Injuries from intimate partner and sexual violence: Significance and classification systems.

UNLABELLED: While intimate partner violence (IPV) and sexual violence (SV) are highly associated with injury, the healthcare and legal significance of these injuries is controversial. PURPOSE: Herein we propose to explore the significance of injury in IPV and SV and examine the current status of injury classification systems from the perspectives of the healthcare and criminal justice systems. We will review current injury classification systems and suggest a typology of injury that could be tested empirically. FINDINGS: Within the published literature, we found that no commonly accepted injury typology exists. While nuanced and controversial issues surround the role of injury detection in the sexual assault forensic examination, enough evidence exists to support the continued pursuance of a scientific approach to injury classification. We propose an injury typology that is measurable, is applicable to the healthcare setting and criminal justice system, and allows us to use uses a matrix approach that includes a severity score, anatomic location, and injury type. We suggest a typology that might be used for further empirical testing on the validity and reliability of IPV and SV injury data. CONCLUSION: We recommend that the community of scientists concerned about IPV and SV develop a more rigorous injury classification system that will improve the quality of forensic evidence proffered and decisions made throughout the criminal justice process.

Health disparities in the forensic sexual assault examination related to skin color.

Little is known about the role of skin color in the forensic sexual assault examination. The purpose of this study was to determine whether anogenital injury prevalence and frequency vary by skin color in women after consensual sexual intercourse. The sample consisted of 120 healthy (63 Black, 57 White) women who underwent a forensic sexual assault examination following consensual sexual intercourse. Experienced sexual assault forensic examiners using visual inspection, colposcopy technique with digital imaging, and toluidine blue application documented the number, type, and location of anogenital injuries. Although 55% of the total sample was observed to have at least one anogenital injury of any type following consensual intercourse, the percentages significantly differed for White (68%) and Black (43%) participants (p= 0.02). When the presence of anogenital injury was analyzed by specific anatomical region, a significant difference between White and Black participants was only evident for the external genitalia (White = 56%, Black = 24%, p= .003), but not for the internal genitalia (White = 28%, Black = 19%, p= .20) or anus (White = 9%, Black = 10%, p= 0.99). A one standard deviation-unit increase in L* values (lightness) was related to a 150% to 250% increase in the odds of external genitalia injury prevalence (p < 0.001). While Black and White participants had a significantly different genital injury prevalence, dark skin color rather than race was a strong predictor for decreased injury prevalence. Sexual assault forensic examiners, therefore, may not be able to detect injury in women with dark skin as readily as women with light skin, leading to health disparities for women with dark skin.

Forensic sexual assault examination and genital injury: is skin color a source of health disparity?

PURPOSE: The study objectives were to (1) estimate the frequency, prevalence, type, and location of anogenital injury in black and white women after consensual sex and (2) investigate the role of skin color in the detection of injury during the forensic sexual assault examination. METHODS: A cross-sectional descriptive design was used with 120 healthy volunteers who underwent a well-controlled forensic examination after consensual sexual intercourse. RESULTS: Fifty-five percent of the sample had at least 1 anogenital injury after consensual intercourse; percentages significantly differed between white (68%) and black (43%) participants (P = .02). Race/ethnicity was a significant predictor of injury prevalence and frequency in the external genitalia but not in the internal genitalia or anus. However, skin color variables--lightness/darkness-, redness/greenness-, and yellowness/blueness-confounded the original relationship between race/ethnicity and injury occurrence and frequency in the external genitalia, and 1 skin color variable--redness/greenness--was significantly associated with injury occurrence and frequency in the internal genitalia. CONCLUSIONS: Although differences exist in anogenital injury frequency and prevalence between black and white women, such differences can be more fully explained by variations in skin color rather than race/ethnicity. Clinical recommendations and criminal justice implications are discussed.

Adolescent risk behavior screening: the difference between patients who come in frequently and infrequently.

Charts were examined retrospectively to identify evidence of risk behavior screening in adolescents, identified from billing data as visiting at least 9 times during a 1-year period (n=55), frequent attenders (FA). These were matched 2:1 on age, gender, and ethnicity with 121 nonfrequent attenders (NFA), < or = 3 visits in 1 year. FA had more evidence of risk behavior screening than NFA, but less preventive care. Risk screening in males occurred less than in females in both FA and NFA. Chart review demonstrated many missed opportunities. Providers are encouraged to fully utilize well teen exams as well as acute visits for risk behavior screening.

