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Associations among Sexual Assault History, Alcohol Use, Blackouts, and Blackout Intentions among College Women

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Title: Associations among Sexual Assault History, Alcohol Use, Blackouts, and Blackout Intentions among College Women
Language: English
Authors: Gabriela López, Jennifer E. Merrill, Rose Marie Ward
Source: Journal of American College Health. 2025 73(3):906-913.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 8
Publication Date: 2025
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Alcohol Abuse, Sexual Abuse, Rape, Females, Undergraduate Students, Physiology, Health Behavior, Intention, Victims of Crime
DOI: 10.1080/07448481.2023.2299415
ISSN: 0744-8481
1940-3208
Abstract: Background: Links between alcohol-induced blackouts and sexual assault (SA) are understudied. We tested whether: (1) history of blackouts, past 30-day blackouts, and past 30-day blackout intentions would be higher among women with histories of SA relative to women without; (2) baseline history of blackouts, past 30-day blackouts, and blackout intentions would predict an increase in SA severity (i.e., a continuous variable that considers SA tactic type and assault frequency) at a one-year follow-up. Methods: 1721 undergraduate women completed a baseline survey and 313 completed the follow-up. Results: Women with SA history had 2.10 higher odds of history of blackouts, 1.47 higher odds of past 30-day blackout during "one" drinking episode, 1.78 higher odds of blackout during a "few" drinking episodes, 3.21 higher odds of blackout during "most/all" drinking episodes, and 1.54 higher odds of blackout intentions in the last 30-days. Longitudinally, history of blackouts and past 30-day blackouts at baseline were associated with an increase in SA severity at follow-up, when peak drinks were not controlled. Conclusion: Longitudinal findings provide some evidence that lifetime history of blackouts and past 30-day blackouts are significant predictors of an increase in SA severity at follow-up and therefore an essential target for interventions.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1472545
Database: ERIC
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  Value: <anid>AN0183596681;acl01mar.25;2025Mar13.02:40;v2.2.500</anid> <title id="AN0183596681-1">Associations among sexual assault history, alcohol use, blackouts, and blackout intentions among college women </title> <p>Background: Links between alcohol-induced blackouts and sexual assault (SA) are understudied. We tested whether: (<reflink idref="bib1" id="ref1">1</reflink>) history of blackouts, past 30-day blackouts, and past 30-day blackout intentions would be higher among women with histories of SA relative to women without; (<reflink idref="bib2" id="ref2">2</reflink>) baseline history of blackouts, past 30-day blackouts, and blackout intentions would predict an increase in SA severity (i.e., a continuous variable that considers SA tactic type and assault frequency) at a one-year follow-up. Methods: 1721 undergraduate women completed a baseline survey and 313 completed the follow-up. Results: Women with SA history had 2.10 higher odds of history of blackouts, 1.47 higher odds of past 30-day blackout during "one" drinking episode, 1.78 higher odds of blackout during a "few" drinking episodes, 3.21 higher odds of blackout during "most/all" drinking episodes, and 1.54 higher odds of blackout intentions in the last 30-days. Longitudinally, history of blackouts and past 30-day blackouts at baseline were associated with an increase in SA severity at follow-up, when peak drinks were not controlled. Conclusion: Longitudinal findings provide some evidence that lifetime history of blackouts and past 30-day blackouts are significant predictors of an increase in SA severity at follow-up and therefore an essential target for interventions.</p> <p>Keywords: Blackouts; alcohol use; sexual assault; blackout intentions; college women</p> <p>Approximately 12% of college students report sexual assault (SA) during their first semester of college.[<reflink idref="bib1" id="ref3">1</reflink>] Approximately 50 to 70% of sexual assault experiences involve alcohol use.[[<reflink idref="bib2" id="ref4">2</reflink>], [<reflink idref="bib4" id="ref5">4</reflink>]] Perpetrators are <emph>always</emph> responsible for SA and blame should never be placed on women who experience SA. Effective SA perpetration prevention programming is still in development[<reflink idref="bib5" id="ref6">5</reflink>] and meta-analyses show that SA perpetration reduction programs have very small effect sizes.[<reflink idref="bib6" id="ref7">6</reflink>] Providing women with behaviors to protect themselves from SA is crucial. Indeed, most SA experiences are perpetrated by men against women[<reflink idref="bib7" id="ref8">7</reflink>] and college women are at very high risk for SA. About 20% of women experience SA during college.[<reflink idref="bib8" id="ref9">8</reflink>] Alcohol use is a strong and consistent contextual risk factor for impairing risk perception and consequently experiencing negative sexual outcomes (i.e., sexual assault) among women.[<reflink idref="bib9" id="ref10">9</reflink>] Further, a history of SA raises risk for being victimized again.[<reflink idref="bib10" id="ref11">10</reflink>] Specific drinking outcomes that may result from, or increase risk for, victimization should be considered. In the present study, we consider one such outcome – alcohol-induced memory loss, or "blackouts," a loss of memory that occurs during or following alcohol consumption.[<reflink idref="bib11" id="ref12">11</reflink>]</p> <p>Associations between SA and alcohol use operate in both directions. Women with histories of SA (versus without) report greater alcohol use and negative alcohol consequences following the SA experience,[<reflink idref="bib12" id="ref13">12</reflink>] even while controlling for SA severity, experiences of revictimization, and whether alcohol was consumed prior to the SA experience.