Lifetime Economic Burden of Rape Among U.S. Adults

Explaining the Unexplainable: Balancing Responsibility, Expectations, and Identity in Narratives of Sexual Recidivism

When someone is caught and punished for a sexual offense, recidivism prevention is of high priority. While a growing body of qualitative research has investigated the desistance process of those who have sexually offended, few studies have examined the narratives of individuals who have sexually recidivated in order to understand how they make sense of their reoffending. This study aims to fill this gap in the literature by exploring the recidivism process and broader life stories of 16 imprisoned men through semi-structured interviews. The results demonstrate how these men explain their recent "failures," the obstacles they face when doing so, and how they attempt to overcome these obstacles in their narratives. Thus, the analysis in this study is both thematic and narrative. Finally, the findings' practical implications are discussed to show how ambiguity in narratives can be a powerful tool in correctional and clinical interventions.

Associations Between Contents of Pornography and Sexual Satisfaction and Function Among Young Adults

Pornography offers a wide variety of sexual contents and has documented potential positive (e.g., higher sexual satisfaction) and negative associations (e.g., lower sexual function) with sexuality. The aims of this study were to describe the proportion of use of five different contents of pornography (i.e. group sex, passion and romance, gender-bending, taboo transgression and forbidden sex, power, control, and rough sex pornography), to examine gender-based differences in the frequency of use of these contents, and to examine the associations between the frequency of use of these contents and sexual satisfaction and function, considering potential differences among genders and individuals with and without a romantic or sexual partner, and controlling for frequency of masturbation. A sample of 827 young adults (503 women; Mage = 23.44) completed online self-report questionnaires. Results of path analysis indicated that, controlling for frequency of masturbation, the use of passion and romance pornography was associated with higher sexual satisfaction, whereas the use of power, control, and rough sex pornography was associated with lower sexual satisfaction. Cisgender men's use of power, control, and rough sex pornography was also associated with lower sexual function. These findings suggest different associations between pornography use and sexual satisfaction and function depending on the pornographic contents used.

Measures Assessing Barriers and Facilitators to Post-Sexual Violence Services: A Critical Review

Sexual violence (SV) is a significant public health problem associated with poor health, social, and economic outcomes. Although services exist to support survivors of SV, many do not access these services. This critical review examines measures used to assess barriers and facilitators to post-SV services and whether these measures address the full breadth of concerns among SV survivors, particularly those who hold marginalized identities. Eligible studies had to be original and peer-reviewed, include a measure of barriers or facilitators to service-seeking, and focus on SV survivors. We reviewed 10 measures that assessed barriers and/or facilitators to mental health, medical, advocacy, and legal services among SV survivors. These measures were designed for and/or applied to survivors of intimate partner violence, human trafficking, military sexual trauma, child sexual abuse, and adult sexual assault. Populations sampled included college students, military personnel, gender and sexual minority youth, women living with HIV, and crime victims seeking legal services. Using a social-ecological model approach, we assessed barriers at the individual, interpersonal/community/provider, and structural/organizational levels. Barriers at the community level were largely absent, and only three measures addressed facilitators. Five measures provided some psychometric data with survivors, and only three incorporated survivor feedback in their development. Four measures included some cultural and/or identity-specific factors. Future research should prioritize the development of trauma- and violence-informed measures that incorporate survivor feedback and address diverse cultural and identity contexts to improve service access and utilization.

Acceptability of Forensic Sexual Assault Telehealth Consultation

Introduction: Telehealth shows promise in increasing access to specialty care for individuals who experience sexual assault. Methods: This study analyzed 466 cases from rural and urban hospitals between September 2018 and March 2024, examining telehealth acceptability rates and reasons for declination. Of 362 eligible cases, 89.5% accepted telehealth consultation. Among those who declined, 65.8% were not given the opportunity to interact with a telehealth sexual assault nurse examiner (teleSANE) during decision-making. Results: These findings indicate high acceptability of forensic sexual assault telehealth and suggest that providing patients the opportunity to interact with teleSANEs before deciding may further increase acceptance. Conclusion: The study contributes to understanding telehealth's viability for sexual assault care across diverse settings and demographics, supporting the potential of teleSANE programs to enhance equitable access to specialty care, particularly in underserved areas. This research addresses gaps in existing literature by exploring acceptability in a wide range of settings, demographics, and circumstances.

Veterans who focus on sexual assault trauma show slower between-session habituation and symptom reduction during prolonged exposure treatment for posttraumatic stress disorder

OBJECTIVE

Prolonged exposure (PE) is an effective treatment for posttraumatic stress disorder (PTSD), but veterans with sexual assault (SA) trauma often discontinue it prematurely. Elevated dropout rates may be due to SA triggering more intense and complex emotions that are more difficult to habituate during imaginal exposures; SA during PE has yet to be examined as a moderator of distress habituation or symptom reduction.

METHOD

Participants were N = 65 veterans (n = 12 SA treatment focus; n = 10 SA history but not treatment focus; n = 43 no SA history) enrolled in a clinical trial of a preparatory sleep intervention followed by PE. The sample was representative of the veteran population. Growth curve modeling was used to examine differences in peak subjective units of distress scale (SUDS) ratings across imaginal exposures and changes in biweekly PTSD symptom assessments between veterans who did versus did not focus on SA during PE and between veterans who did versus did not endorse a history of SA.

RESULTS

Peak SUDS ratings and PTSD symptoms declined slower among veterans who focused on an SA trauma relative to those who did not. In contrast, participants who endorsed SA history showed similar declines in distress and PTSD symptoms relative to veterans with no SA history.

CONCLUSIONS

Veterans who focus on SA during PE may take longer to habituate to trauma content and experience resolution of PTSD symptoms. Awareness of this pattern could allow clinicians to deliver PE more effectively to veterans focusing on an SA trauma. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Lost Prevention? Assessing Secondary and Tertiary Prevention Potential in Sexual Assault Awareness Month Events

During Sexual Assault Awareness Month (SAAM), nonprofits place heavy value on delivering events, often with little evidence of their value to tertiary, secondary, and primary prevention. This multiple case design employed ethnographic methods to assess five SAAM events and the logic by which they contribute to prevention. Articulated through a pairing of communication and planned behavior theories, the findings indicated that events were mainly deployed in service of today's survivors, almost as an extension of intervention programming. Art exhibits, panel discussions, and group activities centered on survivor stories. The events' functions were not to prevent future sexual assault or target perpetrator accountability but, instead, to increase awareness of survivor impact.

Evaluating Personal Safety Within the LGBTQIA+ Campus Community: A Needs Assessment

BACKGROUND

Violence against sexual and gender minorities is a significant concern on university campuses.

METHODS

A needs assessment self-report survey was administered to LGBTQIA+ university campus community members to assess perceptions of vulnerability, interest in, and beliefs related to personal safety/self-defense (PS/SD) training at a public Midwestern university.

RESULTS

Forty-three LGBTQIA+ campus community members responded to the survey. Thirty-six percent of those surveyed reported a history of physical or sexual interpersonal violence. Respondents reported being fearful or occasionally fearful for their personal safety in a variety of day-to-day situations surveyed. Using rideshares, going out alone after dark, and going to parties were some of the most frequently feared situations. Most, 73%, believed that PS/SD training would increase their feelings of overall safety and would improve their ability to defend themselves, with up to 66% expressing interest in attending PS/SD training held in a format of 2-hour sessions occurring weekly.

CONCLUSIONS

This survey supports the need for inclusive and accessible PS/SD training tailored to the specific needs of LGBTQIA+ university campus community members to enhance campus safety.

