Injury from Sexual Assault: Addressing Health Disparity

性侵犯是一种无声的暴力流行病，每年在美国造成约260万女性的身体伤害; 80万女性将因其受伤而接受某种类型的医疗保健。该竞争性继续申请基于以下意外发现：在双方同意和非双方同意的性交后，黑人/非裔美国女性的肛门生殖器损伤显著少于白色/高加索女性。我们认为这些差异可以通过皮肤颜色导致的损伤可见度的变化来解释。如果可见度的差异导致深色皮肤妇女的受伤率较低，那么她们在医疗保健和法律的系统中处于不利地位，因为她们的受伤得不到治疗，检察官也不太可能提出指控。目的包括确定：1）非自愿性侵犯后的女性是否比自愿性行为后的女性具有显著更高的性交相关的肛门生殖器损伤的患病率、频率和严重程度; 2）在调整生物统计学衍生的肤色测量后，在肤色较深的种族/民族的女性中是否不太可能识别性交相关的损伤;以及3）如果有一系列的伤害类型（眼泪、瘀斑、擦伤、发红、肿胀或眼泪）和特定解剖部位的严重程度，这些部位最能区分性侵犯受害者和自愿性交的妇女;并创建4）一个损伤地图和生殖器损伤严重程度量表（GISS），这是经验-衍生工具，可供临床医生使用，以评估缺乏同意。我们将前瞻性地招募400名自愿对照、种族/种族多样化的参与者，他们将在自愿性行为后接受法医检查和数字成像。来自检查的数据将与来自400名匹配的非自愿性侵犯幸存者的法医记录和数字图像的回顾性审查数据进行比较。精细生物成像技术的结果将使我们能够：1）创建一个生殖器损伤严重程度量表（GISS）; 2）经验性地测试皮肤色度变量与每个研究组内的肛门生殖器损伤患病率，频率和严重程度之间的关联; 3）比较自愿和非自愿组在其损伤相关特征方面，控制肤色变量; 4）使用现代分类统计来预测或区分自愿与非自愿的组成员资格;以及5）基于分类分析的结果构建具有临床实用性的预测性损伤图。公共卫生相关性：暴力侵害妇女行为是一种无声的流行病。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): 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.