National study of physical and sexual assault among women with disabilities.

OBJECTIVE: To examine the association between the level of disability impairment and physical and sexual assault in a sample of US women at least 18 years of age. DESIGN, SETTING AND PARTICIPANTS: Retrospective longitudinal study of 6273 non-institutionalized US women from 8000 women participating in the 1995-1996 National Violence Against Women (NVAW) Survey. MAIN OUTCOME MEASURE: Women's experiences of physical and sexual assault in the 12 months before the NVAW interview. RESULTS: Most women reported having no disability (n = 5008, 79.8%) and/or not experiencing an assault in the year before their interview (n = 6018, 95.9%). Less than 5% (n = 280) reported having a disability that severely limited daily activities, and 15.7% (n = 985) reported having a disability that moderately limited activities. Less than 4% (n = 218) of the women reported a physical-only assault, and less than 1% (n = 37) reported being sexually assaulted. Women with severe disability impairments were four times more likely to be sexually assaulted than women with no reported disabilities (RR = 4.0, 95% CI 1.5 to 10.6). Little difference in the risk of sexual assault was found between women with moderate disability impairments and those reporting no disabilities (RR = 1.0, 95% CI 0.3 to 2.8). Women with severe (RR = 1.6, 95% CI 0.9 to 3.0) and moderate (RR = 1.2, 95% CI 0.8 to 1.9) disability impairments were at greater risk, although not quite significantly so, of physical-only assault than were women without a disability. CONCLUSION: The findings suggest that women with disabilities that severely limit activities of daily living are at increased risk of sexual assault.

Predictors of occupational exposure to styrene and styrene-7,8-oxide in the reinforced plastics industry.

OBJECTIVE: To identify demographic and work related factors that predict blood levels of styrene and styrene-7,8-oxide (SO) in the fibreglass reinforced plastics (FRP) industry. METHODS: Personal breathing-zone air samples and whole blood samples were collected repeatedly from 328 reinforced plastics workers in the Unuted States between 1996 and 1999. Styrene and its major metabolite SO were measured in these samples. Multivariable linear regression analyses were applied to the subject-specific levels to explain the variation in exposure and biomarker levels. RESULTS: Exposure levels of styrene were approximately 500-fold higher than those of SO. Exposure levels of styrene and SO varied greatly among the types of products manufactured, with an 11-fold range of median air levels among categories for styrene and a 23-fold range for SO. Even after stratification by job title, median exposures of styrene and SO among laminators varied 14- and 31-fold across product categories. Furthermore, the relative proportions of exposures to styrene and SO varied among product categories. Multivariable regression analyses explained 70% and 63% of the variation in air levels of styrene and SO, respectively, and 72% and 34% of the variation in blood levels of styrene and SO, respectively. Overall, air levels of styrene and SO appear to have decreased substantially in this industry over the last 10-20 years in the US and were greatest among workers with the least seniority. CONCLUSIONS: As levels of styrene and SO in air and blood varied among product categories in the FRP industry, use of job title as a surrogate for exposure can introduce unpredictable measurement errors and can confound the relation between exposure and health outcomes in epidemiology studies. Also, inverse relations between the intensity of exposure to styrene and SO and years on the job suggest that younger workers with little seniority are typically exposed to higher levels of styrene and SO than their coworkers.

Mid-infrared spectroscopy on skin using a silver halide fibre probe in vivo.

BACKGROUND/AIM: Mid-infrared spectroscopy is a versatile method for in vivo investigation of skin after topical treatment with skin care products. METHODS: FTIR-spectrometer (Bruker Optics) with a flexible silver halide fibre probe (Infrared Fiber Sensors). RESULTS: Absorbance spectra from 700 to 3000 cm(-1) have been recorded to gain information about proteins (amide-I and amide-II vibrations at 1650 and 1550 cm(-1)), esters (1740 cm(-1)), carboxylic acid (1710 cm(-1)), polyalcohols (1050 cm(-1)) and hydrocarbons (CH(n) vibrations at 2800-3000 cm(-1)). CONCLUSIONS: Using the particular light guide, we were able to measure for the first time the effects of lip care products on lips directly. Furthermore, water binding and glycerol content of the skin could be determined simultaneously, as well as the replenishment of lipids by lipid-enriched bath oil.