Economic Impacts of Technology-Facilitated Abuse Among U.S. Young Adults

Technology-facilitated abuse (TFA) can result in long-term financial and mental health impacts on survivors. However, little research has been published to date about the types of costs and the economic burden that survivors of TFA experience. This study presents results from a U.S. nationally representative sample of young adults aged 18 to 35 on financial cost experienced as a result of TFA, including findings of healthcare utilization and associated healthcare costs. Respondents who reported experiencing one or more forms of TFA were asked about the lifetime health and economic impacts of the TFA. Nearly one in five TFA survivors (18.2%) reported experiencing an economic cost from the TFA, with a median total cost of $900 USD. There was a significant difference in the likelihood of reporting a financial cost among TFA survivors by race/ethnicity, TFA exposure, average use of online sites/apps, and the number of sites/apps used. Financial fraud, technology, and housing costs were the most common types of cost reported. More than 1 in 10 survivors (11.3%) reported receiving mental health counseling related to the TFA, with a per-person total cost estimate of $6,228 USD from mental health counseling. A similar proportion (11.6%) of TFA survivors reported taking one or more prescribed medications to manage the impact of the TFA, with an average duration of 37.4 weeks of use. Older age, identifying as non-Hispanic Black/African American or Hispanic/Latino/a/x, identifying as a sexual or gender minority, and greater TFA severity were associated with higher financial cost reported. Findings present novel information on the economic and psychological harms associated with TFA and indicate the importance of access to mental health and financial support services for TFA survivors.

How Many Terms Does It Take to Define Sexual Assault? Inconsistencies in U.S. Higher Education Sexual Misconduct Policies

Campus sexual misconduct policies (SMPs) outline prohibited conduct. We sought to document the range of terms used to refer to forms of nonconsensual sexual contact in SMPs and to analyze the content of definitions provided for the term "sexual assault." We coded the 2016-2017 SMPs from a sample of 381 U.S. schools. We identified 125 unique terms and documented both a terminological and conceptual morass around sexual assault. Policy language may have implications for students' and administrators' evaluation of experiences and reports of sexual assault.

Predictors of the Onset of Sexual Violence Perpetration in Adolescence and Emerging Adulthood

To identify factors in adolescence that predict the onset of sexual violence in adolescence and young adulthood. Data were analyzed from six survey waves of the longitudinal Growing up with Media Study (2008-2018) conducted in the USA. Participants were 778 youth 13-18 years old at baseline, who completed online surveys assessing sexual violence behaviors and predictors. Sexual violence perpetration behaviors included sexual assault, rape, attempted rape, and coercive sex. Only 2% of females and 3% of males reported their first sexual violence perpetration by age 14. In contrast, by age 18, 6% of females and 12% of males had perpetrated their first sexual violence. For both males and females, the rate of the onset seems to plateau by age 22. Predictors of the onset of sexually violent behavior for those who began perpetrating when they were 14-17 years old were largely similar to those who began perpetrating when they were 18-25 years old. Alcohol plus other substance use, aggressive and delinquent behavior, caregiver monitoring, behavior problems at school, externalizing peers, exposure to community violence, and exposure to violent media were all implicated. Early prevention-well before college and perhaps even before high school-is needed to have an impact on the onset of sexual violence perpetration, as most perpetrators of sexual violence will have acted for the first time by age 23. Several modifiable risk factors observed in adolescence could signal the opportunity for targeted prevention to reduce the odds of onset of sexual violence.

Reactions to and Impact of Survivor Online Disclosures: A Qualitative Analysis

Social reactions to disclosure of sexual victimization play an important role in the process of recovery. The purpose of this qualitative study was to explore the impact of online disclosure of sexual victimization. The sample for this qualitative study (n = 17) focused on participants who shared their experiences with disclosing about their sexual victimization online and the reactions received in these spaces. Using applied thematic analysis, the research team identified three major themes from the data, each with respective subthemes, including helpful, harmful, and mixed reactions to online disclosure. Findings highlighted the nuances of disclosing online and the diverse reactions that were received. Participants provided in-depth descriptions of not only how the disclosure experience and resulting reactions could be helpful or harmful but also nuanced, mixed, and simultaneously harmful and helpful. This data is a crucial reminder that survivors' stories are unique and that survivors experience many varying motivations for choosing if, when, where, to whom, or for whom they may disclose. The findings may help inform clinical recommendations for mental health practitioners working with survivors of sexual victimization and holding therapeutic space to process these decisions of disclosure. Future researchers should also consider further studying online interactions, especially within and between survivors, including when and how survivors choose to connect or disconnect.

Improving Access to Community-Based Services for Sexual Assault Survivors

BACKGROUND

Emergency department (ED) encounters are often the only healthcare provider encounter for patients seeking care after a reported sexual assault (SA), making the encounter a crucial opportunity to connect patients to support services in the community. An opportunity existed at an urban Level II trauma center to standardize SA discharge planning.

AIMS

This quality improvement project aimed to improve access to SA support services.

METHODS

The Model for Improvement guided two plan-do-study-act (PDSA) cycles. Implementation included (a) creation of a QR-code-accessible SA resource website, (b) ED standardized patient print and electronic medical record after-visit summaries with follow-up guidelines and the QR code, (c) ED staff education, and (d) a community stakeholder survey to assess facilitators and barriers to support services.

RESULTS

During the first PDSA cycle, 19 reported SA survivors were seen in the ED (18 adult, one pediatric) and 14 SA resource website visits. During the second PDSA cycle, 13 reported SA survivors (10 adult, three pediatric) were seen in the ED and 29 website visits. Stakeholder survey data revealed barriers to support services were transportation, overloaded support services, and survivor knowledge of existing services.

CONCLUSION

The QR code intervention model is a discrete method of improving access to resources and is applicable to other vulnerable populations. The multiagency SA response team will utilize partner survey data to improve access to community resources such as housing and transportation.

Experiences of Sexual Assault and Financial Stability: Sense of Control as a Potential Mechanism

This investigation utilized the Midlife in the United States Survey (N = 3,258) to assess the relationships between sexual assault, sense of control, and financial stability. Age of first sexual assault and sexual assault revictimization were also considered in analyses of sexual assault survivors' data. Results revealed consistent associations between experiences of sexual assault and revictimization with lower financial stability and suggest that sense of control may be an indirect mechanism linking these variables. Findings have policy relevance and practical implications for practitioners. Restoring sexual assault victims' internal loci of control may promote more positive financial outcomes.

Global prevalence of non-partner sexual violence against women

Sexual violence against women is a human rights violation and public health concern, with serious implications for women's physical and mental health. Reducing non-partner sexual violence, including rape, sexual assault and other forms of non-contact sexual abuse, is one of the main indicators of the sustainable development goals. World Health Organization estimates, based on available prevalence data from 137 countries between 2000 and 2018, showed that, globally, 6% of women aged 15-49 years reported experiencing sexual violence in their lifetime from someone other than an intimate partner, with prevalence rates varying across regions. However, the reporting, measurement and documentation of the global extent of non-partner sexual violence against women is methodologically challenging, resulting in a gross underestimation of its magnitude and impact. To prevent and respond to this issue, policy-makers must consider interventions on education, access to relevant health-care services, public awareness, and effective and comprehensive legislation. To better estimate the prevalence of both sexual violence overall and non-partner sexual violence, it is essential to continue to strengthen the measurement of non-partner sexual violence, including the types of acts asked about and the mode of interviewing. Further research is needed to understand the cumulative impact of different forms of sexual violence on the lives of women and girls, including sexual violence during childhood and its associated risk with further exposure. Funding is required for more research and implementation of interventions to prevent and reduce all forms of violence against women and girls, including sexual violence.

Sexual assault and the matrix of harm: Sexual assault survivors narrate their whole lives in more negative ways

This paper uses data from the American Voices Project, an interview study based on a random population sample, to explore the relationship between assault experiences and how people narrate their lives. Using quantitative sentiment analysis, we find that survivors of assault express significantly greater negative sentiment when asked to tell their life stories. These negative sentiments are observable throughout the entire interview, including before questions of assault are asked. Survivors of assault narrate their experiences with more anger, disgust, fear, and sadness, and less anticipation, joy, and trust than those who do not report assault experiences. We provide evidence that the negative sentiment associated with sexual violence is greater than having lost a parent and less than having experienced a significant financial hardship within the last month. We contextualize these findings with a qualitative evaluation of the interview transcripts, further substantiating our finding. Overall, this paper suggests that sexual violence is part of what we have called, drawing inspiration from the work of Beth Richie, a "matrix of harm" that structures people's lives. While our finding is consistent with what we might expect given the negative life experiences and sequalae associated with sexual assault, it has important implications. Sentimental differences in narrating life experience are an important yet relatively understudied phenomenon, and experiences of assault are rarely asked about yet may be consequential to both quantitative and qualitative accounts of social processes.

