ObjectiveTo examine whether investments made in public health research align with the health burdens experienced by white and black Americans.MethodsIn this cross-sectional study of all deaths in the United States in 2015, we compared the distribution of potential years of life lost (PYLL) across 39 causes of death by race and identified key differences. We examined the relationship between cause-of-death-specific PYLL and key indicators of public health investment (federal funding and number of publications) by race using linear spline models. We also compared the number of courses available at the top schools of public health relevant to the top causes of death contributor to PYLL for black and white Americans.ResultsHomicide was the number one contributor to PYLL among black Americans, while ischemic heart disease was the number one contributor to PYLL among white Americans. Firearm-related violence accounted for 88% of black PYLL attributed to homicide and 71% of white PYLL attributed to homicide. Despite the high burden of PYLL, homicide research was the focus of few federal grants or publications. In comparison, ischemic heart disease garnered 341 grants and 594 publications. The number of public health courses available relevant to homicide (n = 9) was similar to those relevant to ischemic heart disease (n = 10).ConclusionsBlack Americans are disproportionately affected by homicide, compared to white Americans. For both black and white Americans, the majority of PYLL due to homicide are firearm-related. Yet, homicide research is dramatically underrepresented in public health research investments in terms of grant funding and publications, despite available public health training opportunities. If left unchecked, the observed disproportionate distribution of investments in public health resources threatens to perpetuate a system that disadvantages black Americans.
Missing data are widespread in campus sexual assault surveys. Conclusions drawn from these incomplete data are highly sensitive to assumptions about the sexual assault prevalence among nonresponders.
Introduction Although much research has examined correlates of pain during sex, far less research has examined why women have sex despite having pain and why they avoid telling their partner. Aim The purpose of our study was to examine women’s reports of painful sex, including location of pain, whether they told their partner, factors associated with not disclosing their pain, and their reasons for not disclosing. Methods We used data from the 2018 National Survey of Sexual Health and Behavior, a probability-based online survey of 2,007 individuals ages 14 to 49 years. We limited our sample to adult women who reported a sexual experience that was painful in the past year (n = 382; 23.2%). The primary outcome in quantitative analyses was whether women told their partner they experienced pain during sex. Associations with social identities and sexual health were explored via logistic regression. Those who did not tell their partner about painful sex were asked why; their accounts were coded and analyzed qualitatively. Main Outcome Measure Women were asked, “To what extent was this sexual experience physically painful for you?” Those who reported any pain were asked, “Did you tell your partner that you were in pain during sex?” and, if applicable, “Why didn’t you tell your partner that you were in pain during sex?” Results Of those reporting pain during sex, most said it was “a little painful” (81.6%) and occurred at the vaginal entrance (31.5%), inside the vagina (34.4%), or at or around the cervix (17.4%). Overall, 51.0% (n = 193/382) told their partner about their pain. Adjusting for age and wantedness, women who reported little or no event-level sexual pleasure had nearly 3-fold greater odds of not telling a partner about painful sex (adjusted odds ratio = 3.24; 95% CI, 1.43–7.37). Normalizing painful sex, considering pain to be inconsequential, prioritizing the partner’s enjoyment, and gendered interactional pressures were the predominant themes in women’s narratives. Clinical Implications Providers should ask about painful sex, if the woman continues intercourse despite pain, and how she feels about this as a means of assessing any sexual and social pressures. Strengths & Limitations Strengths include the use of social theory in nationally representative survey research to examine how contextual factors influence sexual health, but experiences were largely limited to heterosexual interactions. Conclusion Many women do not discuss painful sex with their partners, lack of pleasure is significantly more likely among this group, and gender norms and cultural scripts are critical to understanding why.
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