Evidence for changing intimate partner violence safety planning needs as a result of COVID-19: results from phase I of a rapid intervention.

OBJECTIVES: The aim of the study was to examine the need for modified safety planning strategies in response to COVID-19-related increases in intimate partner violence (IPV) as the initial phase of adapting an IPV safety planning intervention in Toronto, Ontario. METHODS: A rapid, systematic review was conducted to elucidate existing safety planning strategies used during public health emergencies. These were supplemented with strategies from an expert panel. A survey of IPV survivors and service providers gauged the helpfulness of each strategy during COVID-19. RESULTS: Together, the systematic review and expert panel yielded 26 conceptually distinct strategies, which were evaluated by 111 IPV survivors and providers. Of these, 19 (69%) were 'highly recommended', 3 (12%) were 'somewhat recommended' and 6 (23%) were not recommended for use during the COVID-19 pandemic because they might make the violence worse. CONCLUSIONS: Safety planning needs have changed owing to the effect of COVID-19 on IPV incidence, service provision and risk factors, as well as policies restricting freedom of movement. These results will be used to modify an existing IPV safety planning mobile application for use during COVID-19 and future public health emergencies.

Co-responding Police-Mental Health Programs: A Review.

Co-responding police-mental health programs are increasingly used to respond to 'Emotionally Disturbed Persons' in the community; however, there is limited understanding of program effectiveness and the mechanisms that promote program success. The academic and gray literature on co-responding police-mental health programs was reviewed. This review synthesized evidence of outcomes along seven dimensions, and the available evidence was further reviewed to identify potential mechanisms of program success. Co-responding police-mental health programs were found to have strong linkages with community services and reduce pressure on the justice system, but there is limited evidence on other impacts. The relevance of these findings for practitioners and the major challenges of this program model are discussed, and future research directions are identified.

Yearly incidence of mental disorders in economically inactive young adults.

Increasing rates of mental health problems in youth and an extended period of school-to-work transition is a major concern in Sweden and many other European countries. In this study, being out of the workforce and not in education was associated with severe mental disorders. The risk of being admitted in hospital due to depression was more than doubled in economically inactive young adults. Similarly, the risk of being admitted to hospital due to self-harm and alcohol-related disorder was tripled. Drug abuse was seven times more prevalent among inactive young adults. Processes leading to economic inactivity and to deteriorating mental health are inextricably intertwined. Even if it is not possible to clarify if the association is caused by selection or if it is being outside of labour force that causes mental disorders, it is still urgent to prevent young persons from ending up in long-term economic inactivity.

South Asian Immigrant Men and Women and Conceptions of Partner Violence.

Limited knowledge exists about conceptual variations in defining intimate partner violence (IPV) by ethnicity, such as South Asian (SA) immigrant men and women. In a multi-ethnic study, we employed participatory concept mapping with three phases: brainstorming on what constitutes IPV; sorting of the brainstormed items; and interpretation of visual concept maps generated statistically. The parent study generated an overall general multi-ethnic map (GMEM) that included participant interpretations. In the current study, we generated a SA specific initial-map that was interpreted by eleven SA men and women in gender specific groups. Their interpretations are examined for similar and unique aspects across men and women and compared to GMEM. SA men and women shared similar views about sexual abuse and victim retaliation, which also aligned closely with GMEM. Both SA women and men had an expanded view of the concept of controlling behaviors compared to GMEM. SA women, unlike SA men, viewed some aggressive behaviors and acts as cultural with some GMEM congruence. SA women uniquely identified some IPV acts as private-public. We discuss implications for research and service assessments.

Retrenched Welfare Regimes Still Lessen Social Class Inequalities in Health: A Longitudinal Analysis of the 2003-2010 EU-SILC in 23 European Countries.

