Anxiety and Anticipated Pain Levels of Women With Self-Reported Penetration-Related Genito-Pelvic Pain are Elevated in Response to Pain-related Images.

BACKGROUND: Genito-pelvic pain (GPP) affects a sizable minority of women and results of existing treatments can be variable. A method of general pain treatment that has not yet been extended to penetration-related GPP is Explicit Motor Imagery (EMI), which uses pain-related images to help individuals with pain alter their responses to pain, resulting in reduced pain, less pain-related anxiety, and improved function. AIM: As a first step toward determining if EMI is a feasible method for treating penetration-related GPP, this study examined whether images that potentially signal genital pain are sufficient to induce an anxiety or anticipated pain response in women. METHODS: Participants were 113 women (62 with genital pain, 51 pain-free) recruited to complete an online study. Participants viewed randomized images of women engaging in various activities that potentially cause pain for people with penetration-related GPP (sitting, walking, running, lifting, inserting a tampon, implied penetrative sex, actual penetrative sex, implied gynecological exam, actual gynecological exam). Participants then rated each image on how much anxiety they experienced viewing the picture (viewing anxiety), and how much anxiety (anticipated anxiety) and pain (anticipated pain) they expected to experience doing the activity in the picture. OUTCOMES: Outcomes were the self-reported viewing anxiety, anticipated anxiety, and anticipated pain of women with and without self-reported penetration-related GPP in response to the pain-related images. RESULTS: Women who experienced self-reported penetration-related GPP reported significantly higher levels of viewing anxiety, anticipated anxiety, and anticipated pain in almost all categories of images, compared to women who were free of pain. The key exception was that women with and without self-reported penetration-related GPP reported similar levels of viewing anxiety when looking at images of implied and actual penetrative sex. CLINICAL TRANSLATION: These results support that pelvic and genital imagery serve as a sufficient stimulus to generate anxiety and anticipated pain in our study sample. EMI, which targets desensitization of heightened anxiety warrants further research as a potential novel treatment option. STRENGTHS & LIMITATIONS: This study was the first to assess responses to a wide array of pain-eliciting images in women with and without self-reported penetration-related GPP. A key limitation was that the pain sample was self-reported and not clinically diagnosed. CONCLUSION: Images of pain-related stimuli were sufficient to induce anxiety and anticipated pain in women with self-reported penetration-related GPP. This first step suggests that EMI may be a useful treatment option for women with penetration-related GPP. Kelly KJM, Fisher BL, Rosen NO, et al. Anxiety and Anticipated Pain Levels of Women With Self-Reported Penetration-Related Genito-Pelvic Pain are Elevated in Response to Pain-related Images. J Sex Med 2022;19:1281-1289.

Victim or Prostitute? The Classification of Commercial Sex Events Involving Minors in the National Incident-Based Reporting System.

Sex trafficking is recognized as a national problem that inflicts serious harm on its victims, yet, legislative responses to trafficking vary depending on jurisdiction. Federal legislation considers youths who engage in commercial sex acts as trafficking victims. States, however, vary in the evidence required to prove a juvenile is a victim of sex trafficking, as opposed to an offender of prostitution. Using four years of data from the National Incident-Based Reporting System, we compared details of commercial sex incidents involving youths who were identified as trafficking victims or arrested as prostitutes. Beyond legislative differences, comparisons between cases are discussed to illuminate how state law enforcement officials legally classify these events involving adolescents (i.e., as victims or prostitutes). Further, we consider the policy implications of the findings.

The Relationship Between Offline and Online Stalking Victimization: A Gender-Specific Analysis.

This study focuses on the relationship between online and offline stalking through a gendered approach. Experiencing offline stalking victimization was examined as a precursor to online stalking victimization, and experiencing cyberstalking victimization was investigated as a predictor of offline stalking victimization. These relationships also were tested separately for females and males using a sample of college students (N = 3,488) from two large universities-one in the Midwest and one in the South. The results for the full sample indicate that being stalked offline increases students' likelihood of being stalked online. However, being a victim of cyberstalking did not affect students' chances of being stalked offline. In the gender-specific analyses, findings suggest that females who are cyberstalked are less likely to be successively stalked offline, whereas males who are cyberstalked are more likely to be stalked offline. Finally, offline stalking victimization was a significant predictor of online victimization for females, but not males. These findings suggest that offline and online forms of stalking victimization are interrelated under some circumstances, and highlight the importance of the victim's gender in moderating this relationship.

