Eve Waltermaurer

Measuring Intimate Partner Violence (IPV) You May Only Get What You Ask For

With the goal of understanding the true extent of intimate partner violence (IPV), researchers have put tremendous effort over the past 20 years developing, revising, and assessing IPV screening instruments. The enhancements made in IPV instrumentation reflect our improved understanding of the nature of IPV. Unfortunately, as is often the case with progress, we are presently at the stage where IPV researchers have an arsenal of multiple IPV screens that are, in some cases, slightly different, whereas in others, the differences are sizeable. This article explores the evolution and variation of a sample of IPV screens. To further progress in IPV research, we must make conscious decisions concerning the best tool for our individual research. Simultaneously, we must enhance our understanding of how these IPV screening instruments overlap so that comparisons of IPV prevalence or incidence across time and population are possible.

Issues in Estimating the Prevalence of Intimate Partner Violence Assessing the Impact of Abuse Status on Participation Bias

This study examines the potential implications of household interviews on participation bias for estimates of intimate partner violence (IPV). Using a variety of scales, IPV prevalence for the 135 women interviewed in a street-intercept survey was compared with the IPV prevalence of a subsample of these women who reported willingness to participate in a household survey with their partner in another room or when their partner also would be interviewed. A potential self-selection bias showed an 8% to 13% deflated prevalence of moderate to highly abused women and a 8% to 11% inflated prevalence of nonabused women among this subsample who would willingly participate in a household survey. Understanding who is included in household surveys, and who is not, is essential to compute and interpret national prevalence estimates for IPV.

Femicide in New York City 1990 to 1999

This article reports resultsof an ongoing studyof femicide in New York City. Using medical examiner records, femicides occurring between 1990 and 1999 were categorized according to whether an intimate partner perpetrated the homicide. Descriptive analyses results revealed that most femicide victims were young, Black, and killed in poor neighborhoods. Among cases with a known perpetrator, 40% were intimate partner femicides. Whereas the rate of nonintimate partner femicide decreased between 1990 and 1999, the rate of intimate partner femicide remained relatively stable. Multivariate analyses revealed that the strongest predictors of femicide by an intimate partner included having children under 18, living in a private residence, and being foreign born. Homicide followed by the suicide of the offender was also strongly associated with intimate partner femicide. Intimate partner femicide exhibits a unique epidemiology, and this knowledge should be used to plan and guide prevention activities.

Black Women's Health The Effect of Perceived Racism and Intimate Partner Violence

This study provides preliminary evidence of the relationship between perceived racial discrimination and intimate partner violence (IPV) and how these exposures interact to affect the mental and physical health of Black women. The exposures of lifetime perceived racial discrimination and IPV were found to be highly associated. Furthermore, women who reported both exposures showed a notably higher prevalence of anxiety and nonspecific physical health symptoms compared with women who reported either or neither exposure. To appropriately respond to the health needs of Black women, it is essential that womens many stressors be considered simultaneously.

Becoming a Patient-Centered Medical Home: A 9-Year Transition for a Network of Federally Qualified Health Centers

PURPOSE The patient-centered medical home (PCMH) model has great potential for optimizing the care of chronically ill patients, yet there is much to be learned about various implementations of this model and their impact on patient care processes and outcomes. METHODS We examined changes in patterns of health care use in a network of Federally Qualified Health Centers throughout a 9-year period of practice transformation that included recognition of all centers by the National Committee for Quality Assurance (NCQA) as Level 3 PCMH practices. We analyzed deidentified data from electronic health records for the period 2003 to 2011 to identify patterns of service use for all 4,595 patients with diabetes. We also examined a subsample of 545 patients who were in care throughout the study period to track improvement in glycated hemoglobin levels as a clinical measure over time. RESULTS Through the transition to a PCMH, the mean number of encounters with outreach, diabetes educators, and psychosocial services increased for all diabetic patients; virtually all patients had visits with a primary care clinician, but the mean number of visits decreased slightly. Among patients in the subsample, mean annual levels of glycated hemoglobin decreased steadily during the 9-year study period, mainly driven by a reduction in patients having baseline levels exceeding 9%. CONCLUSIONS This retrospective study conducted in a real-world setting using electronic health record data demonstrates a shift in resource use by diabetic patients from the primary care clinician to other members of the care team. The findings suggest that PCMH implementation has the potential to alter processes of care and improve outcomes of care, especially among those with higher disease burden.

Understanding intimate partner violence against women in the rural south

Most U.S. intimate partner violence (IPV) research to date has been limited to women residing in urban areas, with the small body of research focusing on rural populations being primarily qualitative. In this case-control study of Southern rural women, while many factors are consistent with those found in urban settings, unlike findings elsewhere, IPV risk appears to increase with age, and race showed no increased risk. Furthermore, in rural areas where guns are more acceptable than in other parts of the United States, partners of IPV victims are considerably more likely to carry weapons than partners of nonabused women. Given the geographic limitations to police and medical response to severe IPV in a rural setting, an improved understanding of IPV risk among this population can aid health care providers in ascertaining risk before it escalates further.

