Descriptive Analysis of Sexual Assault Nurse Examinations in Bethel, Homer, Kodiak, Kotzebue, Nome, and Soldotna

This project examined the characteristics of 172 sexual assault victimizations recorded by sexual assault nurse examiners — all those conducted in Bethel, Alaska in 2005 and 2006, and in Homer, Kodiak, Kotzebue, Nome, and Soldotna in 2005. The report documents the demographic characteristics of patients, pre-assault characteristics, assault characteristics, post-assault characteristics, exam characteristics and findings, suspect characteristics, and legal resolutions.National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. Grant No. 2004-WB-GX-0003Index of Tables and Figures / Acknowledgments \ Executive Summary Descriptive Analysis / Sexual Assaults in Anchorage: 1996-2004 / Sexual Assault Nurse Examinations / Purpose of this Study / Methodology / Sample and Data Limitations / Demographic Characteristics of Patients / Pre-Assault Characteristics / Assault Characteristics / Post-Assault Characteristics / Exam Characteristics and Findings / Suspect Characteristics / Legal Resolutions / Appendix A – Data Collection Instrumen

Reporting Sexual Assault Victimizations to Law Enforcement

As part of a larger study examining the characteristics of sexual assault victimizations in Alaska as observed and recorded by sexual assault nurse examiners, 101 patients in Bethel, Fairbanks, Kodiak, Kotzebue, Nome, and Soldotna provided information about their decision to report their victimization to law enforcement. The report documents who these patients consulted prior to reporting, the actions and reactions that patients received from others, how patients initially attributed blame, and how concerned patients initially were about disbelief and negative reactions from others. The report also examines whether patients had begun to take control over the recovery process, the amount of time elapsed from assault to examination, and what factors predict the amount of time elapsed from assault to examination.National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. Grant No. 2004-WB-GX-0003Index of Tables and Figures / Acknowledgments / Executive Summary / Reporting Sexual Assault Victimizations to Law Enforcement / Patient, Assault, and Suspect Characteristics / Characteristics of Reporting / Reasons for Time Elapsed from Assault to Repor

Final Report: Alaska Sexual Assault Nurse Examiner Study

This project examined the characteristics of sexual assault victimizations in Alaska, as observed and recorded by sexual assault nurse examiners in Anchorage, Kodiak, Bethel, Soldotna, Nome, Fairbanks, Homer, and Kotzebue. The sample utilized for this study includes all sexual assault nurse examinations conducted in Anchorage from 1996 to 2004, in Bethel and Fairbanks in 2005 and 2006, and in Homer, Kodiak, Kotzebue, Nome, and Soldotna in 2005 (N = 1,699). This final report provides a thorough descriptive analysis of the sexual assault nurse examinations included in this study. This descriptive analysis focuses on demographic characteristics of patients; pre-assault, assault, and post-assault characteristics; exam characteristics and findings; suspect characteristics; and legal resolutions. The report then examines the predictors of genital injury. More specifically, it examines the effect of time elapsed from assault to report and of patient condition at the time of the assault. The effect of time elapsed from assault to report is examined by comparing the genital injuries of patients that reported to a sexual assault nurse examiner within 24 hours to the genital injuries of patients that did not. The effect of patient condition at the time of the assault is examined by comparing the genital injuries of patients that were sober, intoxicated, and incapacitated at the time of the assault. Results show that neither time elapsed from assault to report nor patient condition at the time of the assault impacted genital injury. The report also examines the effect of genital injury on legal resolutions. More specifically, it examines how the presence and frequency of genital injury impacts the likelihood that cases are referred for prosecution, the likelihood that cases are accepted by prosecutors, and the likelihood that cases result in a conviction. Results show that genital injury did not impact legal resolutions. Other factors, non-genital injury in particular, were significantly associated with both genital injury and legal resolutions. The relevance of these additional factors is discussedNational Institute of Justice, Office of Justice Programs, U.S. Department of Justice. Grant No. 2004-WB-GX-0003Index of Tables and Figures / Acknowledgments / Executive Summary / I.Final Report: Alaska Sexual Assault Nurse Examiner Study A.Sexual Assaults in Alaska; 1996-2006 B. Sexual Assault Nurse Examinations C. Purpose of this Study D.Review of Prior Research 1. Genital Injury 2. Predictors of Genital Injury 5. Predictors of Legal Resolutions E. Methodology F.Limitations of Sample and Data / II. Descriptive Analysis of Sexual Assault Nurse Examinations A.Demographic Characteristics of Patients B. Pre-Assault Characteristics C. Assault Characteristics D. Post-Assault Characteristics E. Exam Characteristics and Findings F. Suspect Characteristics G. Legal Resolutions / III. Predictors of Genital Injury and Legal Resolutions A. Goals of this Analysis B. Sample and Variables 1. Condition at Time of Assault 2. Time Elapsed from Assault to Report 3. Genital Injury 4. Legal Resolutions 5.Control Variables 6.Case Characteristics 7. Patient Characteristics 8. Assault Characteristics 9.Exam Characteristics 10. Exam Findings 11. Suspect Characteristics 12.Summary C. Methodology D. Bivariate Results E.Multivariate Results: Presence of Genital Injury 1. Main Effects: Presence of Genital Injury 2. Control Variables: Presence of Genital Injury 3. Final Model: Presence of Genital Injury F. Multivariate Results: Frequency of Genital Injury 1. Main Effects: Frequency of Genital Injury 2. Control Variables: Frequency of Genital Injury 3. Final Model: Frequency of Genital Injury G. Summary: Predictors of Genital Injury H. Multivariate Results: Referring a Case for Prosecution 1. Main Effects: Referring a Case for Prosecution 2. Control Variables: Referring a Case for Prosecution 3. Final Model: Referring a Case for Prosecution I. Multivariate Results: Accepting a Case for Prosecution 1. Main Effects: Accepting a Case for Prosecution 2. Control Variables: Accepting a Case for Prosecution 3. Final Model: Accepting a Case for Prosecution J. Multivariate Results: Securing a Conviction 1. Main Effects: Securing a Conviction 2. Control Variables: Securing a Conviction 3. Final Model: Securing a Conviction K. Summary: Predictors of Legal Resolutions L. Conclusions 1. Predictors of Genital Injury 2. Predictors of Legal Resolutions 3. Importance of Non-Genital Injuries / References / Appendix A – Data Collection Instrumen

