Kathryn Andersen Clark

Violence and substance use among North Carolina pregnant women.

OBJECTIVES Prenatal patients were studied to examine the proportion of women who had been violence victims, womens patterns of substance use (cigarettes, alcohol, and illegal drugs) before and during pregnancy, and relationships between violence and substance use. METHODS More than 2000 prenatal patients in North Carolina were screened for violence and substance use. Relationships between violence and patterns of substance use before and during pregnancy were examined, as well as womens continuation of substance use during pregnancy as a function of violence and sociodemographic factors. RESULTS Twenty-six percent of the women had been violence victims during their lives. Before pregnancy, 62% of the women had used one or more substances; during pregnancy, 31% had used one or more substances. Both before and during pregnancy, violence victims were significantly more likely to use multiple substances than nonvictims. Continuation of substance use during pregnancy was significantly more likely among violence victims than nonvictims. CONCLUSIONS Care providers should screen women for violence as well as for substance use and should ensure that women are provided with appropriate interventions.

Partner violence: implications for health and community settings.

OBJECTIVE To assist in the design and implementation of strategies to address partner violence, the objective of this study was to evaluate differences in mental health, health behaviors, and use of health care and specific community services between women who do or do not report experiences of partner violence as an adult. METHODS During interviews with 392 women enrolled in a Medicaid managed care organization, measures of mental health status, health behaviors, use of health care and community services, and experiences of partner violence were collected. Using bivariate statistical analyses, characteristics between women reporting or not reporting partner violence were compared. Chi-square tests were used to assess significant differences between the groups. The relationships between outcomes of interest and violence were estimated with logistic regression models adjusting for significant demographic and health characteristics. RESULTS Overall, 28% of women reported experiences of partner violence. Women reporting partner violence had twice the adjusted odds of depression and three times the adjusted odds of negative self-esteem compared with women not reporting experiences of partner violence. Women reporting partner violence, compared with those who did not, indicated higher use of specific types of health and community services such as mental health services [odds ratio (OR) 2.9; confidence interval (CI) 1.5-5.6] and individual counseling (OR 3.6; CI 2.2-6.1). CONCLUSIONS A communitywide effort that establishes linkages between health care settings and community services may be important in addressing the needs of women who are experiencing partner violence.

Violence in the Lives of Pregnant Teenage Women: Associations with Multiple Substance Use

Using data from a consecutive sample of approximately 700 prenatal patients aged 12 to 19, the extent of violence and substance use in the lives of these women was examined, as were associations between violence and substance use. The findings show that 29% of the study participants had been victims of violence, with 15% experiencing physical violence only, 5% sexual violence only, and 9% both physical and sexual violence. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression analyses showed that, after controlling for confounding factors, victims were more likely than nonvictims to use cigarettes, alcohol, and illicit drugs, with victims of both physical and sexual violence being the most likely to use each type of substance. Ordinal logistic regression analysis found that, compared to nonvictims, violence victims were more likely to have more severe patterns of substance use (use multiple types of substances), with victims of both physical and sexual violence being the most likely to be multiple substance users. These findings underline the importance of both violence and substance use as health concerns among our youth.

Characteristics Associated with Pregnant Women's Utilization of Substance Abuse Treatment Services

There is a dearth of substance abuse treatment programs available to pregnant substance-using women. However, even when specialized substance abuse treatment programs are offered to these high-risk women, some women will choose not to enter treatment. To gain a better understanding concerning the characteristics of pregnant substance-using women related to their decisions regarding treatment utilization, this study compares two groups of substance users: 93 pregnant women who accepted offered substance-related treatment services, and 89 pregnant women who declined the same services. All women were interviewed and information was gathered concerning their sociodemographic characteristics, their types and levels of substance use, substance use by their family members, and their experiences of being victims of violence. Bivariate analyses found that, compared to women who declined treatment, women who accepted treatment were more likely to be African-American, to be single (never married), and to have a significantly greater number of children. Bivariate analyses also showed that, compared to women who declined treatment, women who accepted treatment had more severe substance abuse problems and were more likely to have previously undergone treatment for a substance problem. Women who accepted treatment were twice as likely to have partners who used alcohol and were three times more likely to have experienced physical and/or sexual violence during pregnancy. When logistic regression procedures were used to simultaneously examine the relative impact of all of the variables on treatment utilization, the four strongest independent predictors positively associated with treatment utilization were the womens race (being African-American), the womens use of illegal drugs during pregnancy, the womens past treatment for substance abuse, and the womens use of cigarettes before pregnancy.

