the theory that the development of psychological mental health problems among adolescents exposed to violence depends upon the family context, among other factors (Howard, Feigelman, Li, Cross, & Rachuba, 2002). Future studies are needed to identify the mechanisms or pathways whereby family patterns impact the occurrence of sexual victimization and the development of psychological health problems.

Finally, it is important to note that the majority of studies examining sexual coercion have been conducted primarily with White adolescent women, who may be less likely to be sexually victimized and for whom the experience is likely to be different. One cannot generalize from one ethnic group to another ethnic group, in part because the experience of sexual victimization and violence depends upon the cultural context in which it occurs (Kenny & McEachern, 2000; Kuther & Wallace, 2003; Spencer, Dupree, Cunningham, Harpalani, & Munoz-Miller, 2003). For example, Wyatt (1992) argued that our society may be particularly prone to blaming the African American woman for sexual victimization due to the commonly held view of the African American woman as highly sexualized, which may impact how the African American woman responds to the sexual victimization. Future research is needed to examine and compare the impact of the cultural context of sexual victimization for African American adolescent women with adolescent women of different ethnicities.

APPENDIX

Items Used to Classify Respondents According to Their Highest Level of Sexual Victimization Experienced

Stem: "Have you ever ..."

Nonvictimization/consensual sex

Item: Had sexual intercourse with a boy when you both wanted to?

Sexual coercion

Item: Had a boy misinterpret the level of sexual intimacy (closeness) you desired?

Item: Been in a situation where a boy became so sexually aroused that you felt it was useless to stop him even though you did not want to have sexual intercourse?

Item: Had sexual intercourse with a boy even though you didn't really want to because he threatened to end your relationship otherwise?

Item: Had sexual intercourse with a boy even though you didn't really want to because you felt pressured by his continual arguments?

Item: Found out that a boy had obtained sexual intercourse with you by saying things he didn't really mean?

Item: Been in a situation where a boy used some degree of physical force (ex: twisting your arm, holding you down) to try and make you engage in kissing for fondling when you didn't want to?

Attempted rape

Item: Been in a situation where a boy tried to have sexual intercourse with you when you didn't want to by threatening to use physical force if you didn't cooperate, but for various reasons sexual intercourse did not occur?

Item: Been in a situation where a boy used some degree of physical force to try to get you to have sexual intercourse with him when you did not want to, but for various reasons sexual intercourse did not occur?

Completed rape

Item: Had sexual intercourse with a boy when you didn't want to because he threatened to use physical force if you didn't cooperate?

Item: Had sexual intercourse with a boy when you didn't want to because he used some degree of physical force?

Item: Been in a situation where a boy obtained sexual acts with you such as anal or oral intercourse when you didn't want to by using threats or physical force?

Item: Been raped?

Note. We are grateful to Dr. Steven D. Pinkerton for his helpful comments on earlier versions of this paper. We also thank Jamie Gillmore and Myronica Survillion for administering the interviews and for data entry.

Manuscript accepted October 25, 2004

REFERENCES

Ackard, D. M., & Neumark-Sztainer, D. (2002). Date violence and date rape among adolescents: Associations with disordered eating behaviors and psychological health. Child Abuse & Neglect, 26, 455-473.

Alksnis, C., Desmarais, S., Senn, C., & Hunter, N. (2000). Methodologic concerns regarding estimates of physical violence in sexual coercion: Overstatement or understatement? Archives of Sexual Behavior, 29, 323-334.

Allgeier, E. R. (1987). Coercive versus consensual sexual interactions. G. Stanley Hall Lecture Series, 7, 7-63.

Aktan, G. B., Kumpfer, K. L., & Turner, C. W. (1996). Effectiveness of a family skills training program for substance use prevention with inner city African-American families. Substance Use and Misuse, 31, 157-175.

Arata, C. M. (1998). To tell or not to tell: Current functioning of child sexual abuse survivors who disclosed their victimization. Child Maltreatment, 3, 63-71.