Development of a brief bedside tool to screen women sexual assault survivors for risk of persistent posttraumatic stress six months after sexual assault

This study aims to develop and validate a brief bedside tool to screen women survivors presenting for emergency care following sexual assault for risk of persistent elevated posttraumatic stress symptoms (PTSS) six months after assault. Participants were 547 cisgender women sexual assault survivors who presented to one of 13 sexual assault nurse examiner (SANE) programs for medical care within 72 h of a sexual assault and completed surveys one week and six months after the assault. Data on 222 potential predictors from the SANE visit and the week one survey spanning seven broadly-defined risk factor domains were candidates for inclusion in the screening tool. Elevated PTSS six months after assault were defined as PCL-5 > 38. LASSO logistic regression was applied to 20 randomly selected bootstrapped samples to evaluate variable importance. Logistic regression models comprised of the top 10, 20, and 30 candidate predictors were tested in 10 cross-validation samples drawn from 80% of the sample. The resulting instrument was validated in the remaining 20% of the sample. AUC of the finalized eight-item prediction tool was 0.77 and the Brier Score was 0.19. A raw score of 41 on the screener corresponds to a 70% risk of elevated PTSS at 6 months. Similar performance was observed for elevated PTSS at one year. This brief, eight-item risk stratification tool consists of easy-to-collect information and, if validated, may be useful for clinical trial enrichment and/or patient screening.

Child sexual abuse versus adult sexual assault: A review of psychological and neurobiological sequelae

Sexual trauma (ST) occurs with alarming frequency in the United States (U.S.) in the form of both childhood sexual abuse (CSA) and adulthood sexual assault (ASA). It is well-established that the effects of ST are pervasive, and that ST can be a risk factor for the development of several psychiatric disorders. However, the potential for distinct psychological consequences or neural correlates between CSA and ASA has received little attention. Furthermore, despite the high prevalence of sexual revictimization, the combinatorial effects of CSA and ASA are understudied in comparison to each form of ST on its own. In the current review, we present results from both clinical psychology and neuroscience research on the impacts of CSA and ASA, describing major psychological, biopsychosocial, and neuroimaging findings for each form of ST. We further highlight limitations in the current state of the research and needed areas of future research to better understand the distinct, overlapping, and cumulative effects of ST in both childhood and adulthood. The present study summarizes the state of the literature on this critical form of trauma and provides recommendations for future clinical research practices to mitigate the deleterious outcomes of ST.

Pilot Study of SATELLITE Education on Nurses' Knowledge and Confidence toward Assessing and Caring for Female Victims of Sexual Violence

Sexual violence (SV) can deeply impact victims' physical and psychosocial well-being. Yet many healthcare providers, including registered nurses (RNs), hesitate to screen patients due to a lack of confidence and knowledge. The SATELLITE Sexual Violence Assessment and Care Guide was developed to address this gap; however, the guide's educational effectiveness remained untested. This pilot study aimed to assess the feasibility, acceptability, and efficacy of an education program based on the SATELLITE guide among RNs in clinical settings (n = 8), using a pre- and post-test design. Results indicated that the education was not only feasible and acceptable, but also demonstrated the effects as desired with significant increases in RNs' knowledge and confidence in SV screening and care. The program's assessment tool was reliable, and participant recruitment was feasible. Based on these findings, it is recommended that the SATELLITE education program be further tested with a larger RN sample and extended to other healthcare providers. Additionally, exploring SATELLITE's use in different regions, cultural contexts, and healthcare settings would enhance understanding of the program's broader applicability and effectiveness.

Alcohol's Effects on the Bystander Decision-Making Model: A Systematic Literature Review

To decrease rates of sexual assault victimization, young people are encouraged to become involved when they see questionable sexual situations (i.e., be a prosocial bystander). Several factors can facilitate or inhibit intervention, including alcohol use. To inform bystander prevention programs that aim to address alcohol's impact on bystanders, the current study reviewed research focused on alcohol use and bystander decision making. In December 2022, the authors searched published studies from six major electronic databases. Empirical articles were deemed eligible if they examined alcohol and the bystander decision-making model within the context of sexual assault, were based in the United States or Canada, and not an intervention study; 32 studies were included in the final review. Across 32 studies published between 2015-2022, 12 assessed the proximal effects of alcohol on bystander constructs and the additional studies examined the distal effects of alcohol on bystander constructs. Alcohol use appeared to impede earlier steps of the bystander decision-making model; however, alcohol use was associated with impeding and facilitating bystander decision making at the latter half of the model. Overall, alcohol use appears to be negatively rather than positively associated with bystander constructs. Bystander intervention programs may want to move beyond the narrative of alcohol as a risk factor for sexual assault and discuss how alcohol impairs a bystanders' ability to recognize risk. More work is needed to ensure researchers assess alcohol consistently and with similar methods (number of drinks, subjective intoxication) to increase generalizability of findings to prevention programs.

A Systematic Review of Evidence-Based Treatments for Adolescent and Adult Sexual Assault Victims

BACKGROUND

Sexual assault (SA) is a serious crime that is a prevalent mental and public health problem.

AIMS

Addressing the needs of SA victims and providing appropriate treatment are essential to reduce potential adverse short- and long-term outcomes.

METHODS

Our team undertook an extensive systematic literature review (published between January 2006 and July 2021) to provide evidence-based mental health intervention recommendations for adolescent and adult victims of SA. Where SA-specific research was limited, the literature and clinical practice guidelines on treatments for trauma-induced post-traumatic stress disorder (PTSD) were reviewed to provide additional information to formulate recommendations.

RESULTS

Findings strongly support several primary psychotherapy treatments: cognitive behavioral therapy, cognitive processing therapy, eye movement desensitization and reprocessing, narrative exposure therapy, and prolonged exposure therapy. Complementary (aerobic exercise, art, drama, and music therapy) and pharmacological treatments were explored.

CONCLUSIONS

Mental health nurses who provide services for victims of SA can utilize this overview to guide recommendations for treatment of SA trauma and related PTSD symptoms to mitigate the short- and long-term negative impacts after a traumatic event. When victims of SA receive optimal mental health treatments, our communities benefit as victims heal and recover.

Disclosing Sexual Victimization Online and In-Person: An Examination of Bisexual+ and Heterosexual Survivors

Bisexual+ (bisexual, pansexual, queer, attraction to more than one gender) people are at elevated risk for sexual victimization relative to their heterosexual counterparts. Disclosure of sexual victimization and social reactions received upon disclosure can play a major role in recovery following an assault. Using an online survey, the current study examined whether bisexual+ and heterosexual survivors of sexual victimization (N = 657) varied in disclosure of victimization, the type of disclosure (in-person vs. online via #MeToo), and receipt of various social reactions to disclosure in person and online. A chi-square test examined differences in disclosure and differences in types of disclosure (in-person only vs. MeToo across sexual identity). MANOVAS were used to examine whether in-person and online reactions varied across sexual identity. Bisexual+ survivors were more likely to disclose sexual victimization relative to heterosexual survivors. Among those who disclosed, bisexual+ survivors were more likely to disclose in person only whereas heterosexual survivors were more likely to disclose online via #MeToo. Whereas we did not find any significant differences for in-person reactions, we did find significant differences for online social reactions using #MeToo. Heterosexual survivors received higher turning against reactions (e.g., avoided talking to you or spending time with you) and more unsupportive acknowledgment relative to bisexual+ participants. Whereas bisexual+ participants received less turning against reactions and unsupportive acknowledgment during #MeToo/online disclosure, they were also less likely to disclose using #MeToo. Findings suggest that bisexual+ and heterosexual people vary in the way they disclose sexual victimization, and in how they are responded to when disclosing in person and online.

