Cross-sectional examination of correlates of sexual victimization disclosure via #MeToo

ABSTRACT

Background: Sexual victimization is a serious public health problem, with a range of negative impacts on mental and physical health. Responses that individuals get to disclosure of sexual victimization play an important role in recovery. With the increased use of social media, more survivors are talking about their experiences of sexual victimization online. Research is needed to document the correlates of online disclosure of sexual victimization.

Objective: The current study examined the role of demographic characteristics, assault severity, coping strategies, and social isolation as putative correlates of disclosing sexual victimization online via the hashtag #MeToo.

Methods: A sample of 637 adults recruited via social media who reported a history of sexual victimization since the age of 14 completed self-report surveys using online survey software to assess disclosure of sexual victimization, assault severity, coping strategies, and social isolation.

Results: Multivariate analyses suggest that levels of emotion-focused coping were positively associated with the disclosure of sexual victimization online via #MeToo. Further, individuals who had experienced completed rape by verbal coercion were less likely to disclose via #MeToo, compared to individuals who experienced other forms of assault.

Conclusion: Coping strategies and assault severity play an important role in determining whether survivors disclose sexual victimization online via #MeToo. Findings suggest that individuals may disclose via #MeToo to seek support or express their emotions. Further, individuals whose sexual victimization experiences do not conform to ‘typical’ sexual victimization experiences are less likely to disclose via #MeToo.

HIGHLIGHTS

• Greater reported use of emotion-focused coping is associated with an increased likelihood of disclosing via #MeToo.

• Individuals who experienced completed rape by verbal coercion were less likely to disclose via #MeToo, compared to individuals who experienced other forms of assault.

• Findings highlight the need to further investigate correlates of disclosure via #MeToo.

Antecedentes: La victimización sexual es un grave problema de salud pública, con una serie de impactos negativos en la salud física y mental. Las respuestas que reciben las personas ante la divulgación/revelación de su victimización sexual juegan un papel importante en la recuperación. Con el mayor uso de las redes sociales, más sobrevivientes hablan en línea sobre sus experiencias de victimización sexual. Se necesita investigación para documentar los correlatos de la divulgación/revelación en línea de la victimización sexual.

Objetivo: El presente estudio examinó el papel de las características demográficas, la gravedad de la agresión, las estrategias de afrontamiento y el aislamiento social como correlatos putativos de divulgar/revelar la victimización sexual en línea a través del hashtag #MeToo.

Métodos: Una muestra de 637 adultos reclutados a través de las redes sociales, que informaron un historial de victimización sexual desde los 14 años, completaron encuestas de autoinforme utilizando un software de encuestas en línea para evaluar la divulgación/revelación de victimización sexual, la gravedad de la agresión, las estrategias de afrontamiento y el aislamiento social.

Resultados: Los análisis multivariados sugieren que los niveles de afrontamiento centrado en las emociones se asociaron positivamente con la divulgación/revelación de victimización sexual en línea a través de #MeToo. Además, las personas que habían sufrido una violación consumada mediante coerción verbal tenían menos probabilidades de divulgarlo/revelarlo a través de #MeToo, en comparación con las personas que experimentaron otras formas de agresión.

Conclusión: Las estrategias de afrontamiento y la gravedad de la agresión desempeñan un papel importante a la hora de determinar si los sobrevivientes divulgan/revelan su victimización sexual en línea a través de #MeToo. Los hallazgos sugieren que las personas pueden revelarlo a través de #MeToo para buscar apoyo o expresar sus emociones. Además, las personas cuyas experiencias de victimización sexual no se ajustan a las experiencias de victimización sexual ‘típicas’ tienen menos probabilidades de divulgarlo/revelarlo a través de #MeToo.

KEYWORDS:

• Sexual assault
• rape
• disclosure
• #Metoo
• gender
• sexual orientation

PALABRAS CLAVE:

• Agresión sexual
• violación
• divulgación/revelación
• #MeToo
• género
• orientación sexual

Sexual victimization is a serious public health issue with numerous impacts on health and well-being (Breiding et al., 2015; Dworkin, 2020). Over half of women and almost one in three men experience sexual violence during their lifetime (Basile et al., 2014). Furthermore, one in four women and about one in twenty-six men experience sexual violence over their lifetime (Basile et al., 2014). The health consequences associated with sexual victimization are vast, and include increased risk of transmission of sexually transmitted infections, chronic health issues (e.g. chronic pelvic pain), mental health issues (e.g. post-traumatic stress disorder, anxiety, depression, suicidal ideation), sexual dysfunction, and unintended pregnancies (Ahrens, 2006; Bicanic et al., 2015; Cusano et al., 2023; Dworkin & Allen, 2018). Given the prevalence and morbidity of sexual violence, ensuring that victims are provided with support and resources following experiences of assault is of high public health significance.

Anywhere from 65% to 92% of individuals who experience sexual victimization disclose the experience to at least one person (Ahrens et al., 2007; Fisher et al., 2003; Orchowski & Gidycz, 2012). Although some individuals disclose to a formal support provider, such as a medical provider or counsellor, many individuals disclose the experience to an informal support provider, such as a friend or family member (Filipas & Ullman, 2001; Orchowski & Gidycz, 2012). Disclosure of sexual victimization plays an important role in recovery (Ahrens et al., 2010; Dworkin et al., 2019). Firstly, disclosure of sexual victimization can support individuals in obtaining medical treatment for injuries sustained during the assault (Ahrens et al., 2010; Filipas & Ullman, 2001). Secondly, given that survivors of sexual victimization start the process of making meaning of the trauma immediately after the assault (Park, 2010), the receipt of supportive reactions from family, friends, and support providers that result from discussing the experience may facilitate healing (Ahrens et al., 2007). Indeed, several studies suggest that receipt of positive social reactions following disclosure of sexual victimization is associated with improved coping, less self-blame, reduced PTSD symptoms, and promotes overall well-being among survivors (Harvey et al., 1991; Ullman, 1996; Ullman & Peter-Hagene, 2014). Research that examines factors associated with the disclosure of sexual victimization is therefore important in understanding how survivors heal from sexual trauma.