Sexual behaviour of adolescents in Nigeria: cross sectional survey of secondary school students.

OBJECTIVES: To determine whether family structure (polygamous or monogamous) is associated with sexual activity among school students in Nigeria. DESIGN: Cross sectional school survey with a two stage, clustered sampling design. PARTICIPANTS: 4218 students aged 12-21 years attending 39 schools in Plateau state, Nigeria. Responses from 2705 students were included in the analysis. MAIN OUTCOME MEASURE: Report of ever having had sexual intercourse. Variables of interest included sexual history, age, sex, religion, family polygamy, educational level of parents, having a dead parent, and sense of connectedness to parents and school. RESULTS: Overall 909 students (34%) reported ever having had sexual intercourse, and 1119 (41%) reported a polygamous family structure. Sexual activity was more common among students from polygamous families (42% of students) than monogamous families (28%) (chi2=64.23; P<0.0001). Variables independently associated with sexual activity were male sex (adjusted odds ratio 2.52 (95% confidence interval 2.05 to 3.12)), older age (1.62 (1.24 to 2.14)), lower sense of connectedness with parents (1.87 (1.48 to 2.38)), having a dead parent (1.59 (1.27 to 2.00)), family polygamy (1.58 (1.29 to 1.92)), lower sense of connectedness with school (1.25 (1.09 to 1.44)), and lower educational level of parents (1.14 (1.05 to 1.24)). Multistep logistic regression analysis showed that the effect of polygamy on sexual activity was reduced by 27% by whether students were married and 22% by a history of forced sex. CONCLUSIONS: Secondary school students in Nigeria from a polygamous family structure are more likely to have engaged in sexual activity than students from a monogamous family structure. This effect is partly explained by a higher likelihood of marriage during adolescence and forced sex. Students' sense of connectedness to their parents and school, regardless of family structure, decreases the likelihood of sexual activity, and fostering this sense may help reduce risky sexual behaviour among Nigerian youth.

Screening for intimate partner violence when children are present: the victim's perspective.

Although intimate partner violence (IPV) is routinely encountered in health care, it often goes undetected. Medical organizations recommend routine screening of women alone without children of partner. Separating a mother from her children may not be feasible in busy practices. Therefore, screening may not occur. Little research has examined women's desires about IPV screening in front of their children. This study interviewed 32 mothers/survivors who were in either an IPVshelter or support group regarding their wishes about IPV screening and discussions in front of their children. Interviews were audio taped, transcribed, and analyzed using thematic analysis techniques. Major themes included mothers'comfort with the use of general IPV screening questions in front of children ages 3 to 12 years. In summary, most mothers/survivors were comfortable with physicians using general questions to screen for IPV but preferred in-depth discussions about the abuse and resource sharing in private.

High-risk teen compliance with prescription contraception: an analysis of Ohio Medicaid claims.

STUDY OBJECTIVE: This study examines utilization of and compliance with prescription contraception by adolescents. DESIGN: Retrospective cohort analysis of billing and pharmacy claims. SETTING: Ohio Medicaid fee-for-service enrollees. PARTICIPANTS: Claims data of 12- to 19-year-olds identified at high risk for pregnancy by sexually related service billing or procedure code. MAIN OUTCOME MEASURE: Prescription contraception use and compliance patterns were examined over a 12-month study period. RESULTS: During a 6-month enrollment period, 3338 females were identified at risk for pregnancy. Over one-fourth (920) became pregnant. Across the 12-month follow-up, 40% (1328) used no prescription contraception and 33% (1090) used some prescribed contraceptive. Most teens used injectable medroxyprogesterone (517) or oral contraceptive pills (492). About 20% of those using any type of prescribed contraceptive were compliant for the full year; less than 30% used a method for 3 months or less. Whites were more compliant with contraception than nonwhites. Younger age and concurrent mental health condition were also predictors of noncompliance. CONCLUSIONS: Teens at risk for pregnancy demonstrated poor compliance with prescribed contraceptives. Billing/pharmacy claims analysis is a useful tool for identifying teens at risk for pregnancy in order to target and evaluate interventions or to benchmark care provided to adolescents.