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Sharman LS, Fitzgerald R, Douglas H. Prevalence of Sexual Strangulation/Choking Among Australian 18-35 Year-Olds. ARCHIVES OF SEXUAL BEHAVIOR 2024:10.1007/s10508-024-02937-y. [PMID: 38961025 DOI: 10.1007/s10508-024-02937-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 06/07/2024] [Accepted: 06/09/2024] [Indexed: 07/05/2024]
Abstract
In Australia, strangulation has been explicitly criminalized in all states and territories. However, it continues to be a "normalized" sexual practice despite its potentially fatal consequences and associated short and long-term sequelae. This research aimed to establish the prevalence of strangulation during sex and examine predictors of positive perceptions toward sexual strangulation in Australia. Confidential, cross-sectional online surveys were conducted with 4702 Australians aged 18-35 years. Participants were 47% cis-men, 48% cis-women, and 4% trans or gender diverse. A total of 57% reported ever being sexually strangled (61% women, 43% men, 79% trans or gender diverse) and 51% reported ever strangling a partner (40% women, 59% men, 74% trans or gender diverse). Differences were found across genders on all variables of sexual strangulation, including frequency of engagement, level of pressure on the neck, consequences, wanting and enjoyment, and how consent was given/received. However, when split by gender, sexual orientation of men and women revealed further differences in behaviors, consequences, and wanting, particularly among straight and bisexual women. After accounting for exposure to strangulation in pornography and previous experience of sexual strangulation, positive perceptions of being strangled (R2 = .51) and strangling a partner (R2 = .53) were predicted by ratings that it could be done safely and social normative factors. These findings suggest strangulation is common during sex among young Australians. Non-stigmatizing education strategies are needed to engage with young people so they have a better understanding of the risks involved and how to negotiate consent and safety regarding sexual strangulation.
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Affiliation(s)
- Leah S Sharman
- Melbourne Law School, Faculty of Law, University of Melbourne, Melbourne, VIC, 3010, Australia.
| | - Robin Fitzgerald
- Faculty of Humanities and Social Science, University of Queensland, Brisbane, Australia
| | - Heather Douglas
- Melbourne Law School, Faculty of Law, University of Melbourne, Melbourne, VIC, 3010, Australia
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2
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Peel M, Cunnion K. Recognising and responding to non-fatal strangulation in domestic abuse. Nurs Stand 2024:e12061. [PMID: 38853486 DOI: 10.7748/ns.2024.e12061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 06/11/2024]
Abstract
Victims/survivors (the authors use this term throughout the article but acknowledge that individuals may use various terms to describe their experiences) of non-fatal strangulation associated with domestic abuse are at risk of further serious harm or death, but often do not disclose the assault. In addition, some of the signs and symptoms are not immediately apparent or obvious. Nurses have a professional responsibility to respond to suspicions about and/or disclosure of any type of domestic abuse by initiating safeguarding and protection procedures and must provide effective care. This article discusses non-fatal strangulation in domestic abuse, including the presenting signs and symptoms and barriers to disclosure, and describes the role of the nurse. The authors include a fictional case study to demonstrate the type of situation nurses may experience when they encounter a victim/survivor of non-fatal strangulation.
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Affiliation(s)
- Matthew Peel
- Police Custody Healthcare, Leeds Community Healthcare NHS Trust, Leeds, England
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Adhikari SP, Stranges TN, Tehrani SNZ, Porter S, Mason K, van Donkelaar P. Investigating the Efficacy of a Community Support Network Rehabilitation Intervention for Improving Resiliency, Quality of Life, and Neurocognitive Function in Survivors of Intimate Partner Violence-Caused Brain Injury: Protocol for a Feasibility Study. JMIR Res Protoc 2024; 13:e54605. [PMID: 38788207 PMCID: PMC11177797 DOI: 10.2196/54605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Globally, approximately 1 in 3 women experience intimate partner violence (IPV) in their lifetime. Brain injury (BI) is a common, yet often unrecognized, consequence of IPV. BIs caused by IPV tend to be mild, occur repetitively over the course of months or years, are remote in time, and result in chronic symptoms. Similar to BI from other causes, therapeutic treatment for women with IPV-caused BI (IPV-BI) is crucial to help resolve any physical or cognitive impairments, enhance the quality of life (QoL), and minimize longer-term neurodegeneration. OBJECTIVE This study aims to investigate the feasibility and efficacy of a community support network (CSN) rehabilitation intervention regarding its impact on resiliency, QoL, and neurocognitive function. METHODS In this pre- and postexperimental design, women (aged 18 to 50 years) who are survivors of IPV and IPV-BI will be recruited from various community organizations serving survivors of IPV. Exclusion criteria will include current pregnancy and any diagnosed neurological disorder known to affect cerebrovascular, neurocognitive, or sensorimotor function. A CSN rehabilitation intervention that includes aerobic exercise, cognitive training, mindfulness meditation, and counseling will be administered. A trauma-informed approach will be integrated into the design and implementation of the program. Furthermore, the program will include a participant navigator who will provide trauma- and violence-informed advocacy and systems navigation support to participants, in addition to facilitating a monthly peer support group. The intervention will be provided for 2.5 hours a day and 2 days a week for 3 months. Participants will complete psychological assessments and provide clinic-demographic information in the first assessment. In the second (before intervention), third (after intervention), and fourth (at follow-up) sessions, they will complete tests of resiliency, QoL, and neurocognition. The estimated sample size is 100. The objective of this study will be accomplished by quantitatively measuring resiliency, QoL, and neurocognition before and immediately after the intervention. A follow-up assessment will occur 3 months after the completion of the intervention to evaluate the maintenance of any improvements in function. One-way ANOVAs will be used to evaluate the intervention outcome across the testing times. Relationships among various variables will be explored using regression analysis. RESULTS We anticipate that the CSN rehabilitation intervention will be effective in improving resiliency, QoL, and neurocognitive function in women who have experienced IPV-BI. Furthermore, we anticipate that this intervention will be feasible in terms of study recruitment, adherence, and retention. CONCLUSIONS The CSN rehabilitation intervention will have a positive impact on resiliency, QoL, and neurocognitive functions in survivors of IPV-BI. Subsequently, a comparative study will be conducted by recruiting a control group receiving usual care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/54605.
