Association of Contact Sexual Violence Victimization and Health in the U.S.

INTRODUCTION: Sexual violence victimization is related to negative impacts, including chronic health conditions. Less is known about possible confounders of this relationship. This study examines the association between lifetime experience of contact sexual violence (CSV) and health conditions by sex, controlling for demographics and other victimization. METHODS: Data are from the 2016/2017 National Intimate Partner and Sexual Violence Survey, a nationally representative study of English- or Spanish-speaking adults. Ten health conditions (e.g., HIV/AIDS) and four activity limitations (e.g., difficulty dressing) were examined related to CSV victimization. Logistic regression models examined the association between CSV victimization and health controlling for demographics and other victimization experiences. Analyses were conducted in 2022 to 2023. RESULTS: For women and men, many health conditions and activity limitations were significantly associated with CSV after controlling for demographics. Accounting for other victimization, female CSV victims had higher odds of experiencing difficulty sleeping (Adjusted Odds Ratio [AOR]=1.3); difficulty concentrating, remembering, or making decisions (AOR=1.7); and difficulty doing errands alone (AOR=1.4) than nonvictims. Male victims had higher odds than nonvictims of having HIV/AIDS (AOR=5.2); frequent headaches (AOR=1.5); chronic pain (AOR=1.5); difficulty sleeping (AOR=1.4); serious difficulty hearing (AOR=1.3); and difficulty concentrating, remembering, or making decisions (AOR=1.5). CONCLUSIONS: CSV had a negative impact on health, although other types of victimization appear to also have an impact, especially for women. Demographic characteristics also aid the understanding of the relationship between CSV and health. Efforts to prevent CSV and other forms of violence can be coupled with healthcare- and population-level approaches to improve long-term health.

Association Between Lifetime Sexual Violence and Recent Traumatic Brain Injury Among Adults: 2017 Connecticut Behavioral Risk Factor Surveillance System.

Sexual violence (SV) is a critical public health problem that is associated with numerous negative health consequences, including immediate- and long-term physical and mental health conditions and health-risk behaviors. Some of these health-risk behaviors (e.g., substance use, unsafe driving practices, poor mental health, lower impulse control, and abnormal brain circuitry) might increase the risk for sustaining a traumatic brain injury (TBI). A TBI causes neurological or neuropsychological changes and may also lead to various symptoms that affect a person's cognition, mobility, behavior, and mental health. Determining if those who have experienced SV are at increased risk of sustaining a TBI in their lifetime is critical given the high prevalence and health impacts of SV, the potential vulnerability to TBI after SV, and the known detrimental effects of TBI. This exploratory study examined data from the 2017 Connecticut behavioral risk factor surveillance system and found that lifetime SV victimization (controlling for age and sex) was associated with increased odds of reporting a recent TBI in the past 12 months (adjusted odds ratio [AOR] = 2.1; 95% confidence interval [CI] [1.03, 4.21]). Further research is needed to better understand how SV history is related to the risk of sustaining a TBI. Healthcare professionals can support patients who experience SV by providing resources to help reduce associated physical and mental health conditions and health-risk behaviors.

Rape and Sexual Coercion Related Pregnancy in the United States.

INTRODUCTION: Sexual violence is a major public health problem in the U.S. that is associated with numerous health impacts, including pregnancy. U.S. population-based estimates (2010-2012) found that three million women experienced a rape-related pregnancy during their lifetimes. The current study presents more recent estimates of rape and sexual coercion-related pregnancy and examines prevalence by demographic characteristics. METHODS: Data years 2016/2017 were pooled from the National Intimate Partner and Sexual Violence Survey, a random-digit-dial telephone survey of U.S. non-institutionalized adults 18 years and older. The analysis, conducted in 2023, examined lifetime experience of rape-related pregnancy, sexual coercion-related pregnancy, or both among U.S. women. Authors calculated prevalence estimates with 95% CIs and conducted pairwise chi-square tests (p-value<0.05) to describe experiences by current age, race/ethnicity, and region of residence among U.S. women overall and among victims. RESULTS: One in 20 women in the U.S., or over 5.9 million women, experienced a pregnancy from either rape, sexual coercion, or both during their lifetimes. Non-Hispanic Multiracial women experienced a higher prevalence of all three outcomes compared with non-Hispanic White, non-Hispanic Black, and Hispanic women. Among victims who experienced pregnancy from rape, 28% experienced a sexually transmitted disease, 66% were injured, and over 80% were fearful or concerned for their safety. CONCLUSIONS: Pregnancy as a consequence of rape or sexual coercion is experienced by an estimated six million U.S. women. Prevention efforts may include healthcare screenings to identify violence exposure and use of evidence-based prevention approaches to reduce sexual violence.

