The controversy on screening for intimate partner violence: a question of semantics?

In this paper, we review the basis of the U.S. Preventive Services Task Force's recommendations related to routine screening for intimate partner violence (IPV), focus on two of the arguments of those who have rejected these recommendations, and based on these, suggest that this controversy has occurred, in part, as a result of different interpretations of the meaning of "screening." We differentiate screening from situations in which asking about IPV is essential for differential diagnosis, that is, exploring exposure to IPV when there are signs and symptoms that might result from this exposure. Finally, we describe the randomized, controlled trial CDC is conducting to contribute to the evidence the U.S. Preventive Services Task Force requries to make its recommendations.

Prevalence and characteristics of sexual violence victimization among U.S. adults, 2001-2003.

This article provides the most recent U.S. prevalence estimates of forced sex and unwanted sexual activity. Results of a national telephone survey conducted in 2001-2003 indicate that 1 in 59 U.S. adults (2.7 million women and 978,000 men) experienced unwanted sexual activity in the 12 months preceding the survey and that 1 in 15 U.S. adults (11.7 million women and 2.1 million men) have been forced to have sex during their lifetime. There were 60.4% of females and 69.2% of males who were 17 years old or younger at the time the first forced sex occurred. This study provides an update to the National Violence Against Women Survey with more recent national data. Findings suggest that victimization rates have remained consistent since the 1990s. These findings suggest that a continued effort toward primary prevention of sexual violence, particularly rape of children and adolescents, is needed.

National estimates of sexual violence treated in emergency departments.

STUDY OBJECTIVE: There is little information about sexual violence cases treated in emergency departments (EDs). This study describes ED visits associated with sexual violence and considers the associated health care burden. METHODS: A descriptive analysis was conducted using nationally representative data on nonfatal injury-related ED visits identified in the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) as sexual violence. To better understand these NEISS-AIP data, additional information about ED management of cases was collected, and additional information was collected from NEISS-AIP coders to determine the percentage of hospitals serving as designated examination facilities for sexual assault. RESULTS: Of all assault visits to the ED, 4.2% were sexual assault related, which represents an estimated 143,647 ED visits for sexual assault in 2001 to 2002. The majority of sexual assault-related visits involved female and young patients. Nearly half of ED visits for sexual violence had missing perpetrator data. Additional data from hospitals revealed that in 77.8% of the 54 sexual assault cases, someone with specific training completed the examination, and the majority of the hospitals in this study serve as designated examination facilities for sexual assault. CONCLUSION: Given the dearth of national data on sexual violence cases presented at US EDs, the data presented in this article are useful to understand the impact of sexual violence on the health care system at a national level. More complete documentation of sexual assault-related cases in EDs is needed to get a better estimate of the problem in future studies.

Clinical and personal intimate partner violence training experiences of U.S. medical students.

OBJECTIVE: To learn about U.S. medical students' attitudes, experiences, and practices regarding intimate partner violence (IPV). METHODS: In a sample reflective of all U.S. medical schools, we surveyed the class of 2003 in 16 U.S. medical schools at three different times in their training. RESULTS: A total of 2316 medical students responded, for a response rate of 80%. By senior year, although 91% of medical students reported receiving at least some training in discussing IPV, only one fifth reported extensive training. Although 73% of students entering wards thought IPV was highly important for physicians to discuss with patients, only 55% of students entering wards, decreasing to 35% of seniors, thought IPV would be highly relevant to their own practice. Only 55% of seniors reported talking with general medicine patients at least sometimes about IPV. Greater frequency of discussing IPV for seniors was associated with being a woman (60% vs. 50% for men, p = 0.006), self-designating as politically moderate or liberal (p = 0.0008), and thinking (on entering wards) that it was highly important for physicians to talk to patients about IPV (p = 0.0002). Perceived relevance of discussing domestic violence to intended practice was substantially higher among women, underrepresented minorities, those having a personal or family history of domestic violence, and those categorizing themselves as politically liberal or very liberal. Among seniors, the prevalence of reporting a personal history of IPV was 3% for women and 1% for men; 12% of women and 7% of men reported a family or personal IPV history. CONCLUSIONS: Despite national interest in IPV issues, efforts in U.S. medical schools to increase IPV screening and prevention have not achieved saturation. These gaps in IPV instruction in medical schools are a concern because studies have reported that physicians who receive IPV education training are significantly more likely to screen for it.

The association between self-reported lifetime history of forced sexual intercourse and recent health-risk behaviors: findings from the 2003 National Youth Risk Behavior Survey.

PURPOSE: To expand the understanding of the association between recent health-risk behaviors and a history of forced sexual intercourse, using a nationally representative sample of female and male high school students. METHODS: Data were from the 2003 National Youth Risk Behavior Survey, a nationally representative biennial survey of U.S. high school students. Lifetime history of forced sex, recent physical dating violence, and health-risk behaviors (substance use, diet-related behaviors, violence-related behaviors, and health promoting behaviors) were assessed. Analyses were stratified by gender and controlled for grade and race/ethnicity. RESULTS: Of students surveyed, 8.9% reported ever being forced to have sex. One in eight females and one in 16 males experienced forced sex in their lifetime. For females and males, a history of forced sex was associated with experiencing physical dating violence and suicidal ideation in the 12 months preceding the survey and with substance use in the previous 30 days. Female victims were not as likely as female nonvictims to have participated in team sports during the previous 12 months. Male victims were more likely than male nonvictims to have fasted for more than 24 hours to lose weight during the previous 30 days. CONCLUSIONS: A lifetime history of forced sex is associated with recent dating violence and participation in unhealthy behaviors. Services and intervention programs for victimized youth should address health concerns that have been linked to sexual assault. Such programs would provide opportunities for early intervention with lasting implications for improved health.

