Sexual Violence in America: Public Funding and Social Priority

Reducing the Methodological Heterogeneity ("Noise") in the Literature Predicting In-Prison Interpersonal Harm in Male Populations

Interpersonal harm is a preventable public health problem. A growing body of literature shows persistently elevated exposure rates to physical and sexual victimization during incarceration. Yet how to prevent interpersonal harm during incarceration has proven far more elusive. A public health approach to prevention offers promise. To develop effective prevention strategies, the public health approach begins with defining and measuring the problem, followed by identifying risk and protective factors for the problem. The dynamic literature on in-prison interpersonal harm includes both parts of the public health approach but theoretical and methodological "noise" in this literature limits its instrumental utility to build effective prevention strategies. Herein, we critically review this evidence base (15 peer-reviewed articles published since 2000 with samples of 1,000+) to isolate the noise and the substance. We, then, minimize the methodological noise by testing for risk factors using self-report data that is representative of an entire U.S. state prison system for men and best data collection practices. Multilevel logistic regression is used to predict four types of interpersonal harm using theoretically grounded individual and prison-level covariates that are supported by the empirical literature. We conclude with recommendations for building an evidence base from which to develop prevention strategies that would create and sustain custodial conditions for people to be safe and healthy while incarcerated.

"Hardly Able to Move, Much Less Open a Book": A Systematic Review of the Impact of Sexual and Gender-Based Violence Victimization on Educational Trajectories

Sexual and gender-based violence (SGBV) is a highly prevalent issue, both in North America and globally, with well-recognized adverse impact on survivors' physical, emotional, and economic well-being. The objective of this systematic review is to collect and synthesize empirical work on the effects of SGBV victimization on educational trajectories, goals, attainment, and outcomes. The review summarizes what is known about factors associated with victimization that affect survivors' educational trajectories and highlights gaps in the literature pertaining to the effects of victimization on education. Five databases were searched for this review: Web of Science, Sociological Abstracts, PubMed, APA PsycInfo, and ERIC. For inclusion, the articles must present research on the academic impact of any form of SGBV experienced in higher education and must have been conducted in the United States or Canada. The 68 studies that met these criteria presented research on six key areas of educational outcomes: impacts on academic performance and motivation; attendance, dropout, and avoidance; changes in major/field of study; academic disengagement; educational attitudes and satisfaction; and academic climate and institutional relationships. Research also revealed factors mediating the relationship between SGBV exposure and educational outcomes such as mental health, physical health, social support, socioeconomic status, and resiliency, which we summarize in a pathway model. The research reviewed had significant limitations, including weak study designs, limited generalizability, and diversity concerns. We offer recommendations for future research on this topic.

"There Is No One Way to Get Over It": An Examination of Psychotherapy and Complementary Therapy Use Within a Sample of Survivors Who Experienced Sexual Violence

Literature on sexual violence survivors' service utilization is limited due to examination of singular therapies or narrow timeframes. Using surveys (n = 303) and interviews (n = 20), this study increases understanding of survivors' healing. Results show varied therapy use including psychotherapy (76.9%), yoga (50.2%), and massage (32.1%), among others. Mean number of therapies used was over three. Service utilization was delayed over a decade on average. Latent class analysis divided respondents into classes: psychotherapy and bodywork use (42.66%), high therapy use (9.14%), and minimal therapy use (48.20%). Interviews provide additional insight and describe barriers. Recommendations for policy, practice, and future research are discussed.

Prevention of mental illness within public health: An analysis of progress via systematic literature review and a pathway forward

Primary prevention is the cornerstone of public health. Prevention is especially important for chronic diseases of significant burden such as mental illnesses because many of them have limited treatment options, an onset in childhood or in adolescence, and are linked to adverse childhood experiences requiring a focus on early childhood and maternal-child health (MCH). Despite this need, there appears to be a paucity of research into prevention of mental illnesses within public health. To confirm this, we performed a systematic literature review to quantify the proportion of articles in public health that focus on prevention of mental illness versus intervention for these illnesses after their onset, and the proportion of published articles within MCH that focus on mental health. Between November 2019 and August 2021, we reviewed 211,794 published articles from 147 Scimago-ranked English public health journals with no limit on year of publication. As hypothesized, a very small portion (2.2%) of mental health articles included primary prevention and a small portion of MCH articles (7.8%) included mental health. These results are consistent with the existence of a research gap in mental illness prevention within the public health field. Given the early onset of mental illness, the importance of early childhood experiences in the later development of mental illness, and the importance of the social-emotional connection between mother and child for building resilience, public health professionals must incorporate evidence from the field of MCH to develop and assess more primary prevention programs for mental illness.

