Key FINDINGS

From “Sexual Violence Victimization and 
Associations with Health in a Community 
Sample of African American Women”



© National Sexual Violence Resource Center 2016. All rights reserved.

This document was supported by Cooperative Agreement #5UF2CE002359-03 from the Centers for Disease Control and 
Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official 
views of the CDC.

The content of this publication may be reprinted with the following acknowledgement: This material was reprinted, with 
permission, from the National Sexual Violence Resource Center’s publication entitled Key findings from “Sexual Violence 
Victimization and Associations with Health in a Community Sample of African American Women.” This guide is available by 
visiting www.nsvrc.org. 



Key FINDINGS

From “Sexual Violence Victimization and 
Associations with Health in a Community 
Sample of African American Women”

Victims of sexual violence can experience a range of negative health outcomes over 
the course of their lives. A substantive body of research finds that individuals can 
experience physical, mental, and behavioral health impacts well beyond the duration 
of the event(s). Less is known, however, about particular consequences and life contexts of 
Black/African American1 women who have been victimized.

Basile, Smith, Fowler, Walters, and Hamburger 
(2016) offer a window into the lived experiences 
of African American women in Sexual violence 
victimization and associations with health in a 
community sample of African American women. 
This study is part of a larger effort to better 
understand the context surrounding the findings 
that women of color experience sexual violence 
at a much higher rate than White women 
(Breiding et al., 2014; Tjaden & Thoennes, 
2006). This research translation summarizes 
the article’s key findings to help support sexual 
violence prevention and response strategies 
with Black and African American communities.

BACKGROUND

While there is substantial literature focused 
on the health-related consequences of sexual 
violence, existing research is often limited 
to findings that are generalized to all sexual 
violence victims. Sexual assault is associated 
with increased risk for behaviors or coping 
mechanisms such as excessive drinking, 
illicit drug use, and sexual practices that 
can cause negative health/mental health 
outcomes; however, many studies did not 
examine differences by race or ethnic groups 
(Wadsworth & Records, 2013).

Research translation by NSVRC


1The terms Black and African American will be used interchangeably. Sexual violence in the lives of Caribbean and African immigrant 
women is beyond the scope of this paper.





In those studies that did focus on African 
American women, there were indications that 
mental and behavioral health problems may 
be especially impactful for African American 
women survivors, particularly for those that 
experience the additional and overlapping 
burdens of poverty and housing insecurity 
that frequently co-exist. For example, women 
earning low or no incomes often experience 
homelessness or live in housing where they 
may be at risk for multiple forms of violence.

There are additional research studies that find 
high correlations between low incomes, poverty, 
sexual violence, and/or adverse mental health 
outcomes (Bryant-Davis, Ullman, Tsong, Tillman, 
S., & Smith, 2010; Loya, 2014).

Methods

Researchers generated a random sample to 
identify addresses of potential participants from 
urban neighborhoods in a southeastern city 
predominantly comprised of African American 
residents. Interviewers then visited those 
households to recruit participants. Participants 
were told the study was about “women’s 
health and well-being.” Informed consent was 
obtained from interested participants in a safe, 
comfortable, and private location. During the 
informed consent process, participants were 
then given the specific information that the 
study was about sexual violence. A community 
sample of 168 African American women were 
interviewed in person and in private locations 
(most often in their homes) about their 
experiences with rape, sexual coercion, and a 
range of mental and physical health indicators as 
well as health-related behaviors.

The average age of the women in the sample 
was 48 years old. Total household incomes 
varied but tended to be low: 29% of participants 
reported an annual income of less than $5,000, 
and 12% reported incomes of $50,000 or greater. 
The remainder fell between those two ranges.

All participants were asked a wide ranging set 
of questions that included:

• each women’s lifetime history of rape and 
sexual coercion (see below for definitions);

• experiences with negative health behaviors over 
the past 12 months, e.g. alcohol and drug use;

• experiences of food and housing insecurity;

• lifetime experiences with mental health conditions, 
including depression, suicidality, and PTSD.