Health-Related Costs of Intimate Partner Violence: Using Linked Police and Health Registers

This study aims to estimate direct health-related costs for victims of intimate partner violence (IPV) using nationwide linked data based on police reports and two healthcare registers in Finland from 2015 to 2020 (N = 21,073). We used a unique register dataset to identify IPV victims from the data based on police reports and estimated the attributable costs by applying econometric models to individual-level data. We used exact matching to create a reference group who had not been exposed to IPV. The mean, unadjusted, attributable healthcare cost for victims of IPV was €6,910 per individual over the 5-year period after being first identified as a victim. When adjusting for gender, age, education, occupation, and mental-health- and pregnancy-related diagnoses, the mean attributable health-related cost for the 5 years was €3,280. The annual attributable costs of the victims were consistently higher than those for nonvictims during the entire study period. Thus, our results suggest that the adverse health consequences of IPV persist and are associated with excess health service use for 5 years after exposure to IPV. Most victims of IPV were women, but men were also exposed to IPV, although the estimates were statistically significant only for female victims. Victims of IPV were over-represented among individuals outside the labor force and lower among those who were educated. The total healthcare costs of victims of IPV varied according to the socioeconomic factors. This study highlights the need for using linked register data to understand the characteristics of IPV and to assess its healthcare costs. The study results suggest that there is a significant socioeconomic gradient in victimization, which could also be useful to address future IPV prevention and resource allocation.

Pranks, Obscene Chatters, and Ambiguous Content: Exploring the Identification and Navigation of Inappropriate Messages to a Web-Based Sexual Assault Hotline

Sexual assault crisis hotlines provide crucial support for survivors. Though some hotline users engage in inappropriate conduct (e.g. prank or obscene calls), few studies explore these interactions. To address the lack of literature exploring inappropriate hotline interactions, we conducted a secondary data analysis of chat transcripts (n = 233) shared with the research team as part of the formative evaluation of a university-based sexual assault program's web-based crisis hotline. From those transcripts, we analyzed potentially inappropriate interactions (n = 38), most of which (n = 28) hotline responders flagged as inappropriate in post-chat log forms. We used codebook thematic analysis to explore how hotline responders identified and navigated these interactions. Our analysis generated three themes describing the processes through which responders seemed to identify potentially inappropriate chats - detecting implausibly graphic and abusive content, identifying patterns of presumably inauthentic chat topics, and interpreting ambiguous content. Hotline responders seemed to navigate ambiguous and less egregious boundary violations by gently redirecting conversations, and addressed clearer violations by setting firm, direct boundaries. Chatters responded to boundary setting by desisting and disconnecting or attempting to reengage responders. Findings highlight ambiguities and challenges web-based sexual assault hotline responders face and suggest a need for additional responder support, training, and debriefing options.

Systematic Review of Per Person Violence Costs

INTRODUCTION

Data on the long-term and comprehensive cost of violence are essential for informed decision making regarding the future benefits of resources directed toward violence prevention. This review aimed to summarize original per-person estimates of the attributable cost of interpersonal violence to support public health economic research and decision making.

METHODS

In 2023, English-language peer-reviewed journal articles published in 2000-2022 with a focus on high-income countries reporting original per-person average cost of violence estimates were identified using index terms in multiple databases. Study contents, including violence type (e.g., adverse childhood experiences), timeline and payer cost perspective (e.g., hospitalization event-only healthcare payer cost), and associated per-person cost estimates, were summarized. Costs were in 2022 U.S. dollars.

RESULTS

Per-person cost estimates related to adverse childhood experiences, community violence, sexual violence, intimate partner violence, homicide, firearm violence, youth violence, workplace violence, and bullying from 73 studies (majority focusing on the U.S.) were summarized. For example, among 23 studies with a focus on adverse childhood experiences, monetary estimates ranged from $390 for adverse childhood experience-related annual healthcare out-of-pocket costs per U.S. adult with ≥3 adverse childhood experiences to $20.2 million for the lifetime societal economic burden of a U.S. child maltreatment fatality.

CONCLUSIONS

This review provides a descriptive summary of available per-person cost of violence estimates. Results can help public health professionals to describe the economic burden of violence, identify the best available estimate for a particular public health question, and address data gaps. Ultimately, understanding the long-term and comprehensive cost of violence is necessary to anticipate the economic benefits of prevention.

The association between alcohol use and sexual assault victimization among college students differs by gender identity and race

PURPOSE

Alcohol use and sexual assault (SA) are common on college campuses. The purpose of this study is to examine if the association between alcohol use and SA differs by gender identity, sexual orientation, race, or ethnicity.

METHODS

A total of 3,243 college students aged 18-25 at two large, minority-serving, public universities in the southwest and southeast United States completed an online survey about alcohol and sexual behaviors. Two negative binomial regressions were conducted to examine main effects and interaction effects.

RESULTS

Almost half of the sample reported a SA victimization history. The main effects negative binomial regression indicated that more drinks per week, older age, identifying as a cisgender woman (vs. cisgender man), identifying as a gender minority (vs. cisgender man), and identifying as a sexual minority (vs. heterosexual) were associated with more severe SA victimization. Participants who identified as Latine (vs. non-Latine White) reported less severe SA. The negative binomial regression assessing interactions indicated that the association between alcohol use and SA severity was stronger among cisgender women and gender minority identities than cisgender men, and Black identities than non-Latine White identities.

CONCLUSION

Findings suggests that alcohol use is an important factor for SA severity among all students, but that the association is stronger among some with marginalized identities. Given that perpetrators target people who hold some marginalized identities, prevention programming could address cisnormative, heteronormative, and White normative ideas about alcohol and sex to attain social justice and health equity.

Role of Alexithymia in the Association Between Childhood Abuse and Risk Perception for Sexual Victimization in College Women

Sexual victimization is prevalent among college women with a history of childhood abuse (CA), which some research suggests is linked to impaired risk perception for sexual victimization or difficulties identifying and responding to unwanted sexual advances. Alexithymia is one construct yet to be examined in the association between CA and risk perception for sexual victimization. The purpose of this study was to elucidate the associations between CA, alexithymia, and risk perception for sexual victimization in a sample of college women with a history of CA. Participants included 294 undergraduate women with a history of childhood emotional, physical, and/or sexual abuse (Mage = 20.6, 80.6% White). An a priori path analysis was conducted to examine whether alexithymia indirectly explains the association between CA and risk perception for sexual victimization (i.e., comprising two related constructs, including threat detection and behavioral response to threat). Supplementary analyses were conducted post hoc to examine potential differences across CA subtypes (emotional, physical, and sexual). Alexithymia indirectly explained the relationship between CA and threat detection, and behavioral response to threat. However, indirect effects were negative, suggesting that undergraduate women with more severe CA and alexithymia identify sexual assault threat cues and intentions to "leave" a hypothetical sexual assault scenario sooner rather than later. The same pattern of results was observed for emotional and physical (but not sexual) CA when examining their indirect effects on threat detection, and for emotional CA when examining behavioral response to threat. Findings contribute to the literature on sexual victimization by clarifying the role of alexithymia in risk perception for sexual victimization. Results also highlight the potential utility of increasing emotional literacy among college women with a history of CA (and especially emotional abuse) to facilitate adaptive responding to unwanted sexual advances.

