性暴力与生殖健康研究

目的:了解未婚人工流产(人流)女青少年中的性暴力发生现状及其对生殖健康的影响。方法:于2002年10月~2003年2月在北京、郑州、深圳、南宁市8所医院对2002名自愿要求人流的未婚女青少年进行了自填式问卷调查和妇科检查以及有关性传播疾病(STDs)的实验室检测。结果:2002名未婚人流女青少年中有282名报告曾遭受了性暴力,其发生率为14·08%。在首次性行为和近1年中曾遭受了性暴力的比例分别为7·99%和8·39%。性暴力施暴者中最常见的是男朋友(76·24%)。在性暴力受害者中,有46·10%的人被证实目前患有STDs(包括滴虫性阴道炎、念珠菌性阴道炎、沙眼衣原体感染、淋病、尖锐湿疣、生殖器疱疹)。性暴力受害者更可能首次性行为年龄<18岁、有多个性伴侣、在月经期有性行为、受教育程度低和有吸烟、饮酒嗜好。单因素分析显示,性暴力受害者中有STDs感染史和目前有STDs感染的比例明显高于无性暴力的女青少年,差异有极显著性(P<0·01);多因素分析表明,性暴力经历、首次性交年龄<18岁、性伴侣数≥2个、不使用避孕方法、父母关系不良是未婚人流女青少年是否感染性传播疾病的预测因子。与未遭受性暴力的女青少年相比,性暴力受害者目前有STDs感染的风险增加了1·3倍。结论:未婚人流女青少年中有较高的性暴力发生率和性传播疾病患病率,对未婚人流女青少年的生殖健康造成了明显的影响。     

Adverse consequences of intimate partner abuse among women in non-urban domestic violence shelters

OBJECTIVE: This study examined the health consequences of having experienced both sexual and physical abuse relative to women experiencing physical abuse but not sexual abuse. METHODS: A cross-sectional study was conducted among 203 women seeking refuge in battered women's shelters. Controlling for sociodemographics, logistic regression analyses were conducted to assess the consequences of experiencing both sexual and physical abuse. RESULTS: Compared to women experiencing physical abuse, women experiencing both sexual and physical abuse were more likely to have a history of multiple sexually transmitted diseases (STDs) in their abusive relationships, have had an STD in the past 2 months, be worried about being infected with HIV, use marijuana and alcohol to cope, attempt suicide, feel as though they had no control in their relationships, experience more episodes of physical abuse in the past 2 months, rate their abuse as more severe, and be physically threatened by their partner when they asked that condoms be used. CONCLUSIONS: Given the prevalence of adverse health outcomes, domestic violence shelters could counsel women to avoid using alcohol/drugs as a coping strategy, educate women about alternative healthy coping strategies, counsel women about methods of STD prevention that they can control, and provide STD screening and treatment.     

Childhood abuse and neglect and the risk of STDs in early adulthood

CONTEXT: Given the threat posed by STDs in young adulthood, identifying early predictors of STD risk is a priority. Exposure to childhood maltreatment has been linked to sexual risk behaviors, but its association with STDs is unclear. METHODS: Associations between maltreatment by parents or other adult caregivers during childhood and adolescence and STD outcomes in young adulthood were examined using data on 8,922 respondents to Waves 1, 3 and 4 of the National Longitudinal Study of Adolescent Health. Four types of maltreatment (sexual abuse, physical abuse, supervision neglect and physical neglect) and two STD outcomes (self‐reported recent and test‐identified current STD) were assessed. Multivariate logistic regression analyses, stratified by sex, tested for moderators and mediators. RESULTS: Among females, even after adjustment for socioeconomic and demographic characteristics, self‐report of a recent STD was positively associated with sexual abuse (odds ratio, 1.8), physical abuse (1.7), physical neglect (2.1) and supervision neglect (1.6). Additionally, a positive association between physical neglect and having a test‐identified STD remained significant after further adjustments for exposure to other types of maltreatment and sexual risk behaviors (1.8). Among males, the only association (observed only in an unadjusted model) was between physical neglect and test‐identified STD (1.6). CONCLUSIONS: Young women who experienced physical neglect as children are at increased risk of test‐identified STDs in young adulthood, and exposure to any type of maltreatment is associated with an elevated likelihood of self‐reported STDs. Further research is needed to understand the behavioral mechanisms and sexual network characteristics that underlie these associations.     

