The moderating effects of alcohol use on the association between sexual orientation and HIV testing: results from the 2013-2018 National Health Interview Study.

Routine screening and testing for HIV are recommended for all adolescents and adults. However, only one-third of the U.S. population has been tested for HIV. Women, sexual minorities, and people who use alcohol are more likely to be tested for HIV, but less is known about how alcohol use and sexual orientation impact the likelihood of HIV testing synergistically. Examining both alcohol use and sexual orientation is especially relevant, because sexual minorities are at increased risk for alcohol use, including heavy drinking. This study tested an alcohol x sexual orientation interaction effect on HIV testing through logistic regression modeling with a nationally representative sample. Results of the significant interaction identify demographic groups that are particularly at-risk for not being tested for HIV. These groups include lesbian women who currently use alcohol or previously used alcohol; bisexual men who have not used or previously used alcohol; and gay men who previously used alcohol. Although efforts to test all adolescents and adults are warranted, these findings highlight the importance of assessing alcohol and sexual orientation and augmenting testing efforts for highrisk groups.

Telephone-delivered behavioral health interventions for people living with HIV: patients' perspectives from a qualitative study.

People living with HIV (PLWH) often experience mental health concerns as well as difficulties with medication adherence; they also report barriers to receipt of health services. Telephone-delivered interventions can overcome some of these barriers. To obtain patients' perspectives on telephone-delivered behavioral health services, we conducted a qualitative study with patients who participated in one of two telephone-delivered interventions (mindfulness training, health coaching) in a research trial. Patients (N = 42; M age = 46 years, 50% female, 26% Black) participated in semi-structured qualitative interviews after completing the study. They identified several advantages (e.g., being able to schedule sessions more flexibly compared to in-person appointments, ease of developing rapport with interventionists) as well as occasional challenges of phone delivery (e.g., network connectivity). Overall, PLWH view telephone-delivery as a convenient and flexible method to engage in behavioral health interventions.

Partner Type and Young Women's Sexual Behavior: A Qualitative Inquiry.

The incidence of sexually transmitted infections (STIs) has increased over recent years, particularly among young women. Partner type is believed to influence women's STI risk. However, researchers often restrict partner type to "casual" versus "committed," labels that can mask risk variability. Therefore, in this study, we identified and explored a range of sexual partner types in order to understand how young women's perceived risk and condom use intentions vary by partner type. Data were obtained during six focus groups of young women (N =25) who were recruited from a community reproductive healthcare clinic. Women described a range of monogamous and non-monogamous partner types that were distinguished based on partner regularity (i.e., whether the sexual partnership was ongoing) and personal relationship (i.e., degree of involvement outside of the sexual relationship). Women's perceived STI risk was higher and condom use intentions stronger with new partners, particularly unfamiliar partners (i.e., "one-night stand," "fuck boy"). Women identified potential harm from condom negotiation with all but the "friends with benefits" partners. However, the nature of this harm differed by partner type. Clinicians and researchers should consider how to support women in advocating for safer sexual behaviors across these partner types by understanding how partner regularity, degree of personal relationship, and emotional attachment differentially impact couples' condom use decisions.

A Brief Clinic-Based Intervention to Reduce Alcohol Misuse and Sexual Risk Behavior in Young Women: Results from an Exploratory Clinical Trial.

This exploratory trial determined the feasibility, acceptability, and preliminary efficacy of a brief intervention (BI), supplemented with text messaging and a curated Web site, on alcohol use and sexual risk behavior among young women. Young women seeking care at a reproductive health clinic were screened for alcohol misuse and sexual risk behavior. Those who screened positive and who agreed to participate (N = 48; M = 22.67 years) were randomized to either (a) a brief in-person session during which personalized feedback regarding alcohol use and sexual risk taking was provided and discussed, or (b) a control condition. Feasibility was assessed by recruitment and retention rates. Acceptability was assessed with participant ratings of their intervention. Efficacy was measured using self-reported alcohol use and sexual behavior at baseline and during a 3-month follow-up. We supplemented the quantitative data with qualitative data from semi-structured interviews. Feasibility data indicated that 64% of eligible women agreed to participate, 74% of eligible women were enrolled, and 86% of enrolled women were retained through follow-up. Acceptability data showed that women who received the BI reported strong satisfaction with their intervention (M = 4.65 vs. 3.98 on a five-point scale) and also reported that text messaging was helpful (M = 4.73 on a seven-point scale) and acceptable (M = 5.27 on a seven-point scale). Qualitative data provided additional support for BI feasibility and acceptability. Efficacy data showed that women in both conditions reduced alcohol use and sexual risk behavior over time; women who received the BI reduced their maximum daily alcohol intake more than controls (BI from 7.68 to 4.82 standard drinks vs. control from 6.48 to 5.65; Wald χ2 = 4.93, p < .05). Women in the BI reported fewer occasions of condomless sex (median = 2.50) than controls (median = 5.00) at the follow-up, but this difference was not statistically significant (OR = 0.61, 95% CI [0.32, 1.15]). A brief intervention, supplemented with text messaging and a Web site, that targeted alcohol use and sexual behavior was feasible and acceptable to young women and led to lower levels of alcohol misuse and sexual risk behavior.

