Assessing Intimate Partner Violence in South Asian Women Using the Index of Spouse Abuse.

Intimate Partner Violence (IPV) affects 21-40% of South Asian (SA) women in the United States. No screening tool has been validated in this population. This study sought to determine the validity of the Index of Spouse Abuse (ISA) as an IPV screening tool and to determine the prevalence of IPV among a SA immigrant population. Thirty-one percent of women screened positive on one or both ISA scales. The ISA-P and ISA-NP items were highly reliable as was the correlation between the ISA-P and ISA-NP scores. The ISA is a valid and reliable IPV screening tool in the SA immigrant population.

Intimate partner violence screening and the comparative effects of screening mode on disclosure of sensitive health behaviours and exposures in clinical settings.

OBJECTIVE: Detecting sensitive health information in clinical settings is of scientific and practical importance. The purpose of this study was to determine whether mode of screening influenced disclosure of intimate partner violence (IPV) in patterns similar to other forms of sensitive information. STUDY DESIGN: This cross sectional study was designed to compare effects of face-to-face vs computer self-assessment for sensitive health information on disclosure rates. Multivariate logistic regression was used for the analysis. METHODS: Data were collected in 2012 from 639 eligible African American consenting women receiving services in women, infants and children (WIC) clinics. Women were randomized to complete assessments of sensitive exposures via computer-assisted self-interview (CASI) or face-to-face interview (FTFI). Those with complete information were included in the analysis (n = 616). RESULTS: Of 39 sensitive health exposures, reporting was higher for FTFI than CASI for exposure to IPV (7 of 7 outcomes), tobacco use (2 of 3 outcomes) and reproductive health care (2 of 3 outcomes). For example, face-to-face improved disclosure of IPV in the last year (adjusted odds ratios [aOR] = 2.27; 95% CI = 1.60-3.21) and any drug, tobacco or alcohol in the last week (aOR = 1.39; 95% CI = 1.00-1.93). CONCLUSION: Trained personnel may enhance disclosure above computer-based assessments for IPV for African American women receiving public assistance through The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) Propensities to disclose sexual health behaviour and drug use by CASI may not apply to IPV in this population. The context and personal motivations influence women's decision to disclose IPV.

Intimate Partner Victimization and Health Risk Behaviors Among Pregnant Adolescents.

OBJECTIVES: To provide lifetime estimates of intimate partner victimization among pregnant adolescents and examine associations between victimization and health risk behaviors identified by the Centers for Disease Control and Prevention as leading causes of adolescent morbidity and mortality. METHODS: Participants (n = 1233) were predominantly Latina (58%) and non-Latina Black (34%) pregnant adolescents (aged 14-21 years) enrolled in a randomized controlled trial of group prenatal care in 14 clinical sites in New York City (2008-2012). They completed surveys to assess interpersonal victimization and risk behaviors: substance use, risky sexual behaviors, injuries or violence, unhealthy dietary behavior, and inadequate physical activity. RESULTS: Fifty-two percent reported intimate partner victimization, which was associated with nearly all health risk behaviors. CONCLUSIONS: Pregnant adolescents who experienced intimate partner victimization were significantly more likely to engage in health risk behaviors, which can have adverse health consequences. Expanded prevention programs tailored to specific needs of pregnant adolescents are needed. Health care providers and others who work with pregnant adolescents should consistently screen for and intervene in intimate partner victimization.

Physical intimate partner violence and low birth weight in newborns from primary health care units of the city of Rio de Janeiro / Violência física entre parceiros íntimos e baixo peso ao nascer em recém nascidos atendidos em unidades básicas de saúde da cidade do Rio de Janeiro

ABSTRACT Objective To investigate the association between physical intimate partner violence and low birth weight. Methods This cross-sectional study included 604 children with approximately 30 days of age who visited four primary health care units in the city of Rio de Janeiro , Brazil, for the second dose of hepatitis B vaccine. Children with a birth weight below 2.500 g were considered underweight. Information regarding physical intimate partner violence was obtained by the Portuguese version of the Conflict Tactics Scale. The study investigated the 12 months prior to interview. Physical intimate partner violence was analyzed as a dichotomous variable and cumulatively. Associations between physical intimate partner violence and low birth weight were verified by logistic regression models based on crude and adjusted odds ratios and their respective 95% confidence intervals. Results Some (7.1%) babies were born underweight, and 33.6% of the mothers had been exposed to physical intimate partner violence. Physical intimate partner violence was significantly associated with low birth weight (OR=3.69; 95%CI=1.57-8.66). Notably, the odds of low birth weight increase with the severity of violence. Conclusion These findings draw attention to the consequences of physical intimate partner violence on the nutritional status of newborns and emphasize the need of greater attention during prenatal care to improve women's quality of life and to reduce the rate of low birth weight.

