Laura S. Sadowski

Spousal physical violence against women during pregnancy

Objective  To determine the prevalence of physical violence during pregnancy and the factors associated with it.

Effect of Screening for Partner Violence on Women's Quality of Life: A Randomized Controlled Trial

CONTEXT Although partner violence screening has been endorsed by many health organizations, there is insufficient evidence that it has beneficial health outcomes. OBJECTIVE To determine the effect of computerized screening for partner violence plus provision of a partner violence resource list vs provision of a partner violence list only on womens health in primary care settings, compared with a control group. DESIGN, SETTING, AND PARTICIPANTS A 3-group blinded randomized controlled trial at 10 primary health care centers in Cook County, Illinois. Participants were enrolled from May 2009-April 2010 and reinterviewed 1 year (range, 48-56 weeks) later. Participants were English- or Spanish-speaking women meeting specific inclusion criteria and seeking clinical services at study sites. Of 3537 women approached, 2727 were eligible, 2708 were randomized (99%), and 2364 (87%) were recontacted 1 year later. Mean age of participants was 39 years. Participants were predominantly non-Latina African American (55%) or Latina (37%), had a high school education or less (57%), and were uninsured (57%). INTERVENTION Randomization into 3 intervention groups: (1) partner violence screen (using the Partner Violence Screen instrument) plus a list of local partner violence resources if screening was positive (n = 909); (2) partner violence resource list only without screen (n = 893); and (3) no-screen, no-partner violence list control group (n=898). MAIN OUTCOME MEASURES Quality of life (QOL, physical and mental health components) was the primary outcome, measured on the 12-item Short Form (scale range 0-100, mean of 50 for US population). RESULTS At 1-year follow-up, there were no significant differences in the QOL physical health component between the screen plus partner violence resource list group (n = 801; mean score, 46.8; 95% CI, 46.1-47.4), the partner violence resource list only group (n = 772; mean score, 46.4; 95% CI, 45.8-47.1), and the control group (n = 791; mean score, 47.2; 95% CI, 46.5-47.8), or in the mental health component (screen plus partner violence resource list group [mean score, 48.3; 95% CI, 47.5-49.1], the partner violence resource list only group [mean score, 48.0; 95% CI, 47.2-48.9], and the control group [mean score, 47.8; 95% CI, 47.0-48.6]). There were also no differences between groups in days unable to work or complete housework; number of hospitalizations, emergency department, or ambulatory care visits; proportion who contacted a partner violence agency; or recurrence of partner violence. CONCLUSIONS Among women receiving care in primary care clinics, providing a partner violence resource list with or without screening did not result in improved health. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00526994.

World studies of abuse in the family environment--risk factors for physical intimate partner violence.

Objectives: To identify risk factors for physical intimate partner violence against women in Chile, India, Egypt and the Philippines Design: Population-based household survey Settings: Selected urban communities in Temuco, Chile; Ismailia, Egypt; Lucknow, Trivandrum and Vellore in India and Metro Manila, Philippines. Participants: Women aged 15–49 years of age who care for at least one child younger than 18 years of age. The number of participants was 442 in Chile, 631 in Egypt, 506 in Lucknow, 700 in Trivandrum, 716 in Vellore and 1000 in the Philippines. Main outcome measure: Risk of and protective factors against lifetime physical IPV. Results: Significant associations were found between several risk factors like regular alcohol consumption of the husband/partner, past witnessing of father beating mother, the womans poor mental health and poor family work status, with any lifetime physical IPV. Womans poor mental health and witnessing father beat mother were statistically significant only in a few sites. Poor family work status, differences in employment between husband and wife and experiencing harsh physical punishment during childhood, were not found to be statistically significant across all sites. Protective factors, like higher levels of husbands and wifes education, were only found to be significantly associated with any lifetime physical IPV in Trivandrum, India. Social support was not significantly associated with any lifetime physical IPV across all sites. Conclusions: These large population-based household surveys have provided empirical evidence of the widespread nature of domestic violence and the relative commonality of risk factors across sites.