Air samples versus biomarkers for epidemiology.

BACKGROUND: It has been speculated on theoretical grounds that biomarkers are superior surrogates for chemical exposures to air samples in epidemiology studies. METHODS AND RESULTS: Biomarkers were classified according to their position in the exposure-disease continuum-that is, parent compound, reactive intermediate, stable metabolite, macromolecular adduct, or measure of cellular damage. Because airborne exposures and these different biomarkers are time series that vary within and between persons in a population, they are all prone to measurement error effects when used as surrogates for true chemical exposures. It was shown that the attenuation bias in the estimated slope characterising a log exposure-log disease relation should decrease as the within- to between-person variance ratio of a given set of air or biomarker measurements decreases. To gauge the magnitudes of these variance ratios, a database of 12,077 repeated observations was constructed from 127 datasets, including air and biological measurements from either occupational or environmental settings. The within- and between-person variance components (in log scale, after controlling for fixed effects of time) and the corresponding variance ratios for each set of air and biomarker measurements were estimated. It was shown that estimated variance ratios of biomarkers decreased in the order short term (residence time < or =2 days) > intermediate term (2 days < residence time < or =2 months) > long term biomarkers (residence time >2 months). Overall, biomarkers had smaller variance ratios than air measurements, particularly in environmental settings. This suggests that a typical biomarker would provide a less biasing surrogate for exposure than would a typical air measurement. CONCLUSION: Epidemiologists are encouraged to consider the magnitudes of variance ratios, along with other factors related to practicality and cost, in choosing among candidate surrogate measures of exposure.

On the importance of exposure variability to the doses of volatile organic compounds.

The connection between occupational exposure to volatile organic compounds (VOCs) and the resulting internal doses is complicated by variability in air levels from day to day and by nonlinear kinetics of metabolism. We investigated long-term liver doses of VOCs and their metabolites using a physiologically based toxicokinetic model, to which 10,000 random 8-h exposures were inputted. Three carcinogenic VOCs were studied (i.e., benzene, perchloroethylene, and acrylonitrile); these compounds are all bioactivated in the liver and represent a wide range of an important toxicokinetic parameter Vmax/QL x KM. For each VOC, simulations were performed using mean air concentrations (muX) between 0.0003 and 1 mg/l (which covers both linear and saturated metabolism) and using coefficients of variation of exposure (CVX) between 0.23 and 2.18 (which includes most occupational settings). Two long-term measures of internal dose were examined, i.e., the area under the liver concentration-time curve (AUCL) and the area under the metabolic rate-time curve (AURC). Interestingly, both AUCL and AURC were linear functions of cumulative exposure (CE, mg x h/l air) even when metabolism was saturated and CVX was large. Yet, at a given CE, both AUCL and AURC were affected by CVX, with the magnitude of the effect increasing with Vmax/QL x KM (i.e., perchloroethylene < benzene < acrylonitrile). Nonetheless, the effects of CVX were typically only a few percent and should be of little consequence unless a VOC has large values of Vmax/QL x KM, muX,and CVX. We conclude that CE should be a sufficient predictor of the dose of either the parent chemical (VOC) or its metabolite in the liver, even when metabolism is nonlinear. We also observed that AUCL and AURC were sensitive to changes in values of model parameters in the high-variability scenarios, suggesting that (when CVX is large) the population variability of AUCL and AURC can be quite large at a fixed CE.

Novel infrared optical probes for process monitoring and analysis based on next-generation silver halide fibers.