This article builds on recent work that has explored how welfare regimes moderate social class inequalities in health. It extends research to date by using longitudinal data from the EU-SILC (2003-2010) and examines how the relationship between social class and self-reported health and chronic conditions varies across 23 countries, which are split into five welfare regimes (Nordic, Anglo-Saxon, Eastern, Southern, and Continental). Our analysis finds that health across all classes was only worse in Eastern Europe (compared with the Nordic countries). In contrast, we find evidence that the social class gradient in both measures of health was significantly wider in the Anglo-Saxon and Southern regimes. We suggest that this evidence supports the notion that welfare regimes continue to explain differences in health according to social class location. We therefore argue that although downward pressures from globalization and neoliberalism have blurred welfare regime typologies, the Nordic model may continue to have an important mediating effect on class-based inequalities in health.

Maternal employment during the early postpartum period: effects on initiation and continuation of breast-feeding.

This study sought to determine whether and to what extent maternal employment in the early post-partum period is associated with the initiation and continuation of breast-feeding in a heterogeneous, urban population. A panel of women were interviewed twice during the first 3 months postpartum. In analyses adjusted for maternal demographic characteristics, there was no association between planning to be employed within the first 6 months postpartum and initiation of breast-feeding. However, actually being employed was significantly associated with cessation of breast-feeding as early as 2 or 3 months postpartum, even after adjustment for maternal demographic variables. Less than one half of mothers who were employed were still breast-feeding at the second postpartum interview, whereas two thirds of those who were not employed were still breast-feeding. Among employed mothers, working no more than 20 hours per week appeared to be protective for continued breast-feeding.

Occupational hierarchy, economic sector, and mortality from cardiovascular disease among men and women. Findings from the National Longitudinal Mortality Study.

PURPOSE: Although socioeconomic position has been identified as a determinant of cardiovascular disease among employed men and women in the U.S., the role of economic sector in shaping this relationship has yet to be examined. We sought to estimate the combined effects of economic sector-one of the three major sectors of the economy: finance, government and production-and socioeconomic position on cardiovascular mortality among employed men and women. METHODS: Approximately 375,000 men and women 25 years of age or more were identified from selected Current Population Surveys between 1979 and 1985. These persons were followed for cardiovascular mortality through use of the National Death Index for the years 1979 through 1989. RESULTS: In men, the lowest cardiovascular mortality was found for professionals in the finance sector (76/100,000 person/years). The highest cardiovascular mortality was found among male non-professional workers in the production sector (192/100,000 person years). A different pattern was observed among women. Professional women in the finance sector had the highest rates of cardiovascular mortality (133/100,000 person years). For both men and women, the professional/non-professional gap in cardiovascular mortality was lower in the government sector than in the production and finance sectors. These associations were strong even after adjustment for age, race and income. CONCLUSIONS: Characteristics of government, finance and production work differentially influence the risk of cardiovascular disease mortality. Men, women, professionals and non-professionals experience this risk differently.

Confirmation of self-report of HIV testing among a cohort of pregnant women.

Early identification of pregnant women infected with the human immunodeficiency virus (HIV) is becoming increasingly important in light of recent findings that interventions during and shortly after pregnancy can reduce the rates of vertical transmission. The ability of patients to accurately self-report previous HIV testing and test results is important in clinical settings. Over a one-year period, 283 women attending a hospital-affiliated obstetrical clinic reported previous HIV testing (44% of the total women approached), and 105 women (37% of the women reporting previous testing) reported being previously tested at that hospital. Self-reported data on previous HIV testing at the hospital were compared with information maintained in a centralized computerized database by the hospital laboratory. Only 41.9% of the women who reported previous HIV testing at the hospital had their reports confirmed. Women whose HIV testing reports were confirmed were found to be similar to those women whose reports were not confirmed with regard to age, educational level, gestational age, parity, reason(s) for seeking HIV testing, and knowledge of testing, transmission and acquired immunodeficiency syndrome (AIDS). These data suggest that, when HIV status is of concern, health care professionals should continue to encourage testing in the absence of laboratory documentation of recent HIV antibody testing.

The impact of pregnancy on women's prenatal and postpartum smoking behavior.