Acceptability of a smartphone-based intervention targeting anxiety sensitivity among women receiving emergency care after sexual assault: A pilot uncontrolled trial

Anxiety sensitivity (AS), defined as the fear of anxious arousal, is a promising therapeutic target to reduce posttraumatic stress disorder (PTSD) symptom development after trauma exposure. Computerized AS interventions have been shown to be acceptable to individuals with PTSD symptoms and effective in achieving symptom reduction; however, to our knowledge, no research has examined AS interventions initiated in the immediate aftermath of trauma. We evaluated the feasibility, acceptability, and credibility of a brief (i.e., ∼75 min of psychoeducation, ∼2 hr of ecological momentary intervention) smartphone-based AS intervention in a pilot study. Participants were 12 women who presented for emergency care after sexual assault with high levels of peritraumatic PTSD symptoms. Most women who started the intervention completed the majority of it and reported using the techniques provided. Results indicated that participants perceived the intervention as logical and believed it would help in reducing their symptoms. Qualitative feedback was mostly positive but also indicated concern regarding intervention length. Although not the purpose of the study, results indicated medium-to-large, statistically significant decreases in AS, g = 0.74, and PTSD symptoms, g = 1.20. Overall, these preliminary findings suggest that this novel smartphone-based intervention targeting AS was feasible, acceptable, and credible in this small sample of women receiving emergency care following sexual assault. Treatment outcome data must be considered in the context of natural recovery; however, these promising preliminary feasibility, acceptability, and credibility data support continuing to pilot the feasibility and potential efficacy of the intervention to reduce AS and prolonged PTSD symptoms.

Variation in rates of sexual assault crisis counsellor usage during forensic examination in California: an observational study

OBJECTIVES

A critical asset to post-assault care of survivors is support from sexual assault crisis counsellors (SACCs). We sought to elucidate variation in implementation between California counties in SACC accompaniment during Sexual Assault Forensic Examination (SAFE).

METHODS

SACC attendance data from 2019 was obtained from the California Governor's Office of Emergency Services (CalOES). To assess SACC attendance rates during SAFEs, we requested SAFE quantity data from sheriffs and public health departments, the State Forensic Bureau, and the California Department of Justice (DOJ), but all requests were unanswered or denied. We also sought SAFE data from District Attorneys (DAs) in each county, and received responses from Marin and Contra Costa Counties. To estimate numbers of SAFEs per county, we gathered crime statistics from the Federal Bureau of Investigation's (FBI's) Uniform Crime Reporting Program and OpenJustice, a transparency initiative by the California DOJ. For each data source, we compared SACC attendance to SAFE quantities and incidences of sexual assault statewide.

RESULTS

At the state level, data on SACC attendance per CalOES and DOJ archival data on sexual assault were used to approximate relative rates of SACC accompaniment at SAFEs; 83% (30 of 36) of counties had values <50%. The joint sexual assault crisis centre for Contra Costa and Marin Counties reported that 140 SACCs were dispatched in 2019, while DAs in Contra Costa and Marin reported completion of 87 SAFEs in 2019, for a calculated SACC accompaniment rate of 161%. Proxy data sourced from FBI and DOJ crime statistics displayed significant inconsistencies, and DOJ data was internally inconsistent.

CONCLUSIONS

SACC accompaniment at SAFEs appears to be low in most California counties, however, limited data accessibility and data discrepancies and inaccuracies (e.g., rates over 100%) prevented reliable determination of SACC accompaniment rates during SAFEs. Substantial improvements in data accuracy and transparency are needed to ensure survivors' adequate access to resources.

Intimate Partner Violence, Economic Insecurity, and Health Outcomes Among American Indian and Alaska Native Men and Women: Findings From a National Sample

Limited data are available on experiences of intimate partner violence (IPV) and sexual violence (SV) and health outcomes among American Indian and Alaska Native (AIAN) populations. This study explores the relationship between IPV and SV, food insecurity, housing insecurity, healthcare access, and self-reported physical and mental health status in a nationally representative sample of AIAN adults (N = 3,634). IPV and SV were associated with poorer physical and mental health at the bivariate level, but not in multivariate analyses. Economic inequalities are a salient predictor of health and may be compounded by demographic and geographic contexts.

Physicians and nurses professional relationship with criminal investigation in dealing with survivors of sexual abuse: a scoping review

Survivors of sexual abuse and their families seek help from criminal law enforcement agencies and health professionals to obtain justice and health care. Many communities have implemented multi-professional collaborative models so that the victim's well-being is assured and the truth is established. However, there is a general lack of evidence on how to best articulate these teams with the healthcare professionals caring for the survivors.Therefore, this Scoping Review was conducted in order to analyze and to map the barriers and facilitators of the relationship between health professionals and the criminal investigation team in the care of survivors of sexual abuse. The methodology proposed by the Joanna Briggs Institute for Scoping Reviews was used, and the Bronstein five dimension model of interprofessional collaboration served as the basis for the analysis of barriers and facilitators. Quantitative, qualitative and mixed studies, primary and secondary sources, text and opinion documents were included. Content analysis was performed on the main findings of the collected studies. Twelve articles were identified and analyzed. Collaboration, communication, hierarchy, skills, confidentiality, and leadership emerged as key themes. Multidisciplinary Sexual Assault Nurse Examiner (SANE) and Sexual Assault Response Teams (SARTs) were implemented to coordinate care, but conflicting goals and values among professionals posed challenges. Communication failures and inadequate information sharing hindered collaboration. Neutral leaders who coordinate teams, minimize groupthink, and improve decision-making were found to be valuable. Engaging across disciplinary boundaries and addressing power dynamics were challenging but could be addressed through facilitation and conflict resolution. This review highlights the importance of effective collaboration and interaction within teams and with other professionals in the care of sexual abuse survivors.

A preliminary examination of sexual and physical victimization 6 months after recent rape

One in four US women will experience a completed or attempted rape in their lifetime, and more than 50% of survivors will experience two or more rapes. Rape and physical violence also co-occur. Multiple experiences of sexual and physical violence are associated with elevated mental and physical health problems. This secondary analysis examined the prevalence and correlates of experiencing sexual or physical violence within 6 months of a sexual assault medical forensic exam (SAMFE). Between May 2009 and December 2013, 233 female rape survivors aged 15 and older were enrolled in a randomized controlled trial during a SAMFE in the emergency department (ED). Demographics, rape characteristics, distress at the ED, and pre-rape history of sexual or physical victimization were assessed. New sexual and physical victimization was assessed 6 months after the SAMFE via telephone interview. Six months after the exam, 21.7% reported a new sexual or physical victimization. Predictors of revictimization during follow-up included sexual or physical victimization prior to the index rape, making less than $10,000 annually, remembering the rape well, life threat during the rape, and higher distress at the ED. In adjusted models, only pre-rape victimization and making less than $10,000 annually were associated with revictimization. Factors assessed at the ED can inform subsequent victimization risk. More research is needed to prevent revictimization among recent rape victims. Policies to provide financial support to recent rape victims and/or targeted prevention for those with pre-rape victimization at the SAMFE could reduce revictimization risk. TRIAL REGISTRATION: NCT01430624.

What undergraduates want in campus sexual assault prevention programming: Findings from a formative research study

OBJECTIVE

Campus sexual assault (SA) prevention programs are widely implemented, despite few having strong empirical support. To inform the development and refinement of prevention programs, we collected pilot qualitative data to capture undergraduates' perspectives regarding desirable program characteristics.

PARTICIPANTS

Undergraduates completed an audio-taped interview (n = 19) or a focus group (n = 16) in June - November 2016.

METHODS

We double-coded transcripts for a priori and emerging themes using NVivo 11. A third coder resolved disagreements; we assessed intercoder reliability using Cohen's Kappa.

RESULTS

Participants preferred SA prevention programming to be delivered in-person to small, coed groups of unfamiliar students. Students preferred programming with peer-facilitated, candid conversation about SA outcomes and prevention strategies. Participants also preferred for the tone of these training sessions to match the serious subject matter.

CONCLUSIONS

Students' perceptions of desirable program characteristics differ somewhat from current evidence-based programs in several ways, highlighting important future directions for SA prevention research.