Mid-infrared spectroscopy has proved to be a powerful method for the study of various samples and chemical media as found in different industrial processes. In general, the analysis of such samples takes advantage of the fact that multiple analytes can be quantified simultaneously and rapidly without the need for additional reagents. When compared to near-infrared spectroscopy, for which quartz fiber probes can be successfully applied, the application of previously used mid-infrared fiber materials was restricted due to deficiencies with regard to their optical transmission and mechanical properties. Progress in the quality of infrared transparent silver halide fibers and their extrusion with different cross-sections enabled us to construct several flexible fiber-optic probes of different geometries which are particularly suitable and inert for process monitoring. Transmission and attenuated total reflection measurement techniques have mainly been employed for the analysis of liquid and gaseous media. One larger field, for which results are reported, is chemical reactor monitoring. Other applications are concerned with bio-reactor monitoring, or quasi-continuous measurements for the food industry. Infrared spectroscopic cosmetic assays for determining the chemical composition of skin-care formulations are a further promising field of application, for which an example is given.

Simultaneous assessment of occupational exposures from multiple worker groups.

The methods developed by Rappaport et al. [Ann. Occup. Hyg. 39 (1995) 469] and Lyles et al. [J. Agri. Bio. Environ. Stat. 2 (1997a) 64; Ann. Occup. Hyg. 41 (1997b) 63]) for assessing workplace exposures on a group-by-group basis are extended to allow for the simultaneous assessment of data from multiple worker groups within the same industry. These extended methods allow models to be fit simultaneously to data on all groups in a study, even when some of the groups might not contribute adequate information to be modeled separately. We assume that the exposures are log-normally distributed, and that they can be adequately modeled by a mixed effects regression model with parameters for exposure levels and for between- and within-worker variance components. Simultaneously analyzing data from multiple groups is only advantageous when at least one of these variance components can be assumed to be homogeneous across the groups. Here, we advocate testing an assumption of homogeneous within-worker variance components, sigma(2)(w,h), using a likelihood ratio test to choose between a full model (distinct sigma(2)(w,h) for each group) and a reduced model (common sigma(2)(w) across groups). We then develop a procedure, which is conditional on the results of the likelihood ratio test, for testing whether or not each group of workers is overexposed to the contaminant of interest. This modeling and testing procedure was applied to 39 different data sets, each containing data for multiple groups, from a wide variety of industries. For these data, the testing procedure generally resulted in the same conclusion regarding overexposure under both models, even in those data sets where the within-worker variance components appeared to be quite heterogeneous. We also conducted a small simulation study to estimate the significance level of the proposed testing procedure, and found that the significance levels tended to be adequately close to the specified nominal level when a likelihood ratio test with significance level of at least 0.01 was used as a preliminary test. Additionally, we make specific recommendations for designing studies and suggest a method for determining whether engineering and administrative controls or individual-level interventions would be of most benefit to an overexposed group of workers.

Stressful life events and physical abuse among pregnant women in North Carolina.

OBJECTIVES: This study estimates the prevalence of stressful life events and physical abuse among North Carolina women prior to infant delivery, and examines potential associations between abuse and the other stressors. METHODS: Data were from the North Carolina Pregnancy Risk Assessment Monitoring System, a statewide representative survey of over 2,600 postpartum women. The survey assessed women's sociodemographic characteristics and their experiences of physical abuse and 13 other stressful life events before delivery. The prevalences of each life event and abuse were estimated. Logistic regression modeled the probability of women having high levels of stressful life events in relation to physical abuse and sociodemographics. RESULTS: Most women were married, white, high school graduates, aged 20 or older. The most common stressful life events were residential moves, increased arguing with husbands/partners, family member hospitalizations, financial hardship, and deaths of loved ones. Fourteen percent of women had high levels of stressful events (5 or more), and almost 9% were physically abused. Abuse was positively associated with increased arguing with husbands/partners, physical fighting, having someone close with an alcohol/drug problem, becoming separated/divorced, and financial hardship. Logistic regression analysis showed that a high level of stressful life events was significantly more likely among women abused both before and during pregnancy (OR = 11.94) and among women abused before but not during pregnancy (OR = 14.19). CONCLUSIONS: The high frequency of multiple stressful events and abuse in women's lives suggests that women's care providers should ask their patients about these issues, and offer appropriate referral/interventions to those in need.

Partner violence among adolescents in opposite-sex romantic relationships: findings from the National Longitudinal Study of Adolescent Health.