Baer, J. (1999). The effects of family structure and SES on family processes in early adolescence. Journal of Adolescence, 22, 341-354.

Banyard, V. L., Plante, E. G., & Maynihan, M. M. (2004). Bystander education: Bringing a broader community perspective to sexual violence prevention. Journal of Community Psychology, 32, 61-79.

Beebe, D. K., Gulledge, K. M., Lee, C. M., & Replogle, W. (1994). Prevalence of sexual assault among women patients seen in family practices clinics. Family Practice Research Journal, 14, 223-228.

Belknap, J., Fisher, B. S., & Cullen, F. T. (1999). The development of a comprehensive measure of the sexual victimization of college women. Violence Against Women, 5, 185-214.

Benedict, L. L. W., & Zautra, A. A. J. (1993). Family environmental characteristics as risk factors for childhood sexual abuse. Journal of Clinical Child Psychology, 22, 365-374.

Bergman, L. (1992). Dating violence among high school students. Social Work, 37, 21-27.

Bhatia, S. (1998). Drug abuse in adolescents in relation to their values and perceived family environment. International Journal of Adolescent Medicine and Health, 10, 27-37.

Biglan, A., Noell, J., Ochs, L., Smolkowski, K., & Metzler, C. (1995). Does sexual coercion play a role in high-risk sexual behavior of adolescents and young adult women? Journal of Behavioral Medicine, 18, 549-568.

Blascovich, J., & Tomaka, J. (1991). Measures of self-esteem. In J. P. Robinson, E R. Shaver, & L. S. Wrightsman (Eds.), Measures of personality and social psychological attitudes. San Diego, CA: Academic Press.

Boney-McCoy, S., & Finkelhor, D. (1995a). Psychosocial sequelae of violent victimization in a national youth sample. Journal of Consulting & Clinical Psychology; 63, 726-736.

Boney-McCoy, S., & Finkelhor, D. (1995b). Prior victimization: A risk factor for child sexual abuse and for PTSD-related symptomatology among sexually abused youth. Child Abuse & Neglect, 19, 1,401-1,421.

Boney-McCoy, S., & Finkelhor, D. (1996). Is youth victimization related to trauma symptoms and depression after controlling for prior symptoms and family relationships? A longitudinal, prospective study. Journal of Consulting and Clinical Psychology, 64, 1,406-1,416.

Boyd, C. P., Gullone, E., Needleman, G. L., & Burt, T. (1997). The Family Environment Scale: Reliability and normative data for an adolescent sample. Family Process, 36, 369-373.

Braungart-Rieker, J., Rende, R. D., Plomin, R., & DeFries, J. C. (1995). Genetic mediation of longitudinal associations between family environment and childhood behavior problems. Development and Psychopathology, 7, 233-245.

Brener, N. D., McMahon, E M., Warren, C. W., & Douglas, K. A. (1999). Forced sexual intercourse and associated health-risk behaviors among female college students in the United States. Journal of Consulting and Clinical Psychology, 67, 252-259.

Bureau of Justice Statistics. (2001). Victimization rates for persons age 12 and over, by type of crime and age of victims (Table 3). Retrieved March 30, 2003, from http://www.ojp.usdoj.gov/bjs/pub/pdf/cvus/current/cv0103.pdf.

Burns, R. B. (1979). The self-concept: Theory measurement, development and behavior. New York: Longman.

Cecil, H., & Matson, S. C. (2001). Psychological functioning and family discord among African-American adolescent females with and without a history of childhood sexual abuse. Child Abuse & Neglect, 25, 973-988.

Cecil, H., & Matson, S. C. (in press). Sexual victimization among African American adolescent females: Examination of the reliability and validity of the Sexual Experiences Survey. Journal of Interpersonal Violence.

Chiu, L. H. (1988). Measures of self-esteem for school-age children. Journal of Counseling and Development, 66, 298-301.

Clark, R., & Armstead, C. (2000). Preliminary study examining relationship between family environment and resting mean arterial pressure in African-American youth. Journal of Adolescent Health, 27, 3-5.

