Prevalence and Characteristics of Nonfatal Strangulation in Medical Forensic Examination: A Retrospective Chart Review, 2017–2023

Abstract

This study examined prevalence and characteristics of nonfatal strangulation (NFS) in medical forensic examinations from 2017 to 2023. A retrospective chart review of 1,396 records revealed 243 NFS cases (17.4%), prevalence increasing from 13.3% in 2017 to 22.2% in 2023. Adult NFS comprised 15.2% of cases, children 2.2%. Analysis of the NFS group revealed partner/spouse perpetrators were most common overall. Children were most commonly victimized by friends/acquaintances. NFS disproportionately affected females (94.2% of all NFS cases). Among children experiencing NFS, minority groups were overrepresented, accounting for 74.2% of pediatric NFS cases. The COVID-19 period showed distinct changes in age-related patterns.

Introduction

Nonfatal strangulation (NFS) is a critical yet often overlooked form of violence with severe and long-lasting health consequences. These health consequences range from immediate physical symptoms, such as loss of consciousness and difficulty breathing to long-term neurological damage. Furthermore, NFS has been documented as a significant predictor of future lethal violence (Glass et al., 2008; Strack et al., 2001). Despite its severity, the prevalence and patterns of NFS among individuals presenting for medical forensic examination remains understudied. Recent studies have estimated that between 3% and 10% of the general population have experienced NFS, with higher rates among specific vulnerable groups (Sharman et al., 2024). Researchers have hypothesized the existence of factors that may predict risk for NFS, including individual characteristics (female biological sex, minority ethnicity, and age), direct exposure to acute physical violence, and sexual assault (Knutson & Carter, 2025). However, limited research is available regarding changes in NFS prevalence over time and prevalence by age and race/ethnicity and by assault type (i.e., physical vs. sexual). Understanding these temporal, demographic, and assault-related patterns is crucial for developing targeted detection, prevention, and intervention strategies and improving healthcare responses. This research aimed to address this gap by examining the prevalence and patterns of NFS among individuals undergoing medical forensic examination over a 7-year period. Using a quantitative descriptive retrospective chart review, data was analyzed from medical forensic examinations conducted between January 2017 and December 2023.

Background

NFS is defined as the application of external pressure to the neck, causing asphyxia by obstructing blood vessels and/or the airway, without resulting in death (Faculty of Forensic & Legal Medicine, 2024). NFS is a severe form of violence that often goes underreported due to various factors. Individuals may not disclose NFS experiences because of more immediate traumas or memory issues caused by oxygen deprivation to the brain. This underreporting emphasizes the critical need for healthcare providers and first responders to receive specialized training in recognizing strangulation signs and asking targeted questions, as victims may not voluntarily provide this information (Donaldson et al., 2023; Peel & Cunnion, 2024).

While NFS has long been associated with an increased risk of future violence, research on its prevalence and trends over time remains limited, particularly in pediatric populations. Understanding these patterns is crucial for developing effective prevention strategies, improving detection techniques, and enhancing clinical practices. Such knowledge can significantly inform healthcare providers, social services, and law enforcement in implementing targeted safety planning and support services.

Nonconsensual NFS

For this research, the definition of NFS is restricted to an action carried out by one person on another without consent, underscoring its role as an instrument of violence and control. This characteristic has been extensively documented in research, particularly in the context of domestic violence and intimate partner violence (Pritchard et al., 2017).

Because the focus of most research has involved NFS by intimate partners, a significant gap persists in the research concerning NFS in pediatric populations. This has resulted in a paucity of evidence regarding longitudinal prevalence patterns within this demographic. While extant studies have documented an increase in domestic violence rates during the COVID-19 pandemic, it is noteworthy that the preponderance of research on NFS during the COVID-19 pandemic has focused on adult populations (Kourti et al., 2021). This limitation in the scope of existing literature underscores the need for further investigation into the prevalence and temporal patterns of NFS among children. Such research should encompass prepandemic baselines, pandemic-era fluctuations, and postpandemic trends to provide a holistic understanding.

The EHRiC Model

The Extremely High Risk Category (EHRiC) Model for Nonfatal Strangulation, developed by Knutson and Carter (2025), provides a conceptual framework for understanding NFS risk based on currently published literature (Figure 1). This model, visualized as a Venn diagram, comprises three Moderate Risk Categories (MRCs):

1. Individual characteristics (female sex, age, minority ethnicity)

2. Direct exposure to acute physical violence (often in the form of domestic violence or intimate partner violence)

3. Experiencing acute sexual assault

Figure 1.