OBJECTIVES: This report examines (1) the prevalence of psychological and minor physical violence victimization in a nationally representative sample of adolescents and (2) associations between sociodemographic factors and victimization. METHODS: Analyses are based on 7500 adolescents who reported exclusively heterosexual romantic relationships in the National Longitudinal Study of Adolescent Health. Items from the Conflict Tactics Scale were used to measure victimization. Associations between victimization patterns and sociodemographic characteristics were assessed with polytomous logistic regression. RESULTS: One third of adolescents reported some type of victimization, and 12% reported physical violence victimization. Although most sociodemographic characteristics were significantly associated with victimization, patterns varied by sex and type of victimization. CONCLUSIONS: Psychological and minor physical violence victimization is common in opposite-sex romantic relationships during adolescence. The sex-specific associations between sociodemographic characteristics and patterns of partner violence victimization underscore the importance of pursuing longitudinal, theory-driven investigations of the characteristics and developmental histories of both partners in a couple to advance understanding of this public health problem.

A mixture model for occupational exposure mean testing with a limit of detection.

Information from detectable exposure measurements randomly sampled from a left-truncated log-normal distribution may be used to evaluate the distribution of nondetectable values that fall below an analytic limit of detection. If the proportion of nondetects is larger than expected under log normality, alternative models to account for these unobserved data should be considered. We discuss one such model that incorporates a mixture of true zero exposures and a log-normal distribution with possible left censoring, previously considered in a different context by Moulton and Halsey (1995, Biometrics 51, 1570-1578). A particular relationship is demonstrated between maximum likelihood parameter estimates based on this mixture model and those assuming either left-truncated or left-censored data. These results emphasize the need for caution when choosing a model to fit data involving nondetectable values. A one-sided likelihood ratio test for comparing mean exposure under the mixture model to an occupational exposure limit is then developed and evaluated via simulations. An example demonstrates the potential impact of specifying an incorrect model for the nondetectable values.

Preventive counseling during prenatal care: Pregnancy Risk Assessment Monitoring System (PRAMS).

BACKGROUND: Prenatal care provides an opportunity for counseling about behaviors and experiences that increase the likelihood of adverse maternal and fetal outcomes. OBJECTIVE: To document (1) prevalence of preventive health counseling during prenatal care, (2) prevalence of women in higher need of counseling about specific health concerns, and (3) whether women in higher need for counseling were more likely than women in lower need to have received counseling. METHODS: Analysis of the Pregnancy Risk Assessment Monitoring System (PRAMS), a state-specific, population-based, random sample of postpartum women, was performed by using data from 14 states for births during 1997 or 1998, for a total of 24,620 participants. Outcome measures included report of preventive health counseling during prenatal visits by specific topic as well as behaviors and experiences about cigarette use, alcohol use, breast-feeding, partner violence, and preterm labor. RESULTS: The percentage of women that report preventive counseling during prenatal care is relatively high (> or =75%) for 9 of 13 topics. However, the percentage of women that report counseling is relatively low (<75%) for partner violence, seat belt use, illegal drug use, and human immunodeficiency virus (HIV) risk. Except for counseling about cigarette and alcohol use, women in higher need, compared with women in lower need, for three other health topics were not significantly more likely to receive counseling. CONCLUSIONS: Preventive health counseling for partner violence, seat-belt use, illegal drug use, and risk of HIV could be increased across prenatal settings. Counseling should involve assessment of risks, with focused counseling related to those risks.

Physical abuse of women before, during, and after pregnancy.

