A Mixed-Methods Analysis of Coercive Control and COVID-19 Stress Among Black Women Experiencing Intimate Partner Violence During the COVID-19 Pandemic.

OBJECTIVE: During times of crises, women are at elevated risk for intimate partner violence (IPV), but extant discourse fails to consider how this landscape amplifies disparities for Black women. This study examined the prevalence and associations of COVID-19 pandemic-specific coercive control and COVID-19-related stress among Black women experiencing IPV. METHODS: Fifty-five Black women reporting past-year IPV participated in a prospective cohort study in 2020 and completed surveys on pandemic-specific coercive control, COVID-19-related stress, and sociodemographic characteristics. A subset of 15 participants completed semi-structured interviews in 2021. We conducted multivariable regression analyses to examine associations between coercive control and stress. We used interpretive phenomenological analysis to contextualize women's experiences of coercive control and stress during the pandemic. RESULTS: In the past 3 months, 76% (42 of 55) of women had a partner blame them for exposing them to COVID-19, 74% (41 of 55) had a partner minimize their pandemic concerns, and 52% (29 of 55) had a partner prevent them from getting a COVID-19 test. A higher average of pandemic-specific coercive control was associated with greater severity of COVID-19-related traumatic stress (b [SE] = 0.033 [0.009]; P = .001) and socioeconomic consequences related to COVID-19 (b [SE] = 0.019 [0.008]; P = .03). We identified 3 superordinate themes that illustrated Black women's experiences: (1) coercive control, (2) pandemic-driven shifts in relational context, and (3) women's structural and psychosocial stressors. CONCLUSIONS: Experiencing coercive control during the pandemic interfered with Black women's engagement in preventive behaviors, which exacerbated distress. Intersectional public health efforts should address sociostructural and relational factors to prevent coercive control and stress among Black women experiencing IPV.

Intimate Partner Violence and Immigration in the United States: A Systematic Review.

This systematic review sought to describe the prevalence of intimate partner violence (IPV) victimization among immigrants in the United States (U.S.) and the prevalence of IPV perpetration among immigrants in the U.S. PsycInfo, PubMed, Global Health and Scopus databases were searched for peer-reviewed literature that quantitatively examined IPV in relation to immigration. Twenty-four articles were included in the final review. Past-year IPV victimization rates among immigrants ranged from 3.8% to 46.9% and lifetime IPV victimization rates ranged from 13.9% to 93%; past-year IPV perpetration rates ranged from 3.0% to 24.8% and the one lifetime IPV perpetration rate was 12.8%. Estimates varied widely by country of origin, type of violence measured, and measure used to quantify IPV. Reliance on small convenience samples is problematic when trying to determine the true prevalence of IPV among immigrants. Epidemiological research is needed to improve the accuracy and representativeness of findings.

Web-Based Delivery of a Family-Based Dating Abuse Prevention Program for Adolescents Exposed to Interparental Violence: Feasibility and Acceptability Study.

BACKGROUND: Numerous studies have demonstrated that exposure to caregiver intimate partner violence (IPV) can have cascading negative impacts on children that elevate the risk of involvement in dating abuse. This cascade may be prevented by programs that support the development of healthy relationships in children exposed to IPV. This paper describes the results of a study of the web-based adaptation of an evidence-based dating abuse prevention program for IPV-exposed youth and their maternal caregivers. Core information and activities from an evidence-based program, Moms and Teens for Safe Dates, were adapted to create the web-based program (e-MTSD), which comprises 1 module for mothers only and 5 modules for mother-adolescent dyads to complete together. OBJECTIVE: The primary objective of this study was to evaluate the feasibility and acceptability of the e-MTSD program and the associated research processes. We also examined the practicability of randomizing mothers to receive SMS text message reminders and an action planning worksheet, which were intended to support engagement in the program. METHODS: Mothers were recruited through community organizations and social media advertising and were eligible to participate if they had at least one adolescent aged 12 to 16 years of any gender identity who was willing to participate in the program with them, had experienced IPV after their adolescent was born, and were not currently living with an abusive partner. All mothers were asked to complete the program with their adolescent over a 6- to 8-week period. Participants were randomized to receive SMS text message reminders, action planning, or both using a 2×2 factorial design. Research feasibility was assessed by tracking recruitment, randomization, enrollment, and attrition rates. Program feasibility was assessed by tracking program uptake, completion, duration, and technical problems, and acceptability was assessed using web-based surveys. RESULTS: Over a 6-month recruitment period, 101 eligible mother-adolescent dyads were enrolled in the study and were eligible for follow-up. The median age of the adolescent participants was 14 years; 57.4% (58/101) identified as female, 32.7% (33/101) identified as male, and 9.9% (10/101) identified as gender diverse. All but one mother accessed the program website at least once; 87.1% (88/101) completed at least one mother-adolescent program module, and 74.3% (75/101) completed all 6 program modules. Both mothers and adolescents found the program to be highly acceptable; across all program modules, over 90% of mothers and over 80% of adolescents reported that the modules kept their attention, were enjoyable, were easy to do, and provided useful information. CONCLUSIONS: Findings suggest the feasibility of web-based delivery and evaluation of the e-MTSD program. Furthermore, average ratings of program acceptability were high. Future research is needed to assess program efficacy and identify the predictors and outcomes of program engagement.