Violent Victimization During Childhood in the United States: Associations With Revictimization and Health.

Childhood violence victimization is a serious adverse childhood experience with lasting health impacts. This study examined the prevalence and characteristics of five forms of childhood violence victimization and their association with revictimization and negative health conditions among adults. Data are from the 2010-2012 National Intimate Partner and Sexual Violence Survey. Age at first victimization and perpetrator sex were assessed; adjusted odds ratios assessed associations with revictimization and health. Ages 14-17 were the most common age at first victimization for most violence types; almost half of male (46.7%) and a quarter of female (27.0%) rape victims reported first victimization before age 10. Most victimization was associated with revictimization and negative health, controlling for adult victimization. Primary prevention of childhood violence may reduce later health risks.

Intimate Partner Violence and Health Conditions Among U.S. Adults-National Intimate Partner Violence Survey, 2010-2012.

INTRODUCTION: Few studies of intimate partner violence and health outcomes include multiple forms of intimate partner victimization, so this paper sought to examine health associations with intimate partner violence (IPV), including sexual, physical, stalking, and psychological forms, as well as polyvictimization. METHODS: Data are from the 2010-2012 National Intimate Partner and Sexual Violence Survey, an on-going national random-digit-dial telephone survey of U.S. adults. There were 41,174 respondents. Logistic regression was used to compute prevalence ratios for any IPV, adjusted for demographics and non-IPV victimization. For individual forms of IPV, prevalence ratios were further adjusted for other forms of IPV. Tests for linear trend in poly-victimization were performed. RESULTS: Any IPV was associated with all health conditions for both sexes with a few exceptions for males. Female penetrative sexual victimization and male stalking victimization were associated with the most health conditions. For each health condition, a significant linear trend indicated that as the number of forms of IPV experienced increased, prevalence of each health condition increased, with a few exceptions for males. CONCLUSIONS: It is important for service providers to screen for multiple forms of IPV, including psychological aggression, because individual forms or polyvictimization may have unique and cumulative health effects.

Sports Participation, Social Networks, and Sexual Violence Perpetration.

Adolescent sexual violence (SV), which includes non-contact verbal sexual harassment (SH) and forced sexual contact (FSC), is a significant public health problem with long-term impacts on health and well-being. Understanding how sports participation is linked to SV can inform prevention efforts; however, the current literature is unclear about the nature of this association. Using data from 20 high schools, we investigate whether athletes in certain sports are at higher risk of SH and FSC perpetration than either other athletes or sports non-participants, and whether the risk is moderated by gender, dismissiveness of SV, or substance use intentions. We also utilize social network data to explore the role of relationships with peers and trusted adults to attenuate SH and FSC perpetration. Second, we incorporate characteristics of friends to further examine the role and composition of peer groups in the association between sports participation and perpetration of SH and FSC. Findings revealed a bivariate association between sport contact level and SH perpetration, but not FSC, and the association disappeared after adjusting for other covariates. Most prominently, dismissiveness of SV, intentions to use substances, and prior perpetration had the strongest association with perpetration regardless of sport contact level. Results also provided some support for the influence of peers and trusted adults in the sports context. Notably, the percentage of friends who perpetrated FSC and the percentage of friends who play a low-contact sport were positively associated with FSC perpetration, and the percentage of friends who play a high-contact sport was positively associated with SH perpetration. The paper concludes with a discussion of the sports context as an important venue for comprehensive prevention efforts, including a focus on changing norms around adolescent SV and substance use.

Hostile home environment predicting early adolescent sexual harassment perpetration and potential school-related moderators.

