Associations of Structural Racism and Forced Sexual Intercourse Among High School Students in the United States

Background: Adverse experiences that occur during adolescence are a major public health issue given risky behaviors that begin during this period often continue into adulthood. One of the major adverse experiences that can affect a person’s well-being is experiencing sexual assault at a young age. The societal support of hypersexualized race-based stereotypes may serve as a contributing factor that explains the increased risk of sexual assault victimization among American Indian/Alaskan Native (AIAN) and Black youth. The aim of this study was to assess the association between race, as a proxy for having experienced structural racism, and ever having been forced to have sexual intercourse among high school students in the United States (U.S.). Methods: This study used data from the 2013, 2015, 2017, and 2019 National Youth Risk Behavior Surveys (YRBS) to examine associations among a nationally representative sample of U.S. high school students who identify as AIAN, Black, or White. Multivariable logistic regression served as the formal method of analysis with race as the exposure variable and forced sexual intercourse as the outcome variable. Results: Overall, 15% of AIAN female students, 11% of Black female students, and 11% of White female students reported ever having experienced forced sexual intercourse. For male students, 11% of AIAN students, 5% of Black students, and 3% of White students reported ever having experienced forced sexual intercourse. AIAN female students were 89% more likely to report ever having experienced forced sexual intercourse compared to White female students (Odds Ratio (OR) = 1.89; 95% CI: 1.19, 3.01). AIAN male students were 375% more likely (OR = 4.75; 95% CI: 2.65, 8.51) and Black male students were 59% more likely (OR = 1.59; 95% CI: 1.23, 2.06) to report ever having experienced forced sexual intercourse compared to White male students. In the analysis adjusted for potential mediating variables (binge drinking, cannabis use, and hard drug use), the odds of forced sexual intercourse in AIAN female students and Black female students were comparable to White female students (OR = 1.11; 95% CI: 0.59, 2.09 and OR: 1.02; 95% CI: 0.84, 1.24, respectively), and AIAN male students were 137% more likely to report ever having experienced forced sexual intercourse compared to White male students (OR: 2.37; 95% CI: 1.21, 4.64). Conclusion: Students who identified as AIAN or Black were more likely to report forced sexual intercourse than their White counterparts. Also, the results of adjusting for potential mediators suggest that part of the effect of race, as a proxy for structural racism, on forced sexual intercourse operated through binge drinking, cannabis use, and hard drug use for AIAN female students and Black students, while for AIAN male students, it operated through pathways beyond the mediating variables that were accounted for.