Recent Economic Intimate Partner Violence and Posttraumatic Stress Symptoms Among a Racially and Ethnically Diverse Sample of U.S. Women Experiencing Intimate Partner Violence.

Posttraumatic stress disorder (PTSD) is a prevalent consequence of physical and sexual intimate partner violence (IPV); however, little is known about the unique contributions of economic IPV. Furthermore, women's economic self-sufficiency may explicate the potential relationship between economic IPV and PTSD symptoms. Guided by the Stress Process Theory and Intersectionality, this study examined associations between economic IPV and women's PTSD symptoms and assessed economic self-sufficiency as a mediator. Participants were 255 adult women experiencing IPV recruited from metropolitan Baltimore, MD, and the state of CT who participated in two different studies. Participants completed surveys on IPV, economic self-sufficiency, and PTSD. Path analyses were conducted to examine direct and indirect associations of economic IPV with economic self-sufficiency and PTSD. Economic IPV was uniquely associated with PTSD symptoms while controlling for other forms of IPV. Economic self-sufficiency significantly partially mediated the association between economic IPV and PTSD symptoms such that economic IPV was associated with PTSD symptoms through economic self-sufficiency. Economic IPV may limit women's ability to make autonomous decisions related to finances, which could be distressing. The mental health impact of economic IPV may be particularly debilitating for women with low economic self-sufficiency as their posttraumatic stress occurs within the context of feeling unable to meet their financial goals and also having a partner control their economic resources. Fostering economic empowerment and asset building may be a strengths-based approach to reduce the PTSD symptomatology among women experiencing IPV.

Web-Based Delivery of a Family-Based Dating Violence Prevention Program for Youth Who Have Been Exposed to Intimate Partner Violence: Protocol for an Acceptability and Feasibility Study.

BACKGROUND: Children exposed to intimate partner violence (IPV) between caregivers are at an increased risk of becoming involved in dating violence during adolescence. However, to date, few adolescent dating violence (ADV) prevention programs have been developed for and evaluated with youth exposed to IPV. An exception is Moms and Teens for Safe Dates (MTSD), an evidence-based ADV prevention program for mothers or maternal caregivers (mothers) exposed to IPV and their teenagers. The MTSD program comprises a series of booklets that families complete together in a home that includes activities to promote positive family communication and healthy teenager relationships. We developed a web-adapted version of the MTSD program-entitled eMoms and Teens for Safe Dates (eMTSD)-to provide a delivery format that may increase program appeal for digitally oriented teenagers, lower dissemination costs, lower reading burden for low-literacy participants, and incorporate built-in cues and reminders to boost program adherence. OBJECTIVE: This protocol is for a research study that has the following three main objectives: to assess the acceptability of eMTSD; to identify the feasibility of the research process, including program adherence and participant recruitment and assessment; and to explore the acceptability, feasibility, and preliminary efficacy of 2 features-text reminders and the creation of an action plan for engaging with the program-that may increase program uptake and completion. METHODS: Approximately 100 mothers and their teenagers will be invited to complete eMTSD, which includes six 30-minute web-based modules over a 6-week period. Mothers will be recruited through community organizations and social media advertising and will be eligible to participate if they have at least 1 teenager aged 12 to 16 years living with them, have experienced IPV after the teenager was born, are not currently living with an abusive partner, and have access to an internet-enabled device. Using a factorial design, enrolled dyads will be randomized to the following four adherence support groups (n=25 dyads per group): text reminders and action planning, text reminders only, action planning only, and no adherence supports. All participants will complete brief web-based assessments at enrollment after each module is completed, after the full program is completed, and 90 days after enrollment. Program adherence will be tracked using website use metrics. RESULTS: The data collected will be synthesized to assess the acceptability of the program and the feasibility of the study procedures. An exploratory analysis will examine the impact of adherence support on program completion levels. In November 2021, ethical approval was received and recruitment was initiated. Data collection is expected to continue until December 2022. CONCLUSIONS: The web-based delivery of a family-based healthy relationship program for teenagers exposed to IPV may offer a convenient, low-cost, and engaging approach to preventing ADV. The findings from this study are expected to guide future research. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/35487.

