The mental health and substance use treatment experiences of racially and ethnically minoritised women who have experienced sexual violence.

The mental health and substance use treatment experiences of racially and ethnically minoritised women who have experienced sexual violence is not well understood. To address this we conducted a systematic review and meta-synthesis of qualitative studies. Our search strategy included electronic searches of 18 databases and grey literature, citation tracking and reference list screening. Studies were eligible if they presented qualitative data from racially and/or ethnically minoritised women or girls, who had experienced sexual violence at any age and described their experiences of receiving treatment from statutory mental health and/or substance use services. Studies were analysed using meta-ethnography. Fourteen papers based on 12 individual studies were included. Analysis developed three main themes: (1) understanding minoritised women holistically, (2) processing the trauma and beginning the healing and (3) the need for social connectedness and empowering relationships. For minoritised women to benefit from treatment, mental health and substance use services need to challenge the dynamics of the multiple traumas minoritised women experience. Knowledge and understanding of the racial trauma minoritised women experience is limited and many are subjected to further harm from racist practices occurring in some treatment services. Offering culturally safe, trauma-informed care which promotes anti-racist practices may help improve mental health and substance use service responses to minoritised women who have experienced sexual violence.

A Longitudinal Study of Risk Factors for Sexual Victimization in Puerto Rican Youth.

OBJECTIVE: To determine whether youth, family, and neighborhood factors and minoritized status are associated with youth-reported sexual victimization from childhood through young adulthood. METHODS: We analyzed longitudinal data from 2 population-based samples of Puerto Rican youth living in the South Bronx (as a minoritized group) and Puerto Rico (as a nonminoritized group). Waves 1 to 3 were collected annually beginning in 2000 (youth age 5-13). Wave 4 was collected 2013 to 2017 (youth age 15-29). We estimated multivariable associations between youth, family, and neighborhood factors and minoritized status at Wave 1 (independent variables); and youth-reported sexual victimization at Waves 1 to 4 (dependent variables). RESULTS: None of the factors was associated with youth-reported sexual victimization at Wave 1 (N = 1911). Among youth reporting no previous history of sexual victimization at Wave 1 (n = 1823), youth in the South Bronx vs Puerto Rico were more likely to report sexual victimization at Waves 2 or 3 (odds ratio (OR) [95% confidence interval (CI)] = 3.62 [1.46-8.97]). Older youth were less likely to report sexual victimization (OR [95% CI] = 0.77 [0.65-0.91]) (all P < .01). Among youth reporting no history of sexual victimization at Waves 1 to 3 (n = 1782), youth in the South Bronx (OR [95% CI] = 2.53 [1.52-4.22]), female youth (OR [95% CI] = 2.81 [1.83-4.30]), and youth whose parents had more than a high school degree (OR [95% CI] = 2.25 [1.38-3.67]) were more likely to report sexual victimization at Wave 4 than their counterparts (all P ≤ .001). CONCLUSIONS: Future research should investigate how living as a minoritized youth may contribute to an increased risk of sexual victimization.

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.

Intimate Partner Violence, Economic Insecurity, and Health Outcomes Among American Indian and Alaska Native Men and Women: Findings From a National Sample.

Limited data are available on experiences of intimate partner violence (IPV) and sexual violence (SV) and health outcomes among American Indian and Alaska Native (AIAN) populations. This study explores the relationship between IPV and SV, food insecurity, housing insecurity, healthcare access, and self-reported physical and mental health status in a nationally representative sample of AIAN adults (N = 3,634). IPV and SV were associated with poorer physical and mental health at the bivariate level, but not in multivariate analyses. Economic inequalities are a salient predictor of health and may be compounded by demographic and geographic contexts.

Sexual violence among LGB+ South Asian Americans: Findings from a community survey.

Lesbian, gay, bisexual, and other sexual minority (LGB+) South Asian Americans represent a disproportionately underserved and often invisible community in the United States. While issues of sexual violence have been documented in the South Asian American community, little is known on its impact among LGB+ individuals. This study explores the experience of sexual violence, related attitudes, and mental health outcomes among LGB+ South Asian Americans. A community-informed online survey of 18-34-year-old South Asian Americans living near the New York State region, recruited from online social media platforms, was conducted. Study design, implementation, and evaluation occurred in partnership with an advisory board of South Asian young adult representatives; data was analyzed both descriptively and through multivariable logistic regression models. Of the 385 participants who reported their sexuality, LGB+ participants comprised 24.1% (n = 93) of the sample. LGB+ participants were more likely to have experienced rape multiple times (17.2% vs. 9.6%) in bivariate analyses, and higher odds of depression (AOR:3.47, 95%CI:1.61-8.17) in adjusted analyses. Overall, LGB+ South Asian Americans displayed a disproportionate burden of sexual violence and depression. Findings identify policy and research pathways to address sexual violence among LGB+ South Asians.