Particular attention was paid to a group of 80 
women who identified their first unwanted sexual 
experience as either rape or sexual coercion. This 
group was asked additional questions including:

• age at first having been raped;

• age of the person who perpetrated the assault;

• relationship to the person who perpetrated 
the assault;

• physical health conditions following the first 
nonconsensual experience.

Rape was defined as “completed or attempted 
sex after a perpetrator used physical force or 
threats of physical harm, gave the victim drugs 
or alcohol, or when the sex occurred when the 
victim was passed out, asleep, drunk, or high 
(and unable to provide consent to sex)” (Basile 
et al., 2016, p 7). Sexual coercion was defined as 
“completed sex after a perpetrator did any of the 
following: told lies, made false promises about 
the future, or threatened to end a relationship 
or spread rumors; wore down the victim by 
repeatedly asking for sex; or used his or her 



influence or authority to make the victim engage 
in unwanted sex” (Basile et al., 2016, p 7). Note 
that these definitions do not include other forms 
of sexual violence such as unwanted sexual 
contact, non-penetrative child sexual abuse, 
voyeurism, or exhibitionism.

Findings

Over half (53%) of all study participants 
indicated rape victimization, and 44% reported 
sexual coercion within their lifetime, with 
approximately 42% reporting both. These 
are higher prevalence rates than other 
national survey estimates but in line with 
other community-based studies of high-risk 
populations when face-to-face interviews are 
used for data collection.

Participants with lifetime experiences of rape 
and/or sexual coercion: 

• Mental health: Participants with experiences 
of rape and/or sexual coercion were more likely 
than those women who had not been victimized 
to report PTSD symptoms and/or depression. 
A significant majority (88%) of this group had 
a history of rape/sexual coercion. Additionally, 
21% of all study participants indicated they had 
seriously considered suicide during their lifetime.

• Substance abuse: Over half (65%) of the 
participants who indicated rape/coercion 
victimization engaged in binge drinking at 
some point in the last 12 months versus 35% 
of participants who were not victimized. 
Approximately 95% of participants who were 
victimized indicated drug use/misuse during 
the previous year versus 5% of those who were 
not victimized.

• Financial and housing instability: During the 
previous 12 months, 62% of those victimized 
worried about their ability to pay housing 
costs versus 38% of non-victims. Additionally, 
68% of participants who were victimized were 
concerned about their ability to buy nutritious 
meals during the previous 12 months versus 
32% of non-victims.

• First unwanted experience: Among women 
who indicated their first unwanted sexual 
experience was rape or sexual coercion:

• 73% were under the age of 18 years when 
they were victimized;

• 96% reported that the perpetrator was the 
same race;

• 90% knew their perpetrator (e.g., friend/
acquaintance, family member, intimate partner);

• 40% were physically injured (ranging from 
minor cuts to being knocked unconscious);

• 8% contracted a sexually transmitted disease 
(STD);

• 18% became pregnant.

Within this group of women who experienced 
both physical injury and mental health 
problems resulting from their first experience 
with rape or sexual coercion, only half received 
the services they needed.

Study Limitations and 
Opportunities for further 
research:

• Generalizability: As with any race-level 
analysis, it is important to recognize the 
significant cultural diversity that exists; 
generalizations of the study results beyond 
the studied group must be made with care. For 
example, this study was conducted with women 



in an urban setting in the southeast whose total 
household incomes varied but tended to be 
low. The findings may not generalize to higher 
income Black women or those who live in rural 
or suburban areas. 

• First-time victims of rape and sexual 
coercion: Delving deeper into the reasons 
women identified for not getting multiple 
service needs met as first-time victims is 
important. Of the women who said they needed 
medical services, slightly over half were able 
to get them. Of those needing mental health 
services, about half indicated they were able to 
get them. It was not clear whether this group 
of women chose not to reach out, did reach out 
and services weren’t accessible, or relied on 
informal help as an alternative.

