Concerned friends of intimate partner violence survivors: results from the myPlan randomized controlled trial on college campuses.

BACKGROUND: Nearly half of intimate partner violence (IPV) survivors experience their first abusive relationship at college age (18-24 years). Most often they disclose the violence to friends. Existing college campus "bystander" interventions training peers to safely intervene have been effective in sexual assault prevention; similar interventions have rarely been tested for IPV. Therefore, we evaluated the effectiveness of an interactive, personalized safety decision and planning tool, myPlan app, on decisional conflict, decisional preparedness, confidence in intervening, supportive safety behaviors, and IPV attitudes with concerned friends of abused college women. METHODS: We recruited college students (age 18-24, N = 293) of any gender who had a female-identified friend who had recently experienced IPV ("concerned friends") from 41 Oregon and Maryland colleges/universities. Participants were randomized to myPlan (n = 147) or control (usual web-based resources; n = 146). Outcomes included decisional conflict, decisional preparedness, confidence to intervene, safety/support behaviors, and IPV attitudes. RESULTS: At baseline, concerned friends described the abused person as a close/best friend (79.1%); 93.7% had tried at least one strategy to help. Most (89.2%) reported concerns their friend would be seriously hurt by the abuser; 22.7% reported extreme concern. Intervention participants had greater improvements in decisional conflict (specifically, understanding of their own values around the decision to intervene and help a friend) and decisional preparedness immediately after their first use of myPlan, and a significantly greater increase in confidence to talk with someone about their own relationship concerns at 12 months. At 12-month follow-up, both intervention and control groups reported increased confidence to intervene, and did not differ significantly in terms of percentage of safety/support strategies used, whether strategies were helpful, or IPV attitudes. CONCLUSIONS: A technology-based intervention, myPlan, was effective in reducing one aspect of decisional conflict (improving clarity of values to intervene) and increasing decisional preparedness to support a friend in an unsafe relationship. Information on IPV and related safety strategies delivered through the myPlan app or usual web-based resources both increased confidence to intervene with a friend. College students in the myPlan group were more likely to talk with someone about concerns about their own relationship, demonstrating potential for IPV prevention or early intervention. TRIAL REGISTRATION: Clinicaltrials.gov ID: NCT02236663, registration date 10/09/2014.

Intimate partner violence during the perinatal period by disability status: Findings from a United States population-based analysis.

AIMS: The aim of the current study was to compare the prevalence of intimate partner violence (IPV) during the perinatal period among respondents with self-reported disability compared with those without a disability. DESIGN: We conducted a secondary analysis of nationally representative data from the Pregnancy Risk Assessment Monitoring System data from 24 participating United States between 2018 and 2020. METHODS: A cross-sectional sample of 43,837 respondents provided data on disability, including difficulty in vision, hearing, ambulation, cognition, communication and self-care. The exposure was perinatal IPV, defined as experiencing abuse by a current or ex-partner in the year before or during pregnancy. Regression models were used to calculated odds of IPV by disability status while accounting for relevant sociodemographic characteristics. RESULTS: Respondents who self-reported disabilities experienced IPV at a higher rate than those without disabilities, both before and during pregnancy. In fully adjusted models, respondents with disabilities had about 2.6 times the odds of experiencing IPV before pregnancy, and about 2.5 times the odds of experiencing IPV during pregnancy, compared with those without disabilities. CONCLUSION: Respondents with disabilities experienced IPV at higher rates than the general population, and thus are at increased risk for adverse maternal, neonatal and infant health outcomes. IMPACT: Perinatal IPV is a significant issue globally, and our findings suggest perinatal IPV is particularly salient for persons with disability. Findings highlight the need to screen women with disabilities for IPV during the perinatal period as well as the importance of providing them appropriate, accessible information, resources and referrals.

Health and safety concerns of female asylum seekers living in an informal migrant camp in Matamoros, Mexico.