Effect of Screening for Partner Violence on Women's Quality of Life

CONTEXT Although partner violence screening has been endorsed by many health organizations, there is insufficient evidence that it has beneficial health outcomes. OBJECTIVE To determine the effect of computerized screening for partner violence plus provision of a partner violence resource list vs provision of a partner violence list only on womens health in primary care settings, compared with a control group. DESIGN, SETTING, AND PARTICIPANTS A 3-group blinded randomized controlled trial at 10 primary health care centers in Cook County, Illinois. Participants were enrolled from May 2009-April 2010 and reinterviewed 1 year (range, 48-56 weeks) later. Participants were English- or Spanish-speaking women meeting specific inclusion criteria and seeking clinical services at study sites. Of 3537 women approached, 2727 were eligible, 2708 were randomized (99%), and 2364 (87%) were recontacted 1 year later. Mean age of participants was 39 years. Participants were predominantly non-Latina African American (55%) or Latina (37%), had a high school education or less (57%), and were uninsured (57%). INTERVENTION Randomization into 3 intervention groups: (1) partner violence screen (using the Partner Violence Screen instrument) plus a list of local partner violence resources if screening was positive (n = 909); (2) partner violence resource list only without screen (n = 893); and (3) no-screen, no-partner violence list control group (n=898). MAIN OUTCOME MEASURES Quality of life (QOL, physical and mental health components) was the primary outcome, measured on the 12-item Short Form (scale range 0-100, mean of 50 for US population). RESULTS At 1-year follow-up, there were no significant differences in the QOL physical health component between the screen plus partner violence resource list group (n = 801; mean score, 46.8; 95% CI, 46.1-47.4), the partner violence resource list only group (n = 772; mean score, 46.4; 95% CI, 45.8-47.1), and the control group (n = 791; mean score, 47.2; 95% CI, 46.5-47.8), or in the mental health component (screen plus partner violence resource list group [mean score, 48.3; 95% CI, 47.5-49.1], the partner violence resource list only group [mean score, 48.0; 95% CI, 47.2-48.9], and the control group [mean score, 47.8; 95% CI, 47.0-48.6]). There were also no differences between groups in days unable to work or complete housework; number of hospitalizations, emergency department, or ambulatory care visits; proportion who contacted a partner violence agency; or recurrence of partner violence. CONCLUSIONS Among women receiving care in primary care clinics, providing a partner violence resource list with or without screening did not result in improved health. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00526994.

The world studies of abuse in the family environment (WorldSAFE): a model of a multi-national study of family violence

The World Studies of Abuse in the Family Environment (WorldSAFE) designed and implemented a study of family violence – intimate partner violence and child abuse and neglect – using standardized methods to cover over 12,000 women in eighteen communities within five lesser-developed countries. The rationale, process and methods for developing the population-based survey are described. Standardized methods included common training of investigators and field staff, sampling strategies, eligibility criteria, instruments, data collection methods, operational definitions, analysis strategies and data management. Special features of the WorldSAFE model are described – namely an ecological conceptual framework, an extensive and broad-based dissemination strategy, and community advisory boards. The World Studies of Abuse in the Family Environment (WorldSAFE) Steering Committee and principal investigators are as follows: Bhopal (India): Gandhi Medical College, S.S. Bhambal (MD) and A.K. Upadhyaya (MD) Chapel Hill (USA): University of North Carolina at Chapel Hill, Shrikant Bangdiwala (PhD); Wanda Hunter (MPH); Desmond K. Runyan (MD, DrPH); and Laura S. Sadowski (MD, MPH) Chennai (India): Chennai Medical College, Saradha Suresh (MD) and Shuba Kumar (PhD) Delhi (India): All India Institute of Medical Sciences, R.M. Pandey (PhD) Ismailia (Egypt): Suez Canal University Faculty of Medicine, Fatma Hassan (MD, PhD) Lucknow (India): King Georges Medical College, M.K. Mitra (MD) and R.C. Ahuja (MD) Manila (the Philippines): University of the Philippines School of Medicine, Laurie Ramiro (PhD); M. Lourdes Amarillo (MS); Bernadette Madrid (MD) Nagpur (India): Government Medical College, Dipty Jain (MD) São Paulo (Brazil): Escola Paulista de Medicina, Isabel Bordin (MD) and Cristiane Silvestre De Paula Temuco (Chile): Universidad de La Frontera, Sergio R. Muñoz (PhD) and Beatriz Vizcarra Thiruvananthapuram (India) formerly Trivandrum: Government Medical College, M.K.C. Nair (MD) and Rajamohanan Pillai (MD) Vellore (India): Christian Medical College, L. Jeyaseelan (PhD) and Abraham Peedicayil (MD)