[<reflink idref="bib12" id="ref14">12</reflink>] In a systematic review, alcohol use was strongly associated with the decision to have sex and engage in other risky behaviors (e.g., multiple or casual partners)[<reflink idref="bib13" id="ref15">13</reflink>] that heighten risk for SA.[<reflink idref="bib14" id="ref16">14</reflink>]</p> <p>Alcohol impacts risk for sexual assault in many ways. Specifically, we know that women's likelihood of experiencing sexual coercion (unwanted sexual experience as a result of being pressured, threatened, or forced in a nonphysical way) increases as a function of event-level intoxication levels[<reflink idref="bib15" id="ref17">15</reflink>] and history of alcohol-related blackouts in particular predict a greater likelihood of being coerced into sexual activity.[<reflink idref="bib16" id="ref18">16</reflink>] Women who report recent blackouts are at increased risk for experiencing unwanted, unsafe, and regretted sexual behavior, relative to men/peers who do not report recent blackouts.[<reflink idref="bib17" id="ref19">17</reflink>] White and colleagues (2002) found that 25% of college women later found out that they had engaged in sexual intercourse during a blackout episode.[<reflink idref="bib18" id="ref20">18</reflink>] One next step is to examine whether blackout <emph>intentions</emph> (a potentially modifiable treatment target) are also associated with SA history.</p> <p>The Theory of Planned Behavior[<reflink idref="bib19" id="ref21">19</reflink>] posits that the single most important predictor of a person's behavior is their intention to perform that specific behavior. Though perhaps counterintuitive, some drinkers express an intention to blackout. For example, Riordan et al. (2019) demonstrated that 22% of posts on Twitter about blackouts were written <emph>prior</emph> to a drinking session and that 51% of that subset of Tweets expressed an intention to blackout.[<reflink idref="bib20" id="ref22">20</reflink>] Blackout intentions not only exist, but they also relate to future blackout experiences.[<reflink idref="bib20" id="ref23">20</reflink>],[<reflink idref="bib21" id="ref24">21</reflink>] Yet, the extent to which blackout intentions and SA history are related is yet unknown.</p> <p>Despite strong associations between blackout intentions and blackouts, and between blackouts and SA, potential associations between blackout intentions and SA history and have yet to be studied. It is plausible that women with a SA history not only report increased likelihood of prior blackouts, but also increased blackout intentions. A speculative reason for this association is that women with a SA history, who may be more motivated to drink more heavily (for a review see:[<reflink idref="bib22" id="ref25">22</reflink>]) may also be more motivated to black out, in order to cope or forget about their SA experience. Understanding blackout intentions in women is important given that intentions may be a target of intervention, especially as women who are visibly highly intoxicated might be targeted by perpetrators.</p> <hd id="AN0183596681-2">The present study</hd> <p>This study aimed to: (<reflink idref="bib1" id="ref26">1</reflink>) compare levels of drinking, lifetime history of blackouts, past 30-days blackouts, and blackout intentions among women with and without histories of SA and (<reflink idref="bib2" id="ref27">2</reflink>) determine whether lifetime history of blackouts, blackouts in the past 30 days, and/or blackout intentions are related to an increase in SA severity scores (i.e., a continuous variable that considers SA tactic type and assault frequency) over time. We hypothesized that peak drinks, blackouts (past 30-days and lifetime), and intentions to blackout in the last 30 days would be higher among women with histories of SA relative to women without. Additionally, we hypothesized that reporting lifetime history of blackouts, blackouts in the last 30 days, and blackout intentions in the last 30 days would be associated with an increase in SA severity at one-year follow-up. We expected that study findings would replicate prior findings related to blackouts history and sexual assault, and extend the literature by specifically examining blackout intentions.</p> <hd id="AN0183596681-3">Methods</hd> <p></p> <hd id="AN0183596681-4">Participants and procedure</hd> <p>Participants were part of a larger study examining campus climate at a public university in the Midwestern part of the United States. In 2017, participants were recruited <emph>via</emph> a campus-wide email invitation <emph>via</emph> Qualtrics. Full time students (<emph>n =</emph> 15,429) were invited, and a total of 4,212 participated (27.29% response rate), of which 2,601 were women. However, 879 women were excluded because they were nondrinkers at baseline, and one person was excluded due to implausible reporting (40 drinks on one occasion), leaving a <emph>baseline study sample</emph> of 1,721 to address Aim 1. After survey completion, participants received an electronic $3 gift card for a local coffee shop. See Table 1 for participant demographics.</p> <p>Table 1. Participant demographics.</p> <p> <ephtml> <table><thead><tr><td>Demographic</td><td /><td>Baseline (Percent)</td><td>Follow-up (Percent)</td></tr></thead><tbody valign="top"><tr><td><italic>Age</italic></td><td /><td><italic>M</italic> = 19.90 <italic>SD</italic> = 1.28</td><td><italic>M</italic> = 20.54 <italic>SD</italic> = 1.00</td></tr><tr><td><italic>Year in School</italic></td><td /><td /><td /></tr><tr><td /><td>First Year</td><td char=".">29.1%</td><td char=".">0.3%</td></tr><tr><td /><td>Second Year</td><td char=".">25.5%</td><td char=".">31.3%</td></tr><tr><td /><td>Third Year</td><td char=".">24.1%</td><td char=".">33.9%</td></tr><tr><td /><td>Fourth Year</td><td char=".">19.6%</td><td char=".">33.2%</td></tr><tr><td /><td>Fifth Year</td><td char=".">1.0%</td><td char=".">1.3%</td></tr><tr><td><italic>Sexual Orientation</italic></td><td /><td /><td /></tr><tr><td /><td>Heterosexual</td><td char=".">91.8%</td><td char=".">87.2%</td></tr><tr><td /><td>Bisexual</td><td char=".">4.2%</td><td