Psychological Distress and Workplace Bullying Among Registered Nurses

Workplace bullying (WPB) behaviors are pervasive in some healthcare organizations leading to difficult work environments for registered nurses. We conducted an exploratory quantitative dominant (QUANT/qual) mixed method design study to determine the differences in respondents in three Midwestern states on psychological distress symptoms using WPB exposure levels and select nurse characteristics. This article discusses background information and WPB consequences. We report on the study purpose, methods, and Phase I qualitative results, including significant differences with perceived stress, anxiety, and posttraumatic symptoms reported by persons with frequent to daily WPB behavior exposure. The discussion section considers significant differences found between respondents related to age and posttraumatic stress symptoms. Narrative analysis on strategies used after bullying also illuminates the discussion. Finally, we examine implications for nurse leaders and empowerment of their direct reports to resolve minor interpersonal conflicts and move swiftly to resolve escalating bullying.

Prevalence and correlates of self-reported access to a gun among students at 24 postsecondary institutions by sex and gender identity.

OBJECTIVE: Estimate prevalence and identify correlates of self-reported access to a gun among college students. PARTICIPANTS: Degree seeking students never serving in the military at 24 postsecondary institutions participating in ACHA-NCHA III during spring of 2020 and 2021 (N = 17,293) stratified by ciswomen, cismen, and transgender/gender nonconforming. METHODS: Independent variables included measures of individual-level risk behaviors and experiences including interpersonal violence, mental health issues, and current and lifetime substance use. Individual-level demographics, indicators of institutional affiliation, and institutional characteristics used as controls. Descriptive statistics, chi-square tests of independence, and adjusted odds ratios are reported. RESULTS: About 14% (n = 2,349) of sample self-reported access. Students' involvement with multiple different risk behaviors and experiences increased the odds of access. CONCLUSIONS: Access is a prerequisite to firearm use and resulting on-campus assaults, suicides, and homicides. Additional research on access prevalence, location and type of firearm being accessed, and the correlates of access is needed.

College Faculty Experiences With Student Disclosures of Victimization.

Victimization of college students is widespread, and it is not uncommon for students to disclose these experiences to faculty. Given that how faculty respond to disclosures may have implications for students' psychosocial and academic outcomes, it is key to know more about disclosures to help faculty prepare a supportive response. This study used data from an online survey of members of two U.S.-based professional scholarly associations for criminal justice and criminology (N = 637) to look at the nature of student disclosure of victimization and which faculty are more likely to receive such disclosures. Disclosure to faculty was widespread (87% of faculty had received at least one disclosure of victimization from a student), and disclosures were mostly made in person. Over half the time (52.3%), participants thought the disclosure was prompted by an incident in class or another aspect of the course, and more than a quarter of the time (28.8%), the disclosure came from a student in a course that utilized trigger warnings. A faculty member's individual identities, such as gender or race and ethnicity, did not appear to render them more or less likely to receive student disclosures. However, faculty with victimization experiences who had links to victim services organizations, who were teaching in a Sociology department, or who had been teaching longer were more likely to have received a disclosure. Graduate student instructors were less likely to have received a disclosure, even controlling for years of teaching. This suggests widespread training of college-level instructors in how to respond to a student's disclosure of victimization may be warranted, at least for faculty teaching courses focusing on criminology and criminal justice.

The influence of anogenital injury on women's willingness to engage with the criminal justice process after rape.

Medical-legal-social science research has documented that nongenital and/or anogenital injuries play a significant role throughout the criminal justice system from victims reporting to judges determining the length of a sentence. What remains an open question is whether the documentation of anogenital injury influences women's willingness to engage in the criminal justice system. A sample of women age 21 years and older residing in an urban area were asked about willingness to report to police, file charges, and work with the courts to prosecute after rape. Questions were framed with a qualifying statement about the forensic examination being able to detect injury related to forced sexual intercourse. Results show that women had a high willingness to act if the examination could detect anogenital injury and women with and without a history of forced sexual intercourse had significant differences in their responses to these questions. Implications for health care, criminal justice system, and future research are discussed.

Adolescents' experience with workplace aggression: school health implications.