Sexual and reproductive health of adolescent Syrian refugee girls in Lebanon: a qualitative study of healthcare provider and educator perspectives.

BACKGROUND: Adolescent Syrian refugee girls in Lebanon are thought to experience a disproportionate risk of poor sexual and reproductive health, related in part to conflict and displacement. The purpose of this qualitative study was to explore healthcare provider and educator perceptions of the sexual and reproductive health determinants and care-seeking behaviors of this vulnerable population. The findings of the study will inform a health intervention that aims to reduce early marriage and improve access to sexual and reproductive health information and services. METHODS: In-depth interviews and focus group discussions were conducted with stakeholders who work with adolescent Syrian refugee girls in an under-resourced area of eastern Lebanon bordering Syria. Data analysis followed principles of Clarke and Braun's thematic analysis. RESULTS: Study participants perceived adolescent pregnancy, reproductive tract infections, and sexual- and gender-based violence as major population health needs. The study also identified a number of influencing structural and sociocultural determinants of health, including early marriage, adolescent disempowerment, and men's disengagement from care. A conceptual framework based upon the Gelberg-Andersen Behavioral Model for Vulnerable Populations was developed to relate these determinants and guide pathways for potential interventions. CONCLUSIONS: Adolescent sexual and reproductive health interventions among Syrian refugees in Lebanon should adopt a multi-pronged, community-based approach to address underlying health determinants and engage with men and parents of adolescents. Special attention should be given to provider biases in healthcare settings accessible to adolescents, as these may reflect underlying tensions between host and refugee populations and discourage adolescents from seeking care.

Studies suggest that adolescent Syrian refugee girls in Lebanon are at risk of early marriage and related poor sexual and reproductive health outcomes, yet little is known about this population's specific sexual and reproductive health needs and care-seeking practices. To help fill this gap, we conducted a qualitative study with healthcare providers and educators who provide adolescent Syrian refugee girls with sexual and reproductive health services and education. The study aimed to better understand this population's health needs and behaviors to aid in the development of a sexual and reproductive health program for Syrian refugee girls that seeks to reduce early marriage. Respondents identified adolescent pregnancy, reproductive tract infections and sexual and gender-based violence as major health issues in this population. Early marriage, disruption of education, restrictive gender roles and men's detachment from healthcare were all recognized as potential risk factors. Stigma and bias, even among the study participants themselves, were also found to be potential barriers to care. We adapted a behavioral model for healthcare-seeking practices among vulnerable populations to categorize these risks and develop recommendations for health interventions in this community. Sexual and reproductive health initiatives in this population should be multi-faceted, community-based and aimed not only at adolescents but also their spouses and parents, who hold decision-making power.

Evaluaciones psicológicas forenses de abuso sexual en menores: proceso de revelación y cronicidad del evento en la serranía peruana / Forensic psychological evaluations of child sexual abuse: process of disclosure and its chronicity in the peruvian highlands

Objetivo: Analizar la relación que existe entre las características de la víctima, del agresor y del abuso sexual en niñas, niños y adolescentes con el proceso de revelación; así como con la cronicidad del evento en la División del Instituto de Medicina Legal de la Región Junín-Perú. Materiales y métodos: Diseño transversal analítico. Se analizaron todas las evaluaciones psicológicas forenses desarrolladas de enero a diciembre del año 2017, de las cuales se seleccionaron solo aquellas que cumplían con los criterios de selección, quedando un total de 97 casos. Resultados: El 90% de las víctimas fueron de sexo femenino, el 99% de los agresores fueron de sexo masculino, 66,0% de los casos ocurrieron en un ambiente intrafamiliar y el 5% de las víctimas quedó embarazada. La mayor frecuencia de eventos recurrentes fueron al no tener a la madre viviendo en casa (RPa: 1,44; IC95%: 1,34-1,56; p<0,001), vivir fuera de la ciudad (RPa: 1,27; IC95%: 1,11-1,45; p=0,001), el revelar tardíamente el abuso (RPa: 2,94; IC95%: 1,79-4,84; p<0,001), y entre los que revelaron de manera no intencional (RPa: 1,37; IC95%: 1,06-1,78; p=0,001); en cambio, los agresores extrafamiliares fueron menos frecuentes entre los que tuvieron múltiples eventos (RPa: 0,63; IC95%: 0,44-0,91; p=0,014), ajustados por el sexo y la edad. Conclusiones: Los factores asociados al abuso sexual recurrente fueron: relación de la víctima con la madre, lugar de procedencia de la víctima, latencia de revelación, circunstancia de la revelación y tipo de vínculo de la víctima con el agresor. (AU)