Although the vast majority of the studies do not apply theoretical models when examining the disclosure of sexual violence (Sabina & Ho, 2014) seminal studies on disclosure have utilized the ecological model to understand disclosure behaviour (Liang et al., 2005; Ullman, 1996; Walsh et al., 2010). The ecological model posits that no single factor impacts the disclosure of sexual violence (Collin-Vézina et al., 2015). Rather, complex interactions among individual, interpersonal, and societal level factors influence disclosure processes. Salient individual factors include demographics (e.g. gender, sexual orientation), sexual violence severity (tactic use, act involved), and coping strategies (e.g. problem-solving coping, emotion-focused coping) (Edwards et al., 2023; Ullman, 1996; Walsh et al., 2010). Relevant interpersonal factors include social support (Jonzon & Lindblad, 2004; Ullman, 1999; Wilson & Scarpa, 2014) and societal-level factors include cultural and societal attitudes towards sexual violence (Collin-Vézina et al., 2015). For the purpose of the study, we focused on individual and interpersonal correlates of disclosure.

1.1. Disclosure of sexual victimization online via #MeToo

Disclosure of sexual victimization does not exclusively occur via in-person interactions. With the growing popularity of social media, survivors may also choose to disclose sexual victimization experiences online (Andalibi et al., 2016; Gorissen et al., 2023; Moors & Webber, 2013). The broader #MeToo social media campaign for sexual violence was popularized by activist, Tarana Burke in 2006. Use of the hashtag #MeToo to post on social media gained further momentum in 2017 when actress Alyssa Milano urged others to share their victimization experiences online by tweeting ‘If you’ve been sexually harassed or assaulted write “me too” as a reply to this tweet’ (Jaffe et al., 2021). Milano’s social media post went viral, resulting in over 85 million social media posts with the hashtag #MeToo in 45 days (Sayej, 2017). Over the course of the year, the #MeToo movement provided a platform for millions of survivors to come forward and share their stories (Zacharek et al., 2017).

1.2. Gender and sexual orientation as correlates of disclosure

Whereas extensive research has focused on determining the correlates of in person disclosure of sexual victimization (Halstead et al., 2017; Orchowski & Gidycz, 2012; Sabina & Ho, 2014), research examining correlates of online disclosure of sexual victimization broadly, and disclosure of sexual victimization via the hashtag #MeToo specifically, is still in its infancy. The majority of research examining online disclosure of sexual victimization has utilized publicly available data such as online posts (e.g. tweets) (Bogen, Orchowski, et al., 2021; Gorissen et al., 2023). Given the lack of demographic information associated with publicly available tweets, studies examining online disclosure of sexual violence do not report on the demographic characteristics of the study sample (Bogen et al., 2019; Bogen et al., 2022; Bogen, Bleiweiss, et al., 2021). For example, four studies have examined how gender impacts online disclosure of sexual victimization and all of them found that women, compared to men, were more likely to disclose sexual victimization online (Andalibi et al., 2016; Gallagher et al., 2019; Lokot, 2018; Modrek & Chakalov, 2019). In fact, Gallagher et al. (2019) analysis of 2500 tweets utilizing the hashtag #MeToo found that only 2.6% of the tweets were written by individuals who identified as non-women and/or men. Findings from the nascent literature on differences in the online disclosure of sexual violence based on gender are consistent with the literature on in-person disclosure of sexual violence. For example, one study found that whereas 85% of women disclosed an experience of victimization, 67% of men reported disclosing (Banyard et al., 2007). These findings are corroborated by other studies which report similar patterns of an increased likelihood of disclosure among women compared to men (Alaggia et al., 2019; Guerra et al., 2021; Ullman & Filipas, 2005).

Despite the burgeoning evidence on gender and disclosure of sexual victimization online, data documenting whether disclosure of sexual victimization in online forums varies by sexual orientation or gender minority identity is lacking. Whereas more studies have examined in-person disclosure experiences of sexual and gender minorities, their findings are mixed (Edwards et al., 2023; Harris et al., 2020; Langenderfer-Magruder et al., 2016; Long et al., 2007; Moschella et al., 2020; Richardson et al., 2015; Sabina & Ho, 2014). Specifically, some studies have found differences in disclosure rates based on sexual orientation (Edwards et al., 2023). For example, two studies have found that individuals who identify as a gender minority are less likely to disclose sexual victimization to formal and informal sources of support compared to cisgender men (O’Connor et al., 2023) and cisgender women (Cusano et al., 2023). Another study found that sexual and gender minority individuals were less likely to disclose experiences of sexual victimization to both informal and formal sources compared to their heterosexual counterparts (Richardson et al., 2015). In contrast, other studies report that bisexual victims of sexual assault had the highest rates of disclosure to both informal and formal sources of support compared to lesbian or heterosexual women (Langenderfer-Magruder et al., 2016; Long et al., 2007; Moschella et al., 2020). These studies also suggested that lesbian women had similar rates of disclosure compared to heterosexual women (Langenderfer-Magruder et al., 2016; Long et al., 2007; Moschella et al., 2020). Studies specifically examining rates of sexual victimization disclosure among men who identify as a sexual minority are lacking.

Prior studies on pattern of broader internet use suggest that sexual minority and gender minority individuals use social media websites as a primary way of connecting with others, building relationships, and findings social support (Chong et al., 2015; Pew Research Center, 2013). Indeed, a report comparing social media use by sexual orientation and gender found that individuals who identify as sexual and/or gender minority tend to use social media more frequently compared to the average US adult (Pew Research Center, 2013). Thus, one would expect that sexual and gender minority individuals may be more likely to disclosure sexual victimization online, compared to heterosexual and cisgender counterparts. Given that rates of in person disclosure differ by sexual orientation and gender identity (Edwards et al., 2023) and use of social media differs by sexual orientation and gender identity, one may expect that both sexual orientation and gender identity would also impact the likelihood of sexual victimization disclosure via #MeToo.

1.3. Coping strategy as a correlate of disclosure

There are several other gaps in research addressing online disclosure of sexual victimization. For example, research has yet to examine how other individual characteristics, such as coping strategies and social support influence the likelihood of online disclosure of sexual victimization. Coping strategies are often classified into two broad categories: problem-solving coping strategies and emotion-focused coping strategies (Chiavarino et al., 2012; Cooper et al., 2008). Problem-solving coping strategies include responding to challenges through the implementation of behavioural activities, such as action and planning, while emotion-focused coping strategies include responding to challenges through strategies such as reframing, seeking emotional support, or expressing emotions. Coping strategies are robustly associated with help-seeking behaviours among individuals who experience intimate partner violence and sexual victimization (DeLoveh & Cattaneo, 2017; Shannon et al., 2006; Ullman & Filipas, 2001). Given that disclosure is a precursor for help-seeking behaviours, it would be reasonable to expect that coping styles would be associated with the disclosure of sexual victimization as well. Indeed, studies have found that coping style, particularly coping via emotional support, is associated with the increased likelihood of disclosure in-person (Orchowski & Bhuptani, 2023; Orchowski & Gidycz, 2012). Further, studies document that individuals with higher levels of problem-solving coping are more likely to disclose private information compared to individuals with lower levels of problem-solving (Jie et al., 2019; Talley & Bettencourt, 2011).

