Injury in Latina Women after Sexual Assault: Moving Toward Health Care Equity

描述(由申请人提供)：肤色在检测性侵中的皮肤损伤方面发挥着明显的作用，甚至可能是保护皮肤免受伤害。我们发现，黑人和白人女性在两厢情愿的性行为和性侵犯后，无生殖器损伤的患病率存在显着差异，这可以更充分地由肤色而不是种族/民族来解释。关于这一现象对美国最大的少数群体--拉丁裔--的普适性，人们知之甚少。虽然DNA和毒物学样本的经验基础在过去20年中有了重大发展，但在性侵犯背景下以经验为基础的科学的发展并没有发生在伤害方面。我们建议通过数字图像分析来前瞻性地研究美国和波多黎各200名拉丁裔在两厢情愿的性行为后的无生殖器损伤，并将他们的损伤与200名拉丁裔在性侵后的医疗记录中记录的损伤进行比较。我们将把这些数据与以黑人和白人为主的女性(n=800)的样本相结合，并分析来自自愿参与者的大约36,000张数字图像和性侵犯受害者(N=1,200)的记录，以实现以下目标：1)确定自愿参与者和性侵犯受害者与性交相关的无生殖器损伤的发生率、频率和严重程度；2)确定性侵犯受害者是否比有两厢情愿的性行为的女性具有更离散的数字图像特征(例如，损伤面积更大，形状更清晰，位置更局部化，纹理与邻近区域更明显，比邻近区域更红)；3)确定以前报道的与性交相关的生殖器损伤的发生率、频率和严重程度在种族/民族之间的差异是否可以通过量化肤色来解释；4)调查非生殖器损伤是否因皮肤力学(皮肤弹性和皮肤水分)和可能决定表皮组织整体健康的因素(年龄、体重指数、阳光暴晒和健康状况)而有显著差异；5)确定无生殖器损伤的类型和位置、社会人口学和性交相关变量的星座，这些变量最有效地区分那些经历过两厢情愿的性侵的人。 与公共卫生相关：对无生殖器损伤的法医记录影响整个刑事司法程序的决策，特别是在从受害者报告到判刑的关键把关阶段。强奸后用于收集证据的法医检查需要对深色皮肤的女性和浅色皮肤的女性同样敏感。

DESCRIPTION (provided by applicant): Skin color plays a distinct role in the detection of and perhaps the protection from skin injury in sexual assault. We have found significant differences in ano-genital injury prevalence in Black and White females after consensual sexual intercourse and sexual assault that can be more fully explained by skin color than by race/ethnicity. Little is known about the generalizability of this phenomenon to the largest minority population in the US: Latinos. While major developments in the empirical basis of DNA and toxicology samples have occurred in the past 20 years, the development of empirically-based science in the context of sexual assault has not occurred with respect to injuries. We are proposing to study ano-genital injury prospectively through digital image analysis in 200 Latinas in the U.S. and Puerto Rico following consensual sexual intercourse, and compare their injuries to those documented in medical records of 200 Latinas following sexual assault. We will combine these data with a sample of predominantly Black and White women (n=800) and analyze approximately 36,000 digital images from consensual participants and records of sexual assault victims (N=1,200) to achieve the following aims: 1) determine prevalence, frequency, and severity of intercourse- related ano-genital injuries in consensual participants and sexual assault victims; 2) determine if sexual assault victims have more discrete digital image characteristics than women who have had consensual sexual intercourse (e.g., larger area of injury, better-defined shape, more localized location, texture more distinct from adjacent areas, more redness than adjacent areas); 3) determine if previously reported differences in the prevalence, frequency, and severity of intercourse-related ano-genital injury between racial/ethnic groups will be accounted for by quantification of skin color; 4) investigate if ano-genital injuries significantly vary as a function of skin mechanics (skin elasticity and skin hydration) and factors that could potentially determine the overall health of epidermal tissue (age, body mass index, sun exposure, and health status); 5) identify the constellation of ano-genital injury type and location, socio-demographic, and intercourse-related variables that most effectively differentiates those who experienced consensual intercourse versus sexual assault. PUBLIC HEALTH RELEVANCE: Forensic documentation of ano-genital injuries influences decision-making throughout the criminal justice process, especially at pivotal gate-keeping stages from victim reporting to sentencing. The forensic exam used to collect evidence after rape needs to be equally sensitive for females with dark skin as well as females with light skin.