CONTEXT: Clinicians who care for new mothers and infants need information concerning postpartum physical abuse of women as a foundation on which to develop appropriate clinical screening and intervention procedures. However, no previous population-based studies have been conducted of postpartum physical abuse. OBJECTIVES: To examine patterns of physical abuse before, during, and after pregnancy in a representative statewide sample of North Carolina women. DESIGN, SETTING, AND PARTICIPANTS: Survey of participants in the North Carolina Pregnancy Risk Assessment Monitoring System (NC PRAMS). Of the 3542 women invited to participate in NC PRAMS between July 1, 1997, and December 31, 1998, 75% (n = 2648) responded. MAIN OUTCOME MEASURES: Prevalence of physical abuse during the 12 months before pregnancy, during pregnancy, and after infant delivery; injuries and medical interventions resulting from postpartum abuse; and patterns of abuse over time in relation to sociodemographic characteristics and use of well-baby care. RESULTS: The prevalence of abuse before pregnancy was 6.9% (95% confidence interval [CI], 5.6%-8.2%) compared with 6.1% (95% CI, 4.8%-7.4%) during pregnancy and 3.2% (95% CI, 2.3%-4.1%) during a mean postpartum period of 3.6 months. Abuse during a previous period was strongly predictive of later abuse. Most women who were abused after pregnancy (77%) were injured, but only 23% received medical treatment for their injuries. Virtually all abused and nonabused women used well-baby care; private physicians were the most common source of care. The mean number of well-baby care visits did not differ significantly by maternal patterns of abuse. CONCLUSION: Since well-baby care use is similar for abused and nonabused mothers, pediatric practices may be important settings for screening women for violence.

New tool for epidermal and cosmetic formulation studies by attenuated total-reflection spectroscopy using a flexible mid-infrared fiber probe.

The potential of mid-infrared attenuated total-reflection spectroscopy for dermatology studies has been increased by the development of a flexible fiber-optic probe from silver halide material. Such a tool significantly eases epidermal surface characterization. Spectra of human forearm skin and of bovine udder skin (BUS-model), which is used as a substitute for in-vivo tests on man, were compared, and as an example low concentrations of vitamin E acetate (alpha-tocopherol acetate) in the stratum corneum were measured after topical skin application. Depth profiling was enabled by repeated steps of tape stripping and subsequent skin measurement. The infrared methodology is rapid and can be applied to small areas of skin. It is also sufficiently sensitive for analysis of a large variety of cosmetic formulations and dermatopharmaca. Discrimination of vehicle formulations is possible because of the large information content of mid-infrared spectra.

Stability of hemoglobin and albumin adducts of benzene oxide and 1,4-benzoquinone after administration of benzene to F344 rats.

The stability of cysteinyl adducts of benzene oxide (BO) and mono-S-substituted cysteinyl adducts of 1,4-benzoquinone (1,4-BQ) was investigated in both hemoglobin (Hb) and albumin (Alb) following administration of a single oral dose of 400 mg [U-14C/13C6]benzene/kg body weight to F344 rats. Total radiobound adducts to Hb were stable, as were adducts formed by the reaction of [13C6]BO with cysteinyl residues on Hb. In both cases adduct stability was indicated by zero-order kinetics with decay rates consistent with the lifetime of rat erythrocytes. Hb adducts of 1,4-BQ were not detected, possibly due to the production of multi-S-substituted adducts within the erythrocyte. Regarding Alb binding, total radiobound adducts decayed more rapidly than expected (half-life of 0.4 days), suggesting that uncharacterized benzene metabolites were noncovalently bound or formed unstable adducts with Alb. Although adducts from reactions of BO and 1,4-BQ with Alb both decayed with rates consistent with those of Alb turnover in the rat, the half-life for 1,4-BQ-Alb (2.5 days) was shorter than that for BO-Alb (3.1 days), suggesting some instability of 1,4-BQ-Alb. Assuming similar rates of adduct instability in humans and rats, the 1,4-BQ-Alb adducts would be eliminated with a half-life of approximately 8 days, compared with BO-Alb, which would be expected to turnover with Alb (half-life of approximately 21 days).

Meta-analyses of the relation between silicone breast implants and the risk of connective-tissue diseases.