Using family systems theory, this longitudinal study of middle school youth examined the effects of abuse, family conflict, and sibling aggression on sexual harassment perpetration (N = 1563; Mage 11.2, 51% boys; 39% Hispanic, 29% Black, and 19% White). Boys reported more sexual harassment than girls; perpetration increased for both. The association between a hostile home environment and sexual harassment perpetration was moderated by school experiences. School belonging buffered effects of hostile home environment on baseline sexual harassment perpetration for boys who experienced abuse and White adolescents with high sibling aggression. Academic grades moderated change in perpetration over time, but effects differed by sex and race. It is important to understand how early violence exposures relate to sexual violence perpetration during early adolescence.

Violence perpetration prevalence among Colorado (United States) high school students across gender, racial/ethnic, and sexual identities.

Adolescent violence, including sexual violence, homophobic name-calling, and teen dating violence, are public health problems that cause harm to many adolescents in the United States. Although research on the perpetration of these forms of adolescent violence has increased in recent years, little is known about perpetration rates across gender, race/ethnicity, and sexual orientation. To address this gap, the current study descriptively examined perpetration rates between and across different identities, including self-identified race/ethnicity, sexual identity, and gender identity. In Fall 2017, 9th - 11th grade students (N = 4782) at 20 high schools in Colorado (United States) completed a survey that assessed demographics (e.g., race/ethnicity, sexual identity, and gender identity) and various forms of violence perpetration. Compared to female adolescents, male adolescents reported significantly higher perpetration rates for: any sexual violence (27% vs. 17%); sexual harassment (26% vs. 15%); unwanted sexual contact (8% vs. 4%); and homophobic name-calling (61% vs. 38%). Differences in perpetration rates were also observed among various racial/ethnic, sexual, and gender minority students compared to non-minority students. This emphasizes a need for more research on how minority stress that results from the dynamics of intersecting identities and societal systems of power-including racism, sexism, homophobia, and transphobia-contributes to violence perpetration. Evidence-based violence prevention approaches, particularly strategies targeted at changing social norms about violence, gender, and sexuality, need to be tailored and evaluated for students with diverse cultural and social identities to ensure safe school climates for all students.

A Latent Class Approach to Understanding Associations between Sports Participation, Substance Use, Dismissive Attitudes, and Sexual Violence Perpetration among High School Athletes.

Sexual violence (SV) among adolescents continues to be a major public health concern with numerous consequences. Research, predominantly with male collegiate samples, has suggested an association between sports participation and SV perpetration, and has included other important risk factors such as substance use and attitudes. However, more research is needed in this area among adolescents. The current study uses latent class analysis (LCA) to examine data- driven classes of high school student athletes (N = 665) engaged in three risk factor areas for SV: sport contact level, likelihood of substance use, and attitudes dismissive of SV. Once classes were enumerated and fit separately for male and female samples, pairwise comparisons were conducted on scores on two forms of SV (perpetration of sexual harassment and unwanted sexual contact) as a function of class membership. A 5-class solution was retained for both males and females. In the female sample, regarding SV-harassment, those most likely to perpetrate sexual harassment were those characterized by high likelihood of use of cigarettes, marijuana, alcohol, vape products, and those who played any type of sport. Too few females endorsed perpetration of unwanted sexual contact for pairwise comparisons to be conducted. For males, the classes most likely to perpetrate both forms of SV were those who were likely to endorse high likelihood to use of cigarettes, marijuana, alcohol, vape products, endorse attitudes dismissive of SV, and play any type of sport but especially high contact sports. These findings implicate high school athletic spaces as important venues for sexual violence prevention efforts.

Sexual Violence Victimization of U.S. Males: Negative Health Conditions Associated with Rape and Being Made to Penetrate.

Sexual violence is a significant public health problem with long-term health implications. Previous investigations of male victimization have often relied on nongeneralizable samples to examine the health consequences of rape. Furthermore, made to penetrate (MTP) victimization has received very little attention as a specific form of sexual violence. Using data from the 2010 to 2012 National Intimate Partner and Sexual Violence Survey, we examined negative impacts (e.g., injury) and health conditions associated with experiences of rape and MTP among male victims in the United States. Results indicate that approximately 1 in 4 victims of rape-only and 1 in 12 victims of MTP-only reported physical injuries. An estimated 62.7% of rape-only victims and 59.8% of MTP-only victims reported at least one impact due to the perpetrator's violence. Rape victims were significantly more likely than non-rape victims to report 2 of 11 health conditions measured, while MTP victims had greater odds of reporting 6 of 11 health conditions measured compared to non-MTP victims. This article fills gaps in understanding the impacts of rape and MTP on male victims, and it is the only study to do so using a large, nationally representative sample. Sexual violence is linked to serious health effects but is also preventable. Screening for violence victimization and preventing male sexual violence before it happens are both important to reduce the risk for immediate and chronic health impacts.