char=".">8.0%</td></tr><tr><td><italic>Race/Ethnicity</italic></td><td /><td /><td /></tr><tr><td /><td>Asian</td><td char=".">5.9%</td><td char=".">7.0%</td></tr><tr><td /><td>Black</td><td char=".">3.1%</td><td char=".">3.5%</td></tr><tr><td /><td>Hawaiian/ Pacific Islander</td><td char=".">0.3%</td><td char=".">0.0%</td></tr><tr><td /><td>Hispanic/Latina</td><td char=".">4.6%</td><td char=".">3.8%</td></tr><tr><td /><td>Native American/ Alaska Native</td><td char=".">1.0%</td><td char=".">0.6%</td></tr><tr><td /><td>Other</td><td char=".">1.7%</td><td char=".">1.6%</td></tr><tr><td /><td>White</td><td char=".">90.9%</td><td char=".">92.0%</td></tr><tr><td><italic>Sexual Assault</italic></td><td /><td /><td /></tr><tr><td /><td>Yes</td><td char=".">37.1%</td><td char=".">49.8%</td></tr><tr><td><italic>Sexual Assault Severity</italic></td><td /><td /><td /></tr><tr><td /><td>Rape</td><td char=".">16.1%</td><td char=".">25.6%</td></tr><tr><td /><td>Attempted rape</td><td char=".">6.4%</td><td char=".">6.1%</td></tr><tr><td /><td>Coercion</td><td char=".">2.0%</td><td char=".">1.9%</td></tr><tr><td /><td>Attempted sexual coercion</td><td char=".">2.3%</td><td char=".">2.9%</td></tr><tr><td /><td>Unwanted sexual contact</td><td char=".">10.3%</td><td char=".">13.4%</td></tr></tbody></table> </ephtml> </p> <p>1 <emph>Note.</emph> Total <emph>n</emph> = 1,721 at baseline. Total <emph>n</emph> = 313 at follow-up.</p> <p>In 2018, similar procedures were used to conduct a campus-wide survey; 15,536 full-time students were invited and 3,917 participated (25.21% response rate). Of note, only current students were invited to participate in this campus-wide survey; those who had completed the survey in 2017 but had since graduated were not recruited for this survey. The goal of each annual survey was to recruit as many students as possible, rather than focusing specifically on retaining those who had participated in the prior year. While the study was not designed to be longitudinal, IRB approval was obtained to connect participant identifiers across timepoints. A total of 365 women completed both the 2017 and 2018 survey and reported drinking at both time points. An additional 52 were excluded due to missing data on SA at follow up, leaving a final longitudinal sample of 313.</p> <p>Women who completed the follow-up survey were younger (M<subs>age</subs> = 19.51) relative to women who did not (M<subs>age</subs> = 19.99), <emph>F</emph>(<reflink idref="bib1" id="ref28">1</reflink>, 1712) = 39.49, <emph>p</emph> <.001, which was expected based on the study design. Women who completed the follow-up survey did not differ from women who did not based on race/ethnicity, peak drinking, lifetime history of blackouts, past 30-day blackouts, or blackout intentions.</p> <hd id="AN0183596681-5">Measures</hd> <p></p> <hd id="AN0183596681-6">Gender identity</hd> <p>Participants were asked "What is your gender identity?" and could choose from seven options: woman, man, transwoman, transman, genderqueer/gender non-conforming, a gender not listed here, prefer not to answer. Only people that selected "woman" were retained.</p> <hd id="AN0183596681-7">Alcohol use</hd> <p>The definition of a standard drink (12 oz beer, 8-9 oz malt liquor, 5 oz wine, 1.5 oz 80-proof spirits)[<reflink idref="bib23" id="ref29">23</reflink>] was provided. Single items with continuous response options were used to assess peak drinks on any one occasion in the last 30 days and drinks per typical drinking day.</p> <hd id="AN0183596681-8">Lifetime blackouts</hd> <p>One item with yes/no responses assessed history of blackouts, "Have you ever had a blackout (i.e., due to your alcohol consumption, the inability to recall all or parts of your actions)." This variable was coded dichotomously (0 = no; 1 = yes).</p> <hd id="AN0183596681-9">Past 30-day blackout frequency</hd> <p>Participants were asked "In the last 30 days, have you had a blackout as a result of your alcohol consumption." Multiple choice response options included: no blackouts; yes, during one drinking episode; yes, during a few drinking episodes; yes, during most of my drinking episodes; and yes, during all of my drinking episodes." Due to very small sample sizes in the "most" and "all" response options, "most" (<emph>n</emph> = 19) and "all" (<emph>n</emph> = 4) were collapsed.</p> <hd id="AN0183596681-10">Blackout intentions</hd> <p>One item asked, "In the last 30 days, on how many occasions have you drank alcohol with the goal of "blacking out'"? Response options included none, few occasions, most occasions, and all occasions. Due to very small sample sizes in the "most" and "all" response options, "most" (<emph>n</emph> = 9) and "all" (<emph>n</emph> = 3) were collapsed.</p> <hd id="AN0183596681-11">Sexual assault history</hd> <p>The sexual experiences survey (SES-R;[<reflink idref="bib24" id="ref30">24</reflink>] assessed SA history since starting college. Twenty-five items measure different types of SA ranging in severity including unwanted sexual contact, sexual coercion, attempted rape, and rape. Internal consistency was.89 at baseline and.87 at follow-up. For cross-sectional, group difference analyses, and for longitudinal analyses predicting any new victimization among those without a history of SA at baseline, this variable was coded dichotomously (0 = no SA; 1 = yes SA). Thus, participants had to say no to all items on this measure to be considered to have no sexual assault. The measure was also scored using Davis, Gilmore, Stappenbeck, Balsan, George, Norris[<reflink idref="bib25" id="ref31">25</reflink>] guidelines that incorporate characteristics of assault such as tactic type or assault frequency to compute a continuous score, with higher scores indicating a higher severity of SA. Because we were interested in the impact of blackouts on <emph>change</emph> in SA history, we then calculated a change score (follow-up severity minus baseline severity) to be used as the outcome variable in longitudinal models.