Elizabeth Miller

Exposure to partner, family, and community violence: gang-affiliated Latina women and risk of unintended pregnancy.

While teen pregnancy rates appear to be declining in the USA overall, the rate of decline among young Latinas has been less than other ethnic groups. Among the myriad factors associated with elevated pregnancy rates, for Latina girls living in the inner city, exposure to gang and community violence may be a critical context for increased pregnancy risk. This study explores the relationship between gang involvement and reproductive health, and the pathways through which childhood, family, and relationship violence exposure may lead to unintended pregnancy. Interviews of 20 young adult Latinas with known gang involvement in Los Angeles County were audiotaped, transcribed, and coded for key themes related to violence exposure and reproductive health. Limited access to reproductive health care compounded by male partner sexual and pregnancy coercion, as well as physical and sexual violence, emerged in the interviews. Exposures to interparental domestic violence, childhood physical and sexual abuse, and gang violence were prominent and closely associated with unhealthy and abusive intimate relationships. Adverse childhood experiences and exposure to partner, family, and community violence impact the reproductive lives and choices of young Latina women in gangs. These findings may guide targeted pregnancy prevention efforts among urban gang-affiliated Latinas as well as encourage the integration of sexual violence prevention and reproductive health promotion within gang violence intervention programs.

Comparison of Physician Implicit Racial Bias Toward Adults Versus Children

BACKGROUND AND OBJECTIVESnThe general population and most physicians have implicit racial bias against black adults. Pediatricians also have implicit bias against black adults, albeit less than other specialties. There is no published research on the implicit racial attitudes of pediatricians or other physicians toward children. Our objectives were to compare implicit racial bias toward adults versus children among resident physicians working in a pediatric emergency department, and to assess whether bias varied by specialty (pediatrics, emergency medicine, or other), gender, race, age, and year of training.nnnMETHODSnWe measured implicit racial bias of residents before a pediatric emergency department shift using the Adult and Child Race Implicit Association Tests (IATs). Generalized linear models compared Adult and Child IAT scores and determined the association of participant demographics with Adult and Child IAT scores.nnnRESULTSnAmong 91 residents, we found moderate pro-white/anti-black bias on both the Adult (meanxa0=xa00.49, standard deviationxa0=xa00.34) and Child Race IAT (meanxa0=xa00.55, standard deviationxa0=xa00.37). There was no significant difference between Adult and Child Race IAT scores (differencexa0=xa00.06, Pxa0=xa0.15). Implicit bias was not associated with resident demographic characteristics, including specialty.nnnCONCLUSIONSnThis is the first study demonstrating that resident physicians have implicit racial bias against black children, similar to levels of bias against black adults. Bias in our study did not vary by resident demographic characteristics, including specialty, suggesting that pediatric residents are as susceptible as other physicians to implicit bias. Future studies are needed to explore how physicians implicit attitudes toward parents and children may impact inequities in pediatric health care.

Factors Associated With Interest in Same-Day Contraception Initiation Among Females in the Pediatric Emergency Department

PURPOSEnThe purposes were to describe interest in hormonal contraception initiation among female adolescent in the emergency department (ED) and to assess for associations with factors known to increase pregnancy risk such as violence victimization.nnnMETHODSnWe used a computerized survey to assess sexual and dating practices, pregnancy history/likelihood, contraception use (including long-acting reversible contraception [LARC]) and concerns, contraception initiation interest, violence victimization, medical utilization, and demographics among sexually experienced females aged 14-19 years in our ED. The primary outcome was interest in contraception initiation. We compared responses between subgroups using the chi-square test.nnnRESULTSnA total of 168 adolescents participated (82% of approached; mean age 16.6 years; 41% white; 48% black; 21% commercial insurance). Interest in contraception initiation was high: 60% overall and 70% among those not using hormonal contraception (n = 96). Among those using non-LARC contraception (n = 59), 29% were interested in LARC initiation. Contraception/LARC interest was positively associated with lack of recent well care (p < .06) and concerns about cost (p < .01), privacy (p = .03), and where to obtain contraception (p < .01). Nearly all planned on avoiding pregnancy, although many (23%) used no contraception at last intercourse. One third (36%) reported violence victimization. Most (70%) reported ≥1 concern about contraception (most commonly cost).nnnCONCLUSIONSnMany reported behaviors and exposures, including violence victimization, that increase their risk for pregnancy and most expressed interest in same-day initiation of hormonal contraception, including LARC. These findings may inform novel strategies for increased adolescent access to contraception and pregnancy prevention through use of nontraditional sites such as EDs.

A randomized crossover study of web-based media literacy to prevent smoking

Feasibly implemented Web-based smoking media literacy (SML) programs have been associated with improving SML skills among adolescents. However, prior evaluations have generally had weak experimental designs. We aimed to examine program efficacy using a more rigorous crossover design. Seventy-two ninth grade students completed a Web-based SML program based on health behavior theory and implemented using a two-group two-period crossover design. Students were randomly assigned by classroom to receive media literacy or control interventions in different sequences. They were assessed three times, at baseline (T0), an initial follow-up after the first intervention (T1) and a second follow-up after the second intervention (T2). Crossover analysis using analysis of variance demonstrated significant intervention coefficients, indicating that the SML condition was superior to control for the primary outcome of total SML (F = 11.99; P < 0.001) and for seven of the nine individual SML items. Results were consistent in sensitivity analyses conducted using non-parametric methods. There were changes in some exploratory theory-based outcomes including attitudes and normative beliefs but not others. In conclusion, while strength of the design of this study supports and extends prior findings around effectiveness of SML programs, influences on theory-based mediators of smoking should be further explored.