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Affiliation(s)
| | - Tori N Stranges
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | | | | | - Karen Mason
- Supporting Survivors of Abuse and Brain Injury Through Research (SOAR), Kelowna, BC, Canada
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
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4
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Esopenko C, Jain D, Adhikari SP, Dams-O'Connor K, Ellis M, Haag HL, Hovenden ES, Keleher F, Koerte IK, Lindsey HM, Marshall AD, Mason K, McNally JS, Menefee DS, Merkley TL, Read EN, Rojcyk P, Shultz SR, Sun M, Toccalino D, Valera EM, van Donkelaar P, Wellington C, Wilde EA. Intimate Partner Violence-Related Brain Injury: Unmasking and Addressing the Gaps. J Neurotrauma 2024. [PMID: 38323539 DOI: 10.1089/neu.2023.0543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Intimate partner violence (IPV) is a significant, global public health concern. Women, individuals with historically underrepresented identities, and disabilities are at high risk for IPV and tend to experience severe injuries. There has been growing concern about the risk of exposure to IPV-related head trauma, resulting in IPV-related brain injury (IPV-BI), and its health consequences. Past work suggests that a significant proportion of women exposed to IPV experience IPV-BI, likely representing a distinct phenotype compared with BI of other etiologies. An IPV-BI often co-occurs with psychological trauma and mental health complaints, leading to unique issues related to identifying, prognosticating, and managing IPV-BI outcomes. The goal of this review is to identify important gaps in research and clinical practice in IPV-BI and suggest potential solutions to address them. We summarize IPV research in five key priority areas: (1) unique considerations for IPV-BI study design; (2) understanding non-fatal strangulation as a form of BI; (3) identifying objective biomarkers of IPV-BI; (4) consideration of the chronicity, cumulative and late effects of IPV-BI; and (5) BI as a risk factor for IPV engagement. Our review concludes with a call to action to help investigators develop ecologically valid research studies addressing the identified clinical-research knowledge gaps and strategies to improve care in individuals exposed to IPV-BI. By reducing the current gaps and answering these calls to action, we will approach IPV-BI in a trauma-informed manner, ultimately improving outcomes and quality of life for those impacted by IPV-BI.
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Affiliation(s)
- Carrie Esopenko
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Divya Jain
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shambhu Prasad Adhikari
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Kristen Dams-O'Connor
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael Ellis
- Department of Surgery, Section of Neurosurgery, University of Manitoba, Pan Am Clinic, Winnipeg, Manitoba, Canada
| | - Halina Lin Haag
- Faculty of Social Work, Wilfrid Laurier University, Ontario, Canada
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada
| | - Elizabeth S Hovenden
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Finian Keleher
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Inga K Koerte
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Mass General Brigham, Harvard Medical School, Somerville, Massachusetts, USA
| | - Hannah M Lindsey
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amy D Marshall
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Karen Mason
- Supporting Survivors of Abuse and Brain Injury through Research (SOAR), Kelowna, British Columbia, Canada
| | - J Scott McNally
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Deleene S Menefee
- Michael E. DeBakey VA Medical Center, The Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Tricia L Merkley
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, Utah, USA
| | - Emma N Read
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Philine Rojcyk
- cBRAIN, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Mass General Brigham, Harvard Medical School, Somerville, Massachusetts, USA
| | - Sandy R Shultz
- Health Sciences, Vancouver Island University, Nanaimo, Canada
- Department of Neuroscience, Monash University, Alfred Centre, Melbourne, Australia
| | - Mujun Sun
- Department of Neuroscience, Monash University, Alfred Centre, Melbourne, Australia
| | - Danielle Toccalino
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Eve M Valera
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, British Columbia, Canada
| | - Cheryl Wellington
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, Canada
- School of Biomedical Engineering, University of British Columbia, Vancouver, Canada
| | - Elisabeth A Wilde
- Traumatic Brain Injury and Concussion Center, Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Radiology and Imaging Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
- George E. Wahlen ,VA Salt Lake City Heathcare System, Salt Lake City, Utah, USA
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Raskin SA, DeJoie O, Edwards C, Ouchida C, Moran J, White O, Mordasiewicz M, Anika D, Njoku B. Traumatic brain injury screening and neuropsychological functioning in women who experience intimate partner violence. Clin Neuropsychol 2024; 38:354-376. [PMID: 37222525 DOI: 10.1080/13854046.2023.2215489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 05/12/2023] [Indexed: 05/25/2023]
Abstract
Objective: The potential for traumatic brain injury (TBI) to occur as the result of intimate partner violence (IPV) has received increased interest in recent years. This study sought to investigate the possible occurrence of TBI in a group of women who survived IPV and to measure the specific profile of cognitive deficits using standardized neuropsychological measures. Method: A comprehensive questionnaire about abuse history; neuropsychological measures of attention, memory and executive functioning; and measures of depression, anxiety and post-traumatic stress disorder were given to women who were IPV survivors, women who were sexual assault (SA) survivors, and a comparison group of women who did not experience IPV or SA. Results: Overall, rates of potential TBI, as measured by the HELPS brain injury screening tool, were high and consistent with previous studies. Consistent with potential TBI, lower scores were demonstrated on measures of memory and executive functioning compared to survivors of SA or those not exposed to violence. Importantly, significant differences on measures of memory and executive functioning remained, after controlling for measures of emotion. Of note, cognitive changes were highest among women who experienced non-fatal strangulation (NFS) compared to IPV survivors who did not. Conclusions: Rates of TBI may be high in women who survive IPV, especially those who survive strangulation. Better screening measures and appropriate interventions are needed as well as larger studies that look at social factors associated with IPV.
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Affiliation(s)
- Sarah A Raskin
- Department of Psychology, Trinity College, Hartford, CT, USA
- Neuroscience Program, Trinity College, Hartford, CT, USA
| | | | | | - Chloe Ouchida
- Neuroscience Program, Trinity College, Hartford, CT, USA
| | - Jocelyn Moran
- Neuroscience Program, Trinity College, Hartford, CT, USA
| | - Olivia White
- Neuroscience Program, Trinity College, Hartford, CT, USA
| | | | - Dorothy Anika
- Neuroscience Program, Trinity College, Hartford, CT, USA
| | - Blessing Njoku
- Neuroscience Program, Trinity College, Hartford, CT, USA
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Nemeth J, Ramirez R, Debowski C, Kulow E, Hinton A, Wermert A, Mengo C, Malecki A, Glasser A, Montgomery L, Alexander C. The CARE Health Advocacy Intervention Improves Trauma-Informed Practices at Domestic Violence Service Organizations to Address Brain Injury, Mental Health, and Substance Use. J Head Trauma Rehabil 2023; 38:439-447. [PMID: 36951455 DOI: 10.1097/htr.0000000000000871] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the impact that domestic violence (DV) service organizations' (SO) agency-wide adoption of CARE had on improving DVSO trauma-informed care (TIC) practices, overall, and in relation to addressing brain injury and mental health. CARE is an advocacy intervention designed to raise DVSOs' capacity to C ONNECT with survivors; A CKNOWLEDGE that head trauma, strangulation, and mental health challenges are common; R ESPOND by accommodating needs in services and providing targeted referrals; and E VALUATE effectiveness of response to meet survivors' stated concerns. We hypothesized that TIC would significantly improve among DVSO staff with the agency's use of CARE. SETTING/PARTICIPANTS/DESIGN Pre- ( n = 53) and 1-year post-CARE ( n = 60) implementation online surveys were completed by staff at 5 DVSOs in Ohio from 2017 to 2019. MAIN MEASURES Trauma-Informed Practice Scales (TIPS) were used to assess agency support and overall staff impression of implementing TIC; scales were modified to assess the use of TIC-practices related to head trauma, strangulation, mental health, suicide, and substance use. Attitudes Regarding Trauma-Informed Care (ARTIC-45) subscales assessed DVSO staff's endorsement of personal and organizational support in implementing TIC practices. Response options on the Survivor Defined Practice Scale (SDPS) were modified to gain staff insight into DVSO's ability to facilitate survivor empowerment. Differences in endorsement of TIC practices between pre- and post-CARE implementation were evaluated using regression models. RESULTS DVSO agency environment ( P < .01) and overall staff impression ( P < .001) regarding implementing TIC practices, and in respect to head trauma ( P < .01), strangulation ( P < .01), mental health ( P < .01), suicide ( P = .04), and substance use ( P < .01), significantly improved with the agency's use of CARE. CARE increased DVSO staff's belief in personal and organizational support to implement TIC ( P < .01 and P = .02, respectively) and in their agency's ability to foster survivor empowerment ( P < .01). CONCLUSION CARE improved TIC practices of DVSOs, overall, and to address brain injury and mental health.
