Racial/Ethnic and Age Disparities in Women's Use of Follow-Up Services after Sexual Assault

Background and Purpose: Victims of sexual assault face considerable short term and long term health and mental health risks that can be minimized with appropriate follow-up care. Some available evidence suggests that women of color, and older women, may be less likely to use follow-up care after a sexual assault. However, it is not clear whether utilization differences are due to access barriers or other factors. This descriptive study examined the relationships between race/ethnicity and age and the use of follow-up services among women served in a comprehensive program that reduced access barriers. This program systematically links forensic sexual assault exams with follow-up medical and mental health care; all women are scheduled for follow-up appointments unless they are too ill or intoxicated to consent to the appointment, are leaving the area within the next week, or explicitly refuse services. Methods: The study sample comprises 581 women who received forensic exams in a public sector hospital emergency room following a sexual assault between 2001 and 2005. Logistic regression was used to examine relationships between demographic characteristics (age and race/ethnicity) and referral to follow-up care and attendance at follow-up care. Results: In this sample, 41% of the women were white, 27% were Black, 15% were Hispanic, and 18% were of other races/ethnicities. The median age was 28 (range 18-74). At the time of the forensic exam, 485 (83%) of the 581 women were scheduled for a follow-up medical appointment that would involve direct linkage to a social worker who provides trauma-focused mental health care and other social services. Scheduling of a follow-up appointment was not associated with race/ethnicity or age. Of the 485 women scheduled for a follow-up appointment, 282 (58%) attended. Women from all other racial/ethnic groups attended follow-up appointments more frequently than did Black women (whites: OR=2.2, p<.01; Hispanics: OR=2.5, p<.01; others: OR=3.5, p<.01). Women aged 28 and older were somewhat less likely to attend follow-up appointments than were younger women (OR=.7, p=.06). No statistically significant interactions were observed between race/ethnicity and age. Conclusions and Implications: These findings suggest potentially troubling racial/ethnic and age disparities in use of follow-up medical and mental health services following sexual assault, even when appointment access barriers are minimized. It appears that Black women and older women are less likely to use services that may reduce the negative impact of sexual assault and its sequelae. These data provide no insights into the causes of these apparent disparities, but motivate further examination of the roles of age, race/ethnicity and other factors--such as socioeconomic status and community context--in the use of medical and mental health services following sexual assault. There may be an important role for social workers to play in linking underserved victims of sexual assault to needed medical and mental health care.