Karisa K. Harland

Rural Disparity in Domestic Violence Prevalence and Access to Resources

OBJECTIVE Intimate partner violence (IPV) against women is a significant health issue in the United States and worldwide. The majority of studies on IPV have been conducted in urban populations. The objectives of this study are to determine if prevalence, frequency, and severity of IPV differ by rurality and to identify variance in geographic access to IPV resources. METHODS A cross-sectional clinic-based survey of 1478 women was conducted to measure the 1-year prevalence of physical, sexual, and psychologic IPV. IPV intervention programs in the state were inventoried and mapped, and the distance to the closest program was estimated for each participant based on an innovative algorithm developed for use when only ZIP code location is available. RESULTS Women in small rural and isolated areas reported the highest prevalence of IPV (22.5% and 17.9%, respectively) compared to 15.5% for urban women. Rural women reported significantly higher severity of physical abuse than their urban counterparts. The mean distance to the nearest IPV resource was three times greater for rural women than for urban women, and rural IPV programs served more counties and had fewer on-site shelter services. Over 25% of women in small rural and isolated areas lived >40 miles from the closest program, compared with <1% of women living in urban areas. CONCLUSIONS Rural women experience higher rates of IPV and greater frequency and severity of physical abuse yet live much farther away from available resources. More IPV resources and interventions targeting rural women are needed.

Cumulative exposure to paternal seminal fluid prior to conception and subsequent risk of preeclampsia

A growing body of literature suggests that prior and prolonged exposure to paternal antigens in seminal fluid induces maternal tolerance to the allogeneic fetus, protecting it from rejection and facilitating successful implantation and placentation. In this case-control study of nulliparous women, we test the hypothesis that increased exposure to paternal seminal fluid via the vaginal or oral route will confer a reduced risk of preeclampsia. Preeclampsia cases (n=258) and normotensive controls (n=182) were selected from live births to Iowa women over the period August 2002 to April 2005. Disease status was verified by medical chart review. Seminal fluid exposure indexes incorporated information on type and frequency of sexual practices, contraceptive use, and ingestion practices prior to conception with the babys father. Preeclampsia risk decreased significantly with increasing vaginal exposure to paternal semen (test for trend p<0.05). Women in the highest 10th percentile of vaginal exposure had a 70% reduced odds of preeclampsia relative to women in the lowest 25th percentile of exposure (aOR=0.3; 95% CI: 0.1-0.9). Oral seminal fluid exposure was not associated with a reduced risk of preeclampsia. These findings are congruent with the immune maladaptation hypothesis of preeclampsia causation and indicate that paternal antigen exposure via the vaginal mucosa may facilitate immune tolerance to paternal HLA. Thus, advising nulliparous women to decrease their use of barrier contraceptive methods and to increase vaginal sexual intercourse prior to conceiving may reduce their risk of preeclampsia.

More fatal all-terrain vehicle crashes occur on the roadway than off: increased risk-taking characterises roadway fatalities

Background All-terrain vehicles (ATVs) have steadily increased in popularity, size and speed, characteristics that likely contribute to the alarming rise in ATV-related fatalities. One potentially high-risk activity is riding on the road. Objectives To compare fatal ATV crashes that occur on the roadway and off, to more fully understand factors that contribute to fatalities at each location. Methods Fatality data from the US Consumer Product Safety Commission (CPSC) were used for descriptive and comparative analyses. Multivariate logistic regression analysis was performed to determine relative risk. Results Over 60% of all fatalities (1985–2009) resulted from roadway crashes. After 1998, roadway fatalities increased at over twice the rate of off-road fatalities. Roadway crashes were more likely than off-road crashes to involve multiple fatalities, carrying passengers, alcohol use, collisions and head injuries. Roadway victims were less likely to be helmeted than off-road victims. Passengers and operators with passengers were also less likely to be helmeted than operators riding alone. Helmeted victims were half as likely to suffer a head injury. Conclusions Fatal roadway crashes were more likely than off-road crashes to involve risk-taking behaviours (eg, carrying passengers) that could exacerbate the inherent difficulty of operating ATVs on roadway surfaces. Higher crash forces from greater speed, and lower use of protective equipment, may also have contributed to higher roadway mortality rates. Eliminating non-essential ATV road use may be an effective way to reduce ATV-related fatalities. This will likely require a substantial investment in rider education and better enforcement of ATV road use restriction laws.

Prevalence of intimate partner violence among an abortion clinic population.