Physical intimate partner violence in Chile, Egypt, India and the Philippines.

Background: Violence against women is recognized globally as a serious health and social problem that impedes development. Objectives: To determine the magnitude of physical intimate partner violence against women in six selected communities from Chile, Egypt, India and the Philippines. Design: Population-based household surveys. Settings: Selected urban communities in Temuco, Chile; Ismailia, Egypt; Lucknow, Trivandrum, and Vellore non-slum areas of India; and in Manila, the Philippines. Participants: Women aged 15–49 years who cared for at least one child younger than 18 years old. The number of participants per community was 442 (Santa Rosa, Chile), 631 (El-Sheik Zayed, Egypt), 506 (Lucknow, India), 700 (Trivandrum, India), 716 (Vellore, India) and 1000 (Paco, the Philippines). Main Outcome Measures: Lifetime and Current physical intimate partner violence (IPV) was measured using standard definitions and four behaviors or actions – namely slap, hit, kick and beat. Three derived variables for severity included: disabling IPV, IPV-related injury requiring health care and multiple severe IPV (presence of hit and kick and beat). Results: Percentages of lifetime and current physical intimate partner violence (IPV) against women in our sample of 3975 were as follows: 24.9 and 3.6 (Santa Rosa), 11.1 and 10.5 (El-Sheik Zayed), 34.6 and 25.3 (Lucknow), 43.1 and 19.6 (Trivandrum), 31.0 and 16.2 (Vellore), and 21.2 and 6.2 (Paco). Multiple severe physical IPV was more common in the three communities within India (9.0%, 5.9% and 8.0% in Trivandrum, Lucknow and Vellore) than the other three communities (Santa Rosa 2.1%; El-Sheik Zayed 2.9% and Paco 1.9%). Conclusions: Physical IPV was found to be a common phenomenon in all six communities. Overall, patterns of IPV behaviors were similar among the six communities.

Intimate partner violence and the role of socioeconomic indicators in WorldSAFE communities in Chile, Egypt, India and the Philippines.

Background: The literature documenting the influence of socioeconomic status (SES) on health and injury does not provide a clear consensus on how to account for socioeconomic indicators in population and health outcome studies across countries. The World Studies of Abuse in the Family Environment (WorldSAFE) consortium conducted a series of population-based, multi-stage probability sampling cross-sectional surveys in selected communities in five countries from 1997 to 2003 that allows for the examination of the relationship of SES with current physical and psychological intimate partner violence (IPV). Methods: Women aged 15–49 years (n = 3975) from six urban low- and middle-income communities participating in the WorldSAFE consortium were interviewed. Using a standardized instrument, the following SES indicators were collected: dwelling ownership, land ownership, number of rooms in the house along with number of residents, toilet facilities, ownership of 13 specific individual/household items, current work status of the woman and her husband/partner, and years of formal schooling completed by the woman and her husband/partner. A family asset index was constructed using principal coordinate analysis. The outcome variables utilized in this manuscript were current (past 12 months) physical IPV, and current psychological IPV. Basic bivariate associations between the categorical predictors and outcome variables were followed by a multiple logistic regression analysis to investigate the effect of covariates on the study outcomes. Results: There was considerable variability among the six sampled communities with respect to the relationship between socioeconomic indicators and current physical and psychological IPV. In general, the employment status of the woman was related to her experience of intimate partner violence, and her educational level and the familys assets index were protective factors. When considered in multiple logistic regression models, the asset index was the only indicator that was consistently significant across communities. Conclusion: The derived asset index as an SES indicator was found to be associated with current psychological and physical IPV against women across the sampled six communities in four countries.

