A systemic approach to achieving population-level impact in injury and violence prevention.

The contemporary public health model for injury and violence prevention is a four-step process, which has been difficult to fully actualize in real-world contexts. This difficulty results from challenges in bridging science to practice and developing and applying population-level approaches. Prevention programmes and policies are embedded within and impacted by a range of system-level factors, which must be considered and actively managed when addressing complex public health challenges involving multiple sectors and stakeholders. To address these concerns, a systemic approach to population-level injury and violence prevention is being developed and explored by the Division of Analysis, Research, and Practice Integration in the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention. This article makes the case for and provides a high-level overview of this systemic approach, its various components, and how it is being applied in one governmental unit.

The Power of Academic-Practitioner Collaboration to Enhance Science and Practice Integration: Injury and Violence Prevention Case Studies.

One of the most substantial challenges facing the field of injury and violence prevention is bridging the gap between scientific knowledge and its real-world application to achieve population-level impact. Much synergy is gained when academic and practice communities collaborate; however, a number of barriers prevent better integration of science and practice. This article presents 3 examples of academic-practitioner collaborations, their approaches to working together to address injury and violence issues, and emerging indications of the impact on integrating research and practice. The examples fall along the spectrum of engagement with nonacademic partners as coinvestigators and knowledge producers. They also highlight the benefits of academic-community partnerships and the engaged scholarship model under which Centers for Disease Control and Prevention-funded Injury Control Research Centers operate to address the research-to-practice and practice-to-research gap.

Effect of face-to-face interview versus computer-assisted self-interview on disclosure of intimate partner violence among African American women in WIC clinics.

African American women in the United States report intimate partner violence (IPV) more often than the general population of women. Overall, women underreport IPV because of shame, embarrassment, fear of retribution, or low expectation of legal support. African American women may be especially unlikely to report IPV because of poverty, low social support, and past experiences of discrimination. The purpose of this article is to determine the context in which low-income African American women disclose IPV. Consenting African American women receiving Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) services in WIC clinics were randomized to complete an IPV screening (Revised Conflict Tactics Scales-Short Form) via computer-assisted self-interview (CASI) or face-to-face interview (FTFI). Women (n = 368) reported high rates of lifetime and prior-year verbal (48%, 34%), physical (12%, 7%), sexual (10%, 7%), and any (49%, 36%) IPV, as well as IPV-related injury (13%, 7%). Mode of screening, but not interviewer race, affected disclosure. Women screened via FTFI reported significantly more lifetime and prior-year negotiation (adjusted odds ratio [aOR] = 10.54, 3.97) and more prior-year verbal (aOR = 2.10), sexual (aOR = 4.31), and any (aOR = 2.02) IPV than CASI-screened women. African American women in a WIC setting disclosed IPV more often in face-to-face than computer screening, and race-matching of client and interviewer did not affect disclosure. Findings highlight the potential value of face-to-face screening to identify women at risk of IPV. Programs should weigh the costs and benefits of training staff versus using computer-based technologies to screen for IPV in WIC settings.

Relationship of intimate partner violence to health status, chronic disease, and screening behaviors.

While victims of intimate partner violence (IPV) have increased risk of chronic disease, little is known about their preventive screening behaviors. The objective of this study was to relate IPV to health status, chronic disease, and preventive screening behaviors. We hypothesized that women who reported poorer health statuses, higher rates of HIV, no primary care, and less-frequent HIV testing, breast exams, and Pap smears would be more likely to experience IPV. Adult females who presented to three Emergency Departments (EDs) on weekdays from 11:00 a.m. to 7:00 p.m. over a 14-month period were asked to participate in a computerized survey. Women were excluded if they were critically ill, did not speak English, intoxicated, or psychotic. Validated measures were used, including the Universal Violence Prevention Screen and the Short Form-12. Patients were asked about their health statuses, HIV statuses, and testing, if they had a regular doctor, and how often they had received pap smears and breast exams. Logistic regression modeling was used to test associations between IPV and the predictor variables, adjusting for age, employment, and education. Out of 3,381 approached, 1,474 women (43.6%) agreed to be surveyed. Age averaged 39 years ± 12.3 (range = 18-65), and most participants were Black (n = 722, 86.8%). One hundred and fifty-three out of 832 women (18.4%) who had been in a relationship the previous year had experienced IPV. Compared with HIV-negative women, those with HIV were 5 times more likely to suffer IPV (adjusted odds ratio [AOR] = 5.113, p = .001), and women who were not sure of their HIV status were 9 times more likely to experience IPV (AOR = 8.818, p < .001). Women who performed monthly self-breast exams were 53% less likely to experience IPV as those who rarely examined themselves (AOR = 0.470, p = .010). Women who have HIV or are unsure of their status and those who rarely perform self-breast exams are at increased risk of IPV.