Effective Empowerment-Based Training Is One Approach Identified in CDC's STOP-SV Technical Package as Part of Comprehensive, Multi-Sector Prevention of Sexual Violence: A Response to Ullman(2020).

In this response to Sarah Ullman's 2020 Journal of Aggression, Maltreatment, and Trauma article, Rape Resistance: A Critical Piece of all Women's Empowerment and Holistic Rape Prevention, the author highlights the importance of a holistic and comprehensive strategy for sexual violence prevention that involves many approaches across the social ecological model, as outlined in the Centers for Disease Control and Prevention's STOP SV technical package, including effective empowerment-based training approaches. She describes that more work is needed to evaluate and identify evidence-based approaches, including those that address prevention within marginalized groups and those grassroots approaches that are already being implemented but have not been evaluated. She ends by stressing that the field has much to gain from this kind of collective, multi-sector effort.

The Role of Middle School Sports Involvement in Understanding High School Sexual Violence Perpetration.

A number of studies have examined the association between male involvement in sports and sexual violence (SV) perpetration, especially among college-age males. Less is known about the association between sports involvement and SV perpetration for adolescent males and females. To address this gap, the current study examined sports involvement in middle school (no sports, no/low contact, and high contact) among 1,561 students, who were then followed into high school and asked about the frequency of SV perpetration. Results from logistic regression models indicated that, even after controlling for mother's education, race/ethnicity, SV perpetration in middle school, and traditional beliefs about masculinity and substance use, middle school sports participation was significantly associated with risk of SV perpetration in high school. Compared with youth who reported no sports involvement in middle school, youth categorized as no/low contact sports involvement had greater odds of SV perpetration in high school. Sex differences emerged, revealing that no/low contact sports involvement was associated with SV perpetration for females and high contact sports involvement was associated with SV perpetration for males, compared with no sports involvement. These findings suggest potential opportunities to intervene in middle school to improve coaching practices, enhance respectful relationships, and modify athletes' norms, attitudes, and behaviors to reduce risk for SV perpetration in high school.

Sexual Violence Prevalence and Related Pregnancy Among Girls and Young Women: A Multicountry Analysis.

This study aims to quantify the prevalence of forced sex, pressured sex, and related pregnancy among adolescent girls and young women in five low- and middle-income countries. Nationally representative, cross-sectional household surveys were conducted in Haiti, Malawi, Nigeria, Zambia, and Uganda among girls and young women aged 13 to 24 years. A stratified three-stage cluster sample design was used. Respondents were interviewed to assess prevalence of sexual violence, pregnancy related to the first or most recent experience of forced or pressured sex, relationship to perpetrator, mean age at sexual debut, mean age at pregnancy related to forced or pressured sex, and prevalence of forced/coerced sexual debut. Frequencies, weighted percentages, and weighted means are presented. The lifetime prevalence of forced or pressured sex ranged from 10.4% to 18.0%. Among these adolescent girls and young women, the percentage who experienced pregnancy related to their first or most recent experience of forced or pressured sex ranged from 13.2% to 36.6%. In three countries, the most common perpetrator associated with the first pregnancy related to forced or pressured sex was a current or previous intimate partner. Mean age at pregnancy related to forced or pressured sex was similar to mean age at sexual debut in all countries. Preventing sexual violence against girls and young women will prevent a significant proportion of adverse effects on health, including unintended pregnancy. Implementation of strategies to prevent and respond to sexual violence against adolescent girls and young women is urgently needed.

Intimate Partner and Sexual Violence Prevention Among Youth: A Community Guide Systematic Review.