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Affiliation(s)
- Julianna Nemeth
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus (Drs Nemeth, Montgomery, and Debowski and Mss Wermert, Malecki, and Glasser); Ohio Domestic Violence Network, Columbus (Mss Ramirez, Kulow, and Alexander); Division of Biostatistics, College of Public Health, The Ohio State University (Dr Hinton);and School of Social Work, The Ohio State University, Columbus (Dr Mengo)
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7
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Hou J, Huibregtse ME, Alexander IL, Klemsz LM, Fu T, Rosenberg M, Fortenberry JD, Herbenick D, Kawata K. Structural brain morphology in young adult women who have been choked/strangled during sex: A whole-brain surface morphometry study. Brain Behav 2023; 13:e3160. [PMID: 37459254 PMCID: PMC10454256 DOI: 10.1002/brb3.3160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Being choked/strangled during partnered sex is an emerging sexual behavior, particularly prevalent among young adult women. Using a multiparameter morphometric imaging approach, we aimed to characterize neuroanatomical differences between young adult women (18-30 years old) who were exposed to frequent sexual choking and their choking naïve controls. METHODS This cross-sectional study consisted of two groups (choking [≥4 times in the past 30 days] vs. choking-naïve group). Participants who reported being choked four or more times during sex in the past 30 days were enrolled in the choking group, whereas those without were assigned to the choking naïve group. High-resolution anatomical magnetic resonance imaging (MRI) data were analyzed using both volumetric features (cortical thickness) and geometric features (fractal dimensionality, gyrification, sulcal depth). RESULTS Forty-one participants (choking n = 20; choking-naïve n = 21) contributed to the final analysis. The choking group showed significantly increased cortical thickness across multiple regions (e.g., fusiform, lateral occipital, lingual gyri) compared to the choking-naïve group. Widespread reductions of the gyrification were observed in the choking group as opposed to the choking-naïve group. However, there was no group difference in sulcal depth. The fractal dimensionality showed bi-directional results, where the choking group exhibited increased dimensionality in areas including the postcentral gyrus, insula, and fusiform, whereas decreased dimensionality was observed in the bilateral superior frontal gyrus and pericalcarine cortex. CONCLUSION These data in cortical morphology suggest that sexual choking events may be associated with neuroanatomical alteration. A longitudinal study with multimodal assessment is needed to better understand the temporal ordering of sexual choking and neurological outcomes.
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Affiliation(s)
- Jiancheng Hou
- Research Center for Cross‐Straits Cultural DevelopmentFujian Normal UniversityFuzhouChina
- Department of KinesiologyIndiana University School of Public Health‐BloomingtonBloomingtonIndianaUSA
| | - Megan E. Huibregtse
- Department of KinesiologyIndiana University School of Public Health‐BloomingtonBloomingtonIndianaUSA
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgiaUSA
| | - Isabella L. Alexander
- Department of KinesiologyIndiana University School of Public Health‐BloomingtonBloomingtonIndianaUSA
| | - Lillian M. Klemsz
- Department of KinesiologyIndiana University School of Public Health‐BloomingtonBloomingtonIndianaUSA
| | - Tsung‐Chieh Fu
- Department of Applied Health Science, Indiana University School of Public HealthIndiana UniversityBloomingtonIndianaUSA
- The Center for Sexual Health Promotion, Indiana University School of Public HealthIndiana UniversityBloomingtonIndianaUSA
| | - Molly Rosenberg
- Department of Epidemiology and Biostatistics, Indiana University School of Public HealthIndiana UniversityBloomingtonIndianaUSA
| | - James Dennis Fortenberry
- Department of Pediatrics, Indiana University School of MedicineIndiana UniversityIndianapolisIndianaUSA
| | - Debby Herbenick
- Department of Applied Health Science, Indiana University School of Public HealthIndiana UniversityBloomingtonIndianaUSA
- The Center for Sexual Health Promotion, Indiana University School of Public HealthIndiana UniversityBloomingtonIndianaUSA
| | - Keisuke Kawata
- Department of KinesiologyIndiana University School of Public Health‐BloomingtonBloomingtonIndianaUSA
- Program in NeuroscienceThe College of Arts and SciencesIndiana UniversityBloomingtonIndianaUSA
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Brady PQ, Zedaker SB, McKay K, Scott D. The Darker the Skin, the Greater the Disparity? Why a Reliance on Visible Injuries Fosters Health, Legal, and Racial Disparities in Domestic Violence Complaints Involving Strangulation. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:7602-7629. [PMID: 36695177 DOI: 10.1177/08862605221145726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The reliance on external injuries for justice is misguided given that assault injuries may be less visible among victims of color due to increased melanin in the skin. To date, however, less is known whether racial/ethnic disparities extend to officers' identification of signs of nonfatal strangulation (NFS). The current study estimates the extent of NFS indicators identified by officers who completed a standardized strangulation assessment in 133 family violence complaints. Breathing difficulties were the most common symptoms identified by officers (98%), followed by external signs (89%), and symptoms of impeded blood circulation (87%). Compared to cases involving White/Asian survivors, officers were less likely to identify external injuries on Black survivors' neck, chin, and chest/shoulders. While racial/ethnic differences did not emerge for symptoms of disrupted airflow, Hispanic survivors were twice as likely to report losing control of bodily functions. Implications for policy and practice are discussed.
