The Impact of Sexual Violence on
Mental Health and Chronic Disease
Advocacy in Action Annual Conference
March 16, 2016
Danielle Reed, MA and Jessica Reno, MPH
Violence as a Public Health Issue
Among women aged between 15 and 44, acts of violence
cause more death and disability than cancer, malaria, traffic
accidents and war combined. Perhaps the most pervasive
human rights violation that we know today, violence against
women devastates lives, fractures communities, and stalls
development.
Say No UNite,
Campaign to End Violence Against Women
Sexual Violence Among NM Adults, 2005
% Adults ever Raped or Attempted Raped, New
Mexico, 2005
50
45
35
30
25
20
15
10
% RAPED OR ATTEMPTED RAPED
40
24
21
4
5
5
0
Completed Rape
Attempted or Completed Rape
Women
•
Men
Source: Survey of Violence Victimization in New Mexico, 2005
Forced Sexual Intercourse Among
NM and US High School Students, 2013
% Students Ever Forced to Have Sexual Intercourse
50
45
40
30
25
20
15
% FORCED TO HAVE SEX
35
11.7
10.5
6.6
10
4.2
5
0
NM Youth
US Youth
Girls
•
Source: 2013 NM YRRS (NM Sample)
Boys
Forced Sexual Intercourse Among NM & US Youth
% Students Forced to Have Sex by Year,
Grades 9-12, NM and US, 2005-2013
New Mexico
United States
50
% FORCED TO HAVE SEX
45
40
35
30
25
20
15
10
5
8.4
9.2
8.7
8.6
7.7
7.5
7.8
7.4
8.0
7.3
2005
2007
2009
YEAR
2011
2013
0
Source: CDC YRBS & NM YRRS
New Mexico Youth Risk and
Resiliency Survey (YRRS)
•
•
•
•
Representative sample of high school students
Administered in odd years in class
Part of the CDC’s Youth Risk Behavior Surveillance System
Key elements:
• Demographics, experiences with violence, risk behaviors, mental
health & suicide, Resiliency Factors
• Survey question: “Have you ever been
physically forced to have sexual
intercourse when you didn’t want to?”
Disparities in Sexual Violence Victimization
• Lesbian, Gay, Bisexual (LGB) youth – 230% greater risk
• Youth living with disabilities – 190% greater risk
• Foreign-born youth – 40% greater risk
Forced Sexual Intercourse among
NM Youth by Sexual Orientation
% Students Forced to Have Sex by Sexual Orientation,
Grades 9-12, NM, 2013
50
45
% Forced to Have Sex
40
35
30
25
23.5
20
20.5
22.7
15
10
5
9.1
6.9
0
Straight
Source: NM YRRS
Gay/Lesbian
Bisexual
Sexual Orientation
Not Sure
Total
Forced Sexual Intercourse among
NM Youth by Disability
% Students Forced to Have Sex by Disability,
Grades 9-12, NM, 2013
50
45
% Forced to Have Sex
40
35
30
25
20
15
18.0
10
5
8.8
6.2
0
No Disability or Not Sure
Source: NM YRRS
Long-term Disability
Disability Status
Total
Forced Sexual Intercourse among
NM Youth by Country of Birth
% Students Forced to Have Sex by Country of Birth,
Grades 9-12, NM, 2013
50
% Forced to Have Sex
45
40
35
30
25
20
15
10
5
11.7
8.5
8.9
0
USA Born
Source: NM YRRS
Foreign Born
Country of Birth
Total
Impact of Sexual Violence
on Mental Health
Low
Selfesteem
Poor
Mental
Health
Major
Depressive
Disorder
Substance
Abuse and
Dependence
Anxiety
Disordered
Eating
Behaviors
Sexual
Violence
Victimization
Suicidal
Ideation
Suicide
Attempts
PTSD
Poor
Emotional
Well-being
Suicide
Plan
Poor mental health outcomes are correlated with sexual violence victimization. Suicidal ideation and behaviors are
correlated with sexual violence victimization even after controlling for MDD and PTSD.