• Spectrum of violence: This study’s focus 
was specifically on rape and sexual coercion 
experiences throughout the lifetime of this 
group of women. Future research is needed to 
examine the full spectrum of sexual violence, 
including sexual harassment, non-contact child 
sexual abuse, and other types of sexual violence.

Woman and girl looking out a window.

Discussion

While prevalence rates between national 
studies vary, they consistently show that 
African American women experience sexual 
violence at high rates. Additionally, help-
seeking behaviors—the decision or ability to 
reach out for help—may be different for this 
group of survivors compared to white women 
survivors in their willingness to reach out to 
formal systems for help, e.g. law enforcement, 
medical services, or other organizations.

Offering responsive solutions to sexual violence 
requires looking at victimization within the lived 
experiences and larger contexts of survivors’ 
lives. For this group of African American women, 
sexual violence victimization was associated 
with a broad range of compounding struggles 
including mental health needs, substance use, 
housing instability, and/or poverty.

The experiences of sexual violence are often 
reciprocal: women living in poverty are often 
at increased risk of victimization; victimization 
can then increase risk of unemployment and 
reduced income. African American women are 
disproportionately impacted, often living within 
complex intersections of violence, poverty, 
and mental and physical health struggles. The 
authors acknowledge that “...the added burden 
of traumatic sexual violence victimization for 
women living in poverty potentially exacerbates 
the need for multiple services and resources to 
address various intersecting problems” (Basile 
et al., 2016, p 18).

Prevention

Implications

Effective prevention strategies embrace 
socio-cultural relevance (Nation et al., 2003), 
meaning they are created for specific audiences 
with messages that resonate and reflect the 
cultural values and strengths within those 
communities. Additionally, sexual violence 
prevention is most effective when mobilized 
at all levels of the social ecology (individual, 
relationship, community, and societal) and 
throughout the lifespan (Tharp et al., 2012).

• Child sexual abuse prevention: Given that 
most women in the current study were sexually 
victimized before turning 18, prevention efforts 
that start early in life and continue through 
different developmental ages are crucial. There 
is a large body of existing research supporting 
the notion that child sexual abuse is a strong 
predictor of adult rape or revictimization (Black 
et al., 2011; Fargo, 2009; Rinehart, Yeater, Musci, 
Letourneau, & Lenberg, 2014). 

Teachers, faith leaders, neighbors, parents, 
caregivers, and other community members can 
work together to protect children from sexual 
abuse; it is critical that they have the tools to 
identify and respond to child sexual abuse.

• Supporting broad-based community norms 
change: Investing in and supporting promising 
prevention practices with messages that combat 
racism and amplify the strengths, values, and 
aspirations of this community are critical. These 
can also be important countermeasures to 
generational or historical trauma that may be 
contributing to community and/or individual 
responses to sexual violence. Destructive, 
inaccurate images of African American women 
must be challenged and replaced.

 
Among participants 
reporting PTSD symptoms, 
88% had a history of rape/
sexual coercion.



Grass-roots education and media campaigns 
can provide a unifying voice to these messages. 
They can be a natural tie-in to messages 
promoting respect, consent, and the right that 
all bodies are worthy of respect and dignity.

• Community organizing: Sexual assault 
advocates can initiate, join, and support existing 
community organizing efforts. They play a key 
role in helping to educate on the relationship 
between sexual violence and the larger field 
of violence and forms of oppression including 
misogyny and racism. Connecting these dots in 
partnership with communities can allow for a 
powerful response to take shape for survivors 
and non-survivors both.

Community leaders are not just those 
with identified roles. Leaders exist in many 
pockets in all communities and have significant 
impact in influencing attitudes and opinions 
of those around them. The fragile relationship 
between many communities of color and law 
enforcement makes informal networks even 
more important. Beyond prevention, informal 
support networks may also be first responders 
for survivors. Understanding sexual violence 
can preclude inappropriate responses and 
victim blaming attitudes which can have serious 
impacts on survivors.