</p> <hd id="AN0183596681-12">Preliminary data analyses</hd> <p>Data distributions, normality, and outliers were assessed. The peak drinks variable was not normally distributed; A total of 19 responses were recoded (to 16 drinks) due to being 3 standard deviations above the mean.[<reflink idref="bib1" id="ref32">1</reflink>]1 There were no other variable outliers and outcome distributions were normal.</p> <hd id="AN0183596681-13">Data analytic plan</hd> <p>To address Aim 1 (cross-sectional associations), ANCOVA was used to examine associations between SA history and peak drinks in the last 30 days. Age was covaried given known age differences in SA history[<reflink idref="bib26" id="ref33">26</reflink>] and drinking.[<reflink idref="bib27" id="ref34">27</reflink>] Multinomial and logistic regressions were used to analyze the associations between SA history and (<reflink idref="bib1" id="ref35">1</reflink>) lifetime blackouts, (<reflink idref="bib2" id="ref36">2</reflink>) past 30-day blackout frequency, and (<reflink idref="bib3" id="ref37">3</reflink>) blackout intentions, all while controlling for peak drinks and age. To address Aim 2 (longitudinal associations), three sets of multiple regression models were used to predict SA severity score at follow-up from baseline (<reflink idref="bib1" id="ref38">1</reflink>) lifetime history of blackouts, (<reflink idref="bib2" id="ref39">2</reflink>) past 30-day blackouts, and (<reflink idref="bib3" id="ref40">3</reflink>) blackout intentions. Models controlled for age. For each outcome, we ran one model without and one model with a control for peak drinks.</p> <hd id="AN0183596681-14">Results</hd> <p></p> <hd id="AN0183596681-15">Baseline study sample descriptives</hd> <p>In the current sample, 58.7% reported a lifetime history of blackouts, 31.8% reported a blackout in the last 30 days, and 9.2% reported that they had intentions to blackout in the last 30 days (see Table 2). The subsample of women who reported blackout intentions also reported more blackouts in the past 30 days, higher mean peak drinks, and higher number of drinks on a typical drinking day relative to women who did not endorse blackout intentions.</p> <p>Table 2. Baseline descriptives for sexual assault history, blackouts, blackouts intentions, and alcohol use.</p> <p> <ephtml> <table><thead><tr><td>Sexual Assault History</td><td>Blackout History</td><td>Past 30-day Blackout</td><td>Blackout Intentions in the last 30 days</td><td># Typical Drinks</td><td># Peak Drinks</td></tr><tr><td><italic>Yes</italic></td><td><italic>No</italic></td><td><italic>Yes</italic></td><td><italic>No</italic></td><td><italic>Yes</italic></td><td><italic>No</italic></td><td>M</td><td>SD</td><td>M</td><td>SD</td></tr></thead><tbody valign="top"><tr><td>Yes</td><td char=".">466</td><td char=".">172</td><td char=".">268</td><td char=".">370</td><td char=".">73</td><td char=".">565</td><td char=".">3.80</td><td char=".">1.89</td><td char=".">6.38</td><td char=".">3.34</td></tr><tr><td>No</td><td char=".">501</td><td char=".">506</td><td char=".">256</td><td char=".">751</td><td char=".">77</td><td char=".">930</td><td char=".">3.28</td><td char=".">2.05</td><td char=".">5.03</td><td char=".">3.01</td></tr><tr><td><italic>All Women</italic></td><td char=".">1009</td><td char=".">712</td><td char=".">546</td><td char=".">1175</td><td char=".">158</td><td char=".">1563</td><td char=".">3.48</td><td char=".">2.01</td><td char=".">5.56</td><td char=".">3.22</td></tr></tbody></table> </ephtml> </p> <p>2 <emph>Note.</emph> Blackout in the last 30 days and blackout intentions in the last 30 days were dichotomized into yes/no categories. Drink quantities are in standard drinks.</p> <hd id="AN0183596681-16">Aim 1: Cross-sectional analyses</hd> <p>There was a main effect of SA history on peak drinks, <emph>F</emph>(<reflink idref="bib1" id="ref41">1</reflink>, 1636) = 70.67, <emph>p</emph> <.001, partial η<sups>2</sups> =.041. Women with no history of SA drank fewer peak drinks (<emph>M</emph> = 5.03, <emph>SD</emph> = 3.01) in the last 30 days compared to women with a history of SA (<emph>M</emph> = 6.38, <emph>SD</emph> = 3.34) (See Table 2).</p> <p>Controlling for peak drinks and age, SA history was significantly associated with blackout history, <emph>X</emph><sups>2</sups> (<reflink idref="bib1" id="ref42">1</reflink>) = 38.70, <emph>p</emph> <.001. Participants with a history of SA had 2.10 higher odds of reporting a history of blackouts, <emph>b</emph> = 0.74, SE =.12, <emph>p</emph> <.001 relative to participants without SA.</p> <p>Controlling for peak drinks and age, SA was significantly associated with past 30-day blackout frequency, <emph>X</emph><sups>2</sups> (<reflink idref="bib3" id="ref43">3</reflink>) = 18.49, <emph>p</emph> <.001. Specifically, when "no blackouts" in the past 30 days was the reference category, women with a history of SA (relative to women without) had 1.47 higher odds of a blackout during "one" drinking episode, <emph>b</emph> = 0.39, SE =.14, <emph>p</emph> =.005, 1.78 higher odds of having a blackout during a "few" drinking episodes, <emph>b</emph> = 0.56, SE =.18, <emph>p</emph> <.001, and 3.21 higher odds of having a blackout during "most/all" drinking episodes, <emph>b</emph> = 1.17, SE =.47, <emph>p</emph> =.012.</p> <p>Controlling for age, history of SA was significantly associated with blackout intentions, <emph>X</emph><sups>2</sups> (<reflink idref="bib2" id="ref44">2</reflink>) = 7.24, <emph>p</emph> =.027. When "no" blackout intentions was the reference category, women with a history of SA had 1.52 higher odds of reporting blackout intentions during a "few occasions" relative to women without a history of SA, <emph>b</emph> = 0.42, SE =.18, <emph>p</emph> =.019. When "no" blackout intentions was the reference category, women with a history of SA did not significantly differ on likelihood of reporting blackout intentions on "most/all occasions" relative to women without SA histories, <emph>b</emph> = 0.90, SE =.65, <emph>p</emph> =.168. We ran a parallel model to determine whether an association between SA history and blackout intentions was evident when peak drinks was covaried. When peak drinks was covaried, history of SA was not significantly associated with blackout intentions, <emph>X</emph><sups>2</sups> (<reflink idref="bib2" id="ref45">2</reflink>) = 0.88, <emph>p</emph> =.645. Only the covariate, peak drinks, was significant, <emph>X</emph><sups>2</sups> (<reflink idref="bib2" id="ref46">2</reflink>) = 86.40, <emph>p</emph> <.001. We also replicated all Aim 1 study analyses in the smaller longitudinal sample (<emph>n</emph> = 313). Please see our supplementary materials for a full report and summary.