Patricia A. Cluss

Understanding Turning Points in Intimate Partner Violence: Factors and Circumstances Leading Women Victims Toward Change

OBJECTIVE When counseling women experiencing intimate partner violence (IPV), healthcare providers can benefit from understanding the factors contributing to a womens motivation to change her situation. We wished to examine the various factors and situations associated with turning points and change seeking in the IPV situation. METHODS We performed qualitative analysis on data from 7 focus groups and 20 individual interviews with women (61 participants) with past and/or current histories of IPV. RESULTS The turning points women identified fell into 5 major themes: (1) protecting others from the abuse/abuser; (2) increased severity/humiliation with abuse; (3) increased awareness of options/access to support and resources; (4) fatigue/recognition that the abuser was not going to change; and (5) partner betrayal/infidelity. CONCLUSIONS Women experiencing IPV can identify specific factors and events constituting turning points or catalyst to change in their IPV situation. These turning points are dramatic shifts in beliefs and perceptions of themselves, their partners, and/or their situation that alter the womens willingness to tolerate the situation and motivate them to consider change. When counseling women experiencing IPV, health providers can incorporate understanding of turning points to motivate women to move forward in their process of changing their IPV situation.

The Pittsburgh study of normal sleep in young adults: focus on the relationship between waking and sleeping EEG spectral patterns

The effects of age and gender on spectral characteristics of the waking EEG were investigated in a large sample of young adult men and women. In addition, relationships between spectral characteristics of the waking and sleeping EEG within an individual were explored. The sample included 28 females and 33 males in two age groups: 20-29 years (n = 32), and 30-40 years (n = 29). Spectral analysis was used to quantify EEG frequency characteristics for waking EEG just prior to sleep onset, as well as for the entire sleep recording. Significant effects of age were seen in the waking EEG but only in the delta frequency range (0.5-4.5 Hz) with lower delta activity in the older group (F = 11.6, P = 0.001). No significant gender effects were found in the waking EEG. Independent of age and gender, spectral profiles in the delta, theta, alpha and beta frequency bands of a subjects waking EEG were found to be highly correlated with their sleep EEG. In addition, subjects with high voltage alpha profiles during waking were found to sleep significantly longer and deeper than those with low voltage records. Significant correlations between waking and sleep EEG suggest that the spectral signature of an individuals EEG may be found across sleep/wake states.

Partner violence screening in mental health

OBJECTIVE To study a mental health sample to assess (1) the prevalence of physical, sexual and emotional intimate partner violence (IPV) victimization and perpetration, (2) the extent this sample reported being asked about IPV by mental health clinicians and (3) how prevalence and screening rates varied by gender. METHOD Women and men receiving services at a large psychiatric facility completed anonymous written questionnaires. RESULTS A total of 524 adults were approached for study participation, and 428 (158 men, 270 women) completed a survey. Over half (51%) of participants experienced some form of IPV; 63% of women and 32% of men reported IPV victimization. Experience of IPV was more likely if participants were women and had diagnoses of posttraumatic stress disorder, anxiety disorder or bipolar disorder. Both women (33%) and men (16%) reported perpetrating IPV. The reported IPV screening rate by mental health providers was 44% for the whole sample (women: 55%; men: 27%). CONCLUSION IPV victimization and perpetration is a prevalent problem among women and men receiving mental health services. Clinicians are missing opportunities to screen for IPV as part of mental health evaluation and treatment.

The Pittsburgh STOP Program: Disseminating an Evidence-Informed Intervention for Low-Income Pregnant Smokers

Purpose. Prenatal smoking is a preventable risk factor for poor perinatal outcomes and is more prevalent in pregnant smokers of low socioeconomic status (SES). We describe the intervention model and factors associated with quitting from the Pittsburgh STOP Program, an evidence-informed dissemination intervention for low-SES pregnant smokers. Setting. STOP is delivered in community health care clinics serving economically disadvantaged women. Participants. Participants were 856 pregnant women who were current smokers (93%) and recent quitters (7%). Most were white (59%) or black (35%), single (74%), young (mean age = 25), and experiencing an unplanned pregnancy (84%); 90% were insured by Medicaid/uninsured. Methods. An evidence-informed intervention for community pregnant women was delivered individually in a single-group pre-post evaluation design. Measures were demographics, participation and retention, smoking status, satisfaction, and cost. Analyses included descriptive statistics and logistic regression. Results. Participants attended an average of 4.7 sessions. Dropout rate after the first session was 5%. Over 11% of smokers quit; 48% of preenrollment spontaneous quitters remained abstinent. Factors significantly associated with quitting included race, mothers age, nicotine dependence, and number of sessions attended. Limitations. STOP is a community program with self-selected participants and no control group. Conclusion. Low-income pregnant smokers will engage in an evidence-informed cessation program tailored for this group, with quit rates that compare to controlled research results. (Am J Health Promot 2011;25[5 Supplement]:S75-S81.)

Translating an Evidence-Based Intervention for Pediatric Overweight to a Primary Care Setting

The objective of this study was to train pediatric providers to address weight, body mass index (BMI), diet, and physical activity with parents. Children aged 8 to 12 years with BMI of ≥85th percentile were eligible if accompanied by a parent. The intervention was a family-based, 11-session behavioral program focusing on healthy eating and physical activity. Outcome measures were weight and BMI. Seventy-three child—parent dyads enrolled. Children who attended at least 6 of 8 intervention sessions and 1 of 3 follow-up sessions (completers) lost an average of 2.84 lb; change in BMI z scores was statistically significant at 5 months (P < .001). Primary care providers can acquire skills to increase their confidence in approaching children and parents regarding weight and BMI. Parents and children will attend an intervention targeting healthy weight in the pediatric practice. Professional office staff can be trained to provide an evidence-informed intervention that promotes healthy weight.

