Del Bove, G., Stermac, L., & Bainbridge, D. (2005). Comparisons of sexual assault among older and younger women. Journal of Elder Abuse & Neglect, 17, 1-18. [Posted August 2007]

Key Points: Older victims were more likely to be sexually assaulted in their homes and were more likely to live alone than younger women.

Summary: This study compared sexual assault of older and younger women by reviewing medical records of those treated at a sexual assault care center in Ontario, Canada. The authors divided women into three groups by age: young (15-30 years; n=78), mid-age (31-54 years; n=73), and eldest (55-87; n=61).

Elder women were more likely to be cognitively disabled than women in the younger groups. Older women were more socially isolated: they were more likely to live alone and significantly less likely to be accompanied to the care center by a friend than either of the other groups. More than half (51%) of elders were attacked in their homes, compared with 20% of mid-age women and 19% of young women.

There was no significant difference found between the groups in the relationship of the attacker to the victim: about 40% of all assailants were strangers, and acquaintances were responsible for between 35-48% of attacks. Significant differences were not found in the type(s) of assault, injuries sustained, or need for hospitalization, although there was a trend toward increased vaginal injuries in older women. Weapons were used more frequently on younger women; however, the same levels of physical violence and restraint were used against older and younger women.

To develop preventive strategies, the authors recommended that further research be done with women in assisted care facilities (almost 15% of elder victims were living in group settings). They also suggested identifying the actual relationship of acquaintances to their victims, as this may differ by age group.

Topics: Elderly, injury

 Heise, L., Ellsberg, M., & Gottemoeller, M. (1999). Ending violence against women. Population Reports, Series L, Number 11, 1-43.

This report provides an admirably thorough review of the various dimensions concerning violence against women across the globe. The authors begin by addressing the concept of gender-based violence, how health care providers can help, and what societal responses should entail in curbing the problem. The report discusses in detail the prevalence and ramifications of intimate partner abuse, sexual coercion, impact of violence on women’s reproductive health, threats to health and development, the role of health providers in recognizing and treating the effects of violence, and finally, an agenda for change. The report includes numerous charts presenting, for example, cross-cultural data on issues related to rates of approval of wife-beating and prevalence of forced first intercourse in various countries. The report also includes examples of posters used to educate women and increase awareness of the issues in different countries as well as several useful charts with instructions and guidelines for health care providers. This is an invaluable resource for anyone interested in understanding violence against women on a global level.

Topics: Community attitudes/responses; disclosure; effects; injury; male-female relations; marital rape; medical response; myths/stereotypes; perpetration; prevalence; prevention; racial/ethnic differences; risk; statistics; underserved populations; vulnerability

Magid, D. J., Houry, D., Koepsell, T. D., Ziller, A., Soules, M. R., & Jenny, C. (2004). The epidemiology of female rape victims who seek immediate medical care: Temporal trends in the incidence of sexual assault and acquaintance rape. Journal of Interpersonal Violence, 19, 3-12.

The emergency department is an important source of information about sexual assault occurrence since victims of sexual assault usually go to the emergency department for medical assistance after being assaulted. This is a study comparing the number of female sexual assault victims treated in a Colorado county’s emergency department between July and November of 1974 and 1991. It was hypothesized that there would be a significant increase in the incidence of sexual assault between 1974 and 1991. As predicted, there was a 60% increase in sexual assault incidence with this increase primarily caused by an increase in sexual assaults involving known assailants. Moreover, victims in the emergency department reported more physical force and physical injury in 1991 when compared to 1974. Additional differences between study years (e.g., incidence of oral/anal intercourse during assaults as well as administration of pregnancy prophylaxis and antibiotics) are also presented. Implications of these findings concerning rates of acquaintance rape, reporting rates, and changes in treatment practices are discussed.

Topics: Injury; medical response; statistics

Mantak, F. J. (1995). Creating an alternative framework for preventing rape: Applying Haddon's injury prevention strategies. Journal of Public Health Policy, Spring, 13-28.

