Shattering silence: exploring barriers to disclosure for African American sexual assault survivors

Barriers to Formal Help-Seeking Among Black American Young Adults: Exploring the Roles of Sexual Violence Victimization, Intersectional Oppression, and Perceived Burdensomeness

Though sexual violence can impact people across genders, sexual orientations, ages, and incomes, societal inequities can increase the risk of experiencing sexual violence. Such inequities are often intersectional in nature (e.g., racism and sexism) and may impact a person's ability to engage in help-seeking for experiences of sexual violence, especially among those who perceive themselves to be a burden on others or society as a whole. Therefore, the purpose of the current study was to examine the association between experiencing sexual violence, intersectional oppression, and perceived burdensomeness on barriers to help-seeking among Black American young adults. Participants (n = 289) completed an online questionnaire assessing constructs of interest. We found that half of our sample experienced any sexual violence and nearly three-fourths experienced more than one form of intersectional oppression (e.g., racism, sexism, and homophobia). Ultimately, we found that sexual violence and perceived burdensomeness - but not intersectional oppression - were correlates of experiencing barriers to help-seeking. Through incorporating multiple marginalized identities beyond Black race, our findings can expand our understanding of barriers to help-seeking among diverse Black sexual violence survivors, while revealing a new area for practitioners, healthcare providers, social workers, and related professionals to focus intervention strategies on: perceived burdensomeness. These findings are relevant to all who care for the health and well-being of those who have experienced sexual violence, chronic stress (due to singular and multiple forms of discrimination), and/or other traumas.

The Influence of Race on Detected and Undetected Sexual Offense Histories: A Comparison of White and Black Men Committed as Sexually Violent Persons

Understanding the difference between the proportion of sexual offenses that are officially detected versus the total number of sexual crimes that occur has been of interest to decision makers for some time. Previous studies have not considered possible racial differences. More aggressive responses by police and the criminal justice system as well as cultural differences in victim type/reporting rates may result in differences between detection rates of Black versus White men. In the current study (N = 190), we examined the difference between Black (n = 51) and White (n = 139) men committed to a forensic hospital as a Sexually Violent Person on factors that could impact the detected rate. Overall, we found that White men had significantly more total victims, undetected victims, undetected and detected child victims, total male victims, undetected male victims, undetected acquaintance victims, and total (detected and undetected) acquaintance victims than Black men. Black men had significantly more detected adult victims, but this difference did not remain when accounting for undetected victims. We explore reasons for these differences as well as provide recommendations for practice.

The Safe Sport Allies bystander training: developing a multi-layered program for youth sport participants and their coaches to prevent harassment and abuse in local sport clubs

Harassment and abuse represent a pervasive and critical problem in sport with far-reaching consequences. Survivors' testimonials underscore the profound and enduring impact of these experiences at individual, interpersonal, organizational and community level. Many of their stories reveal painful inaction from responsible adults in the sport organization, aggravating the harm. Other contributing factors to the harm inflicted include a culture of silence, lack of knowledge and understanding of what constitutes abuse, unawareness of reporting and supporting mechanisms, and fear of potential consequences. While effective bystander interventions have been developed outside the sport context, particularly targeting students in higher education, such initiatives have yet to be extensively adapted and assessed within the sport context. To address this gap, the Safe Sport Allies Erasmus+ collaborative partnership relied on the intervention mapping approach as a guiding framework to systematically develop a bystander training program (i.e., Safe Sport Allies) to train youth sport participants and youth sport coaches to act as effective bystanders. The current paper describes the comprehensive development process and provides an overview of implementation and evaluation possibilities. Throughout the paper, it is explained how each step of the Intervention Mapping approach shaped the Safe Sport Allies bystander training program. The program development, and the developed plans for implementation and evaluation are presented, shedding light on challenges encountered. The bystander training program developed in this paper and the implementation and evaluation plans can serve as an outline to build future interventions within this critical domain of safeguarding in sport.

Barriers to Seeking Healthcare Services After Sexual Assault: A Scoping Review

BACKGROUND

Sexual violence by an intimate partner or by a stranger remains highly prevalent in the United States. Yet, the use of post-sexual-assault health care is still underutilized. Persons in vulnerable populations such as immigrants, LGBTQIA+, and Black women may experience additional barriers to care.

OBJECTIVE

We sought to determine the extant research in this area, the methodologies used, and whether specific barriers exist for seeking sexual assault services. We sought to understand if barriers differed for vulnerable populations.

INCLUSION CRITERIA

Peer-reviewed literature published before September 2023, written in English, conducted in the United States, and that included survivors of sexual violence and explored barriers to seeking care postassault (i.e., sexual assault nurse examiners) were included in the review.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews protocols were followed. PubMed, Scopus, CINAHL, PsycINFO, and PTSDpubs databases were used to identify literature that met the inclusion criteria, from which we selected 14 publications.

RESULTS

Much of the literature employed qualitative or mixed methods designs. Several studies focused on underserved minority groups, including immigrant women, Black women, and homeless youth. Common barriers existed on the intrapersonal, interpersonal, organizational, community, and societal levels.

CONCLUSION

The literature provided substantive context for the multilevel barriers, all contributing to survivors remaining silent rather than seeking much-needed help. Although there is a need for additional research on barriers to sexual assault services specifically, the extant research supports strengthening multilevel, alternative approaches to deliver much-needed services.

Reasons for Not Reporting Among Sexual Assault Survivors Who Seek Medical Forensic Exams: A Qualitative Analysis

After a sexual assault, survivors have the option of seeking a medical forensic exam, which includes medical evaluation and treatment, as well as forensic evidence collection. Forensic evidence is collected in a sexual assault evidence kit (SAEK) and typically released to police to aid in the investigation and potential prosecution of the assault. However, 20% to 25% of survivors who have a SAEK collected do not report their assault to police at that time and choose instead to have their SAEK stored for possible future use. This study sought to understand the reasons for not reporting among this group of survivors. We examined medical records of 296 individuals aged 18 and older who had documented their reasons for not reporting to police in their medical record and used a non-theory-driven coding framework to conduct a reflexive thematic analysis based on that data. We identified four themes: Reporting Won't Help, Reporting Will Harm, Not Now, and Not What I'm Here For. These data illustrate that survivors are making an active choice which, for many, was based on concerns that reporting would not meaningfully help their situation or may even make their situations worse. For some survivors, the decision to have forensic evidence collected without a police report was based on their needs at that moment, whereas for other survivors it was based on their desire to move on from the assault more permanently. Practice and policy recommendations are discussed, including the importance of providing survivors information about what police reporting would look like in specific circumstances as well as ensuring that financial concerns are not a barrier to survivors receiving post-assault medical care without forensic evidence collection.

It's Just a Distance Thing: Affordances and Decisions in Online Disclosure of Sexual Violence Victimization

The Internet offers an alternative context in which personal experiences with sexual violence can be shared. It has been suggested that victims experience lower barriers to disclosing their stories in a digital environment due to an online disinhibition effect and mainly anonymity. However, little is known about the lived experiences of victims who have shared their experiences online regarding these disinhibiting affordances of the Internet. Twenty-three interviews with victims were conducted to understand the digital affordances involved in the online disclosure of sexual victimization. The results suggest that the Internet offers several opportunities (visibility management, asynchronicity, and connectivity) and constraints (lack of non-verbal communication, disclosing online is irreversible, and Internet as a source of triggers) when disclosing sexual violence victimization online. We learn that disclosures are informed by previous experiences and weighed against digital affordances. Victims use multiple platforms or multiple accounts on the same platform and manipulate anonymity and visibility through the settings of online platforms. The Internet offers a potential for informal online peer support. The results have practical implications for victims, clinicians, and support providers for guiding the disclosure process. Furthermore, a re-evaluation and nuance of the online disinhibition theory is suggested. Suggestions for future research are made.