Whereas no study has examined how coping strategies are associated with online disclosure of sexual victimization, prior body of literature has found that greater levels of emotion-focused coping and problem-solving coping are associated with increased internet use (Sriwilai & Charoensukmongkol, 2016; Sun et al., 2023). Specifically, following a stressful event, such as sexual assault, individuals may engage with internet sites such as social media to seek resources and information (problem-solving coping) or to seek social support (emotion-focused coping). Given that coping strategies are positively associated with in-person disclosure of personal information such as sexual violence (Jie et al., 2019; Orchowski & Bhuptani, 2023; Orchowski & Gidycz, 2012) and increased internet use (Sriwilai & Charoensukmongkol, 2016; Sun et al., 2023) in general, one may expect that they may would be associated with increased likelihood of online disclosure of sexual victimization.

1.4. Social isolation as a correlate of disclosure

Perceived social support is also an important component of recovery following trauma (Jonzon & Lindblad, 2004; Ullman, 1999; Wilson & Scarpa, 2014). In a sample of 262 college students who experienced rape, Littleton (2010) found that perceived social support and negative social reactions to disclosure of sexual victimization were predictors of post-assault adjustment. Relatedly, social isolation is another important correlate of disclosure of sexual victimization, such that several studies suggest that increased levels of social isolation are associated with a decreased likelihood of disclosure (Bry et al., 2017; Ullman et al., 2020). However, social isolation may lead to seeking support elsewhere such as the internet. Although research has yet to examine how social isolation influences online disclosure of sexual victimization, the broader literature examining factors that influence the disclosure of personal information online has found that increased levels of social isolation are associated with increased disclosures of personal information online (De Choudhury & De, 2014; Lyngdoh et al., 2023). One qualitative study that conducted an analysis of 31 questions and answers on Yahoo! Answers in Australia containing disclosures of sexual violence found that survivors who disclosed on the site frequently noted feelings of ‘nowhere to turn to’ (Moors & Webber, 2013, p. 811), highlighting the association between social isolation and increased disclosure of sexual victimization online. Thus, one may expect that higher levels of social isolation would increase the likelihood of sexual victimization disclosure via #MeToo, a pattern that contrasts in person disclosure processes.

1.5. Assault severity as a correlate of disclosure

Assault severity (i.e. contact, attempted rape, rape) plays a salient role in the in-person disclosure of sexual victimization such that sexual victimization of less severity such as sexual contact by verbal coercion were less likely to be disclosed compared to rape or attempted rape (Fisher et al., 2003; Kilpatrick et al., 2007; Priebe & Svedin, 2008). Additional research is also needed to examine how assault characteristics influence online disclosure of sexual victimization. Whereas studies have qualitatively described assault characteristics (coercion tactics used, severity of assault) shared by survivors when disclosing their experiences online (Bogen et al., 2019; Bogen et al., 2021), no study has examined how assault characteristics correlate with whether or not an individual chooses to share their experience in an online forum. Given that assault characteristics influence in-person disclosure of sexual victimization (Orchowski & Bhuptani, 2023; Orchowski & Gidycz, 2012), they may also impact online disclosure of sexual victimization.

1.6. In-person disclosure as a correlate of disclosure via #MeToo

Lastly, research has yet to examine how in-person disclosure of sexual victimization intersects with disclosure of sexual victimization online. Studies find that over half of the survivors who disclosed their experience online had never disclosed before (Moors & Webber, 2013; Webber, 2014; Webber & Wilmot, 2012). For many survivors, online disclosure may be an alternative to in-person disclosure of sexual victimization (Moors & Webber, 2013). Other studies not that survivors may choose to disclose online if they are not ready to disclose in-person or are seeking resources that may be difficulty to access in-person (Lee et al., 2013; Naslund et al., 2016) Thus, in-person non-disclosure may be positively associated with online disclosure of sexual victimization. However, no study to our knowledge has examined this association.

1.7. Purpose of the present study

In sum, sexual victimization is prevalent and associated with numerous consequences. Disclosure of sexual victimization plays a key role in recovery (Ahrens et al., 2010; Filipas & Ullman, 2001) and the majority of survivors disclose either in-person or via #MeToo (Ahrens et al., 2007; Gorissen et al., 2023). Thus, it is important to identify correlates of disclosure among survivors who have disclosed either in-person or via #MeToo. Extant research has determined the role of assault characteristics (i.e. coercion tactic and sexual assault severity) and individual characteristics (gender, sexual orientation, coping strategies, isolation) as key correlates of in-person disclosure (Edwards et al., 2023; Orchowski & Bhuptani, 2023; Ullman et al., 2020). However, research examining correlates of disclosure via #MeToo is lacking. This is the first study that aimed to identify correlates of disclosure via #MeToo among a sample of 637 survivors of sexual victimization who have disclosed either in-person or via #MeToo. Given the lack of literature on correlates of sexual violence disclosure via #MeToo, tentative hypothesis for bivariate associations were formed based on the literature on patterns of general internet use and in-person disclosure of sexual violence:

Hypothesis 1 and 2: Based on research suggesting that increased levels of problem-solving and emotion-focused coping strategy are associated with a greater likelihood of disclosure (Jie et al., 2019; Orchowski & Gidycz, 2012) and increased use of internet (Sriwilai & Charoensukmongkol, 2016; Sun et al., 2023). it was hypothesized that use of problem-solving coping strategies (H1) and use of emotion-focused coping strategies (H2) would be positively associated with the disclosure of sexual victimization online via #MeToo.

Hypothesis 3: Based on prior research suggesting that higher levels of social isolation are associated with greater disclosure of personal information online (De Choudhury & De, 2014; Lyngdoh et al., 2023), it was proposed that social isolation will be positively associated with disclosure via #MeToo.

Hypothesis 4: In light of prior research suggesting that the majority of survivors who disclosed their experience online had never disclosed before (Moors & Webber, 2013; Webber, 2014; Webber & Wilmot, 2012), it was expected that in-person disclosure would be negatively associated with disclosure via #MeToo.