IPV, PrEP, and Medical Mistrust.

INTRODUCTION: HIV pre-exposure prophylaxis (PrEP) is an effective HIV prevention method for women experiencing intimate partner violence (IPV). This study aimed to examine (1) relationships between physical, sexual, and psychological IPV and women's PrEP communication with a health care provider and domestic violence advocate; and (2) how IPV-specific medical mistrust modifies the association between IPV and PrEP communication. METHODS: Data were from 2 studies conducted in Connecticut and Baltimore, MD on adult women experiencing IPV (N = 272). Logistic regressions examined associations between IPV, PrEP communication, and IPV-specific medical mistrust. RESULTS: The average age was 25.7. The most common identity was non-Hispanic black (37.1%), followed by non-Hispanic white (33.8%), Hispanic (20.6%), and non-Hispanic another racial group (8.5%). Higher severity of psychological IPV was associated with more embarrassment to initiate a PrEP discussion with a health care provider (P = 0.009) or domestic violence advocate (P = 0.026). However, women with more severe psychological IPV were more willing to accept a PrEP recommendation from a health care provider (P = 0.033) or domestic violence advocate (P = 0.044). IPV-specific medical mistrust modified the association between physical IPV and willingness to accept a PrEP recommendation by a domestic violence advocate, such that women with physical IPV were significantly less likely to accept a PrEP recommendation by a domestic violence advocate, but only for women with high IPV-specific medical mistrust (P = 0.021). CONCLUSIONS: PrEP initiation among women experiencing IPV may be strengthened by addressing and dismantling systems that perpetuate IPV-specific medical mistrust and stigma against IPV survivors.

Enhancing domestic violence advocates' ability to discuss HIV pre-exposure prophylaxis (PrEP): Feasibility and acceptability of an educational intervention.

BACKGROUND: Survivors of intimate partner violence are at elevated risk for HIV acquisition, yet there is limited research on the best strategies to optimize biomedical HIV prevention, such as pre-exposure prophylaxis among this population. Domestic violence agencies are critical collaborating partners and function as potential entry points into HIV prevention services for survivors; however, limited knowledge regarding HIV prevention has been an important barrier to advocate-led discussions. This study aimed to develop, implement, and evaluate an HIV prevention intervention for domestic violence advocates. SETTING: A nonrandomized, group-based intervention with pre-intervention, immediate post-intervention, and 3-month post-intervention periods were conducted with multiple domestic violence agencies in Mississippi. METHODS: Overall, 25 domestic violence advocates participated in the two-session intervention. Surveys were administered to assess pre-exposure prophylaxis knowledge, self-efficacy, subjective norms, and willingness to provide HIV prevention services to intimate partner violence survivors. Generalized estimating equations were conducted to assess change in behavioral outcomes over time. RESULTS: Compared to pre-intervention, there were significant increases at immediate and 3-month post-intervention in advocates' intervention acceptability, pre-exposure prophylaxis knowledge, and self-efficacy to provide HIV prevention information, discuss pre-exposure prophylaxis eligibility criteria, assist pre-exposure prophylaxis-engaged clients, and initiate pre-exposure prophylaxis counseling. CONCLUSION: This group-based intervention enhanced domestic violence advocates' acceptability, pre-exposure prophylaxis knowledge, and self-efficacy to offer HIV care information, discuss pre-exposure prophylaxis eligibility, assist pre-exposure prophylaxis-engaged survivors, and initiate pre-exposure prophylaxis counseling with intimate partner violence survivors. Efforts should focus on training domestic violence advocates in HIV prevention care for survivors and also include these agencies in collaborative strategies to reduce HIV incidence.

Preference for and Efficacy of a PrEP Decision Aid for Women with Substance Use Disorders.