Descriptive Analysis of Sexual Assault Nurse Examinations in Alaska

This project examined the characteristics of 1,699 sexual assault victimizations recorded by sexual assault nurse examiners — all those conducted in Anchorage, Alaska from 1996 to 2004, in Bethel and Fairbanks in 2005 and 2006, and in Homer, Kodiak, Kotzebue, Nome, and Soldotna in 2005. The report documents the demographic characteristics of patients, pre-assault characteristics, assault characteristics, post-assault characteristics, exam characteristics and findings, suspect characteristics, and legal resolutions.National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. Grant No. 2004-WB-GX-0003Index of Tables and Figures / Acknowledgments / Executive Summary / Descriptive Analysis / Sexual Assaults in Alaska; 1996-2005 / Sexual Assault Nurse Examinations / Purpose of this Study / Methodology / Sample and Data Limitations / Demographic Characteristics of Patients / Pre-Assault Characteristics / Assault Characteristics / Post-Assault Characteristics / Exam Characteristics and Findings / Suspect Characteristics / Legal Resolutions / Appendix A – Data Collection Instrumen

The Healing and Empowering Alaskan Lives Toward Healthy-Hearts (HEALTHH) Project: Study protocol for a randomized controlled trial of an intervention for tobacco use and other cardiovascular risk behaviors for Alaska Native People

BackgroundTobacco use and tobacco-related diseases disproportionately affect Alaska Native (AN) people. Using telemedicine, this study aims to identify culturally-tailored, theoretically-driven, efficacious interventions for tobacco use and other cardiovascular disease (CVD) risk behaviors among AN people in remote areas.DesignRandomized clinical trial with two intervention arms: 1) tobacco and physical activity; 2) medication adherence and a heart-healthy AN diet.ParticipantsParticipants are N = 300 AN men and women current smokers with high blood pressure or high cholesterol.InterventionsAll participants receive motivational, stage-tailored, telemedicine-delivered counseling sessions at baseline and 3, 6, and 12 months follow-up; an individualized behavior change plan that is updated at each contact; and a behavior change manual. In Group 1, the focus is on tobacco and physical activity; a pedometer is provided and nicotine replacement therapy is offered. In Group 2, the focus is on medication adherence for treating hypertension and/or hypercholesterolemia; a medication bag and traditional food guide are provided.MeasurementsWith assessments at baseline, 3, 6, 12, and 18 months, the primary outcome is smoking status, assessed as 7-day point prevalence abstinence, biochemically verified with urine anabasine. Secondary outcomes include physical activity, blood pressure and cholesterol, medication compliance, diet, multiple risk behavior change indices, and cost-effectiveness.CommentsThe current study has the potential to identify novel, feasible, acceptable, and efficacious interventions for treating the co-occurrence of CVD risk factors in AN people. Findings may inform personalized treatment and the development of effective and cost-effective intervention strategies for use in remote indigenous communities more broadly. Clinical Trial Registration # NCT02137902

Evaluating Community-Based Translational Interventions Using Historical Controls: Propensity Score vs. Disease Risk Score Approach.

Many community-based translations of evidence-based interventions are designed as one-arm studies due to ethical and other considerations. Evaluating the impacts of such programs is challenging. Here, we examine the effectiveness of the lifestyle intervention implemented by the Special Diabetes Program for Indians Diabetes Prevention (SDPI-DP) demonstration project, a translational lifestyle intervention among American Indian and Alaska Native communities. Data from the landmark Diabetes Prevention Program placebo group was used as a historical control. We compared the use of propensity score (PS) and disease risk score (DRS) matching to adjust for potential confounder imbalance between groups. The unadjusted hazard ratio (HR) for diabetes risk was 0.35 for SDPI-DP lifestyle intervention vs. control. However, when relevant diabetes risk factors were considered, the adjusted HR estimates were attenuated toward 1, ranging from 0.56 (95% CI 0.44-0.71) to 0.69 (95% CI 0.56-0.96). The differences in estimated HRs using the PS and DRS approaches were relatively small but DRS matching resulted in more participants being matched and smaller standard errors of effect estimates. Carefully employed, publicly available randomized clinical trial data can be used as a historical control to evaluate the intervention effectiveness of one-arm community translational initiatives. It is critical to use a proper statistical method to balance the distributions of potential confounders between comparison groups in this kind of evaluations