Listening to Black Pregnant and Postpartum People: Using Technology to Enhance Equity in Screening and Treatment of Perinatal Mental Health and Substance Use Disorders

Perinatal mood and anxiety disorders (PMADs), perinatal substance use disorders (PSUDs), and intimate partner violence (IPV) are leading causes of pregnancy-related deaths in the United States. Screening and referral for PMADs, PSUDs and IPV is recommended, however, racial disparities are prominent: Black pregnant and postpartum people (PPP) are less likely to be screened and attend treatment compared to White PPP. We conducted qualitative interviews to better understand the experience of Black PPP who used a text/phone-based screening and referral program for PMADs/PSUDs and IPV-Listening to Women and Pregnant and Postpartum People (LTWP). We previously demonstrated that LTWP led to a significant reduction in racial disparities compared to in-person screening and referral, and through the current study, sought to identify facilitators of PMAD/PSUD symptom endorsement and treatment attendance. Semi-structured interviews were conducted with 68 Black PPP who were or had been pregnant within the last 24 months, and who either had or did not have a PMAD or PSUD. Participants were enrolled in LTWP and provided feedback on their experience. Using a grounded theory approach, four themes emerged: usability, comfort, necessity, and recommendations. Ease of use, brevity, convenience, and comfort in discussing mental health and substance use via text were highlighted. Need for a program like LTWP in Black communities was discussed, given the reduction in perceived judgement and access to trusted information and resources for PMADs/PSUDs, which may lessen stigma. These qualitative findings illuminate how technology-based adaptations to behavioral health screening and referral can reduce perceived negative judgment and facilitate identification and referral to treatment, thereby more adequately meeting needs of Black PPP.

Social Reactions to Disclosures of Multiple-Perpetrator Sexual Assault: Do Number of Offenders Matter?

Sexual assault (SA) victimization is a prevalent issue both in the U.S. and globally. Although SA victimization is usually perpetrated by a single-perpetrator, multiple-perpetrator sexual assaults (MPSAs) also occur. Unfortunately, there is less literature concerning MPSAs, including the well-being of survivors' post-assault. One factor that has been shown to be important in the well-being of SA survivors' post-assault are the social reactions survivors receive from others following disclosure. The current study sought to compare social reactions received by MPSA survivors to the social reactions received by single-perpetrator sexual assault (SPSA) survivors in a community sample of adult female SA survivors (N = 1,863). We examined "turning against" (TA) reactions, a type of negative social reaction in which the supporter expresses more overtly distressing reactions that focus blame on the victim. We also examined unsupportive acknowledgment reactions (UA) the second type of negative reaction in which survivors receive acknowledgment that the assault occurred but are not supported. Additionally, we examined differences in positive reactions that survivors received from their support systems. One-way Analysis of Variance showed statistically significant differences in social reactions to disclosure according to number of offenders in the SA, with MPSA survivors receiving more TA and UA negative reactions than SPSA survivors. There were no differences in positive reactions by number of offenders. Multiple regression analyses also revealed that several demographics, assault characteristics, and post-assault factors (total Post-Traumatic Stress Disorder (PTSD) symptoms, coping, attributions of self-blame) were related to the social reactions received by MPSA survivors post-assault. Implications and recommendations for support providers are discussed.

Racial and ethnic differences in perceptions of campus climate related to sexual violence

Objective: To assess perceptions of university institutional climate related to sexual violence and whether these differed by race/ethnicity. Participants: Matriculated undergraduates > age 18 (n = 1028). Methods: Students were invited via campus email to participate in an online survey. Results: Overall, only 20% agreed that the university is creating an environment in which unwanted sexual experiences seemed common or normal, but these findings differed by race. Black students were more likely than their white peers to feel the university is creating an environment in which unwanted sexual experiences seem common or normal (37.3% vs. 19.7%, p < .001) and creating an environment in which such instances were more likely to occur (33.3% vs. 13.4%, p < .001). Conclusions: Data suggest that while students generally perceive that the university is working to create a positive and safe climate, these perceptions vary by race. Further investigation is necessary to better understand the concerns of students of color.

Prevalence of Sexual Violence and Intimate Partner Violence Among US Military Veterans: Findings from Surveys with Two National Samples

BACKGROUND

Sexual violence (SV) and intimate partner violence (IPV) experiences are major social determinants of adverse health. There is limited prevalence data on these experiences for veterans, particularly across sociodemographic groups.

OBJECTIVE

To estimate the prevalence of SV before, during, and after military service and lifetime and past-year IPV for women and men, and explore differences across sociodemographic groups.

DESIGN

Data are from two national cross-sectional surveys conducted in 2020. Weighted prevalence estimates of SV and IPV experiences were computed, and weighted logistic regression models were used for comparisons across gender, race, ethnicity, sexual orientation, and age.

PARTICIPANTS

Study 1 included veterans of all service eras (N = 1187; 50.0% women; 29% response rate). Study 2 included recently separated post-9/11 veterans (N = 1494; 55.2% women; 19.4% response rate).

MAIN MEASURES

SV was assessed with the Deployment Risk and Resilience Inventory-2 (DRRI-2). IPV was assessed with the extended Hurt-Insult-Threaten-Scream Tool.

KEY RESULTS

Women were more likely than men to experience pre-military SV (study 1: 39.9% vs. 8.7%, OR = 6.96, CIs: 4.71-10.28; study 2: 36.2% vs. 8.6%, OR = 6.04, CIs: 4.18-8.71), sexual harassment and/or assault during military service (study 1: 55.0% vs. 16.8%, OR = 6.30, CIs: 4.57-8.58; study 2: 52.9% vs. 26.9%, OR = 3.08, CIs: 2.38-3.98), and post-military SV (study 1: 12.4% vs. 0.9%, OR = 15.49, CIs: 6.42-36.97; study 2: 7.5% vs. 1.5%, OR = 5.20, CIs: 2.26-11.99). Women were more likely than men to experience lifetime IPV (study 1: 45.7% vs. 37.1%, OR = 1.38, CIs: 1.04-1.82; study 2: 45.4% and 34.8%, OR = 1.60, CIs: 1.25-2.04) but not past-year IPV (study 1: 27.9% vs. 28.3%, OR = 0.95, CIs: 0.70-1.28; study 2: 33.1% vs. 28.5%, OR = 1.24, CIs: 0.95-1.61). When controlling for gender, there were few differences across other sociodemographic groups, with the exception of sexual orientation.

CONCLUSIONS

Understanding veterans' experiences of SV and IPV can inform identification and intervention efforts, especially for women and sexual minorities.

"I'm not going to do it alone": A qualitative study of barriers to sexual assault service-seeking among college students

Objective: To understand barriers to seeking post-sexual assault services for students of color and lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ+) students. Methods: Qualitative interviews about campus and community resources for sexual and relationship violence were conducted with 29 undergraduate and graduate students who held diverse sexual, gender, and racial identities (n = 15 disclosed violence-related service-seeking). Results: Organized within trauma-informed care pillars, thematic coding revealed aspects of campus environment/culture that prevent students from accessing support including challenges identifying experiences as violence; limited cultural and identity-affirming care; limited clarity about resources; confidentiality concerns; difficulty accessing resources; and navigating resources alone. Suggestions to address concerns included regular prevention training; better coordinated care and systems with increased accountability, increased survivor support and peer support, and heightened transparency on websites/trainings about processes and confidentiality. Conclusions: Findings suggest promising avenues to improve support, particularly for minoritized survivors of violence, at this campus.