The EHRiC Model for nonfatal strangulation.

Note. Moderate Risk Category (MRC), High Risk Category (HRC), Extremely High Risk Category (EHRiC); Copyright 2024 [Chelsea Knutson].

The intersections of these categories form High Risk Categories (HRCs), with the central intersection of all categories representing the Extremely High Risk Category (EHRiC). While this model synthesizes existing literature on NFS risk factors, it requires further empirical validation through comparison with current patient data.

This study aims to address the gap in understanding NFS prevalence and changes over time by examining data from individuals undergoing medical forensic examination over a 7-year period. By doing so, it seeks to contribute to the growing body of knowledge on NFS and provides data for validation and refinement of the EHRiC Model.

Methods

This study employed a quantitative descriptive retrospective chart review design with a longitudinal component to examine the prevalence and characteristics of NFS among individuals presenting for medical forensic examination over a 7-year period, which included the COVID-19 lockdown period. This study aimed to address the following research questions, both in the overall population and when stratified into adult and child populations:

1. What is the prevalence of NFS among individuals presenting for medical forensic examination?

2. What changes over time can be observed in the prevalence of NFS among people who present for medical forensic examination?

Medical forensic examination records were reviewed from a forensic nursing program in a rural hospital and associated Childhood Advocacy Center (CAC) in a small metropolitan area serving a diverse seven-county region in a gulf coast state. This setting was selected due to its diverse patient population and well-established medical forensic examination program with nurses educated in NFS assessment. Records spanning from January 1, 2017, to December 31, 2023, were included, allowing for a comprehensive analysis of temporal data. Inclusion criteria were: (a) complete medical forensic assessment data within the designated period, and (b) nonprisoner status. After applying exclusion criteria for incomplete or missing data and prisoner status, a total of 1,396 medical forensic examination records met the inclusion criteria and were included in the final analysis. Ethical approval for the study was obtained from the University of Texas Medical Branch Internal Review Board (IRB) as well as the IRB for the hospital (IRB #24-0270 and 408245, respectively) and from which data was obtained.

Data were extracted by the PI, an experienced forensic nurse and doctoral candidate, using a standardized method and predefined decision rules. Data extracted included demographic information (age, sex assigned at birth), presence of NFS, presence of sexual assault (SA), and year of examination. Adults were defined as individuals ≥18 years old, while children were <18 years old. NFS was defined as external pressure applied to the neck by any nonconsensual force that did not result in death, as documented in the medical record. SA was defined as any nonconsensual sexual contact reported by the patient or suspected by the examiner. The primary investigator (PI), a forensic nurse with specialized credentials, conducted the data extraction. Holding state and international credentials as Sexual Assault Nurse Examiner (SANE), the PI possesses comprehensive expertise in examining and identifying violence, with specific education in nonfatal strangulation (NFS) assessment across adult, adolescent, and pediatric populations. Descriptive statistics were used to determine the overall prevalence of NFS in the sample, stratified by age groups. Changes in prevalence over the 7-year period were analyzed using descriptive statistics.

Results

The overall sample consisted of 1,396 medical forensic records, with ages of individuals ranging from less than 1 year to 73 years. Within this sample, 243 records of NFS were identified, representing 17.4% of the total sample. The overall NFS group had an age range of 5–73 years with a mean age of 26.9 years and a median age of 23 years.

The NFS group was further divided into adult and child subgroups. The Adult NFS Group represented 15.2% of the overall sample (n = 212) and included records of individuals aged 18–73 years, with a mean age of 28.8 years, median of 26 years, and mode of 19 years. The Child NFS Group represented 2.2% of the overall sample (n = 31) and included records of individuals aged five to 17 years, with a mean age of 14.3 years, and median and mode of 16 years. The majority of the Child NFS Group was post pubertal with only three cases of prepubertal NFS in the sample. Table 1 presents the prevalence of NFS across the total sample and stratifies results into adult and child subgroups. The table further compares the prevalence of nonfatal strangulation (NFS) in cases involving sexual assault (SA) to those unrelated to sexual assault.

Table 1.

Prevalence of NFS: Overall Sample and Subgroup Analysis.