Sexual Violence against Women in STEM: A Test of Backlash Theory Among Undergraduate Women

It has been argued that increasing the number of women in the science, technology, engineering, and math (STEM) fields could mitigate violence against women by advancing gender equality. However, some research points to a "backlash" effect wherein gains in gender equality are associated with heighted sexual violence (SV) against women. In this study, we compare SV against undergraduate women majoring in STEM disciplines to those majoring in non-STEM disciplines. Data were collected between July and October of 2020 from undergraduate women (N = 318) at five institutions of higher education in the United States. Sampling was stratified by STEM versus non-STEM majors and male-dominated versus gender-balanced majors. SV was measured using the revised Sexual Experiences Survey. Results indicated that women majoring in STEM disciplines that are gender balanced reported more SV victimization in the form of sexual coercion, attempted sexual coercion, attempted rape, and rape compared to their peers in both gender-balanced and male-dominated non-STEM and male-dominated STEM majors. These associations held even after controlling for age, race/ethnicity, victimization prior to college, sexual orientation, college binge drinking, and hard drug use during college. These data suggest that the risk of repeated SV victimization within STEM populations may be a threat to sustained gender parity in these fields and ultimately to gender equality and equity. Gender balance in STEM should not be furthered without addressing the potential use of SV as a potential means of social control over women.

Participatory Design Application in Youth Sexual Violence and Abuse Prevention: A Mixed-Methods Systematic Review

Youth sexual violence and abuse (SVA) are leading public health and human rights issues around the world. Prevention is key to reducing SVA rates and minimising resultant harms. Despite advocacy for more collaborative approaches, knowledge of how to effectively engage young people and key stakeholders in the design, implementation, and evaluation of SVA prevention programs is limited. This mixed-methods systematic review aimed to synthesise available evidence on participatory design (PD) application in primary and secondary SVA prevention targeting young people. A systematic search was executed across seven electronic databases. Eligible studies were peer-reviewed, published in English, reported primary or secondary SVA prevention, described application of PD or a related approach, and targeted young people aged 12-25 years. Quality was assessed using the Mixed Methods Appraisal Tool. Overall, 20 articles reporting 15 studies were included. Most (55%; n = 11) employed a qualitative design. Descriptions, methods, and scope of PD application varied across included studies. A lack of empirical evaluations prevented conclusions regarding the utility of PD application in terms of measured outcomes. The methodology, agent of change, training, and engagement (MATE) taxonomy was subsequently developed to describe and classify PD application. As illustrated in the MATE taxonomy, PD methods promoting agency, encouraging input, and facilitating empowerment are likely to facilitate more meaningful engagement of participants. Integration of participant and expert views, community consultation, and appropriate socio-cultural adaption appear to be critical determinants of program acceptability and feasibility. Empirical evaluations are needed to assess the relative utility of PD methods in line with SVA prevention objectives.

Disclosure of Sexual Assault Among Sexual and Gender Minorities: A Systematic Literature Review

Sexual assault is common in sexual and gender minority (SGM) individuals, but few studies have examined SGM victims' disclosure experiences. This systematic review identified 13 studies through searches of research databases on SGM populations with sexual victimization. These studies showed wide variation in disclosure rates, various barriers to disclosure, and psychological impacts of social reactions to disclosure on SGM individuals. Bisexual women were more likely to disclose to formal (e.g., police, healthcare providers) and informal (e.g., friends, family members) sources than other women, and SGM victims disclose to mental health professionals at particularly high rates. Sexual and gender minority victims also reported numerous barriers to disclosure, including those unique to SGM individuals (e.g., fear of being outed). Impacts of negative social reactions appear to be more negative on psychological symptoms of SGM victims, whereas positive reactions are helpful to recovery. Future research is needed taking an intersectional perspective to studying disclosure and social reactions to SGM individuals from both college and community samples, by examining both sexual minority and racial/ethnic identities in the context of intersectional minority stress theory. Studies are needed of both correlates and consequences of disclosures to both informal and formal support sources to better understand SGM individuals' reasons for telling and not telling various support sources and the impacts of their disclosure experiences on their recovery. Such data is also needed to inform interventions seeking to identify and intervene with support network members and professionals to reduce negative social reactions and their psychosocial impacts and to increase positive social reactions and general social support from informal support sources.

Developing a trauma focused cognitive behavioral therapy application for adolescents with problematic sexual behaviors: A conceptual framework

Sexual abuse (SA) perpetration is a significant public health problem; SA perpetration is most likely to emerge during adolescence and youth ages 13 to 17 account for a significant portion of all child sexual abuse. While research shows that these youth have high rates of adversity, once they have engaged in problem sexual behavior (PSB), their own trauma histories are often ignored with treatment primarily focused on reducing risk for reoffending. Although sexual re-offense rates among adolescents with PSB are very low, the rates of non-sexual recidivism are considerably higher; with almost half of known youth have reoffended non-sexually, requiring development, implementation, and testing of therapeutic interventions responsive to the indicated risks and unmet needs of adolescents who have engaged in a range of problematic sexual behaviors (PSB-A) and their families. Yet, there are no empirically supported interventions designed specifically to address PSB-A with trauma histories. This article introduces how Trauma-Focused Cognitive Behavioral Therapy can be applied to PSB-A and provides implications for practice and future research.

An examination of associations between sexual assault and health problems, depression or suicidal ideation in a large nationally representative cohort of male and female 20-30-year-olds

BACKGROUND

A long line of research has examined whether being the victim of sexual assault is associated with negative and maladaptive outcomes, but has mainly focused on women and girls.

AIMS

To replicate and extend prior research by examining whether various measures of sexual assault are related to physical ill-health, depression and/or suicidal ideation, regardless of sex or age of victim. Our research questions were (1) is sexual assault related to health problems, depression and suicidal ideation and (2) do these associations differ between men and women?

METHOD

We analyse data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a longitudinal study of a US nationally representative sample of nearly 21,000 young people recruited for the first wave of interviews when most of the participants were between ages 12 and 18 years. We used Wave 4 data, collected for participants who were in their 20s and 30s, on experience of both physical sexual assault and non-physical sexual assault and mental state, allowing for some characteristics measured in Wave 1. Allowing for missing data, sample sizes were between 6868 and 10,489 for the women and 6024 and 10,263 for the men.

RESULTS

Statistically significant associations were revealed between the physical and non-physical measures of sexual assault and the health problems scale, the depression scale and the measure of suicidal ideation. These associations remained statistically significant even after controlling for key covariates measured at Wave 1, including exposure to delinquent peers, poverty and demographic characteristics.

CONCLUSIONS

Sexual assault at some time and of whatever kind, although more commonly reported by women than men, is similarly associated with serious physical and mental health problems during their 20s and 30s. More sequencing detail is required for better prevention of harms.

Separate units for incarcerated people who committed sexual offenses: luxury or necessity?

Introduction

The policy on treatment of people who commit sexual offenses (PSOs) varies greatly across countries, creating different treatment environments. This study was conducted in Flanders (i.e., the Dutch-speaking part of Belgium) where PSOs receive their treatment in the community. Before this transfer takes place, many PSOs spend time inside prison together with other offenders. This raises the question to what extent PSOs are safe in prison and whether this period would benefit from an integrated therapeutic program. This qualitative research study focuses on the possibility of separate housing for PSOs by examining the current experiences of incarcerated PSOs and contextualizing those with the professional experience of national and international experts in the field.

Methods

Between 1 April 2021 and 31 March 2022, 22 semi-structured interviews and six focus groups took place. Participants were comprised of 9 imprisoned PSOs, 7 international experts on prison-based PSO treatment, 6 prison officer supervisors, 2 prison management delegates, 21 healthcare workers (both inside and outside prison), 6 prison policy coordinators, and 10 psychosocial service staff members.

Results

Nearly all interviewed PSOs reported suffering at the hands of fellow inmates or prison staff because of the nature of their offenses, varying from exclusion and bullying to physical violence. These experiences were corroborated by the Flemish professionals. Consistent with scientific research, the international experts all reported working with incarcerated PSOs who reside in living units separate from other offenders and the therapeutic benefits to this approach. Despite this growing evidence, the Flemish professionals remained reluctant to implement separate living units for PSOs in prisons because of the perceived risk of increased cognitive distortions and further isolation of this already stigmatized group.

