IPV, SA, Trafficking and STI Risk in Indigenous Women (Part 1)

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IPV, SA, Trafficking and STI Risk in Indigenous Women (Part 1)

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The Intersection of Intimate Partner Violence, Sexual Assault, Trafficking and STI Risk in Indigenous WomenIdentifying Root Causes to Improve Care and Seek Social Justice Content developed December 2020 1 Thank You To Our Co-Sponsors 2 We are honored to co-sponsor this event with the UW School of Nursing STREAM Program, Native American Center for Health Professions and UW Milwaukee's School of Nursing and Women's and Gender Studies program. And, we are very excited to have you all join us today for this webinar. 2 Disclaimer Funding: This presentation is supported by the Health Resources andServices Administration (HRSA) of the U.S. Department of Health andHuman Services (HHS) as part of an award totaling $3,994,961 with nopercentage financed with nongovernmental sources. The contents arethose of the author(s) and do not necessarily represent the official viewsof, nor an endorsement, by HRSA, HHS or the U.S. Government. The research study referenced in this presentation was supported by a generous giftfrom the Forest Country Potawatomi Foundation. Terminology: We are committed to using terminology that respects andhonors the individuals to whom this research is concerned. Currently, thereare over 560 federally recognized American Indian and Alaskan NativeIndian tribes in the U.S. While no single term is universally accepted by allindigenous peoples in the U.S., the terms "American Indian, AlaskanNative, Indigenous, and Native American," are used for data reportingpurposes only, and appear in the form the terminology was originallypublished. It is not meant to minimize, exclude or generalize the individualsinvolved nor endorse one form of terminology over the other. 3 3 Land Acknowledgement 4 Before we begin the presentation I would just like to acknowledge that the University of Wisconsin Madison campus is located on the ancestral lands of the Ho-Chunk nation. 4 Presenters Jeneile Luebke, PhD, RN her/hers Ogimaakwe (Bad River Band Chippewa) Post-doctoral Nurse Research Associate UW-Madison School of Nursing Katie Klein, BA she/they MA Student & Instructor Women's & Gender Studies, UW-Milwaukee 5 This presentation was prepared by Dr. Jeneile Luebke and Katie Klein from in December 2020. 5 Learning Objectives Recognize how intimate partner violence (IPV), sexual assault (SA)and trafficking disproportionately impact Indigenous women in Wisconsin Discuss how intersecting systems of oppression contributes to high rates of IPV/ SA/ trafficking among Indigenouswomen Recall how identity shapes experience and care for SA survivors Describe how stigma plays a role in successful identification and intervention of survivors of IPV 6 6 US IndigenousPopulation Image created by "Presidentman" 7 The ancestors of living Native Americans arrived in what is now the United States at least 15,000 years ago, possibly much earlier In 2010, the U.S. Census Bureau estimated that about 0.8% of the U.S. population was ofAmerican IndianorAlaska Nativedescent. This population is unevenly distributed across the country. According to 2003United States Census Bureauestimates, a little over one-third of the 2,786,652 Native Americans in the United States live in three states:California(413,382),Arizona(294,137) andOklahoma(279,559) As of 2012, 70% of Native Americans live in urban areas, up from 45% in 1970 and 8% in 1940. Urban areas with significant Native American populations include Minneapolis, Denver, Phoenix, Tucson, Chicago, Oklahoma City, Houston, New York City, and Los Angeles. The ancestors of living Native Americans arrived in what is now the United States at least 15,000 years ago, possibly much earlier In 2010, the U.S. Census Bureau estimated that about 0.8% of the U.S. population was ofAmerican IndianorAlaska Nativedescent. This population is unevenly distributed across the country. According to 2003United States Census Bureauestimates, a little over one-third of the 2,786,652 Native Americans in the United States live in three states:California(413,382),Arizona(294,137) andOklahoma(279,559) As of 2012, 70% of Native Americans live in urban areas, up from 45% in 1970 and 8% in 1940. Urban areas with significant Native American populations include Minneapolis, Denver, Phoenix, Tucson, Chicago, Oklahoma City, Houston, New York City, and Los Angeles. 