Advances in diagnostic codes to document sexual assault in health care service.

OBJECTIVE: To explore trends in documented sexual abuse/assault (SA) related episodes in California hospitals and emergency departments (ED), including the impact of a change in health care service reporting codification (from ICD-9-CM to ICD-10-CM) that more clearly defined SA in October 2015. DATA SOURCES: Hospital and ED data were drawn from California's Office of Statewide Health Planning and Development (OSHPD). STUDY DESIGN: Descriptive and trend analyses of SA-related hospital and ED records (including patients' demographic information) were conducted to determine whether changes in ICD codification had an impact on documented SA-related episodes. DATA COLLECTION: All SA-related episodes (ICD-9-CM codes 995.83, 995.53; ICD-10-CM codes T74.21-T74.22, T76.21-T76.22) in California hospitals and EDs for the last decade of available data (2008-2017) were analyzed (n = 20,215). PRINCIPAL FINDINGS: An abrupt increase in documented SA episodes in hospitals and EDs began in October 2015, when specific ICD10 codes for suspected cases of SA were created. Documented SA-related episodes doubled in 1 month (164 vs. 385 episodes in September 2015 and October 2015, respectively). More than half (58.2%) of all SA-related episodes documented in Oct 2015 were coded as suspicious. The number of documented SA-related episodes continued increasing to the end of the time series (December 2017). Overall, the annual number of documented SA-related episodes increased by over 700% in only 4 years (900 vs. 6441 in 2013 and 2017, respectively), suggesting high rates of prior under-reporting and the need to introduce the new codes. African Americans were disproportionally impacted; however, the highest increases in age-adjusted rates between the ICD-9-CM and the ICD-10 codification period were found among the White population (2.46 vs. 16.53 per 100,000 inhabitants). CONCLUSIONS: SA episodes in the clinical population have been underestimated for many decades. Identifying SA victims and measuring SA-related health care utilization is a real challenge that needs further investigation.

Novel Coronavirus (COVID-19): Violence, Reproductive Rights and Related Health Risks for Women, Opportunities for Practice Innovation.

While the novel coronavirus (COVID-19) has broad health implications across the globe, being overlooked in response and policy debates is the impact on women's reproductive rights and violence risk. This is especially salient for minoritized women. In this commentary, we describe the potential negative impact of mandates such as shelter-in-place for domestic violence victims, and how public reproductive health policy is being shaped to disadvantage women, especially minoritized women. We argue that now is the time for violence prevention leaders to advocate for bold action. This includes prioritizing the needs of women (especially minoritized women) in medical, social and legal settings using innovative intervention and service engagement (e.g., e-filing for protection orders, virtual advocacy services), urging policy makers to pass legislation to support women, and shining an accountability spotlight on leadership.

Perceptions of College Campus Alcohol and Sexual Violence Prevention Among Students with Disabilities: "It Was A Joke".

PURPOSE: The purpose of this study was to understand perceptions of campus-based alcohol and sexual violence (SV) prevention programming among college students with disabilities to inform future development of prevention programs appropriate for the needs of these students. METHOD: The study included semi-structured, qualitative interviews with 51 college students with disabilities who reported histories of SV recruited from a larger parent study investigating a brief universal intervention to reduce alcohol related SV involving 28 campuses across Western Pennsylvania and West Virginia. Interviews focused on college-related experiences of prevention programming, and experiences of health, disability, alcohol use and violence victimization. Data were analyzed using thematic analysis. RESULTS: Three themes emerged: (1) Students with disabilities described campus prevention programming as ineffective and irrelevant to their experiences, including referring to programs as "a joke," (2) Students wanted multi-dose, developmentally relevant content that directly addresses the complexities of their experiences with disability, alcohol, and violence, and (3) Students called for programing focused on engaging their interests. CONCLUSIONS: Our results point to the need to augment campus-based programming, with attention to the unique needs and relevant concerns of students with disabilities, within the broader context of campus prevention programming.

Saving Lives: Working across Agencies and Individuals to Reduce Intimate Homicide among those at Greatest Risk.

This special issue of the Journal of Family Violence offers insights on intimate homicide prevention from leading researchers and practitioners. The insights offered are timely, given the pervasiveness of domestic violence (DV), including some data since the emergence of COVID-19 noting an increase in DV-related  cases with severe  injury and police calls. Contributors in this special issue argue for interagency advocacy, protection orders, and firearm removal, along with reimagining data capture, risk assessment, firearm protocols, and fatality reviews to improve equitable services and care for DV survivors at the highest risk of homicide.