BACKGROUND: Whilst increased numbers of people worldwide exercise their human right to seek asylum, the US has greatly reduced the number of asylum seekers able to enter its southern border, resulting in informal encampments. Women and children are uniquely vulnerable to violence and other health risks. AIM: To describe the health and safety concerns of female asylum seekers living in an informal migrant camp, with a particular focus on the risks of violence against women and children. METHODS: For this qualitative descriptive study, female asylum seekers were purposively recruited in an informal tent encampment in Matamoros, Mexico (n = 43). Semi-structured interviews were conducted in January and February 2020. Qualitative data were analysed using thematic analysis. RESULTS: The themes identified were constant vigilance, the effects of constant vigilance, lack of resources, and uncertainty. Women's unrelenting fears about their own safety and that of their children impacted their ability to access the camp's meagre resources and exacerbated negative effects on women and children. CONCLUSION: Applying established guidelines and best practices for health and safety in humanitarian settings could mitigate threats to women and children. Additionally, camp conditions represent human rights violations. Nurses have an ethical duty to advocate for an end to the US policies creating and maintaining this humanitarian crisis. IMPACT: As a result of changes to the United States immigration policy, individuals seeking asylum at the Southern border of the US have been largely prevented from entering the US since early 2018. Asylum seekers living in an informal encampment on the border awaiting entry describe a public health, humanitarian and human rights crisis. Women in this already vulnerable group lacked necessities, such as housing, food security, potable water, protection against gender violence and other forms of physical threats to themselves and their children. This created a heightened sense of vigilance and fear, with implications for their mental health and well-being and that of their children. These findings highlight the need for governmental and international organizations to implement the best health and safety practices for humanitarian settings to ensure equity in relation to the social determinants of health. Nurses have an ethical obligation to be strong human rights advocates. PATIENT OR PUBLIC CONTRIBUTIONS: One member of the research team has extensive experience as an advocate for recently immigrated women experiencing intimate partner violence. The study procedures were reviewed with advocates providing direct services to migrant women and children.

Depressive symptoms during the perinatal period by disability status: Findings from the United States Pregnancy Risk Assessment Monitoring System.

AIMS: The aim of the current study was to compare the prevalence of depressive symptoms during the perinatal period among respondents with a disability as compared to those without a disability. DESIGN: We conducted a secondary analysis of nationally representative data from the Pregnancy Risk Assessment Monitoring System data from 24 participating United States between 2018 and 2020. METHODS: A cross-sectional sample of 37,989 respondents provided data on disability, including difficulty in vision, hearing, ambulation, cognition, communication and self-care. The outcome of interest was perinatal depressive symptoms, defined as experiencing depressive symptoms during the antenatal period or postpartum period. Regression models were used to calculate odds of depressive symptoms during these two time periods by disability status while controlling for relevant sociodemographic characteristics and depressive symptoms prior to pregnancy. RESULTS: Respondents with disabilities experienced a higher prevalence of depressive symptoms in both the antenatal period and postpartum period as compared to those without disabilities. In fully adjusted models, respondents with disabilities had 2.4 times the odds of experiencing depressive symptoms during pregnancy and 2.1 times the odds of experiencing postpartum depressive symptoms as compared to respondents without disabilities. CONCLUSION: Respondents with disabilities experience a higher prevalence of depressive symptoms throughout the perinatal period thereby increasing the risk for adverse maternal, neonatal and infant health outcomes. IMPACT: Perinatal depression is a significant public health issue globally, and our findings suggest that persons with disability are at an increased risk for depressive symptoms both during pregnancy and in the postpartum period. Our findings represent a call to action to improve clinical and supportive services for women with disabilities during the perinatal period to improve their mental health and the consequent health of their offspring. PATIENT OR PUBLIC CONTRIBUTION: We thank our Community Advisory Board members who have been instrumental in the conception of this study.

Predictors of cervical cancer screening for refugee women attending an international family medicine clinic in the United States.

