Kathy Watson

Intimate partner sexual assault against women: frequency, health consequences, and treatment outcomes.

OBJECTIVE: To describe the characteristics and consequences of sexual assault within intimate relationships specific to racial or ethnic group, compare the findings to a similar group of physically assaulted–only women, and measure the risk of reassault after victim contact with justice and health services METHODS: A personal interview survey of 148 African-American, Hispanic, and white English- and Spanish-speaking abused women seeking a protection order. Extent of sexual assault, prevalence of rape-related sexually transmitted diseases and pregnancy, symptoms of posttraumatic stress disorder (PTSD) and depression, and risk of reassault after treatment were measured RESULTS: Sixty-eight percent of the physically abused women reported sexual assault. Fifteen percent of the women attributed 1 or more sexually-transmitted diseases to sexual assault, and 20% of the women experienced a rape-related pregnancy. Sexually assaulted women reported significantly (P = .02) more PTSD symptoms compared with nonsexually assaulted women. One significant (P = .003) difference occurred between ethnic groups and PTSD scores. Regardless of sexual assault or no assault, Hispanic women reported significantly higher mean PTSD scores compared with African-American women (P = .005) and White women (P = .012). The risk of sexual reassault was decreased by 59% and 70% for women who contacted the police, or applied for a protection order, after the first sexual assault. Receiving medical care decreased the womans risk of further sexual assault by 32% CONCLUSION: Sexual assault is experienced by most physically abused women and associated with significantly higher levels of PTSD compared with women physically abused only. The risk of reassault is decreased if contact is made with health or justice agencies. LEVEL OF EVIDENCE: III

Secondary Prevention of Intimate Partner Violence: A Randomized Controlled Trial

Background: Despite the recognition of intimate partner violence (IPV) against women as a global health issue associated with significant morbidity and mortality, evidence-based treatment strategies for primary care settings are lacking. Objective: To assess the comparative safety behaviors, use of community resources, and extent of violence following two levels of intervention. Methods: A randomized, two-arm, clinical trial was completed in urban public primary care clinics with 360 abused women who assessed positive for physical or sexual abuse within the preceding 12 months. Two interventions were tested: a wallet-sized referral card and a 20-minute nurse case management protocol. Outcome measures were differences in the number of threats of abuse, assaults, danger risks for homicide, events of work harassment, safety behaviors adopted, and use of community resources between intervention groups over a 24-month period. Results: Two years following treatment, both treatment groups of women reported significantly (p <.001) fewer threats of abuse (M = 14.5; 95% CI 12.6, 16.4), assaults (M = 15.5, 95% CI 13.5, 17.4), danger risks for homicide (M = 2.6; 95% CI 2.1, 3.0), and events of work harassment (M = 2.7; 95% CI 2.3, 3.1), but there were no significant differences between groups. Compared to baseline, both groups of women adopted significantly (p <.001) more safety behaviors by 24 months (M = 2.0; 95% CI 1.6, 2.3); however, community resource use declined significantly (p <.001) for both groups (M = −0.2; 95% CI −0.4,−0.2). There were no significant differences between groups. Discussion: Disclosure of abuse, such as what happens with abuse assessment, was associated with the same reduction in violence and increase in safety behaviors as a nurse case management intervention. Simple assessment for abuse and offering of referrals has the potential to interrupt and prevent recurrence of IPV and associated trauma.

Relative Reliability and Validity of the Block Kids Questionnaire among Youth Aged 10 to 17 Years

This cross-sectional study tested the reliability and validity of the Block Kids Questionnaire to assess diet during the past 7 days. Within a 7-day period, 10- to 17-year-old children and adolescents completed two 24-hour dietary recalls by telephone, followed by the Block Kids Questionnaire at the end of the week. Test-retest reliability was assessed using intraclass correlations for 18 participants who completed a second Block Kids Questionnaire 1 month later. Validity of the Block Kids Questionnaire compared to the 24-hour dietary recall was assessed for the whole sample and by age group using paired t tests and Pearson correlation coefficients adjusted for attenuation and energy intake. Participants were 83 children and adolescents (57% Hispanic, 21% African-American, and 23% white; 53% were female subjects, mean age 13 years). The Block Kids Questionnaire mean daily consumption values were higher for percent energy from carbohydrate, and servings of fruit, 100% fruit juice, and vegetables, and lower for all other categories compared to the 24-hour dietary recall. All reliability intraclass correlations were >0.30, except percent energy from protein and fruit/vegetable servings. Significant differences in the means between the two dietary assessment methods were noted for most nutrients/food groups. The adjusted correlation coefficients ranged from 0.69 for percent energy from carbohydrate to -0.03 for grain servings, with 60% of the food group servings <0.18. Overall, the majority of the correlation coefficients for children aged >12 years were higher than those aged < or =12 years. These results suggest that the Block Kids Questionnaire has validity for some nutrients, but not most food groups assessed, and appears more useful for adolescents.

