Trends in Sexual Assault Against Detainees in US Immigration Detention Centers, 2018-2022

This study examines sexual assault allegations perpetrated against individuals detained across US Immigration and Customs Enforcement (ICE) detention facilities from 2018 to 2022.

COVID-19 pandemic and violence: rising risks and decreasing urgent care-seeking for sexual assault and domestic violence survivors

BACKGROUND

There is little information on care-seeking patterns for sexual assault and domestic violence during the COVID-19 pandemic. The objective of this study was to examine the changes in emergency department (ED) admissions for sexual assault and domestic violence since the COVID-19 pandemic was declared.

METHODS

Observational ED admissions data from The Ottawa Hospital were analyzed from March 4 to May 5 (62 days) in 2020 (COVID-19 period) and compared to the same period in 2018 (pre-COVID-19). Total and mean weekly admissions were calculated for all-cause ED admissions and for sexual and domestic violence cases. A Poisson regression (without offset term) was used to calculate the weekly case count ratio and 95% confidence intervals (CI) between the two time periods. Case characteristics were compared using chi-square tests, and percent differences were calculated.

RESULTS

Compared to pre-COVID-19, total ED admissions dropped by 1111.22 cases per week (32.9% reduction), and the Sexual Assault and Domestic Violence Program cases dropped 4.66 cases per week. The weekly case count ratio for sexual assault cases was 0.47 (95% CI 0.79-0.27), equivalent of 53.49% reduction in cases, and 0.52 (95% CI 0.93-0.29), equivalent to a 48.45% reduction in physical assault cases. The characteristics of presenting cases were similar by age (median 25 years), sex (88.57% female), assault type (57.14% sexual assault, 48.57% physical assault), and location (31.43% patient's home, 40.00% assailant's home). There was a significant increase in psychological abuse (11.69% vs 28.57%) and assaults occurring outdoors (5.19% vs 22.86%).

CONCLUSION

This study found a decrease in ED admissions for sexual assault and domestic violence during COVID-19, despite societal conditions that elevate risk of violence. Trends in care-seeking and assault patterns will require ongoing monitoring to inform the provision of optimal support for individuals experiencing violence, particularly as countries begin to re-open or lock-down again.

Male victims of sexual abuse and domestic violence: A steadily increasing phenomenon

Violence perpetrated on male victims is a phenomenon that is currently underestimated by both national and international scientific communities, since males are historically (and stereotypically) considered the perpetrators rather than the victims of violence. As a consequence, the available literature lacks data which would allow a better understanding of this issue and its presenting features. We undertook a retrospective analysis of 231 medical files of male victims of violence over a five-year-period (2014-2018) at the Soccorso Violenza Sessuale e Domestica Centre in Milan, Italy. The sample included 112 victims of sexual violence and 119 victims of domestic violence, most of whom were younger than 18 years of age. The main aim of this study was to describe the presentations of male victims of violence in order to understand the phenomenon better, increase awareness of the issue and enable improved health-care management. The need to pay more attention to this vulnerable part of the population is mandatory in health-care services, and it includes: the provision of management guidelines, training to attending physicians and a supportive service to male survivors. Understanding which risk factors are related to male abuse can help with the development of programmes that identify, prevent and minimise violence - this being especially useful for primary-care clinicians. This is the first Italian study to deal with domestic and sexual violence involving male victims.

The prevalence rate of sexual violence worldwide: a trend analysis

BACKGROUND

The purpose of the present study is to showcase the image of Sexual Violence (SV) temporal trends through exploring differences in its prevalence rates during 1990-2017 across 195 countries and territories.

METHODS

The SV prevalence rates were derived from the Global Burden of Disease (GBD) database during 1990-2017, worldwide. First, the Latent Growth Model (LGM) was employed for assessing the change in SV prevalence rate over time in Asia, Africa, Europe, North America, South America, Australia & Oceania, for men and women separately. Then, the change in SV prevalence rate over time was determined within countries with high and low Human Development Index (HDI). Finally, the Latent Growth Mixture Models (LGMM) were applied for identifying classes where countries within each class have similar trend of SV prevalence rate over time.

RESULTS

The SV prevalence was higher among women than men and decreased in both genders over time across the world. The declining trend in SV prevalence against men is visible in both countries with high and low HDI, but SV prevalence against women in countries with low HDI shows an increase. The findings of LGMM identified six classes of SV prevalence trajectories. LGMM allocated Bermuda into the class with the highest decrease in SV prevalence against men, and Equatorial Guinea and Luxembourg into the class with the highest increase. Other countries had very slow declining trends. In terms of SV prevalence against women, LGMM allocated China, North Korea, and Taiwan into the class with the most increase among the countries in the world. Bermuda, Guyana, Mexico, Nigeria, and Saint Lucia were placed into the class which witnessed the largest decline and Angola, Congo, and Equatorial Guinea were ranked next. The trend in other countries was mostly decreasing.

CONCLUSION

Given the high economic and social burden that SV has on victims and societies, the rate of SV in most countries does not seem to have dropped remarkably and requires special attention by relevant policymakers. The SV prevalence rate is highly heterogeneous among world countries which may be due to the definitions and tools used, and more importantly, the culture norms.

Trends in rape cases in a Nigerian state

Background

Rape remains a controversial issue with a few victims reporting experience because of the myriad of societal perception, prolonged steps in pursuing a case to logical conclusion of securing conviction, as well as psychological and physical residuals of the experience. Data in Nigeria is therefore hard to come by as it is diminished and often not available.

Objectives

To assess the pattern and trend of rape cases in a State in Nigeria.

Methods

A descriptive and retrospective study where data records on socio-demographics and case specifics was collected on victims of sexual assault that reported to DFID/ PATHS 2 supported Tamar Sexual Assault Centre between 2014 and 2016 after which it was analysed and presented in bar charts.