RESUMO Objetivo Investigar a associação da violência física entre parceiros íntimos e a ocorrência de baixo peso ao nascer. Métodos Estudo seccional com 604 crianças com cerca de 30 dias que compareceram a quatro unidades de saúde do município do Rio de Janeiro, Brasil, para realização da segunda dose da vacina contra hepatite B. Crianças nascidas com peso inferior a 2,500 g foram consideradas baixo peso. Informações referentes à violência física entre parceiros íntimos foram obtidas por meio da versão em português do instrumento Conflict Tactics Scale. O período de tempo investigado referiu-se aos 12 meses anteriores à entrevista. A violência física entre parceiros íntimos foi analisada de maneira dicotômica e cumulativa. As associações entre violência física entre parceiros íntimos e baixo peso ao nascer foram verificadas via modelos de regressão logística, mediante estimativas de razões de chances brutas e ajustadas e seus respectivos intervalos de 95% de confiança. Resultados Nasceram com baixo peso 7,1% das crianças e foram expostas à violência física entre parceiros íntimos 33,6% das mulheres estudadas. A violência física entre parceiros íntimos foi significativamente associada com o baixo peso ao nascer (OR=3,69; IC95%=1,57-8,66). Destaca-se que à medida que a gravidade da violência cresce, aumentam também as chances de ocorrência para o baixo peso ao nascer. Conclusão Esses achados chamam a atenção para as consequências da violência física entre parceiros íntimos no estado nutricional do recém nato, e apontam para necessidade de maior atenção durante os cuidados do pré-natal, visando à melhoria da qualidade de vida da mulher assim como à diminuição de nascimentos de baixo peso.

Reproductive Health Knowledge among African American Women Enrolled in a Clinic-Based Randomized Controlled Trial to Reduce Psychosocial and Behavioral Risk: Project DC-HOPE.

BACKGROUND: Washington, DC, has among the highest rates of sexually transmitted infections and unintended pregnancy in the United States. Increasing women's reproductive health knowledge may help to address these reproductive health issues. This analysis assessed whether high-risk pregnant African American women in Washington, DC, who participated in an intervention to reduce behavioral and psychosocial risks had greater reproductive health knowledge than women receiving usual care. METHODS: Project DC-HOPE was a randomized, controlled trial that included pregnant African American women in Washington, DC, recruited during prenatal care (PNC). Women in the intervention group were provided reproductive health education and received tailored counseling sessions to address their psychosocial and behavioral risk(s) (cigarette smoking, environmental tobacco smoke exposure, depression, and intimate partner violence). Women in the control group received usual PNC. Participants completed a 10-item reproductive knowledge assessment at baseline (n = 1,044) and postpartum (n = 830). Differences in total reproductive health knowledge scores at baseline and postpartum between groups were examined via χ(2) tests. Differences in postpartum mean total score by group were assessed via multiple linear regression. RESULTS: Women in both groups and at both time points scored approximately 50% on the knowledge assessments. At postpartum, women in the intervention group had higher total scores compared with women receiving usual care (mean 5.40 [SD 1.60] vs. 5.03 [SD 1.53] out of 10, respectively; p < .001). CONCLUSIONS: Although intervention participants increased reproductive health knowledge, overall scores remained low. Development of interventions designed to impart accurate, individually tailored information to women may promote reproductive health knowledge among high-risk pregnant African American women residing in Washington, DC.