The impact of current and past interpersonal violence on women's mental health

Violence against women, and more particularly male partner violence, is frequent. Although there are many studies on the consequences of violence on women's mental health, a number of aspects are still unclear. The impact of violence is seldom studied in the context of other risk factors of mental distress, psychological abuse is rarely considered, and older women are generally excluded from the sample. This study aims to analyze the relationships between current and past violence and three indicators of current women's health--psychological distress, the use of psychoactive drugs and a subjective evaluation of health--controlling for demographic and social characteristics. We conducted a cross-sectional survey among patients of family practices in an Italian town and 444 women responded to a self-administrated questionnaire: 20% of them had experienced some kind of abuse in the last 12 months and 5.2% reported physical or sexual aggression, mostly (4%) inflicted by a partner or ex-partner. Current violence was strongly associated with psychological distress, the use of psychoactive drugs and a negative evaluation of health. Experiencing solely psychological abuse with no sexual or physical violence was also associated with impaired health. The relationship between current violence and health was independent of age. After controlling for age, education, children, marital and employment status, women victims of partner violence were around 6 times more likely to be depressed and to feel in bad health, and 4 times more likely to use psychoactive pills than other women. Moreover, there was a strong association between past and current violence. Compared to women who reported no violence, women who reported both types were 5.95 times, women who reported only current but no past violence were 4.81 times, and women who reported only past but no current violence were 3.01 times more likely to report psychological distress.     

Domestic violence and abuse, health status, and social functioning

BACKGROUND: Current and past history of domestic violence (DV), including physical, sexual, and emotional abuse is common among women patients seen in health care settings and is associated with a higher frequency of many health problems. However, the association of DV with self-assessed social functioning is less well known. METHODS: We administered a telephone survey to a random sample of 391 women HMO members seen for a routine annual check-up. The survey included questions about current and past physical, sexual, and emotional violence and self-assessed social functioning and health status from the SF-36. We included questions about attitudes toward routine DV screening, likelihood of disclosure, and the health care setting as a resource. RESULTS: Seven percent of the women reported recent DV and 34% reported lifetime abuse. Abuse was related to limitations in social functioning (adjusted OR = 2.26). Among women with no recent history of abuse, those with a history of past physical (adjusted OR = 1.90), sexual (adjusted OR = 2.04), or emotional (adjusted OR = 2.20) abuse reported significantly poorer social functioning. Emotional abuse, even in the absence of a history of physical or sexual abuse, was strongly associated with limitations in social functioning (adjusted OR = 4.95). Most women believed it appropriate for clinicians to inquire routinely about DV (87%) and 83% believed that the health care setting was a source of help. CONCLUSIONS: Current and past DV, including emotional abuse, adversely affect social functioning. Therefore, clinicians in the health care setting have a unique and important opportunity to assist women victims of DV and abuse.     

Coercive forms of sexual risk and associated violence perpetrated by male partners of female adolescents

CONTEXT: Partner violence is associated with STDs among female adolescents, but the mechanisms underlying this association remain unclear. Sexually coercive and deceptive behaviors of male partners that increase female STD risk may be factors in this relationship. METHODS: A sample of 356 females aged 14–20 who attended adolescent health clinics in Greater Boston between April and December 2006 were assessed for physical and sexual violence perpetrated by male partners and for exposure to sexual risk factors. Adjusted logistic regression models were used to examine the associations between intimate partner violence and standard sexual risk behaviors (e.g., multiple partnerships) and coercive or deceptive sexual risk factors (e.g., coerced condom nonuse). RESULTS: More than two‐fifths of the sample had experienced intimate partner violence. In adjusted analyses, adolescents reporting intimate partner violence were more likely than others to report standard sexual risk behaviors—multiple partners, anal sex and unprotected anal sex (odds ratios, 1.7–2.2). They also were more likely to report coercive or deceptive sexual risk factors—partner sexual infidelity, fear of requesting condom use, negative consequences of condom request, and coerced condom nonuse (2.9–5.3). CONCLUSION: The high prevalence of intimate partner violence against young women attending adolescent clinics strongly indicates the need to target this population for abuse‐related interventions. This need is underlined by the observed association between partner violence and sexual risk involving coercion or deception by male partners. Clinic‐based STD and pregnancy prevention efforts should include assessment of sexual risk factors that are beyond the control of young women, particularly for those experiencing abuse.     