</p> <hd id="AN0183596681-17">Aim 2: Longitudinal analyses</hd> <p>Within the longitudinal sample (<emph>n</emph> = 313), 32.9% of women reported a SA experience at baseline. As shown in Table 3, blackout intentions were not associated with an increase in SA severity, regardless of whether peak drinks was controlled. Whereas lifetime history of blackouts and past 30-day blackouts at baseline did not significantly predict an increase in SA severity when peak drinks were controlled, they were significant predictors when peak drinks were not controlled. A higher frequency of past 30-day blackouts and lifetime history of blackouts each were associated with an increase in SA severity (i.e., higher SA change score) at follow-up.</p> <p>Table 3. Multiple Linear regression for increase in sexual assault severity at follow-up.</p> <p> <ephtml> <table><thead><tr><td /><td>Without peak drinks</td><td>With peak drinks</td></tr><tr><td /><td>β</td><td><italic>S.E.</italic></td><td><italic>p</italic></td><td>β</td><td><italic>S.E.</italic></td><td><italic>p</italic></td></tr></thead><tbody valign="top"><tr><td><italic>Lifetime blackouts</italic></td><td char=".">−0.13</td><td char=".">0.96</td><td char=".">.028</td><td char=".">−0.05</td><td char=".">1.06</td><td char=".">.465</td></tr><tr><td>Age</td><td char=".">0.02</td><td char=".">0.48</td><td char=".">.710</td><td char=".">0.03</td><td char=".">0.48</td><td char=".">.650</td></tr><tr><td>Peak drinks</td><td>---</td><td>---</td><td>---</td><td char=".">0.18</td><td char=".">0.16</td><td char=".">.004</td></tr><tr><td><italic>Past 30-day blackouts</italic></td><td char=".">0.12</td><td char=".">0.68</td><td char=".">.029</td><td char=".">0.03</td><td char=".">0.76</td><td char=".">.534</td></tr><tr><td>Age</td><td char=".">0.02</td><td char=".">0.48</td><td char=".">.687</td><td char=".">0.03</td><td char=".">0.48</td><td char=".">.645</td></tr><tr><td>Peak drinks</td><td>---</td><td /><td>---</td><td char=".">0.18</td><td char=".">0.17</td><td char=".">.004</td></tr><tr><td><italic>Blackout intentions</italic></td><td char=".">0.02</td><td char=".">1.57</td><td char=".">.715</td><td char=".">−0.03</td><td char=".">1.59</td><td char=".">.604</td></tr><tr><td>Age</td><td char=".">0.02</td><td char=".">.49</td><td char=".">.787</td><td char=".">0.03</td><td char=".">0.48</td><td char=".">.640</td></tr><tr><td>Peak drinks</td><td>---</td><td>---</td><td>---</td><td char=".">0.21</td><td char=".">0.15</td><td char=".">.001</td></tr></tbody></table> </ephtml> </p> <p>3 <emph>Note.</emph> Peak drinks = highest number of standard drinks consumed in the past 30 days. VIF = variance inflation factor. VIF's ranged from 1.00 – 1.28 indicating no concerns for multicollinearity.</p> <p>Women with no SA at baseline (<emph>n</emph> = 210) were used to run subsequent regression models predicting new victimization (0 = no new SA; 1 = yes new SA) at follow-up. Of the 210 participants, 53 women (25.2%) reported SA at follow-up. Three sets of linear regression models were used to predict new SA at follow-up among women with no prior SA at baseline from (<reflink idref="bib1" id="ref47">1</reflink>) lifetime history of blackouts, (<reflink idref="bib2" id="ref48">2</reflink>) past 30-day blackouts and (<reflink idref="bib3" id="ref49">3</reflink>) blackout intentions (all variables at baseline). All models included controls for age at baseline. For each outcome, we ran one model without and one with a control for peak drinks. As shown in Table 4, regardless of whether or not peak drinks were controlled, lifetime history of blackouts did not predict new SA at follow-up. However, past 30-day blackouts were significantly associated with new SA among women who reported no prior SA at baseline whether or not peak drinks were controlled. Whereas blackout intentions at baseline did not significantly predict an increase in SA severity when peak drinks were controlled, they were significant predictors when peak drinks were not controlled.</p> <p>Table 4. Multiple Linear regression for sexual assault at follow-up: Only women with no prior SA at baseline.</p> <p> <ephtml> <table><thead><tr><td /><td>Without peak drinks</td><td>With peak drinks</td></tr><tr><td /><td>β</td><td><italic>S.E.</italic></td><td><italic>p</italic></td><td>β</td><td><italic>S.E.</italic></td><td><italic>p</italic></td></tr></thead><tbody valign="top"><tr><td><italic>Lifetime blackouts</italic></td><td char=".">−0.08</td><td char=".">0.90</td><td char=".">.259</td><td char=".">0.01</td><td char=".">0.97</td><td char=".">.927</td></tr><tr><td>Age</td><td char=".">−0.04</td><td char=".">0.45</td><td char=".">.582</td><td char=".">−0.02</td><td char=".">0.45</td><td char=".">.781</td></tr><tr><td>Peak drinks</td><td>---</td><td>---</td><td>---</td><td char=".">0.21</td><td char=".">0.14</td><td char=".">.005</td></tr><tr><td><italic>Past 30-day blackouts</italic></td><td char=".">0.23</td><td char=".">0.64</td><td char=".">.001</td><td char=".">0.17</td><td char=".">0.71</td><td char=".">.028</td></tr><tr><td>Age</td><td char=".">−0.04</td><td char=".">0.44</td><td char=".">.606</td><td char=".">−0.03</td><td char=".">0.44</td><td char=".">.742</td></tr><tr><td>Peak drinks</td><td>---</td><td>---</td><td>---</td><td char=".">0.13</td><td char=".">0.14</td><td char=".">.082</td></tr><tr><td><italic>Blackout intentions</italic></td><td char=".">0.14</td><td char=".">1.47</td><td char=".">.044</td><td char=".">0.09</td><td char=".">1.53</td><td char=".">.258</td></tr><tr><td>Age</td><td char=".">−0.06</td><td char=".">0.45</td><td char=".">.423</td><td char=".">−0.03</td><td char=".">0.45</td><td char=".">.667</td></tr><tr><td>Peak drinks</td><td>---</td><td>---</td><td>---</td><td char=".">0.18</td><td char=".">0.14</td><td char=".">.012</td></tr></tbody></table> </ephtml> </p> <ulist> <item>4 <emph>Note.