In this cross-sectional, clinic-based study, we estimated 1-year prevalence of intimate partner violence among 986 patients who had elective abortions. We assessed physical, sexual, and battering intimate partner violence via self-administered, computer-based questionnaires. Overall, physical and sexual intimate partner violence prevalence was 9.9% and 2.5%, respectively; 8.4% of those in a current relationship reported battering. Former partners perpetrated more physical and sexual assaults than did current partners. Violence severity increased with frequency. Abortion patients experience high intimate partner violence rates, indicating the need for targeted screening and community-based referral.

All-Terrain Vehicles (ATVs) on the Road: A Serious Traffic Safety and Public Health Concern

Objectives: On-road all-terrain vehicle (ATV) crashes are frequent occurrences that disproportionately impact rural communities. These crashes occur despite most states having laws restricting on-road ATV use. A number of overall risk factors for ATV-related injuries have been identified (e.g., lack of helmet, carrying passengers). However, few studies have determined the relative contribution of these and other factors to on-road crashes and injuries. The objective of our study was to determine whether there were differences between on- and off-road ATV crashes in their demographics and/or mechanisms and outcomes of injuries. Methods: Data were derived from our statewide ATV injury surveillance database (2002–2009). Crash location and crash and injury mechanisms were coded using a modification of the Department of Transportation (DOT) coding system. Descriptive analyses and statistical comparisons (chi-square test) of variables were performed. Multivariate logistic regression analysis was used to determine relative risk. Results: 976 records were included in the final analysis, with 38 percent of the injured individuals from on-road crashes. Demographics were similar for crashes at each location, with approximately 80 percent males, 30 percent under the age of 16, and 15 percent passengers. However, females and youths under 16 were over 4 times more likely to be passengers (P ≤ 0.0001), regardless of crash location. Compared to those off-road, on-road crash victims were approximately 10 times more likely to be involved in a vehicle–vehicle collision (P < 0.001), 3 times more likely to have a severe brain injury (P < 0.001), and twice as likely to have suffered major trauma (P < 0.001). Adult operators in on-road crashes were also twice as likely to test positive for alcohol as those off-road (P < 0.05). Helmet use significantly reduced the odds of sustaining a brain injury and on-road victims were only half as likely to be helmeted (P < 0.01). Conclusions: More than 1 in 3 on-road crashes involved a collision with another vehicle, suggesting that ATVs on the road represent a potential traffic safety concern. Of note, helmets were associated with reduced risk for the number and severity of brain injuries, providing further support for the importance of helmet use. Finally, even controlling for helmet use, on-road crash victims suffered more major trauma and severe brain injuries than those off-road. Overall, our data reinforce the importance of laws restricting ATV road use and the need for effective enforcement, as well as the need to increase user education about ATV road-use laws and the dangers of riding on the roads.

Cervical surgery for cervical intraepithelial neoplasia and prolonged time to conception of a live birth: a case-control study

To determine whether women with a history of surgery for cervical intraepithelial neoplasia (CIN) are at an increased risk of subfertility, measured as a time to pregnancy of more than 12 months.

A school-based study of adolescent all-terrain vehicle exposure, safety behaviors, and crash experience.

PURPOSE More youth are killed every year in the United States in all-terrain vehicle (ATV) crashes than on bicycles, and since 2001, one-fifth of all ATV fatalities have involved victims aged 15 years or younger. Effectively preventing pediatric ATV-related deaths and injuries requires knowledge about youth riding practices. Our objective was to examine ATV use, crash prevalence, and riding behaviors among adolescent students in a rural state. METHODS We administered a cross-sectional survey to 4,684 youths aged 11 to 16 years at 30 schools across Iowa from November 2010 to April 2013. Descriptive and comparative analyses were performed. RESULTS Regardless of rurality, at least 75% of students reported having been on an ATV, with 38% of those riding daily or weekly. Among ATV riders, 57% had been in a crash. Most riders engaged in risky behaviors, including riding with passengers (92%), on public roads (81%), or without a helmet (64%). Almost 60% reported engaging in all 3 behaviors; only 2% engaged in none. Multivariable modeling revealed male youth, students riding daily/weekly, and those reporting both riding on public roads and with passengers were 1.61 (95% CI, 1.36–1.91), 3.73 (95% CI, 3.10–4.50), and 3.24 (95% CI, 2.09–5.04) times more likely to report a crash, respectively. CONCLUSIONS Three-fourths of youths surveyed were exposed to ATVs. The majority of riders had engaged in unsafe behaviors and experienced a crash. Given this widespread use and the potentially considerable morbidity of pediatric ATV crashes, prevention efforts, including anticipatory guidance by primary care clinicians serving families at risk, should be a higher priority.