Objective: To analyse the relationship between the characteristics of the victim, the aggressor and sexual abuse in children and adolescents with the disclosure process; as well as with the chronicity of the event in the Division of the Institute of Legal Medicine of the Junín region-Perú. Materials and methods: As a general method of research, the scientific method was applied, carrying out a quantitative study, with a cross-sectional design. All forensic psychological evaluations from January to December of 2017 were analysed, of which only those that fulfilled the selection criteria were selected, leaving a total of 97 cases. Results: Of all the victims, 90% were female, 99% of the aggressors were male, 66.0% of cases occurred in a family environment and 5% of victims became pregnant. The highest frequency of recurrent events was when the mother was not living at home (aPR: 1.44; 95%CI: 1.34-1.56; p <.001), living outside the city (aPR: 1, 27; 95%CI: 1.11-1.45; p=.001), late disclosure of abuse (aPR: 2.94; 95%CI: 1.79-4.84; p <.001), and among those who unintentionally revealed the event (aPR: 1.37; 95%CI: 1.06-1.78; p=.001); in contrast, extra-family offenders were less frequent among those with multiple events (aPR: 0.63, 95%CI: 0.44-0.91, p=.014), adjusted for sex and age. Conclusions: The factors associated with recurrent sexual abuse were the victim's relationship with the mother, place of birth of the victim, disclosure latency, circumstance of the disclosure and type of link between victim and aggressor. (AU)

Determinants of Sexual Violence Against Married Women: Qualitative Evidence From Ghana.

Some evidence suggests that in sub-Saharan Africa, sexual violence is commonplace among married women, yet this problem is underresearched. Using qualitative methods and applying Heise's social-ecological model, this study examined the experiences of 15 Ghanaian women suffering sexual violence in their marriages. Results from the thematic analysis indicate several determinants of sexual violence. Whereas some participants identified macro-level and exosystem factors, including poverty, others pointed to micro-level and ontogenic factors, such as husbands' substance abuse. The results corroborate the core idea of Heise's framework, namely, that structural- and individual-level factors make women vulnerable to violence. The study concludes that Ghanaian legal and policy frameworks must be enforced and strengthened to address the etiology of sexual violence and abuse.

Racial Identity, Masculinities, and Violence Exposure: Perspectives From Male Adolescents in Marginalized Neighborhoods.

PURPOSE: Male youths living in neighborhoods with concentrated disadvantage are exposed to high levels of violence, which increases the risk for violence victimization and perpetration and shapes identify formation. We explored male youths' conceptions of manhood, influences on manhood, and intersections with interpersonal violence in the context of a community-partnered sexual violence prevention study. METHODS: We conducted semistructured interviews with predominantly Black males, aged 14-19 years, participating in a gender-transformative sexual violence prevention study. We used an iterative coding process to identify developing themes around youths' definitions of manhood, influences on manhood, and intersections with racial identity and racism. RESULTS: Participants outlined visions of manhood that included many traditionally masculine attributes and also offered nuance and subversion of traditional masculinity. Participants' definitions of manhood centered on themes of responsibility while also acknowledging the importance of emotional expression. Many participants described growing into manhood as a journey toward becoming a moral agent. Participants identified three predominant influences on their conceptions and experiences of manhood: (1) family and community connections; (2) interpersonal and structural racism; and (3) racial pride. Family, particularly fathers and other father figures, emerged as invaluable in understanding manhood and navigating racial identities. CONCLUSIONS: These stories suggest that the process of entering manhood comes with unique challenges for adolescents who do so in the context of community violence and racism. Being mindful of intersections between masculinity and racial injustice can inform violence prevention programs that address the lived experiences of minority male youths in neighborhoods with concentrated disadvantage.

The impact of intimate partner violence on the trajectory of perinatal depression: a cohort study in a Chinese sample.

