Article Trauma and Sexual Risk: Do Men and Women Veterans Differ? Joan L. Combellick, PhD, MSN a,b, * , James Dziura, PhD, MPH a,c , Galina A. Portnoy, PhD a,d , Kristin M. Mattocks, PhD, MPH e,f , Cynthia A. Brandt, MD, MPH a,g , Sally G. Haskell, MD, MS a,c a VA Connecticut Healthcare System, West Haven, Connecticut b Department of Midwifery, Yale School of Nursing, Orange, Connecticut c Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut d Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut e VA Central Western Massachusetts Healthcare System, Northampton, Massachusetts f Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts g Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut Article history: Received 30 August 2018; Received in revised form 19 April 2019; Accepted 22 April 2019 abstract Purpose: Trauma has been associated with risky sexual behavior in diverse populations. However, little is known about this association among men and women veterans. This study hypothesized that 1) a history of trauma would be associated with risky sexual behavior among men and women veterans, 2) interpersonal trauma would predict risky sexual behavior among women, whereas noninterpersonal trauma would predict risky sexual behavior among men, and 3) military-related trauma would constitute additional risk. Using data from 567 women and 524 men veterans enrolled at the Veterans Health Administration, this study investigated the association between trauma-related experiences and risky sexual behavior in the last 12 months. Risk and protective factors that have been frequently associated with sexual behavior in previous research were also included in the model. Methods: This study was drawn from the Women Veterans Cohort Study, a national survey of veterans. Bivariate and multivariate analyses were performed after multiple imputation for missing data. Results: Predictive factors associated with risky sexual behavior differed between men and women veterans. Among women, childhood sexual victimization and intimate partner violence were associated with risky sexual behavior. Among men, binge drinking was the single significant risk factor. Military exposures were not significantly associated with risky sexual behavior in either men or women. Conclusions: This study lays the groundwork for theory-generating research into the psychological underpinnings of noted associations and underscores the importance of integrated health services to address the range of issues affecting sexual behavior and related health outcomes. Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health. Risky sexual behavior has been associated with a range of traumatic experiences including childhood violence (Wilson et al., 2015), intimate partner violence (IPV; Cavanaugh, Hansen, & Sullivan, 2010), post-traumatic stress disorder (PTSD; Strom et al., 2012), childhood sexual abuse (Littleton, Grills, & Drum, 2014; Senn, Carey, Vanable, Coury-Doniger, & Urban, 2006), adult sexual assault (Littleton et al., 2014), and community violence (Yi, Poudel, Yasuoka, Palmer, Yi, & Jimba, 2010). Risky sexual behavior is generally defined as any behavior that increases the risk of adverse health outcomes, including sexually trans- mitted infections (STIs), cervical cancer, or unintended preg- nancy. This category typically includes behaviors such as sex without a condom, transactional sex, unintended sex related to drug and alcohol use, sex with many partners, concurrent sexual partners, and sex with partners who are at high risk for infection (Mirzaei, Ahmadi, Saadat, & Ramezani, 2016). The term “risky sexual behavior” does not a priori imply an act of personal volition or consent. Rather, the so-called risky The Women Veterans Cohort Study (WVCS) is supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Project [IIR 12-118]. Joan Combellick had full access to all the data in the study and takes re- sponsibility for the integrity of the data and accuracy of the data analysis * Correspondence to: Joan L. Combellick, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516. Phone: 914-329-3397. E-mail address: joan.combellick@va.gov (J.L. Combellick). www.whijournal.com 1049-3867/$ - see front matter Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health. https://doi.org/10.1016/j.whi.2019.04.014 Women's Health Issues 29-S1 (2019) S74–S82