Age-Based Risk Factors for Pediatric ATV-Related Fatalities

OBJECTIVES: To compare and contrast characteristics and determinants of fatal all-terrain vehicle (ATV) crashes among pediatric age groups. METHODS: Retrospective descriptive and multivariable analyses of Consumer Product Safety Commission fatality data (1985–2009) were performed. RESULTS: Relative to 1985–1989 (baseline), pediatric deaths over the subsequent 4-year periods were lower until 2001–2004, when they markedly increased. Also, the proportion of vehicles involved in fatalities with engine sizes >350 cubic centimeter increased, reaching ∼50% of crashes in 2007–2009. Ninety-five percent of all pediatric fatalities were on adult-size vehicles. Victims <6 years old had the highest proportion of girls (24%) and passengers (76%), and the lowest helmet use (17%). More than half of 6- to 11-year-old children were vehicle operators; 1 in 4 were carrying passengers in their own age range. Over the study period, 12- to 15-year-old children accounted for more than half of all pediatric ATV-related fatalities. The proportion of youth riding on the road increased with age, as did the proportion of collisions with other vehicles. Older teens had the highest proportions of roadway fatalities (72%) and collision events (63%), and 19% of their crashes involved alcohol. Head injuries occurred in 63% of victims (the major determinant being roadway riding), and helmets reduced the likelihood of head injury among fatal crash victims by 58%. CONCLUSIONS: There were significant differences between pediatric age groups in the relative contribution of known risk factors for ATV-related fatalities. Future injury prevention efforts must recognize these differences and develop interventions based on the age range targeted.

Maternal-fetal HLA sharing and preeclampsia: variation in effects by seminal fluid exposure in a case-control study of nulliparous women in Iowa.

Whereas histocompatibility is critical for transplantation, HLA histoincompatibility is associated with successful pregnancy. Literature on HLA sharing and preeclampsia has been inconsistent; most studies focused on maternal-paternal rather than maternal-fetal sharing. This study examines whether maternal-fetal histocompatibility is associated with preeclampsia, and whether effects vary by semen exposure history. This case-control study of nulliparous women was designed to examine associations among HLA sharing, semen exposure, and preeclampsia. 258 preeclampsia cases and 182 normotensive controls met the eligibility criteria. HLA typing for mother and baby was performed for HLA-A, -B, -C, -DRB1, and -DQB1. We further restricted our study sample to 224 mother-baby pairs who had complete HLA typing for all five genes. Seminal fluid exposure indexes incorporated information on type of practice, frequency, contraceptive use (for vaginal exposure) and ingestion practices (for oral exposure). Multivariate models were adjusted for BMI and education. HLA-A matching, Class I matching, and combined Class I and II matching were associated with increased odds of preeclampsia. Among women with low semen exposure, effects of Class I matching were amplified (HLA-A matching, OR=6.27, 95%CI=1.04, 37.97; Class I matching, OR=4.49 per one-match increase, 95%CI=1.89, 14.50). With moderate to high semen exposure, Class II matching effects predominated (HLA-DQB1, OR=3.22, 95%CI=1.04, 9.99; Class II, OR=1.76 per one-match increase, 95%CI=1.05, 2.98; and total matches, OR=1.45 per one-match increase, 95%CI=1.02, 2.06). We found consistent evidence that maternal-fetal HLA sharing was associated with preeclampsia in a pattern influenced by prior vaginal exposure to paternal seminal fluid.

Using event-triggered naturalistic data to examine the prevalence of teen driver distractions in rear-end crashes

INTRODUCTION While teen driver distraction is cited as a leading cause of crashes, especially rear-end crashes, little information is available regarding its true prevalence. The majority of distraction studies rely on data derived from police reports, which provide limited information regarding driver distraction. METHOD This study examined over 400 teen driver rear-end crashes captured by in-vehicle event recorders. A secondary data analysis was conducted, paying specific attention to driver behaviors, eyes-off-road time, and response times to lead-vehicle braking. RESULTS Among teens in moderate to severe rear-end crashes, over 75% of drivers were observed engaging in a potentially distracting behavior. The most frequently seen driver behaviors were cell phone use, attending to a location outside the vehicle, and attending to passengers. Drivers using a cell phone had a significantly longer response time than drivers not engaged in any behaviors, while those attending to passengers did not. Additionally, in about 50% of the rear-end crashes where the driver was operating/looking at a phone (e.g., texting), the driver showed no driver response (i.e., braking or steering input) before impact, compared to 10% of crashes where the driver was attending to a passenger. CONCLUSIONS The high frequency of attending to passengers and use of a cell phone leading up to a crash, compounded with the associated risks, underlines the importance of continued investigation in these areas. PRACTICAL APPLICATIONS Parents and teens must be educated regarding the frequency of and the potential effects of distractions. Additional enforcement may be necessary if Graduated Driver Licensing (GDL) programs are to be effective. Systems that alert distracted teens could also be especially helpful in reducing rear-end collisions.