Non-Partner Sexual Violence Among Asian American, Native Hawaiian, and Pacific Islander Adults: A Scoping Review

The Asian American, Native Hawaiian, and Pacific Islander (AANHPI) population is rapidly growing in the United States. Despite sexual violence being a persistent and significant public health issue, research on this topic among AANHPIs is lacking. The study objective is to conduct a systematic scoping review on the published literature on non-partner sexual violence among AANHPIs to identify gaps and priorities to inform actionable research. The systematic review was conducted following the PRISMA Protocol for Systematic Reviews. Database searches were conducted of MEDLINE, Embase, PsycINFO, and Cochrane Central of Clinical Trials, along with and AgeLine and CINAHL for peer-reviewed articles describing non-partner sexual violence among AANHPIs. The search was limited to articles in English published after 1990. Each citation was reviewed by two trained independent reviewers, with a third researcher resolving any conflicts. Of the 998 articles screened and subsequently 496 full-text articles assessed for eligibility, 38 articles were included in the final analysis. The majority of studies did not report disaggregated data for AANHPI subgroups, with most focusing on East Asian subgroups and little evidence on NHPI communities. Most studies were cross-sectional, quantitative, and employed non-probability sampling. There was a lack of studies on effectiveness of interventions and validity of sexual violence-related measures. Our review provides a first step in mapping the extant literature on non-partner sexual violence among this underserved and under-researched population and will serve as a guide for future research, policy, and intervention.

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

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

Study Title-Based Framing Effects on Reports of Sexual Violence and Associated Risk Factors in College Students

OBJECTIVE

There are many methodological issues in studying sexual violence, including potential framing effects. Framing effects refer to how researchers communicate the purpose of a study to participants, such as, how the study is advertised or explained. The aim of this study was to investigate if framing effects were associated with differences in participants' self-reported experiences of sexual violence and related correlates.

METHODS

College students (N = 782) were recruited to participate in one of four identical studies that differed in the title: "Questionnaires about Alcohol," "Questionnaires about Crime," "Questionnaires about Health," or "Questionnaires about Sexual Assault." Participants chose one of the four studies and completed measures of sexual violence as well as attitudinal and behavioral measures in randomized order.

RESULTS

We found significantly more reports of childhood sexual abuse (33.6% vs. 18.5%), rape (33.9% vs. 21.1%), higher frequency of victimization (M = 11.35 vs. 5.44), and greater acknowledged rape for bisexual people (46.2% vs. 0.0%) in the sexual assault (SA) condition compared to other conditions. There were no differences in sexual violence perpetration or attitudinal or behavioral measures.

CONCLUSION

These results revealed that framing effects, based on the study title, affect outcomes in sexual victimization research. Rape was reported 1.6× more in the "Sexual Assault" condition than in the "Health" condition. It is unclear whether these framing effects reflect self-selection bias or framing related increased reports in the SA condition, suppression of reports in other conditions, or a combination thereof.

Constructivist Correlates to Anniversary Reactions Across Bereavement and Sexual Violence

Anniversary reactions are an accepted part of bereavement, but recent research demonstrates that ARs can be seen across many traumatic events. The present study explores how constructivist theories could characterize ARs caused by the death of a loved one or sexual violence. N = 234 women answered questionnaires regarding their posttraumatic adjustment, meaning made of the trauma, trauma centrality, and social validation or invalidation of their trauma. Our data demonstrate that ARs are marked by statistically and clinically significant increases posttraumatic stress disorder symptoms. Participants in this study did not endorse significant posttraumatic growth during their AR. The women in the sexual violence group endorsed more social validation and invalidation as well as less meaning made of their trauma compared to the bereavement group. There were no group differences regarding trauma centrality. Results of this study provide empirical support for an understudied yet significant phenomenon and directions of future study.