Collins, K. W., & Lightsey, O. R. Jr. (2001). Racial identity, generalized self-efficacy, and self-esteem: A pilot study of a mediation model for African American women. Journal of Black Psychology, 27, 272-287.

Crandall, R. (1973). Measures of self-esteem. In J. E Robinson & E R. Shaver (Eds.), Measuring social psychological attitudes. Ann Arbor, MI: Institute of Social Research.

Demo, D. H. (1985). The measurement of self-esteem: Refining our methods. Journal of Personality and Social Psychology, 48, 1,490-1,502.

Draucker, C. B. (1996). Family-of-origin variables and adult female survivors of childhood sexual abuse: A review of the research. Journal of Child Sexual Abuse, 5, 35-63.

Erickson, P. I., & Rapkin, A. J. (1991). Unwanted sexual experience among middle and high school youth. Journal of Adolescent Health, 12, 319-325.

Field, N. P., Classen, C., Butler, L. D., Koopman, C., Zarcone, J., & Spiegel, D. (2001). Revictimization and information processing in women survivors of childhood sexual abuse. Journal of Anxiety Disorders, 15, 459-469.

Finch, M. D., Shanahan, M. J., Mortimer, J. T., & Ryu, S. (1991). Work experience and control orientation in adolescence. American Sociological Review, 56, 597-611.

Finkelhor, D., & Hashima, P. Y. (2001). The victimization of children and youth: A comprehensive overview. In S. O. White (Ed.), Handbook of youth and justice. New York: Kluwer Academic/Plenum.

Fisher, B. S., & Cullen, F. T. (2000). Measuring the sexual victimization of women: Evolution, current controversies, and future research. Criminal Justice, 4, 317-390.

Fisher, B., Cullen, F., & Turner, M. (2000). The sexual victimization of college women. Washington, DC: National Institute of Justice and Bureau of Justice Statistics, U.S. Department of Justice.

Fisher, B. S., Daigle, L. E., Cullen, F. T., & Turner, M. G. (2003). Reporting sexual victimization to the police and others: Results from a national-level study of college women. Criminal Justice and Behavior, 30, 6-38.

Fleming, J. S., & Courtney, B. E. (1984). The dimensionality of self-esteem. II. Hierarchical facet model for revised measurement scales. Journal of Personality and Social Psychology, 46, 404-421.

Forbes, G. B., & Adams-Curtis, L. E. (2001). Experiences with sexual coercion in college males and females: Role of family conflict, sexist attitudes, acceptance of rape myths, self-esteem, and the big-five personality factors. Journal of Interpersonal Violence, 16, 865-889.

Foshee, V. A., Linder, G. E, Bauman, K. E., & Langwick, S. A. (1996). The safe dates project: Theoretical basis, evaluation, design, and selected baseline findings. American Journal of Preventive Medicine, 12, 39-47.

Gehring, T. M., & Feldman, S. (1988). Adolescents' perceptions of family cohesion and power: A methodological study of the Family System Test. Journal of Adolescent Research, 3, 33-52.

Gidycz, C. A., & Koss, M. P. (1989). The impact of adolescent sexual victimization: Standardized measures of anxiety, depression, and behavioral deviancy. Violence and Victims, 4, 139-149.

Gondoli, D. M., & Jacob, T. (1993). Factor structure within and across three family-assessment procedures. Journal of Family Psychology, 6, 278-289.

Goodman, L. A., Koss, M. P., & Russo, N. F. (1993). Violence against women: Physical and mental health effects. Applied and Preventive Psychology, 2, 79-89.

Gray, H. M., & Foshee, V. (1997). Adolescent dating violence: Differences between one-sided and mutually violent profiles. Journal of Interpersonal Violence, 12, 126-141.

Greenberger, E., Chen, C., Dmitrieva, J., & Farruggia, S. P. (2003). Item-wording and the dimensionality of the Rosenberg Self-Esteem Scale: Do they matter? Personality and Individual Differences, 35, 1,241-1,254.