Conclusion

The Belgian prison system is not currently organized to create separate living units for PSOs, which has important ramifications for the safety and therapeutic opportunities of these vulnerable prisoners. International experts emphasize a clear benefit for introducing separate living units where a therapeutic environment can be created. Although this would have significant organizational and policy-oriented implications, it would be useful to explore whether these practices could be implemented in Belgian prisons as well.

Event Characteristics of Sexual Violence Perpetration Against Romantic Partners Versus Non-Romantic Partners

Tactics used to perpetrate sexual violence may be crucial to understanding when and why sexual violence occurs. Moreover, most sexual violence occurs between people who know each other-including in the context of dating or sexual relationships. Little is known about the context of sexual violence that occurs with non-romantic partners. To address these research gaps, we examined online survey data from 786 young adults (weighted n = 763) aged 19 to 27 years, living across the United States. Findings suggest that 60% of sexual assault, 40% of attempted rape, 42% of rape, and 67% of coercive sex were perpetrated against a romantic partner, defined as a current or ex-boyfriend, girlfriend, spouse, or domestic partner. Contextual differences were noted by relationship type: Those who perpetrated against romantic partners were more likely than those who targeted non-romantic partners to report that it occurred because they were feeling sad or angry. They were also more likely to say that the other person was completely responsible for what happened. Conversely, those who aggressed against non-romantic partners were more likely to say that someone else found out about what happened. Making the other person feel guilty was the most common tactic for both groups. The most frequently endorsed reason for perpetrating sexual violence was "feeling really horny," although feeling "good" or being drunk/high were also common reasons noted by aggressors. Afterward, many said they felt guilty or ashamed and were worried about the other person's feelings. Fear of getting caught was universally absent. Findings support the importance of building emotion regulation and emotional awareness skills in sexual violence prevention programming. Prevention programs should also discuss coercion as a violence tactic, since perpetrators may not always recognize this to be sexual violence. More generally, violence prevention programs should also address healthy relationships, consent, and taking responsibility.

Prospective Predictors of Work Limitations in Young Adult Lesbian and Bisexual Women: An Examination of Minority Stress, Trauma Exposure, and Mental Health

Trauma exposure and mental health problems adversely affect work functioning. Sexual minority women are at increased risk for trauma exposure, depression, and PTSD. Sexual minority women also experience unique stressors related to their sexual orientation, which can directly impact work functioning. However, little research to date has examined the impact of trauma exposure and mental health problems among sexual minority women on their occupational outcomes. The goal of the current study was to examine whether trauma exposure, mental health problems, and minority stressors were associated with occupational functioning one year later in a large sample of young adult lesbian and bisexual women. The study utilized a subset of data (N = 304) from a larger longitudinal study on health risk behaviors among young adult lesbian and bisexual women. Results indicated that trauma exposure, posttraumatic stress, depression, and perceived heterosexism were each associated with subsequent work limitations, but after accounting for shared variance between predictors, only perceived heterosexism and depression were uniquely associated with subsequent work functioning. These findings highlight the roles of mental health and sexual orientation-related stress in the challenges that lesbian and bisexual women experience at work and point to a need for additional research to better understand risk and protective factors related to negative employment outcomes among lesbian and bisexual women.

Comprehensive policies for victims of sexual assault returning to the campus classroom: Lessons from university sports-related concussion policies

ObjectiveThe current paper presents a comparison of university policies and health and academic accommodations offered to undergraduate students following sexual assault (SA) and sports-related concussions (SRC). Procedures and protocols for universities to consider adapting from their SRC policies to their SA policies are detailed.Participants: The SRC and SA policies at the 50 United States public flagship universities were analyzed.Methods: The research team coded for a number of policy details including health referrals, academic and financial accommodations, and requirements for follow-up with university personnel.Results: Compared to SA polices, SRC policies at the public flagship universities offer more comprehensive academic accommodations and physical and mental health resources. Conclusions: Comprehensive policies for student SA survivors, like those available for students who suffer SRCs, would improve student health and academic outcomes and increase SA survivors' likelihood of graduating college, thereby reducing individual and societal human capital loses.

Risk for dating violence and sexual assault over time: The role of college and prior experiences with violence

Objective: Despite increased research on emerging adults and interpersonal violence, evidence on the role of college attendance in risk for dating violence and sexual assault is mixed. We examined the role of college attendance on victimization risk in emerging adulthood. Participants: Participants were a diverse longitudinal sample of 630 emerging adults. Methods: We conducted regression analyses to examine the association of college attendance by type (community and public/private four year) with subsequent victimization, controlling for prior victimization and other factors. Results: Participants who attended public and private four-year colleges had significantly less risk for physical dating violence (OR = 0.35, p < 0.001), but not prior sexual or psychological dating violence or other sexual assault. Prior victimization was the most significant predictor of victimization in emerging adulthood. Conclusions: The context of higher education and prior victimization experience should be considered for addressing dating violence and sexual assault in emerging adulthood.

WISQARS Cost of Injury for public health research and practice

AIM

Since 2011 the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System (WISQARS) has demonstrated per-injury average and population total medical and non-medical costs of injuries by type (such as unintentional cut/pierce) in the USA. This article describes the impact of data and methods changes in the newest version of WISQARS Cost of Injury.

METHODS

Data sources and methods were compared for the legacy version of the WISQARS Cost of Injury website (available 2011-2021; most recent prior update was published in 2014 with 2010 injury incidence and costs) and the new version (published 2021; 2015-present injury incidence and costs). Cost data sources were updated for the new website and the basis for medical costs and non-fatal injury work loss costs changed from mathematical modelling (combined estimates from multiple data sources) in the legacy website to statistical modelling of actual injury-related medical and work loss financial transactions in the new website. Monetary valuation of non-medical costs for injury deaths changed from lost employment income and household work in the legacy website to value of statistical life. Quality of life loss costs were added for non-fatal injuries. Per-injury average medical and non-medical costs by injury type (mechanism and intent) and total population injury costs were compared for years 2010 (legacy website data) and 2020 (new website data) to illustrate the impact of data and methods changes on reported costs in the context of changed annual injury incidence.

RESULTS

Owing to more comprehensive cost capture yielding higher per-injury average costs for most injury types-including those with high incidence in 2020 such as unintentional poisoning and unintentional falls-reported total US medical and non-medical injury costs were substantially higher in 2020 (US$4.6 trillion) compared with 2010 (US$693 billion) (both 2020 USD).

CONCLUSIONS AND RELEVANCE

New data and methods increased the injury costs reported in WISQARS Cost of Injury. Researchers and public health professionals can use this information to proficiently communicate the burden of injuries and violence in terms of economic cost.

Influence of comorbid social anxiety disorder in PTSD treatment outcomes for Prolonged Exposure in female military sexual trauma survivors with PTSD

OBJECTIVE

Posttraumatic stress disorder (PTSD) is a common psychiatric disorder that frequently presents alongside other comorbid diagnoses. Although several evidence-based psychotherapies have been well-studied for PTSD, limited research has focused on the influence of diagnostic comorbidity on their outcomes. The present study sought to investigate the influence of comorbid social anxiety disorder on treatment outcomes in patients with PTSD.

METHODS

One hundred and twelve treatment-seeking female veteran participants with PTSD completed baseline assessments and received 12-15 sessions of Prolonged Exposure. Symptom measures were completed biweekly as well as at immediate posttreatment, 3-month, and 6-month follow-ups.

RESULTS

Thirty (26.8%) participants seeking PTSD treatment also met diagnostic criteria for social anxiety disorder. Multilevel modeling was used to examine effects of social anxiety disorder diagnosis on post-intervention symptoms and revealed significantly worse outcomes for symptoms of PTSD and depression in participants with comorbid PTSD and social anxiety disorder.

CONCLUSION

Consistent with previous studies of co-occurring PTSD and depression, present findings suggest that comorbid diagnoses may adversely affect disorder-specific treatment outcomes. As such, the presence of diagnostic comorbidity may merit further consideration and potential adaptions to the traditional, disorder-specific assessment and treatment practices for PTSD.