Result

The yearly prevalence varied for the different age groups studied with the highest prevalence noted for 13 years and above (175,200,255) over the 3 years of 2014, 2015 and 2016 studied. The reported cases also improved over the studied years with rates of 0.47, 0.96 and 0.5 respectively.

Conclusion

The yearly comparison and baseline data show that the centre's establishment caused an improvement in rape case reporting and follow-up.

Building an adaptable resident curriculum for acute pediatric sexual abuse evaluations: A qualitative needs assessment

BACKGROUND

Residents are undertrained to perform acute pediatric sexual abuse evaluations. The American Academy of Pediatrics has proposed development of an adaptable child abuse curriculum, though no such curriculum exists.

OBJECTIVES

Our goal was to perform a needs assessment for pediatric residents performing acute sexual abuse evaluations in an emergency department setting, thus laying groundwork for an adaptable curriculum. The objective was to explore pediatric resident training, knowledge, confidence, expectations, learning needs, and educational goals.

PARTICIPANTS AND SETTING

We conducted a qualitative exploratory study of pediatric residents, faculty, and program directors at two academic health centers in New York City.

METHODS

Using purposive and convenience sampling, we conducted focus groups and semi-structured interviews until saturation of ideas was achieved. Through an iterative process using constructivist grounded theory, themes were organized into a curricular model.

RESULTS

We conducted 3 resident focus groups (n = 21) and 7 interviews with emergency medicine, pediatric, and child abuse faculty. Themes emerged in three categories: barriers (e.g., knowledge deficits), facilitators (e.g., pre-learning), and educational goals. Despite recognizing the importance and increased availability of subspecialists, participants supported gradual autonomy for pediatric residents in the evaluation of suspected sexual abuse, with a goal of independent competency in history and examination skills, and supervised competency of forensic evidence collection.

CONCLUSIONS

Our data support a multimodal, blended curriculum for the acute sexual abuse evaluation, including: (1) asynchronous pre-learning; (2) live workshops; (3) reference tools; and (4) modeled clinical experiences. Our proposed curricular model may be utilized by a variety of frontline clinicians.

Artificial Intelligence Crime: An Interdisciplinary Analysis of Foreseeable Threats and Solutions

Artificial intelligence (AI) research and regulation seek to balance the benefits of innovation against any potential harms and disruption. However, one unintended consequence of the recent surge in AI research is the potential re-orientation of AI technologies to facilitate criminal acts, term in this article AI-Crime (AIC). AIC is theoretically feasible thanks to published experiments in automating fraud targeted at social media users, as well as demonstrations of AI-driven manipulation of simulated markets. However, because AIC is still a relatively young and inherently interdisciplinary area-spanning socio-legal studies to formal science-there is little certainty of what an AIC future might look like. This article offers the first systematic, interdisciplinary literature analysis of the foreseeable threats of AIC, providing ethicists, policy-makers, and law enforcement organisations with a synthesis of the current problems, and a possible solution space.

Sex Offenders in Croatia: Fifteen Years Later

BACKGROUND

The aim of the study was to compare the characteristics of sex offenders today, and those who committed a sex crime fifteen years ago, in regard to their psychiatric-forensic aspects.

SUBJECTS AND METHODS

Data from the University psychiatric hospital Vrapče, Center for forensic psychiatry on court people sent for psychiatric and forensic evaluation, who were accused of sex offense in two time frames (1998-2001 and 2010-2016) were analysed. In total there were 50 and 57 male subjects sent for an evaluation.

RESULTS

In both groups rape was the most prevalent offence, and both groups had the same prevalence of abuse, earlier psychiatric treatment and the majority of offenders were diagnosed with dissocial personality disorder and other personality disorders. Paedophilia was diagnosed in only a minority (14% and 7% respectively) of cases. The latter group (2010-2016) committed more sex offences against children, more often were with no mental disorder and less often had alcohol dependence and mental retardation. Up to one third of the later group were not giving their defence, compared to 4% of the former group.

CONCLUSIONS

Changes in court case law and psychiatrists' usage of diagnostic criteria have influenced the prevalent diagnoses in sex offenders. Paraphilias are not often diagnosed in sex offenders because they do not confirm the act, and in recent years more often use not to give their defence (which makes reaching the diagnosis more challenging).

Arrest and Prosecution of Animal Sex Abuse (Bestiality) Offenders in the United States, 1975-2015

Bestiality is an uncomfortable topic about which there is limited scientific literature. Prevalence research has focused on self-reported acts, and no research has established the actual frequency and nature of deliberate sex acts with animals. This quantitative, descriptive study examined 456 arrests for bestiality-related incidents in the United States from 1975 to 2015 to explore patterns of offending, offender characteristics, and how cases were adjudicated. The results suggest that animal sex offending may be linked to other criminal behavior, and involves a spectrum of sexual acts, including coercive, violent, and non-violent penetration; solicitation for sex with animals; and deviant behavior including torture and necrophilia. Findings of concern were that 31.6% of animal sex offenders also sexually offended against children and adults; 52.9% had a prior or subsequent criminal record involving human sexual abuse, animal abuse, interpersonal violence, substances, or property offenses; and only 39.1% of arrests involving the direct sexual abuse of animals resulted in prosecution. The broad range of sexual assault patterns and varied legal outcomes suggest that bestiality is more pervasive and more serious than previously thought and point to a need for additional research to aid in detection, intervention, sentencing, treatment, and supervision methods.