Abstract. AIMS: Intimate partner violence (IPV) is an important risk factor for perinatal depression (PND). But IPV's impact on the natural prognosis of PND symptoms is not well understood. We tested two hypotheses: (1) pregnant women with IPV experiences will exhibit more severe PND symptoms than women without IPV experience; (2) IPV experience will impede the recovery prognosis of PND. We also explored the contribution of IPV to PND comparing with other risk factors. METHOD: The sample is comprised of 813 pregnant women followed through perinatal period in Hunan, China. We assessed IPV experience using items from the Short Form of the Revised Conflict Tactics Scale (CTS2S), and PND symptoms via the Edinburgh Postnatal Depression Scale (EPSD). We conducted Linear Mixed-effects Model to compare the trajectories of PND symptoms between victims and non-victims and a multistage Generalised Estimating Equations Model to explore salient factors on the trajectory of PND symptoms. RESULTS: There were 90 participants (11.07%) who reported IPV experience in the past 12 months. With respect to physical, psychological and sexual violence, the prevalence was 4.55% (37/813), 9.23% (75/813) and 2.34% (19/813). Victims reported more severe PND symptoms (t = 5.30, p < 0.01) and slower decreasing slope of trajectories (t = 28.89, p < 0.01). The PND trajectory was associated with IPV experience (OR = 3.78; 95% CI 1.39-10.26), social support (OR = 0.93; 95% CI 0.88-0.97), positive coping strategies (OR = 0.85; 95% CI 0.80-0.91), negative coping strategies (OR = 1.25; 95% CI 1.14-1.37) and monthly income of $0.15-$298.36 (compared to no income, OR = 0.0075; 95% CI 0.00052-0.11). CONCLUSIONS: The findings suggest the reported prevalence of IPV is lower in Hunan than most of the previous studies during perinatal period in other provinces of China, and IPV victimisation is associated with increased severity and slowed prognosis of PND symptoms. Future studies that screen for victimisation and establish its explicit mechanism to the poorer prognosis of PND symptoms would benefit the prevention and treatment of PND.

Female Genital Mutilation/Cutting as Grounds for Asylum Requests in the US: An Analysis of More than 100 Cases.

Female Genital Mutilation or Cutting (FGM/C) is a human rights violation used to claim asylum in the US. We sought to understand the nature of these asylum requests. Analysis of 121 FGM/C-focused medical affidavits, and 132 legal case reports. Of 119 eligible affidavits analyzed, 84% were reportedly cut: 4.6% Type I, 84.6% Type II, 16.5% Type III. Average age: 9. Reported acute effects: bleeding (76.3%), infection (27.6%), shock (6.7%), broken bones (2.7%), and hospitalization (2.7%). Reported chronic issues: intercourse difficulty (81.7%), pregnancy complications (54.2%), chronic pain (42.4%), scarring (37.3%), urinary difficulty (31.8%). Psychological consequences included PTSD (72.4%), depression (65.9%), anxiety (51.1%), and lack of trust (10.1%). Co-occurring abuses included domestic violence (62.4%), forced marriage (46%), rape (33.3%), torture (33.3%), child marriage (31.3%), assault due to LGBTQ + status (2.9%). Women claiming asylum based on FGM/C report high rates of chronic health issues. Their histories suggest FGM/C co-occurs with other forms of gender-based violence.

Drought and intimate partner violence towards women in 19 countries in sub-Saharan Africa during 2011-2018: A population-based study.