PURPOSE: Cervical cancer screening (CCS) rates are lower for foreign-born women in the United States (U.S.) compared with the overall population. This study aimed to determine the CCS rate and predictors among refugees who were identified as female attending a family medicine clinic. METHODS: A retrospective chart review included refugee individuals aged 21+, seen in the previous 3 years (3/23/2015-3/20/2018), without hysterectomy (n = 525). Lab results determined CCS rate. Chi-square and logistic regression models explored predictors of CCS. RESULTS: Overall, 60.0% were up-to-date (UTD) on CCS. Individuals aged 30-49, married, and with [Formula: see text] 1 child had higher odds of being UTD. Ten or more years living in the U.S. was a significant bivariate predictor of CCS, and approached significance in the multivariate model. CONCLUSION: This study begins to fill gaps in knowledge about cervical cancer control among individuals who resettled in the U.S. as refugees and, given that CCS rates are suboptimal, informs clinical practice improvements and directions for future research.

The relationship between housing instability and intimate partner violence: A retrospective study.

OBJECTIVE: To examine the relationship between housing instability (HI) and intimate partner violence (IPV) over time, controlling for individual, situational, and social structural factors among women and to determine whether race/ethnicity modifies these relationships. DESIGN AND SAMPLE: The study was a retrospective secondary data analysis from the Fragile Families and Child Well-Being Study. The sample included women who reported their housing status at year 5, yielding 4,000 women. MEASURES: Housing instability was our main independent variable. Our dependent variable of IPV was divided into two categories: no IPV or IPV overtime (IPV reported at baseline, year 1 and year 5). RESULTS: Women were more likely to report HI if they were between the ages of 20-24 (36%), Black (53.2%), did not graduate from high school (48.6%), and were employed with an income of less than $10,000 USD (69%). Race/ethnicity was not found to influence the association between HI and IPV overtime. CONCLUSIONS: Women in their early to mid-twenties, with a low level of education and are employed at low-wage jobs have an increased risk for HI and experiencing IPV. Therefore, nurses need to move beyond traditional assessments and screening to elicit information that will help determine increased risk for HI.

Risk Factors and Indicators for Commercial Sexual Exploitation/Domestic Minor Sex Trafficking of Adolescent Girls in the United States in the Context of School Nursing: An Integrative Review of the Literature.

As trusted health care providers in the school setting, school nurses are positioned uniquely to identify children at risk for or victims of commercial sexual exploitation of children (CSEC). Nevertheless, many victims go unrecognized and unaided due to inadequate provider education on victim identification. This review provides a comprehensive overview of the major risk factors for CSEC of girls aged 12-18, the largest group of CSEC victims in the United States. A search of four databases (Web of Science, CINAHL, PsychINFO, and PubMed) yielded 21 articles with domestic focus, published in English between January 2014 and May 2020. While childhood maltreatment trauma was found most relevant, a variety of other risk factors were identified. Future nursing research is called to address the numerous research gaps identified in this review that are crucial for the development of policies and procedures supporting school nurses in recognizing victims quickly and intervening appropriately.

Self-collection of samples for HPV testing to increase participation in cervical cancer screening by immigrant women: An integrative review.

OBJECTIVE: To examine methods and results of studies assessing self-collection of cervico-vaginal samples for human papillomavirus (HPV) testing by immigrant women for insights into how future research using this method with unique subpopulations of women may improve the rates of cervical cancer screening (CCS) compared to current strategies. DATA SOURCES: Four electronic databases were systematically searched through March 2020, with no limits applied. A manual review of reference lists was also completed. STUDY SELECTION: The search resulted in 63 articles. After removal of duplicates, 36 were reviewed against inclusion criteria. A manual review of reference lists yielded two additional studies. The final sample included 15 relevant publications representing 13 unique empirical studies. DATA EXTRACTION: Data related to study methodology and empirical results were extracted into table form. DATA SYNTHESIS: The methods of the studies were summarized and synthesized, including diversity of participants, community engagement, including collaboration with public health nurses or community health workers. In addition, methods and findings related to the educational components of the studies, and empirical findings related to various cultural groups, were described. CONCLUSION: To reduce health disparities in CCS, researchers should focus on diverse groups, such as immigrant women, to understand important individual and group-specific factors that may influence screening, including whether self-collection of samples for HPV testing along with appropriate education and support for follow-up will address these factors.

