The effects of skin pigmentation on the detection of genital injury from sexual assault

Rossman, Linda; Solis, Stephanie; Rechtin, Crosby; Bush, C.; Wynn, Barbara N.; Jones, J. Stephen

doi:10.1016/j.ajem.2018.09.019

Cited by 6 publications

(3 citation statements)

References 5 publications

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“…For example, forensic examination techniques and technology bias are potential sources for underrecognized detection and reporting of SA injuries among survivors with dark skin. 11 Stigma and shame associated with sexual violence also contribute to underreporting of SA, especially for boys (as suggested by Wong et al 3 ), although reporting trends among adult men may be rising (as documented by Vogt et al 4 ). In addition, despite well-documented knowledge that sexual and gender minorities experience some of the highest rates of sexual violence, 12 neither study included analyses of the ED experiences among these populations.…”

Section: Openmentioning

confidence: 99%

“…These vulnerabilities should be considered in the context of other marginalization, including sexual and gender identity, ability, and systemic racism. For example, forensic examination techniques and technology bias are potential sources for underrecognized detection and reporting of SA injuries among survivors with dark skin . Stigma and shame associated with sexual violence also contribute to underreporting of SA, especially for boys (as suggested by Wong et al), although reporting trends among adult men may be rising (as documented by Vogt et al).…”

mentioning

confidence: 99%

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Sexual Violence—Another Public Health Emergency

Alexander

Miller

2022

JAMA Netw Open

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Sexual violence (encompassing sexual assault [SA], child sexual abuse [CSA], and rape) remains a major public health concern. An estimated 1 in 3 women globally experience physical or sexual intimate partner violence or nonpartner sexual violence during their lifetime. 1 In the US, the Centers for Disease Control and Prevention estimates that 1 in 4 women and 1 in 26 men have experienced a completed or attempted rape in their lifetime. 2 Two articles in JAMA Network Open report on the incidence of CSA and adult SA cases reported to emergency departments (EDs) in Hong Kong and the US, respectively. 3,4 Wong et al 3 report on incident rates of CSA among youth presenting to EDs in Hong Kong before and during the COVID-19 pandemic. By using medical record data from EDs across Hong Kong, they found that the number of ED visits to report CSA decreased more than 50% during the pandemic.

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Section: Openmentioning

confidence: 99%

mentioning

confidence: 99%

Sexual Violence—Another Public Health Emergency

Alexander

Miller

2022

JAMA Netw Open

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“…Studies exploring disparities in the specific context of EDs are also scarce. Disparities in evidence collection, including lapses documenting anogenital injury on darker skin tones, suggest that providers are particularly underequipped to care for non-white SA patients (Bradshaw, 2021; Rossman et al, 2019; Sommers et al, 2008). Beyond this, research providing a nationwide perspective on the attitudes and beliefs of ED staff towards SA patients has only explored the attitudes of nursing staff specifically (Nielson et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Impact of Sexual Assault Survivor Identity on Patient Care in the Emergency Department

Chalmers

Parameswaran

Dussault

et al. 2022

J Interpers Violence

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Interactions between emergency department (ED) staff and sexual assault (SA) survivors can be a source of retraumatization for survivors, increasing their risk of posttraumatic stress and decreasing utilization of longitudinal medical care. Little is known about nationwide trends in ED staff attitudes and behaviors toward survivors, including the impact of survivor identity. We conducted a survey to determine if survivor identity influenced ED staff behaviors. A nationwide survey of SA patient advocates was conducted between June and August 2021. Advocates are volunteers or staff dispatched from rape crisis centers to support survivors during ED care. Advocates participated in an online survey to determine the frequency of observing six potentially retraumatizing provider attitudes and behaviors. Adaptive questioning was used to explore the impact of survivor identity on each attitude or behavior and which identity groups were more likely to be affected. Three hundred fifteen advocates responded to the survey. Less than 10% indicated that ED staff often or always convey disbelief or blame to survivors. Almost 75% of advocates indicated that they often or always observe ED staff showing empathy to survivors. Disparities were found in provider attitudes. Over 75% of advocates observed that survivors’ mental health status or substance use impacted conveyed belief from providers. Patients who were intoxicated when assaulted, had psychiatric disorders, were Black, Hispanic/LatinX, or indigenous, or were not cis-females were more likely to experience disbelief. Patients who were white and/or cis-gender females were more likely to be pressured by ED staff to complete the forensic exam and/or report to the police. Our study documents disparities in ED staff behavior towards SA survivors according to survivor identity. Given that post-assault ED interactions are critical turning points in survivors’ future medical processes, disparities in ED care may be linked to larger disparities in healing from trauma.

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