Gruber, K. J. (1983). Identifying determinants of risk of sexual victimization of youth: A multivariate approach. Child Abuse & Neglect, 7, 17-24.

Grunbaum, J. A., Kann, L., Kinchen, S. A., Williams, B., Ross, J. G., Lowry, R., et al. (2002). Youth risk behavior surveillance--United States, 2001. Morbidity and Mortality Weekly Report, 51(SS04), 1-64.

Hagborg, W. J. (1993). The Rosenberg Self-esteem scale and Harter's Self-perception Profile for adolescents: A concurrent validity study. Psychology in the Schools, 30, 132-136.

Hamby, S. L., & Koss, M. P. (2003). Shades of gray: A qualitative study of terms used in the measurement of sexual victimization. Psychology of Women Quarterly, 27, 243-255.

Hanson, R. F. (2002). Adolescent dating violence: Prevalence and psychological outcomes (invited commentary). Child Abuse & Neglect, 26, 447-451.

Hanson, R. F., Kievit, L. W., Saunders, B. E., Smith, D. W., Kilpatrick, D. G., Resnick, H. S., et al. (2003). Correlates of adolescent reports of sexual assault: Findings from the national survey of adolescents. Child Maltreatment, 8, 261-272.

Hashima, P. Y., & Finkelhor, D. (1999). Violent victimization of youth versus adults in the national crime victimization survey. Journal of Interpersonal Violence, 14, 799-820.

Hilton, N. Z., Harris, G. T., & Rice, M. E. (1998). On the Validity of self-reported rates of interpersonal violence. Journal of Interpersonal Violence, 13, 58-72.

Hoge, D. R., & McCarthy, J. D. (1983). Issues of validity and reliability in the use of real-ideal discrepancy scores to measure self-regard. Journal of Personality and Social Psychology, 44, 1,048-1,055.

Howard, D. E., Feigelman, S., Li, X., Cross, S., & Rachuba, L. (2002). The relationship among violence victimization, witnessing violence, and youth distress. Journal of Adolescent Health, 31, 455-462.

Howard, D., Qiu, Y., & Boekeloo, B. (2003). Personal and social contextual correlates of adolescent dating violence. Journal of Adolescent Health, 33, 9-17.

Humphrey, J. A., & White, J. W. (2000). Women's vulnerability to sexual assault from adolescence to young adulthood. Journal of Adolescent Health, 27, 419-424.

Kaminer, D., Seedat, S., Lockhat, R., & Stein, D. J. (2000). Violent trauma among child and adolescent girls: Current knowledge and implications for clinicians. International Clinical Psychopharmacology, 15 (Supp3), S51.

Kenney, J. W., Reinholtz, C., & Angelini, P. J. (1997). Ethnic differences in childhood and adolescent sexual abuse and teenage pregnancy. Journal of Adolescent Health, 21, 3-10.

Kenny, M. C., & McEachern, A. G. (2000). Racial, ethnic, and cultural factors of childhood sexual abuse: A selected review of the literature. Clinical Psychology Reviews, 20, 905-922.

Kilpatrick, D. G. (1996, November). From the mouth of victims: What victimization surveys tell us about sexual assault and sex offenders. Paper presented at the 15th annual Research and Treatment conference of the Association for Treatment of Sexual Abusers, Chicago.

Kilpatrick, D. G., Edmunds, C., & Seymour, A. (1992). Rape in America: A report to the nation. Arlington, VA: National Center for Victims of Crime; Charleston, SC: Medical University of South Carolina, Crime Victims Research and Treatment Center.

Kilpatrick, D. G., & Saunders, B. E. (1997). Prevalence and Consequences of Child Victimization: Results from the National survey' of adolescents. Final report. Washington, DC: US Department of Justice, Office of Justice Programs, National Institute of Justice.

