Challenges in conducting research on sexual violence and HIV and approaches to overcome them

Studies have implicated sexual violence as a strong correlate of HIV acquisition in women. Characterizing how such violence affects the female immune system may provide insight into the biological mechanisms of HIV transmission and ultimately improve global HIV prevention strategies. Little research has been carried out in this domain, and the obstacles to investigation can be daunting. Here, we describe methodological challenges encountered and solutions explored while implementing a study of dysregulation of immune biomarkers potentially indicative of increased HIV susceptibility in women following sexual assault. Challenges included accessing sexual assault survivors and defining sexual assault, promoting study participant well‐being during research engagement, reducing selection and information bias, collecting and processing biological samples, and adjusting for confounders such as reproductive tract infections and emotional and physical abuse. We found that many survivors of sexual assault welcomed the attention from study staff and felt empowered by the opportunity to help other women at risk for violence. Well‐trained research staff and well‐articulated community and medical partnerships were key methods to overcoming challenges while promoting the safety and welfare of vulnerable study participants.     

Scope and correlates of high school youths' exposure to dating and sexual violence prevention initiatives

The researchers examined the extent to which high school youth were exposed to dating and sexual violence (DSV) prevention types (e.g., social marketing campaign) across various locations (e.g., in-school) and how exposure to DSV prevention related to perceptions of social norms and collective efficacy. Participants included 877 high school youth who completed in-school surveys across three towns in New England. Most youth (92%) were exposed to DSV prevention. In general, active exposure and active participation, more so than passive exposure, were related to greater perceptions of collective efficacy and perceptions of social norms more intolerant of DSV. Results also suggested that online exposure to DSV prevention was the most consistent correlate of greater perceptions of collective efficacy and perceptions of social norms more intolerant of DSV. These findings provide clues about the types and locations that might be most effective at preventing DSV among youth.     

The forensic nursing in sexual assaults: the immunochemical diagnosis and prevention of its adverse effects

Sexual assault was a ubiquitous and serious problem in our society. The world’s care centers and forensic associations, which were at the forefront of scientific research in sexual assaults, discussed the role of the Forensic Nursing in their early diagnosis and their prevention, but little has been written in literature regarding their appropriate management. This article focuses on the immunochemical laboratory investigation in diagnosis and prevention of its adverse effects in sexual assaults and the role of the Forensic Nursing played in this task. After a careful reading of all the material received from many of the care centers and the associations contacted, a Forensic Nursing Examination Program, with specific immunochemical address, is identified.     

A System Justification View of Sexual Violence: Legitimizing Gender Inequality and Reduced Moral Outrage Are Connected to Greater Rape Myth Acceptance

Rape is a pervasive social problem that causes serious physical and psychological repercussions. Rape victims’ recovery is often complicated by the public's failure to believe the victim and restore justice. This study applied system justification theory to examine whether the justification of gender inequality is related to moral outrage (an emotional precursor to corrective action) and rape myth acceptance; we also examined whether rape myth acceptance is associated with moral outrage at injustice. Results showed that gender-specific system justification correlated with less moral outrage at human suffering as well as greater rape myth acceptance. The relationships between these variables were similar for men and for women, a finding that suggests that rape myths are system justifying for women. When we controlled for gender-specific system justification, rape myth acceptance correlated with less moral outrage. Results are discussed in the context of how legitimizing ideologies reduce moral outrage at injustice and perpetuate a system of sexual violence.     

The relation of adult experience of domestic harassment, violence, and sexual abuse to health and sickness absence

Sense of coherence (SOC), self-reported health (SF-36), and sickness absence were estimated in three groups of women (n = 1075): those never exposed to domestic harassment, violence, sexual abuse, or a combination thereof; those exposed to domestic harassment; and those exposed to domestic violence, sexual abuse, or both. A lower SOC, a lower self-reported health, and a higher sickness absence was found both among women exposed to domestic harassment and among those exposed to domestic violence, sexual abuse, or both. The association was strongest for the dimensions of SF-36 reflecting vitality and mental health. The difference between women exposed and not exposed to domestic harassment, violence, sexual abuse, or a combination thereof was largest regarding the length of sick leave in long (>30 days) sick-leave spells. Increased efforts for prevention of domestic harassment, violence, sexual abuse, or a combination thereof are needed as well as future research.     