Intervention

Greater community investment

Bridge building and cross-training between 
service providers: A broad community-based 
approach to services for people impacted by 
sexual violence may be more responsive to the 
needs of some African American women. For 
many, sexual violence is often experienced as 
one of many burdens present in their lives. They 
may not even identify victimization as being the 
primary issue in their lives demanding attention. 
Women in lower socioeconomic classes are 
likely to live farther from service providers and/
or lack insurance, transportation, child care, and/
or stable housing. Multiple and other pressing 
basic needs may take priority over reporting and 
accessing services for sexual violence.

The consequences stemming from sexual 
violence victimization may or may not be at the 
root of other challenges this group of women 
face, given the systemic barriers that racism, 
classism, and other forms of oppression have on 
their lives. Do unstable housing situations, for 
example, create conditions where women face a 
higher risk for sexual violence? Does untreated 
victimization create instability in women’s lives 
that can lead to unhealthy coping mechanisms 
such as substance abuse and others?

If African American women are reluctant 
to seek help from formal systems such as 
law enforcement, medical providers, or the 
formal social service network, then allied or 
community organizations where women are 
receiving help for other needs can be cross-
trained in sexual violence issues and trauma-
informed responses, even if women choose not 
to disclose their victimization. For example, 
engaging faith-based leaders in understanding 
the dynamics of sexual violence and the 
importance of expressing unconditional support 
for all victims may encourage survivors to 
access help. 

Training can be made accessible to 
community groups or allied organizations 
in a manner that doesn’t require advanced 
education levels or laborious training 
requirements. Providing education and training 
to other service providers including social 



workers, child care workers, educators, health 
care providers, attorneys, faith/traditional 
leaders as well as the community at large 
is important in ensuring that survivors are 
surrounded by knowledgeable providers and 
community members. 

Culturally relevant organizations: Services 
currently offered by more mainstream 
organizations do not always reflect the cultural 
diversity of the community, which can affect 
survivors’ willingness to seek help from them. It 
is important that survivors can see themselves 
and their realities in the organizations designed 
to be of service to them. When organizations 
are staffed by diverse counselors and service 
providers, and they work to establish rapport 
and collaborations within the community, they 
may begin to be seen as trustworthy, safe, 
and culturally relevant places for traditionally 
marginalized populations to access help. While 
informal systems of support are crucial, it is 
also important that sexual violence programs 
and other agencies are relevant and responsive 
to the people they serve and that they partner 
with both formal and informal sources of help 
to ensure African American communities have 
access to quality services.

Woman teaching two children.
Culturally relevant approaches to trauma: 
PTSD symptoms, depression, anxiety, and 
suicide were found to be significantly connected 
to sexual trauma. It is important to understand 
that mental health struggles such as PTSD and 
depression are not necessarily experienced 
or described in the same way across cultures. 



Victim service providers can adopt a trauma-
informed approach—one that understands the 
role trauma plays at individual, organizational, 
and larger systemic levels. Central to this 
approach is an understanding of the similarities 
and differences across cultures and individuals’ 
experiences with violence and trauma. 

Also central to a trauma-informed approach 
is a focus on strengths. Services that are 
strengths-based acknowledge the healing 
strategies that have been successfully used by 
African American women, including spiritual 
practices, music, storytelling, activism, artistic 
expressions, and others.

Conclusion

This study contributes to the growing 
research base expanding our understanding of 
sexual violence victimization. It acknowledges 
and identifies ways that sexual violence is 
experienced for some African American/
Black women within a host of overlapping 
and compounding situations. Responding 
effectively as well as working preventively has 
to occur within the larger realities of victims/
survivors and their communities that are often 
impacted by racism, classism, and other forms 
of oppression.

This study identifies a large number of women 
who experienced both physical injury and 
mental health problems resulting from their first 
experience with rape or sexual coercion, yet 
only half received the services they needed. This 
speaks to the need for both early and sustained 
culturally relevant prevention strategies as well as 
the need to strengthen the safety net of services 
that women may require after victimization. This 
will be accomplished by developing stronger and 
more meaningful community partnerships as 
well as developing culturally relevant prevention 
messaging and programs.