Intrauterine Devices at Six Months: Does Patient Age Matter? Results from an Urban Family Medicine Federally Qualified Health Center (FQHC) Network

Background: Federally qualified health centers (FQHCs) can address high rates of unintended pregnancy among adolescents in the United States by increasing access to intrauterine devices (IUDs) in underserved settings. Despite national guidelines endorsing adolescent use of IUDs, some physicians remain concerned about IUD tolerance and safety in adolescents. Therefore we compared adolescents and adults in a family physician staffed FQHC network with regard to (1) IUD postinsertion experience, (2) device discontinuation, and (3) sexually transmitted infection (STI) rates. Methods: We conducted a retrospective cohort study among women <36 years old who had an IUD inserted in 2011 at a New York City FQHC staffed by family physicians. Results: We included 684 women (27% adolescents, 73% adults). During the 6-month postinsertion period, 59% of adolescents and 43% of adults initiated IUD-related clinical contact after insertion, most commonly for bleeding changes and pelvic or abdominal pain. There were no significant differences between groups in IUD expulsion or removal or STI rates. Conclusions: Urban FQHC providers may anticipate that, compared with their adult IUD users, adolescents will initiate more clinical follow-up visits after insertion. Both groups will, however, have similar clinical concerns about, reasons for, and rate of device discontinuation and low STI rates.

An examination of domestic partner violence and its justification in the Republic of Georgia

BackgroundLittle research on Intimate Partner Violence (IPV) and social perceptions toward this behavior has been disseminated from Eastern Europe. This study explores the prevalence and risk factors of IPV and the justification of this behavior among women in the Republic of Georgia. It seeks to better understand how IPV and IPV justification relate and how social justification of IPV differs across socio-economic measures among this population of women.MethodsThis study utilizes a national sample of ever-married women from the Republic of Georgia (N = 4,302). We describe the factors that predict IPV justification among these women and the relationship between of the acceptability of IPV and victimization overall and across socio-demographic factors.ResultsWhile the overall lifetime prevalence of IPV in this sample was relatively low (4%), these women were two to four times more likely to justify IPV, Just under one-quarter of the sample agreed that IPV was justified in at least one scenario, namely when the wife was unfaithful, compared with women who had no experience being abused by a partner. Georgian women who were poor, from a rural community, had lower education, were not working and who experienced child abuse or IPV among their parents were more likely to justify this behavior.ConclusionsThese findings begin to fill a gap in our understanding of IPV experienced by women in Eastern Europe. In addition, these findings emphasize the need for researchers, practitioners and policy makers to contextualize IPV in terms of the justification of this behavior among the population being considered as this can play an important role in perpetration, victimization and response.

Emergency Contraception Considerations and Use Among College Women

BACKGROUND Emergency contraception (EC) has been available behind the counter without a prescription since 2006. Evidence has shown increased use of EC among young women, but no recent findings have been published to date of current use. METHODS This cross-sectional study surveyed 482 college heterosexually active college women attending a large public university who either visited the college-based health clinic or were enrolled in selected undergraduate classes. Prediction models were created for each outcome, EC consideration and use, using Poisson regression with robust variance estimates. RESULTS Just over 58% of college women sampled reported ever considering EC, and just under 47% reported actual use. Consideration and actual EC use were highest for students who were nonwhite and who reported more sexual partners. Although female students who did not use condoms were more likely to use EC, there was no difference in EC relative to hormonal contraception use. CONCLUSIONS As EC becomes both better known and more readily available, use is expected to grow. Moving forward, greater attention is needed to the efficacy of EC use on preventing unwanted pregnancies.

Examining the effect of residential change on intimate partner violence risk

Objectives: To examine the relationship between residential change and a woman’s subsequent risk of intimate partner violence (IPV), whether by a past or a new offender, a relationship that has not been prospectively examined to date. Design: A dynamic cohort of women who recently changed residence (movers) was compared with those who did not (non-movers) for 12-month risk of IPV by a past offender and of IPV by a new offender. Participants and methods: Secondary analysis of a linked, longitudinal National Crime Victimization Survey dataset including 10 754 recent movers and 10 236 non-movers among women aged 18–44 years. Results: The risk of IPV by either a past or a new offender was almost double for women who had recently moved compared with those who had not moved. This increased risk proved to be robust, as it persisted when the data were weighted and unweighted, and when the main effect was adjusted by measured covariates. Conclusions: The apparent increase in IPV risk after residential change may be a marker of a pre-existing problem or a precursor of subsequent problems. Unlike past research that has considered residential change after abuse or as a simultaneous exposure, this study focused solely on empirically measuring the risk of IPV after a recent move. This decision has important public health ramifications: determination of IPV exposure is not always possible, whereas soliciting a woman’s history of residence may be more feasible. If transience puts a woman at greater risk for victimisation by an intimate partner, increased awareness may have a vital role in protecting women who move.