New Mexico Behavior Risk Factor
Surveillance System (BRFSS)
• 2016: Sexual and Intimate Partner Violence Optional Questions
• Random telephone survey of adults
• Administered every year
• Part of CDC’s national BRFSS
• Key elements:
• Demographics
• General and specific health status
• 2005: Optional Sexual and Intimate Partner Violence
Module
• 2009: Adverse Childhood Experiences (ACEs)
Frequent Mental Distress among
NM Adults by History of Forced Sex
% Adults with Frequent Mental Distress by History of
Forced Sex, 18+ Years, NM, 2009
Not Forced to Have Sex
14.4
Forced to Have Sex
31.6
0
Source: NM BRFSS
10
20
30
40
% with 6+ Days Poor Mental Health in Past 30 Days
50
Mental Health Outcomes among
NM Youth by Forced Sexual Intercourse
% Students with Mental Health and Self Harm Outcomes,
Grades 9-12, NM, 2013
% Students
0
10
Made a Suicide Plan
Attempted Suicide
50
60
70
41.8
14.4
36.9
12.6
37
8.9
45.5
24.7
49.2
18.1
Forced to Have Sex
Source: NM YRRS
40
29.3
Injured in Suicide Attempt
Self Harm
30
57.8
Sad or Hopeless
Considered Suicide
20
Not Forced to Have Sex
80
90
100
Impact of Sexual Violence on Physical Health
Fair/poor
General
Health
Eating
Disorders
Poor
Physical
Health
Sexual
Violence
Victimization
Limited
Health
Care
Access
Arthritis
Cancer
Cardiovascular
Disease
African proverb:
"The ax forgets, the
tree remembers."
Physical Health Conditions among
NM Adults by Sexual Abuse
% Adults with Physical Health Conditions by History of
Sexual Abuse, 18+ Years, NM, 2009
Arthritis
23.9
Asthma
Stroke
19
12.9
3.4
1.9
High Blood Cholesterol
33.6
14+ Days Poor Physical Health in Past 30
10.3
0
5
Sexual Abuse
Source: NM BRFSS
34.7
10
40.5
17.2
15
20
25 30
% Adults
No Sexual Abuse
35
40
45
50
Impact of Sexual Violence on Risk Factors
Smoking
Using
Marijuana
Illicit
Drug Use
Physical
Inactivity
Sexual
Violence
Victimization
Binge
Drinking
Cocaine
Use
Drug
Use
Risky
Sexual
Behavior
Alcohol
Abuse
Substance Abuse among
NM Youth by Forced Sexual Intercourse
% Students with Substance Use by History of Forced Sex,
Grades 9-12, New Mexico, 2013
0
10
20
30
% Students
40
50
60
70
Any Tobacco
Any Alcohol
Binge Drinking
Cocaine
Inhalant
Heroin
Methamphetamine
Ecstasy
Painkiller to Get High
Lifetime Prescription Drug
Lifetime Injection Drug Use
Forced to Have Sex
Source: NM YRRS
Not Forced to Have Sex
80
90
100
Preventing Sexual Violence
Recommendations from Centers for Disease Control and Prevention
• Primary prevention of sexual violence, stalking, and intimate
partner violence must begin early
• Focus on preventing perpetration rather than preventing
victimization
• Evidence regarding change in sexual violence perpetration
behavior is limited
• Reduce risk factors and strengthen protective factors
• Protective factors for dating violence perpetration
• high parental attachment
• self-control
• academic performance
• Perceptions of availability of support may serve to buffer the
relationship between victimization and psychological outcomes
Preventing Sexual Violence Perpetration
• Risk Factors for Sexual Violence Perpetration – Individual Level
• Negative, hostile and dominating attitude toward women
• “Hypermasculinity,” or strong endorsement of traditional male
gender roles
• Rape-supportive attitudes, and endorsement of “rape myths”
• “If someone is raped while they are
drunk or on drugs, they are at least
somewhat responsible for letting things
get out of control.”