Hypothesis 5: Based on prior research suggested that women, compared to men, were more likely to disclose sexual victimization online (Andalibi et al., 2016; Gallagher et al., 2019; Lokot, 2018; Modrek & Chakalov, 2019), it was proposed that cisgender women will be more likely to disclose via #MeToo compared to cisgender men and individuals who identify as a gender minority.

Hypothesis 6: No study has examined differences in online disclosure of sexual victimization based on sexual orientation. Prior research that suggests bisexual victims of sexual assault are more likely to disclose in-person compared to lesbian or heterosexual women (Langenderfer-Magruder et al., 2016; Long et al., 2007; Moschella et al., 2020), tend to use social media more social media more frequently compared to the average US adult (Pew Research Center, 2013), and use social media websites as a primary way of connecting with others, building relationships, and findings social support (Chong et al., 2015; Pew Research Center, 2013). Thus, it was hypothesized that individuals who identify as bisexual would be more likely to disclose via #MeToo compared to heterosexual and gay/lesbian individuals (H6a and H6b).

Hypothesis 7: Given no study has examined how sexual victimization severity is associated with disclosure via #MeToo, hypotheses regarding this relation were exploratory in nature.

Given no prior studies have examined correlates of online disclosure of sexual victimization, hypotheses regarding multivariate associations between the independent variables (coping strategies, social isolation, in-person disclosure, gender, sexual orientation, assault severity) and the dependent variable (disclosure via #MeToo) were exploratory in nature.

2. Methods

2.1. Participants

The current study utilized a sample of 637 participants. Online advertisements on various social media platforms including Instagram, Facebook, and Twitter were used to recruit participants. The advertisements solicited individuals who experienced an unwanted sexual experience. To qualify for the current study participants needed to be residing in the United States, needed to endorse experiencing an unwanted sexual experience from the age of 14 to the time of the current study and be currently over the age of 18. To ensure that the sample consisted of survivors of sexual victimization from the age of 14 to the time of the current study, participants completed the Sexual Experiences Survey – Short Form Victimization (SES-SFV; Johnson et al., 2017; Koss et al., 2007). Five participants were eliminated for not reporting an experience of sexual victimization on the SES-SFV. Additionally, 125 participants did not disclose an experience of sexual victimization occurring since the age of 14 either via #MeToo or in-person. These individuals were also eliminated resulting in the total analytic sample of 637 participants. Of the 637 participants included in the sample, 69.4% (n = 442) reported not disclosing via #MeToo and 30.6% (n = 195) reported disclosing via #MeToo. Furthermore, of these 637 participants, 90.9% (n = 579) reported disclosing in-person and 9.1% (n = 58) reported not disclosing in-person.

Majority of the sample identified White or Caucasian (n = 141, 67.8%), followed by Asian or Pacific Islander (n = 43, 6.8%), multiracial (n = 31, 4.9%), Black or African American (n = 30, 4.7%) and Native American or American Indian (n = 23, 3.6%). The remaining participants listed ‘other’ as their race (n = 12, 1.1%) or preferred not to answer (n = 3, 0.5%). 9.9% of the participants identified as Latinx or Hispanic (n = 63). Majority of the sample identified as a woman (n = 471, 73.9%) followed by gender minority (n = 126, 19.8%) and man (n = 36, 5.7%). Of the gender minority group (n = 126), 19.84% (n = 25) identified as transgender man, 2.3% as transgender woman (n = 3), 73.01% (n = 92) as non-binary, 3.9% (n = 5) as gender fluid, and 0.7% (n = 1) as two spirit. The remaining preferred not to answer (n = 4, 0.6%). Majority of the sample identified as heterosexual (n = 236, 37%), followed bisexual (n = 219, 34.9%), and pansexual (n = 75, 12%). A small portion of the sample identified as gay/lesbian (n = 57, 8.9%), asexual (n = 10, 1.5%) and Other (n = 33, 5.3%). The remaining 1.1% preferred not to answer (n = 7). Of the 33 participants who identified as ‘other’, majority identified as queer (n = 27), bisexual (n = 1), bisexual/demisexual (n = 1), demisexual (n = 3), and heteroflexible (n = 1). The bisexual, pansexual, and other category was combined into one category ‘bisexual + ’.

Finally, the sexual victimization severity in the current sample was as follows: 48 individuals (7.5%) experienced sexual contact by verbal coercion, intoxication, or physical force, 24 (3.8%) experienced attempted rape by verbal coercion, 71 (11.1%) experienced completed rape by verbal coercion, 40 (6.3%) experienced attempted rape by intoxication or physical force, and 454 (71.3%) completed rape by intoxication or physical force.

2.2. Procedure

All study procedures were approved by the Institutional Review Board. Participants were recruited throughout the United States via advertisements on various social media platforms including Instagram, Facebook, and Twitter. Consent was obtained from the participants prior to gaining access to the survey materials and a $10 Amazon gift card was provided upon survey completion as compensation. The study was conducted from February 2020 to February 2022. The survey took approximately 25–30 min to complete.

Several quality control checks were performed throughout data collection to limit the potential that bots would contaminate study validity. First, prior to accessing survey items, participants were asked to check a reCAPTCHA box to verify they were not a robot. Second, further manual quality control of each collected response was conducted by individual members of the research team. Responses could be flagged for reasons including having inconsistent responses, potential ballot stuffing (i.e. multiple survey responses from the same participant), suspicious email patterns (e.g. random letters before the email domain), and nonsensical responses to open-ended questions. Responses were omitted from the final data analysis if they had at least one suspected quality response concern. A total of 1191 responses were collected with 767 responses (64.3%) passing the quality control checks.

2.3. Measures

Demographic Characteristics. Race was measured by the following 1-item question ‘Describe your racial identity (select all that apply)’ and the answer choices provided were ‘White or Caucasian’, ‘Black or African American’, ‘Native American or American Indian’, ‘Asian/Pacific Islander’, ‘Multiracial’, ‘Other’, or ‘prefer not to answer’. Gender was assessed by 1-item question, ‘What is your gender identity?’ and participants were asked to choose from the following response options ‘Man’, ‘Woman’, ‘Non-Binary’, ‘Transgender man’, ‘transgender woman’, and ‘Other’. Participants who identified as ‘transgender man/woman’, ‘non-binary’ and ‘other’ were collapsed into one ‘gender minority’ category. Sexual orientation was measured by a 1-item question ‘What is your sexual orientation?’ and participants were asked to choose from the following options ‘Straight/Heterosexual’, ‘Gay/Lesbian’, ‘Bisexual’, ‘Pansexual’, ‘Asexual’, and ‘other’. Participants that identified as ‘Bisexual’, ‘Pansexual’, ‘Asexual’, and ‘Other’ were collapsed into one ‘Bisexual+’ category.