BACKGROUND: The postulated relation between silicone breast implants and the risk of connective-tissue and autoimmune diseases has generated intense medical and legal interest during the past decade. The salience of the issue persists, despite the fact that a great deal of research has been conducted on this subject. To provide a stronger quantitative basis for addressing the postulated relation, we applied several techniques of meta-analysis that combine, compare, and summarize the results of existing relevant studies. METHODS: We searched data bases and reviewed citations in relevant articles to identify studies that met prestated inclusion criteria. Nine cohort studies, nine case-control studies, and two cross-sectional studies were included in our meta-analyses. We conducted meta-analyses of the results of these studies, both with and without adjustment for confounding factors, and a separate analysis restricted to studies of silicone-gel-filled breast implants. Finally, we estimated the annual number of new cases of connective-tissue disease that could be attributed to breast implants. RESULTS: There was no evidence that breast implants were associated with a significant increase in the summary adjusted relative risk of individual connective-tissue diseases (rheumatoid arthritis, 1.04 [95 percent confidence interval, 0.72 to 1.51]; systemic lupus erythematosus, 0.65 [95 percent confidence interval, 0.35 to 1.23]; scleroderma or systemic sclerosis, 1.01 [95 percent confidence interval, 0.59 to 1.73]; and Sjögren's syndrome, 1.42 [95 percent confidence interval, 0.65 to 3.11]); all definite connective-tissue diseases combined (0.80; 95 percent confidence interval, 0.62 to 1.04); or other autoimmune or rheumatic conditions (0.96; 95 percent confidence interval, 0.74 to 1.25). Nor was there evidence of significantly increased risk in the unadjusted analyses or in the analysis restricted to silicone-gel-filled implants. CONCLUSIONS: On the basis of our meta-analyses, there was no evidence of an association between breast implants in general, or silicone-gel-filled breast implants specifically, and any of the individual connective-tissue diseases, all definite connective-tissue diseases combined, or other autoimmune or rheumatic conditions. From a public health perspective, breast implants appear to have a minimal effect on the number of women in whom connective-tissue diseases develop, and the elimination of implants would not be likely to reduce the incidence of connective-tissue diseases.

Application of mixed models to assess exposures monitored by construction workers during hot processes.

Particulate exposures were assessed among construction workers engaged in hot processes in four jobs (boilermakers, ironworkers, pipefitters and welder-fitters) at nine sites in the U.S. After being trained by occupational hygienists, the workers obtained shift-long personal samples at each site for total particulates (TP). Selected samples were also assayed for manganese (Mn), nickel (Ni), and chromium (Cr). Workers provided information about process- and task-related covariates that were present on the days of monitoring. Data were investigated with mixed-model regression analyses that designated the jobs and covariates as fixed effects and the worker and error terms as random effects. Results indicated that the within-worker variance components, but not the between-worker variance components, could be pooled among jobs. Mean air levels for a given agent varied by roughly six to 100 fold among the jobs, with boilermakers and ironworkers experiencing much higher levels of TP and Mn than pipefitters and welder-fitters. Limited data also suggested that welder-fitters were exposed to greater levels of Ni and Cr than pipefitters. Sufficient sample sizes were available to evaluate the effects of covariates upon exposures to TP and Mn. As expected, processes involving more than 50% hot work led to substantially higher levels of TP and Mn than those involving shorter durations of hot work. Local-exhaust or mechanical ventilation reduced exposure to TP (but not Mn) by as much as 44%, and shielded or manual arc welding increased exposure to Mn (but not TP) by about 80%. Parameters estimated with these mixed models were used to calculate probabilities that workers were exposed at levels above U.S. occupational exposure limits (OELs). Regarding TP and Mn, these calculations suggested that 26-95% of exposures to boilermakers and pipefitters and 2-13% of exposures to pipefitters and welder-fitters exceeded the current Threshold Limit Values. Among welder-fitters, limited data also pointed to probabilities of 2-50% for exceeding particular OELs for Ni and Cr. Using the significance of the estimated random-worker effects as a gauge for the uniformity of exposure within a job, administrative or engineering changes appear appropriate for reducing exposures to boilermakers and ironworkers, while individual personal environments should be investigated for pipefitters and welder-fitters.

Sexual behaviors and reproductive health outcomes: associations with wife abuse in India.

