Rula Btoush

Association between exposure to political violence and intimate-partner violence in the occupied Palestinian territory: a cross-sectional study

BACKGROUND Intimate-partner violence might increase during and after exposure to collective violence. We assessed whether political violence was associated with male-to-female intimate-partner violence in the occupied Palestinian territory. METHODS A nationally representative, cross-sectional survey was done between Dec 18, 2005, and Jan 18, 2006, by the Palestinian Central Bureau of Statistics. 4156 households were randomly selected with a multistage random cluster design, from which 3815 ever-married women aged 15-64 years were identified. We restricted our analysis to presently married women (n=3510, 92% participation rate), who completed a short version of the revised conflict tactics scales and exposure to political violence inventory. Exposure to political violence was characterised as the husbands direct exposure, his indirect exposure via his familys experiences, and economic effects of exposure on the household. We used adjusted multinomial logistic regression models to estimate odds ratios (ORs) for association between political violence and intimate-partner violence. FINDINGS Political violence was significantly related to higher odds of intimate-partner violence. ORs were 1.89 (95% CI 1.29-2.76) for physical and 2.23 (1.49-3.35) for sexual intimate-partner violence in respondents whose husbands were directly exposed to political violence compared with those whose husbands were not directly exposed. For women whose husbands were indirectly exposed, ORs were 1.61 (1.25-2.07) for physical and 1.97 (1.49-2-60) for sexual violence, compared with those whose husbands were not indirectly exposed. Economic effects of exposure were associated with increased odds of intimate-partner violence in the Gaza Strip only. INTERPRETATION Because exposure to political violence is associated with increased odds of intimate-partner violence, and exposure to many traumas is associated with poor health, a range of violent exposures should be assessed when establishing the need for psychosocial interventions in conflict settings.

Identifying Individual Competency in Emerging Areas of Practice: An Applied Approach

Competency designation is important for any discipline to define individual performance expectations. Although public health (PH) agencies have always responded to emergencies, individual expectations have not been specified. The authors identified individual competencies necessary for organizations to meet performance standards. In the first stage, a Delphi survey served to identify competencies needed by staff to respond to any emergency, including bio-terrorism, yielding competency sets for four levels of workers. In the second stage, focus groups were used to assess the competencies with public health agencies. This feedback validated the Delphi-identified competencies as accurate and necessary for emergency response. The authors demonstrate the feasibility of using these methods to arrive at statements of value to PH practice at a reasonable investment of resources.

Care provided in visits coded for intimate partner violence in a national survey of emergency departments

PURPOSE This article describes the health status of and care provided to patients in visits coded to intimate partner violence (IPV) victims in a national survey of emergency departments (EDs). Visits coded for IPV were defined by International Classification of Diseases, 8th edition-Clinical Modification (ICD-9-CM) codes. METHODS Data from the National Hospital Ambulatory Medical Care Survey for 1997-2001 were analyzed. The sample consisted of 111 ED visits with ICD codes for IPV (or 12 IPV visits per 10,000 ED visits, and 21 female IPV visits per 10,000 female ED visits). FINDINGS The majority of visits coded to IPV were for patients who presented with mild to moderate pain (86%), physical or sexual violence (50%), and injuries to the body (38%). The majority of patients in visits coded to IPV received radiologic testing, wound care, and pain medications (odds ratios [ORs], 1.6, 3.3, and 2.3 respectively). Disposition was mostly referral to another physician or clinic (42%) or return to the ED when needed (20%), but much less to nonphysician services such as social services, support services, and shelters (14%). Uninsured IPV patients were more likely to receive radiologic testing and pain medications (ORs 5.1 and 3, respectively). Patients seen by nurses were 9 times more likely to receive wound care. CONCLUSION Caution should be exercised when interpreting the study results because they reflect only coded IPV visits in the ED and these might be the most obvious IPV cases. The results signal the need for further studies to evaluate access to and the quality of care for IPV patients and to improve screening, documentation, coding, and management practices.