Aggression exposure is a critical health issue facing adolescents in the United States. Exposure occurs in various settings including home, school, and the community. An emerging context for aggression exposure is in the workplace. Thirty adolescent employees age 16-18 participated in a qualitative study exploring proposed responses to future workplace aggression. Semistructured interviews were used to gather participants' proposed responses to a series of hypothetical aggressive incidents in the workplace. Conventional content analysis identified patterns and themes among the participants' responses. Results indicated adolescent employees' proposed responses to workplace aggression are similar to other forms of aggression such as peer-bullying and teen dating violence. Education and training are needed within the school setting to promote appropriate responses to various forms of aggression encountered by adolescents. Implications for school health professionals' involvement in addressing responses to such aggression and further research opportunities are explored.

The Application of Bystander Intervention Scripts: Implications for Guardianship in Action.

Responding to high rates of interpersonal victimization and perpetration among adolescents, schools have implemented bystander intervention (BI) training to educate students to intervene to prevent or stop violence. These trainings function much like an application of scripts for guardianship in action. The current study builds on the overlapping and complementary bodies of BI and routine activities research by testing whether participation in BI training, namely Green Dot (GD), influences individuals' underlying ability to intervene. Using four years of survey data collected from high school students (N = 2,374-3,443), we use item response theory to model the difficulty of engaging in different BI behaviors. We then estimate multivariate ordinary least squares regression models, one for each year, to estimate the effect of GD training on students' ability to intervene. The item response theory results show that BI behaviors differ in terms of how "difficult" they are for respondents to engage in. Findings show that in each year, GD training increased students' underlying ability to intervene. Our findings suggest BI training and guardianship in action scripts should take into account this varying difficulty of intervention behaviors to best train individuals for successful intervention to prevent victimization.

Who Are the Mavens of Bystander Intervention? Implications for the Social Diffusion of Intervention Norms.

A recent randomized controlled trial reported that Green Dot (GD)-a bystander intervention training program that targets popular opinion leaders for intensive training-reduced school-level interpersonal violence perpetration and victimization. Expanding GD's targeted group members to include "mavens" of bystander intervention-those who spread bystander intervention norms to others by communicating with peers-may increase the effectiveness of such training. Self-report data collected from students at the 13 intervention high schools in Kentucky are analyzed to identify characteristics of those who engage in discussions with peers about preventing interpersonal violence. Findings show that students who engage in more frequent bystander behaviors are more likely to have such conversations with peers, but GD participants were no more likely than nonparticipants to discuss preventing interpersonal violence with peers.

Sexual assault of college students: victimization and perpetration prevalence involving cisgender men, cisgender women and gender minorities.

Objective To study eight types of sexual assault among cisgender women, cisgender men and gender minority college students, estimating the prevalence of perpetration by persons of particular gender identities. Participants and Methods: 13,685 sexual assault survivors were surveyed. For each type of sexual assault victimization experienced by cisgender women, cisgender men and gender minorities, prevalence estimates assessed the extent of perpetration by persons of each gender identity. Results: Cisgender men were the most prevalent perpetrators of all types of sexual assault against cisgender women and gender minorities. Cisgender women were the most prevalent perpetrators of five types of sexual assault against cisgender men, with cisgender women and cisgender men being similarly likely to perpetrate three types of sexual assault against cisgender men. Conclusions: Cisgender men perpetrate most sexual assaults against cisgender women and gender minority students; cisgender women and cisgender men perpetrate most sexual assaults against cisgender men students.

Examining the Effect of Perceived Responsibility on Online Bystander Intervention, Target Hardening, and Inaction.

Failure to take responsibility for intervening has been identified as a primary barrier to bystander intervention. Building on these findings, we examine how perceptions of responsibility affect responses to witnessing victimization in the online realm-a topic that has received limited attention. Using a maximum-likelihood selection model, we analyze data from the Pew American Trends Panel (N = 3709) to estimate the effects of respondents' perceptions of the role different groups should play in addressing online harassment on their likelihood to engage in intervention, target hardening, or inaction in response to witnessing online harassment, conditioned upon their likelihood of having witnessed such behavior. Findings indicate that the greater role respondents believe online users should have in addressing online harassment, the more likely they are to intervene. (b = .310). The greater role respondents believe law enforcement or elected officials should have in addressing online harassment, the less likely they are to intervene (b = -.135 and -.072, respectively). These findings have implications for future efforts to curb online harassment through users' crime prevention efforts.

Poly-Victimization Among Female College Students: Are the Risk Factors the Same as Those Who Experience One Type of Victimization?