Preventing sexual violence in sexual orientation and gender diverse communities: A call to action

Background: Members of the lesbian, gay, bisexual, transgender, queer, and other sexual orientation and gender diverse (SOGD) communities are at disproportionately higher risk for sexual violence compared to cisgender heterosexual people. Despite this elevated risk, relatively few sexual violence prevention efforts effectively reduce these victimization disparities based on sexual orientation or gender identity.Objective: This narrative review provides an overview of the prevalence of sexual violence in the SOGD communities, delineates risk factors for sexual victimization among SOGD community members, and reviews and evaluates existing prevention efforts for the SOGD communities. We outline specific recommendations for ensuring that prevention efforts meet the needs of the SOGD communities.Method: Drawing on ecological systems theory and public health approaches to sexual violence prevention, we outline current approaches and opportunities for preventionists and scholars to push the field forward.Results: There have been promising prevention programmes designed to be implemented within SOGD communities specifically; however, it is important that general primary prevention programmes endeavour to specifically address sexual violence perpetrated against SOGD people. While many packaged programmes that endeavour to prevent sexual violence across all gender identities and sexual orientations are inclusive of SOGD participants, more programming is needed that integrates anti-oppression training to target social norms that perpetuate SOGD-specific rape myths and normalize sexual violence against SOGD community members.Conclusion: Ecological prevention strategies in line with a public health approach for primary prevention may be particularly valuable for reducing victimization disparities based on SOGD status and identity. Comprehensive sexual education and anti-discrimination policies should be considered front-line prevention programming. To assess if these strategies are effective, the implementation of large-scale surveillance surveys that use comprehensive assessments of sexual orientation, gender identity, and sexual violence are needed. Using theoretically grounded implementation strategies for prevention programmes can ensure effective programme delivery.

Adverse Childhood Experiences and BMI: Lifecourse Associations in a Black-White U.S. Women Cohort

INTRODUCTION

Although adverse childhood experiences (ACEs) have been positively associated with adiposity, few studies have examined long-term race-specific ACE-BMI relationships.

METHODS

A Black and White all-women cohort (N=611; 48.6% Black) was followed between 1987 and 1997 from childhood (ages 9-10 years) through adolescence (ages 19-20 years) to midlife (ages 36-43 years, between 2015 and 2019). In these 2020-2022 analyses, the interaction between race and individual ACE exposures (physical abuse, sexual abuse, household substance abuse, multiple ACEs) on continuous BMI at ages 19-20 years and midlife was evaluated individually through multivariable linear regression models. Stratification by race followed as warranted at α=0.15.

RESULTS

Race only modified ACE-BMI associations for sexual abuse. Among Black women, sexual abuse was significantly associated with BMI (Badjusted=3.24, 95% CI=0.92, 5.57) at ages 19-20 years and marginally associated at midlife (Badjusted=2.37, 95% CI= -0.62, 5.35); among White women, corresponding associations were null. Overall, having ≥2 ACEs was significantly associated with adolescent BMI (Badjusted=1.47, 95% CI=0.13, 2.80) and was marginally associated at midlife (Badjusted=1.45, 95% CI= -0.31, 3.22). This was similarly observed for physical abuse (adolescent BMI: Badjusted=1.23, 95% CI= -0.08, 2.54; midlife BMI: Badjusted=1.03, 95% CI= -0.71, 2.78), but not for substance abuse.

CONCLUSIONS

Direct exposure to certain severe ACEs is associated with increased BMI among Black and White women. It is important to consider race, ACE type, and life stage to gain a more sophisticated understanding of ACE-BMI relationships. This knowledge can help strengthen intervention, prevention, and policy efforts aiming to mitigate the impacts of social adversities and trauma on persistent cardiometabolic health disparities over the lifecourse.

Representative Survivorship: A Look Into the Race-Evasiveness of Title IX and Understanding the Barriers to Reporting for Women of Color

While there are many cultural norms that serve as barriers to Women of Color reporting sexual assault on college campuses, there are also several institutional and systemic barriers. This paper explores some of these barriers and argues for Title IX, a policy that addresses issues of sexual assault on college campuses, to encompass and protect more than a person's sex alone. In addition to the legal system, institutions of higher education have a long-standing history of discrimination against racial and ethnic minority groups, in particular with addressing sexual assault crimes. This paper argues that specific measures need to be outlined in Title IX that acknowledge and redress the effects of institutional harms on the BIPOC community. This paper also discusses how adopting a restorative justice and intersectional approach to policy reform will aid in building a supportive relationship between survivors and their educational institutions.

(Non-)disclosure of lifetime sexual violence in maternity care: Disclosure rate, associated characteristics and reasons for non-disclosure

BACKGROUND

In maternity care, disclosure of a past sexual violence (SV) experience can be helpful to clients to discuss specific intimate care needs. Little evidence is available about the disclosure rates of SV within maternity care and reasons for non-disclosure.

AIM

The aim of this study was to examine (1) the disclosure rate of SV in maternity care, (2) characteristics associated with disclosure of SV and (3) reasons for non-disclosure.

METHODS

We conducted a descriptive mixed method study in the Netherlands. Data was collected through a cross-sectional online questionnaire with both multiple choice and open-ended items. We performed binary logistic regression analysis for quantitative data and a reflexive thematic analysis for qualitative data.

RESULTS

In our sample of 1,120 respondents who reported SV, 51.9% had disclosed this to a maternity care provider. Respondents were less likely to disclose when they received obstetrician-led care for high-risk pregnancy (vs midwife-led care for low-risk pregnancy) and when they had a Surinamese or Antillean ethnic background (vs ethnic Dutch background). Reasons for non-disclosure of SV were captured in three themes: 'My SV narrative has its place outside of my pregnancy', 'I will keep my SV narrative safe inside myself', and 'my caregiver needs to create the right environment for my SV narrative to be told'.

CONCLUSIONS

The high level of SV disclosure is likely due to the Dutch universal screening policy. However, some respondents did not disclose because of unsafe care conditions such as the presence of a third person and concerns about confidentiality. We also found that many respondents made a positive autonomous choice for non-disclosure of SV. Disclosure should therefore not be a goal in itself, but caregivers should facilitate an inviting environment where clients feel safe to disclose an SV experience if they feel it is relevant for them.

The Association of Military Sexual Harassment/Assault With Suicide Ideation, Plans, Attempts, and Mortality Among US Service Members/Veterans: A Meta-Analysis

Suicide rates continue to increase among service members/veterans. Military sexual harassment/assault (MSH/A) may increase risk of suicide, but little is known about the collective magnitude of associations between MSH/A and suicide outcomes, including ideation, plan, attempt, and mortality. The current meta-analysis addressed this literature gap while testing potential moderators of gender, marital status, discharge status, and military branch. PsycINFO, PubMed, Dissertations/Theses, relevant citation lists, and conference brochures were reviewed for papers that included quantitative analyses in English, U.S. military samples, and measures of MSH/A and suicide ideation/plan/attempt/mortality. The search resulted in 22 studies (N = 10,898,875) measuring the association of MSH/A with suicide ideation (k = 15), plans (k = 1), attempts (k = 14), and mortality (k = 2), with papers published from 2007-2021. MSH/A was associated with suicide ideation (r   ¯ = .14) and attempts (r   ¯ = .11, ps < .05). The association of MSH/A and suicide ideation and attempts was higher among women relative to men, those identifying as married versus not married, those actively serving compared to discharged, and those reporting service in the Air Force relative to all other branches. The association of MSH/A with suicide plans and mortality was not calculated due to the small number of studies reporting those effect sizes (ks = 1-2). The effect sizes observed suggest MSH/A is part of a larger network of risk factors for suicide. Moderators indicate that suicide risk is higher among specific groups, and prevention strategies would be most effective if they targeted these individuals. This research area would be strengthened by additional studies of plans and mortality.

Factors Related to Police Reporting in Sexual Assault Care Centers: Are We Underestimating the Role of Support Persons?

Few victims of sexual assault (SA) report to the police. Research on the role of support persons in victims' reporting is sparse. We address this gap by examining the association of victim, assailant, victimization incident, and support characteristics with reporting rates among victims attending sexual assault care centers (SACCs). Logistic regression results show that type of SA, delay between SA and presentation at SACC, and presence of an informal support person at SACC and SACC site are significantly associated with police reporting. These findings reveal the importance of targeting victims' support persons to alter reporting behavior among SA victims.