BACKGROUND: Women with substance use disorders (SUDs) are a key population for HIV prevention with pre-exposure prophylaxis (PrEP), though uptake is limited by awareness of PrEP, misestimation of personal HIV risk, and minimally integrated HIV prevention and addiction treatment services. Patient-centered decision aids (DA) could address these barriers to PrEP, but no extant DA for PrEP has been published, including for women with SUDs. METHODS: We developed a patient-centered PrEP DA for women in addiction treatment. In a pilot randomized preference trial, we compared the DA to enhanced standard of care (eSOC) providing standardized information. The primary outcome was opting to receive more information through the DA; we also assessed the impact of the DA on PrEP decisional preference and PrEP uptake over 12 months. RESULTS: A total of 164 enrolled participants (DA: 83; eSOC: 81) were similar in terms of HIV risk and demographics, which are representative of women in addiction treatment programs nationally, and most (92%) had opioid use disorder. Half of participants were PrEP eligible, though 37% underestimated their personal HIV risk. Independent correlates of selecting the PrEP DA relative to eSOC included higher alcohol use severity (aOR 4.13, 95% CI 1.05-16.28, p=0.04) and perception of high risk for HIV (aOR 2.95, 95% CI 1.19-7.35, p=0.02). For those selecting the DA, interest in PrEP increased significantly from 25% to 89%. DA participants were also significantly more likely than eSOC participants to see a provider for PrEP during follow-up (15.7% vs 6.2%; p=0.05). CONCLUSION: Half of the women selected to use the DA, and those who did significantly increased their engagement in the HIV prevention cascade through increased interest in and initiation of PrEP. Future iterations should accelerate the HIV prevention cascade for women with SUDs by integrating PrEP decision aids into existing addiction treatment services and actively linking women to PrEP.

Ultrasound evaluation of the hands and wrists in patients with systemic sclerosis: Osteophytosis is a major contributor to tender joints.

OBJECTIVE: To evaluate the prevalence and clinical associations of ultrasound (US) findings of inflammatory arthritis and joint and soft tissue pathology in patients with systemic sclerosis (SSc). METHODS: The hands and wrists of 43 SSc patients and 35 age-balanced controls were evaluated by clinical exam and musculoskeletal US. Synovial and tenosynovial pathology were assessed using semi-quantitative Gray Scale (GS) and Power Doppler (PD) scoring. US evaluation for osteophytes, erosions, ulnar artery occlusion, and median nerve cross-sectional areas was performed. Tender joints (TJ), swollen joints (SJ), modified Rodnan skin score (mRSS), digital ulcers, contractures, and calcinosis were evaluated. Concordance between US and physical exam findings at each joint region were assessed, and associations between their severity were analyzed. RESULTS: TJs and SJs were present in 44.2% and 62.8% of SSc patients, respectively. Inflammatory arthritis, defined as having both GS>0 and PD>0, was observed in 18.6% of SSc patients and no controls. There was a high concordance by joint region between GS synovial hypertrophy and osteophytes (κ=0.88) as well as TJs (κ=0.72). SSc patients had more osteophytes compared to controls (48.8% vs 22.9%, p = 0.018) as well as higher osteophyte severity (p = 0.033). CONCLUSIONS: Despite a high percentage of tender and swollen joints, less than 20% of SSc patients met criteria for inflammatory arthritis on US. The high concordance of osteophytes with GS synovial hypertrophy and tender joints suggest that osteophytosis may be a significant contributor to joint pain in SSc patients.

"There's no place like home": Examining the associations between state eviction defense protections and indicators of biopsychosocial stress among survivors of intimate partner violence.

Housing instability is prevalent among intimate partner violence (IPV) survivors and a source of biopsychosocial stress among this population. Eviction policies play an important role in determining housing instability of IPV survivors. However, few studies have investigated whether state-level policies that prevent evictions lessen vulnerability to biopsychosocial stress among IPV survivors. This study examined the relationship between state eviction defense policy and indicators of biopsychosocial stress among 6577 IPV survivors. State-level data on IPV-related housing policies were from a compendium on homelessness and violence. Individual-level data were collected from the National Intimate Partner and Sexual Violence Survey (NISVS), a nationally representative study of noninstitutionalized U.S. women and men from Wave 1 (2010). Multilevel regression models were conducted to investigate associations between the presence of an eviction defense policy and indicators of biopsychosocial stress (i.e., headaches, sleeping, safety concerns and PTSD symptoms). Stratified multilevel modeling was conducted to examine differences in the policy-stress associations across racial and ethnic groups and gender. Nearly 26% of states had an eviction defense policy for IPV survivors. Overall, residing in a state with an eviction defense policy (vs. none) was associated with no reports of frequent headaches (B [95% CI] = -0.21 [-0.41, -0.01], p < .05). For non-Hispanic Black survivors, residing in a state with an eviction defense policy (vs. none) was associated with reduced likelihood of reporting safety concerns (B [95% CI] = -1.36 [-2.16, -0.56], p < .001) and PTSD symptoms (B [SE] = -1.91 [-2.82, -1.01], p < .000). Among men survivors, residing in a state with an eviction defense policy was associated with reduced likelihood of reporting safety concerns (B [95% CI] = -0.63 [-1.26, -0.01], p < .05). State housing policies are important protective policies for IPV survivors. For IPV survivors, the eviction defense policy may interrupt the psychological sequeale of IPV and housing instability.