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Affiliation(s)
- Patrick Q Brady
- The University of Northern Colorado, Greeley, USA
- The University of Colorado Colorado Springs, USA
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Herbenick D, Guerra-Reyes L, Patterson C, Wilson J, Rosenstock Gonzalez YR, Voorheis E, Whitcomb M, Kump R, Theis E, Rothman EF, Nelson KM, Maas MK. #ChokeMeDaddy: A Content Analysis of Memes Related to Choking/Strangulation During Sex. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1299-1315. [PMID: 36526942 PMCID: PMC9757635 DOI: 10.1007/s10508-022-02502-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/04/2022] [Accepted: 11/30/2022] [Indexed: 05/11/2023]
Abstract
Recent research indicates that some young people initially learn about sexual choking through Internet memes. Thus, a qualitative content analysis was performed on 316 visual and textual memes collected from various social media websites and online searches to assess salient categories related to choking during sex. We identified nine main categories: communication, gendered dynamics, choking as dangerous, choking as sexy, sexualization of the nonsexual, shame and worry, romance/rough sex juxtaposition, choking and religious references, instructional/informational. Given that memes, through their humor, can make difficult topics more palatable and minimize potential harm in the phenomenon they depict, more concerted, synergistic effort that integrates media literacy into sexuality education programming on the potential risks that may ensue for those engaging in sexual choking is warranted.
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Affiliation(s)
- Debby Herbenick
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA.
- The Center for Sexual Health Promotion, Indiana University School of Public Health, SPH 116, Indiana University, Bloomington, IN, 47405, USA.
| | - Lucia Guerra-Reyes
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, SPH 116, Indiana University, Bloomington, IN, 47405, USA
| | - Callie Patterson
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, SPH 116, Indiana University, Bloomington, IN, 47405, USA
| | - Jodi Wilson
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, SPH 116, Indiana University, Bloomington, IN, 47405, USA
| | - Yael R Rosenstock Gonzalez
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, SPH 116, Indiana University, Bloomington, IN, 47405, USA
| | - Eva Voorheis
- The Center for Sexual Health Promotion, Indiana University School of Public Health, SPH 116, Indiana University, Bloomington, IN, 47405, USA
| | - Maddy Whitcomb
- The Center for Sexual Health Promotion, Indiana University School of Public Health, SPH 116, Indiana University, Bloomington, IN, 47405, USA
| | - Rachel Kump
- The Center for Sexual Health Promotion, Indiana University School of Public Health, SPH 116, Indiana University, Bloomington, IN, 47405, USA
| | - Evan Theis
- The Center for Sexual Health Promotion, Indiana University School of Public Health, SPH 116, Indiana University, Bloomington, IN, 47405, USA
| | - Emily F Rothman
- Department of Occupational Therapy, Boston University, Boston, MA, USA
| | - Kimberly M Nelson
- Department of Community Health Sciences and Department of Psychiatry, Boston University, Boston, MA, USA
| | - Megan K Maas
- Department of Human Development and Family Studies, Michigan State University, East Lansing, MI, USA
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10
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Abstract
OBJECTIVES Non-fatal strangulation (NFS) is a serious form of gendered violence that is fast becoming an offence in many jurisdictions worldwide. However, it often leaves little or no externally visible injuries making prosecution challenging. This review aimed to provide an overview of how health professionals can support the prosecution of criminal charges of NFS as part of regular practice, particularly when externally visible injuries are absent. METHOD Eleven databases were searched with terms related to NFS and medical evidence in health sciences and legal databases. Eligible articles were English language and peer reviewed, published before 30 June 2021; sample over 18 years that had primarily survived a strangulation attempt and included medical investigations of NFS injuries, clinical documentation of NFS or medical evidence related to NFS prosecution. RESULTS Searches found 25 articles that were included for review. Alternate light sources appeared to be the most effective tool for finding evidence of intradermal injury among NFS survivors that were not otherwise visible. However, there was only one article that examined the utility of this tool. Other common diagnostic imaging was less effective at detection, but were sought after by prosecutors, particularly MRIs of the head and neck. Recording injuries and other aspects of the assault using standardised tools specific for NFS were suggested for documenting evidence. Other documentation included writing verbatim quotes of the experience of the assault and taking good quality photographs that could assist with corroborating a survivor's story and proving intent, if relevant for the jurisdiction. CONCLUSION Clinical responses to NFS should include investigation and standardised documentation of internal and external injuries, subjective complaints and the experience of the assault. These records can assist in providing corroborating evidence of the assault, reducing the need for survivor testimony in court proceedings and increasing the likelihood of a guilty plea.
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Affiliation(s)
- Leah S Sharman
- Melbourne Law School, The University of Melbourne, Carlton, Victoria, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Robin Fitzgerald
- Faculty of Humanities and Social Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Heather Douglas
- Melbourne Law School, The University of Melbourne, Carlton, Victoria, Australia
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11
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Sexual violence and self-reported sexually transmitted infections among women in sub-Saharan Africa. J Biosoc Sci 2023; 55:292-305. [PMID: 35193714 DOI: 10.1017/s0021932022000062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Sexual violence has proven to be associated with sexually transmitted infections (STIs) in sub-Saharan Africa (SSA). We examined the association between sexual violence and self-reported STIs (SR-STIs) among women in sexual unions in 15 sub-Saharan African countries. This was a cross-sectional study involving the analysis of data from the Demographic and Health Surveys (DHS) from 15 countries in SSA. A total sample of 65,392 women in sexual unions were included in the final analysis. A multilevel binary logistic regression analysis was carried out and the results were presented using adjusted odds ratios (aOR) at 95% Confidence Interval (CI). Women who experienced sexual violence in the last 12 months were more likely to self-report STIs compared to those who did not experience sexual violence [aOR = 1.76, 95% CI = 1.59-1.94]. Compared to women in Angola, those who were in Mali, Nigeria, Sierra Leone, Uganda, and Liberia were more likely to self-report STIs while those in Burundi, Cameroon, Chad, Ethiopia, Malawi, Rwanda, South Africa, Zambia, and Zimbabwe were less likely to self-report STIs. The study has revealed variations in the country level regarding the prevalence of sexual violence and SR-STI in the last 12 months among women in sexual unions in the selected countries. This study has demostrated that sexual violence in the last 12 months is associated with SR-STIs among women in sexual unions. Moreover, factors that predict SR-STIs were observed in this study. Policymakers and agencies that matter could consider the factors identified in this study when designing policies or strengthening existing ones to tackle STIs among women in SSA. To accelerate the progress towards the achievement of Sustainable Development Goal 3, its imperative efforts and interventions must be intensified in SSA to reduce sexual violence which will go a long way to reduce SR-STIs among women.