This paper reviews current literature on injury prevention and rape. It defines the hazard involved in rape and applies Haddon's model, a host-agent-environment model of classic epidemiology, in order to present a broader foundation for rape prevention. This paper focuses on heterosexual rape. Rape is not treated as an injury itself, separate from any accompanying physical injury. These studies also focus on the behavior of the victim and exclude the behavior of the perpetrator. Haddon's injury prevention strategies to rape underscore sociocultural factors and perpetrator, not victim, responsibility. These strategies have been divided into primary, secondary, and tertiary phases of prevention.

Topics: Effects; injury; prevention

Muram, D., Miller, K., & Cutler, A. (1992). Sexual assault of the elderly victim. Journal of Interpersonal Violence, 7, 70-76. [Posted August 2007]

Key Points: Older female victims of sexual assault were more likely to be assaulted in their homes and by a stranger compared with younger women.

Summary: The researchers compared the sexual assault medical records of 53 women 55 years or older with the records of 53 younger women (aged 18-43). They found no difference in the racial/ethnic makeup of the two groups of victims or of their attackers, although attackers of older women tended to be older.

About the same number of women in each group sustained non-genital injuries (24 older women and 21 younger women) but more than half of older women (51%) had genital injuries while only 13% of younger women had genital injuries.
Younger women were more likely to report a previous sexual assault than older women (25% vs. 9%). The authors speculate that this may be due to older women being less likely to consider child sexual abuse or sexual violence committed by partners to be forms of sexual assault.

The majority of assaults against older women took place in the victim’s home (72%) while most assaults of younger women occurred outside the victim’s home (64%). More older women (79%) were assaulted by complete strangers; among younger women, 43% of attackers were known to the victim prior to the assault. Because of the patterns of stranger assaults, the authors recommend that elders use adequate window and door locks as a prevention strategy.
Limitations of the study included a small sample size collected from one sexual assault response center in Memphis, Tennessee. The results of this study may not be generalizable to other populations.

Topics: Elderly, injury

Ramin, S. M., Satin, A. J., Stone, I.C., & Wendel, G. D. (1992). Sexual assault in postmenopausal women. Obstetrics & Gynecology, 80, 860-864. [Posted August 2007]

Key Points: Older sexual assault victims were more likely to be white and suffered more genital injuries than younger women.

Summary: The authors compared the characteristics of sexual assault victims who were examined and treated in a Dallas County hospital from 1986-1991. About 129 or 2% of all victims were postmenopausal (50-100 years old). Women in the comparison group were 14-49 years old. Racial/ethnic characteristics varied with age: most younger victims were black (53%), and older victims were more likely to be white (64%). Most of the women experienced some kind of physical injury (67% of older and 71% of younger women), but older women suffered more genital injuries (43% vs. 18%). This study did not include information on emotional and psychological trauma suffered by victims, and the authors recommended that further research be done in those areas.

Topics: Elderly; injury

Stermac, L., Del Bove, G., Addison, M. (2004). Stranger and acquaintance sexual assault of adult males. Journal of Interpersonal Violence, 19, 901-915. [Posted December 2006.]

Key Points: Sexual assaults of males by strangers tend to occur outdoors and are more likely to involve weapons and multiple perpetrators than assaults perpetrated by acquaintances. Severity and types of injuries due to sexual assault are similar in men and women.

Abstract: In this descriptive study, researchers looked at the records of three groups of clients at a Canadian Sexual Assault Care Center: male victims of stranger assault (n=64); male victims of non-stranger assault (n=81); and female victims of non-stranger assault (n=106).

Male survivors from both groups were more likely to be living in shelters, institutions (such as transitional housing) or on the street. They were also significantly more likely to have a physical disability than female victims of non-stranger assault.

While acquaintance assaults of men and women usually took place in the assailant’s home (44.3% vs. 43.4%), male acquaintance assaults were significantly more likely to take place in an institution (10.1% vs 0%). Stranger assaults of men were more likely to take place outside, involve multiple perpetrators, and involve use of a weapon, although injuries were similar among the groups. All received similar levels of care at the hospital, although men were admitted more often than women.

The findings suggested that men who were homeless and disabled were at higher risk for sexual assault by strangers, and that safer housing options were needed.

Topics: Injury; male rape; vulnerability

Ullman, S. E. (2003). A critical review of field studies on the link of alcohol and adult sexual assault in women. Aggression and Violent Behavior, 8, 471-486.