	Overall		Adults			Children
Variable	Overall Sample	NFS	NFS	NFS with SA	NFS PA Only	NFS	NFS with SA	NFS PA Only
n	1,396	243	212	110	102	31	21	10
Age range (years)	<1–73	5–73	18–73	18–70	18–73	5–17	6–17	5–17
Age in years (mean)	22.6	26.9	28.8	26.2	31.5	14.3	15	12.9
Age in years (median)	20	23	26	22	30	16	16	14
Age in years (mode)	19	19	19	19	24	16	16	16

Note. NFS = nonfatal strangulation; SA = sexual assault; PA = physical assault.

The data revealed distinct patterns in strangulation cases across different victim–perpetrator relationships, as illustrated in Figure 2. Relationships were defined by the patient during the medical forensic history. Partner/spouse perpetrators represented the highest percentage at 54.5% in the overall sample (n = 243), with higher rates for adult cases (60.4%) compared to children (12.5%). Friend/acquaintance perpetrators constitute the second most common category at 25.1% overall, showing a higher prevalence in child cases (40.6%) compared to adult cases (22.6%). Family members who are not spouses account for 4.1% of overall cases, though this relationship shows a much higher rate in child cases (21.9%) compared to adult cases (1.2%). Multiple perpetrators were reported in 6.6% of cases, with children (15.6%) experiencing this more frequently than adults (5.2%). Stranger-perpetrated strangulation occurred in 8.6% of overall cases, with adults (9.4%) experiencing slightly higher rates than children (3.1%). Unknown perpetrator relationships comprise the smallest category at 1.2% overall, though slightly lower in child cases (0.9%) compared to adult cases (3.1%). Interestingly, 97.1% of all NFS cases involved perpetration by a male. Only 10 cases involved female perpetrators, most commonly a parent (40%), followed by instances involving multiple perpetrators of both sexes (30%).

Figure 2.

Reported perpetrator relationship to patient in NFS cases: Analysis of adult and child cases.

Prevalence of Sexual and Physical Assault in NFS

Analysis of assault patterns revealed that more than half (53.9%) of NFS cases involved sexual assault, while the remainder (46.1%) involved physical assault alone. Age-stratified analysis demonstrated clear differences between groups: children who experienced NFS had a markedly higher prevalence of concurrent sexual assault (67.7%) compared to adults (51.9%). Physical assault without sexual violence was less common in both groups, occurring in 32.2% of child NFS cases and 48.1% of adult NFS cases. These findings are illustrated in Figure 3.

Figure 3.

Prevalence of sexual assault (SA) and physical assault (PA) in NFS stratified by age group.

Prevalence in Minority Ethnicities

Minority racial/ethnicity populations comprised 52% of all NFS records. Age-stratified analysis demonstrated marked disparities, with minority individuals representing 74.2% of child NFS cases compared to 48.6% of adult cases. Analysis of biological sex distribution revealed that females comprised 94.2% of all NFS records. Age-stratified analysis demonstrated that females represented 95.3% of adult NFS cases and 87.1% of pediatric NFS cases, indicating a strong gender disparity across both age groups. These findings are illustrated in Figure 4.

Figure 4.

Prevalence of SA and PA in NFS stratified by age group.

Prevalence in Male Biological Sex

Among the 14 males in the sample who experienced nonfatal strangulation (NFS), the majority (78.6%) were strangled in the context of a physical assault, while 21.4% experienced NFS in relation to a sexual assault. These males aligned with the broader group in terms of minority ethnicity, with 50% identifying as part of a minority group. None of the males had anogenital injuries, but all sustained bodily injuries. Regarding the relationship between the victim and the perpetrator, four males were strangled by a friend or acquaintance, two by multiple individuals, two by a male parent, two by a partner (one male and one female), and three by a stranger.

Changes in Prevalence of NFS Over Time

The overall prevalence of NFS in the data demonstrates a general increase in identification of NFS from 2017 to 2023. Prevalence increased from 13.3% in 2017 to 22.2% in 2023, representing a 66.9% rise over the 7-year period. The largest increase occurred between 2019 and 2020, with prevalence increasing from 14.5% to 18.8%. The data also reveal changes in the distribution of NFS records between adults and children. The proportion of adult (versus pediatric) cases initially increased from 85.7% in 2017 to a peak of 93.8% in 2020. However, this change reversed in subsequent years, with the adult proportion (versus pediatric) decreasing to 82.8% by 2023. Conversely, the proportion of child cases decreased from 14.4% in 2017 to a low of 6.3% in 2020, before increasing again to 17.2% in 2023. Figure 5 visually represents the changes in NFS from 2017 to 2023 and illustrates the overall increase in prevalence, with fluctuations between years.