"Sometimes It Seems Easier to Push It Away": A Study Into the Barriers to Help-Seeking for Victims of Sexual Violence

Experiencing sexual violence may have serious long-term consequences for victims. Seeking help may decrease the chances of developing long-term physical and psychosocial problems. Still not every victim seeks help, and especially with victimization of sexual violence, there may be several reasons as to why. The barriers to help-seeking are diverse and may depend on several contextual factors. This study, as part of a larger research project, aimed to determine the barriers that victims of sexual violence experience in their decision to seek help in a non-college setting. This mixed-methods study included an online survey (N = 133) and open-ended survey (N = 207) amongst victims of 18 years and older. The online survey data were analyzed using chi-square tests for independence and t-tests; the open-ended survey data were analyzed using a descriptive approach. The online survey data showed that minimization of the incident was higher for non-help-seekers, whilst distrust toward support providers and issues with the accessibility of help were higher for help-seekers. No further significant associations were found between the decision to seek help and the barriers to help-seeking. From the open-ended survey data, three categories of barriers were distinguished: (a) individual barriers, such as feelings of shame, (b) interpersonal barriers, such as the fear of negative social reactions and (c) sociocultural barriers, such as societal stereotypes regarding sexual violence. The findings suggest that victims experience various, but primarily individual, barriers to help-seeking and that these barriers do not strongly differ between help-seekers and non-help-seekers. This study highlights the importance of addressing barriers to help-seeking on an organizational and societal level to encourage help-seeking.

Reacting to Non-Prototypical Victims: Blame, Empathy, and Willingness to Label Sexual Assaults of Men and Sexual Minority Victims

Sexual assault is prevalent in the U.S. society, with an estimated 16% of women and 8% of men experiencing some form of sexual violence during their lifetime (Breiding, 2014). Sexual violence crosses all identity lines; however, legislation, cultural representation, and academic scholarship on sexual violence has historically been limited to assaults against women perpetrated by men. This dominant analysis of sexual assault focuses on the impact of sexism on sexual violence, neglecting the impact off other forms of oppression and attitudes related to sexuality and gender. This dominant representation leaves non-prototypical victims, such as men, people of other genders, and sexual minorities of all genders, less visible and less understood. This underrepresentation may lead to negative reactions toward these victims including blame, exoneration of the perpetrator, and reluctance to acknowledge assaults. In the current study, I explored the impact of both victim gender and sexual orientation on reactions to a hypothetical intimate partner sexual assault victim. Results indicated that perpetrators who assaulted a man were blamed less than those who assaulted a woman. Furthermore, study participants had more empathy for women who were assaulted than they did for men. There were no differences in participants' negative reactions to victims by sexual orientation. Results suggest that, while some advances have been made in public support for sexual assault victims, these advances may not extend yet to men as victims.

VIOLENCE, TRAUMA, AND COLONIALISM: A STRUCTURAL APPROACH TO UNDERSTANDING THE POLICY LANDSCAPE OF INDIGENOUS REPRODUCTIVE JUSTICE

Indigenous peoples in the U.S. have the highest rates of violence against women, disproportionate representation in the child welfare system, and exorbitant amounts of traumatic injuries among all ethnic groups within the U.S. yet discussions of trauma and violence against Native communities fail to consider the ongoing influence of settler colonialism. Too often trauma-focused work takes an individualist approach while policy work focuses on the collective, leading to a siloed approach in which micro-trauma work misses policy influences and in which policy work fails to seriously consider the ongoing trauma and violence experienced by Native Nations. Through the application of three Indigenous theoretical models that account for both historic and ongoing colonial influence, this work introduces relevant issues in the policy landscape of reproductive justice for Indigenous communities that are essential for trauma scholars and practitioners to understand.

Rape Myth Acceptance and Other Barriers to Formally Reporting Sexual Assault Among College Students With and Without Sexual Assault Histories

Low rates of reporting sexual assault to law enforcement have been attributed to a culture of rape myth acceptance. Yet, rape myth acceptance rates and specific barriers to reporting have not been examined by sexual assault and reporting histories. This study compared the rape myth acceptance levels of reporting survivors, non-reporting survivors, and individuals without sexual assault histories. The sample consisted of 579 undergraduate students (68.0% White, 72.5% women) at a public university in the southeastern U.S. Differences in non-reporting survivors' experienced barriers to reporting and the perceived barriers of those without sexual assault histories were also examined. Results indicate differences in rape myth endorsement by sexual assault and reporting status, with the highest rape myth adherence rates endorsed by individuals without a sexual assault history and the lowest endorsed by reporting survivors. While non-reporting survivors and those without sexual assault histories shared two of the top three barriers to reporting (i.e., wanted to avoid thinking or talking about it, did not want family or friends to find out), non-reporting survivors were more likely to endorse personal reasons for not reporting, and those without sexual assault histories were more likely to endorse concerns about the law enforcement response to rape. Several barrier factors were identified among non-reporting survivors (i.e., fear of law enforcement involvement, personal reasons, ambiguity of the event, responsibility) and among individuals without sexual assault histories (i.e., risks outweigh benefits, victim blaming, ambiguity). Although both survivors and individuals without sexual assault histories acknowledge the personal, social, and legal risks of reporting a sexual assault to law enforcement, survivors' experienced barriers differed in nuanced ways from the presumed barriers of individuals without sexual assault histories. Findings may enhance sexual assault prevention trainings and awareness campaigns by targeting both rape myth beliefs and specific barriers to reporting of those with and without sexual assault histories.

Restorative Justice for Survivors of Sexual Violence Experienced in Adulthood: A Scoping Review

Sexual violence (SV) is a widespread human rights issue. Survivors of SV often experience profound dehumanization and poor health outcomes when their trauma is not properly addressed, rendering it critical that they are honored and empowered within subsequent processes of healing and seeking justice. With adjudication through the criminal legal system largely underutilized due to retraumatization, scrutiny from law enforcement professionals, and high rates of case closure, restorative justice (RJ) has emerged as a promising option for survivors to repair harm and experience accountability. Little is known, however, regarding the best practices for its use in cases of SV. To meet this need, a scoping review was conducted to identify the best practices for the implementation of RJ after instances of SV experienced in adulthood. Following the search methodology outlined by the JBI Manual for Evidence Synthesis for scoping reviews, 15 articles met search criteria, including four empirical studies and 11 nonempirical research materials spanning five academic disciplines. Best practices and structures for RJ were subsequently identified, including key phases for appropriate implementation. This review can be used to create increasingly productive RJ processes for SV survivors, which is particularly important for those coming from marginalized communities facing structural inequities, as well as survivors on university campuses. As researchers, we have the power to use science to propel society toward the creation of more efficacious healing spaces for survivors of SV, and optimizing safe RJ processes plays a key role in bringing this to fruition.

Alcohol Use Before Sexual Violence and Cognitive Appraisals: Differential Associations With Barriers to Help-Seeking

The current study examined two cognitive appraisals-labeling (identifying an unwanted sexual experience as sexual violence) and self-blame-as potential mechanisms between survivor alcohol use before sexual violence and three help-seeking barriers (minimization, negative treatment, and social-emotional barriers) among non-service-seeking sexual violence survivors. Participants were 141 undergraduate women who completed self-report measures. Three parallel mediation models were tested. Survivors who were drinking were more likely to label their victimization as sexual violence and, in turn, perceived fewer minimization and greater social-emotional barriers. Further, survivors who were drinking blamed themselves more and, in turn, perceived greater negative treatment and social-emotional barriers.