What We Think When We Think About (Interpersonal) Violence: Understanding Knowledge Production

Amid growing consensus that violence against women is structurally produced, neoliberalism produces an individualist understanding of violence that blames women while simultaneously framing it as personal failings of men, obscuring the link between the structural and the personal. Using examples from federal grant funding opportunities in the United States, activism in Bangladesh, and data from qualitative research, I analyze how such individual readings of violence get produced–reproduced. I call for radical responsibility to produce equitable and just research that serves the communities that we study, not just the interests of grant funders and the neoliberal university.

COVID-19 and gender-based violence service provision in the United States

INTRODUCTION

Gender-based violence (GBV) policies and services in the United States (U.S.) have historically been underfunded and siloed from other health services. Soon after the onset of the COVID-19 pandemic, reports emerged noting increases in GBV and disruption of health services but few studies have empirically investigated these impacts. This study examines how the existing GBV funding and policy landscape, COVID-19, and resulting state policies in the first six months of the pandemic affect GBV health service provision in the U.S.

METHODS

This is a mixed method study consisting of 1) an analysis of state-by-state emergency response policies review; 2) a quantitative analysis of a survey of U.S.-based GBV service providers (N = 77); and 3) a qualitative analysis of in-depth interviews with U.S.-based GBV service providers (N = 11). Respondents spanned a range of organization types, populations served, and states.

RESULTS

Twenty-one states enacted protections for GBV survivors and five states included explicit exemptions from non-essential business closures for GBV service providers. Through the surveys and interviews, GBV service providers note three major themes on COVID-19's impact on GBV services: reductions in GBV service provision and quality and increased workload, shifts in service utilization, and funding impacts. Findings also indicate GBV inequities were exacerbated for historically underserved groups.

DISCUSSION

The noted disruptions on GBV services from the COVID-19 pandemic overlaid long-term policy and funding limitations that left service providers unprepared for the challenges posed by the pandemic. Future policies, in emergency and non-emergency contexts, should recognize GBV as essential care and ensure comprehensive services for clients, particularly members of historically underserved groups.

Assistance to Victims of Sexual Violence in a Referral Service: A 10-Year Experience

OBJECTIVE

 To evaluate the assistance provided to women victims of sexual violence and their participation in the follow-up treatment after the traumatic event, presenting a sociodemographic profile, gynecological background, and circumstances of the event, and reporting the results, acceptance, and side effects of prophylaxis for sexually transmitted infections (STIs) and pregnancy.

METHODS

 A retrospective cohort study comprising the period between 2007 and 2016. All women receiving medical care and clinical follow-up after a severe episode of sexual violence were included. Records of domestic violence, male victims, children, and adolescents who reported consensual sexual activity were excluded. The present study included descriptive statistics as frequencies and percentages.

RESULTS

 A total of 867 medical records were reviewed and 444 cases of sexual violence were included. The age of the victims ranged from 10 to 77 years old, most of them self-declared white, with between 4 and 8 years of education, and denying having a sexual partner. Sexual violence occurred predominantly at night, on public thoroughfare, being committed by an unknown offender. Most victims were assisted at the referral service center within 72 hours after the violence, enabling the recommended prophylaxis. There was high acceptance of antiretroviral therapy (ART), although half of the users reported side effects. Seroconversion to human immunodeficiency virus (HIV) or to hepatitis B virus (HBV) was not detected in women undergoing prophylaxis.

CONCLUSION

 In the present cohort, the profile of victims of sexual violence was low-educated, young, white women. The traumatic event occurred predominantly at night, on public thoroughfare, being committed by an unknown offender. Assistance within the first 72 hours after sexual violence enables the healthcare center to provide prophylactic interventions against STIs and unwanted pregnancies.

The case for "investigate all": Assessing the cost-effectiveness of investigating no CODIS hit cases in a sexual assault kit initiative

An increasing number of US jurisdictions have begun to submit their previously untested sexual assault kits (SAKs) for DNA testing. However, best practices for what should happen after testing are not well established. Should all cases be investigated regardless of the testing outcome or only those that returned a DNA hit? We examine an early-adopter jurisdiction that has completed testing and investigating all 5165 previously never tested kits. We explore and compare the criminal justice outcomes and cost-effectiveness of investigating: all cases, those with CODIS hits, and those without CODIS hits. Findings indicate the SAK initiative produced a cost savings to the community: $26.48 million ($5127 p/kit) after the inclusion of tangible and intangible costs of future sexual assaults averted through convictions, of which $9.99 million ($1934 p/kit) was from also investigating no CODIS hit cases. When considering only the costs to law enforcement, investigating all cases cost $12,000 p/additional conviction. Findings also illustrate the cost-effectiveness of investigating no CODIS hits cases and support an "investigate all" approach. This study enhances our understanding of the economic value of what comes after testing kits and investigating cases and provides a framework for jurisdictions for prioritizing resources and maximizing outcomes from testing.