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Herbenick D, Fu TC, Patterson C. Sexual Repertoire, Duration of Partnered Sex, Sexual Pleasure, and Orgasm: Findings from a US Nationally Representative Survey of Adults. JOURNAL OF SEX & MARITAL THERAPY 2023; 49:369-390. [PMID: 36151751 DOI: 10.1080/0092623x.2022.2126417] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
In a confidential U.S. nationally representative survey of 2,525 adults (1300 women, 1225 men), we examined participants' event-level sexual behaviors, predictors of pleasure and orgasm, and perceived actual and ideal duration of sex, by gender and age. Event-level kissing, cuddling, vaginal intercourse, and oral sex were prevalent. Sexual choking was more prevalent among adults under 40. While women and men reported a similar actual duration of sex, men reported a longer ideal duration. Participants with same-sex partners reported a longer ideal duration than those with other-sex partners. Finally, findings show that gendered sexual inequities related to pleasure and orgasm persist.
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Affiliation(s)
- Debby Herbenick
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
| | - Tsung-Chieh Fu
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
| | - Callie Patterson
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
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Nguyen TC, Donovan EE, Wright ML. Doula Support Challenges and Coping Strategies during the COVID-19 Pandemic: Implications for Maternal Health Inequities. HEALTH COMMUNICATION 2022; 38:1099-1110. [PMID: 34894931 DOI: 10.1080/10410236.2021.1991641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The COVID-19 pandemic has made birthing more stressful and isolating, which has raised particular concern for populations of birthing people affected by maternal health inequities. Doulas have been proposed as one means of improving health outcomes by providing emotional, physical, and informational support to patients and their families before, during, or after labor. However, the social and economic conditions of the COVID-19 pandemic have posed new challenges for doula care. We conducted thematic analysis on 25 semi-structured interviews with practicing doulas in the United States to explore changes to doula care during the pandemic. Although doulas have faced many challenges in providing virtual and socially-distanced support during the pandemic, the rising use of telehealth among doulas has revealed new coping strategies and opportunities for virtual communication with the doula community. Our findings indicate that doula experiences during the pandemic can inform future doula care practices, particularly for birthing people of color and low-income birthing people.
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Affiliation(s)
- Tien C Nguyen
- College of Natural Sciences, The University of Texas
| | - Erin E Donovan
- Department of Communication Studies, The University of Texas
| | - Michelle L Wright
- School of Nursing, The University of Texas
- Department of Women's Health, Dell Medical School
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14
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Death Threats and Attempted Femicide in the Context of Domestic Violence in Portugal. SOCIAL SCIENCES 2022. [DOI: 10.3390/socsci11080347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Domestic violence is a serious problem in Portugal, affecting mainly women. The significant number of femicides in the context of intimate partner violence has been showing not only the severity of the crime, but also the necessity to reinforce strategies to prevent and combat it. Although several studies were developed in the last decades to portray domestic violence, research on the threat of death and attempted femicide is scarce. This study aims to characterize death threats and attempts of femicide, in the light of the professionals’ perspectives from the Portugal National Support Network for Victims of Domestic Violence, contributing to informing best practices of risk assessment. Seventy-one professionals, 62 female (87.3%) and 9 male (12.7%), at an average age of 37.69 years, filled a questionnaire survey. Results suggest weaknesses in the application of current legislation and the adoption of effective measures in situations where victims experience death threats and attempted murders. Although there are criminal proceedings before these episodes, this does not seem to have effective consequences in terms of protection and security, whereby the development of strategies that safeguard victims from tragic endings such as femicide are necessary.
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15
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Herbenick D, Fu TC, Eastman-Mueller H, Thomas S, Svetina Valdivia D, Rosenberg M, Guerra-Reyes L, Wright PJ, Kawata K, Feiner JR. Frequency, Method, Intensity, and Health Sequelae of Sexual Choking Among U.S. Undergraduate and Graduate Students. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3121-3139. [PMID: 35902430 PMCID: PMC9333342 DOI: 10.1007/s10508-022-02347-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 05/25/2023]
Abstract
Although sexual choking is now prevalent, little is known about how people engage in choking in terms of frequency, intensity, method, or potential health sequelae. In a campus-representative survey of undergraduate and graduate students, we aimed to: (1) describe the prevalence of ever having choked/been choked as part of sex; (2) examine the characteristics of choking one's sexual partners (e.g., age at first experience, number of partners, frequency, intensity, method); (3) examine the characteristics of having been choked during sex; and (4) assess immediate responses of having been choked including the extent to which frequency and method (e.g., hand, ligature, limb) of having been choked predicts the range of responses endorsed by participants. A total of 4254 randomly sampled students (2668 undergraduate, 1576 graduate) completed a confidential online survey during Spring 2021. The mean age of first choking/being choked was about 19, with more undergraduates than graduate students reporting first choking/being choked in adolescence. Women and transgender/gender non-binary participants were significantly more likely to have been choked than men. Participants more often reported the use of hands compared to limbs or ligature. Common responses to being choked were pleasurable sensations/euphoria (81.7%), a head rush (43.8%), feeling like they could not breathe (43.0%), difficulty swallowing (38.9%), unable to speak (37.6%), and watery eyes (37.2%). About 15% had noticed neck bruising and 3% had lost consciousness from being choked. Greater frequency and intensity of being choked was associated with reports of more physical responses as was use of limb (arm, leg) or ligature.
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Affiliation(s)
- Debby Herbenick
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA.
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47405, USA.