We report patterns of prenatal smoking cessation and postpartum relapse for a large urban population of pregnant women. We examined associations between sociodemographic factors and prepregnancy, pregnancy, and early postpartum smoking behavior. Forty-one percent of women smoking before pregnancy quit smoking during pregnancy. Sociodemographic factors important in predicting smoking cessation during pregnancy, as determined through logistic regression analyses, differed significantly for white and black women. Among white women, education, age, and parity were important predictors of cessation, whereas among black women, only intention to breastfeed was a significant predictor of smoking cessation during pregnancy. Early postpartum smoking relapse rates differed by ethnicity. Twenty-eight percent of white women and 46% of black women who had quit during pregnancy relapsed within 6-12 weeks postpartum. Using logistic regression, we found formula feeding to be the most important predictor of early postpartum smoking relapse for both white and black women.

Women's opinions about domestic violence screening and mandatory reporting.

BACKGROUND: The purpose of this paper is to describe women's opinions and policy preferences concerning domestic violence screening and mandatory reporting. METHODS: This case-control study included 202 abused women and 240 randomly selected non-abused women recruited from a large metropolitan health maintenance organization who were interviewed by telephone. Of these women, 46.6% had a college degree, 53.4% were white, and 60% had a household income of $50,000 or more. RESULTS: Forty-eight percent of the sample agreed that health care providers should routinely screen all women, with abused women 1.5 times more likely than non-abused women to support this policy. For mandatory reporting, 48% preferred that it be the woman's decision to report abuse to the police. Women thought it would be easier for abused women to get help with routine screening (86%) and mandatory reporting (73%), although concerns were raised about increased risk of abuse with both screening (43%) and reporting (52%) policies. Two thirds of the sample thought women would be less likely to tell their health care providers about abuse under a mandatory reporting policy. Interventions offered in managed care settings that would be well received, according to the women in this study, include counseling services, shelters, and confidential hotlines. CONCLUSIONS: Women expressed fears and concerns about negative consequences of routine screening and, even more so, for mandatory reporting. Domestic violence policies and protocols need to address the safety, autonomy, and confidentiality issues that concern women.

Smoking cessation interventions for pregnant women: review and future directions.

A substantial proportion of disease and death in the US could be prevented if tobacco use was curtailed or eliminated. Low birth weight, pregnancy complications, and infant morbidity are but a few of the adverse outcomes experienced by pregnant and postpartum women and infants that result from cigarette smoking. Pregnancy may be an ideal time to intervene with smoking women. On learning of their pregnancy, many women reduce or quit smoking on their own. For those who do not quit, interventions during the childbearing year could provide additional incentive and support for complete cessation. Successful clinic-based interventions share similar characteristics and tailoring cessation messages to client populations may enhance the effectiveness of interventions. Assessing a smoker's degree of addiction and tailoring counseling for cessation according to the patient's readiness might enhance current clinical practices. Even with the most effective individual counseling, it is increasingly evident that additional strategies are needed to achieve population-wide reductions in smoking and its related health conditions. Examples of these efforts are increased taxation on cigarettes, community-based anti-tobacco programs, and increasing the number of smoke-free environments. Thus, in addition to clinic-based efforts, health professionals might take an active role in supporting the broad range of programmatic, legislative, and advocacy efforts.

A critical appraisal of the demand/control model of the psychosocial work environment: epistemological, social, behavioral and class considerations.

During the last decade the demand/control model has emerged as the dominant model to explain the relationship between the psychosocial features of work organization and health. Although originating from the field of occupational social epidemiology, the conceptual and methodological basis of the demand/control model parallel construct based models used in social psychology. Using behavioral and sociological perspectives the current paper discusses the model's limitations. Recommendations regarding incorporation of social levels of analysis, the relationship between self-report and behavior, worker vs expert knowledge, and the generalized effects of stress on mental health are discussed to provide a positive heuristic to the demand/control model.

Psychosocial work environment in human service organizations: a conceptual analysis and development of the demand-control model.