Does stage of change predict improved intimate partner violence outcomes following an emergency department intervention?

OBJECTIVES: The objective was to assess the effect of an emergency department (ED)-based computer screening and referral intervention on the safety-seeking behaviors of female intimate partner violence (IPV) victims at differing stages of change. The study also aimed to determine which personal and behavioral characteristics were associated with a positive change in safety-seeking behavior. The hypothesis was that women who were in contemplation or action stages of change would be more likely to endorse safety behaviors during follow-up. METHODS: This was a prospective cohort study of female IPV victims at three urban EDs, using a computer kiosk to deliver targeted education about IPV to provide referrals to local resources. All noncritically ill adult English-speaking women triaged to the ED waiting room during study hours were eligible to participate. Women were screened for IPV using the validated Universal Violence Prevention Screening Protocol (UVPSP), and all IPV-positive women further responded to validated questionnaires for alcohol and drug abuse, depression, and IPV severity. The women were assigned a baseline stage of change using the University of Rhode Island Change Assessment (URICA) scale for readiness to change their IPV behaviors. Study participants were contacted at 1 week and 3 months to assess a variety of predetermined safety behaviors to prevent further IPV during that period. Descriptive analyses were performed to determine if stage of change at enrollment and a variety of specific sociodemographic characteristics were associated with taking protective action during follow-up. RESULTS: A total of 1,474 women were screened for IPV; 154 (10.4%) disclosed IPV and completed the full survey. Approximately half (47.4%) of the IPV victims were in the precontemplation stage of change, and 50.0% were in the contemplation stage. A total of 110 women returned at 1 week of follow-up (71.4%), and 63 (40.9%) women returned for the 3-month follow-up. Fifty-five percent of those who returned at 1 week and 73% of those who returned at 3 months took protective action against further IPV. Stage of change at enrollment was not significantly associated with taking protective action during follow-up. There was no association between demographic characteristics and taking protective action at 1 week or 3 months. CONCLUSIONS: Emergency department-based kiosk screening and health information delivery is a feasible method of health information dissemination for women experiencing IPV and was associated with a high proportion of study participants taking protective action. Stage of change was not associated with actual IPV protective measures.

Association between Intimate Partner Violence and Health Behaviors of Female Emergency Department Patients.

INTRODUCTION: We assessed the correlation between intimate partner violence (IPV) and health behaviors, including seat belt use, smoke alarm in home, handgun access, body mass index, diet, and exercise. We hypothesized that IPV victims would be less likely to have healthy behaviors as compared to women with similar demographics. METHODS: All adult female patients who presented to 3 Atlanta-area emergency department waiting rooms on weekdays from 11AM to 7PM were asked to participate in a computer-based survey by trained research assistants. The Universal Violence Prevention Screen was used for IPV identification. The survey also assessed seatbelt use, smoke alarm presence, handgun access, height, weight, exercise, and diet. We used chi-square tests of association, odds ratios, and independent t-tests to measure associations between variables. RESULTS: Participants ranged from 18 to 68 years, with a mean of 38 years. Out of 1,452 respondents, 155 patients self-identified as white (10.7%), and 1,218 as black (83.9%); 153 out of 832 women who were in a relationship in the prior year (18.4%) screened positive for IPV. We found significant relationships between IPV and not wearing a seatbelt (p<0.01), handgun access (p<0.01), and eating unhealthy foods (p<0.01). CONCLUSION: Women experiencing IPV are more likely to exhibit risky health behaviors than women who are not IPV victims.