Development and Assessment of Novel Lung Ultrasound Interpretation Criteria for the Detection of Interstitial Lung Disease in Systemic Sclerosis.

OBJECTIVE: Interstitial lung disease (ILD) is a frequent complication of systemic sclerosis (SSc), and ILD screening, characterization, and monitoring are important for therapeutic decision-making and prognostication. Lung ultrasonography (US) is a potential alternative imaging modality for ILD detection. In this study, our objective was to develop and test a novel lung US examination technique and interpretation criteria for detecting SSc-ILD. METHODS: Lung US acquisition was performed by collecting short US movies at 14 lung positions. Lung US interpretation criteria for SSc-ILD detection focused on visualized pleural changes. To assess the performance of our methodology for SSc-ILD detection, we prospectively enrolled SSc patients with high-resolution computed tomography (HRCT) imaging within 3 months of lung US. Lung US examinations were scored independently by 2 blinded readers (1 ultrasonographer and 1 nonultrasonographer). The sensitivity and specificity for SSc-ILD detection were assessed, and agreement was measured with Cohen's kappa statistic. RESULTS: To test the performance of our lung US acquisition technique and interpretation criteria, 20 SSc patients were evaluated by lung US (278 lung zones) and HRCT. HRCT confirmed ILD in 9 patients (45%). Lung US was positive for SSc-ILD in 11 patients (55%) with a sensitivity of 100% and specificity of 82% versus HRCT, with perfect agreement between the 2 readers (κ = 1). Analysis by individual lung zones found excellent agreement between readers, with 93.8% concordance and κ = 0.82. CONCLUSION: We developed a novel lung US examination technique and interpretation criteria that are highly sensitive and specific for SSc-ILD detection in an SSc cohort, affording perfect agreement between ultrasonographer and nonultrasonographer readers.

Ultrasound Detection of Calcinosis and Association With Ulnar Artery Occlusion in Patients With Systemic Sclerosis.

OBJECTIVE: To investigate the ability of ultrasound (US) compared to radiographs to detect calcinosis in hands/wrists of patients with systemic sclerosis (SSc), and to assess US markers of pathologic perfusion. METHODS: Patients with SSc were evaluated for calcinosis in the hands/wrists by radiograph and US. The presence or absence of calcinosis was recorded by patient, hand, and anatomic zone; sensitivity and specificity for calcinosis detection by US versus radiographs was determined. Bilateral US vascular measurements of ulnar artery occlusion (UAO) and finger pulp blood flow (FPBF) were obtained. For each hand, associations between markers of pathologic blood flow (UAO, FPBF, and a composite severity score of UAO and FPBF) and the presence of calcinosis were assessed using generalized estimating equations. RESULTS: Of 43 patients with SSc (19 diffuse, 24 limited), 39.5% had calcinosis on radiographs compared to 30.2% on US. Sensitivity and specificity for US, respectively, were 61% and 95% by zone, 78% and 98% by hand, and 76% and 100% by patient. UAO was seen in 30% and 28% of left and right hands, respectively; FPBF was absent in ≥1 digit of the left and right hands in 49% and 44%, respectively. UAO was associated with radiograph-identified calcinosis by hand (odds ratio [OR] 8.08 [95% confidence interval (95% CI) 2.45-26.60], P < 0.001), whereas FPBF and the composite severity score were not significant. UAO was associated with calcinosis even in the absence of digital ulcers (OR 33.00 [95% CI 3.39-321.09], P = 0.003). CONCLUSION: US was sensitive and highly specific in detecting calcinosis in SSc. UAO was strongly associated with radiograph-identified calcinosis.