CONTEXT: Wife abuse has been associated with a variety of health concerns. Associations between abuse and reproductive health in India are not well known. OBJECTIVE: To examine relationships between men's reports of wife abuse and reproductive health issues in northern India. DESIGN: Structured face-to-face interviews were conducted as part of the male reproductive health supplement of the PERFORM System of Indicators Survey, a systematic multistage survey conducted in 1995-1996. SETTING: The northern state of Uttar Pradesh, one of the least developed states in India. PARTICIPANTS: A total of 6632 married men aged 15 to 65 years who lived with their wives and completed all survey questions for the study variables reported here. MAIN MEASURES: Physically and sexually abusive behaviors toward wives, sexual activities outside marriage, sexually transmitted disease (STD) symptoms, contraception use, unplanned pregnancies, and sociodemographic characteristics. RESULTS: Fifty-four percent of men reported not abusing their wives, while 17% reported physically but not sexually abusing their wives, 22% reported sexual abuse without physical force, and 7% reported sexual abuse with physical force. Abuse was more common among men who had extramarital sex (for sexual abuse using force: odds ratio [OR], 6.22; 95% confidence interval [CI], 3.98-9.72). Similarly, men who had STD symptoms were more likely to abuse their wives (with current symptoms: OR, 2.43; 95% CI, 1.73-3.42). Unplanned pregnancies were significantly more common among wives of abusive men, especially sexually abusive men who used force (OR, 2.62; 95% CI, 1.91-3.60). CONCLUSIONS: Wife abuse appears to be fairly common in northern India. Our findings that abusive men were more likely to engage in extramarital sex and have STD symptoms suggest that these men may be acquiring STDs from their extramarital relationships, thereby placing their wives at risk for STD acquisition, sometimes via sexual abuse. These abusive sexual behaviors also may result in an elevated rate of unplanned pregnancies.

Violence in the lives of pregnant teenage women: associations with multiple substance use.

Using data from a consecutive sample of approximately 700 prenatal patients aged 12 to 19, the extent of violence and substance use in the lives of these women was examined, as were associations between violence and substance use. The findings show that 29% of the study participants had been victims of violence, with 15% experiencing physical violence only, 5% sexual violence only, and 9% both physical and sexual violence. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression analyses showed that, after controlling for confounding factors, victims were more likely than nonvictims to use cigarettes, alcohol, and illicit drugs, with victims of both physical and sexual violence being the most likely to use each type of substance. Ordinal logistic regression analysis found that, compared to nonvictims, violence victims were more likely to have more severe patterns of substance use (use multiple types of substances), with victims of both physical and sexual violence being the most likely to be multiple substance users. These findings underline the importance of both violence and substance use as health concerns among our youth.

Domestic violence and sexually transmitted diseases: the experience of prenatal care patients.

OBJECTIVES: The authors analyzed interview responses of patients at a prenatal care clinic to explore whether women who had been victims of sexual and physical abuse were more likely than non-victimized women to have experienced a sexually transmitted disease (STD). METHODS: A consecutive sample of 774 prenatal patients of a large health department in North Carolina were interviewed concerning a variety of health issues, including violence and STDs. Logistic regression analysis was used to model the women's STD status as a function of their experiences of sexual and physical abuse, controlling for several potentially confounding factors. RESULTS: Thirty percent of the women reported having experienced at least one STD, with the most common infections being chlamydia and gonorrhea. Twenty-eight percent of the women reported having been victims of abuse; 16% reported physical abuse only, while 12% reported both physical and sexual abuse. The majority of violence was domestic in nature, perpetrated by the victims' husbands, boyfriends, male friends, and relatives. After controlling for confounding variables, the authors found that women who reported both physical and sexual abuse were significantly more likely to have experienced STDs than non-victims (odds ratio [OR] = 2.25; 95% confidence interval [CI] 1.37, 3.69). The logistic regression analysis also showed a relationship of borderline statistical significance between non-sexual physical abuse and STDs. CONCLUSIONS: Health care providers should routinely screen patients for both abuse and STDs, and they should assist identified women in accessing appropriate health, social, and legal services.

Violence victimization experiences of pregnant prisoners.

The violence victimization histories of pregnant incarcerated women were studied in relation to those of pregnant health department patients in North Carolina. Prisoners were twice as likely as health department patients to have experienced both physical and sexual violence compared to no violence, and over three times more likely to have experienced both types of violence compared to only one type. Implications for research and program development are noted.