Predictors of dropout from a randomized clinical trial of cognitive processing therapy for female veterans with military sexual trauma-related PTSD

Many veterans do not complete evidence-based treatments (EBTs) for posttraumatic stress disorder (PTSD). Veterans with military sexual trauma (MST)-related PTSD were shown to have higher than average rates of dropout from PTSD treatment in a national study of EBT implementation. Although predictors of dropout from EBTs have been identified, these factors are largely unmodifiable (e.g., age, service era). The purpose of the present study was to identify dynamic psychosocial predictors of dropout among female veterans from cognitive processing therapy (CPT). Data were utilized from 56 female veterans who participated in a randomized clinical trial investigating the effectiveness of CPT for MST-related PTSD. Dropout was defined continuously (i.e., number of sessions attended) and dichotomously (i.e., attending six or more sessions). Potential predictors included sociodemographic factors, psychotherapist fidelity, PTSD-related service connection, psychiatric symptom severity (i.e., PTSD, depression), trauma-related negative cognitions (about self, self-blame, world), and treatment expectations. Higher trauma-related negative cognitions about self-blame and lower trauma-related negative cognitions about self were protective against dropout. The current study generated testable hypotheses for further research on dynamic predictors of dropout from CPT in female veterans with MST-related PTSD. With replication, results may assist with identifying pre-treatment strategies to reduce dropout in this clinical population.

Campus Sexual Assault: Future Directions for Research

Campus sexual assault (CSA) has received unprecedented attention over recent years, resulting in an abundance of federal guidance and mandates. In response, efforts to address and prevent CSA at Institutions of Higher Education (IHE) across the country have grown quickly, including the development and implementation of programs and policies. Because the changes on campuses have occurred at such a rapid pace, a number of gaps exist within the field of CSA research. To ensure that changes on IHE are evidence-based, there is a need to review the existing research available and the inquiry still needed, based on key areas outlined in federal guidance, the expressed needs of campus community members, survivors, and students who commit sexual offenses on college campuses. The purpose of this review is to summarize the empirical research related to CSA gained from the past two decades and identify areas in which further work is needed, specifically related to key areas identified in recent guidance provided to IHE. This article concludes with guidance for research moving forward to help strengthen response and prevention efforts.

Male and Female Single-Victim Sexual Homicide Offenders: Distinguishing the Types of Weapons Used in Killing Their Victims

Most studies have focused on male sexual homicide offenders (SHOs) without testing whether sex differences exist. Accordingly, little is known about the distinctions between male and female SHOs, particularly with respect to their use of weapons in killing their victims. This study used a sample of 3,160 single-victim sexual homicide cases (3,009 male and 151 female offenders) from the U.S. Supplementary Homicide Reports database to explore sex differences in the types of murder weapons used by offenders in killing victims over the 37-year period 1976 to 2012. Findings indicated that significantly more male SHOs used personal weapons (43%) and more female SHOs used firearms (63%) in their offense commission. In general, female offenders predominantly used weapons that were physically less demanding (e.g., firearms and edged and other weapons; 89%). Different trends in the murder weapons used by male and female SHOs from different age groups were observed. Interestingly, findings showed that the type of weapon used by SHOs was in part influenced by the victims and their characteristics.

Characteristics of Female Solo and Female Co-Offenders and Male Solo Sexual Offenders Against Children

Studies have highlighted differences in the victim choice, offender, and offense characteristics of female and male sexual offenders. However, little is known about how solo and co-offending females differ from solo male sexual offenders. We compared the characteristics of 20 solo and 20 co-offending females (co-offended with a male and/or female accomplice), and 40 male sexual offenders against children. We found that solo female offenders showed the most evidence of personal problems, including depression and sexual dissatisfaction. Compared with male offenders, female co-offenders showed poorer self-management, but better sexual self-regulation. Male offenders had a greater history of offending and showed more evidence of sexual abuse supportive cognitions relative to both solo and co-offending females. These results are consistent with the need for a gender-specific approach to working with sexual offenders and may have implications for understanding the often complex treatment needs of these clients.

Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND

Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of "leaving no one behind", it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990-2017, projected indicators to 2030, and analysed global attainment.

METHODS

We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0-100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator.

FINDINGS

The global median health-related SDG index in 2017 was 59·4 (IQR 35·4-67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6-14·0) to a high of 84·9 (83·1-86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030.

INTERPRETATION

The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains-curative interventions in the case of NCDs-towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions-or inaction-today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030.

FUNDING

Bill & Melinda Gates Foundation.

Ten-Year Secular Trends in Youth Violence: Results From the Philadelphia Youth Risk Behavior Survey 2003-2013

BACKGROUND

Youth violence reduction is a public health priority, yet few studies have examined secular trends in violence among urban youth, who may be particularly vulnerable to numerous forms of violence. This study examines 10-year secular trends in the prevalence of violence-related behaviors among Philadelphia high school students.

METHODS

Repeated cross-sectional data were analyzed from 5 waves of the Philadelphia Youth Risk Behavior Survey (YRBS) from 2003 to 2013. Sex-specific multivariate regression models were used to examine secular trends in multiple types of violence, accounting for age, race/ethnicity, and sampling strategy.

RESULTS

In 2013, the most prevalent violent behavior was physical fighting among boys (38.4%) and girls (32.7%). Among girls, the prevalence of sexual assault and suicide attempts declined between 2003 and 2013 (β = -0.13, p = .04 and β = -0.14, p = .007, respectively). Among boys, significant declines in carrying a weapon (β = -0.31, p < .001), carrying a gun (β = -0.16, p = .01), and physical fighting (β = -0.35, p = .001) were observed.

CONCLUSIONS

Whereas the prevalence of some forms of violence stabilized or declined among Philadelphia youth during 2003-2013 time span, involvement in violence-related behaviors remains common among this population. Continued surveillance and evidence-based violence reduction strategies are needed to address violence among urban youth.

The relationships of childhood trauma and adulthood prescription pain reliever misuse and injection drug use

BACKGROUND

We examined associations between childhood trauma and adulthood prescription pain reliever misuse (PPRM) and injection drug use (IDU) in a nationally-representative U.S. sample to further understanding of factors associated with these epidemics.

