Injury from Sexual Assault: Addressing Health Disparity

描述（由申请人提供）：性侵犯是一种无声的暴力流行病，每年在美国估计有260万女性受到身体伤害；80万名妇女将因受伤而获得某种形式的保健。这种竞争性的延续应用建立在一个意想不到的发现之上，即在双方同意和非双方同意的性交中，黑人/非裔美国妇女的肛门生殖器损伤明显少于白人/高加索妇女。我们认为这些差异可以通过皮肤颜色造成的损伤可见度的变化来解释。如果能见度的差异导致深色皮肤妇女受伤的发生率较低，那么她们在医疗保健和法律体系中处于不利地位，因为她们的伤害得不到治疗，检察官也不太可能提出指控。目标包括确定：1)女性在未经同意的性侵犯后是否比女性在未经同意的性行为后有更大的发生率、频率和严重程度的与性交相关的非生殖器损伤；2)如果在对肤色的生物计量方法进行调整后，在肤色较深的种族/民族的妇女中，性交相关损伤不太可能被识别出来；3)如果在特定的解剖位置有一系列的损伤类型（撕裂、瘀斑、擦伤、红肿或撕裂）和严重程度，这是区分性侵犯受害者和双方自愿性交的女性的最好方法；并创建4)伤害图和生殖器伤害严重程度量表（GISS），这是临床医生可以用来评估缺乏同意的经验衍生工具。我们将前瞻性地招募400名双方同意的控制组，不同种族/种族的参与者将在双方同意的性行为后接受法医检查和数字成像。来自测试的数据将与来自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。精细生物识别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)在每个研究组中，实证检验皮肤颜色变量与非生殖器损伤患病率、频率和严重程度之间的关系；3)在控制肤色变量的情况下，比较自愿性群体和非自愿性群体的伤害相关特征；4)使用现代分类统计预测或区分合意与非合意群体成员；5)基于分类分析结果构建具有临床应用价值的损伤预测图。公共卫生相关性：暴力侵害妇女行为是一种无声的流行病。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.