Improvements in Middle School Student Dietary Intake After Implementation of the Texas Public School Nutrition Policy

OBJECTIVES We assessed the effect of the Texas Public School Nutrition Policy on middle school student lunchtime food consumption. METHODS Three years of lunch food records were collected from middle school students in southeast Texas: baseline (2001-2002), after local district changes (2002-2003), and 1 year after implementation of the Texas Public School Nutrition Policy (2005-2006). Students recorded amount and source of foods and beverages they consumed. Analysis of variance and covariance and nonparametric tests were used to compare intake after the policy change with intake during the 2 previous years. RESULTS After implementation of the nutrition policy, student lunch consumption of vegetables, milk, and several nutrients increased (protein, fiber, vitamins A and C, calcium, and sodium), and consumption of less desirable items (sweetened beverages, snack chips) decreased, as did percentage of energy from fat. Most of the desired nutrients and foods (vegetables and milk) were obtained from the National School Lunch Program meal. Fewer sweetened beverages, candy, chips, and dessert foods were purchased and consumed, but more of these items were brought from home and purchased from the snack bar. CONCLUSIONS Overall, state school nutrition policies can improve the healthfulness of foods consumed by students at lunch.

Protection orders and intimate partner violence: an 18-month study of 150 black, Hispanic, and white women

OBJECTIVES We compared types and frequencies of intimate partner violence experienced by women before and after receipt of a 2-year protection order. METHODS Participants were 150 urban English- and Spanish-speaking Black, Hispanic, and White women who qualified for a 2-year protection order against an intimate partner. RESULTS One woman committed suicide 6 weeks into the study. The remaining 149 women completed all interviews. Results showed significant reductions in threats of assault, physical assault, stalking, and worksite harassment over time among all women, regardless of receipt or nonreceipt of a protection order. CONCLUSIONS Abused women who apply and qualify for a 2-year protection order, irrespective of whether or not they are granted the order, report significantly lower levels of violence during the subsequent 18 months.

An intervention to increase safety behaviors of abused women: Results of a randomized clinical trial

BackgroundAlthough intimate partner violence is recognized as a major threat to women’s health, few interventions have been developed or tested. ObjectiveTo test an intervention administered to abused women in order to increase safety-seeking behaviors. MethodA two-group clinical trial randomized 75 abused women to receive six telephone intervention sessions on safety behaviors. A control group of 75 women received standard care. Women in both groups were re-interviewed at 3 months and 6 months post-initial measurement. ResultsUsing repeated measures analysis of variance (ANOVA), we found significantly [F (2,146) 5.11, p = .007] more adopted safety behaviors reported by women in the intervention group than by women in the control group at both the 3-month [F (91,74) = 19.70, p < .001] and 6-month [F (1,74) = 15.90, p < .001] interviews. The effect size (ES) of the intervention was large at 3 months (ES = 1.5) and remained substantial at 6 months (ES = 0.56). DiscussionThese findings demonstrate that an intervention to increase safety behaviors of abused women is highly effective when offered following an abusive incident and remains effective for 6 months.

Exploring changes in middle-school student lunch consumption after local school food service policy modifications.

OBJECTIVE This study assessed the impact of changes in school food policy on student lunch consumption in middle schools. METHODS Two years of lunch food records were collected from students at three middle schools in the Houston, Texas area. During the first year, no changes occurred in the school food environment. After that school year was completed, chips and dessert foods were removed from the snack bars of all schools by the Food Service Director. Students recorded the amount and source of food and beverage items consumed. Point-of-service purchase machines provided a day-by-day electronic data file with food and beverage purchases from the snack bars during the 2-year period. Independent t-tests and time series analyses were used to document the impact of the policy change on consumption and sales data between the two years. RESULTS In general, student consumption of sweetened beverages declined and milk, calcium, vitamin A, saturated fat and sodium increased after the policy change. Snack chips consumption from the snack bar declined in year 2; however, consumption of snack chips and candy from vending increased and the number of vending machines in study schools doubled during the study period. Ice cream sales increased significantly in year 2. CONCLUSIONS Policy changes on foods sold in schools can result in changes in student consumption from the targeted environments. However, if all environments do not make similar changes, compensation may occur.