This paper concerns two models that were introduced in two different research domains during the 1970's. The first model regards human service organizations (HSO) as a specific type of organization. The second model, the demand-control model (DC model), concerns the joint effects of job demands and job control on worker health. In the HSO model, there are analyses of the content of jobs, considering the specific characteristics of HSOs, but little is said about the health effects of such work. Those effects stand in focus in the demand-control model. The aim of this paper is to analyze the relevance of the DC model for human service organizations. The paper argues that the object of human service work-the client relation-makes a difference for demand and control in the job. Demand is analyzed into work load, emotional demands and role conflict. Control is divided into administrative control, outcome control, choice of skills, closeness of supervision, control within and over a situation and ideological control. The conclusion is that in applications on HSOs, the basic concepts of the DC model must be developed.

Quality of life among women living with HIV: the importance violence, social support, and self care behaviors.

This paper describes the relationship between psychosocial factors and health related quality of life among 287 HIV-positive women using items from the Medical Outcomes Study HIV Health Survey to measure physical functioning, mental health and overall quality of life. Multivariate models tested the relative importance of sociodemographic characteristics, HIV-related factors and psychosocial variables in explaining these quality of life outcomes. A history of child sexual abuse and adult abuse, social support and health promoting self-care behaviors were the psychosocial factors studied. Women in the sample were on average 33 years old and had known they were HIV-positive for 41 months; 39% had been hospitalized at least once due to their HIV; 83% had children; 19% had a main sex partner who was also HIV-positive. More than one-half of the women (55%) had a history of injection drug use and 63% reported having been physically or sexually assaulted at least once as an adult. A history of childhood sexual abuse. reported by 41% of the sample, was significantly related to mental health after controlling for sociodemographic and HIV-related characteristics. Women with larger social support networks reported better mental health and overall quality of life. Women who practiced more self-care behaviors (healthy diet and vitamins, adequate sleep and exercise, and stress management) reported better physical and mental health and overall quality of life. The high prevalence of physical abuse and child sexual abuse reported by this sample underscores the importance of screening for domestic violence when providing services to HIV-positive women. That such potentially modifiable factors as social support and self care behaviors are strongly associated with health-related quality of life suggests a new opportunity to improve the lives of women living with HIV.

Interpersonal conflict and physical violence during the childbearing year.

Reducing physical abuse directed at women by male partners is one of the nation's Year 2000 health objectives. An important target group for achieving this health objective is pregnant women. The present study examines the frequency, severity, perpetrators and psychosocial correlates of violence during the childbearing year. A panel of 275 women were interviewed 3 times during pregnancy and at 6 months postpartum. Moderate or severe violence was somewhat more common during the postpartum period than during the prenatal period--19% of women reported experiencing moderate or severe violence prenatally, compared to 25% in the postpartum period. For partner-perpetrated violence, being better educated was associated with increased risk of violence as was having had a sex partner who ever shot drugs; being older, having a confidant and having social support from friends were significant protective factors. For violence perpetrated by someone other than a male partner, having a confidant was a significant protective factor. Obstetric care providers who routinely come in contact with pregnant women, as well as emergency department staff, need to be systematically screening for violence against women. Efforts to enhance women's social support networks should be included in primary and secondary prevention programs.

Does organization matter? A multilevel analysis of the demand-control model applied to human services.