Figure 5.

Changes in NFS prevalence 2017–2023.

Analysis Across EHRiC Model Risk Categories

The distribution of cases across the EHRiC Model risk categories is summarized in Table 2. Among patients who did not experience strangulation (No NFS), the majority were classified into HRC 3 (493 cases) and EHRiC (499 cases), with minimal representation in lower-risk categories such as Low (3 cases), MRC 1 (9 cases), MRC 2 (17 cases), and MRC 3 (17 cases).

Table 2.

Distribution of Cases Across EHRiC Model Risk Categories.

	Model Category
Group	Low	MRC 1	MRC 2	MRC 3	HRC 1	HRC 2	HRC 3	EHRiC
No NFS (n = 1137)	3	9	17	17	78	21	493	499
All NFS (n = 243)	0	2	6	0	104	1	11	119
Adult NFS (n = 212)	0	1	5	0	96	1	9	100
Child NFS (n = 31)	0	1	1	0	8	0	2	19

Note. NFS = nonfatal strangulation; No NFS = cases without strangulation; All NFS = all cases in the sample with strangulation.

For patients who experienced nonfatal strangulation (All NFS), most were classified into HRC 1 (104 cases) and EHRiC (119 cases), with very few cases in lower-risk categories (MRC 1: 2 cases, MRC 2: 6 cases, and MRC 3: 0 cases).

When stratified by age, adults dominated the higher-risk categories for NFS, with 96 adult cases in HRC 1 and 100 adult cases in EHRiC, compared to only a few child cases (8 in HRC 1 and 19 in EHRiC). While children demonstrated a distribution that more closely aligned with the model's intended structure, they were minimally represented across all other risk categories.

Discussion and Implications

The data consistently demonstrated a pronounced gender disparity in NFS incidents, with females disproportionately affected across all age cohorts, which is consistent with previously published research (Sharman et al., 2024; Pritchard et al., 2018). This gender-specific pattern persisted irrespective of the age of the victims, underscoring the gendered nature of NFS as a form of violence regardless of age. The analysis of co-occurring NFS and sexual assault revealed distinct age-related patterns. The findings suggest a concerning pattern of sexual violence co-occurring with NFS, particularly among children. Notably, minority ethnicity appeared to be a more robust predictor of NFS in pediatric populations compared to adults. The data further suggest that NFS in children presenting for MFE exhibits a predominantly sexual etiology when compared with adult cases, which is consistent with currently published literature (White et al., 2024). It is important to note that the majority of these cases involve adolescents, whose perpetrators are more likely to be friends or acquaintances rather than caregivers. This distinction highlights the unique risk factors for adolescents experiencing NFS, such as social encounters with peers, dating relationships, and environments where reduced supervision may increase vulnerability.

The year 2020 marked a significant inflection point, revealing a striking contrast in NFS cases between adult and pediatric populations. In Texas, the pandemic lockdown began with executive orders on March 19, 2020, and expired March 10, 2021 (The Texas Newsroom, 2021). 2020 included the highest proportion of adult NFS cases (93.8%) and, simultaneously, the lowest proportion of pediatric cases (6.3%) during this period. The overall NFS prevalence in 2020 increased to 18.8%, indicating a general upward trend in NFS occurrence. These findings present an intriguing paradox within the context of the COVID-19 pandemic. While mandated lockdowns were often associated with an increase in adult domestic violence rates, as documented in numerous studies, our data suggest a potentially protective effect for children. This unexpected outcome raises several compelling questions about the dynamics of domestic violence during periods of enforced home confinement. We propose several hypotheses that may contribute to this phenomenon: (a) increased visibility, (b) reduced external stressors, and (c) limited access to vulnerable children. More adults working from home or unemployed, children may have been under constant supervision, potentially deterring abuse. The absence of in-person school-related pressures and peer interactions might have also decreased stress levels for some children. Ultimately, lockdowns may have restricted access for nonfamily perpetrators to target children.

The finding that mandated lockdowns may have paradoxically served as a protective factor for children against domestic violence aligns with a study by Gagné et al. (2021). This study found that some pandemic-related factors, such as increased family time, acted as protective elements against child abuse in certain households. However, it is crucial to note that our study specifically focuses on NFS cases, and the broader implications for overall child abuse rates during the pandemic require further investigation. These results also underscore the complex interplay between societal measures and domestic violence patterns, highlighting the need for nuanced approaches in child protection strategies during crisis periods.