</emph> Models included 210 women with no sexual assault at baseline. VIF = variance inflation factor.</item> <item>5 VIF's ranged from 1.01 to 1.28 indicating no concerns for multicollinearity.</item> </ulist> <hd id="AN0183596681-18">Discussion</hd> <p>We compared lifetime history of blackouts, past-30-day blackouts, blackout intentions, and peak number of drinks in a college sample of women with and without histories of SA and found that women with SA histories had higher odds of blackout drinking relative to women without histories of SA. We also examined whether lifetime history of blackouts, past 30-day blackouts, and/or blackouts intentions would predict SA at a one-year follow-up. Longitudinal findings provide some evidence that lifetime history of blackouts and past 30-day blackouts are significant predictors of an increase in SA severity at follow-up and therefore an essential target for interventions (e.g., by aiming to reduce blackout frequency, perhaps women can be empowered to minimize their risk for sexual revictimization).</p> <p>There were statistically significant differences among women's lifetime blackouts history and past 30-day blackouts based on women's SA histories. At baseline, women with SA histories were more than twice as likely to report a lifetime history of blackouts relative to women without SA histories. Similarly, women with SA histories had higher odds of reporting blackouts in the past 30 days relative to women without SA histories. Specifically, women with SA histories were 50% more likely to report "one" blackout, almost twice as likely to have a "few" blackouts, and over three time as likely to black out during "most/all" drinking episodes, relative to women without history of SA.</p> <p>Findings related to SA group differences in blackout intentions were more complex. Blackout intentions were only significant when peak drinks were not controlled. This suggests that peak drinks are a more powerful distinguishing factor than blackout intentions when comparing those with versus without SA history. Notably, blackout intentions were not endorsed by the majority of this sample; only 9% endorsed any blackout intentions despite 32% of the sample reporting that they had blacked out at least once during the past 30 days. This suggests that many college women blackout without intending to, consistent with other literature.[<reflink idref="bib28" id="ref50">28</reflink>] There may be several reasons why blackout intentions were not consistently associated with study outcomes. First, it is possible that social desirability could lead to bias in the frequency at which blackouts intentions were endorsed, reducing the validity of this measure. It could also be a shortfall of retrospective data collection whereby women are endorsing that they intended to black out when they really did not or vice versa. Alternatively, it is possible that during times when women drank with the goal of "blacking out" other influential variables such as their environment and sense of safety prevented them from actually blacking out. In prior qualitative work, participants reported that they will not blackout unless they feel safe in their environment and with the people around them.[<reflink idref="bib28" id="ref51">28</reflink>] It is also possible that when women indicated that they intended to blackout what they really meant is that they intended to drink heavily.[<reflink idref="bib29" id="ref52">29</reflink>] Prior work has drawn a distinction between <emph>intentions</emph> to black out and <emph>willingness</emph> to black out.[<reflink idref="bib28" id="ref53">28</reflink>] Despite blackouts being unintentional, heavy drinking students do report a <emph>willingness</emph> to black out when drinking.[<reflink idref="bib28" id="ref54">28</reflink>] It is also possible that college students perceive blackouts to be normal and part of the college drinking experience and are not necessarily intending to blackout or not blackout. An avenue for future research is to compare blackout willingness between women with and without SA histories. Such findings would provide clarity regarding whether or not to address willingness to blackout in interventions focused on decreasing alcohol use and SA.</p> <p>It is well established in the literature that women with SA histories drink more compared to women without.[<reflink idref="bib12" id="ref55">12</reflink>] It is possible that SA history increases odds of drinking to cope (consistent with prior work[<reflink idref="bib30" id="ref56">30</reflink>]) and that people who drink to cope are more likely to blackout.[<reflink idref="bib31" id="ref57">31</reflink>] Indeed, women with a recent SA experience (first semester of college) report higher coping motives relative to women who do not have a recent SA, even after controlling for lifetime history of SA.[<reflink idref="bib32" id="ref58">32</reflink>] It would be helpful to disentangle this association to understand whether new sexual revictimization experiences may occur in the context of a blackout event. Additionally, it would be helpful to examine associations among coping motives, sexual revictimization, and experiencing a blackout.</p> <p>The longitudinal examination of lifetime history of blackouts, past 30-day blackouts, and blackout intentions at baseline and whether they predict an increase in SA severity at the one year follow up is a major contribution of this study. Blackout intentions at baseline were not significantly associated with an increase in SA severity at follow-up. Both lifetime history of blackouts and past 30-day blackouts at baseline were significant predictors of an increase in SA severity at follow-up, but only when peak drinks was not controlled. Peak drinks in the past 30-days is such a strong predictor of SA that only when we fail to consider it does blackout behavior appear to play a role in follow-up SA. Having a lifetime and past 30-day history of blackouts was associated with SA at follow-up. Importantly though, women who have blacked out might also fail to recall any experiences of SA, obscuring a relationship between blackouts and SA that may actually exist. This is a common limitation of blackout-related research.