Sexual Victimization since the Age of 14. Sexual assault was measured by the Sexual Experiences Survey-Short Form Victimization (SES-SFV). The Sexual Experiences Survey-Short Form Victimization (SESSFV) is a self-report measure designed to assess experiences of unwanted sexual contact since the age of 14. Sexual assault was classified according to the most severe experience indicated, including (a) no experience, (b) sexual contact by verbal coercion, intoxication, by force or threat of force, (c) attempted rape by verbal coercion, (d) completed rape by verbal coercion, (e) attempted rape by intoxication, by force or threat of force, (f) completed rape by intoxication, force, or threat of force. This five-level categorization scheme was utilized as a measure of assault severity (Davis et al., 2014). The SES-SFV has been shown to be a valid and reliable measure of sexual victimization in a variety of different populations and is one of the most commonly used measures in sexual victimization research (Johnson et al., 2017; Koss et al., 2007; Koss & Collaboration, 2006).

Disclosure of Sexual Victimization Online and In-person. The one-item tool was used to assess individuals who disclosed their unwanted sexual experiences and through what methods did the disclosure occur. Participants were asked

Earlier in the survey, you shared that you had an unwanted sexual experience. Have you told anyone about this experience? Please indicate whether you told anyone in-person (only), online via MeToo (only), both in-person and online via MeToo, or never (not at all)

and asked to choose from the following responses: ‘No, I did not disclose online via MeToo nor have I told anyone in-person’, ‘Yes – I disclosed in-person, but NOT via MeToo’, ‘Yes – I disclosed online via MeToo but NOT in-person’, and ‘Yes – I disclosed in-person AS WELL AS online using MeToo’. Participants could have disclosed via #MeToo on any social media platforms. The first group ‘I did not disclose online via MeToo nor have I told anyone in-person’ (n = 125) was removed from the sample. Thus, individuals who checked one of the three remaining categories ‘yes, I disclosed in-person as well as via #MeToo’, ‘yes, I disclosed in-person but not via #MeToo’, and ‘Yes, I disclosed via #MeToo but not in-person’ were retained in the final analytic sample (n = 637).

Problem-solving and Emotion-focused Coping Strategies. Coping strategies were evaluated with the Brief-Cope, a 28-item, self-report measure (Carver, 1997). The items of the questionnaire are rated on a 1 (‘not at all’) to 4 (‘a lot’) point scale according to how much they pertain to the person. Items are summed and a higher score indicates more frequent use of a particular strategy. Consistent with prior research (Chiavarino et al., 2012; Cooper et al., 2008), emotion-focused coping and problem-solving coping subscales were obtained. The Cronbach alpha for the emotion-focused coping subscale was .65 and the Cronbach alpha for the problem-solving coping subscale was .82.

Social Isolation. The Friendship Scale (Hawthorne, 2006; Hawthorne & Griffith, 2000), measuring the level of social isolation, consists of 5 items, (e.g. I found it easy to get on with other people). The items are rated on a 5-point scale, with answers ranging from 1 = not at all to 5 = almost always. Items 2 and 5 are reverse scored. All items are summed, and a higher score indicates lower levels of social isolation. The Cronbach alpha for the scale was .77.

2.4. Data analysis

Hypothesis 1 and 2, proposed that levels of problem- focused coping (H1), emotion-focused coping (H2) would be positively associated with disclosure via #MeToo. Hypothesis 3 proposed that social isolation would be positively associated with disclosure via #MeToo. To examine each of these hypotheses, bivariate correlations were conducted to examine the associations between each of the continuous variables (problem-solving coping, emotion-focused coping, and social isolation) and the dichotomous variables of disclosure via #MeToo (0 = not disclosed via #MeToo, 1 = disclosed via #MeToo) and disclosure in-person (0 = not disclosed in-person, 1 = disclosed in-person). Bivariate correlations and descriptive statistics are presented in Table 1. It was also proposed that in-person disclosure would be less likely to disclose via MeToo (H4). A chi-square analysis was utilized to explore this hypothesis (see Table 2).

Table 1. Bivariate correlations and descriptive statistics.

Variable	1	2	3	4	M (SD)	Range
1. Problem-solving Coping	-				17. 02 (3.92)	6–24
2. Emotion-Focused Coping	.63**	-			25.47 (4.89)	12–40
3. Social Isolation	.42**	.31**	-		16.26 (4.40)	5–25
4. In-person Disclosure	.04	.01	-.01	-
5. #MeToo Disclosure	.06	.11**	.04	-.48**

*p < .05, **p < .01, ***p < .001.

Table 2. Disclosure of sexual victimization in-person and disclosure of sexual victimization online via #MeToo.

Disclosure		Did not disclose in- person	Disclosed in-person
Did not disclose via #MeToo	Count	0	442
	% within disclosure via #MeToo	0.0%	100.0%
	% within in-person disclosure	0.0%	76.3%
	% of Total	0.0%	69.4%
Disclosed via #MeToo	Count	58	137
	% with disclosure via #MeToo	29.7%	70.3%
	% within in-person disclosure	100.0%	23.7%
	% of Total	9.1%	21.5%

Hypothesis 4, 5, and 6 proposed that cisgender women will be more likely to disclose via #MeToo compared to men and individuals who identify as gender minority (H4), bisexual survivors will be more likely to disclose via #MeToo compared to heterosexual and gay/lesbian survivors (H5), and that sexual victimization severity will be negatively associated with disclosure via #MeToo (H6). To examine Hypothesis 4, Hypothesis 5, and Hypothesis 6, three chi-squares were conducted to examine associations among sexual orientation (0 = Straight, 1 = Gay/Lesbian, 2 = Bisexual+) and disclosure via #MeToo, gender (0 = cisgender men, 1 = cisgender women, 2 = gender minority) and disclosure via #MeToo, sexual assault severity (1 = sexual contact by verbal coercion, intoxication, by force or threat of force, 2 = attempted rape by verbal coercion, 3 = completed rape by verbal coercion, 4 = attempted rape by intoxication, by force or threat of force, 5 = completed rape by intoxication, force or threat of force) and disclosure via #MeToo. Additional three chi-squares were calculated to examine univariate associations among in-person disclosure, gender, sexual orientation, and sexual assault severity.