The demand-control model (DC model) in occupational epidemiology suggests that health, an individual attribute, is partly determined by work organization, via the interplay of demand and control, job strain. The objective of this study was empirical assessment of the model's tenet of an organizational determination of individual health. An emerging analytic method, multi-level modelling, permits such an assessment. The study encompasses two large Swedish human service organizations. It was based on a nationally representative sample of 291 local organizational units (level 2) with 8296 employees (level 1), a median of 18 employees per unit. 5730 persons (69.1%) completed the questionnaire. Listwise deletion of missing data left a net study base of 4756 individuals in 284 units. Missing data were largely random. Demand and control were measured by standard questions and combined into a job strain index. Two such indices were calculated, one for quantitative demands and one for emotional demands. Individual attributes included age, gender, marital status, having children, social anchorage, and education. There were two dependent variables, self-assessed psychovegetative symptoms (worry, anxiousness, sadness, sleep difficulties, restlessness, and tension) and exhaustion (fatigue, feelings of being used up and overworked), both measured as summative indices. For psychovegetative health, a null model yielded 2.2% level 2 variance, unchanging when individual attributes were included in a random intercepts model. Inclusion of the strain variables rendered level 2 variance non-significant, decreasing level 1 variance by 23% and level 2 variance by 62%. For exhaustion, level 2 variation was 8.3% in the null model and 1.6% in the final model, with strain variables. The strain variables utilized in the DC-model thus draw a substantial part of their variation from the organizational level. It is concluded that the claim of the DC model to rely on organizational factors receives support.

Welfare reform and women's health: review of the literature and implications for state policy.

In August 1996, the Personal Responsibility Work Opportunity Reconciliation Act (P.L. 104-193) was signed into law, ending a 60-year federal entitlement guaranteeing families some basic level of assistance during periods of economic hardship. Several components of this new legislation have the potential to impact upon the health and well-being of women and children. We summarize studies examining the relationship between welfare participation and physical and mental well-being of women and what is known about the effects of poverty on health; the patterns of employment among welfare participants and the health consequences of low-wage work on women; domestic violence among welfare recipients; the potential health consequences of the provisions of the new Temporary Assistance to Needy Families (TANF) program for women's and adolescent health; and the consequences of the new TANF provisions for the health and well-being of immigrant women. We discuss the implications for policy makers in monitoring and minimizing the negative impact of welfare reforms on women's health and well-being.

Correlates of condom use stage of change: implications for intervention.

A telephone survey was used to collect data on attitudes, beliefs, and practices concerning condom use among 812 African Americans with regular sex partners and of reproductive age in Baltimore. Condom use was "staged" according to Prochaska's model of stage of behavioral change. Characteristics of the respondents' sexual relationships, peer characteristics, and demographic and psychosocial characteristics were examined for their association with the stage of condom use. Multiple logistic regression analysis revealed that a partner's reaction to condom use, condom use self-efficacy with the partner, condom use outcome expectancy with the partner, perceived partner risk, length of relationship, sterility, cohabitation, perceived vulnerability to HIV infection and perceived peer norms about condom use were each independently related to staged condom use. Gender differences in the relationship of these independent variables with stages of change were found. Implications for intervention include differential treatment by gender and stage of change. Couples should also be considered for intervention.

PIP: According to 1996 US Centers for Disease Control data, HIV/AIDS has become the second and third leading cause of death for Black and Hispanic women, respectively, in the US aged 25-44 years. The main risks for infection among minority women are IV drug use and sexual contact with IV drug users. Findings are presented from a telephone survey conducted to collect data on the attitudes, beliefs, and practices concerning condom use among 812 reproductive-age African Americans with regular sex partners in Baltimore. Condom use was "staged" according to Prochaska's model of stage of behavioral change, while characteristics of the respondents' sexual relationships, peer characteristics, and demographic and psychosocial characteristics were examined for their association with the stage of condom use. Multiple logistic regression analysis found that a partner's reaction to condom use, condom use self-efficacy with the partner, condom use outcome expectancy with the partner, perceived partner risk, length of relationship, sterility, cohabitation, perceived vulnerability to HIV infection, and perceived peer norms about condom use were each independently related to staged condom use. Gender differences in the relationship of those independent variables with stages of change were found. Implications for intervention include differential treatment by gender and stage of change. Couples should also be considered for intervention.

Women's protective sexual behaviors: a test of the health belief model.