La violencia contra mujeres en comunidades transnacionales de San Luis Potosí, México: un problema de salud pública / Violence against women in transnational communities in San Luis Potosí, Mexico: a public health problem / A violência contra as mulheres nas comunidades transnacionais de San Luis Potosí, México: um problema de saúde pública

Resumen: La violencia contra las mujeres es un problema mundial, dado el impacto que tiene en la calidad de vida de quienes la viven, bajo la complicidad de una cultura patriarcal y un Estado que la invisibiliza. Este artículo busca hacer visibles los contextos de violencia en que viven mujeres "parejas de migrantes" en las localidades de origen, problematizando cómo atentan contra su salud física y mental. Se trató de un estudio cualitativo con enfoque en la antropología interpretativa, con 21 mujeres de localidades rurales y urbanas de San Luis Potosí, México; se aplicaron entrevistas desde el marco de historia de la vida cotidiana y análisis de discurso. Los resultados muestran que las mujeres viven mayor violencia cuando sus parejas migran, nuevas formas de violencia se cometen contra ellas, y los ámbitos en que la sufren incluyen el doméstico y el comunitario. La violencia contra las mujeres constituye un problema de salud pública que debe atenderse desde un marco sensible a las dinámicas sociales y culturales que caracterizan los contextos en que se aplican los programas de salud.

Abstract: Violence against women is a worldwide problem due to its impact on quality of life for those living under the complicity of a patriarchal culture and a state that makes such violence invisible. This article aims to give visibility to the contexts of violence affecting female "partners of migrants" in their places of origin, problematizing how such violence assaults their physical and mental health. This was a qualitative study with an interpretative anthropological focus, drawing on a sample of 21 women from rural and urban areas in San Luis Potosí, Mexico. Interviews were based on daily life history and discourse analysis. According to the results, women experience more violence when their spouses migrate, new forms of violence are committed against them, and the violence occurs in both the household and the community. Violence against women is a public health problem that should be treated through a framework that is sensitive to the social and cultural dynamics characterizing the contexts in which health programs are implemented.

Resumo: A violência contra as mulheres é um problema mundial, devido ao impacto que tem na qualidade de vida daquelas que a sofrem, submetidas à cumplicidade de uma cultura patriarcal e um Estado que a deixa invisível. Este artigo objetiva visibilizar os contextos de violência que sofrem as mulheres "casais de emigrantes" nas localidades de origem, problematizando de que forma atentam contra a saúde física e mental delas. Foi realizado um estudo qualitativo com uma abordagem na antropologia interpretativa com 21 mulheres das localidades rurais e urbanas de San Luis Potosí, México; foram feitas entrevistas desde a perspectiva da historia da vida cotidiana e análises do discurso. Os resultados mostram que as mulheres vivem uma maior violência quando seus parceiros emigram e novas formas de violência são cometidas contra elas, acontecendo tanto no âmbito doméstico, quanto no comunitário. A violência contra as mulheres constitui um problema de saúde pública que deve ser visto desde um quadro sensível com as dinâmicas sociais e culturais que caracterizam os contextos em que se aplicam os programas de saúde.

Violence screening and viral load suppression among HIV-positive women of color.

Recent research suggests intimate partner violence (IPV) is commonly experienced by many people living with HIV/AIDS, which can complicate their care. We introduce a novel approach to screening for history of violence among 102 women of color living with HIV and receiving care at an outpatient public health clinic. Using a composite measure composed of data from a variety of screening tools, we were able to determine that 70.6% of the women had a history of violence using the composite measure, and that 43% screened positive using multiple screening tools. Although overall viral load suppression rate was high at 81.4%, women with a history of violence were less likely to be virally suppressed when compared to those without such a history (76.4% versus 93.3%, p<0.05). Our findings suggest using a variety of screening questions at entry and at follow-up care appointments may be key to identifying and supporting women survivors who may not disclose violence when first asked. Future research should foster further development, analysis, and use of a variety of screening tools such as those used in this study.

Is screening for depression in the perinatal period enough? The co-occurrence of depression, substance abuse, and intimate partner violence in culturally diverse pregnant women.