7 Wisconsin Tribes Wisconsin: 11 federally recognized tribes: Bad River Band of Lake Superior Chippewa, Ho-Chunk Nation, Lac Courte Oreilles Band of Lake Superior Chippewa, Lac du Flambeau Band of Lake Superior Chippewa, Menominee Tribe of Wisconsin, Oneida Nation, Forest County Potawatomi, Red Cliff Band of Lake Superior Chippewa, St. Croix Chippewa, Sokaogon Chippewa (Mole Lake), and Stockbridge-Munsee, in addition to a non-federally-recognized tribe (Brothertown Nation). Adapted Native Nations Map. Adapted from "Interactive Map from the Ways: Great Lakes Native Culture and Language," by Art & Sons. Retrieved from https://wisconsinfirstnations.org/map/. 2019 by Wisconsin Educational Communications Board. 8 There are approximately 53,585 American Indians living in Wisconsin (WDHS, 2017). The distribution of American Indian populations in Wisconsin included over 60% in the counties of Milwaukee, Brown, Menominee, Shawano, Sawyer, Outagamie, Vilas, Dane, Ashland, and Bayfield. About 45% of Wisconsin's American Indian population resided in metropolitan areas, including 7,313 American Indians in Milwaukee County alone. 8 Intersections of IPV, SA, Trafficking & Sexually Transmitted Infection (STI) Risk What do we mean by each of these? How do disproportionate risks intersect? What are the relationships? Dawson, L., Kates, J., & Ramaswamy, A. (2019, December 2). HIV, intimate partner violence (IPV), and women: An emerging policy landscape. https://www.kff.org/hivaids/issue-brief/hiv-intimate-partner-violence-ip... 9 IPV: SA: Trafficking: Define each and why we're talking about this Relationship among all types of violence: In many cases, the factors that put women at risk for contracting HIV are similar to those that make them vulnerable to experiencing trauma and IPV. Women in violent relationships are at a four times greater risk for contracting STIs, including HIV, than women in non-violent relationships and women who experience IPV are more likely to report risk factors for HIV.17A nationally representative study found 20% of HIV positive women had experienced violence by a partner or someone important to them since their diagnosis and of these, with half perceiving that violence to be directly related to their HIV serostatus.18Indeed, these experiences are interrelated and can become a cycle of violence, HIV risk, and HIV infection (see Figure 2). In this cycle, women who experience IPV are at increased susceptibility for contracting HIV and HIV positive women are at greater risk of experiencing IPV.19,20 9 Why is this important?Impacts of gender-based violence (GBV) Physical injury (including strangulation) Death: Homicide, suicide, or maternal mortality related to high-risk pregnancy Risk of STIs and HIV Chronic pain or frequent illness Psychological: depression, PTSD, drug and alcohol abuse, eating disorders, sleep disturbances Decreased productivity/ missed work and school 10 Share an experience that explains why this important to you, whether it be a personal or professional experience. 10 Disproportionate Impacts Historical & Contemporary Context 11 11 Gender-based Violence GBV is one of the most serious public health issues occurring in Native American communities today Violence against women is greatest among AI than any other racially defined group: up to 84.3% of AI/AN women have experienced violence in their lifetime (NIJ, 2016) AI women also experience one of the highest rates of homicide in the US. Nearly half, or 46.6% of AI women who were murdered were victims of IPV (Petrosky, Blair, Betz, Fowler, Jack, & Lyons, 2017) AI women disproportionately impacted byIPV, SA, and trafficking AI women at risk forSTI/ HIV transmission during SA and trafficking 12 Native Americans (American Indian/ Alaskan Natives) NA represent about 1% of the US population Women of all ages, ethnicities, and socioeconomic backgrounds can become victims of violence, however, the incidence of violence against women is greatest among Native Americans than any other racially defined group. 12 Crisis of Human Trafficking In large urban areas such as Milwaukee, trafficking is a major issue, and underreported Over the past four years, Milwaukeehas consistently ranked among the top five cities in the nation for the recovery of trafficked adolescents Milwaukee (tied with Las Vegas) for third largest trafficking hub in US,behind Denver and Detroit Many of thevictims of trafficking are minors (as young as 12 have been recovered) In 2019, there were 48,326 contacts to the US National Trafficking hotline 13 Milwaukee repeatedly ranksamong the top citiesfor human trafficking. In 2015,an annual nationwideFBIsting,called Operation Cross Country rescued nine adolescents fromcommercial sexual exploitation, which ties Milwaukee with LasVegas for the third highest number of young people rescuedduring the FBI raids across the US. Denver tops the list, with20 young people rescued, and Detroit was next with 19. 