Alcohol Use and Sexual Risk Behavior in Young Women: A Qualitative Study.

Alcohol use and sexual behavior co-occur frequently in young women, increasing risk for HIV and other sexually transmitted infections. To inform preventive interventions, we used qualitative methods to better understand how women think about the contribution of alcohol use to sexual risk-taking. Young women (N = 25; M = 22.8 years; 64% White) were recruited from a community-based reproductive health clinic to attend focus groups; a semi-structured agenda was used to investigate both a priori explanatory mechanisms as well as participant-driven explanations for the alcohol-sex association. Women reported that alcohol reduced their social anxiety, helped them to feel outgoing and confident, and lowered inhibitions and other barriers to sexual encounters (consistent with alcohol expectancies). During drinking events, women described being less concerned with risks, less discriminating regarding sexual partners, and less likely to insist on safer sex practices (consistent with alcohol myopia). These empirical findings support previous theory-based guidance for tailoring preventive programs for alcohol use and sexual risk reduction for young women.

HIV testing intentions and behaviors among 14-17-year-old sexual minority males.

Adolescent sexual minority males have low rates of HIV testing despite increased risk for HIV acquisition. This study will examine adolescent sexual minority males' (a) HIV testing behaviors and intentions, and (b) associations with disclosure to healthcare providers of male-male attraction. Sexual minority males were recruited using social media sites to obtain a national sample. Participants (N = 207) were 14-17-year-old cisgender males living in the U.S. who (1) self-identified as gay/bisexual, (2) reported sexual attraction to males, or (3) reported past-year voluntary sexual contact with a male. Only 14% of participants reported they had tested for HIV, even though 20% reported a history of condomless anal intercourse with male partners. Three-quarters (77%) planned to test for HIV, but only 48% planned to test annually (i.e., current CDC recommendation). Only 20% of participants had disclosed male-male attraction to their healthcare provider, but adolescents who disclosed had five times the odds of testing for HIV (AOR = 5.40). Rates of HIV testing and disclosure of male-male interests to a healthcare provider are low among adolescent sexual minority males. Given the association between disclosure and HIV testing, creating non-judgmental healthcare settings and optimizing patient-provider communication are likely to improve uptake of HIV testing by at-risk youth.

Sexual risk behavior and substance use among young, diverse women seeking care at a reproductive health clinic.

BACKGROUND: To describe sexual risk behavior, alcohol (and other substance) use, and perceived health promotion needs among young adult women seeking care from an urban reproductive health care clinic in the Northeastern United States, and to examine if these needs differ by race and ethnicity. METHODS: Women 18-29 years old presenting for a routine medical visit were invited to participate. Of 486 eligible women, 466 (96%) agreed to participate and completed a brief survey on a tablet computer. Most of the sample (53%) identified as non-Hispanic White. One-quarter (25%) identified as Hispanic/Latina. A smaller proportion of women identified as African American (19%). RESULTS: One-third (31%) of women reported a history of sexually transmitted infection (STI), and women reported infrequent condom use with recent sexual partners. Regarding behavioral health needs, nearly three-quarters of women (72%) reported regular alcohol use, approximately one-third had used marijuana (37%) or tobacco (33%) in the last month, and 19% reported clinically significant depressive symptoms in the last two weeks. Women reported moderate-to-strong interest in receiving information about relationships and sexual health; however, the majority were not interested in information about their substance use. Hispanic and African-American women were more likely to report STI history despite reporting fewer sexual partners than non-Hispanic White women. Minority women also reported significantly less alcohol and cigarette use, but more water pipe tobacco use, and reported significantly greater interest in interventions to promote sexual health. Hispanic women also evidenced significantly elevated rates of depressive symptoms, with 26% of Hispanic women reporting a clinically significant level of depressive symptoms. CONCLUSIONS: Reproductive health centers are opportune settings to address a broad range of healthcare needs, including sexual health, substance use, and mental health. These centers engage a diverse group of women, which is important given observed disparities in health outcomes based on race/ethnicity. Young women, particularly racial and ethnic minority women, report the most interest in services addressing sexual and relationship health.

