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

描述（由申请人提供）：肤色在性侵犯中对皮肤损伤的检测和保护中起着独特的作用。我们发现黑人和白人女性在双方同意的性交和性侵犯后的非生殖器损伤发生率存在显著差异，这种差异可以用肤色而不是种族/民族更充分地解释。很少有人知道这种现象在美国最大的少数民族人口：拉丁美洲人身上的普遍性。虽然DNA和毒理学样本的经验基础在过去20年里取得了重大进展，但在性侵犯的背景下，以经验为基础的科学的发展并没有发生在伤害方面。我们建议通过对美国和波多黎各200名拉丁裔自愿性行为后的数字图像分析前瞻性研究非生殖器损伤，并将其与200名拉丁裔性侵犯后的医疗记录进行比较。我们将把这些数据与以黑人和白人女性为主的样本（n=800）结合起来，并分析大约36000张来自自愿性参与者和性侵犯受害者记录（n= 1200）的数字图像，以实现以下目标：1)确定自愿性参与者和性侵犯受害者中与性交相关的非生殖器损伤的患病率、频率和严重程度；2)确定性侵犯受害者是否比自愿性交的女性具有更离散的数字图像特征（例如，更大的损伤区域，更清晰的形状，更局部的位置，纹理与相邻区域更明显，比相邻区域更红）；3)确定以前报告的不同种族/民族之间性交相关的无生殖器损伤的患病率、频率和严重程度的差异是否可以通过肤色的量化来解释；4)调查无生殖器损伤是否随皮肤力学（皮肤弹性和皮肤水合作用）和可能决定表皮组织整体健康的因素（年龄、体重指数、日晒和健康状况）而显著变化；5)识别无生殖器损伤类型和位置、社会人口统计学和性交相关变量的组合，这些变量最有效地区分了那些经历了双方同意的性交和性侵犯的人。

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.