Campus Service Use Among Students With Disabilities Who Have Experienced Sexual Violence: A Conceptual Model.

Students with disabilities are one student group with elevated risk of sexual violence. Although they would benefit from streamlined access to campus support, little is known about their patterns of campus service use. This qualitative analysis includes data from semi-structured interviews with 51 students with disabilities who experienced sexual violence focused on service use across campus. The resultant conceptual model shows that greater accessibility is associated with positive experiences, and lower accessibility is associated with negative experiences. Students with disabilities who experienced or expected negative reactions (e.g., judgment) were less likely to use services and were less satisfied. Advocacy and support in connecting students with disability or sexual violence services was associated with positive experiences and increased accessibility. These findings highlight key facilitators and barriers to campus service use for students with disabilities with sexual violence histories and suggest key intervention points for increasing accessibility, reducing stigma, and improving student experiences with campus providers, staff, and faculty.

Nonconsensual Porn as a Form of Intimate Partner Violence: Using the Power and Control Wheel to Understand Nonconsensual Porn Perpetration in Intimate Relationships.

Over the last decade, nonconsensual porn (NCP), or the sharing of sexually explicit material without a person's consent, has become a growing problem with potentially far-reaching adverse consequences for victims. The purpose of this article is to propose and consider a framework for advancing the field's understanding of NCP within the context of intimate relationships including situating NCP relative to other forms of relational abuse. Specifically, we examined the extent to which NCP in intimate partner relationships was perpetrated using tactics from the Power and Control Wheel through a summative content analysis of U.S. news stories on NCP from 2012 to 2017. This analysis established that NCP has been perpetrated using all eight of the abuse metatactics in the Power and Control Wheel, with the three most common being emotional abuse, coercion and threats, and denial/blame/minimization. Treating NCP in relationships as a potential form of partner violence provides a basis on which to understand the etiology, manifestation, motives, and impact of this form of abuse and informs practitioners' ability to design prevention efforts and engage a trauma-informed response to survivors.

The impact of the Great Recession on California domestic violence events, and related hospitalizations and emergency service visits.

OBJECTIVE: Explore the impact of the Great Recession on domestic violence (DV) related hospitalizations and emergency department (ED) visits in California. METHODS: Hospital and ED data were drawn from California's Office of Statewide Health Planning and Development (OSHPD). DV-related hospitalizations and ED visits in California were analyzed between January 2000 and September 2015 (53,596), along with total medical costs. Time series were divided into pre-recession (Jan 2000-Nov 2007) and recession/post-recession (Dec 2007-Sept 2015) periods. RESULTS: The medical cost of DV-related hospitalizations alone was estimated as $1,136,165,861. A dramatic increase in DV episodes was found potentially associated with the Great Recession. The number of ED visits per month tripled from pre- to post-recession (104.9 vs. 290.6), along with an increased number of hospitalizations (77.1 vs. 95.6); African Americans and Native Americans were disproportionally impacted. In addition, psychiatric comorbidities, severe DV episodes, in-hospital mortality and charge per hospitalization escalated. The rise in DV hospitalizations and ED visits beginning in December 2007 was mainly attributable to physical abuse episodes in adults; minors had no change in DV trends. DISCUSSION: Recessions are frequent in modern economies and are repeated cyclically. Our study provides critical information on the effects of the 2007 financial crisis on DV-related healthcare service utilization in California. Given the current financial crisis associated with COVID-19, which expert predict could extend for years, the results from this study shine a spotlight on the importance of DV-related screening, prevention and response.

"I Was Grabbed by My Pussy and Its #NotOkay": A Twitter Backlash Against Donald Trump's Degrading Commentary.

The present study assessed how individuals used the #NotOkay hashtag on Twitter to respond to Donald Trump's comments about grabbing women by their genitals. We analyzed 652 tweets which included commentary about the hashtag. Three main themes emerged: (a) users' acknowledgment and condemnation of rape culture, (b) Donald Trump and the national state of sexual assault, and (c) engaging men and boys to end violence against women. Our findings emphasize that powerful political leaders can be salient symbols of rape culture, and Twitter is used as a public platform to organize and challenge problematic social discourse and call for action/change.

Alcohol Use, Mental Health Disability, and Violence Victimization in College Women: Exploring Connections.