Problem Solving Reduces Sexual Risk Associated with Sensation Seeking, Substance Use, and Depressive Symptoms Among African-American Adolescents.

OBJECTIVE: African-American adolescents experience higher rates of sexually transmitted infections (STIs) compared to same-age Caucasian peers. Substance use, sensation seeking, and depression have all been linked to risky sexual practices. Theory suggests that problem-solving skills may help to buffer against these risk factors. METHOD: To test this hypothesis, we used data from African-American adolescents (N = 1018; M age = 16.7, SD = 1.1; 58% female) who participated in a prevention trial. RESULTS: Nearly half of the sample (47%) reported lifetime marijuana use, while 13% reported drug use prior to most recent sexual encounter. Sexual sensation seeking was directly associated with drug use prior to sex (ß = 1.13, b = 0.13,SE = 0.02, p < .001) and lower problem-solving skills (ß = -0.08, b = -0.06,SE = 0.02, p = .01). Problem-solving skills were associated with drug use prior to sex (ß = 0.92, b = -0.08, SE = 0.03, p = .004), such that those with greater problem-solving skills were less likely to report drug use prior to most recent sex. Lastly, problem solving skills mediated the association between sexual sensation seeking and drug use prior to sex, though the effect was small (ß = 0.01, 95% CI: .001, .01). CONCLUSIONS: Problem-solving skills can have a protective influence on risky behavior for adolescents. Future research might examine the utility of strengthening problem-solving skills in order to reduce STI/HIV risk among African American adolescents.

Homosexuality as a Discrete Class.

Previous research on the latent structure of sexual orientation has returned conflicting results, with some studies finding a dimensional structure (i.e., ranging quantitatively along a spectrum) and others a taxonic structure (i.e., categories of individuals with distinct orientations). The current study used a sample (N = 33,525) from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). A series of taxometric analyses were conducted using three indicators of sexual orientation: identity, behavior, and attraction. These analyses, performed separately for women and men, revealed low-base-rate same-sex-oriented taxa for men (base rate = 3.0%) and women (base rate = 2.7%). Generally, taxon membership conferred an increased risk for psychiatric and substance-use disorders. Although taxa were present for men and women, women demonstrated greater sexual fluidity, such that any level of same-sex sexuality conferred taxon membership for men but not for women.

College Student Social Network Characteristics and Alcohol Use: Differences (and Similarities) Based on Sexual Identity and Attraction.

OBJECTIVE: Sexual minority (SM) college students have higher alcohol use and alcohol-related consequences than heterosexual students. Peers are salient determinants of young adult drinking, and examining social network characteristics is useful for understanding peer influence. This study used social network methods to understand network characteristics, alcohol use (i.e., max drinks), and alcohol consequences of SM and heterosexual college students. METHOD: Sexual minority and heterosexual junior-year college students (N = 1,150) were compared on (1) social network features (eigenvector centrality, indegree, outdegree, mutuality, closeness), and (2) alcohol use and consequences. We also determined (3) whether social network characteristics were associated with alcohol use and consequences, and (4) whether these associations differed based on sexual identity or attraction. RESULTS: Students reporting a bisexual identity or same-gender attraction had greater eigenvector centrality (global popularity or prestige) than heterosexual or students reporting exclusively other-gender attraction, respectively. Students reporting same-gender attraction had higher outdegree (expansiveness) and more reciprocated ties (mutuality) than individuals reporting exclusively other-gender attraction, but heterosexual students and students with other-gender attraction reported higher relationship closeness; they also reported a higher number of drinks than bisexual students and students with same-gender attraction. One significant interaction showed that outdegree (expansiveness) was associated with alcohol consequences for students who reported any same-gender attraction, but not for students who reported exclusively opposite-gender attraction. CONCLUSIONS: SM college students' greater network prominence differs from research with adolescents and might reflect students' efforts to establish more affirming social connections in a college environment.

