Background
Sexual assault is a traumatic event with potentially devastating lifelong effects on physical and mental health. According to the Centers for Disease Control and Prevention (CDC), one in four women and one in seven men in the U.S. have reported experiencing sexual violence in their lifetime. Sexual violence is defined as any sex act that is perpetrated against someone's will. It can be classified into four types: a completed sexual act such as rape, 2), an attempted (but not completed) sex act, abusive sexual contact such as intentional touching without consent), and non-contact sexual abuse such as voyeurism, unwanted exposure to exhibitionism, unwanted exposure to pornography, sexual harassment, and threats of sexual violence). All types of sexual violence involve victims who do not consent, or who are unable to consent or refuse to allow the act. Although similar to intimate partner violence (IPV), sexual violence may involve a perpetrator who is unknown to the victim and pertains specifically to forcible sex acts. While the economic burden of sexual violence is difficult to quantify due to limited data, the existing research indicates that the costs are substantial. With a total estimated cost of $127 billion a year (excluding the cost of child sexual abuse), rape is the most costly of all violent crimes.
Despite the high prevalence and economic burden of sexual assault, few studies have investigated the associations between sexual violence and chronic health conditions, which are major causes of morbidity and mortality. Seventy percent of U.S. deaths each year are attributed to chronic diseases, with heart disease, cancer, and stroke accounting for more than 50 percent of all deaths. Research has demonstrated that individuals who experience sexual assault during childhood are more likely to engage in risky behaviors later in life, such as smoking, alcohol and drug abuse, and disordered eating habits, which may increase the risk of developing a chronic disease. Such maladaptive behaviors in this population have been attributed to poor self-esteem, stress, mental illness such as post-traumatic stress disorder, depression), and sleep disorder. A growing body of research suggests that a child's development and adult functioning can be profoundly impacted by sexual violence. Nearly half of sexually victimized females were raped before the age of 18, and more than 25 percent of sexually victimized males were raped before the age of 10. A longitudinal study of sexually victimized girls found that sexual abuse was associated with disruptions in the hypothalamic-pituitary-adrenal axis, which is proposed to result in increased susceptibility to stress later in life. A 2010 meta-analysis supports the hypothesis that childhood sexual abuse is related to higher rates of physical health symptoms, including poor general health, gynecologic pain, cardiopulmonary symptoms, and obesity. Similar pathways linking sexual violence that occurs in adulthood to chronic disease may exist. As part of a large public health survey, Smith & Breiding used data from 25 states/territories that administered the Behavioral Risk Factor Surveillance Survey (BRFSS) sexual violence module in 2005. The BRFSS is a state-level surveillance system of health-related risk behaviors, chronic health conditions, and use of preventive services among adults 18 years and older. Smith & Breiding reported that non-consensual sex among women and men was associated with smoking, excessive alcohol use, Human Immunodeficiency Virus (HIV) risk factors such as use of intravenous drugs, treated for sexually transmitted infection, prostitution, engaged in anal sex without a condom in the past year, arthritis, asthma, activity limitations, high cholesterol, stroke, and heart disease. Women with a history of sexual violence were more likely to experience a heart attack than women without such a history. Similarly, Black et al. found that sexually victimized women were more likely to have asthma, irritable bowel syndrome, and diabetes, and were more likely to experience chronic pain, frequent headaches, and difficulty sleeping. Another study found that women with a history of sexual assault were more likely to smoke, have high cholesterol and hypertension, and to be obese.
The aim of this study was to identify the relationship of sexual violence and chronic disease using current Kansas state-level BRFSS data which includes mental health and additional behavioral risk behaviors that have not been examined previously. The results of this study could support the establishment of public health strategies that implement primary, secondary, and tertiary prevention for chronic disease and sexual violence. In addition, the findings may suggest future avenues of research that will further elucidate this relationship.