METHODS

National Longitudinal Study of Adolescent to Adult Health data (N=12,288) yielded nine childhood traumas: neglect; emotional, physical, sexual abuse; parental incarceration and binge drinking; witnessed, threatened with, and experienced violence. We estimated adjusted odds ratios (AOR) and 95% confidence intervals for the association of each trauma and cumulative trauma and drug initiation in emerging and later adulthood.

RESULTS

Outcome prevalences were 20% (PPRM) and 1% (IDU) in emerging adulthood and 10% PPRM in adulthood. We observed dose-response relationships that varied across outcomes. Cumulative trauma (referent=none) was associated with 34-79% greater odds of PPRM (emerging adulthood) across one to five+ trauma categories. The gradient was most consistent and associations strongest for adulthood PPRM: one trauma AOR=1.46(1.12, 1.91); two AOR=1.71(1.23, 2.36); three AOR=2.16(1.43, 2.36); four AOR=2.70(1.42, 5.62); five+ AOR=3.09(1.52, 6.30). Dose-response was less consistent for IDU, but 4 and 5+ traumas were associated with approximately seven and five times the odds of IDU. Neglect, emotional abuse, and parental incarceration and binge drinking were associated with 25-55% increased odds of PPRM. Sexual abuse and witnessed violence were associated with nearly 3 and 5 times the odds of IDU.

CONCLUSIONS

Associations between childhood trauma and PPRM/IDU highlight the need for trauma-informed interventions for drug users and early trauma screening and treatment for prevention of drug misuse over the life course.

Does military sexual trauma moderate the impact of critical warzone experiences?

The present research sought to replicate the finding that military sexual trauma (MST) moderates the effect of critical warzone experiences on mental health outcomes in a sample of male veterans. One-hundred eighty-one male veterans completed measures of MST, critical warzone experiences, and mental health symptoms. The hypothesized interaction was not significant, nor was a significant main effect observed for MST. In contrast, both critical warzone experiences and childhood maltreatment had significant main effects.

Sentencing Male Sex Offenders Under the Age of 14: A Law Reform Advocacy Journey in Hong Kong

The common law presumption that a boy under the age of 14 is incapable of sexual intercourse has provoked controversial debates in Hong Kong. This article describes a 6-step advocacy journey to examine how community efforts have helped modify this law so that juvenile male sexual offenders under the age of 14 who have committed the crime of having sexual intercourse with underage females can be sentenced to receive appropriate treatment. Seven court cases provided by the magistrates' courts in Hong Kong were used in this advocacy effort for the removal of the presumption in July 2012. Although this effort has yet to reveal signs of effectiveness, it represents greater public awareness about providing rehabilitation appropriate for juvenile sex offenders through a formal sentence. Restorative justice, as opposed to retributive or punitive justice, places an emphasis on rehabilitation of the offender and restoration of victims to a place of wholeness.

Sexually assaulted victims are getting younger

INTRODUCTION

From the clinical forensic examination reports produced by the Department of Forensic Medicine, Department of Forensic Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark, in 2007 concerning rape, attempted rape and sexual assault (RAS), circumstances were extracted and analysed focussing on age, relationship, lesions, violence, location and alcohol intoxication.

MATERIAL AND METHODS

A total of 184 girls and women over the age of 12 years were included in this retrospective study.

RESULTS

The median age of the victims was 20 years (range 12-89 years). 75.5% were under 30 years of age. 53% knew the perpetrator. More than one perpetrator was reported in 11%. 46% of the assaulted victims had a total number of 1-5 observed lesions and these were observed in all types of perpetrator relationship. Eight victims with more than 20 lesions were assaulted by a stranger or an acquaintance (first contact) (ACQ). 50% of the victims who had lesions were assaulted by a stranger or an ACQ. 55% of assaults occurred in private homes. A total of 107 had their blood alcohol concentration (BAC) measured. In all, 133 victims were assessed by the examining doctor to be unaffected by alcohol, eight of these had a BAC exceeding 1.0 per thousand. There was no correlation between the BAC and number of lesions. Two victims had a positive pregnancy test and were pregnant before the RAS.

CONCLUSION

In Denmark, RAS victims' age continues to decrease. RAS by a stranger or an ACQ involves a higher risk of lesions and the possibility of many lesions. More than half of those exposed to manual strangulation or other kinds of violence against the neck were assaulted by a stranger or an ACQ. Half of the women knew the perpetrator and the perpetrator was an ACQ in 26% of the cases.

FUNDING

not relevant.

TRIAL REGISTRATION

not relevant.

Young people who sexually abuse: a historical perspective and future directions

This article presents a historical overview of research on sexually abusive youth. The evolution of the field over the past 30 years is discussed-from the initial development of treatment interventions to contemporary efforts of professionals to move from traditional, adult-oriented interventions toward developmentally sensitive assessment strategies and practice models. Focus is on two critical areas: risk assessment and trauma-informed care. The article reviews contemporary research on risk assessment tools, stressing the need for validated tools that can accurately assess youth and follow changes in risk over time. Etiological models for understanding effects of trauma (Trauma Outcome Process Assessment and Family Lovemap) are presented. Discussed are new ecologically based therapy models for working with sexually abusive youth that approach the youth holistically and are attuned to youths' needs, including providing interventions to address effects of past trauma.