13 Missing and Murdered Indigenous Women (MMIW) The voices of Indigenous people have united to raise awareness of missing and murdered Indigenous woman and girls (MMIWG) Impacts Indigenous peoples in Canada, New Zealand, Australiaand theUS (and in other indigenous populations globally) The National Crime Information Center reported that as of2016 there were 5,712 reports of missing AI/AN women and girls in the US NamUsonly logged 116 of these 5,702cases (Department of Justice, 2018) Indigenous women living on tribal lands are murdered at 10x the national average (NIJ) This is a crisis that has been happening for hundreds of yearswith deep rootsof historical and contemporary settler colonial influence and injustice 14 Indigenous women don't just "disappear like a magic trick". Tied tohistorical roots of dispossession andviolence. NamUS is currently defunded (see news report) 14 STI Stats Dawson, L., Kates, J., & Ramaswamy, A. (2019, December 2). HIV, intimate partner violence (IPV), and women: An emerging policy landscape. https://www.kff.org/hivaids/issue-brief/hiv-intimate-partner-violence-ip... 15 15 Intersecting Systems Of Oppression 16 16 Overlapping and Intersecting Oppressive Systems Violence Against AI Women Environmental and economic policies High levels of incarceration Tensions with law enforcement Jurisdiction and sovereignty Historical trauma Distrust of healthcare and social service agencies Barriers to seeking or receiving care Underfunded IHS facilities 17 Settler Colonialism: Origins of Violence High rates of violence are deeply intertwined in the history of colonization and sociopolitical contexts Colonization and forced assimilation Termination policies, creation of reservations, land dispossession, boarding schools Loss of culture, language, kinship, and ways of life historicracism,discrimination, exclusion, and marginalization. Centuries of sexual violence that starting during colonial times (origins of "trafficking") Harmful assumptions and stereotypesof American Indians 18 18 Contemporary Forms of Oppression Indian Relocation Act (1956) Oliphant vs. Suquamish (1978) Public Law 280 (1953) State foster care systems (Indian Child Welfare Act-1978) Forced sterilization (1970's) Energy and economic policies Fossil fuel extraction Lack of funding for Indian Health Service 19 Public Law 280 Public Law 83- 280(commonly referred to as Public Law 280 or PL 280) was a transfer of legal authority (jurisdiction) from the federal government to state governments which significantly changed the division of legal authority among tribal, federal, and state governments. Congress gave six states (five states initially - California, Minnesota, Nebraska, Oregon, and Wisconsin; and then Alaska upon statehood) extensive criminal and civil jurisdiction over tribal lands within the affected states (the so-called "mandatory states"). Public Law 280 also permitted the other states to acquire jurisdiction at their option. Public Law 280 has generally brought about: an increased role for state criminal justice systems in "Indian country" (a term which is specifically defined in federal statutes), a virtual elimination of the special federal criminal justice role (and a consequent diminishment of the special relationship between Indian Nations and the federal government), numerous obstacles to individual Nations in their development of tribal criminal justice systems, and an increased and confusing state role in civil related matters 19 Jurisdiction, Sovereignty, and Criminal Justice System Indian Law and Order Commission. (2013). A roadmap for making Native America safer (Report No. NCJ 244155). Indian Law and Order Commission. https://www.aisc.ucla.edu/iloc/report/ 20 Wisconsin is one of eight PL-280 states in the US 20 Intimate Partner Violence In The Lives Of Urban American Indian Women:A Continuation Of Colonial Injustice Critical ethnography study insights 21 21 Dissertation Research Understand how IPV manifests in the lives of urban AI women by centering their voices and their individual lived experiences in the local context Crisis of violence against AI women, including IPV, in both urban and reservation areas (NSVIS, 2016) Addresses a gap in the literature: currently no studies published about IPV with AI women in Wisconsin Exemplar of Indigenous feminist activism through a study led by an AI nurse researcher and survivor of IPV 22 Critical ethnography:a qualitative research approach that sets out to challenge racism, colonialism, and oppression to foster social change (Madison, 2011) Is it worthwhile here to discuss terminology? Why you use American Indian and also Native & Indigenous? Also, acknowledging you specifically interviewed women, but recognizing that trans and nonbinary/gender queer folks and femmes who may or may not identify as women are also subject to disproportionate IPV? I can definitely clarify that I used cis women in my study for simplicity 22 Findings and Significance Many barriers exist that prevent AI women from the help that they need and deserve after IPV/ SA 68.8% (N=22) reported physical