Effect of machine-washing semen-stained fabrics on the persistence of human spermatozoa DNA: A systematic review of five articles

Biological evidence of sexual violence, such as semen, can change due to fabric washing. This can be due to attempts by the perpetrator to eliminate evidence or because the victim feels ashamed of sexual violence. While much research on this topic has been conducted, no systematic review has been attempted. This systematic review explores the effect of fabric machine-washing on the persistence of human spermatozoa deoxyribonucleic acid (DNA). This systematic review seeks in vitro experiments in which semen-stained fabrics were washed by washing machines, published in English, and matched with keywords in PubMed, Europe PMC, ScienceDirect, and Google Scholar. We then assessed the obtained articles with the Joanna Briggs Institute quasi-experimental checklist. This systematic review used the narrative synthesis method. Our search yielded five articles. These articles observe the effect of machine-washing factors on the persistence of human spermatozoa DNA, such as water temperature, washing duration, detergent type, washing repetition, and duration of fabric storage before washing. This systematic review shows that fabric washing insignificantly affects spermatozoa DNA persistence, and DNA might persist after multiple washes. However, variations in the articles indicate that future studies on this topic need to account for more variables and be reported in more detail to reduce bias.

Transmuting Girls Into Women: Examining the Adultification of Black Female Sexual Assault Survivors Through Twitter Feedback

The present study explored the adultification of young Black girls, specifically through the mythos of the fast-tailed girl, by examining the commentary on Twitter associated with the #SurvivingRKelly hashtag. Applying critical discourse analysis, three discursive themes emerged: (1) calling out the culture of accepting, (2) resistance through provocation and inquiry, and (3) challenging transgenerational dating. This study's results indicate the need for further research on the social construction of Black girlhood and how societal and cultural beliefs may serve as discursive mechanisms by which the adultification of young Black girls is perpetuated.

Enhancing Inclusivity for LGBTQIA+ Student Survivors of Color Commentary: Creating a University Strategic Plan to Address Relationship Violence and Sexual Misconduct (RVSM): An Application of Principles-Focused Evaluation at Michigan State University

Campbell and colleagues propose a robust and rigorous strategic model to address and reduce Relationship Violence and Sexual Misconduct (RVSM) at Michigan State University, which significantly advances the field of RVSM prevention and education, particularly for survivors belonging to marginalized populations. While prior efforts have addressed RVSM on college and university campuses, Campbell and colleagues' model is groundbreaking in its ability to reduce RVSM against lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual/agender (LGBTQIA+) students of color, by its principles of intersectional and trauma-informed action. This commentary highlights the contributions of Campbell et al.'s model and provides recommendations for enhancing programming and postassault services by addressing the totality of LGBTQIA+ survivors of color's identities.

Correlates of Social Reactions to Victims' Disclosures of Sexual Assault and Intimate Partner Violence: A Systematic Review

Sexual assault and intimate partner violence (IPV) are common experiences in women, but few studies have examined correlates of social reactions experienced by victims telling others about assault. This systematic review identified 30 studies through searches of research databases on correlates of social reactions to disclosure of sexual assault or IPV in samples of adult victims or disclosure recipients. Studies showed evidence of greater negative social reactions for Black and Hispanic victims, less educated, and bisexual victims. More extensive trauma histories in victims were related to receipt of greater negative social reactions, whereas assault characteristics (e.g., victim-offender relationship, alcohol use, perpetrator violence during assault) were sometimes associated with negative reactions. In terms of postassault factors, more psychological symptoms, self-blame, avoidance coping, less perceived control, and less posttraumatic growth were related to more negative social reactions. Disclosure characteristics, telling informal sources, and telling more sources were related to more positive reactions, whereas telling both formal and informal sources was related to negative reactions. Demographic, attitudinal, and relational factors were related to disclosure recipients' intended social reactions. Future research needs to examine how various factors relate to social reactions in the context of theory, and clinical treatment and interventions should use this information to identify and intervene with victims to reduce negative social reactions and their psychological impacts and to increase positive social reactions particularly from informal support sources.

An Experimental Test of the Impact of Varying Questionnaire Response Format on Prevalence Rates for Sexual Violence Victimization and Perpetration

OBJECTIVE

This study examined the impact of a dichotomous versus scaled response format on prevalence rates of sexual violence perpetration and victimization, thus conceptually replicating Hamby et al., 2006 and extending those findings to the context of sexual violence.

METHODS

Two samples were recruited from Amazon Mechanical Turk and were randomly assigned to either a dichotomous or scaled response format of the same questionnaire. Sample 1 was used to examine perpetration and received a perpetration specific version of the Post-Refusal Sexual Persistence Scale (PRSPS). Sample 2 was used to examine victimization and received a victimization specific version of the PRSPS.

RESULTS

Men and women who received the scaled response format reported significantly more incidents of sexual perpetration, and for each type of tactic studied, on the order of 1.7-9x more frequently. The association between response format condition and prevalence rates of sexual violence victimization was significant only for men (23.0 vs 39.4%) and for the tactic of verbal coercion (30.1 vs 41.5%), with the scaled response format producing greater responding.

CONCLUSIONS

The response format of sexual violence items can significantly alter prevalence rates of sexual violence perpetration, with scaled response formats producing greater endorsements than dichotomous formats. Response format also appears to impact prevalence rates of sexual violence victimization, particularly for men.

Barriers to Reporting Sexual Violence: A Qualitative Analysis of #WhyIDidntReport

The present study conducted thematic analyses of tweets including #WhyIDidntReport (N = 500) to examine barriers to reporting sexual victimization. Barriers to reporting were identified across individual, interpersonal, and sociocultural levels of the social ecology. Common barriers to reporting included labeling of the experience, age, fear, privacy concerns, self-blame, betrayal/shock, the relation/power of the perpetrator, negative reactions to disclosure, and the belief-or personal experience-that reporting would not result in justice and societal norms.

To Report or Not to Report? A Focal Concerns Analysis of Victim Reporting Decisions Following Victimization

Sexual assault (SA) decision-making literature primarily focuses on criminal-legal actors and often overlooks victim decision making. This relative dearth in research is problematic, as victims are principal gatekeepers of the criminal-legal process who influence whether perpetrators are arrested and prosecuted. Subsequent victim support is also contingent on the reporting decision. Overall, this body of research would benefit from a better understanding of how victims activate and participate with the criminal-legal system and the potential impact of these decisions on criminal-legal processes. Moreover, victim decision making is often situated in a theoretical analyses. Victim decision making is complex and should be studied within a criminological decision-making framework. Therefore, the current study relies on National Crime Victimization Survey (NCVS) data and applies a focal concerns perspective (FCP), informed by rape culture concepts, to examine why victims of sexual violence may or may not choose to report to legal authorities. The current study offers initial support for the application of FCP to victim reporting decisions. We found that victims consider each of the focal concerns (FC). Victims were more likely to report when offenders threatened them with harm (i.e., suspect blameworthiness), when the offense occurred in a private location (i.e., protection of the community), and when they sought help from victim support agencies or medical treatment (i.e., practical considerations). Additionally, we found that Black victims were more likely to report than other racial-ethnic groups (i.e., perceptual shorthand). These findings highlight a nexus between reporting to police and help-seeking via support agencies. Importantly, the results emphasize the importance for police to implement cultural competence and antiracist training to better support Black victims.

Caught in the Crossroad: An Intersectional Examination of African American Women Intimate Partner Violence Survivors' Help Seeking

OBJECTIVES

African American women are disproportionately impacted by intimate partner violence (IPV)-related homicide. They reflect the second highest prevalence rates and experience the highest rates of murder resulting from IPV victimization. Although most survivors note that they have experienced rejection and anticipatory stigma as barriers to their help seeking, African American women additionally experience racism and racial discrimination as obstacles that may further preclude their help seeking. This systematic review highlights African American women's experiences of rejection from providers and the effects that it may have upon their ability to secure urgent aid.