Provider Perspectives on Intimate Partner Violence in Bluefields, Nicaragua.

BACKGROUND: Intimate partner violence represents a significant public health problem and a substantial human rights' issue for women and girls throughout the world. Design and Purpose: The purpose of this study was to answer these research questions: What are the current practices for addressing gender violence in the RACS? What do professionals consider to be the current strengths and gaps in policies related to gender violence in this region? By employing a qualitative descriptive approach (Sandelowski, 2000 ), researchers traveled from the US to Bluefields, Nicaragua, in 2012. The multidisciplinary team of two US nurses, a prosecutor, and a victim-witness advocate interviewed 18 key informants, police officers, advocates, and nurses, and observed court processes. METHODS: Interviews were transcribed verbatim and analyzed in the language the interview was conducted in. Researchers coded data independently and identified emergent themes. FINDINGS: Informants described the complexity of the nature and dynamics of gender violence, strongly informed by Nicaragua's fairly progressive laws. The participants described holistic, fully integrated services as the intended functioning of the system. These services were often thwarted by gaps-fragmentation and lack of resources-and were additionally hampered by substantial individual and structural economical obstacles.

Reproductive Coercion Among Women With Disabilities: An Analysis of Pregnancy Risk Assessment Monitoring Systems Data.

BACKGROUND/AIMS: Reproductive coercion (RC) is a widespread yet understudied type of intimate partner violence that is associated with numerous negative outcomes. Women with disabilities may be at an increased risk of RC; however, little research has been conducted among this population. Using population-based data, we sought to examine the prevalence of RC in postpartum women with disabilities. METHODS: This is a secondary analysis of a cross-sectional survey, the Pregnancy Risk Assessment Monitoring System, a nationally representative survey conducted by the Centers for Disease Control and Prevention in partnership with participating states. These analyses include 3,117 respondents who had information on both disability status and experiences of RC. RESULTS: Approximately 1.9% of respondents reported experiencing RC (95% CI [1.3, 2.4]). When stratified by disability status, approximately 1.7% of respondents without a disability reported RC whereas 6.2% of respondents with at least one disability reported RC ( p < 0.001). In univariable logistic models, disability, age, education, relationship status, income, and race were all significantly associated with RC. CONCLUSIONS: Our findings highlight the need for healthcare providers working with women with disabilities to screen for RC and potentially uncover intimate partner violence and prevent its negative health consequences. All states participating in Pregnancy Risk Assessment Monitoring System data collection are urged to incorporate measures of RC and disability status to better address this significant issue.

Peer influences within the campus environment on help seeking related to violence.

While partner violence and sexual assault are public health concerns affecting college women, most young women do not seek help after the experience. Limited research explores the interpersonal context of help seeking related to violence in young women. The overall purpose of this research was to understand peer factors within a campus culture associated with seeking help in response to violence within a campus environment. Eight focus groups were held with 64 participants representing a broad spectrum of diversity in race and ethnicity. Narrative analysis was the primary method of analysis. Three themes emerged from the data: victim blaming, fear of direct response, and the alcohol factor. The young women's stories demonstrate the effects of friends and campus culture on perceptions of violence and abuse and help seeking. Findings suggest that peers and the social norms of the campus environment influence help-seeking behavior. An understanding of interpersonal level determinants of help seeking is essential for clinically relevant and effective prevention efforts. Nurse practitioners in campus health settings can use this research to guide assessment, intervention, and prevention strategies.

Neuropsychological and Balance Symptoms of Abused Women Who Have Experienced Intimate Partner Violence-Related Strangulation: A Feasibility and Acceptability Study.

