Sexual assault is a violent event that affects millions of females each year. Of the estimated 6.8 million rapes and physical assaults annually in the U.S., 2.6 million will result in an injury to a women and almost 800,000 will result in the survivor receiving some type of healthcare. Assessment of injuries to the skin resulting from sexual assault is known to play an important role in the health care and criminal justice systems. Recent published findings indicate that women with dark skin who have a forensic examination have a significantly lower genital injury prevalence as compared to women with light skin. These findings, which raise important questions about the relationship of skin elasticity and skin color, may indicate a spurious nature of the relationship between race/ethnicity and injury prevalence. They demonstrated that skin color rather than race/ethnicity is likely the important variable that predicts genital injury prevalence. If women with dark skin are less likely to have injuries detected than women with light skin, a health disparity exists. Little is known about the role of skin elasticity across the continuum of skin colors, and whether or not differences skin elasticity may also explain the findings that injury prevalence varies by skin color. The overall objective of this pre-doctoral application is to determine if skin elasticity varies by skin color. The applicant proposes an innovative approach to answer the question: Can the previous findings that genital injury prevalence varies by skin color be better understood because skin elasticity varies by skin color? The applicant anticipates that variations in skin elasticity will also be explained by age, body mass index, sun exposure, and health status. The proposed clinical research study and training plan are integral to the applicant's long-term goals, which include elucidation of potential differences in skin physiology related to color and other variables, understanding the protective and injurious mechanisms of the skin, and dissemination of applicable findings to further skin science and reduce health disparities in vulnerable populations. Results obtained during this study, to take place at the University of Pennsylvania, have potentially large scale public health benefits. Findings will provide information that will influence the procedure for forensic examinations after sexual assault and guidelines for evaluating injuries in a legal setting. If skin elasticity is indeed different in women with different skin colors, addressing these differences may improve techniques for the forensic examination and provide the impetus for increased reporting rates following sexual assault.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
Project #
Application #
Study Section
National Institute of Nursing Research Initial Review Group (NRRC)
Program Officer
Banks, David
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Pennsylvania
Schools of Nursing
United States
Zip Code
Everett, Janine S; Sommers, Marilyn S (2013) Skin viscoelasticity: physiologic mechanisms, measurement issues, and application to nursing science. Biol Res Nurs 15:338-46
Sommers, Marilyn S; Brown, Kathleen M; Buschur, Carole et al. (2012) Injuries from intimate partner and sexual violence: Significance and classification systems. J Forensic Leg Med 19:250-63
Everett, Janine S; Budescu, Mia; Sommers, Marilyn S (2012) Making sense of skin color in clinical care. Clin Nurs Res 21:495-516
Alexander, Kamila A; Dovydaitis, Tiffany; Beacham, Barbara et al. (2011) Learning health equity frameworks within a community of scholars. J Nurs Educ 50:569-74