One binary logistic regression was conducted to examine multivariate correlates of disclosure via #MeToo. Disclosure via #MeToo [(0 = not disclosed via #MeToo, 1 = disclosed via #MeToo)] was entered as the dependent variable. All variables explored as univariate predictors of disclosure online were entered as independent variables in the model simultaneously. The following variables were entered as the independent variables: sexual orientation (0 = Straight, 1 = Gay/Lesbian, 2 = Bisexual+), gender (0 = cisgender men, 1 = cisgender women, 2 = gender minority), sexual assault severity (1 = sexual contact by verbal coercion, intoxication, by force or threat of force, 2 = attempted rape by verbal coercion, 3 = completed rape by verbal coercion, 4 = attempted rape by intoxication, by force or threat of force, 5 = completed rape by intoxication, force or threat of force), in-person disclosure (0 = not disclosed in-person, 1 = disclosed in-person), problem-solving coping, emotion-focused coping, and social isolation.

3. Results

3.1. Univariate associations

Problem-solving and Emotion-Focused Coping (H1 and H2). Problem-solving coping was not associated with disclosure of sexual victimization online via #MeTo (See Table 1). Use of emotion-focused coping strategies was weakly and positively associated with disclosing sexual victimization via #MeToo (r = .11, p = .005).

Social Isolation (H3). Bivariate correlations did not reveal an association between social isolation and disclosure of sexual victimization via #MeToo.

Disclosure in-person and disclosure via #MeToo (H4). Chi-squares tests (See Table 2 for cross-tabulation) indicated that in-person disclosure was significantly associated with disclosure via #MeToo (X² = 144.64, df = 1, p < .001). Specifically, not disclosing in-person was associated with increased likelihood of disclosing via #MeToo.

Gender (H5). Disclosure via #MeToo was significantly associated with gender (X² = 20.30, df = 2, p < .001) (see Table 3). Bonferroni corrected post-hoc tests (Beasley & Schumacker, 1995; Garcia-Perez & Nunez-Anton, 2003) indicated that compared to women and gender minority individuals, men were more like to disclose via #MeToo.

Table 3. Disclosure of sexual victimization online via #MeToo, in-person and associations with gender and sexual orientation.

		Gender
Disclosure via #MeToo		Cisgender Man	Cisgender Women	Gender Minority
Did not disclose via #MeToo	Count	13	333	93
	% within disclosure via #MeToo	3.0%	75.9%	21.2%
	% within gender	36.1%	70.7%	73.8%
	% of Total	2.1%	52.6%	14.7%
Disclosed via #MeToo	Count	23	138	33
	% with disclosure via #MeToo	11.9%	71.1%	17.0%
	% within gender	63.9%	29.3%	26.2%
	% of Total	3.6%	21.8%	5.2%
In-person Disclosure		Cisgender Man	Cisgender Women	Gender Minority
Did not disclose in-person	Count	16	36	5
	% within in-person disclosure	28.1%	63.2%	8.8%
	% within gender	44.4%	7.6%	4.0%
	% of Total	2.5%	5.7%	0.8%
Disclosed in-person	Count	20	435	121
	% within in-person disclosure	3.5%	75.5%	21.0%
	% within gender	55.6%	92.4%	96.0%
	% of Total	3.2%	68.7%	19.1%
		Sexual Orientation
Disclosure via #MeToo		Heterosexual	Gay/Lesbian	Bisexual +
Did not disclose via #MeToo	Count	147	39	242
	% within disclosure via #MeToo	34.3%	9.1%	56.5%
	% within sexual orientation	62.3%	68.4%	74.0%
	% of Total	23.7%	6.3%	39.0%
Disclosed via #MeToo	Count	89	18	85
	% within disclosure via #MeToo	46.4%	9.4%	44.3%
	% within sexual orientation	37.7%	31.6%	26%
	% of Total	14.4%	2.9%	13.7%
In-person Disclosure		Heterosexual	Gay/Lesbian	Bisexual +
Did not disclose in-person	Count	37	7	14
	% within in-person disclosure	63.8%	12.1%	24.1%
	% within sexual orientation	15.7%	12.3%	4.3%
	% of Total	6.0%	1.1%	2.3%
Disclosed in-person	Count	199	50	313
	% within in-person disclosure	35.4%	8.9%	55.7%
	% within sexual orientation	84.3%	87.7%	95.7%
	% of Total	32.1%	8.1%	50.5%

Sexual Orientation (H6). Disclosure online via #MeToo was significantly associates with sexual orientation (X² = 9.74, df = 2, p = .008) (see Table 3). However, Bonferroni corrected post-hoc tests yielded no significant univariate associations when examining associations between sexual orientation and disclosure via #MeToo.

Assault severity (H7). Chi-square analyses first examined how assault severity was associated with disclosure of sexual victimization online via #MeToo (see Table 4). A chi-square test failed to reveal a-significant univariate associations between disclosure via #MeToo and sexual assault severity (X² = 3.40, df = 4, p = .49).

Table 4. Sexual victimization severity, disclosure via #MeToo, and in-person disclosure.

	Sexual Victimization Severity
Disclosure		Sexual Contact by Verbal Coercion, Intoxication, or Physical Force	Attempted Rape by Verbal Coercion	Completed Rape by Verbal Coercion	Attempted Rape by Intoxication or Physical Force	Completed Rape by Intoxication or Physical Force
Did not disclose via #MeToo	Count	32	16	55	30	309
	% with disclosure via #MeToo	7.2%	3.6%	12.4%	6.8%	69.9%
	% within SV	66.7%	66.7%	77.5%	75.0%	68.1%
	% of Total	5.0%	2.5%	8.6%	4.7%	48.5%
Disclosed via #MeToo	Count	16	8	16	10	145
	% with disclosure via #MeToo	8.2%	4.1%	8.2%	5.1%	74.4%
	% within SV	33.3%	33.3%	22.5%	25.0%	31.9%
	% of Total	2.5%	1.3%	2.5%	1.6%	22.8%
Did not disclose in-person.	Count	4	6	12	5	31
	% with disclosure via #MeToo	6.9%	10.3%	20.7%	8.6%	53.4%
	% within SV	8.3%	25.0%	16.9%	12.5%	6.8%
	% of Total	0.6%	0.9%	1.9%	0.8%	4.9%
Disclosed in-person	Count	44	18	59	35	423
	% with disclosure via #MeToo	7.6%	3.1%	10.2%	6.0%	73.1%
	% within SV	91.7%	75.0%	83.1%	87.5%	93.2%
	% of Total	6.9%	2.8%	9.3%	5.5%	66.4%