INTRODUCTION: Intimate partner violence and sexual violence are widespread and often occur early in life. This systematic review examines the effectiveness of interventions for primary prevention of intimate partner violence and sexual violence among youth. METHODS: Studies were identified from 2 previous systematic reviews and an updated search (January 2012-June 2016). Included studies were implemented among youth, conducted in high-income countries, and aimed to prevent or reduce the perpetration of intimate partner violence or sexual violence. In 2016-2017, Guide to Community Preventive Services (Community Guide) methods were used to assess effectiveness as determined by perpetration, victimization, or bystander action. When heterogeneity of outcomes prevented usual Community Guide methods, the team systematically applied criteria for favorability (statistically significant at p<0.05 or approaching significance at p<0.10) and consistency (75% of results in the same direction). RESULTS: A total of 28 studies (32 arms) met inclusion and quality of execution criteria. Interventions used combinations of teaching healthy relationship skills, promoting social norms to protect against violence, or creating protective environments. Overall, 18 of 24 study arms reported favorable results on the basis of the direction of effect for decreasing perpetration; however, favorability for bystander action diminished with longer follow-up. Interventions did not demonstrate consistent results for decreasing victimization. A bridge search conducted during Fall 2020 confirmed these results. DISCUSSION: Interventions for the primary prevention of intimate partner violence and sexual violence are effective in reducing perpetration. Increasing bystander action may require additional follow-up as effectiveness diminishes over time. Findings may inform researchers, school personnel, public health, and other decision makers about effective strategies to prevent intimate partner violence and sexual violence among youth.

Characteristics and Impacts of Sexual Violence and Stalking Victimization by the Same Perpetrator Using a Nationally Representative Sample.

Authors examine prevalence of sexual violence and stalking victimization by the same perpetrator, reporting perpetrator types, intimate partner context and impacts for this combination of victimization. Data are from the 2010-2012 National Intimate Partner and Sexual Violence Survey, a nationally representative adult telephone survey. Analyses examined the characteristics of the victimization, presence of other intimate partner violence by the same perpetrator, and victim impacts (e.g., injury). An estimated 8.1% (9.8 million) of women and 1.6% (1.9 million) of men in the United States were stalked and sexually victimized by the same perpetrator, most often an intimate partner. Over 90% of female and male victims experienced sexual violence, stalking, psychological aggression, and physical violence by the same intimate partner perpetrator. Impacts of both intimate partner and non-intimate partner perpetrated victimization were most commonly fearfulness, concern for safety, and posttraumatic stress disorder symptoms. Sexual violence combined with stalking is common in the context of intimate partner violence. Early prevention efforts (i.e., in youth) addressing the context of intimate partner violence may be helpful in reducing these forms of violence and their impacts.

Victim and perpetrator characteristics in alcohol/drug-involved sexual violence victimization in the U.S.

The authors examine the prevalence and characteristics of sexual violence victimization - rape and being made to penetrate [MTP] (men only) - involving substances (alcohol or other drugs). Although it has been well-documented that perpetrators commit sexual violence against individuals who are using alcohol or drugs, more research is needed to describe the problem at a national level. Data are from the 2010-2012 National Intimate Partner and Sexual Violence Survey, a nationally representative random-digit-dial telephone survey of English- and Spanish-speaking adults in the United States (n = 41,174). Findings reveal that among victims of physically forced rape, 26.2 % of female and 30.0 % of male victims reported substance use; 44.5 % of male MTP victims reported substance use. The majority of forced rape and MTP victims reported the perpetrator was using alcohol or drugs. Among victims of alcohol/drug-facilitated rape, 29.7 % of female and 32.4 % of male victims reported involuntary use of substances, mostly drugs; 84.0 % of female and 82.6 % of male victims reported voluntary use. Among male victims of alcohol/drug-facilitated MTP, 14.6 % reported involuntary and 85.4 % reported voluntary use of substances. Female and male victims reported that the majority of intimate partner, acquaintance, and stranger perpetrators were using substances during the victimization. These findings suggest the importance of prevention efforts at the individual and community levels to reduce substance-involved sexual violence perpetration and risk reduction programs to reduce the likelihood of voluntary substance-facilitated sexual violence victimization.

Sexual violence in sport: American Medical Society for Sports Medicine Position Statement.

The American Medical Society for Sports Medicine (AMSSM) convened a group of experts to develop a Position Statement addressing the problem of sexual violence in sport. The AMSSM Sexual Violence in Sport Task Force held a series of meetings over 7 months, beginning in July 2019. Following a literature review, the Task Force used an iterative process and expert consensus to finalise the Position Statement. The objective of this Position Statement is to raise awareness of this critical issue among sports medicine physicians and to declare a commitment to engage in collaborative, multidisciplinary solutions to reduce sexual violence in sport.