Preincarceration Risky Behaviors among Women Inmates: Opportunities for Prevention

This study examined the associations between preincarceration risky sex and drug behaviors and HIV status among incarcerated women. A consecutive sample of 805 women felons admitted to the North Carolina Correctional Institution for Women between July 1991 and November 1992 was interviewed. Of these women, 700 granted permission to access their prison medical records and had complete information on relevant variables. Four percent of the women inmates were HIV positive. Over 80% of the women inconsistently used condoms during intercourse, and over 15% injected drugs, had a drug-injecting sex partner, and exchanged sex for money/drugs. The exchange of sex for money/drugs was associated with being HIV positive. The study findings suggest that prison-based HIV prevention programs should emphasize sexual and drug risk-reduction strategies as a means to reduce the heterosexual HIV risks facing women inmates once released back into the general community.

Training and field methods in the WorldSAFE collaboration to study family violence.

Introduction: This paper describes the collaborative efforts of research teams from medical schools in India, Chile, Egypt, the Philippines, Brazil, and the United States to develop and implement a core protocol for household surveys on family violence and to conduct standardized training for field workers. Our objectives are to share successes and difficulties encountered in training and field work and to offer recommendations for similar undertakings. Methods: Study methods, developed by a multidisciplinary group of international investigators, were documented in a procedures manual. On-site standardized training was conducted and field workers were monitored for adherence to protocol. Special attention was given to safety and ethical issues. Results: Overall, the training protocol and field methods were successful with relatively few problems encountered. Study participants were receptive to the interview and cooperated in safety procedures. The most common problem in the field was interruptions of the interview, mostly by children. Community advisory boards were actively involved in some of the sites, providing guidance on the safety and logistical aspects of the study, facilitating access to study communities, and providing community service information that could be shared with all study participants. Conclusions: WorldSAFE successes were attributed to rigorous standardized training and monitoring of field work; meticulous protocol implementation; unflagging attention to the ethical issues and to safeguarding study participants, field workers, and data; and openness and trust developed among the collaborators during the extended developmental phase.

Does Screening or Providing Information on Resources for Intimate Partner Violence Increase Womens Knowledge? Findings from a Randomized Controlled Trial

BACKGROUND Screening for IPV in health care settings might increase womens knowledge or awareness around its frequency and its impact on health. When IPV is disclosed, assuring women it is not their fault should improve their knowledge that IPV is the perpetrators responsibility. Providing information about IPV resources may also increase womens knowledge about the availability of solutions. METHODS Women (n=2708) were randomly assigned to one of three groups: (1) partner violence screen plus video referral and list of local partner violence resources if screening was positive (n=909); (2) partner violence resource list only without screen (n=893); and (3) a no-screen, no-partner violence resource list control group (n=898). One year later, 2364 women (87%) were re-contacted and asked questions assessing their knowledge of the frequency of partner violence, its impact on physical and mental health, the availability of resources to help women experiencing partner violence, and that it is the perpetrators fault. RESULTS There were no differences between women screened and provided with a partner violence resource list compared to a control group as to womens knowledge of the frequency of IPV, its impact on physical or mental health, or the availability of IPV services in their community. However, among women who experienced IPV in the year before or year after enrolling in the trial, those who were provided a list of IPV resources without screening were significantly less likely to know that IPV is not the victims fault than those in the control or list plus screening conditions. CONCLUSIONS The results of this study suggest that providing information on partner violence resources, with or without asking questions about partner violence, did not result in improved knowledge.