BACKGROUND: Drought has many known deleterious impacts on human health, but little is known about the relationship between drought and intimate partner violence (IPV). We aimed to evaluate this relationship and to assess effect heterogeneity between population subgroups among women in 19 sub-Saharan African countries. METHODS AND FINDINGS: We used data from 19 Demographic and Health Surveys from 2011 to 2018 including 83,990 partnered women aged 15-49 years. Deviations in rainfall in the year before the survey date were measured relative to the 29 previous years using Climate Hazards Group InfraRed Precipitation with Station data, with recent drought classified as ordinal categorical variable (severe: ≤10th percentile; mild/moderate: >10th percentile to ≤30th percentile; none: >30th percentile). We considered 4 IPV-related outcomes: reporting a controlling partner (a risk factor for IPV) and experiencing emotional violence, physical violence, or sexual violence in the 12 months prior to survey. Logistic regression was used to estimate marginal risk differences (RDs). We evaluated the presence of effect heterogeneity by age group and employment status. Of the 83,990 women included in the analytic sample, 10.7% (9,019) experienced severe drought and 23.4% (19,639) experienced mild/moderate drought in the year prior to the survey, with substantial heterogeneity across countries. The mean age of respondents was 30.8 years (standard deviation 8.2). The majority of women lived in rural areas (66.3%) and were married (73.3%), while less than half (42.6%) were literate. Women living in severe drought had higher risk of reporting a controlling partner (marginal RD in percentage points = 3.0, 95% CI 1.3, 4.6; p < 0.001), experiencing physical violence (marginal RD = 0.8, 95% CI 0.1, 1.5; p = 0.019), and experiencing sexual violence (marginal RD = 1.2, 95% CI 0.4, 2.0; p = 0.001) compared with women not experiencing drought. Women living in mild/moderate drought had higher risk of reporting physical (marginal RD = 0.7, 95% CI 0.2, 1.1; p = 0.003) and sexual violence (marginal RD = 0.7, 95% CI 0.3, 1.2; p = 0.001) compared with those not living in drought. We did not find evidence for an association between drought and emotional violence. In analyses stratified by country, we found 3 settings where drought was protective for at least 1 measure of IPV: Namibia, Tanzania, and Uganda. We found evidence for effect heterogeneity (additive interaction) for the association between drought and younger age and between drought and employment status, with stronger associations between drought and IPV among adolescent girls and unemployed women. This study is limited by its lack of measured hypothesized mediating variables linking drought and IPV, prohibiting a formal mediation analysis. Additional limitations include the potential for bias due to residual confounding and potential non-differential misclassification of the outcome measures leading to an attenuation of observed associations. CONCLUSIONS: Our findings indicate that drought was associated with measures of IPV towards women, with larger positive associations among adolescent girls and unemployed women. There was heterogeneity in these associations across countries. Weather shocks may exacerbate vulnerabilities among women in sub-Saharan Africa. Future work should further evaluate potential mechanisms driving these relationships.

Correlates of African American sexual assault survivors' medical care seeking.

African American women are at higher risk for sexual assault than other racial/ethnic groups and have an overall high prevalence of lifetime sexual assault. Despite elevated risk and prevalence, African American survivors are often reluctant to use services in the aftermath of sexual assault. Yet, little research has focused exclusively on African American women's sexual assault experiences including their experiences of medical care seeking. A mail survey study was conducted in Chicago (2010-2011) to understand better African American women's sexual assault experiences in relationship to post-assault medical care seeking in a large community sample (N = 836). Multivariable regression analyses examined whether demographics, assault characteristics, trauma history, and post-assault psychosocial factors were related to medical care seeking. Results revealed unique correlates of immediate and long-term help-seeking from a variety of medical/health sources. Being of older age and lower income, perceived life threat, and delayed disclosure were related to less medical care seeking. Survivors who were assaulted by strangers, experienced interpersonal and contextual traumas, and who received tangible aid and mixed social reactions were related to medical care seeking. Implications for research and clinical practice with this population are provided.

Sexual activity, contraceptive use and sexual violence among Asian high school students in the United States.

OBJECTIVE: To compare the prevalence of sexual behaviors and experiences between Asian high school students in the U.S. and students of other race/ethnicities. STUDY DESIGN: We pooled the 2013, 2015 and 2017 rounds of the Youth Risk Behavior Survey (N = 42,854). Logistic regression was used to identify differences between racial/ethnic groups and by sex. RESULTS: Compared to their peers, a smaller proportion of Asian students reported engaging in sexual behaviors or using contraception, including prescription methods, at last sex. Asian students also reported fewer experiences of forced sexual intercourse compared to their peers. CONCLUSIONS: These findings demonstrate distinct patterns in Asian students' sexual health behaviors compared to their peers. Future research should examine determinants of these differences. IMPLICATIONS: Filling a gap in the literature, these data can inform education and health practices that support the sexual and reproductive health needs of Asian and all adolescents in the country.

Deconstructing Meta-Narratives: Utilizing Narrative Therapy to Promote Resilience following Sexual Violence among Women Survivors of Color.

Sexual violence against women is an ongoing social problem that carries serious social and health implications. Although a large body of empirical literature has documented the detrimental effects of sexual violence on women's mental health, the great majority of this work is devoid of considering the unique cultural experiences of women of color (WOC). WOC report disparate rates of sexual violence, coupled with racially biased treatment from providers and law enforcement following an assault, that make them especially vulnerable to mental health challenges. In this theoretical paper, we explain how Narrative Therapy is uniquely suitable for promoting resilience following sexual violence in WOC. Using a case vignette, we demonstrate how Narrative Therapy was used to foster voice and empower a WOC to frame their narrative into a storyline of survival and resilience.

