Injury from Sexual Assault: Addressing Health Disparity

描述(申请人提供)：性侵犯是一种无声的、暴力的流行病，每年在美国估计有260万女性受到身体伤害；80万女性将因受伤而得到某种类型的医疗保健。这一相互竞争的延续申请建立在一个意想不到的发现之上，即在双方自愿和非自愿的性行为后，黑人/非裔美国女性发生的无生殖器损伤明显少于白人/高加索女性。我们认为，这些差异可以用皮肤颜色引起的损伤可见度的不同来解释。如果能见度的差异导致观察到的黑皮肤女性受伤发生率较低，那么她们在医疗保健和法律体系中处于不利地位，因为她们的受伤得不到治疗，检察官提出指控的可能性也较小。目标包括确定：1)非自愿性侵后的女性是否比自愿性交后的女性具有显著更高的与性交相关的生殖器损伤的患病率、频率和严重程度；2)在对肤色的生物测定测量进行调整后，是否不太可能在肤色较深的种族/民族的女性中识别与性交相关的伤害；以及3)在特定的解剖位置内是否存在一系列伤害类型(眼泪、瘀血、擦伤、红肿或泪水)和严重程度，以最好地区分性侵犯受害者与有过两厢情愿性行为的女性；并创建伤害地图和生殖器损伤严重程度量表(GISS)，这是临床医生可以用来评估缺乏同意的经验性工具。我们将前瞻性地招募400名自愿控制的参与者，他们是种族/种族多样化的，他们将在双方自愿的性行为后接受法医检查和数字成像。来自检查的数据将与对400名匹配的非自愿性侵幸存者的法医记录和数字图像进行回顾的数据进行比较。改进的生物成像技术的结果将使我们能够：1)创建生殖器损伤严重程度量表(GISS)；2)在每个研究小组中经验性地测试皮肤比色变量与非生殖器损伤患病率、频率和严重程度之间的关联；3)比较自愿和非自愿组的损伤相关特征，控制肤色变量；4)使用现代分类统计数据预测或区分自愿和非自愿组成员；以及5)基于分类分析结果构建具有临床实用价值的预测性损伤地图。公共卫生相关性：对妇女的暴力是一种无声的流行病。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): Sexual assault is a silent, violent epidemic that physically injures an estimated 2.6 million females in the U.S. ach year; 800,000 females will receive some type of health care as a result of their injuries. This competing continuation application builds on the unexpected finding that significantly fewer ano-genital injuries occurred n Black/African American women than in White/Caucasian women following both consensual and non- consensual sexual intercourse. We believe these differences can be explained by variation in visibility of injury due to skin color. If differences in visibility lead to lower observed prevalence of injury in women with dark skin, they are at a disadvantage within the healthcare and legal systems because their injuries are not treated and prosecutors are less likely to file charges. The objectives include determining: 1) if women after non-consensual sexual assault have a significantly greater prevalence, frequency, and severity of intercourse-related ano-genital injuries than women after consensual sexual intercourse; 2) if intercourse- related injuries are less likely to be identified in women of race/ethnicities with darker skin color after adjusting for biometrically-derived measures of skin color; and 3) if there is a constellation of injury types (Tears, Ecchymoses, Abrasions, Redness, Swelling, or TEARS) and severities within specific anatomical locations that best discriminates victims of sexual assault from women who have had consensual intercourse; and to create 4) an injury map and genital injury severity scale (GISS) that are empirically- derived tools that can be used by clinicians to evaluate lack of consent. We will prospectively enroll 400 Consensual Control, ethnically/racially diverse participants who will undergo a forensic exam and digital imaging following consensual sex. Data derived from the exam will be compared to data from a retrospective review of forensic records and digital images from 400 matched Non-consensual Sexual Assault Survivors. Results of refined biometric imaging techniques will allow us to: 1) create a genital injury severity scale (GISS); 2) empirically test the association between skin colorimetric variables and ano-genital injury prevalence, frequency, and severity within each study group; 3) compare Consensual and Non-consensual Groups in terms of their injury-related characteristics, controlling for skin color variables; 4) predict or differentiate Consensual versus Non-consensual Group membership using modern classification statistics; and 5) construct a predictive Injury Map with clinical utility based on the results of classification analyses. Public Health Relevance: Violence against women is a silent epidemic. 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.