[<reflink idref="bib11" id="ref59">11</reflink>]</p> <p>Among women with no prior SA history only past 30-day blackouts (regardless of whether peak drinks were controlled) and blackout intentions (only when peak drinks were not controlled) were associated with new SA at follow-up. Women's past 30-day blackouts might be used as an additional screening tool to identify which women are at increased risk for follow-up SA regardless of previous SA experience. Colleges can screen first-year students upon arrival and assign alcohol-related interventions to reduce their risk of heavy alcohol use and SA based on their past 30-day blackouts. Ideally this screening tool would utilize a multi-pronged approach and would screen for any drinking, heavy drinking, and history of blackouts. Whereas most current interventions do screen for any drinking and heavy drinking, additional screening for blackouts could add a third level of drinking severity that would allow the intervention to be tailored to people who are experiencing blackouts and provide harm-reduction strategies to reduce the likelihood of future blackouts. Targeting blackouts in specific is important as experiencing a blackout is associated with consequences above and beyond drinking levels,[<reflink idref="bib15" id="ref60">15</reflink>],[<reflink idref="bib16" id="ref61">16</reflink>],[[<reflink idref="bib33" id="ref62">33</reflink>], [<reflink idref="bib35" id="ref63">35</reflink>], [<reflink idref="bib37" id="ref64">37</reflink>]] and may be associated with specific patterns of drinking (e.g., faster paced drinking[<reflink idref="bib38" id="ref65">38</reflink>]) It would be ideal for campuses to repeatedly rescreen women for their current past 30-day blackouts and heavy alcohol use every semester. However, these intervention implications are very preliminary as additional factors including posttraumatic stress disorder, coping, self-blame[<reflink idref="bib39" id="ref66">39</reflink>] and child sexual abuse[<reflink idref="bib40" id="ref67">40</reflink>] may play a role in SA and alcohol use. Future work is needed to also examine how these factors may be integrated into treatment.</p> <hd id="AN0183596681-19">Limitations</hd> <p>This study is not without limitations. First, the sample was very homogeneous (primarily White and heterosexual) and as such this limits the generalizability of the findings. Second, there was low prevalence rates for blackout intentions (<emph>n</emph> = 147 for blackout intentions for a "few" drinking episodes and <emph>n</emph> = 12 for most/all) which may have impacted power to detect small effects. It is possible that social desirability led participants to underreport their blackouts intentions. The findings should be tested in a larger sample with a more even distribution of blackout intentions. Third, an increase in SA severity was assessed by asking about SA since the start of college, instead of assessing only for past-year SA. While we were able to see if participants had any changes in the severity of SA experiences, the measure did not allow us to know whether an additional SA experience occurred or if it was the same experience reported at baseline, but in way that resulted in a higher score on the measure. Fourth, blackout intentions were assessed retrospectively, and retrospective data collection can often lead to inaccurate reporting by participants. Future research should assess whether intentions for future blackouts predict SA. Fifth, it is possible that SA could have occurred while being blacked out and women might not remember the next day. This is a common limitation of blackout-related research. Lastly, we potentially missed women who did not drink at baseline but reported SA at follow-up. This sample of women could have experienced new SA at follow-up due to their history of prior SA, but were not included in our sample given no available drinking data at baseline.</p> <hd id="AN0183596681-20">Future directions</hd> <p>Blackout history, blackouts in the last 30 days, and blackout intentions were significant correlates of SA among college students; thus, it might be important to reduce them. One option could target peer norms to help decrease college students' likelihood or openness to blackout. In a similar study, students with a higher likelihood of having a past 30-day history of alcohol induced blackouts and higher blackout intentions believed that many of their peers group approved of certain alcohol-related behaviors and that their peers drink frequently and drink higher quantities.[<reflink idref="bib41" id="ref68">41</reflink>] An extension to the current research could include examining women's <emph>willingness</emph> to blackout instead of their <emph>intentions</emph> to blackout, particularly among women with and without SA histories. Moreover, another fruitful direction of this work could be to examine whether non-drinking women that report a new SA experience at follow-up would then also report new-onset drinking at follow-up. Notably, regardless of what we learn about links between women's SA and alcohol use, ultimately, we require better interventions aimed at decreasing perpetrator's likelihood to perpetrate SA.</p> <hd id="AN0183596681-21">Conclusion</hd> <p>Relative to college women without histories of SA during college, women with histories of SA during college consumed more alcohol on their heaviest drinking occasion and were more likely to endorse lifetime history of blackouts, past 30-day blackouts, and blackout intentions. Additionally, past lifetime history of blackouts and past 30-day blackouts at baseline predicted sexual assault at follow-up for women who were current drinkers at baseline but only when peak drinks were not controlled. Among women with no history of SA at baseline, past 30-day blackouts were significantly associated with follow-up sexual assault (only when peak drinks were not controlled). More work is needed to replicate these findings. Continuing to identify risk factors for increased alcohol use and sexual revictimization is fundamental to the development of helpful interventions.