• Higher tolerance of interpersonal
violence
• Abuse experiences in childhood
Source: Toward a Multi-Level, Ecological Approach to the Primary Prevention of Sexual Assault: Prevention in
Peer and Community Contexts Erin A. Casey and Taryn P. Lindhorst Trauma Violence Abuse 2009 10: 91
Preventing Sexual Violence Perpetration
• Risk Factors for Sexual Violence Perpetration
– Community and Societal Level
• Membership in social networks characterized by rapesupportive norms
(e.g. fraternities and aggressive sports teams)
• Peer approval of forcing sex on
women and/or using coercive
tactics to gain sex
• Poverty, societal tolerance for
violence, lack of accountability
for perpetrators, and patriarchal
social norms
Source: Toward a Multi-Level, Ecological Approach to the Primary Prevention of Sexual Assault: Prevention in Peer
and Community Contexts Erin A. Casey and Taryn P. Lindhorst Trauma Violence Abuse 2009 10: 91
Sexual Violence in the Media
2013 – “Blurred Lines”
• Critics wrote that the song and the music video
trivialize sexual consent
• Many fans were uncomfortable with both the song
and the video
• Lyrics like "I know you want it" encourage the idea
"no doesn't always mean no" and that some
women who are raped are asking for it
• More than 20 universities in the United Kingdom
banned the song from use at student events
Sexual Violence in the Media
2015 – Game of Thrones
• Many people publicly criticized inclusion of ‘gratuitous’ rape scene
• Almost 60% of tweets about the scene "said something about it was hated, upsetting, or
made them afraid
•
“Ok, I'm done Game of Thrones... Gratuitous rape scene disgusting and unacceptable. It was a rocky ride that just
ended.” — Claire McCaskill (@clairecmc) D-MO
Sexual Violence in the Media
• Lady Gaga reveals sexual assault on Howard Stern
Show
• Created song for “The Hunting Ground”, an expose
of sexual assault on college campuses
• Nominated for Grammy Awards and Academy
Awards
• Reached top 100 in France, Spain, Greece, UK,
Scotland – not US
• Highlighted experiences of survivors
Till your world burns and crashes
Till you're at the end, the end of your rope
Till you're standing in my shoes, I don't wanna hear
nothing from you
From you, from you, cause you don't know
Till it happens to you, you don't know
How I feel
Sexual Violence in the Media
• Spotlight (2015)
• Investigation into cases of widespread and
systemic child sex abuse in the Boston Area by
numerous Roman Catholic priests
• Nominated for six Academy Awards including Best
Picture
• Has grossed $53.5 million worldwide, against a
budget of $20 million
Sexual Violence in the Media
“No More” Super Bowl Ads
• 2015 Super Bowl ad – 911 “pizza” call
• 2016 Super Bowl ad – text
conversation between two friends
• Message: you never truly know what
is going on in someone’s home so if
they’re trying to tell you something
try to really listen to what they are
saying and help if you can.
Resiliency Factors
Resilience: the combination of supportive relationships, adaptive
skill-building, and positive experiences…Resilience transforms
potentially toxic stress into tolerable stress.
- Harvard University’s Center on the Developing Child
YRRS individually measures
the existence of those
supportive relationships and
positive experiences, each
of which is a “resiliency
factor”
Resiliency Factors - Victimization
% Students with History of Forced Sex by Clear
Behavioral Rules at School, Grades 9-12, NM, 2013
True at All
8.4
Not True
17.3
0
10
20
30
% Forced to Have Sex
In my school, there are clear rules about what students can and cannot do.
True at all= “Very much true,” “Pretty much true,” or “A little bit true”
Source: NM YRRS
40
50
Resiliency Factors - Victimization
% Students with History of Forced Sex by Presence of
Caring Friend, Grades 9-12, New Mexico, 2013
True at All
8.4
Not True
15.6
0
10
20
30
% Forced to Have Sex
I have a friend about my own age who really cares about me.