BACKGROUND: The perinatal period provides unique opportunities to identify and intervene with the co-occurrence of perinatal depression, intimate partner violence (IPV), and substance use problems. Psychosocial screening recommended for women seen in maternal child health settings tends to target single rather than multiple risk factors; there is limited research examining the co-occurrence of these issues especially in racially and ethnically diverse women across the perinatal period. These analyses explore the relationships of sociodemographic, psychosocial, and behavioral characteristics in a large, diverse sample of women. METHOD: Women receiving perinatal services at routinely scheduled visits, including the 6-week postpartum visit, were recruited from 10 community obstetric/gynecologic clinics. Data were collected on perinatal depression, IPV, maternal substance use, and sociodemographic characteristics by bilingual, bicultural research assistants. RESULTS: A total of 1868 women were screened, 1526 (82%) Latina, 1099 (58.8%) interviewed in Spanish; 20.4% (n=382) screened positive for depressive symptoms based on an Edinburgh Postnatal Depression Scale score of 10 or above, 20.9% reported harmful drinking, 4.3% reported drug use, 23% reported substance use problems, and 3.5% reported current or recent IPV. Women who were Black, Asian, Pacific Islander, or other race/ethnicity had greater odds for depressive symptoms relative to women who were Hispanic or Latino (odds ratio [OR]=1.81, p=0.005). Women reporting substance use problems (OR=2.37, p<0.0001) and IPV (OR=3.98, p<0.0001) had higher odds for depressive symptoms. CONCLUSION: In a predominately Latina sample, 1 in 5 mothers (20.4%) screened positive for depressive symptoms and over one third (36.7%) reported one or more psychosocial issues during the perinatal period. Screening for multiple risk factors rather than just one can help clinicians tailor interventions for the successful management of psychosocial issues.

Violência doméstica contra mulheres e a atuação profissional na atenção primária à saúde: um estudo etnográfico em Matinhos, Paraná, Brasil / Domestic violence against women and professional intervention in primary healthcare: an etnographic study in Matinhos, Paraná State, Brazil / Violencia doméstica contra mujeres y la actuación profesional en la atención primaria a la salud: un estudio etnográfico en Matinhos, Paraná, Brasil

A violência doméstica provoca múltiplas repercussões na saúde das mulheres e gera desafiadora agenda para os profissionais do SUS. Objetivou-se analisar como profissionais de saúde atendem tais mulheres, problematizando a noção de acolhimento em saúde. Adotou-se pesquisa qualitativa e aproximação etnográfica com profissionais de uma unidade básica de saúde (UBS) de Matinhos, Paraná, Brasil. A pesquisa revelou atendimentos centrados em: (1) preceitos biologizantes, com foco em lesões físicas e medicalização; (2) diálogo, escuta ativa, questões psicossociais e estabelecimento de vínculos, destacando-se agentes comunitários de saúde nesta abordagem. A escassez de estrutura local oficial para manejo da violência doméstica enseja atuação inscrita sob a gramática do acolhimento, preconizada pelo SUS, descrita pela literatura, verbalizada na UBS, mas pouco problematizada. Com este artigo buscou-se, portanto, contribuir com tal debate, não no estabelecimento de prescrições, porém no levantamento de indagações e principalmente visibilizando e traduzindo vozes de quem trabalha diuturnamente com esse desafio.

Domestic violence has multiple repercussions on women's health and raises a challenging agenda for health professionals in Brazilian Unified National Health System (SUS). The aim of this study was to analyze how health professionals treat these women, problematizing the notion of acolhimento (receptiveness or openness to patients). A qualitative ethnographic research approach was used with health professionals from a primary care unit (PHU) in Matinhos, Paraná State, Brazil. The study revealed care that was focused on: (1) biologizing principles, with a focus on physical lesions and medicalization and (2) dialogue, active listening, psychosocial questions, and establishment of ties, especially featuring community health agents in this approach. The limited official local structure for handling domestic violence justifies treatment oriented by the grammar of acolhimento, recommended by the SUS, described in the literature, and verbalized in the PHU, but rarely problematized. This article thus proposed to contribute to this debate, not by establishing prescriptions for action, but by raising questions and mainly highlighting and translating the voices of those who deal with this challenge on a daily basis.