The interaction of sexual orientation and provider-patient communication on sexual and reproductive health in a sample of U.S. women of diverse sexual orientations

ObjectiveOur goal was to examine associations among provider-patient communication, past-year contraceptive use and lifetime sexually transmitted infection.MethodsData were analyzed cross-sectionally from 22,554 women in the Growing Up Today Study and Nurses’ Health Study 3 between the follow-up period of 1996–2020. We used multivariable Poisson regression models adjusted for race/ethnicity, age in years, study cohort, and region of residence to obtain risk ratio (RR) associations and 95% confidence intervals (CI).ResultsProvider-patient communication was associated with higher likelihood of using all methods of past-year contraceptive use (RRs ranging from 1.11 to 1.63) and lifetime STI diagnosis (RRs ranging from 1.18 to 1.96). Completely heterosexual women with no same-sex partners (referent) were 13% more likely than lesbians and 4% less likely than other groups to report a provider ever discussed their SRH. Significant interactions emerged between sexual minority status and provider-patient communication. Sexual minority women whose providers discussed their SRH were less likely to report contraceptive non-use in the past year (p < .0001).ConclusionProvider-patient communication may benefit sexual minority women’s contraceptive practices and engagement with STI testing.Practice implicationsDifferences in provider-patient SRH discussion by sexual orientation indicate lesbian women are not receiving the same attention in clinical encounters.     

Gender differences in associations between depressive symptoms and patterns of substance use and risky sexual behavior among a nationally representative sample of U.S. adolescents

Summary Objective: This study uses a cluster analysis of adolescents, based on their substance use and sexual risk behaviors, to 1) examine associations between risk behavior patterns and depressive symptoms, stratified by gender, and 2) examine gender differences in risk for depression. Methods: Data are from a nationally representative survey of over 20,000 U.S. adolescents. Logistic regression was used to examine the associations between 16 risk behavior patterns and current depressive symptoms by gender. Results: Compared to abstention, involvement in common adolescent risk behaviors (drinking, smoking, and sexual intercourse) was associated with increased odds of depressive symptoms in both sexes. However, sex differences in depressive symptoms vary by risk behavior pattern. There were no differences in odds for depressive symptoms between abstaining male and female adolescents (OR = 1.07, 95% CI 0.70–1.62). There were also few sex differences in odds of depressive symptoms within the highest-risk behavior profiles. Among adolescents showing light and moderate risk behavior patterns, females experienced significantly more depressive symptoms than males. Conclusions: Adolescents who engage in risk behaviors are at increased risk for depressive symptoms. Girls engaging in low and moderate substance use and sexual activity experience more depressive symptoms than boys with similar behavior. Screening for depression is indicated for female adolescents engaging in even experimental risk behaviors.     

Prevention and treatment of depression in pregnancy and the postpartum period – summary of a maternal depression roundtable: a U.S. perspective

Summary This article summarizes the proceedings of a roundtable sponsored by the National Institute of Mental Health on January 31, 2001. The objective of this meeting was to discuss the current status and future directions of research on the prevention and treatment of depression in pregnancy and the postpartum period from multidisciplinary and public health perspectives. The major foci included current U.S. federal initiatives, nosology/diagnosis, approaches to assessment, psychosocial and pharmacological interventions, prevention approaches, and service delivery systems. This summary presents the pertinent topics of discussion from the group of experts and identifies key areas for future research and public health directives.     

Providing support to relatives and friends managing both chronic physical illness and depression: The views of a national sample of U.S. adults

Objective

To describe how comorbid depression in chronically ill adults affects the willingness of their family and friends to provide them with illness management support.