Interpersonal Violence Victimization Experiences of Middle School Youth: An Exploration by Gender and Sexual/Romantic Attraction.

Sexual minority youth (SMY) are at increased risk for interpersonal violence victimization compared to heterosexual youth. The current study examined how self-reported victimization (i.e., bullying, sexual harassment and dating violence) among middle school youth varied as a function of sexual/romantic attraction as well as gender identity. Cross-sectional data were gathered from students at seven middle schools in New England (n = 2245). Mean comparisons with post-hoc Tukey tests determined differences in rates of past 6-month and lifetime interpersonal violence victimization by sexual/romantic attraction and the intersection of gender and attraction. As hypothesized, interpersonal violence victimization among middle school youth differed as a function of sexual/romantic attraction as well as gender. To date, most research has focused on older samples, particularly high-school youth and young adults. These data are consistent with these prior studies documenting increased risk for interpersonal violence victimization among youth who indicate same-gender attraction but add to the literature in demonstrating the expansive forms of peer victimization that same-gender-attracted youth already experience by early adolescence. Given that victimization is associated acutely and longitudinally with many deleterious outcomes, including poorer mental health and increased risk for subsequent victimization, greater structural supports are needed for early adolescent SMY.

Directionality of Dating Violence Among High School Youth: Rates and Correlates by Gender and Sexual Orientation.

Sexual minority adolescents are at greater risk for experiencing teen dating violence (TDV) in their dating relationships. Although adolescents in dating relationships often report experiencing and perpetrating various forms of TDV, the directionality of TDV based on youth's reported gender and sexual orientation is not known. A sample of 10th-grade students (N = 1,622) recruited from high schools in the Northeastern United States completed assessments of TDV victimization and perpetration and reported their past-month heavy alcohol use and marijuana use. Sexual minority girls (58%) and boys (36%) were more likely to experience TDV than heterosexual girls (38%) and boys (25%), respectively. Sexual minority boys were less likely, although the confidence intervals included one, to engage in dual-role physical TDV (odds ratio [OR] = 0.14, 95% confidence interval [CI] [0.00, 1.26]) and threatening TDV (OR = 0.14, 95% CI [0.00, 1.02]), and instead were more likely to be victimized. In contrast, the profiles of TDV were similar for girls, with sexual minority girls only being more likely than heterosexual girls to report dual-role physical TDV (OR = 2.23, 95% CI [1.07, 4.66]). Compared with unidirectional TDV, bidirectional TDV was significantly associated with sexual minority girls' substance use, but not with heterosexual girls' substance use. Sexual minority youth report higher rates of TDV, with sexual minority boys being distinctly at-risk for being victimized within their dating relationships. Engagement in both TDV victimization and perpetration was distinctly associated with substance use for sexual minority girls, highlighting the need for integrated prevention efforts and support.

Understanding Associations Between Exposure to Violent Pornography and Teen Dating Violence Among Female Sexual Minority High School Students.

Previous research indicates that teen dating violence (TDV) is more common among sexual minority than heterosexual adolescents, with approximately half of female sexual minority adolescents (SMA) endorsing TDV victimization in the last year. In samples of adolescents without regard to sexual orientation, exposure to violent pornography is associated with TDV, but this relationship has not been assessed in female SMA. The current study sample consisted of 10th-grade high school students aged 14-17 who identified as cisgender females (N = 1,276). Data were collected from a baseline survey prior to the delivery of a sexual assault prevention intervention. Female SMA had 2.54 times the odds (95%CI [1.75, 3.69]) of being exposed to violent pornography and 2.53 times the odds (95%CI [1.72, 3.70)]) of TDV exposure compared to heterosexual girls. Exposure to violent pornography was not associated with involvement in TDV among female SMA, controlling for episodic heavy drinking (aOR = 2.25, 95%CI [0.88,6.22]).Given the relatively higher rates of violent pornography and TDV exposure among female SMA compared to heterosexual girls, it is critical that sex education curricula address these experiences and meet the needs of adolescents of all sexual orientations. Future research can assess how these TDV interventions might be tailored for female SMA. Although we did not find that exposure to violent pornography was associated with TDV among female SMA, these investigations should be replicated with larger data sets, given that the association between exposure to violent pornography and engagement in TDV was in the expected direction.

