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

描述（由申请人提供）：肤色在检测性侵犯中的皮肤损伤以及保护皮肤损伤方面起着独特的作用。我们发现，黑人和白色女性在自愿性交和性侵犯后肛门生殖器损伤的患病率存在显著差异，这可以用肤色而不是种族/民族更充分地解释。关于这种现象对美国最大的少数民族人口的普遍性知之甚少：拉丁美洲人。虽然在过去的20年里，DNA和毒理学样本的经验基础取得了重大进展，但在性侵犯方面，以法医学为基础的科学尚未在伤害方面取得进展。我们建议通过数字图像分析前瞻性地研究肛门生殖器损伤，在美国和波多黎各的200名拉丁裔自愿性交后，并将他们的伤害与200名拉丁裔性侵犯后的医疗记录中记录的伤害进行比较。我们将联合收割机这些数据与主要是黑人和白色妇女的样本（n=800）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的记录（N= 1，200），以实现以下目标：1）确定自愿参与者和性侵犯受害者中与性交相关的肛门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有过自愿性交的女性具有更多离散的数字图像特征（例如，损伤面积更大、形状更明确、位置更局部化、纹理与相邻区域更明显、比相邻区域更发红）; 3）确定种族/民族之间性交相关的肛门生殖器损伤的患病率、频率和严重程度的先前报道的差异是否将通过皮肤颜色的量化来解释; 4）调查肛门生殖器损伤是否作为皮肤力学的函数而显著变化（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，身体质量指数，阳光照射和健康状况）; 5）确定肛门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星座，最有效地区分那些经历了自愿性交与性侵犯的人。 公共卫生相关性：肛门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。用于收集强奸后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.