La violencia doméstica provoca múltiples repercusiones en la salud de las mujeres y genera una desafiante agenda para profesionales del SUS. El estudio tuvo por objetivo analizar cómo atienden los profesionales de salud a tales mujeres, problematizando la noción de acogida en salud. Se adoptó una investigación cualitativa y una aproximación etnográfica con profesionales de una unidad básica de salud (UBS) de Matinhos, Paraná, Brasil. La investigación reveló atención centrada en: (1) preceptos biologizantes, centrándose en lesiones físicas y medicalización; (2) diálogo, escucha activa, cuestiones psicosociales y establecimiento de vínculos, destacándose los agentes comunitarios de salud en este enfoque. La escasez de estructura local oficial para el manejo de la violencia doméstica da pie a la actuación inscrita bajo las tesis de la acogida, preconizada por el SUS, descrita por la literatura, verbalizada en la UBS, pero poco problematizada. Con este artículo se buscó, por tanto, contribuir con este debate, no en el establecimiento de prescripciones, sino en la realización de indagaciones y, principalmente, visibilizando y traduciendo voces de quien trabaja desde hace mucho tiempo con ese desafío.

A review of the health effects of sexual assault on African American women and adolescents.

OBJECTIVE: To review the research findings for mental and physical health outcomes and health behaviors of African American women and adolescents after sexual assault. DATA SOURCES: Searches of the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, PsycINFO, and PubMed from January 2001 through May 2012 using the terms Blacks, African Americans, sexual abuse, sexual offenses, and rape. STUDY SELECTION: Criteria for inclusion included (a) results of primary research conducted in the United States and published in English, (b) African American females age 13 and older, (c) sexual assault or sexual abuse reported as distinct from other types of abuse, and (d) health status as an outcome variable. Twenty-one publications met inclusion criteria. DATA EXTRACTION: Articles were reviewed for the mental and physical health and health behavior outcomes associated with sexual assault of African American women and adolescents. DATA SYNTHESIS: Sexual assault was associated with increased risk of poor mental and physical health outcomes in the general population of women and adolescents. There was an increased risk of unhealthy behaviors (e.g., drinking, drug use, risky sexual behaviors) for all women and adolescents, with the highest risk reported for African American women and adolescents. Help seeking from family and friends demonstrated conflicting results. Cumulative effects of repeated assaults appear to worsen health outcomes. CONCLUSION: Sexual assault has significant effects on the physical and mental health and health behaviors of women and adolescents in the general population. Less evidence is available for differences among African American women and adolescents. More research is needed to understand the influence of race on women's and adolescents' responses to assault.

An integrated randomized intervention to reduce behavioral and psychosocial risks: pregnancy and neonatal outcomes.

While biomedical risks contribute to poor pregnancy and neonatal outcomes in African American (AA) populations, behavioral and psychosocial risks (BPSR) may also play a part. Among low income AA women with psychosocial risks, this report addresses the impacts on pregnancy and neonatal outcomes of an integrated education and counseling intervention to reduce BPSR, as well as the contributions of other psychosocial and biomedical risks. Subjects were low income AA women ≥18 years living in the Washington, DC, metropolitan area and seeking prenatal care. Subjects (n = 1,044) were screened for active smoking, environmental tobacco smoke exposure (ETSE), depression, or intimate partner violence (IPV) and then randomized to intervention (IG) or usual care (UCG) groups. Data were collected prenatally, at delivery, and postpartum by maternal report and medical record abstraction. Multiple imputation methodology was used to estimate missing variables. Rates of pregnancy outcomes (miscarriage, live birth, perinatal death), preterm labor, Caesarean section, sexually transmitted infection (STI) during pregnancy, preterm birth (<37 weeks), low birth weight (<2,500 g), very low birth weight (<1,500 g), small for gestational age, neonatal intensive care unit (NICU) admission, and >2 days of hospitalization were compared between IG and UCG. Logistic regression models were created to predict outcomes based on biomedical risk factors and the four psychosocial risks (smoking, ETSE, depression, and IPV) targeted by the intervention. Rates of adverse pregnancy and neonatal outcomes were high and did not differ significantly between IG and UCG. In adjusted analysis, STI during the current pregnancy was associated with IPV (OR = 1.41, 95% CI 1.04-1.91). Outcomes such as preterm labor, caesarian section in pregnancy and preterm birth, low birth weight, small for gestational age, NICU admissions and >2 day hospitalization of the infants were associated with biomedical risk factors including preexisting hypertension and diabetes, previous preterm birth (PTB), and late initiation of prenatal care, but they were not significantly associated with active smoking, ETSE, depression, or IPV. Neither the intervention to reduce BPSR nor the psychosocial factors significantly contributed to the pregnancy and neonatal outcomes. This study confirms that biomedical factors significantly contribute to adverse outcomes in low income AA women. Biomedical factors outweighed psychosocial factors in contributing to adverse pregnancy and neonatal outcomes in this high-risk population. Early identification and management of hypertension, diabetes and previous PTB in low income AA women may reduce health disparities in birth outcomes. Level of evidence I.