Prediction of adolescent sexual reoffending: a meta-analysis of the J-SOAP-II, ERASOR, J-SORRAT-II, and Static-99

Several risk assessment tools, including the Juvenile Sex Offender Assessment Protocol-II (Prentky & Righthand, 2003), the Estimate of Risk of Adolescent Sexual Offense Recidivism (Worling & Curwen, 2001), the Juvenile Sexual Offense Recidivism Risk Assessment Tool-II (Epperson, Ralston, Fowers, DeWitt, & Gore, 2006), and the Static-99 (Hanson & Thornton, 1999), have been used to assess reoffense risk among adolescents who have committed sexual offenses. Given that research on these tools has yielded somewhat mixed results, we empirically synthesized 33 published and unpublished studies involving 6,196 male adolescents who had committed a sexual offense. We conducted two separate meta-analyses, first with correlations and then with areas under the receiver operating characteristic curve (AUCs). Total scores on each of the tools significantly predicted sexual reoffending, with aggregated correlations ranging from .12 to .20 and aggregated AUC scores ranging from .64 to .67. However, in many cases heterogeneity across studies was moderate to high. There were no significant differences between tools, and although the Static-99 was developed for adults, it achieved similar results as the adolescent tools. Results are compared to other meta-analyses of risk tools used in the area of violence risk assessment and in other fields.

The constant multiplier assumption misestimates long-term sex offender recidivism rates

Many clinical psychologists have claimed that long-term sexual recidivism rates are a fixed multiple of short-term rates and have estimated that the true value of this constant falls somewhere between 1.5 and 3.0. They have also proposed that it is "mathematically sound" for evaluators to estimate the long-term rate for any actuarial score in sexually violent predator civil commitment cases by multiplying its short-term rate by this constant. The present paper questions the "constant multiplier assumption" and summarizes disconfirming data collected by its proponents and others showing that the fixed ratios for groups with low short-term rates are actually greater than the ratios for groups with high short-term rates. These results rule out the use of the constant multiplier assumption by risk evaluators. It is concerning that this assumption has not been previously tested. The authors call on the developers of risk assessment systems to collect and report data that clearly validate the assumptions that underpin their actuarial tables before they are disseminated or administered. The American Psychological Association ethical standards also require forensic evaluators to acknowledge the limitations of their risk assessments when they testify, a practice that is invaluable to the trier of fact.

Bullying perpetration and subsequent sexual violence perpetration among middle school students

PURPOSE

This study examines the association between bullying experiences and sexual violence (SV) perpetration among a sample of middle school students (n = 1391; males and females in grades 5-8) across five middle schools in a Midwestern state.

METHODS

We include waves 1 and 2 of a larger longitudinal study that aimed to track the overlap between bullying and SV victimization and/or perpetration across a 3-year period. Wave 1 data were collected in the spring of 2008, and wave 2 data were collected in the fall of 2008. Student participants completed a series of scales in a paper and pencil survey. After missing data imputation, a total sample of 1391 students was analyzed.

RESULTS

Using cutoff scores, 12% of males and 12% of females could be considered bully perpetrators. Thirty-two percent of the boys (22% of girls) reported making sexual comments to other students, 5% of boys (7% of girls) spread a sexual rumor, and 4% of boys (2% of girls) pulled at someone's clothing. Bullying perpetration and homophobic teasing were significant predictors of sexual harassment perpetration over time.

CONCLUSIONS

Given the overlap among bullying, homophobic teasing perpetration, and SV perpetration, future studies should address the link among these forms of aggression so that prevention programs can be enhanced to address gender-based bullying and sexual harassment.

Interactions between factors related to the decision of sex offenders to confess during police interrogation: a classification-tree approach

Most studies of confessions have looked at the influence of individual factors, neglecting the potential interactions between these factors and their impact on the decision to confess or not during an interrogation. Classification and regression tree analyses conducted on a sample of 624 convicted sex offenders showed that certain factors related to the offenders (e.g., personality, criminal career), victims (e.g., sex, relationship to offender), and case (e.g., time of day of the crime) were related to the decision to confess or not during the police interrogation. Several interactions were also observed between these factors. Results will be discussed in light of previous findings and interrogation strategies for sex offenders.

Paradoxical payoffs: migrant women, informal sector work, and HIV/AIDS in South Africa

In post-apartheid South Africa, there has been a significant rise in women's out-migration from rural areas and across its territorial borders for economic purposes resulting in gender reconfiguration of migration streams. Alongside, there has been a simultaneous increase in the participation of women in the labor force. However, this has mostly grown in the informal sector,1 which is often associated with low earnings and insecure working conditions. One consequence has been the increasing reliance of migrant women on survivalist activities such as informal sexual exchanges that increase their risk of contracting HIV infection. Insecure working environments also expose migrant women to sexual abuses. This article is based on the author's work in South Africa's major urban centers and examines the nature of the relationship between the increased migration of black African women in South Africa, the nature of their work, and their resultant vulnerability to HIV/AIDS.

Sexual assault, sexual risks and gender attitudes in a community sample of South African men

Sexual assault against women and HIV infection are both prevalent and related social problems in South Africa. The current study examined hostile attitudes toward women, acceptance of violence against women and masculine ideological beliefs in relation to sexual assault history among men in a Cape Town township in South African. Men (n=435) completed anonymous surveys of sexual assault history, HIV risk history and gender-based attitudes. More than one in five men in this community sample reported that they had either threatened to use force or used force to gain sexual access to a woman in their lifetime. Men with a history of sexual assault were at significantly higher risk for HIV transmission than their non-sexually assaultive counterparts. Men with a history of sexual assault were also more likely to endorse hostile attitudes toward women and were more likely to accept violence against women, although these attitudes and beliefs were prevalent and pervasive across men with and without histories of sexual assault. These findings extend previous research to show that men who have a history of sexual assault also exhibit elevated risks for HIV infection and transmission. Interventions are needed to address hostile attitudes toward women, sexual assault and sexual risks for HIV among South African men.

