Campus Service Use Among Students With Disabilities Who Have Experienced Sexual Violence: A Conceptual Model.

Students with disabilities are one student group with elevated risk of sexual violence. Although they would benefit from streamlined access to campus support, little is known about their patterns of campus service use. This qualitative analysis includes data from semi-structured interviews with 51 students with disabilities who experienced sexual violence focused on service use across campus. The resultant conceptual model shows that greater accessibility is associated with positive experiences, and lower accessibility is associated with negative experiences. Students with disabilities who experienced or expected negative reactions (e.g., judgment) were less likely to use services and were less satisfied. Advocacy and support in connecting students with disability or sexual violence services was associated with positive experiences and increased accessibility. These findings highlight key facilitators and barriers to campus service use for students with disabilities with sexual violence histories and suggest key intervention points for increasing accessibility, reducing stigma, and improving student experiences with campus providers, staff, and faculty.

The impact of the Great Recession on California domestic violence events, and related hospitalizations and emergency service visits.

OBJECTIVE: Explore the impact of the Great Recession on domestic violence (DV) related hospitalizations and emergency department (ED) visits in California. METHODS: Hospital and ED data were drawn from California's Office of Statewide Health Planning and Development (OSHPD). DV-related hospitalizations and ED visits in California were analyzed between January 2000 and September 2015 (53,596), along with total medical costs. Time series were divided into pre-recession (Jan 2000-Nov 2007) and recession/post-recession (Dec 2007-Sept 2015) periods. RESULTS: The medical cost of DV-related hospitalizations alone was estimated as $1,136,165,861. A dramatic increase in DV episodes was found potentially associated with the Great Recession. The number of ED visits per month tripled from pre- to post-recession (104.9 vs. 290.6), along with an increased number of hospitalizations (77.1 vs. 95.6); African Americans and Native Americans were disproportionally impacted. In addition, psychiatric comorbidities, severe DV episodes, in-hospital mortality and charge per hospitalization escalated. The rise in DV hospitalizations and ED visits beginning in December 2007 was mainly attributable to physical abuse episodes in adults; minors had no change in DV trends. DISCUSSION: Recessions are frequent in modern economies and are repeated cyclically. Our study provides critical information on the effects of the 2007 financial crisis on DV-related healthcare service utilization in California. Given the current financial crisis associated with COVID-19, which expert predict could extend for years, the results from this study shine a spotlight on the importance of DV-related screening, prevention and response.

Sexist Attitudes Among Emerging Adult Women Readers of Fifty Shades Fiction.

Stereotypical sexist representations of men and women in popular culture reinforce rigid views of masculinity (e.g., males as being strong, in control, masterful, and aggressive) and femininity (e.g., women as being fragile and weak, unassertive, peaceful, irrational, and driven by emotions). The present study examined associations between the fictional series Fifty Shades-one popular culture mechanism that includes pervasive traditional gender role representations-and underlying sexist beliefs among a sample of 715 women ages 18-24 years. Analyses revealed associations between Fifty Shades readership and sexism, as measured through the Ambivalent Sexism Inventory. Namely women who reported reading Fifty Shades had higher levels of ambivalent, benevolent, and hostile sexism. Further, those who interpreted Fifty Shades as "romantic" had higher levels of ambivalent and benevolent sexism. Our findings support prior empirical studies noting associations between interacting with aspects of popular culture, such as television and video games, and individual beliefs and behaviors.

History of dating violence and the association with late adolescent health.