While no event in any person’s life is 
experienced in isolation, the oft-accompanying 
life situations and burdens within this group of 
African American women are significant. They 
demand focused and intentional efforts that are 
instituted across the individual lifespan as well 
as the breadth of the entire community.

Woman smiling.























References

Basile, K. C., Smith, S. G., Fowler, D. N., Walters, M. L., & Hamburger, M. E. (2016). Sexual violence victimization and associations 
with health in a community sample of African American women. Journal of Aggression, Maltreatment & Trauma. Advance 
online publication. doi:


10.1080/10926771.2015.1079283
Black, M. C., Basile, K. C., Breiding, M. J., Smith, S. G., Walters, M. L., Merrick, M. T., … Stevens, M. R. (2011). National Intimate 
Partner And Sexual Violence Survey: 2010 summary report. Retrieved from the Centers for Disease Control and Prevention: 

http://www.cdc.gov/violenceprevention/pdf/nisvs_report2010-a.pdf
Breiding, M. J., Smith, S. G., Basile, K. C., Walters, M. L., Chen, J., & Merrick, M. T. (2014). Prevalence and characteristics of sexual 
violence, stalking, and intimate partner violence victimization—National Intimate Partner and Sexual Violence Survey, United 
States, 2011. Morbidity and Mortality Weekly Report, 63(SS08), 1-18. Retrieved from the Centers for Disease Control and 
Prevention: 

http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6308a1.htm
Bryant-Davis, T., Ullman, S. E., Tsong, Y., Tillman, S., & Smith, K. (2010). Struggling to survive: Sexual assault, poverty, and 
mental health outcomes of African American women. American Journal of Orthopsychiatry, 80, 61-70. doi:

10.1111/j.1939-
025.2010.01007.x
Fargo, J. D. (2009). Pathways to adult sexual revictimization: Direct and indirect behavioral risk factors across the lifespan. 
Journal of Interpersonal Violence, 24, 1771-1791. doi:

10.1177/0886260508325489
Nation, M., Crusto, C., Wandersman, A., Kumpfer K. L., Seybolt, D., Morrissey-Kane, E., & Davino, K. (2003). What works 
in prevention: Principles of Effective Prevention Programs. American Psychologist, 58, 449–456. doi:

10.1037/0003-
66X.58.6-7.449
Loya, R. M. (2014). The role of sexual violence in creating and maintaining economic insecurity among asset-poor women of color. 
Violence Against Women, 20, 1299-1320. doi:

10.1177/1077801214552912 

Rinehart, J. K., Yeater, E. A., Musci, R. J., Letourneau, E. J., & Lenberg, K. L. (2014). The role of ethnicity, sexual attitudes, 
and sexual behavior in sexual revictimization during the transition to emerging adulthood. Child Maltreatment, 19, 178-187. 
doi:

10.1177/1077559514551946
Tharp, A. T., DeGue, S., Valle, L. A., Brookmeyer, K. A., Massetti, G. M., & Matjasko, J. L. (2013). A systematic qualitative 
review of risk and protective factors for sexual violence perpetration. Trauma, Violence, & Abuse, 14, 133-167. 
doi:

10.1177/1524838012470031
Tjaden, P., & Thoennes, N. (2006). Extent, nature, and consequences of rape victimization: Findings from the National Violence 
Against Women Survey. Retrieved from the National Criminal Justice Reference Service: 

https://www.ncjrs.gov/pdffiles1/
nij/210346.pdf
Wadsworth, P., & Records, K. (2013). A review of the health effects of sexual assault on African American women and adolescents. 
Journal of Obstetric, Gynecologic and Neonatal Nursing, 42, 249-273. doi:

10.1111/1552-6909.12041
Acknowledgements

NSVRC thanks Dr. Carolyn West, Associate Professor, University of Washington, Tacoma; Maia Christopher, 
Association for the Treatment of Sexual Abusers; and Grace Mattern, NSVRC Advisory Council Member, 
for their review and contributions to this research translation.



National Sexual Violence Resource Center l (877)739-3895 l resources@nsvrc.org l www.nsvrc.org