Kilpatrick, D. G., Saunders, B. E., & Smith, D. W. (2003). Youth Victimization: Prevalence and implications. Research in brief (NCJ 194972). Washington, DC: US Department of Justice, Office of Justice Programs, National Institute of Justice. Retrieved July 28, 2003, from http://www.ojp.usdoj.gov/nij.

Kilpatrick, D. G., Whalley, A., & Edmunds, C. (2000). Sexual assault. In A. Seymour, M. Murray, J. Sigmon, M. Hook, C. Edmunds, M. Gaboury, & G. Coleman (Eds.), 2000 National Victim Assistance Academy. Retrieved February 18, 2003, from http://www.ojp.usdoj.gov/ovc/ assist/nvaa2000/academy/J-10-SA.htm.

Kimerling, R., & Calhoun, K. S. (1994). Somatic symptoms, social support, and treatment seeking among sexual assault victims. Journal of Consulting and Clinical Psychology, 62, 333-340.

Koss, M. P. (1988). Hidden rape: Sexual aggression and victimization in a national sample of students in higher education. In A.W. Burgess (Ed.), Rape and sexual assault II. New York: Garland Publishing.

Koss, M. P. (1993). Detecting the scope of rape: A review of revalent research methods. Journal of Interpersonal Violence, 8, 198-222.

Koss, M. P., & Cook, S. L. (1998). Facing the facts: Date and acquaintance rape are significant problems for women. In R. K. Bergen (Ed.), Issues in intimate violence. London: Sage Publications.

Koss, M. P., & Gidycz, C. A. (1985). Sexual experiences survey: Reliability and validity. Journal of Consulting and Clinical Psychology, 53, 422-423.

Koss, M. E, Gidycz, C. A., & Wisniewski, N. (1987). The scope of rape: Incidence and prevalence of sexual aggression and victimization in a national sample of higher education students. Journal of Consulting and Clinical Psychology, 55, 162-170.

Koss, M. P., Koss, P. G., & Woodruff, W. J. (1991). Relation of criminal victimization to health perceptions among women medical patients. Journal of Consulting and Clinical Psychology, 58, 147-152.

Koss, M. P., & Oros, C. J. (1982). Sexual Experiences Survey: A research instrument investigating sexual aggression and victimization. Journal of Consulting and Clinical Psychology, 50, 455-457.

Krahe, B., Reimer, T., Scheinberger-Olwig, R., & Fritsche, I. (1999). Measuring sexual aggression: The reliability of the Sexual Experiences Survey in a German sample. Journal of Interpersonal Violence, 14, 91-100.

Krahe, B., Scheinberger-Olwig, R., Waizenhofer, E., & Kolpin, S. (1999). Childhood sexual abuse and revictimization in adolescence. Child Abuse & Neglect, 23, 383-394.

Kronenberger, W. G., & Thompson, R. J. (1990). Dimensions of family functioning in families with chronically ill children: A higher order factor analysis of the Family Environment Scale. Journal of Clinical Child Psychology, 19, 380-388.

Kuther, T. L., & Wallace, S. A. (2003). Community violence and sociomoral development: An African American cultural perspective. American Journal of Orthopsychiatry, 73, 177-189.

Larimer, M. E., Lydum, A. R., Anderson, B. K., & Turner, A. (1999). Male and female recipients of unwanted sexual contact in a college student sample: Prevalence rates, alcohol use, and depression symptoms. Sex Roles, 40, 295-308.

Lawson, D. M., Gaushell, H., & Karst, R. W. (1996). Counselor trainee self-esteem, mastery and current intergenerational family relationships. Clinical Supervisor, 14, 111-121.

Leidig, M. W. (1992). Continuum of violence against women: Psychological and physical consequences. Journal of American College Health, 40, 149-155.

Lockett, C. T., & Harrell, J. P. (2003). Racial identity, self-esteem, and academic achievement: Too much interpretation, too little supporting data. Journal of Black Psychology, 29, 325-336.

Long, P. J. (1991). Children sexually abused by multiple perpetrators: Familial risk factors and abuse characteristics. Journal of Interpersonal Violence, 6, 147-159.