BACKGROUND: The present investigation expands upon prior studies by examining the relationship between health in late adolescence and the experience of physical/sexual and non-physical dating violence victimization, including dating violence types that are relevant to today's adolescents (e.g., harassment via email and text messaging). We examined the relationship between physical/sexual and non-physical dating violence victimization from age 13 to 19 and health in late adolescence/early adulthood. METHODS: The sample comprised 585 subjects (ages 18 to 21; mean age, 19.8, SD = 1.0) recruited from The Ohio State University who completed an online survey to assess: 1) current health (depression, disordered eating, binge drinking, smoking, and frequent sexual behavior); and 2) dating violence victimization from age 13 to 19 (retrospectively assessed using eight questions covering physical, sexual, and non-physical abuse, including technology-related abuse involving stalking/harassment via text messaging and email). Multivariable models compared health indicators in never-exposed subjects to those exposed to physical/sexual or non-physical dating violence only. The multivariable models were adjusted for age and other non-dating abuse victimization (bullying; punched, kicked, choked by a parent/guardian; touched in a sexual place, forced to touch someone sexually). RESULTS: In adjusted analyses, compared to non-exposed females, females with physical/sexual dating violence victimization were at increased risk of smoking (prevalence ratio = 3.95); depressive symptoms (down/hopeless, PR = 2.00; lost interest, PR = 1.79); eating disorders (using diet aids, PR = 1.98; fasting, PR = 4.71; vomiting to lose weight, PR = 4.33); and frequent sexual behavior (5+ intercourse and oral sex partners, PR = 2.49, PR = 2.02; having anal sex, PR = 2.82). Compared to non-exposed females, females with non-physical dating violence only were at increased risk of smoking (PR = 3.61), depressive symptoms (down/hopeless, PR = 1.41; lost interest, PR = 1.36), eating disorders (fasting, PR = 3.37; vomiting, PR = 2.66), having 5+ intercourse partners (PR = 2.20), and having anal sex (PR = 2.18). For males, no health differences were observed for those experiencing physical/sexual dating violence compared to those who did not. Compared to non-exposed males, males with non-physical dating violence only were at increased risk of smoking (PR = 3.91) and disordered eating (fasting, using diet aids, vomiting, PR = 2.93). CONCLUSIONS: For females, more pronounced adverse health was observed for those exposed to physical/sexual versus non-physical dating violence. For both females and males, non-physical dating violence victimization contributed to poor health.

Advances in diagnostic codes to document sexual assault in health care service.

OBJECTIVE: To explore trends in documented sexual abuse/assault (SA) related episodes in California hospitals and emergency departments (ED), including the impact of a change in health care service reporting codification (from ICD-9-CM to ICD-10-CM) that more clearly defined SA in October 2015. DATA SOURCES: Hospital and ED data were drawn from California's Office of Statewide Health Planning and Development (OSHPD). STUDY DESIGN: Descriptive and trend analyses of SA-related hospital and ED records (including patients' demographic information) were conducted to determine whether changes in ICD codification had an impact on documented SA-related episodes. DATA COLLECTION: All SA-related episodes (ICD-9-CM codes 995.83, 995.53; ICD-10-CM codes T74.21-T74.22, T76.21-T76.22) in California hospitals and EDs for the last decade of available data (2008-2017) were analyzed (n = 20,215). PRINCIPAL FINDINGS: An abrupt increase in documented SA episodes in hospitals and EDs began in October 2015, when specific ICD10 codes for suspected cases of SA were created. Documented SA-related episodes doubled in 1 month (164 vs. 385 episodes in September 2015 and October 2015, respectively). More than half (58.2%) of all SA-related episodes documented in Oct 2015 were coded as suspicious. The number of documented SA-related episodes continued increasing to the end of the time series (December 2017). Overall, the annual number of documented SA-related episodes increased by over 700% in only 4 years (900 vs. 6441 in 2013 and 2017, respectively), suggesting high rates of prior under-reporting and the need to introduce the new codes. African Americans were disproportionally impacted; however, the highest increases in age-adjusted rates between the ICD-9-CM and the ICD-10 codification period were found among the White population (2.46 vs. 16.53 per 100,000 inhabitants). CONCLUSIONS: SA episodes in the clinical population have been underestimated for many decades. Identifying SA victims and measuring SA-related health care utilization is a real challenge that needs further investigation.

Dating violence victimization across the teen years: abuse frequency, number of abusive partners, and age at first occurrence.