The present study is an analysis of in-depth interviews with college women reporting a mental health disability and at least one experience of intimate partner violence (IPV) or sexual violence (SV) to elucidate how alcohol use is associated with both violence victimization and mental health symptoms. Our findings underscore salient alcohol-related themes in college women with histories of IPV/SV and mental health disability: alcohol use in their family of origin and/or with intimate partners, partying and heavy drinking as a normal college social context, abusive partners and SV perpetrators using alcohol as a mechanism for control and targeted rape, and worsening mental health symptoms after violence exposure, which prompted alcohol use to cope and was associated with vulnerability to more violence.

#MaybeHeDoesntHitYou: Social Media Underscore the Realities of Intimate Partner Violence.

BACKGROUND: Public intimate partner violence (IPV) discourse emphasizes physical violence. In May 2016, the Twitter hashtag #MaybeHeDoesntHitYou generated a public conversation about abuse beyond physical IPV. Because of the often-disconnect between IPV research and what survivors struggle to name as abuse in their daily lives, we sought to understand how IPV discourse was unfolding as a result of the #MaybeHeDoesntHitYou hashtag. MATERIALS AND METHODS: NCapture was used to collect publically available Twitter data containing the hashtag "#MaybeHeDoesntHitYou" from May 10, 2016 to May 17, 2016. Using the Duluth Power and Control Wheel (a range of tactics used by abusers to control and harm their partners) and the Women's Experience with Battering (WEB) framework (emotional and behavioral responses to being abused), we analyzed 1,229 original content tweets using qualitative content analysis. RESULTS: All dimensions of the Power and Control Wheel and five of six dimensions of the WEB framework were expressed via #MaybeHeDoesntHitYou; users did not express yearning for intimacy with their abusive partners. Users described one form of IPV not currently represented within the Power and Control Wheel-reproductive coercion (e.g., "#MaybeHeDoesntHitYou but he refuses to use condoms and forces you not to use contraception so you try to do it behind his back"). Two additional themes emerged; users challenged the gender pronoun of the hashtag, highlighting that abuse may happen with partners of all genders, and users provided social support for others (e.g., "#MaybeHeDoesntHitYou is real. Bruises and scars aren't the only measure of abuse! If this is you, help is there…"). CONCLUSIONS: Results from our study underscore the potential for social media platforms to be powerful agents for engaging public dialogue about the realities of IPV, as well as a space for seeking and providing social support about this critical women's health issue.

Service seeking experiences of college-aged sexual and intimate partner violence victims with a mental health and/or behavioral disability.

OBJECTIVE: To examine mental health service experiences following sexual violence (SV) and intimate partner violence (IPV) victimization among college women with a disability. PARTICIPANTS: College women (n = 27, ages 19 to 24) with a disability who experienced at least one SV/IPV occurrence; interviewed July/August 2016. METHODS: Qualitative study using in-depth interviews, with thematic analysis. RESULTS: Women tended to wait several months (or did not seek care at all) following SV/IPV, because they downplayed their experience (e.g., not wanting to label an experience as "rape"). Those seeking services primarily did so because of escalating mental health concerns. Among service seekers, women were satisfied when professionals validated their experiences/concerns; and were dissatisfied when faced with extended wait time for care and/or professionals unskilled with SV/IPV and mental health. However, women still sought care following negative experiences. CONCLUSIONS: Improved access to integrated care for SV/IPV and mental health, along with skilled professionals, is essential.

It's (Not) Over: Relationship Instability and Recovery Between Victims and Detained Domestic Abusers.

We used an innovative data set involving audio-recorded conversations between abusers and victims to explore the interactional patterns that occur within violent relationships, following severe violence and the abuser's detainment. Using micro-level conversational data, our analysis sequenced the hopes/desires that victims and abusers expressed around their expectations for continuing or discontinuing a connection with each other. Conversations commonly included an expressed statement to end the relationship. Although it was common for both victims and abusers to express hope of ending the relationship, victims were most likely to initiate this desire. In response, abusers used multiple strategies to regain connection, including 1) challenging the victim, 2) declaring love or a desire to continue the relationship, 3) appealing for sympathy or help from the victim, and 4) mirroring or accepting the victim's desire to end the relationship (when other strategies were unsuccessful). Abusers' responses served to cultivate additional conflict in the relationship while at the same time maintained communication and facilitated relationship recovery following threats of dissolution. These findings contribute to an increased theoretical understanding of the dynamics of domestic violence in the sensitive period involving the couple's physical separation.

Sexual Violence and Intimate Partner Violence in College Women with a Mental Health and/or Behavior Disability.