and/ or emotional IPV during the pregnancy period, and 3/4 (72%) experiencing IPV in more than one pregnancy (N=16) Survivors spoke of linkages between their experiences and adverse health and pregnancy related outcomes The COVID-19 pandemic served to exacerbate barriers to help seeking (job loss, housing,etc.) Many of the participants experienced sexual assault within their intimate partnerships, some experiencing STIs as a result 23 Survivors spoke of linkages between their experiences and adverse health outcomes: negative pregnancy experience Lack of or delays in prenatal care Pregnancy & birth outcomes birth out comes Lack of informal supports and perpetuation of violence through generations Of the 34 survivors interviewed: 67.6% (N=23) refused/ unable to seek medical attention after IPV experience regardless of injury 24% (N=8) of survivors received medical care only because the IPV was witnessed and a call to 911 was placed on their behalf 17% (N=7) sought other types of help such as a domestic violence shelter, counseling, or a call to the police. 23 BARRIERS TO SEEKING CARE What do you think are barriers to seeking care after an experience of SA, IPV and/or trafficking? 24 24 Barriers Women of color are more reluctant to seek help after an experience of violence Silence is a trauma response. Voices have been silenced for centuries. Milwaukee: 2/3 of AI women interviewed for qualitative study did NOT seek help (regardless of injury) Lack of resources (poverty/ insurance/ transportation) Lack of SA advocacy Geographic barriers (few DV shelters in rural areas) Fear of retaliation by perpetrator or partner Lack of culturally specific resources 25 Understanding the barriers to help seeking is crucial To remove barriers, we have to understand them first 25 COVID-19 COVID-19 is greatly exacerbating all types of violence! Not safer at home/limitations of shelters and other resources/ job loss DV-related homicides are increasing in Wisconsin during COVID: 47 domestic violence related homicide deaths in 2018, and 72 in 2019 As of September 29, 2020, 69 Wisconsin lives lost to DV related homicide so far in 2020 22% of the victims were age 18 or under 26 According to End Abuse Wisconsin's Domestic Violence Homicide Report (2020) If this pattern continues, it is estimated that 93 lives will be lost this year. 26 How Identity Shapes Experience How anti-oppressive theories and frameworks help us to understand 27 27 CHAT TIME: Why it Matters 28 Why does it matter that we understand the roots of these systems in order to improve care for Indigenous women experiencing violence? We are trying to remove barriers; to remove them we have to understand them; Understanding barriers means understanding systemic oppression Both the prevalence of violence against AI women, especially the high rates of interracial perpetrators, and the difficulty accessing services are directly tied to colonization and the intersections of racism, sexism, poverty and an absence of tribal sovereignty. Any response must both acknowledge this and center Indigenous ways of knowing and the voices of Indigenous feminists and AI women who have lived this experience. Add further Barriers to care are unique to each individual survivor and affected by multiple factors. Barriers may be structural, cultural, contextual, or a combination. 28 Why it Matters 29 We are seeking to minimize and eliminate barriers to care for victim survivors To understand barriers, we must understand systemic oppression Women experiencing violence are the experts in what they need in terms of interventions Creation of survivor-led interventions will better serve victims and survivors We are trying to remove barriers; to remove them we have to understand them; Understanding barriers means understanding systemic oppression Both the prevalence of violence against AI women, especially the high rates of interracial perpetrators, and the difficulty accessing services are directly tied to colonization and the intersections of racism, sexism, poverty and an absence of tribal sovereignty. Any response must both acknowledge this and center Indigenous ways of knowing and the voices of Indigenous feminists and AI women who have lived this experience. Add further Barriers to care are unique to each individual survivor and affected by multiple factors. Barriers may be structural, cultural, contextual, or a combination. 29 Critical Theoretical Frameworks Indigenous feminism, Postcolonial theory, and Intersectionality Analytical lens(es) to better understand the complexities within sociopolitical and historical locations of vulnerable populations (Mkandawire-Valhmu, 2018) Self-sovereignty is self-governance. My body, my rules! 