Violence and HIV-related risk among young men who have sex with men

Limited research has been conducted on threats or violence by family members and sexual partners against young men who have sex with men (MSM). Young MSM, aged 15-22 years, who attended public venues in New York City were enrolled in an anonymous, cross-sectional HIV seroprevalence and risk-behavior study. About two-thirds (68%) of the young MSM reported ever experiencing threats or violence from either family or partners and 25% reported threats or violence by both family and partners. In multivariate analysis, threats or violence by partners was significantly associated with older age, a history of forced sex and a history of running away from home. Recent unprotected anal sex and club drug use were significantly associated with a history of threats or violence by both family and partners. HIV prevention interventions need to include multiple factors that may have an impact on risk, including substance use and abuse, anti-violence and other mental-health issues.

[Sexual victimization in old age]

A study on the underresearched topic of elderly sexual victimization combined multiple data sources: German police crime statistics, 122 public prosecutor files on sexual victimization of people above age 60, survey data from 76 institutions assisting victims of sexual violence/domestic violence, in-depth interviews with 22 practitioners who had worked with sexually victimized elderly. The study shows that few cases of sexual victimization in old age are known to law enforcement agencies or victim services. Offences dealt with by the criminal justice system differ significantly from those known to battered women's shelters and victim services. The majority of incidents prosecuted by the criminal justice system are hands-off offences; hands-on offences are typically single incidents committed by strangers or loose acquaintances of the victim. Battered women's shelters and institutions of victim assistance are confronted with severe forms of sexual violence in intimate relationships, the prototypical case being an older woman who is repeatedly victimized by her husband over a considerable period of time and within a relationship characterized by a comprehensive system of violence, humiliation, and control (corresponding to Johnson's concept of intimate terrorism). The study demonstrates how small numbers of recorded cases of sexual violence in old age may reflect age-specific detection rates. It provides evidence on older victims' help-seeking behavior and on ways to improve victim services.

Long-term follow-up of exhibitionists: psychological, phallometric, and offense characteristics

Exhibitionism has historically been viewed as more of a nuisance than a serious criminal justice matter. Research has demonstrated that the number of exhibitionists who are detected re-offending is a significant under-representation of the number who actually re-offend. The objective of this study was to extend a previous study conducted on exhibitionists, while attempting to solve the limitations described in that study. Two hundred eight exhibitionists were assessed at a university teaching hospital between 1983 and 1996. Archival data were derived from police and medical files. Results indicated that, over a mean follow-up period of 13.24 years, 23.6, 31.3, and 38.9 percent of exhibitionists were charged with or convicted of sexual, violent, or criminal offenses, respectively. Undoubtedly, this is an under-representation of the true rate, as we have no way of knowing how many exhibitionists re-offended and did not get caught. Nevertheless, in the present investigation, sexual recidivists compared with non-recidivists were less educated, scored higher on the Michigan Alcohol Screening Test (MAST), the Psychopathy Checklist, Revised (PCL-R), and the Pedophile Index. Violent recidivists were also less educated and scored higher on the MAST, PCL-R, and the Pedophile Index, and had accumulated a greater number of prior violent or criminal charges and/or convictions. Criminal recidivists were less educated; scored higher on the MAST, Buss-Durkee Hostility Inventory (BDHI), PCL-R, and Pedophile Index; and had accumulated a greater number of prior sexual, violent, and criminal offenses. Finally, the hands-on sexual recidivists accumulated a greater number of prior violent and criminal charges and or convictions than did the hands-off sexual recidivists.

[Sexual aggression against girls and adult women --definitions and epidemiology]

Various definitions of sexual aggression lead to different rates of incidence and prevalence. Crime statistics indicate the rate of declared judiciable acts (Hellfeld). Research definitions are broader with respect to behavior of the perpetrator, damage to the victim etc. (Dunkelfeld). Taking various data sources into account it emerges that 12-20% of women become victims of sexual aggression, which means that sexual aggression is ubiquitous in society reaching all ages and social classes, women being by far more often exposed than men.

Sexuelle Aggression gegen Mädchen und Frauen – Ursachen und Folgen

Die Ursachen sexueller Aggression sind vielfältig und auf mehreren Ebenen wirksam. Evolutionsbiologisch bedingte Verhaltensdispositionen (sexuelle Aggression als Option männlicher reproduktiver Strategie) wirken zusammen mit spezifischen Gesellschaftsstrukturen mit männlicher Dominanz und damit verbundenen gelernten Stereotypen und Schemata, in denen Frauen sexuelle Selbstbestimmung und Ausdruck ihrer Sexualität verweigert wird und werden verstärkt durch individuelle Sozialisationsbedingungen, bei denen Gewalt ein zentrale Rolle spielt. Bei den Folgen sexueller Aggression für die Opfer unterscheiden wir primäre, mit dem Trauma zusammenhängende frühe und späte körperliche und seelische Folgen auf der einen Seite (Primäre Viktimisierung) und Folgen, die mit den Reaktionen des Umfeldes (Schuldzuweisungen, Entwertungen) zusammenhängen. Das Ausmaß der Folgen hängt von Risikofaktoren wie biographische Vorerfahrungen, Schwere des Übergriffes, kognitive Verarbeitungsschemata und soziale Reaktionen ab. Prävention muss darauf abzielen, gesellschaftliche Rahmenbedingungen abzubauen, die sexuelle Aggression begünstigen, und Programme für Männer und Frauen anbieten, in denen aggressionsmindernde und aggressionshemmende Verhaltensweisen erworben werden können.

Adult perpetrator gender asymmetries in child sexual assault victim selection: results from the 2000 National Incident-Based Report System

Data from the 2000 National Incident-Based Reporting System (NIBRS) show that while males make up about nine out of every 10 adult sexual assault perpetrators, totaling about 26,878 incidents within the reporting period, females account for about one out of 10 perpetrators, totaling about 1,162 incidents. Male sexual assault perpetrators offend against child victims about 25% of the time and predominantly choose female child victims, whereas female perpetrators offend against child victims about 40% of the time and choose child victims of both genders equally. Male perpetrators offend against adolescent victims about 40% of the time, and once again tend to choose female adolescent victims. Female perpetrators offend against adolescent victims a comparable amount of time (about 45%), and for forcible offenses (rape, sodomy, sexual assault with an object, and forcible fondling) choose adolescent victims of both genders equally, while for non-forcible offenses (non-forcible incest and statutory rape) they tend to choose predominantly male victims. Finally, adult male sexual assault perpetrators choose adult victims about 36% of the time while female perpetrators choose adult victims only 16% of the time. Implications for professionals are discussed, including recommendations to aid in correct identification of adult perpetrators and child/adolescent victims of sexual assault.