OBJECTIVES: We address questions about (1) how college women with a disability experience sexual violence (SV) and intimate partner violence (IPV) across partners, including disability-specific abuse and (2) how SV/IPV impacts psychological, behavioral, physical, and academic life domains. METHODS/DESIGN: Twenty-seven female college students (mean age, 21.2; 66.6% white; 66.6% heterosexual) were randomly sampled from university registrar records. To be eligible for the study, students had to have at least one experience of SV/IPV since age 18 and a disability (88.8% reported one or more mental health conditions; 11.1% reported other conditions, such as attention deficit and hyperactivity disorder; with the majority of women indicating their disability preceded SV/IPV victimization). Using the Centers for Disease Control and Prevention's definitions of SV/IPV as guides, clinically trained master's level interviewers conducted semistructured interviews to ascertain SV/IPV patterns across students' three most recent relationships and related life impacts. RESULTS: SV/IPV was pervasive in college women with a disability, within hookup settings and/or recurring SV/IPV with a long-term partner. For some women, SV spanned multiple abusive partners. For women in relationships marked by chronic abuse, in addition to SV, the relationship dynamic included disability-specific abuse, social isolation, threats/intimidation, and technology-related abuse. For women experiencing SV events within hookup settings, alcohol was a common facilitator, with some abusers using a disability to manipulate a sexual connection. All but one participant reported exacerbated adverse mental health consequences (e.g., depression, anxiety, post-traumatic stress disorder, suicidal ideation/attempts, stress) after victimization. These adverse mental health consequences coincided with adverse behavioral (e.g., becoming less social, avoiding usual study lounge areas on campus), physical (e.g., problems sleeping, bruising, pregnancy concerns, and sexually transmitted disease), and academic outcomes (e.g., skipping and/or dropping class, grades suffering). DISCUSSION: Our results underscore the need for continued investment in campus programs that improve response to SV/IPV, including prevention programs and support services tailored to the specific needs and vulnerabilities of women with underlying mental health conditions.

Sexist Attitudes Among Emerging Adult Women Readers of Fifty Shades Fiction.

Stereotypical sexist representations of men and women in popular culture reinforce rigid views of masculinity (e.g., males as being strong, in control, masterful, and aggressive) and femininity (e.g., women as being fragile and weak, unassertive, peaceful, irrational, and driven by emotions). The present study examined associations between the fictional series Fifty Shades-one popular culture mechanism that includes pervasive traditional gender role representations-and underlying sexist beliefs among a sample of 715 women ages 18-24 years. Analyses revealed associations between Fifty Shades readership and sexism, as measured through the Ambivalent Sexism Inventory. Namely women who reported reading Fifty Shades had higher levels of ambivalent, benevolent, and hostile sexism. Further, those who interpreted Fifty Shades as "romantic" had higher levels of ambivalent and benevolent sexism. Our findings support prior empirical studies noting associations between interacting with aspects of popular culture, such as television and video games, and individual beliefs and behaviors.

Risk Factors for Smoking in Rural Women: The Role of Gender-Based Sexual and Intimate Partner Violence.

BACKGROUND: Women living in Ohio Appalachia experience cervical cancer at disproportionately high rates. Intimate partner and sexual gender-based violence (GBV) and smoking are independent risk factors for cervical cancer and interact to heighten risk. Appalachian women smoke at higher rates than other Ohio women, but little is known about GBV exposure in the region. The purpose of this study was to establish prevalence of women's exposure to GBV in Ohio Appalachia and examine the association between GBV and smoking among women in the region. METHODS: A two-phase address-based random sampling approach was used in three purposefully selected Ohio Appalachian counties to identify women to complete an interviewer administered cross-sectional survey (n = 398). The primary exposure variable was GBV Index Score, a 4 level indices representing increasing exposure to eight abuse types. Correlation analysis and logistic regression were used to examine smoking correlations and risk. RESULTS: Almost 57% of women in the three selected Ohio Appalachian counties experienced GBV, with rate increasing to 77.5% among current smokers. The distribution of the GBV Exposure Index Score was significantly different across smoking status (p < = 0.0001), with exposure of GBV increasing when moving from never, to former, to current smokers. When controlling for depression, age, and adult socioeconomic position, GBV Exposure Index was significantly associated with current smoking behavior (OR:1.62, 95% CI [1.21-2.17]). DISCUSSION: Professionals working to reduce disparate disease burden among women in Ohio Appalachia should consider the role GBV plays in health behavior and behavioral change interventions, including smoking and smoking cessation.