METHOD

A dearth of literature examines the subtle ways that African American women survivors experience rejection resulting from the interlocking nature of race, class, and gender oppression. Fundamental to developing more culturally salient interventions is more fully understanding their help-seeking experiences. A systematic review was conducted to provide a critical examination of the literature to understand the intersections of IPV and help-seeking behavior among African American women. A total of 85 empirical studies were identified and 21 were included in the systematic review. The review illuminates both the formal and semiformal help-seeking pathways.

RESULTS

We recommend integrating anti-Blackness racist praxis, incorporating African American women's ways of knowing and centralizing their needs in an effort to improve the health and well-being of this population.

CONCLUSIONS

Eliminating barriers to more immediately accessing the domestic violence service provision system is key to enhance social work practice, policy, and research with African American female survivors of IPV.

The Role of Discrimination Experiences in Postrape Adjustment Among Racial and Ethnic Minority Women

Although recent studies have linked discrimination frequency among Black and Latinx individuals to PTSD symptom severity, to our knowledge, these associations have yet to be examined among a diverse sample of recent rape survivors. The current secondary analysis of existing data examined the role of discrimination experiences in post-traumatic stress disorder (PTSD) symptoms, depression, and alcohol and drug problems among a racially and ethnically diverse sample of recent rape survivors. Participants were 139 Black (48.2%; n = 67), American Indian (18.7%; n = 26), Hispanic (15.1%; n = 21), and mixed race (17.3%; n = 24) girls and women age 15 or older who presented to the emergency department (ED) for a sexual assault forensic medical exam. They were randomly assigned to one of three intervention conditions, and completed a six-month postrape follow-up, including questions about mental health, substance use problems, and discrimination experiences. Regression analyses revealed that Black women experienced discrimination in significantly more situations and with greater frequency compared to American Indian and Hispanic women. Discrimination frequency was positively associated with PTSD and depression symptoms even after controlling for age, education, race, and intervention condition, but was not associated with alcohol or drug problems. Findings highlight the importance of attending to the heterogeneous experiences of discrimination among racial and ethnic minority women. Future work should adapt evidence-based early interventions to be maximally effective at combating both racial and sexual trauma exposures.

Factors Impacting HIV Postexposure Prophylaxis Among Sexually Assaulted Patients Presenting to Two Urban Emergency Departments

INTRODUCTION

Sexually assaulted patients who seek care in emergency departments are often recommended for nonoccupational HIV postexposure prophylaxis treatment. HIV postexposure prophylaxis is an effective method in preventing HIV transmission if the treatment is administered promptly and if a full 28-day course is completed. However, research has shown that only a fraction of patients who start the treatment will complete a 28-day course. Research is needed to explore factors that may be associated with compliance to postexposure prophylaxis so that interventions can be designed to address the factors that put patients at risk for noncompletion.

METHODS

A retrospective chart review was conducted examining 246 medical records of sexually assaulted female patients who presented to one of two urban hospitals. A number of patient and event-related factors were examined to determine whether they were associated with HIV postexposure prophylaxis adherence among patients presenting at an emergency room after a sexual assault.

RESULTS

Results revealed that five factors showed significant associations with sexually assaulted female patients completing HIV postexposure prophylaxis treatment. These factors include educational level, employment, health insurance, vaginal injuries, and tongue-mouth assaults.

IMPLICATIONS FOR PRACTICE

The results of this study represent a starting point from which to inform the development of targeted interventions such that those most at risk for nonadherence can receive additional support or services to improve HIV postexposure prophylaxis adherence.

A Review of Undergraduate Student Disclosures of Sexual Violence

INTRODUCTION

Sexual violence (SV) has been a prevalent issue on college campuses for decades. Researchers, universities, and legislators have tried to understand and prevent it. Despite these efforts, 25% of female and 6% of male undergraduate students will experience a nonconsensual sexual experience (NSE) as a student. An immense amount of research has been conducted on the prevalence, effects, resources for, and outcomes of SV over the last few decades.

OBJECTIVES

The current paper aims to compile and summarize the extant literature on undergraduate student disclosures of sexual violence. The objective is to provide a comprehensive review of the research.

METHODS

A literature search was performed using the terms sexual violence, NSE, undergraduate students, informal and formal reporting, and disclosure.

RESULTS

Disclosure patterns and outcomes for survivors vary widely based on individual factors including type of disclosure source (ie, informal or formal reporting), disclosure recipient response, previous history of NSEs, and personal identity (ie, gender identity, sexual orientation, race/ethnicity). Though there are many formal resources (ie, police, Title IX), the majority of survivors report to informal sources (ie, family or friends). In addition to researching survivors' experiences and rates of disclosures, research also evaluates how disclosure recipients perceive their response to a survivor's disclosure, their likelihood of receiving a disclosure based on their own individual identities, and how the disclosure impacts the recipient and their relationship with the survivor.

CONCLUSION

The individualized response and decision to report SV has made prevention and the creation of effective resources difficult. As there are so many individual factors to consider when evaluating how or whether a NSE will be disclosed, future research should consider these individual differences and use them to create more effective reporting sources and resources. Sears-Greer MA, Friehart BK, Meston CM. A Review of Undergraduate Student Disclosures of Sexual Violence. Sex Med Rev 2022;XX:XXX-XXX.

Explaining the Why in #WhyIDidntReport: An Examination of Common Barriers to Formal Disclosure of Sexual Assault in College Students

Within the current study, we examined themes of college students' reasons for choosing not to formally disclose (report) sexual assault. To complete this objective, we examined tweets (n = 1,297) that used the WhyIDidntReport hashtag in which a user also made reference (within the same thread) to being enrolled at a college or university during the time (and aftermath) of the assault. We deemed Twitter a particularly valuable platform, offering insight into the hidden figure of crime, as users described events, feelings, and perceptions after the event that led to them not formally disclosing. Further, it provides a large sample of cases of women and men who recognize their assault as an assault (at least in hindsight), while also providing open-ended, unstructured explanations of their rationales and motivations. Using an inductive approach, we established broad themes that were then refocused into common barriers of formal disclosure or the continuation of formal disclosure. Subthemes included anticipated social reactions (stemming from vicarious and direct experiences), internalized emotions, often stemming from social reactions (normalization, shame, and blame), victim and offender status, and victim-offender relationship. Three overarching premises were developed from the analysis including (a) victims' internalizations of experiences and observations, (b) the interaction of social factors of the victim, offender, and the victim-offender relationship, and (c) the continual and compounded decision-making process of formal disclosure. These conclusions were then examined within theoretical models, including Black's Behavior of Law Theory (specifically morphology and stratification), Overstreet and Quinn's intimate partner violence stigmatization model, and Chaudoir and Fisher's disclosure process model. Lastly, we provide programmatic recommendations, which includes retailoring current bystander intervention curricula to include more focus on social reactions and social support in anticipation of college students being recipients of sexual assault disclosures by friends and acquaintances.

Exploring Correlates of Social Reactions to Disclosure Among Latina Sexual Assault Survivors

Social reactions to sexual assault (SA) disclosure are well-documented in the literature, but less is known about disclosure and reactions received by Latina survivors. The current study analyzed correlates of positive and negative social reactions to sexual assault disclosure in a community sample of Latina survivors (n = 239). Compared to White survivors, Latina survivors were more likely to report turning against and acknowledgement without support reactions. Among Latina survivors, contrary to hypotheses, both "stereotypical" (e.g. more violent assaults) and "non-stereotypical" (e.g. pre-assault substance use) assault characteristics were associated with acknowledgement without support negative social reactions. Furthermore, total number of sources Latina survivors disclosed to were associated with turning against social reactions. Implications for future research on disclosure/social reactions and Latina survivors are discussed.