Elements Needed for Quality Batterer Intervention Programs: Perspectives of Professionals Who Deal with Intimate Partner Violence

Batterers intervention programs (BIPs) constitute a primary intervention for perpetrators of intimate partner violence (IPV). There is little understanding as to what elements are necessary for a good intervention program. We conducted 36 individual semi-structured interviews with professionals working with BIPs. Our results yielded three thematic categories: (1) optimal BIP structure—group size and program duration should foster change and interaction, (2) facilitator characteristics—co-facilitation is ideal, and facilitators should have IPV training, and (3) program approaches–programs should challenge their clients on their behavior, promote an environment of safety and openness, and strive to adapt to clients.

Racial and Ethnic Differences in Young Men's Sex and Contraceptive Education

PURPOSEnRacial/ethnic disparities exist in young mens contraceptive knowledge. This study examines whether the likelihood of receiving sexual health education varies by race/ethnicity.nnnMETHODSnWe examined racial/ethnic differences in sex and contraceptive education both in school and from parents with multivariable logistic regression models among 4,104 men aged 15-24 years using data from the 2006-2010 National Survey of Family Growth.nnnRESULTSnNearly all respondents (96.6%) reported formal sex education. Fewer reported formal birth control education (66.6%), parental sex discussions (66.8%), and parental discussions specifically about birth control (49.2%). In multivariable analysis, black men were less likely than white men to report receiving formal contraceptive education (adjusted odds ratio [aOR], .70; 95% CI, .51-.96). Both black and U.S.-born Hispanic men reported more parental sex discussions than white men (aOR, 1.44; 95% CI, 1.07-1.94, aOR, 1.47; 95% CI, 1.09-1.99, respectively).nnnCONCLUSIONSnNearly all respondents reported having received formal sexual health education. Fewer reported receiving education about birth control either at school or at home. Black men were less likely to report receiving formal contraceptive education.

Service seeking experiences of college-aged sexual and intimate partner violence victims with a mental health and/or behavioral disability

ABSTRACT Objective: To examine mental health service experiences following sexual violence (SV) and intimate partner violence (IPV) victimization among college women with a disability. Participants: College women (n = 27, ages 19 to 24) with a disability who experienced at least one SV/IPV occurrence; interviewed July/August 2016. Methods: Qualitative study using in-depth interviews, with thematic analysis. Results: Women tended to wait several months (or did not seek care at all) following SV/IPV, because they downplayed their experience (e.g., not wanting to label an experience as “rape”). Those seeking services primarily did so because of escalating mental health concerns. Among service seekers, women were satisfied when professionals validated their experiences/concerns; and were dissatisfied when faced with extended wait time for care and/or professionals unskilled with SV/IPV and mental health. However, women still sought care following negative experiences. Conclusions: Improved access to integrated care for SV/IPV and mental health, along with skilled professionals, is essential.

Comparing residence-based to actual path-based methods for defining adolescents’ environmental exposures using granular spatial data

&NA; This paper uses data from a population‐based case control study of daily activities and assault injury to examine residence‐based versus actual path‐based approaches to measuring environmental exposures that pose risks for violence among adolescents. Defining environmental exposures based on participant home address resulted in significant misclassification compared to gold standard daily travel path measures. Dividing participant daily travel paths into origin‐destination segments, we explore a method for defining spatial counterfactuals by comparing actual trip path exposures to shortest potential trip path exposures. Spatial methods explored herein can be utilized in future research to more accurately quantify environmental exposures and associations with health outcomes. HighlightsExamines residence vs. path‐based approaches to measure environmental violence risks.Home address resulted in significant misclassification compared to daily paths.Trip path analyses provided a method for generating spatial counterfactuals.Proposed actual path‐based methods can be applied to future injury research.

Community Partnered Research Ethics Training in Practice A Collaborative Approach to Certification

This report describes the development and implementation of a tailored research ethics training for academic investigators and community research partners (CRP). The Community Partnered Research Ethics Training (CPRET) and Certification is a free and publicly available model and resource created by a university and community partnership to ensure that traditional and non-traditional research partners may study, define, and apply principles of human subjects’ research. To date, seven academic and 34 CRP teams have used this highly interactive, engaging, educational, and relationship building process to learn human subjects’ research and be certified by the University of Pittsburgh Institutional Review Board (IRB). This accessible, flexible, and engaging research ethics training process serves as a vehicle to strengthen community and academic partnerships to conduct ethical and culturally sensitive research.

Integrating Reproductive Health Services Into Intimate Partner and Sexual Violence Victim Service Programs

This study assessed the feasibility of integrating reproductive health services into intimate partner violence/sexual violence (IPV/SV) programs. After a training for victim service agencies on integration of health services, we conducted semistructured interviews with IPV/SV program leadership. Leadership reported advocates were more likely to recognize the need to refer clients to health services, and revealed challenges operationalizing partnerships with health care centers. Training to integrate basic health assessment into victim services may be one way to address women’s urgent health needs. Formal partnership agreements, protocols to facilitate referrals, and opportunities to cross-train are needed to nurture these cross-sector collaborations.