| | - Tsung-Chieh Fu
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47405, USA
| | - Heather Eastman-Mueller
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47405, USA
| | - Sally Thomas
- Office of Sexual Violence Prevention and Victim Advocacy, Indiana University, Bloomington, IN, USA
| | - Dubravka Svetina Valdivia
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, IN, USA
| | - Molly Rosenberg
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47405, USA
- Department of Epidemiology and Biostatistics, Indiana University School of Public, Health, Indiana University, Bloomington, IN, USA
| | - Lucia Guerra-Reyes
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47405, USA
| | - Paul J Wright
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, 47405, USA
- The Media School, Indiana University, Bloomington, IN, USA
| | - Keisuke Kawata
- Department of Kinesiology, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- Program in Neuroscience, Division of Clinical and Translational Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN, USA
| | - John R Feiner
- Department of Anesthesia and Perioperative Care, University of California at San Francisco School of Medicine, San Francisco, CA, USA
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16
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PATCH M, ANDERSON JC, ALEXANDER K, SOMOANO FA, KELEN G, HOLBROOK DS, CAMPBELL JC. Didn't put a label on it: Examining intimate partner strangulation within a diagnostic framework. J Adv Nurs 2022; 79:1575-1588. [PMID: 35864083 PMCID: PMC9922028 DOI: 10.1111/jan.15380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/26/2022] [Accepted: 07/05/2022] [Indexed: 01/01/2023]
Abstract
AIMS The aim was to examine and describe women's emergency department visits and care-seeking experiences, including recognition, evaluation and communication of symptoms, injuries and health risks after non-fatal intimate partner strangulation. DESIGN Using a diagnostic process framework, this mixed-methods study explores concordance and discordance of interview and medical records data to highlight opportunities for clinical diagnostic improvement. METHODS In-depth, semi-structured interviews with women after an emergency department visit for non-fatal intimate partner strangulation, concurrent with medical records reviews, were conducted between March 2018 and January 2019. A constant comparative approach was used to analyse interview and medical record data using an a priori codebook designed based on the National Academies of Science, Engineering and Medicine's conceptual model of the diagnostic process and prior intimate partner violence research. RESULTS Interviews reflected participants did not have a sense of long-term health risks from their strangulation beyond addressing emotional trauma. Women noted that forensic and emergency nursing support was treatment in and of itself that allowed them to be heard and validated. Medical record clinical impressions and final diagnoses included domestic violence, domestic abuse or sexual assault, but not specifically strangulation. CONCLUSION This study contributes to the growing literature regarding strangulation diagnosis and care. Our findings provide new details of women's emergency department care-seeking experiences which, whilst overall aligned with medical records documentation, were not reflected in final diagnostic impressions nor in patient recollection of long-term health risks. IMPACT Nurses are strongly positioned as clinical practice leaders and policy advocates to improve collective responses to this dangerous violence mechanism. Actions such as improving patient education, referral and follow-up options to better communication and address long-term strangulation risk are one example. Further research on non-fatal intimate partner strangulation and care-seeking is warranted to expand this knowledge, particularly in longitudinal cohorts and varied geographical areas.
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Affiliation(s)
- Michelle PATCH
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Jocelyn C. ANDERSON
- Pennsylvania State University College of Nursing, University Park, Pennsylvania
| | | | | | - Gabor KELEN
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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17
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Huibregtse ME, Alexander IL, Klemsz LM, Fu TC, Fortenberry JD, Herbenick D, Kawata K. Frequent and Recent Non-fatal Strangulation/Choking During Sex and Its Association With fMRI Activation During Working Memory Tasks. Front Behav Neurosci 2022; 16:881678. [PMID: 35722189 PMCID: PMC9201570 DOI: 10.3389/fnbeh.2022.881678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Being strangled, or “choked,” by a sexual partner has emerged as a prevalent, often wanted and consensual sexual behavior among adolescent and young adult women, yet the neurological consequences of repeated exposure to this behavior are unknown. The objective of the study was to examine the association between a history of repeated, recent choking/strangling episodes during sex and fMRI activation during working memory tasks in young adult women. This case-control study involved young adult women (18–30 years old) at a large, public university, and consisted of two study groups: a choking group consisting of participants who were recently and frequently choked/strangled during sex by a partner (≥4 times in the past 30 days) and a choking-naïve (control) group who had never been choked/strangled during sex. Participants completed two variations of the N-back (0-back, 1-back, and 2-back) working memory task during functional magnetic resonance imaging (fMRI): verbal and visual N-back tasks. Data from 20 participants per group were available for analysis. Between-group differences for accuracy and reaction time were not significant for either variation of the N-back task. Significant differences in fMRI activation patterns were detected between the choking and the choking-naïve groups for the three contrasts of interest (1-back > 0-back, 2-back > 0-back, and 2-back > 1-back). The choking group exhibited increased activation in multiple clusters relative to the choking-naïve group for the contrasts between the 1-back and 2-back conditions compared to the 0-back conditions (e.g., superior frontal gyrus, corpus callosum). However, the choking-naïve group exhibited increased activation relative to the choking group in several clusters for the 2-back > 1 back contrast (e.g., splenium, middle frontal gyrus). These data indicate that recent, frequent exposure to partnered sexual strangulation is associated with different neural activation patterns during verbal and visual working memory tasks compared to controls, suggesting that being choked/strangled during sex may modify the allocation of neural resources at increasing levels of cognitive load. Further investigation into the neurologic effects of this sexual behavior is warranted, given the prevalence of sexual choking among adolescent and young adult women.
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Affiliation(s)
- Megan E. Huibregtse
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Isabella L. Alexander
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Lillian M. Klemsz
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Tsung-chieh Fu
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, United States
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States
| | - J. Dennis Fortenberry
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Debby Herbenick
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, United States
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Keisuke Kawata
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, United States
- Program in Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN, United States
- *Correspondence: Keisuke Kawata
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18
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Herbenick D, Patterson C, Khan S, Voorheis E, Sullivan A, Wright P, Keene S. "Don't Just Randomly Grab Someone's Neck during Intercourse!" An Analysis of Internet Articles about Choking/Strangulation during Sex. JOURNAL OF SEX & MARITAL THERAPY 2022; 49:41-55. [PMID: 35570586 DOI: 10.1080/0092623x.2022.2065392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sexual choking/strangulation has become prevalent among young U.S. adults, yet little is known about media articles that teach readers about choking. We conducted a content analysis of 27 Internet articles, examining how choking is described, information related to health risks and healthcare, and article accuracy. Most articles described choking in positive terms and indicated choking can be done safely or properly, even while acknowledging potential dangers. Only two articles indicated having undergone expert/medical review. Few gave information about signs that would warrant seeking healthcare. Sexuality professionals need to be aware of choking-related information and misinformation in online media articles.
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Affiliation(s)
- Debby Herbenick
- The Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Callie Patterson
- The Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Shahzarin Khan
- The Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Eva Voorheis
- The Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Anne Sullivan
- The Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Paul Wright
- The Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, USA
- The Media School, Indiana University, Bloomington, IN, USA
| | - Samantha Keene
- School of Social and Cultural Studies, The Institute of Criminology, Te Herenga Waka - Victoria University of Wellington, Wellington, New Zealand
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Wright PJ, Herbenick D, Tokunaga RS. Pornography and Women's Experience of Mixed-Gender Sexual Choking/Strangulation: Eroticization Mediates, Perceived Similarity Moderates. JOURNAL OF HEALTH COMMUNICATION 2022; 27:173-182. [PMID: 35535648 DOI: 10.1080/10810730.2022.2073406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Sexual choking, which is a form of strangulation, can lead to various health consequences, including death. Recent surveys suggest that sexual choking is prevalent among young U.S. adults, a demographic also likely to view pornography. Pornography professionals, social commentators, and scholars have noted that mixed-gender choking is normative in contemporary pornography. Further, the pornographic portrayal of sexual choking is gendered; men choke women more often than women choke men. Guided by the sexual script acquisition, activation, application model (3AM) of mediated sexual socialization, the present campus-representative probability study explored associations between heterosexual-identified women's pornography exposure and sexual choking behavior. The more frequently women viewed pornography, the more often they were exposed to pornographic depictions of sexual choking. Exposure to sexual choking, in turn, was associated with being choked by men, but not choking men. The link between choking exposure and being choked was mediated by the eroticization of choking (rather than reduced agency to stop rough sex) and became stronger the more women perceived themselves as similar to actors in pornography. These results suggest that women's experience of sexual choking is influenced by their use of pornography, but in an active and willing, rather than a passive and unwilling, manner.
