The Effects of Social Determinants on Long-Term Health Outcomes Among Sexual Assault Survivors

Background: Sexual assault has been linked to a number of chronic health conditions and overall poor physical health. Multiple exposures to sexual victimization appear to lead to especially poor health outcomes among survivors. Few studies have examined the effects of social determinants (race, ethnicity, and socioeconomic status) on the overall physical health status of survivors of sexual assault. This study 1) identifies physical health correlates of sexual assault among survivors based on race, ethnicity, and socioeconomic status (SES) and 2) assesses whether the association between multiple sexual victimizations and physical health is moderated by race, ethnicity, and/or SES.

Methods: A sample of female survivors of sexual assault (i.e. lifetime forcible and incapacitated rape, sexual coercion, and unwanted sexual contact) was extracted from the National Intimate Partner and Sexual Violence Survey (2010). All individuals in the sample self-identified as Black or African American, Latina, or non-Hispanic White (N = 3,622). Multiple sexual victimizations included two or more sexual victimizations of any kind. Dichotomous health conditions (asthma, diabetes, irritable bowel syndrome (IBS), high blood pressure) and a binary measure of self-rated physical health status (poor/fair or good/very good/excellent) were included as dependent variables. Social determinants included race (African American or White), ethnicity (Latina or non-Latina), and SES (i.e. high or low based on indicators of income, education, and past-year food insecurity, housing instability, and financial barriers to healthcare access). Chi-square tests assessed bivariate associations between social determinants and chronic health conditions. Logistic regression models examined interactions between multiple sexual victimization and social determinants on health status.

Results: Chi-square tests revealed significantly higher rates of diabetes (20.1%; χ2 = 22.94, p<.001) and high blood pressure (41.4%; χ2 = 29.68, p<.001) among African American women compared to White women (10.9%, 26.9%, respectively). White women (15.1%; χ2 = 12.14, p<.001) had significantly higher rates of IBS compared to African American women (7.9%). Non-Latina women reported significantly higher rates of IBS (14.9%; χ2 = 10.24, p<.001) and high blood pressure (28.8%; χ2 = 11.76, p<.001) than Latina women (7.4%, 4.4%, respectively). Poor or fair health status, and most chronic health conditions, were significantly associated with each SES indicator at the bivariate level. The odds of poor or fair health were higher for women with multiple, versus single, sexual victimization experiences (OR = 1.54, 95% CI = 1.16, 2.03); however, race significantly moderated this relationship (OR = 2.36, 95% CI = 1.17, 4.75). No significant interactions were found for ethnicity or SES (assessed as individual indicators and as a composite).

Conclusion: Results highlight health disparities among sexual assault survivors based on race, ethnicity, and SES. Results also suggest that the relationship between multiple victimizations and poor/health is stronger among non-Hispanic White women compared to African American women, indicating that other factors beyond multiple victimization histories are important to understanding health disparities associated with sexual victimization among African American women. Findings can inform coordinated victim service efforts (e.g., SARTs) on health risks associated with victimization and highlight the need for culturally relevant health interventions that address socioeconomic needs.