Past research has shown that a significant proportion of college students will experience a victimization during their college tenure. This body of research provides evidence that college students' lifestyle characteristics and routine activities play a role in influencing their risk of victimization; yet, little is known about whether these same risk factors predict both single-type victimization and poly-victimization. Using a sample of more than 4,000 college women from across the United States, multivariate analyses were used to examine the risk factors for poly-victimization. Measures from both target congruence theory and lifestyles-routine activities theory were found to significantly differentiate single-type victims from poly-victims.

Adverse childhood experiences and interpersonal violence among college students: does a relationship exist?

OBJECTIVE: Previous research has found women who experience eight or more Adverse Childhood Experiences (ACEs) are 3.5 times as likely to be victims of adult IPV. This study examined the relationship between ACEs and IPV (physical violence, sexual violence, psychological violence, and stalking) among college students. PARTICIPANTS: This study was conducted among undergraduate students (N = 2,900) at two large, non-profit, public universities in the United States. METHODS: Students completed a web-based survey addressing self-reported ACEs and violence that occurred within the current academic year. Chi-square tests and logistic regression models were used to evaluate the relationship between ACEs and violence. RESULTS: College students with higher ACE scores were more likely to experience violence. Students with ACE scores of four or higher were between 1.9-4.9 times more likely to experience violence. A dose response relationship was found between ACE score and experiences of violence. CONCLUSIONS: Campus violence prevention programs may benefit from incorporating discussion of ACEs into programing.

Do Violence Acceptance and Bystander Actions Explain the Effects of Green Dot on Reducing Violence Perpetration in High Schools?

This study extends prior analyses from a 5-year multisite cluster-randomized controlled trial to examine how the previously reported effects of the Green Dot bystander-based prevention program worked to reduce violence perpetration. Bystander-based interventions are hypothesized to prevent violence by reducing violence acceptance and increasing trained participants' willingness and ability to actively engage others in violence prevention using safe and effective bystander actions to diffuse or avoid potentially violent situations. We tested this hypothesis by examining whether Green Dot worked to reduce violence through two mediators measured over time: reducing violence acceptance and increasing bystander actions. When accounting for changes in these mediators over time, the effect of this intervention on violence perpetration was hypothesized to be attenuated or explained. At baseline (spring 2010) and annually (2011-2014), all students in recruited high schools (13 intervention, 13 control) completed an anonymous survey (response rate = 83.9%). Student responses were aggregated as school-level counts for the analysis. Path analyses estimated direct and indirect effects at specific points in the implementation of the intervention. Longitudinal models were used to determine if changes in violence acceptance and bystander actions could explain or attenuate the effect of the intervention. Time-framed path model analyses indicated that the intervention worked as expected to increase bystander behaviors and reduce violence acceptance; both potential mediators were significantly associated with sexual violence perpetration. In addition, after adjusting intent-to-treat models for the hypothesized mediators, the intervention was no longer associated with violence perpetration. In conclusion, these findings indicate that this bystander intervention worked as hypothesized to reduce sexual violence perpetration by creating theory-based changes in students' violence acceptance and bystander actions.

Comparison of methods for identifying ano-genital injury after consensual intercourse.

BACKGROUND: Microtrauma occurs after consensual intercourse. Understanding the injury pattern from consensual intercourse may enlighten our understanding of the ano-genital injury after sexual assault. OBJECTIVE: The purpose of this report is to compare consensual intercourse-related ano-genital injury prevalence by using three different forensic examination techniques: 1) direct visual inspection, 2) colposcopy, and 3) toluidine-blue contrast application. METHODS: Using a descriptive, comparative design, 120 female volunteers, aged 21 years or older, were examined after consensual sexual intercourse using the above techniques. Ano-genital injuries were noted using the TEARS classification (Tears, Ecchymoses, Abrasions, Redness, and Swelling). RESULTS: Direct visualization and colposcopy yielded similar ano-genital injury findings. However, more tears and abrasions of the external genitalia were identified with toluidine-blue than with direct visual inspection or colposcopy (p < 0.05). More tears were identified on the anus with toluidine-blue as compared to direct visualization (p < 0.05), but not colposcopy. Fewer ecchymoses were identified on the internal genitalia and fewer areas of redness were identified on both the external and internal genitalia when toluidine-blue was used, as compared to either direct visualization or colposcopy (p < 0.05). CONCLUSIONS: The scientific community needs to continue to build information about ano-genital injury prevalence after consensual sexual intercourse. Understanding the ano-genital injury patterns, including frequency and prevalence, that occur with consensual sexual intercourse will help to identify the difference between injury related to consensual vs. non-consensual sexual intercourse. At this time, toluidine-blue staining may add value to the sexual assault forensic examination. It is the health care provider's role to collect all possible evidence and the courts' role to determine what evidence is admissible and to ensure a rightful conviction.