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Affiliation(s)
- Paul J Wright
- The Media School, Indiana University, Bloomington, Indiana, USA
| | - Debby Herbenick
- The Center for Sexual Health Promotion in the School of Public Health, Indiana University, Bloomington
| | - Robert S Tokunaga
- The Department of Communication, University of Texas, Austin, Texas, USA
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How CARE Tools Are Being Used to Address Brain Injury and Mental Health Struggles With Survivors of Domestic Violence. J Head Trauma Rehabil 2022; 37:E39-E47. [PMID: 34985039 DOI: 10.1097/htr.0000000000000745] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION CARE (Connect, Acknowledge, Respond, and Evaluate) is an advocacy framework developed for domestic violence service organization (DVSO) providers to address and accommodate domestic violence (DV) survivors with brain injury and mental health struggles. The CARE tools were designed for use by advocates and include the Just Breathe booklet, the Head Injury education card, and the Invisible Injuries booklet. OBJECTIVE The purpose of this study was to report findings on how CARE tools are being used by DVSO providers as well as their impact on DVSO advocacy practice. METHODS Post-CARE retrospective process evaluation online surveys (n = 60) and focus groups (n = 10 groups; 57 advocates) were conducted with consenting staff at 5 DVSOs in Ohio who partnered with the state coalition to develop and evaluate CARE, overseen by a university research partner. Rigorous, iterative coding qualitative analysis methods, endorsed by the Centers for Disease Control and Prevention, were used (Cohen's κ = 0.903 [stage 1] and 0.810 [stage 2]). RESULTS The use of CARE tools has been integral to DVSO providers' implementation of the CARE advocacy framework. DVSO advocates are using CARE tools to Connect with self, survivors, and other systems; to Acknowledge that head trauma and mental health struggles are common among survivors and that ongoing education and self-care are necessary for advocates. Advocates have been able to provide a more holistic Response through accommodation within DVSOs and referral to other providers, often by using the CARE tools, including the Head Injury education card. CONCLUSION CARE tools were designed for lay use to address head trauma, strangulation, and mental health struggles with DV survivors and are free for download at the Center on Partner Inflicted Brain Injury website: https://www.odvn.org/brain-injury. More widespread use of these tools by advocates has the potential to improve services for DV survivors and address what have historically been invisible injuries and mental health struggles in the population.
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Bergin A, Blumenfeld E, Anderson JC, Campbell JC, Patch M. Describing Nonfatal Intimate Partner Strangulation Presentation and Evaluation in a Community-Based Hospital: Partnerships Between the Emergency Department and In-House Advocates. J Head Trauma Rehabil 2022; 37:5-14. [PMID: 34985029 PMCID: PMC8740625 DOI: 10.1097/htr.0000000000000742] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To describe characteristics of strangulation, and associated medical care, documentation, and injuries of women after nonfatal intimate partner strangulation (NF-IPS) who present for care to a community-based emergency department (ED) with an associated intimate partner violence (IPV) advocacy program between 2008 and 2016. SETTING, DESIGN, AND PARTICIPANTS A retrospective review of 345 female ED patients' medical records who sought care at a community hospital ED following a physical assault including strangulation by an intimate partner was conducted. Demographics, characteristics related to reported signs and symptoms, injuries, and subsequent imaging, diagnoses, and discharge information were abstracted. RESULTS Commonly reported symptoms were neck pain (67.2%) and headache (45.8%), with fewer patients reporting more severe symptoms such as loss of consciousness (22.6%), dysphagia (25.0%), or dysphonia (26.7%). Rates of patients disclosing strangulation to the entire multidisciplinary team and dedicated neck imaging appeared to improve between 2008 and 2014. Among the 45 patients with noted head and neck findings, 2 patients were found to have an internal carotid artery dissection, 2 patients were found to have strokes, and 1 patient was found to have an intracranial hemorrhage. CONCLUSIONS Survivors of NF-IPS may present to community-based hospitals, and existing imaging guidelines can support clinicians in identifying serious internal injury such as carotid artery dissection and stroke. Further research is needed to better discern symptoms previously attributed to psychological trauma from poststrangulation brain injury. This study contributes to the growing literature on NF-IPS with data specific to community-based ED visits.
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Affiliation(s)
- Audrey Bergin
- Northwest Hospital, Randallstown, Maryland (Mss Bergin and Blumenfeld); Pennsylvania State University College of Nursing, University Park (Dr Anderson); and Johns Hopkins University School of Nursing, Baltimore, Maryland (Drs Campbell and Patch)
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22
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Herbenick D, Fu TC, Kawata K, Eastman-Mueller H, Guerra-Reyes L, Rosenberg M, Valdivia DS. Non-Fatal Strangulation/Choking During Sex and Its Associations with Mental Health: Findings from an Undergraduate Probability Survey. JOURNAL OF SEX & MARITAL THERAPY 2022; 48:238-250. [PMID: 34596011 DOI: 10.1080/0092623x.2021.1985025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Choking/strangulation during sex is prevalent among young adults in the United States. We examined associations between having ever been choked and participants' current mental health symptoms (e.g., feeling depressed, anxious, sad, lonely) in the prior 30 days and in the prior year. Participants were 4352 randomly sampled undergraduates who completed a confidential online survey and reported lifetime partnered sexual activity. 33.6% of women and 6.0% of men reported having been choked more than five times. After adjusting for demographic characteristics, having been choked remained significantly associated with all four mental health outcomes, except for overwhelming anxiety among men.
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Affiliation(s)
- Debby Herbenick
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
| | - Tsung-Chieh Fu
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
| | - Keisuke Kawata
- Department of Kinesiology, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- Program in Neuroscience, Division of Clinical and Translational Neuroscience, College of Arts and Sciences, Indiana University, Bloomington, IN, USA
| | - Heather Eastman-Mueller
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
| | - Lucia Guerra-Reyes
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
| | - Molly Rosenberg
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
| | - Dubravka Svetina Valdivia
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, IN, USA
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23
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Herbenick D, Guerra-Reyes L, Patterson C, Rosenstock Gonzalez YR, Wagner C, Zounlome NOO. "If Their Face Starts Turning Purple, You Are Probably Doing Something Wrong": Young Men's Experiences with Choking During Sex. JOURNAL OF SEX & MARITAL THERAPY 2022; 48:502-519. [PMID: 34873995 DOI: 10.1080/0092623x.2021.2009607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Choking/strangulation during sex has become prevalent in the United States. Yet, no qualitative research has addressed men's choking experiences. Through interviews with 21 young adult men, we examined the language men use to refer to choking, how they first learned about it, their experiences with choking, and consent and safety practices. Men learned about choking during adolescence from pornography, partners, friends, and mainstream media. They engaged in choking to be kinky, adventurous, and to please partners. While many enjoyed or felt neutral about choking, others were reluctant to choke or be choked. Safety and verbal/non-verbal consent practices varied widely.