Identifying the prevalence and correlates of STDs among women residing in rural domestic violence shelters

The present study uses a cross-sectional study design to assess the prevalence and abuse-related correlates of STDs among women (n = 203) residing in rural and nonurban domestic violence shelters, a venue in which health care providers could intervene by providing STD prevention counseling, diagnosis and treatment. To our knowledge, this is the first study to examine the prevalence and correlates of self-reported STDs among women residing in domestic violence shelters. In this sample, 99% of women reported being physically abused in the prior 2 months, 55% reported being sexually abused and 43% reported being raped. Further, 33% of women reported acquiring an STD during their abusive relationship, 13.3% reported acquiring multiple STDs and 9.2% reported acquiring an STD in the 2 months prior to entering the shelter. In this sample having a history of rape, having an unfaithful partner and fear negotiating condom use were all associated with having an STD history. Coordinating STD services with domestic violence shelters could reach a high-risk population that is not traditionally targeted by STD programs, could increase early detection of STDs, may increase access to and improve the quality of STD-related care, particularly among rural populations, and could be cost-effective.     

Help-seeking for intimate partner violence and forced sex in South Carolina

PURPOSE: In this population-based, random-digit-dial, cross-sectional survey, we assessed the lifetime victimization of intimate partner violence (IPV) and forced or coerced sex among 556 women and men in South Carolina, and the help-seeking behaviors of victims. RESULTS: Among women, 25.3% experienced IPV (sexual, physical, or emotional violence) compared with 13.2% of men. Although women were significantly more likely to report physical or sexual IPV (17.8%) than were men (4.9%), men (8.3%) were as likely as women (7.4%) to report perceived emotional abuse without physical or sexual IPV. One half of men and women with annual incomes <$15, 000 reported IPV. Among women experiencing physical or sexual IPV, 53% sought community-based or professional services for IPV; women with higher education levels and those experiencing more severe violence were most likely to seek services. CONCLUSIONS: These data show that IPV is common and that most victims do not receive services to address this violence.     

Violence during pregnancy and substance use.

Violent incidents were assessed as part of a prospective study of 1,243 pregnant women. Participants were predominantly poor, urban, minority group women. Seven percent (n = 92) of women reported physical or sexual violence during pregnancy. Most of the women (94 percent) knew their assailant. Victims of violence were at greater risk of having a history of depression and attempted suicide, having more current depressive symptoms, reporting less happiness about being pregnant, and receiving less emotional support from others for the current pregnancy. Comparisons of victims and non-victims showed that victims were more likely to be users of alcohol and drugs. In addition, partners of victims were more likely to use marijuana and cocaine. When possible confounders were controlled using multivariable analyses, a woman's alcohol use during pregnancy and her partner's drug use were independently associated with an increased risk of being a victim of violence during pregnancy. Results of this study highlight the importance of assessing exposure to violence during prenatal care, especially among women who are heavy users of alcohol or drugs or whose partners use these substances.     

Cumulative abuse experiences, physical health and health behaviors

PURPOSE: Our purpose was to investigate the complex relationship between a range of lifetime abuse experiences with current physical health and health behaviors. METHODS: Between October 1998 and May 1999, interviews were conducted with 557 ethnically diverse women seen at two urban primary care centers. Seven forms of abuse were measured: childhood physical and sexual abuse, past physical and sexual intimate partner violence (IPV), and recent emotional, physical, and sexual IPV. Severity was measured for six of these forms. Multiple non-specific physical symptoms were measured with a modified PRIME-MD, and four health behaviors were ascertained. RESULTS: Approximately 10% of women never experiencing abuse reported multiple non-specific physical symptoms, compared with 25.8% to 78.4% of women reporting a range of abuse experiences. Increases in recent IPV, past IPV, child abuse, and economic hardship were associated with increases in reported symptoms. Women who experienced IPV were more likely to report smoking cigarettes, binge drinking, and having poor nutritional habits. CONCLUSIONS: Recent IPV is associated with physical symptoms and risky health behaviors beyond the effects of child abuse, past IPV, and economic disadvantage. Understanding a person's IPV experiences may inform interventions for health behaviors, such as smoking cessation programs.     

Women's Lives After an HIV-Positive Diagnosis: Disclosure and Violence

Objectives: This research addresses four questions: (1) What role do health care providers play in women's disclosure to others of their HIV-positive status? (2) What are women's concerns and experiences with disclosure? (3) What violence do women living with HIV experience? (4) How is the violence related to their diagnosis and disclosures? Methods: Participants were 310 HIV-positive women enrolled in an HIV primary care clinic in an urban teaching hospital. Women were interviewed once using both quantitative and qualitative methods. Results: Women had known they were HIV-positive for an average of 5.8 years; 22% had an HIV-positive partner; 58% had disclosed their status to more than 10 people; and 68% had experienced physical abuse and 32% sexual abuse as an adult. Fifty-seven percent of the sample reported that a health care provider had told them to disclose to their sex partners. Women who were afraid of disclosure-related violence (29%) were significantly more likely than those who were not to report that a health care provider helped them with disclosure (21% vs. 10%). Although 4% reported physical abuse following a disclosure event, 45% reported experiencing emotional, physical, or sexual abuse at some time after their diagnosis. Risk factors for experiencing abuse after diagnosis were a prior history of abuse, drug use, less income, younger age, length of time since diagnosis, and having a partner whose HIV status was negative or unknown. Conclusions: Identifying women at risk for abuse after an HIV-positive diagnosis is important for those who provide HIV testing and care. Routine screening for interpersonal violence should be incorporated into HIV posttest counseling and continuing primary care services.