Correlates of Support Utilization After Experiencing a Sexual Assault Among College Women and Men

Though previous research has examined survivors' use of formal and informal services, less research has looked at whether sexual orientation, race, and different sexual assault types (e.g., coercive) are associated with seeking support services. The purpose of this study is to examine factors associated with utilizing services or support from informal sources (e.g., telling a friend) and formal sources (e.g., psychological counseling) following a sexual assault. Data were gathered in Fall and Spring of 2019-2020 from undergraduate students at a Midwestern university. Logistic regression results showed that heterosexual students had 56% lower odds of using informal supports, while females were 2.05 times more likely to have used informal supports compared to their counterparts. Students who reported more heavy drinking had 37% lower odds of using informal supports compared to their counterparts. Those who experienced physical and incapacitated sexual assault were 2.09 times and 3.60 times more likely to have used informal supports, respectively. Additionally, older students were 1.35 times more likely to have used formal supports compared to younger students, whereas heterosexual students had 67% lower odds of using formal supports compared to sexual minority students. Those with greater PTSD symptoms were 1.07 times more likely to access formal services. Finally, students with greater depressive symptoms had 8% lower odds of using formal supports. Identifying college students who are less likely to access support services following a sexual assault has important implications for targeted prevention and intervention.

Disclosure to friends or family and consequences after interpersonal violence: intersections of sexual identity and race

Objective: This study's purpose was to examine whether disclosures to friends or family post-victimization was associated with emotional and academic consequences (e.g. feeling detached from others, getting worse grades) among students grouped by sexual identity and race intersections. Participants and Methods: We analyzed data from an online survey that was distributed to students (n = 6,331) at a university in the Southeast. Results: Path analyses indicated disclosure to friends and family partially mediated the relationship between victimization and consequences, such that an increase in the number of disclosures was associated with an increase in the number of consequences. These paths were significant among White sexual minority victims, sexual minority victims of color, White heterosexual students, and heterosexual students of color. Conclusions: These findings indicate that disclosure to informal sources is associated with amplified consequences, which may be ameliorated by training friends and family to respond to disclosures in a supportive manner.

When solidarity hurts: (Intra)cultural trust, cultural betrayal sexual trauma, and PTSD in culturally diverse minoritized youth transitioning to adulthood

Sexual trauma is associated with PTSD, with perpetrators putting women and girls more at risk than men and boys. Young adulthood is a time where risk of victimization and susceptibility to mental health problems increase. Certain contributors of costly trauma outcomes may be affected by the larger context of societal inequality. Cultural betrayal trauma theory (CBTT) highlights cultural betrayal in within-group trauma in minoritized populations as a dimension of harm that affects outcomes. In CBTT, within-group trauma violates the (intra)cultural trust-solidarity, love, loyalty, connection, responsibility-that is developed between group members to buffer against societal inequality. This violation, termed a cultural betrayal, can contribute to poorer mental health. The purpose of the current study is to address a gap in the CBTT literature by examining the role of (intra)cultural trust on the association between cultural betrayal sexual trauma and symptoms of PTSD among diverse minoritized youth transitioning to adulthood. Participants (N = 173) were diverse minoritized college students, who completed a 30-min online questionnaire at a location of their own choosing. Participants received course credit and could decline to answer any question without penalty. The results reveal that the interaction between cultural betrayal sexual trauma and (intra)cultural trust predicted clinically significant symptoms of PTSD. These findings have implications for increased cultural and contextual specificity in trauma research in minoritized populations, which can aid in the development and implementation of culturally competent interventions for diverse minoritized youth survivors of sexual trauma.

Building a community-academic partnership to improve screening for intimate partner violence: Integrating advocates in healthcare clinic settings

AIMS

To develop an innovative community-academic partnership to advance, test and promote intimate partner violence screening and referral protocols by comparing the effect of integrating intimate partner violence advocates versus enhancing medical training in medical clinic settings serving women from vulnerable populations. Detecting intimate partner violence in healthcare settings allows for survivors to connect to safety and referral resources prior to violence escalating. Screening for intimate partner violence and connecting patients to referral resources requires creating a safe and trusting relationship between healthcare providers and patients. Developing screening and referral protocols responsive to survivors' needs requires involvement of clinic staff, survivors and community agencies that support survivors.

DESIGN

Three phases of the project include Discovery, Implementation and Dissemination. Mixed-methodology will help in understanding current practices and effects of interventions.

METHODS

Actions included in each phase: Discovery: 1) nurse-led focus groups of clinic staff, providers and survivors to understand current clinic practices; 2) retrospective chart review of the number of screens performed, positive screens detected and interventions performed.

IMPLEMENTATION

1) randomization of patients to be interviewed by a trained advocate or by healthcare provider with enhanced training; and 2) assess the number of screenings and referrals performed in each arm and 3) evaluate outcomes of intervention. Dissemination through: presentations, manuscripts and policy recommendations at the institutional and regional level. This IRB-approved proposal was funded in July 2021 by an Advancing a Healthier Wisconsin grant.

DISCUSSION

The partnership has improved channels of communication and understanding between diverse clinical care providers, survivors and community agency staff as they navigate the complex challenges to the development and integration of screening and referral protocols.

IMPACT

This project will provide evidence of the most effective intimate partner violence screening and referral methodology that can be utilized in a wide variety of medical settings.

Developing Social Entrepreneurship Orientation: The Impact of Internal Work Locus of Control and Bricolage

Using core self-evaluation theory, the current study assesses the effect of internal work locus of control and bricolage on social entrepreneurship orientation. We adopted the cross-sectional survey design using a sampling frame to engage 400 top executives of social enterprises in mainland China. Three hundred and seventy-two of the executives replied, presenting a response rate of 93%. Results of structural equation modeling analysis show significant positive relationships between internal work locus of control, bricolage, and social entrepreneurship orientation. The positive mediating effect of bricolage on the relationship between internal work locus of control and social entrepreneurship orientation was also found to be true. Consequently, to foster social entrepreneurship orientation, top executives of social enterprises need to gather available resources for bricolage tasks. These findings contribute new knowledge to how internal work locus of control affects social entrepreneurship orientation through the bricolage activity of Chinese social enterprises. Through core self-evaluation theory, we demonstrate the effect of internal work locus of control as a preceding factor in the relationship between bricolage and social entrepreneurship orientation.

Feeling Invisible and Unheard: A Qualitative Exploration of Gendered-Racist Stereotypes Influence on Sexual Decision Making and Mistreatment of Black Teen Girls

Gendered racism can impact how Black teen girls perceive themselves in relation to the world and influence their behaviors. This form of discrimination tends to manifest in stereotypes that promote the victimization and mistreatment of Black teen girls. This qualitative study, using Black feminist thought through a Black Girlhood lens as a guiding framework, aims to understand how Black teen girls are affected by gendered-racist stereotypes and how these stereotypes impact sexual decision making among this group. Using a sample of (N = 27) Black teen girls, three major themes arose: (1) experiencing the effects of racist-sexist stereotypes, (2) feeling powerless and invisible due to stereotypes, and (3) navigating the pressure to have sex due to stereotypes. Implications for this study include incorporating elements of Black Feminist Thought through a Black girlhood lens within prevention programing while also providing Black teen girls with the tools to challenge negative stereotypes with support from adult allies in school and family settings.

"I put it all out there. I have nothing to hide. It's my mom": Parents' and Emerging Adults' Perspectives on Family Talk about Sex

Protective effects of talk with parents about sex, for delaying sex and reducing young people's risky sexual behaviour may extend from adolescence to emerging adulthood. However, little is known about the content and process of this communication, or how parents and their emerging adult children perceive their conversations about sex and relationships. This study offers a novel exploration of family talk about sex during emerging adulthood and addresses topics that are not typically assessed as part of communication research, such as consent and positive talk about sexuality. This study uses thematic analysis to investigate perceptions of family talk about sex in a qualitative sample of 16 pairs of parents and their emerging adult children in the USA, and includes talk about protection, sexual behaviour, pregnancy and parenting; the positive aspects of sex; consent; and sexual orientation. Findings identified variation across topics in terms of 1) similarities and differences in parents' and emerging adults' comfort in talking with each other about sexual topics; and 2) how they perceive this communication across a range of sexual issues. Findings can inform the development of resources to support parents on how to talk with their emerging adult children about sexual issues in a developmentally appropriate way.