Prevalence and determinants of intimate partner violence against women in Kazeroon, Islamic Republic of Iran.

The aim of this study was to screen for and estimate the prevalence of intimate partner violence (IPV) among women in Kazeroon, Iran. In November 2007, multistage cluster sampling was employed to recruit 702 women to participate in the study. A descriptive, cross-sectional design was employed. The prevalence of physical, psychological, and sexual abuse against women was 43.7%, 82.6%, and 30.9%, respectively, and there was a significant relationship between IPV and family income, education level, and level of religious commitment in both women and husbands. The study suggests that major strategies for prevention of IPV are empowering women and improving their status in the society by promoting of sexual equality in all rights, especially in employment and education.

Intimate partner violence and other partner-related factors: correlates of sexually transmissible infections and risky sexual behaviours among young adult African American women.

BACKGROUND: Intimate partner violence and other partner-related factors have been associated with acquiring sexually transmissible infections (STIs) and engaging in risky sexual behaviour. The present study examined partner-related risk factors for STIs and risky sexual behaviours among an urban sample of African American women. METHODS: African American women, between 18 and 29 years (n = 848), participated in the study at baseline. Participants completed a 40-min Audio Computer Assisted Survey Interview assessing sociodemographics, partner-related factors and HIV/STI-associated sexual risk behaviours. Subsequently, participants provided two vaginal swab specimens for STIs. RESULTS: The findings indicated that risky sexual behaviours and STIs were prevalent in this sample: 35.6% reported a risky sexual partner, 65.4% reported inconsistent condom use and 17% tested positive for a laboratory-confirmed STI. Women reporting a history of intimate partner violence were more likely to report risky sexual partners (adjusted odds ratio (AOR) = 2.00; 95% confidence interval (CI) = 1.5-2.8), inconsistent condom use (AOR = 1.60; 95% CI = 1.1-2.3) and test positive for an STI (AOR = 1.46; 95% CI = 0.99-2.1). Women reporting high partner-related barriers to condom use were more likely to report risky sexual partners (AOR = 1.69; 95% CI = 1.2-2.3), inconsistent condom use (AOR = 2.13; 95% CI = 1.5-3.0) and test positive for an STI (AOR = 1.98; 95% CI = 1.3-3.0). Finally, women with older partners were more likely to report risky sexual partners (AOR = 1.53; 95% CI = 1.1-2.1) and test positive for an STI (AOR = 1.46; 95% CI = 1.0-2.2). CONCLUSIONS: This study examines partner-related risk factors for STIs and risky sexual behaviours among African American women. These findings underscore the need for combined intimate partner violence and HIV/STI prevention programs for this disproportionately affected high-risk group.

Validation of the Spanish version of the Index of Spouse Abuse.

BACKGROUND: Partner violence against women is a major public health problem. Although there are currently a number of validated screening and diagnostic tools that can be used to evaluate this type of violence, such tools are not available in Spain. The aim of this study is to analyze the validity and reliability of the Spanish version of the Index of Spouse Abuse (ISA). METHODS: A cross-sectional study was carried out in 2005 in two health centers in Granada, Spain, in 390 women between 18 and 70 years old. Analyses of the factorial structure, internal consistency, test-retest reliability, and construct validity were conducted. Cutoff points for each subscale were also defined. For the construct validity analysis, the SF-36 perceived general health dimension, the Rosenberg Self-Esteem Scale and the Goldberg 12-item General Health Questionnaire were included. RESULTS: The psychometric analysis shows that the instrument has good internal consistency, reproducibility, and construct validity. CONCLUSIONS: The scale is useful for the analysis of partner violence against women in both a research setting and a healthcare setting.