3.2. Multivariate associations

Binary logistic regression (see Table 5) was used to determine correlates of disclosure via #MeToo. In-person disclosure, sexual orientation, gender, coping styles, and sexual assault severity were entered as independent variables, and disclosure via #MeToo was entered as the dependent variable. Overall, the model was significant (X² = 181.74, p < .001, Nagalkarke R² = .36). After controlling for other variables, only emotion-focused coping and completed rape by verbal coercion emerged as significant correlates of disclosure via #MeToo. Emotion-focused coping was positively associated with disclosure via #MeToo such that more reported use of emotion-focused coping was associated with an increased likelihood of disclosing via #MeToo. Conversely, completed rape by verbal coercion was negatively associated with disclosure via #MeToo such that completed rape by verbal coercion was related to the decreased likelihood of disclosing via #MeToo.

Table 5. Logistic regression examining multivariate predictors of disclosure of sexual victimization online via #MeToo.

Correlates	B	SE	Wald	Exp (B)
In-person disclosure	−22.83	5112.83	0.00	0.00
Gay/Lesbian	−0.20	0.41	0.24	0.82
Bisexual +	−0.25	0.23	1.29	0.78
Cisgender women	−0.31	0.51	0.35	0.73
Gender Minority	−0.16	0.56	0.10	0.85
Emotion-Focused Coping	0.06	0.03	4.88*	1.06
Problem-solving Coping	0.027	0.04	0.49	1.02
Social Isolation	−0.02	0.03	0.43	0.98
Attempted rape by verbal coercion	−1.20	0.83	2.08	0.30
Completed rape by verbal coercion	−1.79	0.63	8.08**	0.17
Attempted rape by intoxication or physical force	−0.91	0.60	2.26	0.40
Completed rape by intoxication or physical force	−0.18	0.37	0.23	0.83

Note: Bolded correlates are significant. *p < .05, **p < .01, ***p < .001.

4. Discussion

Sexual victimization is widely prevalent and has a detrimental impact on survivors (Dworkin, 2020). Disclosure of sexual victimization plays a key role in recovery (Ahrens et al., 2010; Filipas & Ullman, 2001) and more survivors are disclosing online via popular movements such as #MeToo (Gorissen et al., 2023). Whereas prior research has established correlates of in-person disclosure (Fisher et al., 2003; Orchowski & Bhuptani, 2023), research examining correlates of disclosure via #MeToo is lacking. Thus, the present study used the ecological theory of disclosure to identify correlates of disclosure via #MeToo among a sample of survivors of sexual victimization who have disclosed either in-person or online via #MeToo. Specifically, the current study focused on identifying individual (gender, sexual orientation, coping strategy, assault severity, in-person disclosure) and interpersonal level (social isolation) correlates of disclosure via #MeToo.

Hypothesis 1, which proposed that problem-solving and emotion-focused coping would be positively associated with disclosure via #MeToo, was partially supported. Specifically, disclosure via #MeToo was positively associated with emotion-focused coping such that more reported use of emotion-focused coping was significantly associated with an increased likelihood of disclosing via #MeToo. As a matter of fact, emotion-focused coping remained significantly associated with disclosure via #MeToo even after controlling for other variables highlighting its important role in determining online disclosure. Whereas this is the first study that has examined associations between coping strategies and online disclosure, results are in line with studies examining motivations for online disclosure (Andalibi et al., 2016; Moors & Webber, 2013; O'Neill, 2018; Webber, 2014). These studies have found that most survivors disclosure online to obtain emotional support and validation. Studies on broader use of interent have found that increased use of emotion-focused coping is associated with increased use of internet (Sriwilai & Charoensukmongkol, 2016; Sun et al., 2023). As a matter of fact, one study found that whereas emotion-focused coping was positively associated with internet use, specifically social media use, problem-solving coping was not associated with social media use, a pattern that is consistent with our study findings (Sriwilai & Charoensukmongkol, 2016). Thus, individuals who are more likely to endorse emotion-focused coping are also more likely to disclose via #MeToo.

Hypothesis 3, which proposed that increased levels of social isolation would be positively associated with disclosure via #MeToo, was not supported at the bivariate or multivariate level. Specifically, in the current data, social isolation was not associated with whether someone disclosed via #MeToo or not. Hypothesis 4, which proposed that in-person disclosure would be negatively associated with disclosure via #MeToo was supported. Particularly, bivariate correlations suggest that individuals who do not disclose in-person are more likely to disclose via #MeToo. Results are in line with prior qualitative studies that show survivors who disclose online often have nowhere to turn to and use online spaces as an alternative to in-person disclosure (Alaggia & Wang, 2020; Moors & Webber, 2013). Thus, individuals in our sample may be disclosing via #MeToo because other factors (e.g. fear of negative responses, fear of burdening others) may limit in-person disclosure (Ullman et al., 2020). However, the association between in-person disclosure and disclosure via #MeToo was rendered non-significant in the presence of other variables indicating that experiences of in-person disclosure do not impact disclosure via #MeToo, when emotion-focused coping and type of sexual assault experienced are taken into account.

Hypothesis 4, which proposed that cisgender women would be most likely to disclose via #MeToo compared to cisgender men and gender minority, was not supported. Specifically, in the current sample, cisgender men were more likely to disclose via #MeToo compared to women and gender minority individuals. Results contrast with previous literature has found women, compared to men, were more likely to disclose sexual victimization online (Gallagher et al., 2019; Lokot, 2018; Modrek & Chakalov, 2019; Siuta et al., 2023). These surprising results may be explained by different methodologies utilized in current study compared to prior literature. For example, one study determined the gender of the discloser by classifying the victim’s username as either male or female using the Ukrainian State Census list of gender appropriate names (Lokot, 2018). Another quantitative study used a commercial prediction service to infer the demographic information of disclosers (Modrek & Chakalov, 2019). Lastly, Gallagher et al. (2019) used content analysis of the tweets (‘Not a woman but I’m going to add #MeToo’) to classify the users as non-women or men. These methodologies highlight the limit of examining publicly available data (e.g. tweets). Our findings required individuals to self-identify their gender.

