Original article Lifetime History of Sexual Assault and Emergency Department Service Use among Women Veterans Mark W. Vander Weg, PhD a,b,c, * , Anne G. Sadler, PhD, RN a,d , Thad E. Abrams, MD, MS a,b,d , Kelly Richardson, PhD a , James C. Torner, PhD e,f , Craig H. Syrop, MD, MHCDS g , Michelle A. Mengeling, PhD a,b,h a Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa b Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa c Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa d Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa e Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa f Departments of Neurosurgery and Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa g Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa h VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System, Iowa City, Iowa Article history: Received 26 July 2019; Received in revised form 19 May 2020; Accepted 27 May 2020 abstract Background: Although sexual assault survivors are at increased risk for adverse physical and mental health outcomes and tend to use more health care services, little is known about women Veterans’ lifetime history of experiencing sexual assault (lifetime sexual assault [LSA]) and emergency department (ED) use. We sought to examine associations between experiencing LSA, mental health diagnoses, and ED use among women veterans. Methods: Computer-assisted telephone interviews were conducted with 980 women veterans enrolled at two Veterans Affairs (VA) Medical Centers to assess history of experiencing LSA, health care use, sociodemographic characteristics, and military history. Administrative data provided VA use, mental health, and medical diagnoses. Logistic regression analyses examined associations between experiencing LSA and mental health diagnoses and past 5-year ED use. Classification tree analysis characterized ED use in participant subgroups. Results: Sixty-four percent of participants visited a VA or non-VA ED during the previous 5 years. Women veterans with histories of mental health diagnoses and who experienced sexual assault had an odds of ED use almost two times greater than those with no history of experiencing sexual assault and no mental health diagnoses. The odds were similar for experiencing attempted (adjusted odds ratio, 1.85) and completed (adjusted odds ratio, 1.95) sexual assault. Clas- sification tree analysis identified reliance on VA care and the composite variable representing experiencing LSA and mental health diagnoses as factors that best discriminated ED users from nonusers. Conclusions: Experiencing LSA is associated with greater ED use in women veterans enrolled in the VA. Whether finding this reflects greater emergent health care needs, suboptimal access and treatment for conditions that could be managed in other settings, lack of health care coordination, or some combination of these factors is unclear. Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health. Sexual assault remains a pervasive public health problem. Nearly 2% of women in the United States report being sexually assaulted during the past 12 months, and 19% experience rape during their lifetime (Breiding et al., 2014). Other forms of sexual violence are also highly common, with 44% of women reporting that they experienced lifetime sexual traumas other than assault The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Devel- opment (HSR&D) Service grant: NRI 04-1941 (A. Sadler, PI). The content is solely the responsibility of the authors and does not necessarily represent the views of the Department of Veterans Affairs. The authors have no conflicts of interest to declare. Results were previously presented at the Academy Health 2019 Annual Research Meeting in Washington, DC. * Correspondence to: Mark W. Vander Weg, PhD, Center for Access & Delivery Research and Evaluation (CADRE) Iowa City VA Health Care System, 601 High- way 6 West, Mail Stop 152, Iowa City, IA 52246. Phone: (319) 338-0581; fax: (319) 887-4932. E-mail address: mark.vanderweg@va.gov (M.W. Vander Weg). 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.2020.05.003 Women's Health Issues xxx-xx (2020) 1–10