Sexual Revictimization in College Women: Mediational Analyses Testing Hypothesized Mechanisms for Sexual Coercion and Sexual Assault.

A precollege history of sexual victimization predicts revictimization during college, making it important to understand the mechanisms underlying the victimization-to-revictimization pathway. The study aimed to test whether heavy episodic drinking and personal and peer hookup norms mediate revictimization for two types of unwanted sexual contact: sexual coercion (attempted and/or completed sexual assault by the use of verbal coercion) and sexual assault (attempted and/or completed sexual assault by the use of force, threats, or incapacitation). At college entry, 483 first-year college women completed self-report measures of their precollege experiences, including history of sexual victimization and health behaviors (i.e., alcohol use, personal and peer hookup norms). At the end of the first and second semesters, they also completed measures assessing incident sexual victimization. Nearly one half of women (48%) reported an experience of attempted or completed sexual coercion or assault prior to entering college; 33% endorsed sexual coercion and 15% endorsed sexual assault in their first year of college. Structural equation models demonstrated that heavy episodic drinking and personal and peer hookup norms partially mediated revictimization for sexual assault, but not for sexual coercion. Sexual coercion was the most common tactic leading to unwanted sexual contact in this sample. Alcohol use and personal and peer hookup norms mediated revictimization by force, threats, or incapacitation. In contrast, the hypothesized mediators did not explain the revictimization pathway for verbally coerced assaults. Given the prevalence of sexual coercion, research needs to identify risk factors for verbal coercion to guide prevention efforts.

Validating the Psychosocial Functioning during COVID-19 Questionnaire among a Sample of Informal Caregivers.

The COVID-19 pandemic has had a dramatic impact on global economies and societies. Although social distancing policies are needed to contain the spread and impact of COVID-19, they also impose a psychological and economic burden on people who are already experiencing increased distress such as caregivers. Yet, few measures have been developed and validated to measure the psychosocial impact of COVID-19. Utilizing item response theory (IRT), the purpose of this study was to develop and psychometrically validate a measure of psychosocial functioning-the Psychosocial Functioning during COVID-19 (PFC-19) Questionnaire-to assess changes in social interaction, mental health, health behavior, and global functioning among a sample of informal caregivers during the COVID-19 pandemic. The analytic sample (n = 733) was recruited from Amazon Mechanic Turk (MTurk) (69% male, 55% white). Results suggest a two-factor measure, assessing global functioning (14 items) and affective response (8 items), with strong evidence for reliability, validity, and dimensionality. Future research should replicate this factor structure in other samples.

Peer Victimization of Sexual Minority and Transgender Youth: A Cross-Sectional Study of High School Students.

Objective: To identify rates of victimization experiences by gender identity and sexual orientation in a large regional sample of 14-to-17-year old high school students. Method: All 10th grade students from 27 Northeastern high schools were invited to participate in a survey of dating and sexual experiences (N = 2,766). Results: Compared with heterosexual youth, sexual minority youth reported greater peer victimization of every kind (i.e., bullying, sexual harassment, unwanted sexual contact and intercourse, and every type of dating conflict [threatening behavior, physical abuse, and sexual abuse]). Sexual minority girls evinced particularly high levels of bullying. Similarly, transgender youth were more likely than nontransgender youth to experience every form of peer victimization except physical abuse in a dating relationship. Cumulatively, 91% of sexual minority girls, 86% of transgender youth, and 79% of sexual minority boys experienced at least one form of peer victimization, compared to 78% of heterosexual girls and 63% of heterosexual boys. Further, 14% of transgender youth experienced all 4 victimization types in the past year alone. Finally, bias-based harassment was rarely the only form of victimization experienced by these youth. Conclusion: The victimization of sexual minority youth, particularly girls, and transgender youth was pervasive across individual forms of victimization and multiple forms of victimization concurrently. Further, bias-based harassment was imbedded within a pattern of victimization, such that youth experienced it in concert with multiple other forms of victimization. Researchers implementing prevention-based programs for interpersonal violence should examine the experiences of and impact on youth of diverse gender and sexual identities.

Longitudinal assessment of heavy alcohol use and incapacitated sexual assault: A cross-lagged analysis.