Computerized Intervention in Primary Care for Women Veterans with Sexual Assault Histories and Psychosocial Health Risks: a Randomized Clinical Trial

IMPORTANCE

Sexual assault is a public health concern for women and is associated with subsequent psychosocial health risks of posttraumatic stress disorder (PTSD), hazardous drinking, and intimate partner violence (IPV). Sexual assault is associated with social stigma and other barriers shown to inhibit one from seeking mental health care. Digital health technologies may overcome these barriers.

OBJECTIVE

To test the impact of a brief computerized intervention delivered in primary care to reduce health risks and increase mental health treatment utilization among women with histories of sexual assault and current health risks.

DESIGN, SETTING, AND PARTICIPANTS

The Safe and Healthy Experiences (SHE) program was tested in a randomized controlled trial with N = 153 women veterans at a Veterans Health Administration (VHA) medical center, and they completed assessments at baseline, 2 months, and 4 months.

INTERVENTION

SHE is a brief motivational interviewing and psychoeducation-based computerized intervention. SHE was compared to a screen and referral-only control condition.

MAIN MEASURES

Health risks were measured via validated self-report instruments. Treatment initiation and utilization were measured via self-report and chart review.

RESULTS

SHE did not impact women's number of health risks (all p's > .05). However, women randomized to SHE showed significantly greater increases in treatment use compared to women in the control group, as measured by chart review (χ2 (1, n = 153) = 4.38, p = .036, rs = .16), and self-report (χ2 (1, n = 130) = 5.89, p = .015, rs = .21). SHE was found to be an acceptable intervention.

CONCLUSIONS

SHE was effective in improving mental health treatment initiation and utilization compared to a control group. Computer-based interventions to address sexual trauma and its consequences are acceptable, are highly scalable, and can add value to primary care with little cost or increase in provider time.

TRIAL REGISTRATION

Clinicaltrials.gov identifier NCT02957747.

Delivery of Distance Counselling to Survivors of Sexual Violence: A Scoping Review of Promising and Best Practices

Distance counselling holds immense potential for improving access to trauma supports for survivors of sexual violence (SV), and particularly for under-served groups who disproportionately experience violence and myriad barriers to accessing in-person supports. And yet, the evidence-base for the practice and delivery of distance counselling remains under-developed. In the context of COVID-19, where telehealth applications have undergone a rapid uptake, we undertook a scoping review of existing evidence of therapeutic and organizational practices related to the real-time (synchronous) delivery of distance counselling to survivors of SV. We based our scoping review methods on Arksey and O’Malley framework and in accordance with the guidance on scoping reviews from the Joanna Briggs Institute (JBI) and PRISMA reporting guidelines for scoping reviews. A comprehensive search of MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Sociological Abstracts was undertaken in October 2020, and again in March 2022. Searching, reviewing, appraisal, and data extraction was undertaken by two reviewers. In total, 1094 records were identified that resulted in 20 studies included. Descriptions, findings, and recommendations were gleaned and synthesized into potential practices using inductive thematic analysis. While many studies have an appreciative orientation to distance counselling, these benefits tend to be framed as non-universal, and conditional on survivor safety, flexibility, anonymity, survivor choice, strong and inclusive technology, and a supported workforce.

Despite the limited evidence-base, we present several clusters of findings that, taken together, can be used to support current COVID-19 distance counselling initiatives with survivors, as well as guide the future development of best practices.

Sexual Abuse in the Orthodox Jewish Community: A Literature Review

Sexual abuse is a cross-cultural phenomenon related to multiple cultural contexts including religious affiliation. The Haredi, or Orthodox Jewish community (OJC), constitutes a significant minority group of the worldwide Jewish population, characterized by cultural conservatism, steadfast loyalty to the community, and strict religious behavioral codes. To date, only few empirical studies (as opposed to multiple media reports) have dealt with the issue of sexual abuse within the OJC. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review of the literature on sexual abuse within the OJC and its subgroups that addresses experiences and reports of victims, perpetrators, the Jewish and general community, and professionals in the North America, Israel, and Australia. Articles were collected from peer-reviewed databases and bibliographies; 13 quantitative and qualitative articles were included in the final sample. Three themes emerged: disclosure of sexual abuse, perceptions and attitudes toward the abuse, and its implications. Results indicated that alongside several findings that were specifically grounded in the context of closed collective or religious societies and the OJC in particular, most essentially reflected universal aspects of sexual abuse. The results suggest promoting context-informed interventions based on community knowledge and resilience, together with appropriate training in order to better understand the needs of the OJC and of closed communities in general.

Experience-Based Perception of Vulnerability Factors to Child Sexual Abuse by Health Care Professionals in Nigeria: A Qualitative Approach

Child sexual abuse (CSA) remains a major public health concern worldwide. In Africa, particularly, Nigeria, CSA is a silent, but lethal public health menace with prevalence reaching as high as 56% for different child sexual violence. Understanding the vulnerability factors of CSA promotes the creation of strategies toward prevention of CSA. Due to social stigmatization of victims and their families in Nigeria, it is difficult for researchers and policymakers to have access to firsthand information about predisposing factors to CSA, which negatively impacts efforts toward prevention of CSA. Health care professionals are sources of experience-based, anonymous information about various public health issues. This study aims to understand qualitatively health care professionals' perception of vulnerability factors of CSA. The study presents a thematic content analysis of a semi-structured interview of 14 health care professionals working with sexually abused children in Nigeria, on their perception of vulnerability factors of CSA, while aligning the factors with known models of violence. Participants in the study reported several interrelated vulnerability factors involving the individual, sexual abuse perpetrator, family, environment, socioeconomic situations, and the lack or nonimplementation of policies against CSA. The study concludes that identifying these factors can assist health care professionals, parents, and family to better respond to child sexual violence cases and policymakers to create new strategies of preventing CSA, thereby improving the health and safety of children in Nigeria.

Homicide During Pregnancy and the Postpartum Period in the United States, 2018-2019

OBJECTIVE

To estimate the national pregnancy-associated homicide mortality ratio, characterize pregnancy-associated homicide victims, and compare the risk of homicide in the perinatal period (pregnancy and up to 1 year postpartum) with risk among nonpregnant, nonpostpartum females aged 10-44 years.

METHODS

Data from the National Center for Health Statistics 2018 and 2019 mortality files were used to identify all female decedents aged 10-44 in the United States. These data were used to estimate 2-year pregnancy-associated homicide mortality ratios (deaths/100,000 live births) for comparison with homicide mortality among nonpregnant, nonpostpartum females (deaths/100,000 population) and to mortality ratios for direct maternal causes of death. We compared characteristics and estimated homicide mortality rate ratios and 95% CIs between pregnant or postpartum and nonpregnant, nonpostpartum victims for the total population and with stratification by race and ethnicity and age.

RESULTS

There were 3.62 homicides per 100,000 live births among females who were pregnant or within 1 year postpartum, 16% higher than homicide prevalence among nonpregnant and nonpostpartum females of reproductive age (3.12 deaths/100,000 population, P<.05). Homicide during pregnancy or within 42 days of the end of pregnancy exceeded all the leading causes of maternal mortality by more than twofold. Pregnancy was associated with a significantly elevated homicide risk in the Black population and among girls and younger women (age 10-24 years) across racial and ethnic subgroups.

CONCLUSION

Homicide is a leading cause of death during pregnancy and the postpartum period in the United States. Pregnancy and the postpartum period are times of elevated risk for homicide among all females of reproductive age.