30 Theory and analytical tool rooted in Black Feminism and connected to Woman of Color feminisms &activism Crenshaw (1991) utilizes intersectionality to explore how experiences of violence that women of color face are often the result of intersecting racism and sexism. This helps us to understand the complex, interacting and over lapping systems of oppression which shape Indigenous women's experiences of violence and their experiences seeking care. Intersectionality is particularly salient in recognizing how race and influence the effectiveness of interventions. Poll: Who feels they know what intersectionality is?Answer yes or no in the poll! Also, feel free to add a comment in the chat box to share your understanding of intersectionality. "Intersectionality is a way of understanding and analyzing the complexity in the world, in people, and in human experiences....When it comes to social inequality, people's lives and the organization of power in a given society are better understood as being shaped not by a single axis of social division, be it race or gender or class, but by many axes that work together and influence each other." (Collins& Bilge, 2016, p. 2) How is this a useful tool and lens? 30 How has identity shaped the experience of violence and care? "I tried to go to counseling once at my university, and I just... I see now what was wrong with our counselor, but I didn't like it.Now I see she just had no cultural understanding and really struggled with the way that I had relationships in my life.I went to see the counselor when I was a few years out and was raising my sister, who was a teenager, my mom was living with us and... Raising is a strong word, she was already a teenager. She was living with me and I was just kind of helping her get through high school. And my mom had moved in with me too, and I had a lot going on. And the counselor basically was like, "You're 26, why don't you just go out and get your own apartment and let them deal with what they have going on?"... No understandings around kinship and relationships and family.... She had a very individualistic sense of what was right, and it did not fit very well and made me feel ashamed. So, never went back to counseling there, anywhere" - Hailey* 31 (make sure to highlight that the names are pseudonyms to protect participant identity) 31 Learned Social Practices Dominant social norms facilitates the dismissal of SA experienced by ethnic minority women This happens through the justification of racism and sexism Learned social practices Assumed as truth Imbeded into policies and interventions Impact women's access to healthcare following an experience of SA 32 Postcolonial, Indigenous Feminist and Intersectional theories contribute to an understanding of hegemonic masculinities Hegemonic masculinities are learned social practice sassumed as truth that have been imbeded into policies and interventions that impact women's access to health care following an experience of sexual assault. Hegemonic masculinities serve to facilitate the overlooking or dismissal of the sexual assault experienced specifically by ethnic minority women through the justification of racism and sexism. the justification of racism and sexism (whether implicit or explicit, individual or institutional) facilitates the dismissalof SA experienced by ethnic minority women 32 How has identity shaped the experience of violence and care?(cont.) 33 "Talking about how the medical system treated you. The doctor that I saw, and it was an OBGYN, he... Oh my God, he just had nothing to say to me. He was just like, "You have HPV and there are pre-cancer cells here in your cervix and we gotta freeze those out." But his overall attitude was like, "You're a slut." [laughter] It's like, "No." And I was like, "Well, I guess he's got certain attitudes about sexuality and whatever." [chuckle] But yeah, I was like, to be in that position and that level of power with your patients, it just really blew me away that he would be so blatant about his disgust."- Ivy* "So just, to me, being Native American is so different, and especially being in the system, and I don't even feel like we're considered as humans sometimes."- Laurie* 33 Breaking Down Stigma Identifying and Intervening to Support Victim-Survivors of IPV, SA and Trafficking and Address STI Risk 34 Katie 34 Stigma as a Barrier to Care Screening for IPV, SA & Trafficking & STI risk must be interconnected Shame was a major barrier to care, as was unsupportive and sometimes unsafe experiences with care Normalizing screening for IPV, SA & Trafficking is key to supporting victim-survivors Reduce stigma through the promotion of self-sovereignty More specific and approaches for culturally safe care and effective interventions will be shared in another webinar 35 Katie 35 What happens without screening? Laurie's* story reflects the need for screening: "I wish doctors would notice the signs so that they can help us before we get damaged." Laurie's*advice to