There Is Virtually No Excuse: The Frequency and Predictors of College Students' Bystander Intervention Behaviors Directed at Online Victimization.

Research shows that a large percentage of college students have experienced online victimization. However, bystander intervention behaviors directed at online contexts are absent from both the online victimization and bystander intervention research. With a sample of undergraduate college students, the current study explores the frequency and predictors of bystander intervention behaviors in response to online situations. Results show that a majority of students intervened during the past academic year when faced with the opportunity. Individuals with high self-control, who previously experienced online victimization, and/or witnessed positive peers' norms offline are more likely to intervene.

Adolescent Reproductive and Sexual Coercion: Measurement Invariance in a Population-Based Sample of Male and Female High School Students.

Purpose: Though researchers have documented that adolescents are vulnerable to coercion focused on reproductive and sexual autonomy, measures to assess this type of coercion for both adolescent females and males have not been validated in a population-based sample. Method: The present study used secondary data collected from high school students across Kentucky (n=16,137 from two independent samples in 2010 and 2014) to 1) determine if five items measuring adolescent reproductive and sexual coercion (ARSC) are appropriate for use among both females and males; and 2) estimate prevalence of identified ARSC factors by sex. Results: For both male and females, given measurement items, the results supported a two-factor model of ARSC comprised of 1) verbal relationship manipulation and 2) contraceptive interference. Measurement invariance by sex was also supported. Additional findings indicated the high prevalence of ARSC and its associated subscales. Approximately 4 in 10 females and 3 in 10 males reported experiencing ARSC in the previous year, with almost all of those reporting contraceptive interference also reporting verbal relationship manipulation. Conclusions: Findings suggest verbal relationship manipulation and contraceptive interference (together forming ARSC) may restrict the autonomous sexual and reproductive decision-making of both female and male adolescents.

Close is dead: determinants of firearm injury lethality in women.

BACKGROUND: Accurate data regarding intimate partner violence is difficult to obtain, particularly when examining only homicides or trauma registries. This study characterizes firearm violence against women by examining data from both the county coroner and an urban level I trauma center. METHODS: The Trauma Registry and Coroners database were reviewed for female victims of firearm assault from 1998 to 2006. Data collected included age, race, location of assault (home, public, unknown), mortality, and injuries. Assailants were categorized as intimate partners (IP), acquaintances, strangers, or undetermined. Adjusted odds ratios for effects of assailant and location were calculated using logistic regression analysis, with statistical significance at alpha = 0.05. RESULTS: Of 115 victims identified, 51 (44%) were fatally injured. Forty-two (37%) of assailants were IP. Fatalities occurred in 71% of IP, 50% of acquaintance, and 20% of stranger assaults. Firearm assault by IP was 10 times more lethal than injury by stranger (p < 0.0005). Assaults at home occurred 54% of the time and had 60% mortality. Assault at home was 3.8 times more lethal than assault in public (p < 0.002). Seventy-nine percent of IP assaults, 63% of acquaintance assaults, and 29% of stranger assaults occurred in the home. In 99 victims with documented injuries, head injuries were found in 68% of IP assaults, compared with 33% and 16% of acquaintance and stranger assaults. CONCLUSION: IP firearm assaults against women may be underrepresented in current databases. These assaults are highly lethal, frequently occur at home, and often involve head injury. These observations may lend to strategies for trauma prevention.

College women's experiences with physically forced, alcohol- or other drug-enabled, and drug-facilitated sexual assault before and since entering college.

OBJECTIVE: Research has shown associations between college women's alcohol and/or drug consumption and the risk of sexual assault, but few studies have measured the various means by which sexual assault is achieved. PARTICIPANTS: The authors' Campus Sexual Assault Study obtained self-report data from a random sample of undergraduate women (N = 5,446). METHODS: The authors collected data on sexual assault victimization by using a cross-sectional, Web-based survey, and they conducted analyses assessing the role of substance use. The authors also compared victimizations before and during college, and across years of study. RESULTS: Findings indicate that almost 20% of undergraduate women experienced some type of completed sexual assault since entering college. Most sexual assaults occurred after women voluntarily consumed alcohol, whereas few occurred after women had been given a drug without their knowledge or consent. CONCLUSIONS: The authors discuss implications for campus sexual assault prevention programs, including the need for integrated substance use and sexual victimization prevention programming.