Intimate partner violence (IPV) is a public health crisis that results in acute and long-term health consequences for women, including potential acquired brain injury from non-fatal strangulation. Despite existing evidence on the neuropsychological sequelae experienced by women after experiencing IPV-related assault, limited evidence-based treatment protocols exist for these women. This 14-month study sought to: 1) assess the feasibility and acceptability of recruiting women who experienced strangulation associated with IPV within 7 days of the event and retaining them throughout a 3-month follow-up period; and 2) examine preliminary data from neuropsychological, balance, and symptom assessments. Inclusion criteria were: reported strangulation by an intimate partner in the past 7 days, female, 18-60 years of age, English speaking, and able to consent. Neuropsychological, balance, and symptom assessments were administered at the first time point and again 3 months later. Participants also completed a standardized daily symptom inventory. Eight participants (73%) were recruited and completed daily inventories and the baseline assessment; 4 (36%) completed the baseline and 3-month assessments. Of the 4 participants who completed the 3-month assessment, none reported symptom resolution. Only balance returned to values consistent with normative values. Our results demonstrate the ability to recruit women who have experienced IPV-related strangulation during the post-acute phase of injury with less success retaining participants for a 90-day period for follow-up study. This pilot research protocol demonstrated the feasibility of recruitment from the emergency department and systematic evaluation of neuropsychological and functional symptoms in women who experienced strangulation in the context of IPV.

Exploration and Comparison of Contextual Characteristics and Mistreatment Prevalence Among Older American Indian and Alaska Native Respondents: Secondary Analysis of the National Elder Mistreatment Study.

Limited research on elder abuse among American Indians and Alaska Natives (AIANs) suggests a higher prevalence of abuse. Using data from the National Elder Mistreatment Study (NEMS), we compared contextual characteristics and elder mistreatment prevalence rates from a community-based sample of AIAN (n = 195) and Black (n = 437) and White (n = 5,013) respondents. There were differences in the prevalence of 16 abuse types and the 23 contextual variables. AIAN respondents had more similarities compared with Black respondents than White respondents, though differences existed. The cumulative prevalence of emotional, physical, and sexual mistreatment in the past year, neglect, and financial abuse by a family member for the AIAN group was 33%, almost double the 17.1% reported in the NEMS study. Over their lifetime, 29.7% of AIAN respondents reported experiencing two or more types of neglect, exploitation, or mistreatment. Almost one fourth of AIAN respondents reported emotional abuse since 60 years of age (the most commonly occurring abuse type)-nearly double that of White respondents. This is the first study to offer comparative prevalence of elder abuse for both AIAN older males and females that draws from a nationally representative sample. The study also provides descriptive analysis of important contextual information within the AIAN population, an underrepresented racial group in elder abuse research. Disaggregating nonmajority racial groups to examine contextual variables and the prevalence of elder mistreatment in the NEMS data set specific to AIAN respondents fills a knowledge gap. Known prevalence of various abuse typologies among AIAN elders can be useful in setting priorities for community planning and response, and in prioritization of funding for future research on causative mechanisms by abuse type, screening, and interventions at various levels. Findings may facilitate development of culturally specific evidence-based prevention and intervention practices aimed at needs specific to AIAN older adults.

Longitudinal Impact of the myPlan App on Health and Safety Among College Women Experiencing Partner Violence.

The objective of this study was to examine differences in change over time in health and safety outcomes among female college students randomized to myPlan, a tailored safety planning app, or usual web-based safety planning resources. Three hundred forty-six women (175 intervention, 171 control) from 41 colleges/universities in Oregon and Maryland completed surveys at baseline, 6- and 12-months from July 2015 to October 2017. Generalized estimating equations were used to test group differences across time. Both groups improved on four measure of intimate partner violence (IPV; Composite Abuse Scale [CAS], TBI-related IPV, digital abuse, reproductive coercion [RC]) and depression. Reduction in RC and improvement in suicide risk were significantly greater in the myPlan group relative to controls (p = .019 and p = .46, respectively). Increases in the percent of safety behaviors tried that were helpful significantly reduced CAS scores, indicating a reduction in IPV over time in the myPlan group compared to controls (p = .006). Findings support the feasibility and importance of technology-based IPV safety planning for college women. myPlan achieved a number of its objectives related to safety planning and decision-making, the use of helpful safety behaviors, mental health, and reductions in some forms of IPV.