INTIMATE PARTNER SEXUAL ASSAULT AGAINST WOMEN AND ASSOCIATED VICTIM SUBSTANCE USE, SUICIDALITY, AND RISK FACTORS FOR FEMICIDE

In order to establish the frequency of substance use, following and attributed to sexual assault, and describe the danger for femicide and suicidality for women physically and sexually abused compared to physically-abused only women, a personal interview of 148 African-American, Hispanic, and white English and Spanish-speaking abused women was completed. Women who reported more than one sexual assault were 3.5 (95% CI, 0.9, 13.4) times more likely to report beginning or increasing substance use compared to women who reported only one sexual assault. Sexually assaulted women reported significantly (p = .002) more risk factors for femicide compared to physically- abused only women. Specific to suicide, women reporting sexual assault were 5.3 (95% CI, 1.3, 21.5) times more likely to report threatening or attempted suicide within a 90-day period compared to physically-abused only women. The health assessment and intervention of intimate partner violence must extend beyond injury to include behavior risk sequelae of substance abuse and suicidality.

Food, fun, and fitness internet program for girls: pilot evaluation of an e-Health youth obesity prevention program examining predictors of obesity.

OBJECTIVE This pilot study tested whether an Internet-based intervention could achieve change in fruit, juice, and vegetable consumption, physical activity, and self-efficacy in youth at-risk of obesity. METHOD Participants were 80 8-to-10-year-old African American girls at-risk of obesity, with a home computer, Internet access, and an e-mail address. A two-group design was followed. Groups differed only on incentive schedule (immediate, delayed). The 8-week home-based program, conducted entirely over the Internet, promoted fruit, juice, vegetables, and water intake and physical activity. Pre-post measures were collected through self-report via the program website. The study was conducted in the greater Houston, TX, area September through November, 2004. RESULTS Statistically significant pre-to-post differences were observed in fruit, juice, and vegetable consumption (p=.002), physical activity--yesterday (p<.001), physical activity--usually (p=.001), and fruit, juice, and vegetable self-efficacy (p=.003). CONCLUSION Internet-based obesity prevention programs may be an effective channel for promoting healthy diet and physical activity behaviors to youth at-risk of obesity. Additional research is needed to more fully examine their effectiveness at promoting and maintaining diet and physical activity change.

The Walking School Bus and Children's Physical Activity: A Pilot Cluster Randomized Controlled Trial

OBJECTIVE: To evaluate the impact of a “walking school bus” program on childrens rates of active commuting to school and physical activity. METHODS: We conducted a pilot cluster randomized controlled trial among 4th-graders from 8 schools in Houston, Texas (N = 149). Random allocation to treatment or control conditions was at the school level. Study staff walked with children to and from school up to 5 days/week. Outcomes were measured the week before (time 1) and during weeks 4 and 5 of the intervention (time 2). The main outcome was the weekly rate of active commuting, and a secondary outcome was moderate-to-vigorous physical activity. Covariates included sociodemographics, distance from home to school, neighborhood safety, child BMI z score, parent self-efficacy/outcome expectations, and child self-efficacy for active commuting. A mixed-model repeated measures regression accounted for clustering by school, and stepwise procedures with backward elimination of nonsignificant covariates were used to identify significant predictors. RESULTS: Intervention children increased active commuting (mean ± SD) from 23.8% ± 9.2% (time 1) to 54% ± 9.2% (time 2), whereas control subjects decreased from 40.2% ± 8.9% (time 1) to 32.6% ± 8.9% (time 2) (P < .0001). Intervention children increased their minutes of daily moderate-to-vigorous physical activity from 46.6 ± 4.5 (time 1) to 48.8 ± 4.5 (time 2), whereas control children decreased from 46.1 ± 4.3 (time 1) to 41.3 ± 4.3 (time 2) (P = .029). CONCLUSIONS: The program improved childrens active commuting to school and daily moderate-to-vigorous physical activity.