BACKGROUND: Prior longitudinal studies have shown high cumulative dating violence exposure rates among U.S adolescents, with 36 percent of males and 44 percent to 88 percent of females experiencing victimization across adolescence/young adulthood. Despite promising information characterizing adolescents' dating violence experiences longitudinally, prior studies tended to concentrate on physical and sexual types of violence only, and did not report information on the number of times dating violence was experienced across multiple abusive partners. We used a method similar to the timeline follow-back interview to query adolescents about dating violence victimization from age 13 to 19-including dating violence types (physical, sexual, and psychological), frequency, age at first occurrence, and number of abusive partners. METHODS: A total of 730 subjects were randomly sampled from university registrar records and invited to complete an online survey, which utilized methods similar to the timeline follow-back interview, to retrospectively assess relationship histories and dating violence victimization from age 13 to 19 (eight questions adapted from widely-used surveys covering physical, sexual, and psychological abuse). Then, for each dating violence type, we asked about the number of occurrences, number of abusive partners, and age at first occurrence. Of 341 subjects who completed the survey, we included 297 (64 percent females; 36 percent males) who had a dating partner from age 13 to 19. RESULTS: Fully 64.7 percent of females and 61.7 percent of males reported dating violence victimization between age 13 and 19, with most experiencing multiple occurrences. More than one-third of abused females had two or more abusive partners: controlling behavior (35.6 percent); put downs/name calling (37.0); pressured sex (42.9); insults (44.3); slapped/hit (50.0); and threats (62.5). Males also had two or more abusive partners, as follows: controlling behavior (42.1 percent); insults (51.2); put downs (53.3); threats (55.6); and unwanted calls/texts/visits (60.7). Among abused females, 44.7 percent first experienced controlling behavior between age 13 and 15, whereas the majority (62.5 percent) first experienced pressured sex between age 16 and 17. Among males, for most abuse types, 16 percent to 30 percent of victimization began before age 15. CONCLUSIONS: Our study adds information to a substantial, but still growing, body of literature about dating violence frequency, age of occurrence, and number of abusive partners among adolescents.

Novel Coronavirus (COVID-19): Violence, Reproductive Rights and Related Health Risks for Women, Opportunities for Practice Innovation.

While the novel coronavirus (COVID-19) has broad health implications across the globe, being overlooked in response and policy debates is the impact on women's reproductive rights and violence risk. This is especially salient for minoritized women. In this commentary, we describe the potential negative impact of mandates such as shelter-in-place for domestic violence victims, and how public reproductive health policy is being shaped to disadvantage women, especially minoritized women. We argue that now is the time for violence prevention leaders to advocate for bold action. This includes prioritizing the needs of women (especially minoritized women) in medical, social and legal settings using innovative intervention and service engagement (e.g., e-filing for protection orders, virtual advocacy services), urging policy makers to pass legislation to support women, and shining an accountability spotlight on leadership.

Saving Lives: Working across Agencies and Individuals to Reduce Intimate Homicide among those at Greatest Risk.

This special issue of the Journal of Family Violence offers insights on intimate homicide prevention from leading researchers and practitioners. The insights offered are timely, given the pervasiveness of domestic violence (DV), including some data since the emergence of COVID-19 noting an increase in DV-related  cases with severe  injury and police calls. Contributors in this special issue argue for interagency advocacy, protection orders, and firearm removal, along with reimagining data capture, risk assessment, firearm protocols, and fatality reviews to improve equitable services and care for DV survivors at the highest risk of homicide.

Nonconsensual Porn as a Form of Intimate Partner Violence: Using the Power and Control Wheel to Understand Nonconsensual Porn Perpetration in Intimate Relationships.

Over the last decade, nonconsensual porn (NCP), or the sharing of sexually explicit material without a person's consent, has become a growing problem with potentially far-reaching adverse consequences for victims. The purpose of this article is to propose and consider a framework for advancing the field's understanding of NCP within the context of intimate relationships including situating NCP relative to other forms of relational abuse. Specifically, we examined the extent to which NCP in intimate partner relationships was perpetrated using tactics from the Power and Control Wheel through a summative content analysis of U.S. news stories on NCP from 2012 to 2017. This analysis established that NCP has been perpetrated using all eight of the abuse metatactics in the Power and Control Wheel, with the three most common being emotional abuse, coercion and threats, and denial/blame/minimization. Treating NCP in relationships as a potential form of partner violence provides a basis on which to understand the etiology, manifestation, motives, and impact of this form of abuse and informs practitioners' ability to design prevention efforts and engage a trauma-informed response to survivors.

Perceptions of College Campus Alcohol and Sexual Violence Prevention Among Students with Disabilities: "It Was A Joke".