Effect of a Targeted Women's Health Intervention in an Inner-City Emergency Department.

Objective. To evaluate the effect of an Emergency Department (ED) based, educational intervention for at-risk health behaviors. Methods. A randomized trial over a one-year period. African American women, aged 21-55, presenting to the ED waiting room were eligible. Each participant took a computer-based survey on health risk behaviors. Participants who screened positive on any of four validated scales (for IPV, nicotine, alcohol, or drug dependence) were randomized to standard information about community resources (control) or to targeted educational handouts based upon their screening results (intervention). Participants were surveyed at 3 months regarding contacts with community resources and harm-reduction actions. Results. 610 women were initially surveyed; 326 screened positive (13.7% for IPV, 40.1% for nicotine addiction, 26.6% for alcohol abuse, and 14.4% for drug abuse). 157 women were randomized to intervention and 169 to control. Among women who completed follow-up (n = 71), women in the Intervention Group were significantly more likely to have contacted local resources (37% versus 9%, P = 0.04) and were more likely to have taken risk-reducing action (97% versus 79%, P = 0.04). Conclusion. Targeted, brief educational interventions may be an effective method for targeting risk behaviors among vulnerable ED populations.

Correlation Between Intimate Partner Violence Victimization and Risk of Substance Abuse and Depression among African-American Women in an Urban Emergency Department.

OBJECTIVE: To assess rates of substance abuse (including tobacco, alcohol, and drug abuse) as well as rates of intimate partner violence (IPV) among African-American women seen in an urban emergency department (ED). METHODS: Eligible participants included all African-American women between the ages of 21-55 years old who were seen in an urban ED for any complaint and triaged to the waiting room. Eligible women who consented to participate completed a computer-based survey that focused on demographic information and general health questions, as well as standardized instruments to screen for alcohol abuse, tobacco abuse, and illicit drug use. This analysis uses results from a larger study evaluating the effects of providing patients with targeted educational literature based on the results of their screening. RESULTS: Six-hundred ten women were surveyed; 430 women reported being in a relationship in the past year and among these, 85 women (20%) screened positive for IPV. Women who screened positive for IPV were significantly more likely to also screen positive for tobacco abuse (56% vs. 37.5%, p< 0.001), alcohol abuse (47.1% vs. 23.2%, p < 0.001), and drug abuse (44.7% vs. 9.5%, p<0.001). Women who screened positive for IPV were also more likely to screen positive for depression and report social isolation. CONCLUSIONS: African-American women seen in the ED, who screen positive for IPV, are at significantly higher risk of drug, alcohol, tobacco abuse, depression and social isolation than women who do not screen positive for IPV. These findings have important implications for ED-based and community-based social services for women who are victims of intimate partner violence.

A pilot study of an exposure-based intervention in the ED designed to prevent posttraumatic stress disorder.

Early interventions to prevent PTSD have been limited in scope and effectiveness. This pilot study examines the feasibility and preliminary effectiveness of a model for brief preventive intervention: 1-session individualized exposure-based therapy delivered in the emergency department (ED). Eligible patients who experienced exposure to a traumatic event in the previous 24 hours were screened and assigned to assessment-only (n = 5) or intervention (imaginal exposure, n = 5) conditions. Both groups returned for 1-week follow-up. Results indicate that patients receiving this intervention reported slightly decreased levels of depression at 1-week follow-up and were rated lower on clinician-rated global severity of symptoms than patients in the assessment-only condition. The level of subject participation and ED staff support in this pilot study argues for feasibility of data collection, intervention, and follow-up with this population. Results also offer evidence that the intervention did not appear to harm participants and in fact may be helpful.