Effects of fear of abuse and possible STI acquisition on the sexual behavior of young African American women.

OBJECTIVES: We examined the interactive effects of fear of abuse and knowledge of sexually transmitted infections (STIs) on sexual risk behaviors in a sample of young African American women. METHODS: We recruited 715 young African American women aged 15 to 21 years from a variety of health clinics and assessed them for fear of abuse because of negotiating condom use, knowledge of STIs, and several sexual risk behaviors. RESULTS: Overall, 75% of young African American women reported inconsistent condom use in the past 60 days. Surprisingly, under relatively higher levels of fear, young women with high STI knowledge were more likely than were those with low STI knowledge to exhibit inconsistent condom use in the past 60 days (89% vs 80%; chi(2) = 4.32; P < or = .04) and during the last sexual intercourse with a main sexual partner (76% vs 70%; chi(2) = 8.06; P < or = .01). CONCLUSIONS: Most HIV prevention interventions focus on increasing knowledge about the transmission of STIs. However, other contextual factors such as fear of abuse because of negotiating condom use may heighten the risk of HIV infection. Our findings highlight the need for combining dating violence prevention activities with STI and HIV prevention programs targeting young African American women.

Intimate partner violence: development of a brief risk assessment for the emergency department.

OBJECTIVES: Women assaulted by intimate partners are frequently patients in emergency departments (EDs). Many victims and health care providers fail to take into account the potential risks of repeat partner violence. The objective of this study was to use data from a larger study of domestic violence risk assessment methods to develop a brief assessment for acute care settings to identify victims at highest risk for suffering severe injury or potentially lethal assault by an intimate partner or former partner. METHODS: Victims of intimate partner violence (IPV) were interviewed twice between 2002 and 2004. The baseline interview included the 20 items of Campbell's Danger Assessment (DA; predictor). The follow-up interview, conducted 9 months later on average, assessed abuse inflicted since the baseline interview (outcome). Multiple logistic regression was used to identify questions on the DA most predictive of severe abuse and potentially lethal assaults. Female IPV victims were recruited from New York City family courts, Los Angeles County Sheriff's Department 9-1-1 calls, New York City and Los Angeles shelters, and New York City hospitals; 666 women responded to the DA at baseline, and 60% participated in follow-up interviews. RESULTS: Severe injuries or potentially lethal assaults were experienced by 14.9% of retained study participants between the baseline and follow-up interviews. The best brief prediction instrument has five questions. A positive answer to any three questions has a sensitivity of 83% (95% confidence interval = 70.6% to 91.4%). CONCLUSIONS: This instrument can help predict which victims may be at increased risk for severe injury or potentially lethal assault and can aid clinicians in differentiating which patients require comprehensive safety interventions.

Health behavior in Mexican pregnant women with a history of violence.

This study examines the association between history of violence, attitudes toward pregnancy, and initiation of prenatal care (PNC). Pregnant women receiving their first PNC visit at a public prenatal clinic in Monterrey, Mexico, were enrolled in the study. Structured interviews collected information concerning demographics, reproductive history, current pregnancy, attitudes toward pregnancy, history of violence, and perceived barriers and benefits of PNC. Results showed that 35% of participants reported violence. A current or previous partner was the most common perpetrator. Of women experiencing abuse, 47% reported that abuse was ongoing during the current pregnancy. More women reporting violence were unmarried, did not live with a partner, and reported a lower monthly income. An experience of violence was associated with initiation of PNC, number of pregnancies, perception of barriers, and negative attitudes toward pregnancy. This issue should be emphasized in recognition of the important role that nurses and midwives have regarding violence.

Ha sentido sola? Culturally competent screening for intimate partner violence in Latina women.