The purpose of this study is to examine the relationship between sexual assault victimization and alcohol use. Studies were examined to further identify the role alcohol plays in victimization risk and how victimization may contribute to the perpetuation of alcohol consumption. Further evaluation of existing studies was done to better understand the role of alcohol consumption by the victim or offender in rape and injury outcomes. From these two areas of analysis, the author generates two theoretical models identifying how alcohol effects (a) lifetime sexual assault risk and (b) sexual assault incident outcomes.

Topics: Alcohol; effects; injury

Ullman, S. E., & Fillipas, H. (2001). Correlates of formal and informal support seeking in sexual assault victims. Journal of Interpersonal Violence, 16), 1028-1047.

The purpose of this study was to evaluate different factors associated with the forms of support sought by victims after a sexual assault. The authors evaluated 323 sexual assault victim characteristics, assault variables, and postassault experiences to better understand if these factors were related to whether the victim sought support from formal services or from sources of informal social support. Victims who had incurred injury during the sexual assault and were assaulted by a stranger preferred support from formal service providers. Results also show that victims received unfavorable social reactions from a formal support venue more often than from an informal social network.

Topics: Disclosure; injury; victim services

Ullman, S. E., & Knight, R. A. (1991). A multivariate model for predicting rape and physical injury outcomes during sexual assaults. Journal of Consulting & Clinical Psychology, 59, 724-731.

This report analyzes the court testimonies and police reports of 274 women who had either avoided rape or were raped by offenders who were committed to the Massachusetts Treatment Center for either violent, repetitive, or both types of offenses. The relationship of interest was between the victim’s level of resistance to sexual assault and the severity of the sexual assault. After situational factors were partialed out, hierarchical multiple regression revealed that the victim’s screaming/yelling was associated with a decrease in the level of sexual assault severity. Results also indicate that physical injury to the victim is a result of the offender’s physical aggression level, not the victim’s resistance measures. The victim’s pleading, begging, or reasoning with the offender resulted in higher probability of physical injury while remaining ineffective in reducing the severity of sexual assault. More forceful retaliation by the victim is associated with lower severity in sexual assault while nonforceful retaliation had no effect on sexual assault severity and increased the level of physical injury.

Topics: Avoidance/resistance; injury

Ullman, S. E., & Knight, R. A. (1992). Fighting back: Women's resistance to rape. Journal of Interpersonal Violence, 7, 31-43.

Women's resistance strategies were examined using police reports and court testimonies of 274 women who were survivors of attempted or completed rapes (in cases where the offenders were subsequently incarcerated). The sequence of behaviors in the offender-victim interaction were analyzed to determine whether women who resist rape with physical force are increasing their risk for physical injury. This study indicates that the frequently found correlation between physical resistance and injury to women during a sexual assault might be the result of the initial level of the offender's violence and should not be used to discourage women from physically resisting rape.

Topics: Avoidance/resistance; injury

Ullman, S. E., & Knight, R. A. (1993). The efficacy of women's resistance strategies in rape situations. Psychology of Women Quarterly, 17, 23-38.

This article analyzes the effectiveness of women's resistance strategies for reducing the severity of sexual abuse and physical injury during sexual assaults. Data were obtained from police reports and court testimonies. Resistance strategies varied in their efficacy in different situations in a sample of violent stranger rapes. Results indicate that physical resistance strategies showed equal efficacy, whereas verbal strategies varied in their effectiveness. Over all, women who fought back forcefully were more likely to avoid rape than women who did not fight back, regardless of whether a weapon was present or not.

Topics: Avoidance/resistance; injury

Zoucha-Jensen, J. M., & Coyne, A. (1993). The effects of resistance strategies on rape. American Journal of Public Health, 83, 1633-1634.

The authors investigated which resistance strategies are associated with rape avoidance and the extent to which these strategies place the victim at risk for injury. Data were gathered from initial and supplemental police reports about 150 female sexual assault victims (aged 16+ years). Although the analysis could not determine causality, it did indicate that forceful verbal resistance, physical resistance, and fleeing were all associated with rape avoidance. Women who used forceful resistance were no more likely to have been injured than were women who did not resist.

Topics: Avoidance/resistance; injury

Updated 08/01/07