Lorr, M., & Wunderlich, R. A. (1986). Two objective measures of self-esteem. Journal of Personality Assessment, 50, 18-23.

Marshall, G., & Lang, E. L. (1990). Optimism, self-mastery, and symptoms of depression in women professionals. Journal of Personality and Social Psychology, 59, 132-139.

Maxwell, C. D., Robinson, A. L., & Post, L. A. (2003). The nature and predictors of sexual victimization and offending among adolescents. Journal of Youth and Adolescence 32, 465-477.

Merrill, L. L., Newell, C. E., Thomsen, C. J., Gold, S. R., Milner, J. S., Koss, M. P., et al. (1999). Childhood abuse and sexual revictimization in a female navy recruit sample. Journal of Traumatic Stress, 12, 211-225.

Messman-Moore, T. L., Long, P. J., & Siegfried, N. J. (2000). The revictimization of child sexual abuse survivors: An examination of the adjustment of college women with child sexual abuse, adult sexual assault, and adult physical abuse. Child Maltreatment, 5, 18-27.

Mizell, C. A. (1999). African American men's personal sense of mastery: The consequences of the adolescent environment, self-concept, and adult achievement. Journal of Black Psychology, 25, 210-230.

Molinder, C., & Tolman, R. M. (1998). Gender and contextual factors in adolescent dating violence. Violence Against Women, 4, 180-194.

Moos, R. H., & Moos, B. S. (1993). Family Environment Scale manual (2nd ed.). Palo Alto, CA: Consulting Psychologists Press, Inc.

Muehlenhard, C. L., Harney, P. A., & Jones, J. M. (1992). From "victim-precipitated rape" to "date rape": How far have we come? Annual Review of Sex Research, 3, 219-253.

Mynatt, C. R., & Allgeier, E. R. (1990). Risk factors, self-attributions, and adjustment problems among victims of sexual coercion. Journal of Applied Social Psychology, 20, 130-153.

Noell, J., Rohde, P., Seeley, J., & Ochs, L. (2001). Childhood sexual abuse, adolescent sexual coercion and sexually transmitted infection acquisition among homeless female adolescents. Child Abuse & Neglect, 25, 137-148.

Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd ed.). New York: McGraw Hill, Inc.

Oliver, J. M., Handal, P. J., Enos, D. M., & May, M. J. (1988). Factor structure of the Family Environment Scale: Factors based on items and subscales. Educational & Psychological Measurement, 48, 469-477.

Oliver, J. M., May, M. J., & Handal, P. J. (1988). The factor structure of the Family Environment Scale: Factors derived from subscales. Journal of Clinical Psychology, 44, 723-727.

O'Keefe, M., & Treister, L. (1998). Victims of dating violence among high school students. Are the predictors different for males and females? Violence Against Women, 4, 195-223.

Osborne, L. N., & Rhodes, J. E. (2001). The role of life stress and social support in the adjustment of sexually victimized pregnant and parenting minority adolescents. American Journal of Community Psychology, 29, 833-849.

Owens, T. J., & King, A. B. (2001). Measuring self-esteem: Race, ethnicity, and gender considered. In J. T. Owens, S. Stryker, & N. Goodman (Eds.), Extending self-esteem theory and research: Sociological and psychological currents. New York: Cambridge University Press.

Pearlin, L., Lieberman, M., Menaghan, E., & Mullan, J. (1981). The stress process. Journal of Health and Social Behaviors, 22, 337-356.

Perkins, C. (1997). Age Patterns of Victims of Serious Crimes. Washington, DC: U.S. Department of Justice, Bureau of Justice Statistics.

Perosa, L. M., & Perosa, S. L. (1990). Convergent and discriminant validity for family self-report measures. Educational and psychological measurement, 50, 855-868.

Petterson, S., & Friel, L. V. (2001). Psychological distress, hopelessness and welfare. Women and Health, 32, 79-99.