Heterosexual transmission of the human immunodeficiency virus (HIV) has become a significant health issue for women. The present study describes the extent to which a sample of women from an urban area report making efforts to protect themselves from becoming infected with HIV through several protective sexual behaviors. Secondly, we assess the extent to which adoption of these protective behaviors can be explained by health beliefs and previous HIV testing. Forty-nine percent of the sample reported having used a condom in the past year because of fear of AIDS and 48% reported having carried condoms. Women in this sample perceived themselves to be moderately susceptible to AIDS and they were well aware of the severity of the disease. Women tended to think that protecting themselves from AIDS would not be overly burdensome and that the recommended sexual protective behaviors were highly effective for preventing AIDS. Messages about the severity of AIDS and the effectiveness of protective sexual behaviors seem to be reaching women. Beliefs about personal susceptibility were consistently associated with the adoption of multiple protective behaviors, suggesting that messages emphasizing the ubiquity of risk, especially in demographically high-risk populations, may be particularly appropriate and effective.

PIP: The health belief structures that distinguish women who use condoms to protect themselves from themselves from the human immunodeficiency virus (HIV) and those who fail to take protective measures were investigated in a survey of 573 heterosexual women enrolled during their first prenatal visit to the Johns Hopkins Hospital Obstetrical Clinic. 90% of study subjects were African Americans, only 11% were currently married, and 65% were under 25 years of age. The proportions of respondents who had adopted any of the following 6 protective measures in the past year due to a fear of getting acquired immunodeficiency syndrome (AIDS) was the following: had fewer sexual partners (62%), had sex less often (48%), talked with a sex partner about AIDS (72%), decided to refuse sex because of concern a partner might be HIV-positive (47%), used condoms (49%), and carried condoms (48%). On the basis of the Health Belief Model of Janz and Becker, respondents were then questioned on their perceptions of susceptibility to AIDS, severity of the disease, barriers to condom use, and benefits of protected sex. Their mean scores on the preceding subscales, out of a maximum of 5.0, were 3.19, 4.08, 2.18, and 3.75, respectively. After adjusting for demographic factors and number of high-risk life-style practices, multiple regression analysis was used to determine the importance of these health beliefs to protective sexual behaviors. Beliefs about susceptibility and barriers emerged as the most significant correlates and were associated with having sex less often, deciding not to have sex, and carrying condoms. Condom use in the past year was correlated with beliefs about susceptibility, severity, and barriers. Overall, the findings suggest that women are motivated by feelings of personal susceptibility to try protective behaviors, but then conclude they are burdensome and discontinue.

Verbal abuse and physical violence among a cohort of low-income pregnant women.

We report on the occurrence of verbal abuse and physical violence during pregnancy for 358 low-income women. Overall, 65% of the women in our study experienced either verbal abuse or physical violence during their pregnancies. Twenty percent of the women in our sample experienced moderate or severe violence. Perpetrators, although primarily male partners, included family members and friends. These rates varied by age, with younger women experiencing significantly higher rates of verbal abuse and physical violence. There was no association between verbal abuse or physical violence and birth weight or gestational age. Prenatal care may be one of the only opportunities that women, and especially disadvantaged women, may have to get proper assistance with domestic violence. We conclude that enhanced screening, counseling, and referral by obstetricians and other health care providers are some of the immediate activities that could be implemented in prenatal care settings to address the compelling problems of violence during pregnancy.

PIP: This study examines the frequency, perpetrators, and impact of verbal abuse and physical violence among low-income pregnant women. A cohort of 358 low-income pregnant women attending the Johns Hopkins Hospital Adult Obstetric Clinic between December 1989 and September 1990 were included in the study. Information gathered through interview and descriptive analysis revealed that 65% of the women experienced verbal abuse and physical violence during pregnancy; 20% had been through moderate to severe violence. Violence was primarily inflicted by male partners and also by other family members and friends. Moreover, the occurrence of verbal abuse and physical violence were significantly higher among younger aged women, but no association was noted between violence and birth weight and gestational age. Due to the fact that prenatal care may be the only opportunity for low-income women to obtain medical assistance and referral services, prenatal care should include enhanced screening, counseling, and good referral by obstetricians and other health providers in order to address this problem.