The most recent data from 2023 indicate the highest overall NFS prevalence over the 7-year period at 22.2%, with a slight decrease in the proportion of pediatric cases compared to 2022 (17.2% vs. 19.5%). While this rise cannot be attributed to pandemic-related lockdowns, several other factors may explain this change. One possibility is increased education among law enforcement in the community, leading to more frequent referrals of patients for medical forensic examinations. Additionally, heightened awareness among emergency department staff regarding the importance of consulting forensic nurses for suspected NFS cases could have contributed to the increase. Similarly, forensic nurses may now be more proactive in specifically asking patients about NFS experiences rather than assuming patients will disclose this information unprompted. These potential explanations warrant further investigation to better understand the underlying factors contributing to these temporal variations and their implications for public health interventions and policy formulation.

The EHRiC Model

When considering the EHRiC Model and its use in predicting risk severity for nonfatal strangulation (NFS), most cases of NFS fell into HRC 1 (104 cases) or the EHRiC (119 cases). This suggests that these categories capture most patients but may lack granularity for meaningful differentiation. Minimal representation was noted in MRC 1–3 and HRC 2–3, indicating that these categories may not be well-defined or sensitive to important risk factors.

The misclassification of a striking number of cases without strangulation into HRC 3 (493 cases) and EHRiC (499 cases) highlights a critical limitation in the model's specificity. This suggests that literature-based assumptions may overemphasize extreme and moderate risk factors while underrepresenting lower or intermediate risks. Given the significant misclassification of cases without strangulation into high-risk categories (HRC 3 and EHRiC), there is a critical need to identify additional risk factors that are more specific to nonfatal strangulation (NFS). Ultimately, while the EHRiC Model provides a valuable framework for assessing risk severity in NFS cases, its current design requires refinement to better reflect real-world patient distributions and reduce false positives among those who did not experience strangulation.

Implications for Clinical Forensic Nursing

These findings underscore the complex interplay between demographic factors, societal circumstances, and the prevalence of NFS and present significant implications for clinical forensic nursing practice, education, and research. Forensic nurses should consistently and explicitly screen all patients referred for forensic nursing care for NFS, as many individuals may not recognize its significance, feel hesitant to disclose, or fail to volunteer this information without direct prompting (Walsh et al., 2010). The observed age-related patterns in co-occurring NFS and SA underscore the necessity for developing and implementing age-specific screening protocols, with particular emphasis on pediatric populations. The escalating overall prevalence of NFS necessitates continuous professional development among forensic nurses, with a focus on enhancing skills and knowledge pertinent to NFS assessment and documentation. This pattern also highlights the imperative for forensic nurses to advocate for increased allocation of resources and specialized training within healthcare systems to improve NFS detection and care. Furthermore, the evolving landscape of NFS calls for forensic nurses to participate in policy development and implementation. This involvement would ensure that emerging patterns and evidence-based practices are reflected in institutional and governmental policies addressing these forms of violence.

Implications for Future Research

Further research is essential to better understand the causal mechanisms underlying the observed patterns in the EHRiC Model and to inform targeted prevention and intervention strategies across diverse age groups and demographic subpopulations. Specifically, future studies should focus on examining the demographic and social characteristics associated with NFS cases, investigating how these factors interact to influence the likelihood of NFS occurrence. This approach will provide a more nuanced understanding of the multifaceted elements contributing to NFS incidents.

Priority should be given to developing age-specific detection, intervention, and prevention strategies for NFS. These strategies must address the unique needs and vulnerabilities of different cohorts, recognizing that risk factors and appropriate interventions may vary significantly between adults and children. Additionally, future research should explore the intersectionality of biological sex, race/ethnicity, and cultural factors in NFS victimization. A particular emphasis should be placed on pediatric populations, where social dynamics and caregiver relationships may play a critical role in risk. Investigating these relationships will help uncover how patient–perpetrator characteristics and broader cultural or social influences contribute to elevated NFS risk.

To enhance the predictive accuracy of the EHRiC Model, future studies should aim to identify strangulation-specific indicators that distinguish NFS from broader IPV-related risks. Linear regression analysis could be instrumental in isolating these indicators and refining risk assessment tools. Furthermore, recalibrating thresholds using local data and creating age-specific criteria will improve the model's accuracy across diverse populations.