Ray, K. C., Jackson, J. L., & Townsley, R. M. (1991). Family environments of victims of intrafamilial and interfamilial child sexual abuse. Journal of Family Violence, 6, 365-374.

Rennison, C. M. (June 2001). Criminal Victimization 2000. Changes 1999-2000 with trends 1993-2000. (NCJ 187007). Washington, DC: Bureau of Justice Statistics. Retrieved March 25, 2003, from http://www.ojp.usdoj.gov/bjs/pub/pdf/cv00.pdf.

Rennison, C. M. (September 2002). Criminal Victimization 2001: Changes 2000-2001 with Trends 1993-2001. Report NCJ 194610. Bureau of Justice Statistics. National Crime Victimization Survey. Retrieved March 25, 2003, from http://www.ojp.usdoj.gov/bjs/pub/pdf/cv01.pdf.

Reynolds, W. M. (1988). Measurement of academic self-concept in college students. Journal of Personality Assessment, 52, 223-240.

Robinson, L. (2000). Racial identity attitudes and self-esteem of Black adolescents in residential care: An exploratory study. British Journal of Social Work, 30, 3-24.

Roesler, T. A., & Wind, T. W. (1994). Telling the secret: Adult women describe their disclosure of incest. Journal of Interpersonal Violence, 9, 327-338.

Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.

Russell, C. S. (1980). A methodological study of family cohesion and adaptability. Journal of Marital and Family Therapy, 6, 459-470.

Sandler, I. N., & Barrera, M. (1984). Toward a multimethod approach to assessing the effects of social support. American Journal of Community Psychology, 12, 37-52.

Sanford, K., Bingham, C. R., & Zucker, R. A. (1999). Validity issues with the Family Environment Scale: Psychometric resolution and research application with alcoholic families. Psychological Assessment, 11, 315-325.

Savin-Williams, R. C., & Jaquish, G. A. (1981). The assessment of adolescent self-esteem: A comparison of methods. Journal of Personality, 49, 324-336.

Schmid, K. D., Rosenthal, S. L., & Brown, E. D. (1988). A comparison of self-report measures of two family dimensions: Control and cohesion. American Journal of Family Therapy, 16, 73-77.

Schubiner, H., & Robin, A. (1990). Screening adolescents for depression and parent-teenager conflict in an ambulatory medical setting: A preliminary investigation. Pediatrics, 85, 813-818.

Siegel, J. M., Golding, J. M., Stein, J. A., Burnam, M. A., & Sorenson, S.B. (1990). Reactions to sexual assault: A community study. Journal of Interpersonal Violence, 5, 229-246.

Silber, E., & Tippett, J. (1965). Self-esteem: Clinical assessment and measurement validation. Psychological Reports, 16, 1017-1071.

Smith, P. D., Rivers, P. C., & Stahl, K. J. (1992). Family cohesion and conflict as predictors of drinking patterns: Beyond demographics and alcohol expectancies. Family Dynamics of Addiction Quarterly, 2, 61-69.

Spencer, M. B., Dupree, D., Cunningham, M., Harpalani, V., & Munoz-Miller, M. (2003). Vulnerability to violence: A contextually-sensitive, developmental perspective on African American adolescents. Journal of Social Issues, 59, 33-49.

Stevens-Simon, C., & Reichert, S. (1992). Sexual abuse, adolescent pregnancy, and child abuse: A developmental approach to an intergenerational cycle. Archives in Pediatrics Adolescent Medicine, 148, 23-27.

Synovitz, L. B., & Byrue, T. J. (1998). Antecedents of sexual victimization: Factors discriminating victims from nonvictims. Journal of American College Health, 46, 151-158.

Thompson, R. J. Jr., Armstrong, F. D., Kronenberger, W. G., Scott, D., McCabe, M. A., Smith, B., et al. (1999). Family functioning, neurocognitive functioning, and behavior problems in children with sickle cell disease. Journal of Pediatric Psychology, 24, 491-498.