OBJECTIVE: Intimate partner violence (IPV), a common public health problem, affects women irrespective of ethnicity. Primary care visits provide an excellent opportunity to identify IPV survivors; however, among immigrant Latina women, language can be a barrier. Several IPV screening instruments are available in English, but few are available in Spanish. Therefore, we sought to estimate the screening characteristics of seven validated screening questions translated into Spanish. METHODS: Participants included 105 Spanish-speaking Latina women, aged 18-64 years, seen for primary care in an urban teaching hospital. Measures used were (1) screening questions: seven dichotomous response-option IPV screening questions, and (2) comparison standard: Index of Spouse Abuse (ISA), adapted for lifetime IPV. All measures were professionally translated into Spanish. Sensitivity and specificity, with 95% confidence intervals (CI), of all questions were estimated using 2 x 2 tables. Sensitivity and specificity with 95% CIs were estimated for the two questions with highest sensitivity. RESULTS: Mean age was 38.5 years (SD 11.4); 89.5% were uninsured, and 33% reported lifetime IPV. Spanish translations of the following questions: "Have you ever been in a relationship where you have felt controlled by your partner?" and "Have you ever been in a relationship where you have felt lonely?" had the highest individual sensitivity. The sensitivity of an affirmative response to either question was 94% (95% CI 86%, 100%), and the specificity of an affirmative response to both questions was 86% (95% CI 78%, 94%). CONCLUSIONS: Simple screening questions used in combination are highly sensitive for IPV detection in immigrant Latina women and may assist clinicians caring for them to identify a history of IPV.

Screening for intimate partner violence in a pediatric primary care clinic.

OBJECTIVES: To estimate the prevalence of intimate partner violence among parents at a pediatric primary care clinic and to evaluate the stability, sensitivity, specificity, positive and negative predictive values, and likelihood ratios of a very brief screen for intimate partner violence. METHODS: A total of 200 parents (mostly mothers) bringing in children less than 6 years of age for child health supervision completed the Parent Screening Questionnaire in a primary care clinic. The Parent Screening Questionnaire, a brief screen for psychosocial problems developed for the study, includes 3 questions on intimate partner violence. Mothers then completed the computerized study protocol within 2 months. This included the Parent Screening Questionnaire as well as the Revised Conflict Tactics Scale. Different combinations of the intimate partner violence questions were evaluated against the Revised Conflict Tactics Scale. RESULTS: A total of 12.0% of the mothers answered "yes" to at least one of the screening questions. On the standardized Revised Conflict Tactics Scale, responses ranged from 9% reporting a physical injury in the past year to 76% reporting psychological aggression. There was moderate stability of the screening questions. A single question, "Have you ever been in a relationship in which you were physically hurt or threatened by a partner?" in relation to the "physically injured" Revised Conflict Tactics Scale subscale was most effective. Sensitivity was 29%, specificity was 92%, positive predictive value was 41%, and negative predictive value was 88%. The positive likelihood ratio was 3.8, and the negative likelihood ratio was 0.77. CONCLUSIONS: Intimate partner violence is a prevalent problem. A very brief screen can reasonably identify some mothers who could benefit from additional evaluation and possible services. Additional research is needed to find a more sensitive screen and to examine whether identifying intimate partner violence leads to interventions that benefit mothers, families, and children.

Early detection and prevention of domestic violence using the Women Abuse Screening Tool (WAST) in primary health care clinics in Malaysia.

Despite being an emergent major public health problem, little research has been done on domestic violence from the perspectives of early detection and prevention. Thus, this cross-sectional study was conducted to identify domestic violence among female adult patients attending health centers at the primary care level and to determine the relationship between social correlates of adult patients and domestic violence screening and subsequent help/health-seeking behavior if abused. Face-to-face interviews were conducted with 710 female adult patients from 8 health centers in Selangor who matched the inclusion criteria and consented to participate in the study, using a structured questionnaire that included adaptation of a validated 8-item Women Abuse Screening Tool (WAST). Statistical tests showed significant differences in ethnicity, income, and education between those screened positive and those screened negative for domestic violence. Of the participants, 92.4% reported that during consultations, doctors had never asked them whether they were abused by their husband/partner. Yet, 67.3% said they would voluntarily tell the doctor if they were abused by their husband/partner. The findings indicate that primary care has an important role in identifying domestic violence by applying the WAST screening tool, or an appropriate adaptation, with women patients during routine visits to the various health centers. Such assessment for abuse could be secondary prevention for the abused women, but more important, it will serve as primary prevention for nonabused women. This approach not only will complement the existing 1-stop crisis center policy by the Ministry of Health that copes with crisis intervention but also will spearhead efforts toward prevention of domestic violence in Malaysia.