By identifying key factors that contribute most significantly to NFS incidents and understanding their role in predicting risk, future research can provide invaluable insights for developing more effective risk assessment tools. Ultimately, this knowledge will guide the creation of targeted interventions tailored to specific populations, improving outcomes for individuals at risk of nonfatal strangulation.

Limitations

This study is limited to a single rural hospital and associated Childhood Advocacy Center and may not be representative of the broader population, limiting generalizability of the study findings. As a retrospective study, the results are limited by the accuracy of the original forensic nursing documentation. The study may not have accounted for all potential confounding variables that could influence the prevalence and patterns of NFS. Because our dataset was limited to forensic nursing encounters, cases of noncriminal strangulation are not represented. We were unable to extract the full denominator of trauma or assault-related presentations during the study period, as our IRB approval was limited to forensic service charts. Thus, cases not referred to the forensic team or seen exclusively by other providers could not be captured. This may underestimate prevalence, and future research that incorporates both referral denominators and delayed presentations is warranted. The research may not have fully explored cultural factors that could influence presenting for care following NFS, reporting, or disclosing NFS. Despite these limitations, this study provides valuable insights into the prevalence and patterns of nonfatal strangulation in sexual assault cases and contributes to the growing body of knowledge on this critical public health issue.

Author Biographies

Chelsea Knutson, PhD, RN, CNE, CA/CP-SANE, SANE-A, SANE-P, is a forensic nurse administrator serving as Education and Outreach Specialist at Baylor Scott & White Health in College Station, Texas. Her research focuses on forensic nursing practice, with a particular emphasis on characteristics, temporal changes, and risk of nonfatal strangulation across adult and pediatric populations. She is an active member of the Brazos and surrounding counties Domestic Violence and Human Trafficking Task Force and Scotty's House Multidisciplinary Team, and was recognized as an Outstanding Former Student by Texas A&M University in 2024.

Patricia Carter, PhD, is a tenured Professor of nursing at the University of Texas Medical Branch (UTMB) in Galveston Texas. She has over 40 years’ experience in nursing settings ranging from hospitals to home health, and hospice. This rich clinical work has been combined with 30+ years of research focused on understanding what contributes to quality of life in vulnerable populations. She has designed, implemented, and evaluated over 30 research grants and 9 project grants. She has extensive experience in guiding doctoral students to investigate areas that they are uniquely passionate about, such as the work presented here.

Carol A Carman is a Professor in the Department of Clinical Laboratory Sciences in the School of Health Professions at the University of Texas Medical Branch at Galveston, and also holds an appointment with the Department of Biostatistics and Data Science in their School of Public and Population Health. She teaches statistics, research design, survey design, and scientific writing at the master's and doctoral levels. Her research interests include gifted identification, diversity, and the scholarship of teaching and learning. She served in multiple officer roles for two national professional organizations and on the Editorial Review Boards for two peer-reviewed journals.

Nancy R Downing, PhD, RN, SANE-A, SANE-P, FAAN, is a professor at the University of North Texas Health College of Nursing where she is coordinator of the MSN Nursing Practice Innovation program and project director of the HRSA-funded forensic nursing education program. Her research focuses on the intersections of trauma, interpersonal violence, substance use, and associated health outcomes. She served four terms on the Texas Forensic Science Commission and is Vice Chair of the Forensic Nursing Subcommittee of the Organization of Scientific Area Committees for forensic science. In 2019, she was inducted into the American Academy of Nursing.

Patricia Blair, PhD, LLM, JD, MSN, RN, CNE, CCHP-RN, is an associate professor at the University of Texas Medical Branch (UTMB) School of Nursing where she developed and leads the Correctional Nursing Certificate Program. She is an associate director of the UTMB Correctional Health Center. Her research focuses on health disparities and health outcomes in marginalized populations, inclusive of justice-involved populations. She currently serves on the PCORI Comparative Clinical Effectiveness Research Advisory Panel. She is the current Chair and American Bar Association representative on the National Commission on Correctional Health Care (NCCHC) Board of Representatives.

Stephanie E Meyers, PhD, MEd, RNC-OB, WHNP-BC, CNE, is an Assistant Professor at UTMB School of Nursing. A certified nurse educator and women's health nurse practitioner, she brings over two decades of clinical, academic, and research experience. Her scholarship focuses on maternal health, nursing education, and perinatal care.