Is there a case for a specialist forensic psychiatry service for the elderly?

BACKGROUND

The number of elderly offenders in England and Wales is increasing. There is, therefore, a concern that their needs may not be met by existing forensic services. However, there is a paucity of information on elderly patients referred to existing forensic psychiatric units.

METHOD

Data on patients over the age of 65 years referred to a large medium secure forensic psychiatric unit in London were collected for a 13-year period using a retrospective design. The sample was divided into those who had first offended before the age of 65 and those who had offended after the age of 65. Data was also collected on victims of the offences.

RESULTS

5477 referrals were made during the study period. Those aged over 65 years accounted for 78 (1.4%) of all referrals. These 78 referrals were for 55 patients. Forty-five of these had offended. Case notes of 42 patients from this group were screened. Sexual and violent offences accounted respectively for 20 (47%) and 15 (36%) of offences. 31% had no psychiatric disorder but organic disorders accounted for 21% of cases. Only eight (19%) required admission to the medium secure unit. Fourteen (33%) had first offended after the age of 65 while others were known to either the forensic services or criminal justice system before the age of 65. The two groups did not differ from each other.

CONCLUSIONS

The elderly accounted for very few referrals to the medium secure forensic service, yet there is a high prevalence of psychiatric morbidity in both remand and sentenced elderly prisoners. Therefore, elderly offenders with psychiatric morbidity may benefit from specialist old age psychiatric forensic services, perhaps at a supraregional level.

[Sexual abuse in adolescence: patient assessment, necessity and meaning of the physical examination]

The objective of this paper is to report on the characteristics of sexual abuse in adolescence, on the medical evaluation and interpretation of findings and on the necessity of a multidisciplinary intervention. Sexual abuse is a common problem affecting children and adolescents, males and females of any age or socio-economic class. 10-22% of adolescents are victims of sexual abuse. They engage more frequently in risk-taking behaviours, such as early sexual activity, unprotected sexual contact with multiple partners (risk of sexually transmitted diseases, of an unwanted pregnancy), substance abuse, delinquency, school failure or suicide. Professionals who deal with adolescents should be aware of the devastating medical and psychosocial sequelae of sexual abuse and should be able to recognize it, incorporating questions regarding victimization into the psycho-social or sexual history. A medical examination, including an external anogenital inspection and in selected cases a pelvic examination, should always be performed. It is important to acknowledge that normal anogenital findings do not exclude sexual abuse and that a multidisciplinary medical-psychosocial evaluation is mandatory.

What we do not know about juvenile sexual reoffense risk

States have increasingly subject juvenile sexual offenders to sex offender registration and commitment under sexual predator laws in recent years. These statutes assume that sexual offenders present a sustained risk to recommit sexually violent crimes over an extended time period. Implicit in this assumption is that criminal sexual behavior is a product of some form of stable trait or condition that continues to push the juvenile toward sexually violent behaviors as they get older. This article examines these assumptions in light of the available research on the stability of sexually offending behavior in juveniles. The difficulties attendant to applying adult offender risk assessment models to juvenile sexual offenders are addressed. The available evidence indicates that the development and persistence of sexually criminal behavior is poorly understood, making the prediction of sustained sexual offending in juveniles that is required by some sexual predator statutes a particularly difficult task.

Gynecological examinations for social and legal reasons in Turkey: hospital data

AIM

Women in Turkey are subjected to gynecologic examinations not only for legal reasons, such as sexual assault or violence against pregnant women, but also for various social reasons, such as suspicions of premarital intercourse, prostitution, loss of virginity, and pregnancy at the time of entering into a new marriage. The examinations are performed by general practitioners, forensic physicians, and gynecologists. This study presents social reasons for gynecologic examinations of women in Turkey.

METHOD

We analyzed the reasons for gynecologic examination of 412 women at the 1st Obstetrics and Gynecology Department, Sisli Etfal Training and Research Hospital, between January 1, 1999 and June 30, 2001.

RESULTS

Out of 27,376 women at the Department, 412 (1.5%) underwent gynecologic examination for social or legal reasons: 82 (19.9%) for entering into a new marriage, 41 (10.1%) for violence against pregnant women, 28 (6.7%) for sexual assault, 53 (12.8%) for suspicion of prostitution, and 208 (50.5%) for the determination of virginity.

CONCLUSION

Gynecologic examinations for legal or social reasons in Turkey are still rather common. Medicolegal regulation of gynecological examinations should be changed to protect women's human rights.

[Crimes against life in the material of Cracow's Institute of Forensic Medicine--comparative analysis in the years 1986-2000 and 1996-2000]

The authors presented a comparative analysis of crimes against life in five year periods of the past and present political systems based on autopsy material of Cracow's Institute of Forensic Medicine. Investigation of these types of crime confirmed sociological observations of arising the criminal trends in the last years. The incident of these types of crimes arose in the last period by about 40% in a relation of male to female victims 3.7:1. Probable motives of these crimes were: drinking 8%, decline in family relationships 12%, fight and revenge 9% robbery 8%, sexual offenses only in 1%. In 61% of analyzed cases the motives were unknown. Among the weapons of crime the most often used were blunt objects and death due to stabbings and cuts. A very high incidence of fire arm crimes in comparison to previous period was observed--from 2 cases in 1986-1990 to 25 in the five year period of 1996-2000. 78% of victims were in a state of insobriety at the moment of crime.