nurses & allied health professionals: "Let us know we're safe. Take us to a safe place. If they see what's happening, bring us somewhere. Try to get us away from the abuser, even if they're sitting right outside. Let them know that it's okay, we can get you out safely." Laurie* shares what would be helpful for other women: "Safe testing for us and let them know that it's okay to open up. It took me years. This is actually the first time opening up." 36 S1:Okay, okay, okay. I'm just trying to figure out, as a nurse and maybe coming into contact with people who may have been in a similar situation, like what we can do to try to... S2:Let us know we're safe. Take us to a safe place. If they see what's happening, bring us somewhere. Try to get us away from the abuser, even if they're sitting right outside. Let them know that it's okay, we can get you out safely.S1:Okay. Had someone, if someone would have said that, if they would have somehow maybe read your body language and figured out about alerting whoever waiting, would you have taken that help?S2:Yeah.S1:Yeah. Okay.S2:Because I was tired of getting beaten. S2:Just if they can get us out earlier, it would help us, that we wouldn't go with that because that's what we're used to.[identity being as a victim/survivor] S2:I wish doctors would notice the signs so that they can help us before we get damaged. S2:Safe testing for us and let them know that it's okay to open up. It took me years. This is actually the first time opening up. 36 Breaking Free, Resilience & Finding Support To other survivors: "I know that they aren't feeling pretty or beautiful or strong, but that deep down inside of them, they are walking with hundreds of years of beautiful ancestors that are inside of them, that can and will help them through, whatever it is that they're going through" - Willow* "I think that people just want to be believed." - Shelley* 37 37 Breaking Free... "There's hope. There is hope you can get out. it's almost like you're tangled up in a spider web because of shared housing, children, and love it seems hard to leave.But there's still hope. There are ways out, you can find scissors and cut those webs. I know, because I did". Hailey* 38 38 Next Steps and Call to Action Check out Part II: Providing Survivor Led, Advocacy Driven, and Culturally Safe Care Print pamphlets Post information Write to your legislators. Encourage them to support and pass the Violence Against Women's Act. Help on the front lines! Oppose energy policies that destroy Native lands and communities! Non-Native allies and advocates are needed. We can't do this alone! 39 Check out Part II: Providing Survivor Led, Advocacy Driven, and Culturally Safe Care. In part II, we will focus on the connections between IPV & STI/HIV risk and discuss strategies and resources for providing care Learning Objectives: Recognize how exposure to intimate partner violence increases a women's risk for contracting sexually transmitted infections. Describe three strategies for delivering culturally safe care to survivors of sexual assault and intimate partner violence. Identify two resources to support sexual transmitted infection screening and immediate access to HIV post-exposure prophylaxis. 39 Questions? 40 Thank Jeneile and Katie for working on this for And thank you to all of the research participants for their courage and for empowering us to do better 40 Resources for Patients and Providers IPV, SA and Trafficking Strong hearts Native Helpline: https://www.strongheartshelpline.org(1-844-762-8483) Domestic Abuse Intervention Services: 608-251-4445 (helpline) Rape Crisis Center: 608-251-7273 (24/7help line) RAINN's (Rape, Abuse & Incest National Network): 1-800-656-4673 (helpline)|www.rainn.org/ National Domestic Violence Hotline: 1-800-799-723www.thehotline.org (live chat available online) National Human Trafficking Hotline:1-888-373-7888 (TTY: 711); Text 233733 https://humantraffickinghotline.org(live chat available online) For clinical care teams Midwest AETC: www.matec.info National Clinician Consultation Center (NCCC):nccc.ucsf.edu/ AETC NCRC nPEP Toolkit:https://aidsetc.org/resource/non-occupational-post-exposure-prophylaxis-... Sexual Assault: PEP is an Urgent Health Need: https://aidsetc.org/blog/sexual-assault-pep-urgent-health-need 41 41 References Crenshaw, K. (1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43(6), 1241. Collins, P., & Bilge, S. (2016). Intersectionality. Cambridge, UK ; Malden, MA: Polity Press. Department of Justice (2018). NamUs. Retrieved fromhttps://www.namus.gov/MissingPersons/Search. Luebke J. Intimate Partner Violence in the Lives of Urban American Indian Women: A Continuation of Colonial Injustice. (Unpublished doctoral dissertation). University of Wisconsin-Milwaukee. 2020. National Crime Information Center (2018). Federal Bureau of Investigation. 42