Injury from Sexual Assault: Addressing Health Disparity

性侵犯造成的伤害：解决健康差距

• 批准号: 7433901
• 负责人: Marilyn S Sommers
• 金额: $ 62.01万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-05-01 至 2011-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7433901
• 关键词: Accident and Emergency department; Accounting; Address; African American; Appendix; Area; Biometry; Black race; Caucasians; Caucasoid Race; Characteristics; Charge; Classification; Clinic; Clinical; Coercion; Coitus; Collection; Color; Colposcopy; Confidence Intervals; Consent; Count; Crime; Data; Disadvantaged; Ecchymosis; Enrollment; Epidemic; Ethnic Origin; Ethnic group; Female; Forcible intercourse; Forensic Medicine; Frequencies; Future; Genital injury; Genital system; Healed; Health Sciences; Healthcare; Image; Image Analysis; Imaging Techniques; Injury; Intervention; Lead; Legal; Legal system; Light; Link; Location; Maps; Measurement; Measures; Melanins; Modeling; Numbers; Odds Ratio; Outcome; Participant; Penetration; Population; Prevalence; Progress Reports; Public Health; Race; Rate; Records; Redness; Reporting; Research Personnel; Sampling; Score; Sensitivity and Specificity; Series; Severities; Skin; Spectrophotometry; Standards of Weights and Measures; Structure; Surveys; Survivors; Swelling; Techniques; Testing; Time; Tolonium chloride; Variant; Victimization; Violence; Visual; Woman; Women' s Group; Work; base; clinically relevant; digital; digital imaging; experience; healing; health disparity; indexing; injured; innovation; instrument; novel; novel strategies; physical assault; prevent; prospective; racial and ethnic; racial/ethnic difference; sex; sexual assault; skin color; social; statistics; tool; violence against women

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.

描述（由申请人提供）：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； 800,000 名女性将因受伤而获得某种类型的医疗保健。这一竞争性的延续申请建立在意外发现的基础上，即在自愿和非自愿性交后，黑人/非裔美国女性发生的肛门生殖器损伤明显少于白人/白人女性。我们认为这些差异可以通过肤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女性受伤的发生率较低，那么她们在医疗保健和法律系统中就会处于不利地位，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）遭受非自愿性侵犯的女性与性交后的女性相比，与性交相关的肛门生殖器损伤的患病率、频率和严重程度是否显着更高； 2) 在调整肤色的生物统计测量值后，肤色较深的种族/族裔的女性是否不太可能发现与性交有关的伤害； 3) 特定解剖位置内是否存在一系列损伤类型（眼泪、瘀斑、擦伤、发红、肿胀或撕裂）和严重程度，可以最好地区分性侵犯受害者和自愿性交的女性； 4) 创建伤害地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是否同意的经验得出的工具。我们将前瞻性地招募 400 名具有不同种族/种族的自愿控制参与者，他们将在自愿性行为后接受法医检查和数字成像。检查得出的数据将与对 400 名匹配的非自愿性侵犯幸存者的法医记录和数字图像进行回顾性审查的数据进行比较。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）根据经验测试每个研究组内皮肤色度变量与肛门生殖器损伤患病率、频率和严重程度之间的关联； 3) 比较同意组和非同意组的伤害相关特征，控制肤色变量； 4) 使用现代分类统计来预测或区分共识组成员资格与非共识组成员资格； 5）根据分类分析的结果构建具有临床实用性的预测损伤图。公共卫生相关性：针对妇女的暴力行为是一种无声的流行病。用于在强奸后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。