Costs attributable to criminal justice involvement in injuries: a systematic review

CONTEXT

Costs related to criminal justice are an important component of the economic burden of injuries; such costs could include police involvement, judicial and corrections costs, among others. If the literature has sufficient information on the criminal justice costs related to injury, it could be added to existing estimates of the economic burden of injury.

OBJECTIVE

To examine research on injury-related criminal justice costs, and what extent cost information is available by type of injury.

DATA SOURCES

Medline, PsycINFO, Sociological Abstracts ProQuest, EconLit and National Criminal Justice Reference Service were searched from 1998 to 2021.

DATA EXTRACTION

Preferred Reporting Items for Systematic reviews and Meta-Analyses was followed for data reporting.

RESULTS

Overall, 29 studies reported criminal justice costs and the costs of crime vary considerably.

CONCLUSIONS

This study illustrates possible touchpoints for cost inputs and outputs in the criminal justice pathway, providing a useful conceptualisation for better estimating criminal justice costs of injury in the future. However, better understanding of all criminal justice costs for injury-related crimes may provide justification for prevention efforts and potentially for groups who are disproportionately affected. Future research may focus on criminal justice cost estimates from injuries by demographics to better understand the impact these costs have on particular populations.

Victim-Survivors' Prioritization of Reasons for Non-Reporting Adult Sexual Assaults to Law Enforcement

Despite the potential benefits of reporting a sexual assault to the police, few sexual assault victim-survivors choose to do so. Prior research on reasons for non-reporting has lacked American Indian/Alaska Native representation as well as a quantitative prioritization of non-reporting reasons. This study sought to fill those gaps by using quantitative data from 95 participants in an online, self-administered survey of victim-survivors of adult sexual assaults in Alaska. Descriptive, univariate results revealed great variation in the reasons for non-reporting. Further, which reasons were more commonly endorsed changed when measuring victim-survivor prioritization of reasons (primary, secondary, and tertiary) rather than simple endorsement. Lastly, there were few subgroup differences when conducting bivariate analyses using racial/ethnic identity and the act of reporting other adult sexual assaults in Alaska. The results of this study add to existing literature on non-reporting with an emphasis on changing how we measure the reasons behind non-reporting. The results also signal to criminal justice policy makers and practitioners that proactive, comprehensive efforts must be made to regain the faith and trust of current and potential victim-survivors so that they see the criminal justice system as a viable avenue for securing justice in ways that are meaningful to them.

Sexual health indicators for the United States: Measuring progress and documenting public health needs

Introduction

Today, we are facing increased and continued adverse sexual health outcomes in the United States, including high post-COVID-19 pandemic rates of sexually transmitted infections (STIs). For the past 20 years, there have been calls for a national health strategy and a more comprehensive sexual health approach to address the myriad of persistent sexual health problems in this country. Employing a sexual health approach requires shifting from a longstanding, stigmatizing focus on morbidity toward a holistic and integrated focus on health rather than disease. While strategies are being implemented by multisectoral stakeholders, it is also important to establish a core set of indicators that broadly describe the state of sexual health in the U.S. and allow for measurement across time. The development of a comprehensive scorecard with key sexual health indicators has been proposed by other entities (e.g., Public Health England, World Health Organization), but such an attempt has not been made in the U.S.

Methods

A review of national U.S. surveys and surveillance systems with items related to sexual health was conducted for years 2010-2022 to develop an inventory of existing data that yield national estimates for potential indicators of sexual health.

Results

We selected 23 sexual health indicators in four broad domains including: (1) knowledge; communication and attitudes (five indicators); (2) behaviors and relationships (four indicators); (3) service access and utilization (seven indicators); and (4) adverse health outcomes (seven indicators). Recent data for each indicator are provided.

Discussion

A growing body of evidence shows the positive effects of moving away from a morbidity focus toward an integrated, health-promoting approach to sexual health. Yet, not much has been done in terms of how we implement this national shift. We argue that measurement and monitoring are key to future change. We envision these core sexual health indicators would be published in the form of an index that is publicly available and updated frequently. These sexual health indicators could be used for ongoing monitoring, and to guide related research, programming, and policy development to help promote sexual health in coming years.

Inventory of U.S. Public Data Sources to Measure the Socioeconomic Impact of Experiencing Interpersonal Violence

Introduction

There is limited recent information regarding the impact of interpersonal violence on an individual's non-health-related experiences and attainment, including criminal activity, education, employment, family status, housing, income, quality of life, or wealth. This study aimed to identify publicly available representative data sources to measure the socioeconomic impact of experiencing interpersonal violence in the U.S.

Methods

In 2022, the authors reviewed data sources indexed in Data.gov, the Inter-university Consortium for Political and Social Research data archive, and the U.S. Census Bureau's Federal Statistical Research Data Center network to identify sources that reported both nonfatal violence exposure and socioeconomic status-or data sources linking opportunities to achieve both measures-over time (i.e., longitudinal/repeated cross-sections) at the individual level. Relevant data sources were characterized in terms of data type (e.g., survey), violence measure type (e.g., intimate partner violence), socioeconomic measure type (e.g., income), data years, and geographic coverage.

Results

Sixteen data sources were identified. Adverse childhood experiences, intimate partner violence, and sexual violence were the most common types of violence faced. Income, education, and family status were the most common socioeconomic measures. Linked administrative data offered the broadest and the most in-depth analytical opportunities.

Conclusions

Currently, linked administrative data appears to offer the most comprehensive opportunities to examine the long-term impact of violence on individuals' livelihoods. This type of data infrastructure may provide cost-effective research opportunities to better understand the elements of the economic burden of violence and improve targeting of prevention strategies.

The Body in Crisis: A Health Needs Assessment among Female Survivors of Interpersonal Violence

BACKGROUND

When women who experience violence seek social services, they are looking to meet immediate needs: shelter, safety, and support. Seeking assistance as part of a crisis may inadvertently detract attention away from other critical needs. Literature illustrates the emotional and physical effects of violence on women's bodies, as well as their long-term health. While health may present as an urgent need in cases of serious injury, it is often overlooked in crisis-oriented service delivery systems. This study explored the experience with violence, health status, and holistic healthcare needs among women accessing interpersonal violence services in Texas.

METHODS

A tablet-based survey was conducted at a family justice center, rape crisis center, and emergency shelter among women (N = 99) in Fort Worth, Texas. Survey questions assessed the participants' demographic information, health status, health needs, healthcare utilization, barriers to accessing healthcare, and experience with interpersonal violence among participating women.

RESULTS

Two-thirds of the sample reported suffering injuries from victimization experiences. More than half of the sample (62%) reported they went to the emergency room at least one time in the last 6 months, with 11 women reported staying five or more nights in the hospital in the last 6 months. Participants described urgent (e.g., advised by healthcare provider, too serious for a clinic) and non-urgent (e.g., not having another source of care, closest provider) reasons for using the emergency room. Roughly, half of the sample (50%) reported having at least three chronic conditions.

DISCUSSION

This study illustrated that women seeking interpersonal violence related (IPV) services have multiple unmet needs and lack adequate access to physical and mental health care. Since the majority of the sample was living in poverty, there are multiple costs and investments in the participants' health that were forgone for their survival. This study provides data in support of the development of health-related services for IPV survivors.

Why Young Women Who Use Opioids Are at Risk for Rape: The Impact of Social Vulnerabilities and Sexually Coercive Drug Using Contexts

This study tests a theoretically informed model to understand why women who use opioids (WWUO) are at risk of rape while using drugs. Structured interviews were conducted with 168 WWUO. Three domains were hypothesized to increase risk: the sexually coercive context of drug use, women's social vulnerability, and drug use severity. Logistic regression examined the odds of being raped by domain. One-third of WWUO had been raped while using drugs. The sexually coercive context and social vulnerability domains significantly increased women's odds of being raped. Prevention efforts should target social and contextual factors.