Chronic Diseases, Health Conditions, and Other Impacts Associated With Rape Victimization of U.S. Women.

Sexual violence (SV) is an urgent public health issue that is common and has lifelong effects on health. Previous scholarship has documented the association of SV victimization with numerous health conditions and impacts, but much of this past work has focused on negative health outcomes associated with child sexual abuse using non-nationally representative samples. This article used a nationally representative female sample to examine health conditions associated with any lifetime experience of rape. We also examined injury and health outcomes (e.g., fear, injury) resulting from any violence by a perpetrator of rape. About two in five rape victims (39.1%) reported injury (e.g., bruises, vaginal tears), and 12.3% reported a sexually transmitted disease as a result of the rape victimization. Approximately 71.3% of rape victims (an estimated 16.4 million women) experienced some form of impact as a result of violence by a rape perpetrator. Among U.S. women, the adjusted odds of experiencing asthma, irritable bowel syndrome, frequent headaches, chronic pain, difficulty sleeping, activity limitations, poor physical or mental health, and use of special equipment (e.g., wheelchair) were significantly higher for lifetime rape victims compared with non-victims. This article fills gaps in our understanding of health impacts associated with rape of women and is the only nationally representative source of this information to our knowledge. Primary prevention efforts in youth that seek to prevent the first occurrence of rape and other forms of SV may be most effective for reducing the long-term health effects of this violence.

Prevalence of Intimate Partner Reproductive Coercion in the United States: Racial and Ethnic Differences.

Reproductive coercion (RC) is a specific type of intimate partner violence (IPV). Although clinical studies have highlighted women's experiences of RC, we know little about its national prevalence and differences in prevalence by sex category and race/ethnicity. Data are from the National Intimate Partner and Sexual Violence Survey (NISVS), years 2010 to 2012. NISVS is an ongoing, nationally representative random-digit-dial telephone survey of the noninstitutionalized English- or Spanish-speaking U.S. adult population. This article reports the national lifetime and 12-month prevalence of two RC victimization measures, and proportions among IPV victims. T tests were used to examine differences in estimates across racial/ethnic groups. In the United States, 9.7% of men and 8.4% of women experienced any RC by an intimate partner during their lifetime. Men reported more commonly than women that a partner tried to get pregnant when the man did not want her to; women reported higher prevalence of partner condom refusal. Examination by race/ethnicity revealed that non-Hispanic (NH) Black women and men had significantly higher lifetime prevalence of both RC types than all other groups; in the last 12 months, NH Blacks had significantly higher prevalence across the board than NH Whites. Hispanics had significantly higher lifetime and 12-month prevalence of any RC and partner condom refusal than NH Whites. RC is at the intersection of two public health concerns-IPV and reproductive health. Documenting its prevalence and differences by sex and race/ethnicity may inform prevention efforts to reduce occurrence and negative health outcomes among specific populations.

Association Among Television and Computer/Video Game Use, Victimization, and Suicide Risk Among U.S. High School Students.

With the increasing popularity of mobile Internet devices, the exposure of adolescents to media has significantly increased. There is limited information about associations between the types and frequency of media use and experiences of violence victimization and suicide risk. The current study sought to examine the association of bullying and teen dating violence (TDV) victimization, suicide risk with different types of media use (i.e., television and computer/video game use), and number of total media use hours per school day. Data from the nationally representative 2015 Youth Risk Behavior Survey (n = 15,624) were used to examine the association between media use and violence victimization and suicide risk. Logistic regression models generated prevalence ratios adjusted for demographic characteristics and substance use behaviors to identify significant associations between media use and victimization and suicide risk, stratified by gender. Media use was associated with TDV victimization for male students only, while media use was related to experiences of bullying and suicide risk for both male and female students. In addition, limited (2 or fewer hours) and excessive (5 or more hours) media use emerged as significant correlates of suicide risk and bullying victimization, with limited media use associated with decreased risk and excessive media use with increased risk. Comprehensive, cross-cutting efforts to prevent different forms of victimization should take into account media use and its potential association with adolescent victimization and suicide risk. The current study results suggest limiting adolescent media use, as part of comprehensive prevention programming, might relate to reductions in risk for victimization and suicide.