     

Sexual Aggression Experiences Among Male Victims of Physical Partner Violence: Prevalence,Severity, and Health Correlates for Male Victims and Their Children

Although research has documented the prevalence and health correlates of sexual aggression among women who have experienced severe partner violence (PV), no research has documented the parallel issues among male victims of severe PV. Research also suggests that children of female victims of both physical and sexual PV have worse mental health than children of female victims of physical PV only, but no research has assessed the mental health of children whose fathers experienced both physical and sexual PV. We surveyed 611 men who experienced physical PV from their female partners and sought help. We assessed the types and extent of various forms of PV, the men’s mental and physical health, and the mental health of their oldest child. Results showed that almost half of the men experienced sexual aggression in their relationship, and 28 % severe sexual aggression. Increasing levels of severity of sexual aggression victimization was associated with greater prevalence and types of other forms of PV. In addition, greater levels of severity of sexual aggression victimization among the men was significantly associated with depression symptoms, post-traumatic stress disorder symptoms, physical health symptoms, and poor health, and attention deficit and affective symptoms among their children. These associations held after controlling for demographics and other violence and trauma exposure. Discussion focused on the importance of broadening our conceptualization of PV against men by women to include sexual aggression as well.     

Prevalence and severity of domestic violence among pregnant women, Mexico

OBJECTIVES: To determine whether pregnancy is a risk factor for domestic violence and to compare prevalence and severity of violence reported by women before and during pregnancy. METHODS: There were interviewed 468 women in the third trimester of pregnancy who were seen during prenatal visits at public clinics in the state of Morelos, Mexico. Emotional, physical and sexual violence were investigated. A severity index was built up. Logistic regression analysis was applied in order to identify the main variables associated to domestic violence during pregnancy. RESULTS: The prevalence of domestic violence did not change significantly before and during pregnancy (32%). The prevalence of each type of violence remained the same. About 27% of women who reported violence during pregnancy did not have experience it before, and a comparable proportion had experienced violence before but not during pregnancy. The severity of emotional violence significantly increased during pregnancy (compared to the previous year) whereas the severity of physical violence decreased. Variables most clearly related to violence during pregnancy were: couple's past history of child abuse; women witnessing domestic violence during childhood; and violence in the year before pregnancy. Several risk scenarios were identified, which could be helpful for health care providers. CONCLUSIONS: The results showed that emotional violence is more prevalent than physical and sexual violence, allowing for a better understanding of this phenomenon.     

Intimate partner violence among men and women--South Carolina, 1998

Few studies provide population-based estimates of intimate partner violence (IPV) for men and women, especially at the state level. IPV may result in adverse health effects for victims and perpetrators (1-3). To estimate the lifetime incidence of IPV by type of violence (e.g., physical, sexual, and perceived emotional abuse) and to explore demographic correlates of reporting IPV among men and women, the South Carolina Department of Health and Environmental Control and the University of South Carolina conducted a population-based random-digit-dialed telephone survey of adults in the state. This report summarizes the results of the survey, which indicated that approximately 25% of women and 13% of men have experienced some type of IPV during their lifetime. Although women were significantly more likely to report physical and sexual IPV, men were as likely as women to report emotional abuse without concurrent physical or sexual IPV.     