Adolescents' experiences with uxoricide.

The purpose of this study was to describe the experiences of individuals who survived the loss of one or both parents through parental homicide or homicide/suicide as adolescents. Participants (N = 34) were aged between 12 and 19 years at the time of the death and were aged between 29 and 64 years at the time of the interview. Participants were interviewed twice and asked to tell the story of their lives. Data were analyzed in the hermeneutic phenomenological tradition using a stepwise process of developing categories and then a single complex theme. Common categories of participants' childhoods included abuse both before and after the uxoricide and vivid memories of the homicide. As adults, most participants reported difficulties with intimate relationships, legal problems, and substance use. Integrity was an overarching theme for these participants. Among those who had integrated the story of the homicide into their adult lives, some believed that they were doing well whereas others did not. Some participants had isolated the event and considered that they were doing well as a result. These findings are limited by the convenience sample but offer a rich portrait of the lives of individuals who experienced uxoricide as adolescents. Clinicians might be advised to tread carefully if individuals report that they have isolated rather than integrated the uxoricide into their adult lives. No evidence exists in support that either stance is preferable.

Conceptualizing an approach to secondary prevention of relationship violence among college students.

College-age women represent the highest-risk age group for intimate partner violence (IPV) victimization. Bystander prevention approaches (primarily developed to address sexual assault risk on college campuses), have quickly become the mainstay of primary prevention education for gender-based violence in these settings and have been applied to all forms of gender violence in this setting, including IPV. The purpose of this paper is to critically examine the application of bystander approaches to prevention of IPV among college students. A brief overview of the current policy environment mandating prevention education will precede a summary of the conceptual framework underpinning bystander approaches to preventing and responding to sexual violence, followed by an analysis of how IPV does (and does not) fit within that same conceptual framework. The paper concludes with recommendations informal social network-informed approaches to dating violence that improve our theoretical understanding of IPV prevention on college campuses.

Perceptions of barriers to effective family planning services among women with disabilities.

BACKGROUND: Women with disabilities have the same rights as women without disabilities to prevent unintended pregnancy, yet little is known about their experiences in accessing family planning methods. OBJECTIVE: This qualitative descriptive study explored perceptions of barriers to effective family planning services among women with disabilities. METHOD: Semi-structured, open-ended interviews were conducted with 31 women with diverse disabilities as part of a larger study investigating risks and facilitators of unintended pregnancy among women with disabilities across the United States. RESULTS: Analysis revealed multiple barriers experienced by women with disabilities in accessing effective family planning services needed to prevent unintended pregnancy. Barriers included physical or system barriers, financial limitations, and nonresponsive healthcare providers. Women also identified difficulties in finding appropriate family planning methods, both related and unrelated to disability. CONCLUSIONS: This is the first in-depth exploration of barriers to accessing family planning services and challenges to finding effective family planning options among women with disabilities. The findings underscore the need for targeted interventions, improved provider training, and policy changes to optimize reproductive healthcare, improve access to family planning services, and prevent unintended pregnancy among women of childbearing age with diverse disabilities.

Pregnancy-Associated Deaths from Homicide, Suicide, and Drug Overdose: Review of Research and the Intersection with Intimate Partner Violence.

The leading causes of pregnancy-associated deaths, as defined by the Centers for Disease Control and Prevention, are homicide, suicide, and drug overdose. Intimate partner violence during pregnancy has been shown to contribute to maternal mortality from pregnancy-associated deaths. In this article, we discuss these leading causes of pregnancy-associated deaths. We review the prevalence, demographic characteristics, and possible factors leading to each cause of death, as well as evidence-based methods of identification, prevention, and intervention. The review also will include data showing racial and ethnic inequities. In addition, we identify gaps and guiding questions for further research, as well as suggestions for immediate changes in practice and policy.