PURPOSE: The purpose of this study was to understand perceptions of campus-based alcohol and sexual violence (SV) prevention programming among college students with disabilities to inform future development of prevention programs appropriate for the needs of these students. METHOD: The study included semi-structured, qualitative interviews with 51 college students with disabilities who reported histories of SV recruited from a larger parent study investigating a brief universal intervention to reduce alcohol related SV involving 28 campuses across Western Pennsylvania and West Virginia. Interviews focused on college-related experiences of prevention programming, and experiences of health, disability, alcohol use and violence victimization. Data were analyzed using thematic analysis. RESULTS: Three themes emerged: (1) Students with disabilities described campus prevention programming as ineffective and irrelevant to their experiences, including referring to programs as "a joke," (2) Students wanted multi-dose, developmentally relevant content that directly addresses the complexities of their experiences with disability, alcohol, and violence, and (3) Students called for programing focused on engaging their interests. CONCLUSIONS: Our results point to the need to augment campus-based programming, with attention to the unique needs and relevant concerns of students with disabilities, within the broader context of campus prevention programming.

Changes in health care costs over time following the cessation of intimate partner violence.

BACKGROUND: Research has documented greater health care costs attributable to intimate partner violence (IPV) among women during and after exposure. However, no studies have determined whether health care costs for abused women return to baseline levels at some point after their abuse ceases. OBJECTIVE: We examine whether health care costs among women exposed to IPV converge with those of non-abused women during a 10-year period following the end of exposure. DESIGN: Retrospective cohort analysis. SETTING: Group Health Cooperative, a large integrated health care system in the Pacific Northwest. PARTICIPANTS: Random sample of English-speaking women aged 18-64 enrolled within Group Health and who participated in a telephone survey between June 2003 and August 2005. MEASUREMENTS: Total health care costs over an 11-year period from January 1, 1992 to December 31, 2002 were compiled using automated health plan data and comparisons made among women exposed to IPV since age 18 and those who never experienced IPV. IPV included physical, sexual, or psychological violence involving an intimate partner, and was assessed using five questions from the Behavioral Risk Factor Surveillance System. RESULTS: Relative to women with no IPV history, total health care costs were significantly higher during IPV exposure, costs that were sustained for 3 years following the end of exposure. By the 4th year following the end of exposure to IPV, health care costs among IPV-exposed women were similar to non-abused women, and this pattern held for the remainder of the 10-year study period. CONCLUSIONS: Policy makers should consider the ongoing needs of victims following abuse exposure. Interventions to reduce the prevalence of IPV or to mitigate the impact of IPV have the potential to reduce the rate of growth of health care costs.

Adult health and relationship outcomes among women with abuse experiences during childhood.

Associations between child abuse and/or witnessing intimate partner violence (IPV) during childhood and women's health, adult IPV exposure, and health care use were examined. Randomly sampled insured women ages 18-64 (N = 3,568) completed a phone interview assessing childhood exposure to abuse and witnessing IPV, current health, and adult IPV exposure. Women's health care use was collected from automated health plan databases. Poor health status, higher prevalence of depression and IPV, and greater use of health care and mental health services were observed in women who had exposure to child abuse and witnessing IPV during childhood or child abuse alone, compared with women with no exposures. Women who had witnessed IPV without child abuse also had worse health and greater use of health services. Findings reveal adverse long-term and incremental effects of differing child abuse experiences on women's health and relationships.

Age, period, and cohort effects on intimate partner violence.

This study sought to determine if the recent secular decrease in reported intimate partner violence (IPV) in women was due to cohort or period effects. Women ages 18 to 64 were interviewed about IPV during their adult lifetimes. The lifetime prevalence of any IPV was 42%. Regardless of birth cohort, IPV was most common among women in their mid-20s to early 30s. After adjusting for cohort and period effects, women 26 to 30 had the highest risk of any IPV; risk decreased with age. Younger birth cohorts were at decreased risk for IPV. The estimated risk is lowest for those born between 1966 and 1975, with 31% lower risk of IPV than those born in 1946-1955. There was a substantial drop in IPV for all age-groups beginning in the 1990s.

Health care utilization and costs associated with childhood abuse.