Childhood family violence history and women's risk for intimate partner violence and poor health

BACKGROUND: There is growing evidence for associations between generations in family violence and between family violence in both childhood and adulthood and women's health. Most studies focus on a subset of family violence (child abuse, witnessing intimate partner violence [IPV] as a child, and/or adult IPV), and few examine possible differences associated with the nature of abusive experiences, such as physical versus sexual abuse. METHODS: A population-based telephone survey, the 1999 and 2001 Washington State Behavioral Risk Factor Surveillance System, asked a representative sample of 3527 English-speaking, non-institutionalized adult women whether they had been physically or sexually assaulted or witnessed interparental violence in childhood, and whether they had experienced physical assault or emotional abuse from an intimate partner in the past year. The survey also asked about current general health and mental distress in the past month. RESULTS: The risks associated with childhood family violence experiences varied depending on the nature of those experiences. Women reporting childhood physical abuse or witnessing interparental violence were at a four- to six-fold increase in risk of physical IPV, and women reporting any of the experiences measured were at three- to four-fold increase in risk of partner emotional abuse. In contrast, women reporting childhood sexual abuse only were not at increased risk of physical IPV. Women reporting childhood physical abuse were at increased risk of poor physical health, and women reporting any type of childhood family violence were at increased risk of frequent mental distress. Approximately one third of women reporting poor general health and half of women reporting frequent mental distress also reported at least one of the childhood experiences measured. CONCLUSIONS: These findings underscore the role of childhood experiences of abuse and of witnessing family violence in women's current risk for IPV, poor physical health, and frequent mental distress.     

Voluntary abortion and domestic violence among women attended at a public maternity hospital of Salvador-BA

Quantitative study in order to study domestic violence in women with induced abortion. Interviews were conducted with 147 women hospitalized for induced abortion in a public maternity hospital in Salvador, Bahia. The subjects are characterized by mostly women, black, poorly educated, economically dependent on spouses, experienced psychological abuse, physical and sexual abuse committed by their spouses. Almost half of the women were victims of domestic violence during the current pregnancy, and that was the reason for inducing abortion for 67% of them. The study reveals an association between experience of domestic violence and induced abortion. As mental health consequences, they developed symptoms of post trauma stress disorder. It is necessary that the health professionals consider the cues to identify domestic violence as a health problem associated with induced abortion, which requires a transformation on the training model, including domestic violence as a health issue.     

Risks for abuse against pregnant Hispanic women: Morelos, Mexico and Los Angeles County, California

BACKGROUND: Although violence against women is gaining international attention as a prevention priority, little is known about how risks differ across countries. METHODS: A comparative study of violence against pregnant Mexican women in Morelos, Mexico, and Latina women in Los Angeles County, California, United States. In 1998 and 1999, women in prenatal clinics were interviewed about psychological abuse and sexual and physical violence by their partner, during and the 1 year prior to the index pregnancy. The overall response rate for Morelos was 99%, with a sample size of 914; Los Angeles County had a response rate of 96.9%, with a sample size of 219. RESULTS: Women in Morelos reported a higher prevalence of violence compared to women in the California (14.8% v 11.9%, respectively). A partner aged <20 years was associated with increased violence in both countries, but the association of violence with other socioeconomic factors differed by country. For example, employed women had higher odds of violence in California but lower odds in Morelos. Women who experienced violence during both the year prior to pregnancy and as a child were more than 25 times more likely to be abused during pregnancy than women not reporting this type of abuse. CONCLUSION: The identification of factors associated with violence against women, especially as they differ by culture and ethnicity, will help clinicians to better identify victims and to design and implement culturally appropriate prevention programs.     

Prevalence of intimate partner violence and health implications for women using emergency departments and primary care clinics.

OBJECTIVES: To determine prevalence of intimate partner violence (IPV) among women accessing health care, factors that influence rates of abuse, barriers to disclosure, and associated health problems and perceptions of safety. METHODS: A convenience sample of women seeking health care completed 1268 anonymous surveys (75 in Spanish) while at 1 of 24 urban, suburban, or rural emergency departments or primary care clinics. RESULTS: Of women in this study, 50-57% had experienced physical and/or emotional abuse and 26% reported sexual abuse in their lifetime. In the past year, 28% reported emotional abuse, 12% physical abuse, 6% severe physical abuse, and 4% sexual abuse. Logistic regression models found that younger, less-educated, less-affluent women presenting to urban emergency departments reported the highest rates of physical abuse. Although 83% welcomed abuse screening, only 25% ever had been asked and 86% would disclose abuse if asked directly, respectfully, and confidentially. Abused women reported significantly lower health status ratings than nonabused women (p < 0.001). Emotional abuse was as strongly associated with health problems as physical abuse. The majority (70-93%) of women with headaches, stomach problems, chronic pain, vaginal bleeding, substance abuse, depression, and suicidal thoughts had experienced lifetime physical/emotional abuse. CONCLUSIONS: Women experience many forms of abuse and present to a wide range of health care settings. The striking prevalence of IPV and associated emotional/physical health problems challenges providers to routinely assess for abuse in ways that minimize barriers to disclosure and enhance the development of an effective plan of care based on a patient's abuse experience.