Management of sexual assault

The incidence of sexual assault continues to escalate, and it is under-reported. Victim care requires special attention in the emergency department because the history and physical examination are unique and frequently time consuming. The victim should receive counseling and treatment for potential STDs, HIV, and hepatitis exposure, while stressing the importance of follow-up care. The emergency department physician must fulfill obligations not only to the patient but also to law enforcement. To be done well, documentation of findings and the completion of the evidentiary portion of the exam require a familiarity with the process.

[Social networks and social support in a sample of mentally ill sex offenders]

OBJECTIVE

Characteristics of social networks and social support were investigated in a group of 35 imprisoned mentally ill sex offenders.

METHODS

We compared current parameters (after an average of 3 years of psychosocial therapy) with those at the time of the offence.

RESULTS

Analyses reveal a decrease in social network size but an increase in social support by the remaining or new social network members. These changes are discussed in reference to various influencing variables in a therapeutic prison facility. The impact of psychosocial interventions in relapse prevention of sexual offenders will be outlined.

Sexual abuse is more frequently reported by IBS patients than by patients with organic digestive diseases or controls. Results of a multicentre inquiry. French Club of Digestive Motility

OBJECTIVES

The aim of this multicentre inquiry was to evaluate the prevalence of sexual abuse among IBS patients consulting a gastroenterologist, in comparison to healthy controls and patients with organic digestive diseases.

PATIENTS AND METHODS

Patients with irritable bowel syndrome (IBS; Rome Criteria) were included by eight university hospitals (n = 196; 41.2 +/- 20.6 years; sex ratio (M/F) = 0.23). Control groups were: (i) patients consulting for the follow-up of non-neoplastic organic digestive diseases (n = 135; 41.5 +/- 17.0 years; 1.21); (ii) patients attending ophthalmology units (n = 200; 43.8 +/- 20.7 years; 0.81); (iii) healthy subjects seen in centres of the National Health System (n = 172; 40.3 +/- 16.3 years; 0.83). Each patient filled in an anonymous questionnaire, without help. Prevalence of sexual abuse in the various groups was compared by the chi 2 test.

RESULTS

Sixty-two instance of sexual abuse (55 females, 7 males) were recorded among the 196 IBS patients (31.6%); 8 cases of verbal aggression, 4 of exhibitionism, 11 of sexual harassment, 22 sexual touches, 17 rapes. The prevalence of sexual abuse was 14.0% for the patients with organic digestive diseases (P = 0.0005 vs. IBS), 12.5% among ophthalmology patients (P < 0.0001) and 7.6% in healthy controls (P < 0.0001). Sexual abuse was accompanied by physical abuse in 23 IBS patients and 19 patients from control groups (not significant). Twenty-six IBS patients reported isolated physical abuse (14.7%) versus 40 from control groups (8.8%; P = 0.041). There was a significant trend towards more severe attacks of abuse among IBS patients than in others.

CONCLUSION

This study confirms the high prevalence of sexual abuse among IBS patients consulting in Gastroenterology. Some of these patients would benefit from appropriate therapy. (In the majority of cases, this will be psychotherapy.)

Irritable bowel syndrome and sexual/physical abuse history

There is growing evidence that a history of sexual or physical abuse can affect emotional and physical well-being. Within gastroenterology, attention has focused on the increased frequency of abuse history, particularly for patients with refractory functional gastrointestinal (GI) disorders. Furthermore, regardless of diagnosis, abuse history can impair health status and one's ability to cope with one's medical condition. Especially for patients with painful functional GI disorders resistant to usual treatments, the physician should inquire in a supportive manner about the possibility of a prior abuse history or other psychosocial traumas (e.g., major loss). This can then lead to an appropriate mental health referral (along with continued medical care) and an improved clinical outcome.

Trends in a national sample of sexually abusive youths

OBJECTIVE

To describe sociodemographic factors pertinent to sexually abusive youths, to define common characteristics of the offending behaviors and victims, and to identify issues relevant to treatment recommendations.

METHOD

The Uniform Data Collection system (UDCS), developed by the National Adolescent Perpetrator Network, provided data from 90 contributors in 30 states on more than 1,600 juveniles referred to them for specialized evaluation and/or treatment following a sexual offense. The UDCS comprises four separate structured questionnaires that collect both factual information and clinical impressions.

RESULTS

Physical and sexual abuse, neglect, and loss of a parental figure were common in these youths' histories. Twenty-two percent of the youths, who had been victims of sexual abuse, reported that the perpetrator of their own sexual abuse was female. The youths committed a wide range of sexual offenses, with twice as many of the referring offenses involving female victims than male victims.

CONCLUSION

The discovery of sexually abusive youths across both urban and rural areas supports the need for comprehensive service delivery and a continuum of treatment services to be available in all communities.

Incest perpetrators. Their assessment and treatment

The multitude of articles published in the last decade in the area of intrafamilial sexual abuse highlight the complexity of the issue--both its assessment and treatment. Although no unique profile of an incest perpetrator exists, a review of studies revealed problems in the areas of sexual satisfaction, psychological functioning, interpersonal relationships, and family of origin. As well, incest families have been reported to be dysfunctional, with power imbalances; control struggles; indirect, unclear communication; and inappropriate coalitions among family members. Based on these observations, a wide range of treatment interventions now exists, including offender-oriented cognitive/behavioral therapies and a family-focused multimodal systems approach. Although questions remain to be answered in regard to the effectiveness and process of treatment, efforts limited to the recognition of these problematic families are no longer adequate. The focus must move to prevention through the early identification of individuals at risk both for offending and being part of an incest family structure; the implementation of proven, cost-effective, proactive intervention strategies; and the continuing dissemination of information to the public.