BACKGROUND: Physical and sexual childhood abuse is associated with poor health across the lifespan. However, the association between these types of abuse and actual health care use and costs over the long run has not been documented. OBJECTIVE: To examine long-term health care utilization and costs associated with physical, sexual, or both physical and sexual childhood abuse. DESIGN: Retrospective cohort. PARTICIPANTS: Three thousand three hundred thirty-three women (mean age, 47 years) randomly selected from the membership files of a large integrated health care delivery system. MEASUREMENTS: Automated annual health care utilization and costs were assembled over an average of 7.4 years for women with physical only, sexual only, or both physical and sexual childhood abuse (as reported in a telephone survey), and for women without these abuse histories (reference group). RESULTS: Significantly higher annual health care use and costs were observed for women with a child abuse history compared to women without comparable abuse histories. The most pronounced use and costs were observed for women with a history of both physical and sexual child abuse. Women with both abuse types had higher annual mental health (relative risk [RR] = 2.07; 95% confidence interval [95%CI] = 1.67-2.57); emergency department (RR = 1.86; 95%CI = 1.47-2.35); hospital outpatient (RR = 1.35 = 95%CI = 1.10-1.65); pharmacy (incident rate ratio [IRR] = 1.57; 95%CI = 1.33-1.86); primary care (IRR = 1.41; 95%CI = 1.28-1.56); and specialty care use (IRR = 1.32; 95%CI = 1.13-1.54). Total adjusted annual health care costs were 36% higher for women with both abuse types, 22% higher for women with physical abuse only, and 16% higher for women with sexual abuse only. CONCLUSIONS: Child abuse is associated with long-term elevated health care use and costs, particularly for women who suffer both physical and sexual abuse.

Intimate partner violence among men prevalence, chronicity, and health effects.

CONTEXT: The breadth and depth of intimate partner violence (IPV) experienced by men have not been fully documented. OBJECTIVES: To describe the prevalence, chronicity, and severity of IPV, and the health outcomes associated with IPV, in adult men with healthcare insurance. DESIGN: A retrospective telephone cohort study conducted from 2003 to 2005. The setting was an integrated healthcare system in Washington State and Idaho. PARTICIPANTS: English-speaking men aged 18 and older (N=420) enrolled in the healthcare system for 3 or more years. MAIN OUTCOME MEASURES: Physical, psychological, and sexual IPV were assessed using five questions from the Behavioral Risk Factor Surveillance Survey. Health was measured using the Short Form-36, version 2 (SF-36v2) survey, the Center for Epidemiological Studies Depression Scale, and the National Institute of Mental Health Presence of Symptoms Survey. RESULTS: Men experienced IPV at a rate of 4.6% in the past year, 10.4% in the past 5 years, and 28.8% over their lifetimes. While overall rates of physical and nonphysical IPV were similar, men aged 18-55 were twice as likely to be recently abused (14.2%, SE=2.6%) than were men aged 55 and older (5.3%, SE=1.6%). Abuse was typically nonviolent or mildly violent, occurred on multiple occasions, and was initiated by only one intimate partner. Compared to men with no IPV, older men who experienced IPV had more depressive symptoms (prevalence ratios=2.61 and 2.80 for nonphysical and physical abuse) and had lower SF-36v2 mental health subscales (range=-3.21 to -5.86). CONCLUSIONS: Men experience IPV at moderate rates, and poor mental health outcomes are associated with such experiences.

Six- and twelve-month outcomes among homeless youth accessing therapy and case management services through an urban drop-in center.

RESEARCH OBJECTIVE: To evaluate the impact of case management and individual therapy offered through a drop-in center for homeless youth on substance use, mental health, housing, education, employment, and medical care utilization. STUDY POPULATION: All youth (n=172) between the ages of 14-24 who accessed treatment services through an urban, southwestern drop-in center were included. DATA SOURCE: Semistructured and self-report questionnaires were administered to youth between October 2002 and April 2005. STUDY DESIGN: A repeated measures design was utilized. Youth were assessed at baseline, 6 months, and 12 months postbaseline. Hierarchical linear modeling was used to test the hypotheses. PRINCIPAL FINDINGS: Statistically significant improvements were found in substance abuse, mental health, and percent days housed up to 12 months postbaseline. Decreased alcohol and drug use was associated with an increase in housing. However, most youth did not acquire permanent housing, and education, employment, and medical service utilization did not significantly change over time. CONCLUSIONS: While treatment offered through drop-in centers for homeless youth can positively impact homeless youth, policy, funding, and service provision need greater focus, collaboration, and support if youth homelessness is to be successfully addressed.