Diagnostic certainty of a voluntary bipolar disorder case registry

BACKGROUND Strategies for identifying and recruiting persons with bipolar disorder are of importance as interest in studying this relatively uncommon, but highly disabling illness increases. The development and implementation of a bipolar disorder case registry and the assessment of diagnostic certainty of the resulting sample are described. METHODS Eight hundred and four individuals who self-reported a history of bipolar disorder were recruited. Telephone interviewers gathered demographic information and clinical, medical and treatment history information. One hundred randomly-selected registrants completed an in-person structured diagnostic interview. Self-report of diagnosis was compared to the results of the diagnostic interview. RESULTS Ninety three percent of registrants interviewed met criteria for a lifetime bipolar spectrum diagnosis; of those, 76.3% were diagnosed with bipolar I disorder. Agreement between self-reported and SCID diagnoses was 93%, indicating that self-report of a bipolar diagnosis is highly reliable. Two-thirds had experienced at least one other lifetime Axis I diagnosis, with substance abuse/dependence (55.9%) and panic disorder (19.4%) the most common comorbidities. LIMITATIONS Since nearly all of the sample have previously been diagnosed as having bipolar disorder by a professional, the samples representativeness of the population as a whole may be somewhat limited. CONCLUSIONS Persons with bipolar disorder can accurately identify themselves as having the disorder via a telephone interview, indicating that a case registry method is a useful strategy for recruiting very large samples of persons with this disorder. Such large samples will allow for further study of treatment variations among patient subgroups, of pathways to treatment, and of the effectiveness of new treatments.

Effect of Food Service Nutrition Improvements on Elementary School Cafeteria Lunch Purchase Patterns.

BACKGROUND Schools can play a major role in prevention and intervention for childhood obesity. We describe changes in elementary school cafeteria lunch sales patterns resulting from nutritional improvements in menu offerings that were part of a community-wide focus on health. METHODS Elementary school lunch sales data were collected for 1 week in each of 7 years in a district serving a predominantly poor, rural, and Caucasian student population, with high rates of obesity. Post hoc data analyses described lunch sales patterns and related food service costs over the project years. RESULTS The percentage of high calorie/low nutrition foods sold decreased from 22% of all sales in 2005 to 0% in 2011. High-calorie snack purchases decreased from 535 items to 0 items. The sale of fresh fruits increased by 12%. There was only a slight decline in the percentage of children who purchased cafeteria lunches over the years and a 15.2% cost increase for purchasing healthier food supplies. CONCLUSIONS Elementary school children purchased healthier lunches when healthier menu items were offered and when less healthy foods were eliminated from the menu. There was no significant decline in the number of students who purchased lunches as nutritional improvements were made.

In person versus computer screening for intimate partner violence among pregnant patients

OBJECTIVE To compare in person versus computerized screening for intimate partner violence (IPV) in a hospital-based prenatal clinic and explore womens assessment of the screening methods. METHODS We compared patient IPV disclosures on a computerized questionnaire to audio-taped first obstetric visits with an obstetric care provider and performed semi-structured interviews with patient participants who reported experiencing IPV. RESULTS Two-hundred and fifty patient participants and 52 provider participants were in the study. Ninety-one (36%) patients disclosed IPV either via computer or in person. Of those who disclosed IPV, 60 (66%) disclosed via both methods, but 31 (34%) disclosed IPV via only one of the two methods. Twenty-three women returned for interviews. They recommended using both types together. While computerized screening was felt to be non-judgmental and more anonymous, in person screening allowed for tailored questioning and more emotional connection with the provider. CONCLUSION Computerized screening allowed disclosure without fear of immediate judgment. In person screening allows more flexibility in wording of questions regarding IPV and opportunity for interpersonal rapport. PRACTICE IMPLICATIONS Both computerized or self-completed screening and in person screening is recommended. Providers should address IPV using non-judgmental, descriptive language, include assessments for psychological IPV, and repeat screening in person, even if no patient disclosure occurs via computer.

Adapting Pediatric Obesity Treatment Delivery for Low-Income Families: A Public—Private Partnership:

Objective. The objective was to evaluate the feasibility of delivering a pediatric weight management intervention adapted for low-income families.Academic researchers, a Medicaid health plan, a State Medicaid agency, and community pediatric providers partnered in the project. Methods. Participants were 48 families with 52 overweight/obese children aged 4 to 12 recruited from Medicaid health plan and providers’ offices. Elements of efficacious pediatric obesity interventions were modified for low literacy and implemented in person and telephonically with parents. Results. Families report ents in food shopping and preparation, and child eating and activity habits. The retention rate was 88%. Children grew significantly taller (F = 7.1; P = .012) but did not gain significant weight (F = 0.91; P = .35), with a trend toward decreased BMI ( F = 3.2; P = .08). Conclusions. The authors demonstrate the feasibility of delivering an adapted pediatric obesity intervention with low-income families. They also discuss implications for public—private partnerships among key stakeholders to address pediatric obesity in this high-risk population.

Helping women victims of intimate partner violence: comparing the approaches of two health care settings

Health professionals from two different clinical settings were asked about their comfort level in dealing with intimate partner violence (IPV). Focus groups and semistructured interviews were used to gather information. Staff in an obstetrics and gynecology setting relatively rich in IPV resources described feeling capable dealing with IPV. The staff in a general medicine setting dedicated to women’s health but without a focus on IPV and with fewer supports described discomfort and difficulty dealing with IPV. Presence of systemic prioritization of and resources for IPV were described as contributing to the confidence in addressing the issue. Other necessary elements identified included (a) on-site resources, (b) adequate time, (c) focused IPV training, and (d) a team or systemic approach.