A Cost-Benefit Analysis of the Violence Against Women Act of 1994:

In response to public concern about violence against women in the United States, Congress passed the Violence Against Women Act of 1994 (VAWA-I), which provided

How contraceptive use patterns differ by pregnancy intention: implications for counseling.

1.6 billion for programs over 5 years. The purpose of this research is to estimate the net benefit, using a societal perspective, of VAWA-I in reducing violent criminal victimization of women. Costs included direct property losses, medical and mental health care, police response, victim services, lost productivity, reduced quality of life, and death. Benefits were calculated as averted costs. This analysis found that VAWA-I saved

Physically abused pregnant women's perceptions about the quality of their relationships with their male partners

14.8 billion in net averted social costs, suggesting that VAWA-I is an affordable and beneficial social program.

Early abortion services in the United States: a provider survey

To increase awareness of issues to include in contraceptive counseling-the objectives of this study were to evaluate: 1) how contraceptive use patterns (eg, non-use), level of effectiveness of contraceptive method, and sociodemographic characteristics may be associated with the occurrence of unintended pregnancy; 2) patterns of health care use for women with intended and unintended pregnancy; and 3) the association between contraceptive use patterns and sociodemographic characteristics. In-person interviews were conducted with 279 women enrolled in a Medicaid managed care health plan who had been pregnant in the last 5 years. Self-reported measures of pregnancy intention, contraceptive use, and health care use were collected. The relationships of pregnancy intention with contraceptive use patterns, level of effectiveness of contraceptive method used, and patterns of recent health care use were assessed. Differences in contraceptive use patterns by sociodemographic groups were assessed. Seventy-eight percent of women reported an unintended pregnancy. Non-use of birth control the month before conception was reported by 57% of women with unintended pregnancies and 84% of women with intended pregnancies. Use of birth control of low effectiveness was reported by 20% of women with unintended pregnancies and 8% of women with intended pregnancies. Non-use or use of contraceptive methods of low effectiveness did not differ for women in different sociodemographic groups regardless of pregnancy intention status. A majority of women reported recent health care use. Health care providers should be aware that women who have no intention for pregnancy may not be using an effective contraceptive method NOR have an effective pattern of contraceptive use.

TREATMENT COMPLIANCE AMONG PRENATAL CARE PATIENTS WITH SUBSTANCE ABUSE PROBLEMS

SUMMARY Objectives. Most studies of pregnant victims of intimate partner violence have focused on the violent behaviors, without examining other potentially important dimensions of the relationships. This research studies pregnant abuse victims to examine the frequency of violent behaviors occurring during pregnancy, how women characterize the quality of their relationships, and the association between violence frequency and womens perceptions concerning the overall quality of their relationships. Methods. Eighty-one women who were physically abused by intimate partners during pregnancy were interviewed. Information was collected concerning the womens: experiences of partner violence during pregnancy; perceptions of other aspects of the quality of their relationships; and sociodemographic characteristics. Results. The most frequent type of violent behavior occurring during pregnancy was verbal aggression, followed by minor violence, and then severe violence. Men perpetrated each type of violent behavior at significantly higher rates than did their female partners. In general, the women were quite negative in their characterizations of many dimensions of their relationships, as well as in their perceptions concerning the overall quality of their relationships, with women who had been victims of more frequent violence being significantly more likely to characterize their relationships as being of lower overall quality (OR = 3.5, 95% CI = 1.4–8.7). Conclusions. Prenatal care providers are encouraged to screen their patients for intimate partner violence, and to work with others in their community to assure that women in abusive situations are offered appropriate services/interventions including safe and feasible alternatives to staying in unsatisfactory relationships with abusive partners.

The effect of implementing a more comprehensive screening for substance use among pregnant women in North Carolina.

The objective of this study was to describe the availability of early surgical and medical abortion among members of the National Abortion Federation (NAF) and to identify factors affecting the integration of early abortion services into current services. Telephone interviews were conducted with staff at 113 Planned Parenthood affiliates and independent abortion providers between February and April 2000, prior to FDA approval of mifepristone. Early abortion services were available at 59% of sites, and establishing services was less difficult than or about what was anticipated. Sites generally found it easier to begin offering early surgical abortion than early medical abortion. Physician participation was found to be critical to implementing early services. At sites where some but not all providers offered early abortion, variations in service availability resulted. Given the option of reconsidering early services, virtually all sites would make the same decision again. These data suggest that developing mentoring relationships between experienced early abortion providers/sites and those not offering early services, and training physicians and other staff, are likely to be effective approaches to expanding service availability.