Correlates of medical and legal help seeking among women reporting intimate partner violence.

OBJECTIVE: To examine the relationship between intimate partner violence (IPV) type, severity, and duration and abused women's use of medical and legal services. METHODS: Participants were 1509 randomly sampled women from a large health plan who were interviewed by telephone to assess (1) self-reported lifetime exposure to IPV type (physical, sexual, and psychological), severity, and duration and (2) women's use of medical and legal services (civil protection orders). RESULTS: Compared with women who experienced psychological abuse only, sexually abused women were 1.3 times as likely to seek medical care, and women exposed to physical IPV or sexual IPV were 3.2 times and 1.6 times as likely, respectively, to seek legal services. Rates of medical and legal help seeking increased with increasing abuse severity among physically abused women, and rates of legal help seeking increased with abuse severity among sexually and psychologically abused women. Longer duration of physical and sexual IPV was also found to be associated with increased legal help seeking. CONCLUSIONS: Abused women who sought formal help were more likely to be exposed to physical or sexual IPV, severe psychological IPV, and severe and long-lasting physical and sexual IPV. Efforts should be considered to improve the healthcare and legal system's response to IPV.

Use of brief tools to measure depressive symptoms in women with a history of intimate partner violence.

BACKGROUND: Nurses play a crucial role in the routine assessment of depression. However, brief depression assessment tools--necessary for busy clinical settings--have not been evaluated to identify depression in women with histories of intimate partner violence. OBJECTIVE: To evaluate the utility of two 5-question subsets from the Center for Epidemiologic Studies-Depression (CES-D) scale in detecting depressive symptoms in women with abuse histories. METHODS: The sample comprised 448 women involved in police- or court-reported incidents of intimate partner violence who completed a questionnaire used to assess depression with the 20-item CES-D scale. Receiver operating characteristic (ROC) analysis was used to identify score thresholds for two 5-question subsets from the CES-D for detecting (a) depressive symptoms and (b) severe depressive symptoms. Depression prevalence was estimated using score thresholds identified in the ROC analysis. The discriminating ability of the CES-D question subsets was also evaluated. RESULTS: Using thresholds identified in the ROC analyses, sensitivities ranged from .94 to .95 according to the CES-D question subsets for depressive symptoms and .97 to .98 for severe depressive symptoms. Specificity ranged from .73 to .87. Depression prevalence according to the 20-item CES-D was 84% for depressive symptoms and 67% for severe depression. Depression prevalences were 81%-84% (depressive symptoms) and 72% (severe depressive symptoms) using the CES-D question subsets. The two CES-D question subsets were comparable in their ability to identify minor and severe depressive symptoms, using the 20-item score as the gold standard (area under the curve range = .96-.97). DISCUSSION: Two brief question subsets were effective in identifying depression and can be used by nurses to assess depression in women with histories of abuse.

Association between self-reported health and physical and/or sexual abuse experienced before age 18.

OBJECTIVE: The present study evaluated the association between women's health and physical and sexual abuse suffered before age 18. METHODS: A total of 3,568 randomly sampled insured women ages 18-64 completed a telephone interview to assess history of physical only, sexual only, or both physical and sexual abuse before age 18 (Behavioral Risk Factor Surveillance System); and current health (Short Form-36, Center for Epidemiologic Studies-Depression, Presence of Symptoms surveys). Adjusted analyses compared the health of women with physical abuse only, sexual abuse only, or physical and sexual abuse to the health of women without these abuse histories. RESULTS: Poorest health status was observed in women with a history of both physical and sexual child abuse compared to women without these abuse histories. In models that adjusted for age and income, women with both abuse types had increased prevalence of depression (prevalence ratio, 2.16), severe depression (PR, 2.84), physical symptoms (PR range, 1.33 for joint pain to 2.78 for nausea/vomiting), fair/poor health (PR, 1.84), and lower SF-36 scores (3.15-5.40 points lower). Women with physical abuse only or sexual abuse only also had higher prevalence of symptoms and lower SF-36 scores but the associations were not as strong. CONCLUSIONS: This study adds to the literature showing a graded association between multiple adverse events in childhood and adult health.