True at all= “Very much true,” “Pretty much true,” or “A little bit true”
Source: NM YRRS
40
50
Resiliency Factors - Victimization
Presence of a Caring Adult
0
10
In my home, there is a parent or some other adult
who is interested in my school work.
8.1
In my home, there is a parent or some other adult
who believes that I will be a success.
8.3
At my school, there is a teacher or some other
adult who listens to me when I have something to
say.
20
30
40
50
17.4
18.3
True At All
8.2
14.3
At my school, there is a teacher or some other
adult who believes that I will be a success.
8.3
Outside of my home and school, there is an adult
who really cares about me.
8.4
Outside of my home and school, there is an adult
who tells me when I do a good job.
8.3
Not True
16
15.1
13.8
% Students Forced to Have Sex
True at all= “Very much true,” “Pretty much true,” or “A little bit true”
Source: NM YRRS
NMDOH Strategy for Preventing
Sexual Violence
NMDOH Strategy for Preventing
Sexual Violence
• Strengthening Individual Knowledge and Skills
• Support multi-session programs that promote healthy masculinity, active bystander
behavior, and flexible gender roles, and decrease rape myth acceptance
• Promoting Community Education
• Develop statewide communications plan to change norms around sexual violence
• Educating Providers
• Educate residence life staff, parents, teachers, group home staff
• Fostering Coalitions and Networks
• Engage members of priority populations in developing prevention strategies
• Changing Organizational Practices
• Policies around appropriate touching in organizations serving people with disabilities
• Influencing Policy and Legislation
• Create comprehensive anti-harassment policies, support Gay-Straight Alliances,
reduce alcohol outlet density
NMDOH Strategy for Preventing
Sexual Violence
• Communications and Messaging
• Development of a statewide messaging campaign
• Messages with evidence of effectiveness are being tested with a variety of audiences
• “My Strength”
– redefining masculinity
• “It Starts with You”
– community of
responsibility
Help and Support for Survivors

Rape Crisis Center of Central New Mexico
 Hotline number: 505-266-7711

Solace Crisis Treatment Center
 24/7 Crisis Advocacy HOTLINE
1.800.721.7273
 Provides prevention programming
 505.988.1951
References
•
Adverse Childhood Experiences Reported by Adults – Five States, 2009. Morbidity and Mortality Weekly Report 2010; 59 (49).
•
Basile, K.C., Black, M.C., Simon, T.R., Arias, I., Brener, N.D., and Saltzman, L.E. (2006). The Association between Self-Reported Lifetime
History of Forced Sexual Intercourse and Recent Health-Risk Behaviors: Findings from the 2003 National Youth Risk Behavior Survey.
Journal of Adolescent Health, 39(5):752.
•
Bedi, S, Nelson, E.C., Lynskey, M.T., McCutcheon, V.V., Heath, A.C., Madden, P.A.F., and Martin, N.G. (2011). Risk for Suicidal Thoughts
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•
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•
Casey, Erin A. and Lindhorst, Taryn P. (2009). Toward a Multi-Level, Ecological Approach to the Primary Prevention of Sexual Assault:
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•
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•
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•
Idaho Department of Health and Welfare. Sexual Violence Victimization and Health in Idaho, 2011.
•
Kaukinen, C. (2014). Dating Violence Among College Students: The Risk and Protective Factors. Trauma, Violence, and Abuse, 15(4):28396.
•
Kilpatrick, D.G., Acierno, R., Resnick, H.S., Saunders, B.E., Best, C.L. (1997). A 2-year longitudinal analysis of the relationships between
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•
Santaularia, J., Johnson, M., Hart, L., Haskett, L., Welsh, E., and Faseru, B. (2014) Relationships between sexual violence and chronic
disease: a cross-sectional study. BMC Public Health, 14:1286.
•
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Questions?