Ethical conduct in intimate partner violence research: challenges and strategies.

Intimate partner violence (IPV) research has expanded dramatically in the past 2 decades. However, updated ethical guidelines to protect the safety and autonomy of research participants, study data, and the research team are still lacking in this evolving area of research. This article presents general concepts in research ethics and the specific challenges and strategies for IPV research related to recruitment and retention, maintenance of womens safety, privacy, and confidentiality, and their voluntary participation as well as assessment of benefits and risks, strategies to minimize risk, the Certificates of Confidentiality, and training of the research team. This area of nursing research is critical for developing practice guidelines and improving the health and quality of life of abused women.

Visits coded as intimate partner violence in emergency departments: characteristics of the individuals and the system as reported in a national survey of emergency departments.

INTRODUCTION This study was conducted to explore the characteristics of intimate partner violence (IPV) victims whose visit was coded as IPV and the health care delivery system in emergency departments (ED). METHODS This study utilized a secondary data analysis of a national probability sample that comprised the National Hospital Ambulatory Medical Care Survey for 1997 to 2001. RESULTS There were 111 coded ED visits of IPV victims 16 years or older (equivalent of 482,979 out of 4 million national visits for the 5-year study period). Women (94%), African Americans (35%), those 25 to 44 years of age (64%), and uninsured patients (38%) were significantly more likely to be categorized as an IPV visit (odds ratios 14, 1.9, 2.7, and 2.4, respectively) compared with non-IPV visits. Characteristics of the health care delivery system (region, metropolitan vs. non-metropolitan, type of hospital, and type of health care provider) were not associated with IPV. DISCUSSION Caution should be implemented when interpreting the study results because they represent only coded IPV visits in the emergency department. The study findings suggest the critical need to improve identification, documentation, and coding of IPV visits.

Initiation of Human Papillomavirus Vaccination Among Predominantly Minority Female and Male Adolescents at Inner-City Community Health Centers.

OBJECTIVES We examined the prevalence and correlates of human papillomavirus (HPV) vaccine initiation among adolescents in low-income, urban areas. METHODS The study consisted of electronic health record data on HPV vaccination for 3180 adolescents (aged 10-20 years) at a multisite community health center in 2011. RESULTS Only 27% initiated the HPV vaccine. The adjusted odds ratio (AOR) of HPV vaccination was lower among older adolescents (AOR = 0.552; 95% confidence interval [CI] = 0.424, 0.718) and those seen by nonpediatric health care providers (HCPs; AOR = 0.311; 95% CI = 0.222, 0.435), and higher among non-English speakers (AOR = 1.409; 95% CI = 1.134, 1.751) and those seen at 2 site locations (AOR = 1.890; 95% CI = 1.547, 2.311). Insurance status was significant only among female and Hispanic adolescents. Language was not a predictor among Hispanic adolescents. Across all analyses, the interaction of age and HCP specialty was associated with HPV vaccination. Dramatically lower HPV vaccination rates were found among older adolescents seen by nonpediatric HCPs (3%-5%) than among other adolescents (23%-45%). CONCLUSIONS Improving HPV vaccination initiation in low-income urban areas is critical to reducing disparities in cervical and other HPV-related cancer, especially among Black, Hispanic, and low-income populations.

Intimate Partner Violence and Risk for Cervical Cancer

The purpose of this paper is to critically examine the literature and present a comprehensive model of three pathways through which IPV increases the risk for cervical cancer. The first pathway is increased exposure to cervical cancer risk factors among IPV victims, including smoking, psychosocial stress, risky sexual behaviors, and sexually transmitted infections (STDs/STIs), particularly human papillomavirus infection. The second pathway is poor compliance with cervical cancer screening. The third pathway is delay/discontinuation in treatment for cervical dysplasia and neoplasia. Control imposed by the abusive partner, competing life priorities, and limited access to financial/support resources restrict a woman’s ability to seek cancer services. Higher rates, severity, and duration of IPV among low-income, Black, and Hispanic women may explain the pervasive cervical cancer disparities.