Testing a Talkstory Intervention to create Supportive and Safe Violence-Free Communities for Women

The purpose of this paper is to report on a community-designed and led talkstory intervention to increase awareness of intimate partner violence (IPV), decrease acceptability of IPV, and increase community leadership to address IPV. In collaboration with women engaged in prior IPV outreach and education in Hawai'i, a talkstory intervention for IPV was developed, and a single-group, pre-post-test design was used to test it. The intervention included five talkstory sessions over seven months with community groups interested in violence prevention. Pre- and post-testing were conducted to determine changes in group means on three measures. Ninety-two individuals participated in the intervention, 77 (84%) of these completed the 1-month follow-up measure, and 59 (64%) of these also completed the 6-month follow-up measure. The findings included: (1) participants in the talkstory intervention groups decreased their acceptability of violence and increased their awareness, knowledge, and confidence to address IPV; (2) the community leaders in the intervention groups gained skills in facilitation; and (3) intervention groups continued to sponsor other IPV awareness-raising activities in their communities following completion of the study. Working with community leaders to design and facilitate the intervention not only provided IPV education within the context of the community, but also led to sustainable efforts to enhance the safety and wellbeing of women experiencing violence.

Internet Searches for Sexual Harassment and Assault, Reporting, and Training Since the #MeToo Movement

This study analyzes US internet search numbers to evaluate changes in searches for sexual harassment and assault, reporting, and training since the #MeToo movement.

Social Dimensions of Sexual Consent Among Cisgender Heterosexual College Students: Insights From Ethnographic Research

PURPOSE

Nonconsensual sexual experiences on college campuses represent a serious public health problem. The preponderance of existing research on students' actual consent practices is quantitative, lab based, or focused on how single dimensions of social context shape consent practices. Filling those gaps and illustrating ethnography's potential to lay the groundwork for innovative prevention, this paper draws on research conducted with undergraduates on two interconnected campuses to examine multiple social dimensions of sexual consent practices.

METHODS

Data include in-depth interviews with over 150 students, 16 months of participant observation, 17 focus groups, and key informant interviews. Research conducted for this study took place between September 2015 and January 2017 at Columbia University and Barnard College.

RESULTS

Although sexual consent is often approached as an individual or interpersonal practice, this research highlights potentially modifiable social dimensions of consent. These seven dimensions of sexual consent practices are as follows: (1) gendered heterosexual scripts; (2) sexual citizenship; (3) intersectionality; (4) men's fear of "doing" consent wrong; (5) "drunk sex"; (6) peer groups; and (7) spatial/temporal factors shaping when consent is assumed.

CONCLUSIONS

Effective promotion of consensual sex, as a strategy to prevent assault, will likely require understanding and modifying the social structures that shape consent practices, rather than just legislation that mandates the promotion of affirmative consent. We describe seven potential modifiable social contextual dimensions of consent practices, along with related strategies to promote consensual sex and prevent sexual assault.

Long-term impacts of college sexual assaults on women survivors' educational and career attainments

OBJECTIVE

To examine the well-documented mental and physical health problems suffered by undergraduate women sexually assaulted while on campus with an exploration of how the trauma impacts a survivor's lifetime education trajectory and career attainment.

PARTICIPANTS

In November and December 2015, researchers recruited US participants using an online crowdsourcing tool and a Listserv for sexual violence prevention and response professionals.

METHODS

Of 316 women who completed initial screening, 89 qualified to complete a Qualtrics survey. Eighty-one participants completed the online survey, and 32 participated in phone interviews.

RESULTS

Ninety-one percent of the participants reported health problems related to the assault that they attributed to difficulties they faced in their attainment of their education and career goals.

CONCLUSIONS

The findings suggest the importance of simultaneously examining the effects of human capital losses and mental and physical health problems attributed to the costly public health problem of campus sexual assault.