Methods

We identified a national sample of U.S. adults (n = 1027), all of whom had a close relative or friend with a chronic physical illness. We examined whether respondents were less willing to help their relatives/friends with disease management when they reported that these relatives/friends were also diagnosed with depression.

Results

In multivariate models, the odds of respondents being willing to provide disease-management support doubled when the relative/friend was depressed (adjusted odds ratio (AOR) = 1.99; 95% C.I. = 1.31, 3.02). Respondents were willing to perform an equal number of illness support tasks for relatives/friends with and without depression. However, respondents reported 30% more difficulties discussing health issues (incidence rate ratio (IRR) = 1.30; 95% C.I. = 1.11, 1.53), and 44% more barriers to providing support (IRR = 1.44; 95% C.I. = 1.18, 1.75) to depressed relatives/friends.

Conclusion

U.S. adults are more willing to provide disease-management support for chronically ill relatives/friends with depression. However, helping depressed relatives/friends is also more challenging.

Practice implications

By providing resources for potential supporters, health providers could mobilize an important source of disease-management support for patients with chronic illness and depression.     

The prevalence of allergic skin test reactivity to eight common aeroallergens in the U.S. population: results from the second National Health and Nutrition Examination Survey

Immediate hypersensitivity skin tests to eight select allergens were performed on a sample (N = 16,204) of the civilian noninstitutional population of the United States, 6 to 74 years of age, in the second National Health and Nutrition Examination Survey (NHANES II). The eight allergens were house dust, cat, dog, Alternaria, mixed giant/short ragweed, oak, perennial ryegrass, and Bermuda grass. Skin test reactivity was defined as a mean erythema diameter greater than or equal to 10.5 mm at the 20-minute reading. Overall, 20.2% of the participants reacted to at least one allergen. Peak reactivity occurred in the 12 to 24-year-old age group. Reactivity was higher in blacks versus whites, but the difference did not reach statistical significance (23.2% versus 19.8%; p greater than 0.05). Male participants had an increased prevalence of reactivity versus female participants in whites (22.0% versus 17.6%), but not in blacks (23.2% versus 23.3%). Skin test reactivity increased in both whites and blacks with increasing income and education. The prevalence of skin test reactivity was higher in urban versus rural areas, but the difference was statistically significant only for whites (whites, 21.6% versus 16.4%; blacks, 23.8% versus 18.4%; p greater than 0.05). With logistic regression, the most important predictors of skin test reactivity in whites were age, sex, urban residence, and poverty status. In blacks, the most important predictors were age, urban residence, and poverty status.     

Involving patients and their families in deciding to use next generation sequencing: Results from a nationally representative survey of U.S. oncologists

ObjectiveNext generation sequencing (NGS) may aid in tumor classification and treatment. Barriers to shared decision-making may influence use of NGS. We examined, from oncologists’ perspectives, whether barriers to involving patients/families in decision-making were associated with NGS use.MethodsUsing data from the first national survey of medical oncologists’ perspectives on precision medicine (N = 1281), we approached our analyses in two phases. Bivariate analyses initially evaluated associations between barriers to involving patients/families in deciding to use NGS and provider- and organizational-level characteristics. Modified Poisson regressions then examined associations between patient/family barriers and NGS use.ResultsApproximately 59 % of oncologists reported at least one barrier to involving patients/families in decision-making regarding NGS use. Those reporting patient/family barriers tended to have fewer genomic resources at their practices, to be in rural or suburban areas, and to have a higher proportion of Medicaid patients. However, these barriers were not associated with NGS use.ConclusionsOncologists encounter barriers to involving patients/families in NGS testing decisions. Organizational barriers may also potentially play a role in testing decisions.Practice implicationsTo foster patient-centered care, strategies to support patient involvement in genomic testing decisions are needed, particularly among practices in low-resource settings.