Trends in Nonfatal Strangulation During Sexual Assault, 2016-2025.

Objectives. To document prevalence and trends in nonfatal strangulation (NFS) among sexual assault survivors. Methods. This study is a retrospective analysis of forensic medical records from January 1, 2016, through December 31, 2025, maintained at a high-volume sexual assault nurse examiner program in Arizona. We fit modified Poisson regression models to test for trends in NFS prevalence and estimated the adjusted relative risk of NFS associated with individual and interpersonal factors. Interactions by year evaluated changes in risk factors over time. Results. Prevalence of NFS during sexual assault doubled over the study time frame, reaching 25.7% in 2025. The vast majority of NFS survivors were women. Assaults involving NFS were more likely to involve a weapon and to occur when the survivor knew their assailant compared with incidents that did not involve NFS. Factors associated with NFS did not change over time. Conclusions. This study documents a rise in NFS during sexual assault in recent years. Public Health Implications. NFS is a pernicious form of violence with numerous short- and long-term consequences for survivors. Its rising prevalence warrants greater attention and intervention. (Am J Public Health. Published online ahead of print September 24, 2026:e1-e4. https://doi.org/10.2105/AJPH.2026.308727).