The gender differences in the online disclosure pattern in our study may also be explained by motivation for disclosure. Although not examined here, prior literature suggests that males and females may have different reasons for disclosing victimization experiences online. Qualitative interviews with female survivors have documented that women may disclosure online to raise awareness regarding sexual violence, express solidarity for survivors, and engage in advocacy on issues related to sexual violence (Gueta et al., 2020; Gundersen & Zaleski, 2021; Naresh et al., 2022). In contrast, Eckstein (2021) found that male survivors of intimate partner violence prefer disclosing intimate partner violence online as opposed to in-person disclosure. The authors postulated men’s preference for online disclosure is likely due to comparatively fewer in-person resources available to them as well as higher levels of stigma experienced by them compared to women.

Hypothesis 5 proposed that bisexual survivors were more likely to disclose via #MeToo compared to heterosexual and lesbian/gay survivors. However, in the current sample, sexual orientation was not associated with disclosure via #MeToo. Thus, in the current sample, individuals across all sexual identities were equally likely to disclose via #MeToo. Prior research documented that receiving positive responses to disclosure of sexual victimization, increased awareness of sexual victimization, and availability of resources for survivors would lead to increased disclosure among all sexual minority individuals (Jackson et al., 2017; Ollen et al., 2017). These reasons have also been documented as the associated benefits of the #MeToo movement (Bogen et al., 2021b; Gorissen et al., 2023). Thus, it could be possible that the benefits of larger #MeToo movement led to increased disclosure among all individuals, irrespective of sexual identity. Non-significant results may also occur due to a small sample size, especially of the gay/lesbian group. Large variability within each sexual orientation group may also account for non-significant results. Specifically, sexual identity was not stratified by gender when examining associations among sexual identity and disclosure via #MeToo. Nascent research suggests that gender differences are important to consider within sexual orientation groups as well. For example, results from a nationally representative sample of adults in the United States (U.S.), indicated that past-year prevalence of PTSD was highest among bisexual women (21%) compared to heterosexual women (5.7%), lesbian/gay women (7.4%), heterosexual men (3%), gay men (6.2%), and bisexual men (10.3%) (Evans-Polce et al., 2020). No study has examined disclosure rates among individuals stratified by both gender and sexual orientation at the same time, an important inquiry for future research to consider.

Hypotheses 6 proposed that sexual victimization severity would be positively associated with disclosure via #MeToo. Whereas univariate association demonstrated that assault severity and coercion tactic were not associated with disclosure via #MeToo, in the multivariate model, completed rape by verbal coercion was significantly associated with #MeToo. Specifically, individuals who experienced completed rape by verbal coercion were less likely to disclose via #MeToo, even after controlling other variables. Whereas rape involving verbal coercion is common (Mollet & Black, 2023), survivors may view these experiences as less serious (Brown et al., 2005; Testa et al., 2004) and many survivors have not conceptualized these experiences as victimization (Maryn & Dover, 2022) which limits their disclosure.

4.1. Limitations and future directions

Study findings should be interpreted in the context of limitations, which also pave the way for future directions. Firstly, whereas the study characterized gender and sexual orientation differences in disclosure via #MeToo, low sample sizes of other sexual orientation groups (‘asexual’) or gender groups (self-described as transgender) limited examination of individual group differences. Future studies would benefit from examining these differences to inform a comprehensive understanding of online disclosure processes. Secondly, online disclosure was examined by participation in only one movement i.e. #MeToo. However, the #MeToo movement has been criticized for almost exclusively focusing on experiences of sexual violence that impact largely white, cisgender, and heterosexual survivors (Ison, 2019; Kagal et al., 2019). It is possible that participants may have participated in other movements that ran parallel such as #UsToo or #NotOkay that may capture voices of survivors with marginalized identities. Future studies should assess participation in any online disclosure movement. In addition, it should also be noted that to be included in the study, participants needed to indicate an experience of sexual victimization since the age of 14. The study findings should be interpreted with this context in mind. It is unclear what percent of the current sample also experienced childhood victimization before the age of 14. Future studies with an explicit focus on disclosure of childhood sexual victimization are warranted. Thirdly, the measure of problem-solving coping had average internal reliability in the current sample which may contribute to non-significant results. Future studies should utilize improved measures of problem-solving coping. Fourthly, the study investigated individual and interpersonal level correlates of sexual victimization disclosure via #MeToo. Thus, future research should expand on current study findings and identify additional correlates, including other individual level correlates (e.g. age, race, time since assault, relationship with the perpetrator, history of child sexual abuse), interpersonal correlates (e.g. prior disclosure recipient) and societal correlates (e.g. cultural beliefs, stigma, geographic region) of online disclosure of sexual violence. Additionally, whereas the current study incorporated multiple methods to detect bots, studies using web-based recruitment strategies should incorporate additional methods (e.g. interaction with study staff) to improve detection of bots. Lastly, whereas the current study investigated the association between in-person disclosure and disclosure via #MeToo, the impact of responses received to in-person and online disclosure were not examined. Future studies would benefit from examining the impact of how others respond to in-person and online disclosure responses as a factor that influences the likelihood of subsequent disclosure. Along this vein, the impact of responses received to online disclosure on survivor’s well-being should also be investigated.

5. Conclusion

Sexual victimization is widely prevalent and associated with numerous consequences. Disclosure of sexual victimization plays an important role in recovery. With the increased use of social media, more survivors are disclosing sexual victimization online. The current study used the ecological model to identify correlates of online disclosure of sexual victimization via #MeToo. Results indicated that greater reported use emotion-focused coping was positively associated with disclosure via #MeToo. Further, individuals who experienced completed rape via verbal coercion were less likely to disclose via #MeToo. This is the first study that aimed to identify correlates of disclosure via #MeToo and lays direction for future studies. Thus, future research should focus on identifying additional correlates of online disclosure of sexual victimization. Future research is also required to examine the impact of online social reactions on survivor’s well-being.

Authors’ contributions

The first author Prachi H. Bhuptani was involved in the conceptualization of the study, data collection, data analysis, and writing. The second author Margarita Cruz-Sanchez was involved in data collection and writing. The last author Lindsay M. Orchowski was involved in study conceptualization, data collection, data analysis, and writing. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author, Prachi H. Bhuptani, upon reasonable request.