A police-led community response to Child abuse and Youth Sexual Violence and Abuse in Indigenous communities in Far North Queensland: "Speak Up. Be strong. Be Heard."

BACKGROUND: Child abuse and Youth Sexual Violence and Abuse (YSVA) are persistent social issues across the globe. The development and implementation of effective prevention strategies are a common focus for those working at the coalface. The Cairns Child Protection Investigation Unit of the Queensland Police Service (QPS) developed and implemented the "Speak Up. Be Strong. Be Heard." (SUBSBH) initiative. This police-led multi-component child abuse prevention initiative has been implemented in 26 Aboriginal and Torres Strait Islander communities across the Far North Queensland Police District since June 2016. OBJECTIVE: The aim of this research was to evaluate the success of the SUBSBH initiative. PARTICIPANTS AND SETTING: Existing data held by QPS were examined. These data include statistics on reporting of YSVA offences, internal program documents and reports, and evaluation feedback forms completed prior to this evaluation study. Information collected via these sources pertained to 26 Indigenous communities within the Far North Queensland Police District. The above-mentioned feedback forms were completed by 307 participants, of whom approximately 90% are Indigenous. METHODS: This study adopted desktop analysis and triangulation through a range of qualitative and quantitative data to ensure robust and rigorous evaluation of the SUBSBH initiative. RESULTS: The study found that the initiative was successful in meeting basic accepted practice for child abuse and YSVA prevention programs, receiving positive participant feedback on the educational program, achieving the initiative's objective to increase reporting of YSVA, and achieving cost-efficiency in meeting outcomes. Importantly, the increase in reporting of YSVA was statistically significant. CONCLUSION: This study contributes to current understanding regarding the implementation of multi-component child abuse prevention initiatives and provides an example of a cost-efficient police-led community response to child abuse and YSVA in Indigenous communities. The findings may guide responses in other communities which grapple with this critical social issue.

Race and the Criminal Justice System Response to Sexual Assault: A Systematic Review.

Prior research has consistently documented that the vast majority of sexual assault cases do not progress through the criminal justice system. However, there is less agreement in prior work on how race influences case progression, resulting in a literature frequently described as "inconsistent." This systematic review examines all prior research that has included race as an independent variable in predicting the criminal justice system response to sexual assault (N = 34) in an effort to provide insight into seemingly disparate findings. We assess each study for the degree to which race was a focal point of interest, if and what theory was used to inform the investigation of race, how samples were drawn, and how and whose race was measured. Results illustrate that findings in prior research are not inconsistent, but rather unite to tell a nuanced story of the role of race in the criminal justice system response to sexual assault. The review demonstrates how decisions made by researchers throughout the research process can have significant impacts on reported findings, and how such findings may be used to influence policy and practice.

Combining Natural Language Processing of Electronic Medical Notes With Administrative Data to Determine Racial/Ethnic Differences in the Disclosure and Documentation of Military Sexual Trauma in Veterans.

BACKGROUND: Despite national screening efforts, military sexual trauma (MST) is underreported. Little is known of racial/ethnic differences in MST reporting in the Veterans Health Administration (VHA). OBJECTIVE: This study aimed to compare patterns of MST disclosure in VHA by race/ethnicity. RESEARCH DESIGN: Retrospective cohort study of MST disclosures in a national, random sample of Veterans who served in Afghanistan and Iraq and completed MST screens from October 2009 to 2014. We used natural language processing (NLP) to extract MST concepts from electronic medical notes in the year following Veterans' first MST screen. MEASURE(S): Any evidence of MST (positive MST screen or NLP concepts) and late MST disclosure (NLP concepts following a negative MST screen). Multivariable logistic regressions, stratified by sex, tested racial/ethnic differences in any MST evidence, and late disclosure. RESULTS: Of 6618 male and 6716 female Veterans with MST screen results, 1473 had a positive screen (68 male, 1%; 1405 female, 21%). Of those with a negative screen, 257 evidenced late MST disclosure by NLP (44 male, 39%; 213 female, 13%). Late MST disclosure was usually documented during mental health visits. There were no significant racial/ethnic differences in MST disclosure among men. Among women, blacks were less likely than whites to have any MST evidence (adjusted odds ratio=0.75). In the subsample with any MST evidence, black and Hispanic women were more likely than whites to disclose MST late (adjusted odds ratio=1.89 and 1.59, respectively). CONCLUSIONS: Combining NLP results with MST screen data facilitated the identification of under-reported sexual trauma experiences among men and racial/ethnic minority women.