Stalking in the United States: recent national prevalence estimates.

BACKGROUND: Stalking is a major public health concern, primarily for women, and is associated with many adverse health outcomes, including death. However, the prevalence of stalking among adults in the United States has not been assessed since 1995-1996. The objective of this analysis is to provide more recent national estimates on lifetime stalking and demographic characteristics of stalking victims. METHODS: A sample of adults aged 18 years and older living in the United States (n = 9684) participated in the second Injury Control and Risk Survey (ICARIS-2), a cross-sectional, random-digit-dial telephone survey conducted from 2001 to 2003. Analyses conducted in 2005 focused on the respondents' reports of having ever been stalked in a way that was somewhat dangerous or life-threatening. RESULTS: In the United States, 4.5% of adults reported having ever been stalked. Women had significantly higher prevalence (7%) of stalking victimization than did men (2%) (odds ratio [OR] = 3.68, 95% confidence interval [CI] = 2.77-4.90). People who were never married (OR = 1.43, 95%CI = 1.03-1.99) or who were separated, widowed, or divorced (OR = 1.68, 95% CI = 1.28-2.21) had significantly higher odds of being stalked than those who were married or had a partner. People aged 55 years or older and those who were retired were least likely to report stalking victimization. CONCLUSIONS: Comparable to previous national estimates, this study shows that stalking affects many adults. Nearly 1 in 22 adults (almost 10 million, approximately 80% of whom were women) in the United States were stalked at some time in their lives.

Homicide: a leading cause of injury deaths among pregnant and postpartum women in the United States, 1991-1999.

OBJECTIVES: We identified risk factors for pregnancy-associated homicide (women who died as a result of homicide during or within 1 year of pregnancy) in the United States from 1991 to 1999. METHODS: Pregnancy-associated homicides were analyzed with data from the Pregnancy Mortality Surveillance System at the Centers for Disease Control and Prevention. RESULTS: Six hundred seventeen (8.4%) homicide deaths were reported to the Pregnancy Mortality Surveillance System. The pregnancy-associated homicide ratio was 1.7 per 100000 live births. Risk factors included age younger than 20 years, Black race, and late or no prenatal care. Firearms were the leading mechanism for homicide (56.6%). CONCLUSIONS: Homicide is a leading cause of pregnancy-associated injury deaths.

Issues related to defining and measuring violence against women: response to Kilpatrick.

This paper asserts that although there is considerable agreement in the U.S. and internationally about the importance of uniform terminology and measurement related to violence against women, we need a strategy for choosing standardized definitions and measures. Responding to Kilpatrick's comments at the October 2003 national research conference on violence against women, the author stresses the importance of developing and using uniform terminology related to violence against women, and discusses the lack of a formal mechanism to achieve uniformity of definitions and measurement. Uncertainty about the impact of context on survey findings and the lack of agreement about the optimal scope of measurement are discussed. The author also comments on some difficulties associated with implementing Kilpatrick's proposed modifications to existing measures of rape and sexual assault.

Physical abuse around the time of pregnancy: an examination of prevalence and risk factors in 16 states.

OBJECTIVES: From self-reports we describe and compare the levels and patterns of physical abuse before and during pregnancy while also describing the demographic and pregnancy-related characteristics of physically abused women, the stressful experiences of abused women prior to delivery, and the relationship of the abused woman to the perpetrator(s). METHODS: We used population-based estimates from the Pregnancy Risk Assessment Monitoring System (1996-98) to calculate a multiyear 16-state prevalence with 95% confidence intervals (CIs) and unadjusted risk ratios for demographic, pregnancy-related, and stressful experiences variables. RESULTS: We found the prevalence of abuse across the 16 states to be 7.2% (95% CI, 6.9-7.6) during the 12 months before pregnancy, 5.3% (95% CI, 5.0-5.6) during pregnancy, and 8.7% (95% CI, 8.3-9.1) around the time of pregnancy (abuse before or during pregnancy). The prevalence of physical abuse during pregnancy across the 16 states was consistently lower than that before pregnancy. For time periods both before and during pregnancy, higher prevalence was found for women who were young, not White, unmarried, had less than 12 years of education, received Medicaid benefits, or had unintended pregnancies, and for women with stressful experiences during pregnancy, particularly being involved in a fight or increased arguing with a husband or partner. For each of these risk groups, the prevalence was lower during pregnancy than before. Abuse was ongoing before pregnancy for three quarters of the women experiencing abuse by a husband or partner during pregnancy. CONCLUSIONS: Women are not necessarily at greater risk of physical abuse when they are pregnant than before pregnancy. Both the preconception period and the period during pregnancy are periods of risk, which suggests that prevention activities are appropriate during routine health care visits before pregnancy as well as during family planning and prenatal care.