Researchers have argued there are bidirectional associations between heavy alcohol use and sexual assault; however, research in this area is inconclusive due to methodological differences, particularly in study design. The purpose of this study is to clarify the longitudinal associations between heavy alcohol use and incapacitated sexual assault among first-year college women, accounting for hypothesized autoregressive effects within each construct over their first year of college. A sample of 483 women completed regular surveys that assessed a range of health behaviors, including alcohol use and sexual behavior, during their first year of college. We used cross-lagged analyses to examine prospective associations between incapacitated sexual assault and heavy alcohol use (frequency of heavy episodic drinking and peak blood alcohol content). There were significant autoregressive effects, such that women who were engaging in heavier alcohol use as they entered college continued to be heavier alcohol users throughout their first year, and women with a history of assault at college entry were at greater risk for assault during their first year of college. There was a significant cross-lagged effect from precollege incapacitated assault to first-semester alcohol use after controlling for pre-college alcohol use. There were no significant cross-lag paths from alcohol use to subsequent incapacitated assault. Women with a history of incapacitated sexual assault engaged in heavier drinking during their transition to college, but heavy alcohol use did not predict subsequent assault risk.

African-American sexual minority adolescents and sexual health disparities: An exploratory cross-sectional study.

PURPOSE: To better understand sexual health disparities among African-American sexual minority adolescents. METHODS: African-American adolescents (N = 1120; mean age = 15.24 years) were recruited from 4 cities (Columbia, SC; Macon, GA; Providence, RI; Syracuse, NY) to a larger trial. The current analyses used data from the 18-month follow-up when adolescents reported on their sexual partnerships, condom use knowledge, self-efficacy and outcome expectancies for condom use, sexual risk behavior, and STI testing history. RESULTS: Compared with heterosexual adolescents, sexual minority adolescents reported more concerns about potential relationship harms resulting from safer sex negotiation. Sexual minority adolescents were also more likely to engage in riskier sexual behaviors, with females reporting more sexual partners and drug use prior to sex, and males reporting inconsistent condom use and higher rates of HIV. CONCLUSIONS: African-American sexual minority adolescents evidence disparities in sexual risk behavior and STI history that appear to result from interpersonal and relationship concerns. These concerns need to be targeted in sexual health interventions for sexual minority adolescents.

Marijuana use is associated with alcohol use and consequences across the first 2 years of college.

College entry is associated with marijuana initiation, and co-use of alcohol and marijuana is associated with problematic outcomes, including alcohol-related consequences. The present study explored if: (a) use of marijuana on a given day would be associated with greater alcohol use within the same day; (b) use of marijuana within a given week would be associated with increased alcohol-related consequences in that same week; and (c) the association between marijuana use and alcohol consumption and consequences varies across time or by precollege level of problematic alcohol use. Participants (N = 488 college student drinkers, 59% female) completed assessments of marijuana use, alcohol use, and alcohol consequences across 2 years. Analyses revealed: (a) daily marijuana use predicted greater number of daily drinks and estimated breath alcohol concentration; (b) weekly marijuana use predicted more weekly positive and negative alcohol consequences; (c) the effect of daily marijuana use on alcohol use strengthened over time, while the effect of weekly marijuana use on positive alcohol consequences reduced over time; and (d) precollege level of problematic alcohol use moderated the association between daily marijuana and alcohol use and weekly marijuana use and negative consequences. This study provides the first longitudinal evidence of the association between marijuana use and greater alcohol use and consequences in college students. Future research examining event-level measurement of alcohol and marijuana co-use is important for the prevention of alcohol-related consequences. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Mental health consequences of sexual assault among first-year college women.

OBJECTIVE: One in five college women experience unwanted sexual contact while in college, with first-year women being at the greatest risk. Given these data, we investigate how first-semester sexual assault impacts college women's mental health. PARTICIPANTS: 483 female first-year students enrolled in the study during the first month of college. METHODS: All participants completed a health questionnaire when they arrived on campus and again at the end of their first semester. RESULTS: Twelve percent of participants reported sexual assault during the first semester of college. After controlling for baseline mental health and precollege sexual assault history, sexual assault during the first semester predicted clinically significant levels of anxiety and depression at the end of that semester. CONCLUSIONS: The occurrence of sexual assault early in college has adverse mental health consequences.