</p> <hd id="AN0183596681-22">Acknowledgments</hd> <p>The first author would like to express gratitude to Dr. Chance R. Strenth who contributed to the development of this manuscript.</p> <hd id="AN0183596681-23">Conflict of interest disclosure</hd> <p>The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States and received approval from the IRB of the university at which this research was conducted.</p> <hd id="AN0183596681-24">Funding</hd> <p>No funding was used to support this research and/or the preparation of the manuscript.</p> <ref id="AN0183596681-25"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Analyses were also conducted while retaining the 19 responses with their original value and retaining them did not alter the findings.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref2" type="bt">2</bibl> <bibtext> Supplemental data for this article can be accessed online at https://doi.org/10.1080/07448481.2023.2299415.</bibtext> </blist> </ref> <ref id="AN0183596681-26"> <title> References </title> <blist> <bibtext> Carey KB, Norris AL, Durney SE, Shepardson RL, Carey MP. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Associations among Sexual Assault History, Alcohol Use, Blackouts, and Blackout Intentions among College Women
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Gabriela+López%22">Gabriela López</searchLink><br /><searchLink fieldCode="AR" term="%22Jennifer+E%2E+Merrill%22">Jennifer E. Merrill</searchLink><br /><searchLink fieldCode="AR" term="%22Rose+Marie+Ward%22">Rose Marie Ward</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2025 73(3):906-913.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 8
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Alcohol+Abuse%22">Alcohol Abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Sexual+Abuse%22">Sexual Abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Rape%22">Rape</searchLink><br /><searchLink fieldCode="DE" term="%22Females%22">Females</searchLink><br /><searchLink fieldCode="DE" term="%22Undergraduate+Students%22">Undergraduate Students</searchLink><br /><searchLink fieldCode="DE" term="%22Physiology%22">Physiology</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Behavior%22">Health Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Intention%22">Intention</searchLink><br /><searchLink fieldCode="DE" term="%22Victims+of+Crime%22">Victims of Crime</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/07448481.2023.2299415
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0744-8481<br />1940-3208
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Links between alcohol-induced blackouts and sexual assault (SA) are understudied. We tested whether: (1) history of blackouts, past 30-day blackouts, and past 30-day blackout intentions would be higher among women with histories of SA relative to women without; (2) baseline history of blackouts, past 30-day blackouts, and blackout intentions would predict an increase in SA severity (i.e., a continuous variable that considers SA tactic type and assault frequency) at a one-year follow-up. Methods: 1721 undergraduate women completed a baseline survey and 313 completed the follow-up. Results: Women with SA history had 2.10 higher odds of history of blackouts, 1.47 higher odds of past 30-day blackout during "one" drinking episode, 1.78 higher odds of blackout during a "few" drinking episodes, 3.21 higher odds of blackout during "most/all" drinking episodes, and 1.54 higher odds of blackout intentions in the last 30-days. Longitudinally, history of blackouts and past 30-day blackouts at baseline were associated with an increase in SA severity at follow-up, when peak drinks were not controlled. Conclusion: Longitudinal findings provide some evidence that lifetime history of blackouts and past 30-day blackouts are significant predictors of an increase in SA severity at follow-up and therefore an essential target for interventions.
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  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1472545
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1472545
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1080/07448481.2023.2299415
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 8
        StartPage: 906
    Subjects:
      – SubjectFull: Alcohol Abuse
        Type: general
      – SubjectFull: Sexual Abuse
        Type: general
      – SubjectFull: Rape
        Type: general
      – SubjectFull: Females
        Type: general
      – SubjectFull: Undergraduate Students
        Type: general
      – SubjectFull: Physiology
        Type: general
      – SubjectFull: Health Behavior
        Type: general
      – SubjectFull: Intention
        Type: general
      – SubjectFull: Victims of Crime
        Type: general
    Titles:
      – TitleFull: Associations among Sexual Assault History, Alcohol Use, Blackouts, and Blackout Intentions among College Women
        Type: main
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            NameFull: Gabriela López
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            NameFull: Jennifer E. Merrill
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            NameFull: Rose Marie Ward
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            – D: 01
              M: 01
              Type: published
              Y: 2025
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              Value: 0744-8481
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              Value: 1940-3208
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              Value: 73
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            – TitleFull: Journal of American College Health
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