Tjaden, P., & Thoennes, N. (1998). Prevalence, Incidence, and Consequences of Violence Against Women: Findings from the national violence against women survey. Washington, DC: U.S. Department of Justice, Office of Justice Programs, and the National Institute of Justice. Retrieved May 11, 2003, from http://www.ojp.usdoj.gov/nij/victdocs.htm#1998.

Tjaden, P., & Thoennes, N. (2000). Full Report of the Prevalence, Incidence, and Consequences of Violence against Women. Washington, DC: U.S. Department of Justice, Office of Justice Programs, and the National Institute of Justice. Retrieved May 11, 2003, from http://www.ojp.usdoj.gov/nij/victdocs.htm#2000.

Tyerman, A., & Humphrey, M. (1983). Life stress, family support and adolescent disturbance. Journal of Adolescence, 6, 1-12.

Tyler, K. A., Hoyt, D. R., & Whitbeck, L. B. (2000). The effects of early sexual abuse on later sexual victimization among females homeless and runaway adolescents. Journal of Interpersonal Violence, 15, 235-250.

Urquiza, A. J., & Goodlin-Jones, B. L. (1994). Child sexual abuse and adult revictimization with women of color. Violence and Victims, 9, 223-232.

Vostanis, P., & Nicholls, J. (1995). The Family Environment Scale: Comparison with the construct of expressed emotion. Journal of Family Therapy, 17, 299-315.

Walford-Kraemer, P., & Light, H. K. (1984). Depression and mastery in women: Differences according to personal characteristics. Psychological Reports, 54, 710.

Whiteside-Mansell, L., & Corwyn, R. F. (2003). Mean and covariance structures analyses: An examination of the Rosenberg Self-Esteem Scale among adolescents and adults. Educational and Psychological Measurement, 63, 163-173.

Whitfield, C. L. (1997a). Traumatic amnesia: The evolution of our understanding from a clinical and legal perspectives. Sexual Addiction & Compulsivity: The Journal of Treatment and Prevention, 4, 107-133.

Whitfield, C. L. (1997b). Internal verification and corroboration of traumatic memories of child sexual abuse. Journal of Child Sexual Abuse, 6, 99-122.

Whitfield, C. L. (1998). Adverse childhood experiences and trauma. American Journal of Preventive Medicine, 14, 361-364.

Wordes, M., & Nunez, M. (2002). Our vulnerable teenagers: Their victimization, its consequences, and directions for prevention and intervention. Oakland, CA: National Council on Crimes and Delinquency.

Wyatt, G. E. (1992). The sociocultural context of African American and white American women's rape. Journal of Social Issues, 48, 77-91.

Wyatt, G. E., Loeb, T. B., Solis, B., Carmona, J. V., & Romero, G. (1999). The prevalence and circumstances of child sexual abuse: Changes across a decade. Child Abuse & Neglect, 23, 45-60.

Zweig, J. M., Barber, B., & Eccles, J. S. (1997). Sexual coercion and well-being in young adulthood: Comparisons by gender and college status. Journal of Interpersonal Violence, 12, 291-308.

Heather Cecil

Penn State University--Capital College

Steven C. Matson

University of Wisconsin Medical School

This research was supported by grant 1097-06 awarded by the Medical College of Wisconsin to Heather Cecil.

Address correspondence to Heather Cecil, Ph.D., Penn State University--Capital College, 777 W. Harrisburg Pike, W157 Olmsted, Middletown, PA, 17057; e-mail: [e-mail].

Table 1. Socio-demographic Characteristics

Variable                     Percent

Grade in school
  7th grade                     2.8
  8th grade                    12.4
  9th grade                    20.1
  10th grade                   22.1
  11th grade                   26.1
  12th grade                    9.2
  GED                           2.4
  Not in school                 3.6
  College                       1.2
Grades received in school
  Mostly As                    10.8
  Mostly Bs                    48.2
  Mostly Cs                    33.7
  Mostly Ds                     5.2
  Mostly Fs                     2.0