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Affiliation(s)
- Debby Herbenick
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
| | - Lucia Guerra-Reyes
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
| | - Callie Patterson
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
| | - Yael R Rosenstock Gonzalez
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
| | - Caroline Wagner
- Department of Applied Health Science, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
- The Center for Sexual Health Promotion, Indiana University School of Public Health, Indiana University, Bloomington, IN, USA
| | - Nelson O O Zounlome
- Department of Educational, School, and Counseling Psychology, College of Education, University of Kentucky, Lexington, KY, USA
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Sharpe M, Mead D. Problematic Pornography Use: Legal and Health Policy Considerations. CURRENT ADDICTION REPORTS 2021; 8:556-567. [PMID: 34518793 PMCID: PMC8426110 DOI: 10.1007/s40429-021-00390-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 11/30/2022]
Abstract
Purpose of Review Reports of sexual violence, especially towards women and children, are rapidly increasing. At the same time, rates of problematic pornography use (PPU) are accelerating across the world too. The purpose of this review is to consider the recent research on PPU and its contribution to sexual violence. The article offers guidance to governments on possible health policy interventions and legal actions to prevent the development of PPU and to reduce the incidence of sexual violence in society. Recent Findings Working from the consumer’s point of view, we identify PPU and ask how much pornography is needed to cause PPU. We examine how PPU drives sexual offending in children, adolescents and adults. The impact of PPU on some consumers’ behaviour suggests significant links to domestic violence. Sexual strangulation is highlighted as an example. Artificial intelligence algorithms play a key role in the pornography industry and appear to be driving escalation to more violent material, inducing high levels of sexual dysfunction in consumers and creating appetites for viewing child sexual abuse material (CSAM). Summary Easy access to internet pornography has led to an increase in PPU and sexual violence. Diagnoses and treatments for PPU are examined, as are legal transgressions of a civil and criminal nature arising from PPU. Legal remedies and government policy implications are discussed from the point of view of the precautionary principle. Strategies covered include age verification for pornography, public health campaigns and embedded health and legal warnings for users at the start of pornography sessions along with lessons for pupils about pornography’s impact on the brain.
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Affiliation(s)
- Mary Sharpe
- The Reward Foundation, The Melting Pot, 15 Calton Road, Edinburgh, EH8 8DL UK.,Lucy Cavendish College, University of Cambridge, Cambridge, CB3 0BU UK
| | - Darryl Mead
- The Reward Foundation, The Melting Pot, 15 Calton Road, Edinburgh, EH8 8DL UK
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'I thought he was going to kill me': Analysis of 204 case files of adults reporting non-fatal strangulation as part of a sexual assault over a 3 year period. J Forensic Leg Med 2021; 79:102128. [PMID: 33618205 DOI: 10.1016/j.jflm.2021.102128] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/21/2021] [Accepted: 01/24/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is growing awareness internationally around the prevalence and dangerousness of non-fatal strangulation (NFS). The aim of this study was to: (i) identify the prevalence of NFS in patients presenting to the Saint Mary's Sexual Assault Referral Centre (SARC), Manchester, UK for an acute forensic medical examination (FME) after a report of rape or sexual assault, (ii) explore the characteristics of patients reporting NFS compared to those who did not and (iii) explore the prevalence of various symptoms and signs associated with NFS. METHOD Data from case files of all patients attending in a three year period, January 1, 2017 to December 31, 2019, were analysed. There was not any age or gender related exclusion criteria. In the NFS cases the Saint Mary's SARC NFS pro-forma used as part of the contemporaneous medical notes was also reviewed. RESULTS A total of 2196 adults (≥18 years old) attended Saint Mary's SARC for an acute FME during the three year study period. This comprised 1994 (90.7%) non-NFS cases and 204 (9.28%) NFS cases. The prevalence of NFS was 18.9% where the alleged perpetrator was a partner or ex-partner. For NFS cases, 96.6% (n = 197) of the patients were female and the alleged perpetrator was male in 98% (n = 200) of the NFS cases. 40% of the NFS cases had been strangled in their own homes and in 33% of cases children lived in that home. In 27% (n = 55) of the NFS cases the patient said that the alleged perpetrator had also strangled them on a previous occasion. 46.6% had an injury to the neck or above attributable to the NFS. 15.7% (n = 32) of the NFS cases reported loss of consciousness, 8.8% (n = 18) were incontinent of urine and 2% (n = 4) incontinent of faeces as a result of the NFS. Over a third of the patients (36.6%) thought that they were going to die during the NFS. CONCLUSION The study shows that NFS in sexual assault is a gendered crime, with most victims female and most assailants male. NFS is prevalent and this prevalence increases where the alleged perpetrator is a partner or ex-partner. Many are assaulted in their own homes, homes frequently shared with children. Visible NFS injuries are not the norm yet fear of death is not uncommon. Over 1 in 6 (15.7%) reported loss of consciousness suggesting that they were victims of a near lethal assault. That 27% had previously been a victim of NFS by the same alleged perpetrator indicates that there are considerable numbers potentially living in fear and at risk. Awareness of the risk of NFS, and an enhanced response to it, is required by those looking after victims and all those in the criminal justice system.
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St Ivany A, Schminkey DL, Munro-Kramer ML. Acquired Brain Injuries and Intimate Partner Violence: A Situational Analysis of Help Seeking Barriers in Rural Northern New England. Glob Qual Nurs Res 2021; 8:23333936211008163. [PMID: 33912624 PMCID: PMC8047928 DOI: 10.1177/23333936211008163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 11/10/2022] Open
Abstract
Nurses care for women experiencing non-fatal strangulation and acquired brain injuries whether or not it is disclosed. Situational analysis was used to analyze 23 interviews from Northern New England with survivors, healthcare workers, and violence/legal advocates to explore overlapping relationships between violence, acquired brain injuries, non-fatal strangulation, and seeking care. Findings included the concepts of paying social consequences and the normalization of violence. Non-fatal strangulation was described as increasingly related to violence and other areas. Repetitive acquired brain injuries can impair functioning needed to address violence and healthcare providers and advocates are generally unaware of the impact of acquired brain injuries. A lack of resources, training, and tools for acquired brain injury screening were barriers in recognizing and responding to it, causing hidden symptoms. This study adds to the literature examining intimate partner violence in rural areas; specifically intimate partner violence-related acquired brain injuries in rural areas.
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