Assessing the success of the WomanKind program: an integrated model of 24-hour health care response to domestic violence

PURPOSE: The WomanKind program, a non-profit health care based program for for victims of domestic/intimate partner violence (IPV), seeks to enable and motivate health care providers to identify victims of such violence and refer them to WomanKind's in-house services. An evaluation designed to assess client referral to WomanKind services and the impact of health care provider training was carried out. METHODS: Data were collected at three intervals over a 2-year period at 3 intervention and 2 comparison hospitals located in Minneapolis, MN. The focus of data collection efforts was to assess the providers' knowledge, attitudes, beliefs, and behaviors (KABB) concerning identification and referral of victims of IPV. Hospital staff and volunteer advocate training programs also were evaluated. Chart reviews were conducted and client referrals assessed. RESULTS: Providers at WomanKind hospitals demonstrated significantly higher knowledge, attitudes, beliefs and behaviors than those at comparison hospitals throughout the study. During the data collection period, 1719 IPV victims were identified and referred to the WomanKind program, while only 27 IPV victims were referred to trained social workers at the comparison hospitals. Chart reviews indicated that emergency staff at the intervention sites provide documentation of IPV in patient records twice as frequently as emergency staff at the comparison sites. CONCLUSION: This research underscores the efficacy of a well-structured, multidisciplinary effort to deliver services to IPV victims. The results demonstrate that specialized training and on-site client services create a significant positive impact on the KABB of health care providers.     

Intimate Partner Homicide and Corollary Victims in 16 States: National Violent Death Reporting System, 2003–2009

Objectives. We estimated the frequency and examined the characteristics of intimate partner homicide and related deaths in 16 US states participating in the National Violent Death Reporting System (NVDRS), a state-based surveillance system.Methods. We used a combination of quantitative and qualitative methods to analyze NVDRS data from 2003 to 2009. We selected deaths linked to intimate partner violence for analysis.Results. Our sample comprised 4470 persons who died in the course of 3350 intimate partner violence–related homicide incidents. Intimate partners and corollary victims represented 80% and 20% of homicide victims, respectively. Corollary homicide victims included family members, new intimate partners, friends, acquaintances, police officers, and strangers.Conclusions. Our findings, from the first multiple-state study of intimate partner homicide and corollary homicides, demonstrate that the burden of intimate partner violence extends beyond the couple involved. Systems (e.g., criminal justice, medical care, and shelters) whose representatives routinely interact with victims of intimate partner violence can help assess the potential for lethal danger, which may prevent intimate partner and corollary victims from harm.Intimate partner violence (IPV) is a serious public health problem that affects millions in the United States. IPV is defined as physical violence, sexual violence, stalking, or psychological aggression (including coercive tactics) by a current or former intimate partner.1 IPV that is severe enough to lead to injury or significant harm is primarily but not always perpetrated by men. Estimates from the 2010 National Intimate Partner and Sexual Violence Survey indicate that more than 74 million people in the United States have experienced IPV (physical violence, sexual violence, stalking) at some point in their lives, and more than 12 million in the previous 12 months.2 In the United States, IPV disproportionately affects women, especially racial/ethnic minorities.2,3The most extreme form of IPV is intimate partner homicide (IPH). In 2007, intimate partners committed 14% of all US homicides, and 70% of those victims were female.4 Although IPH has decreased during the past 15 to 20 years,4 it remains a disturbing possibility for people experiencing abusive relationships. Across studies, major risk factors for IPH consistently include previous domestic violence, unemployment, access to firearms, estrangement, threats to kill, threats with a weapon, previous nonfatal strangulation, a stepchild in the home (if the victim is female), and previous mental health problems of the perpetrator (for homicide–suicide).5,6 Of these, previous IPV is the strongest predictor.6 Furthermore, homicides followed by suicide of the perpetrator are more than twice as likely to be committed by former or current spouses as by other perpetrators and are significantly more likely to involve firearms than other weapons.6,7 It is estimated that one third of IPHs in the United States involve suicide of the perpetrator, who is most often male.6,8The Centers for Disease Control and Prevention estimates that societal costs resulting from IPV victimization approach $6 billion annually.9 Such cost estimates and scientific studies of IPH have largely focused on intimate partners of the perpetrator (e.g., spousal homicides). However, a substantial portion of IPV-related homicide victims are not the intimate partners themselves. These corollary victims may be family members, friends, neighbors, persons who intervene in IPV, law enforcement responders, or bystanders. Previous studies10,11 have used the term “collateral victims” to refer to non–intimate partner victims in situations stemming from IPV. Because of the colloquial usage of “collateral” and out of concern for the negative connotations associated with the word, we selected the word “corollary” to refer to non–intimate partner victims whose death is connected to IPV.Few studies have examined corollary victims or included them in analyses of IPH.10,11 In one exception, a British study examined murder connected to intimate partner conflict and found that 37% of the 166 victims were not intimate partners of the murderer.10 Instead, the victims were children of the intimate partner, allies (e.g., relatives, neighbors, friends, lawyers connected to the abuse victim), or new partners. In the United States, it is difficult to estimate the magnitude of corollary victimization. Existing data systems, such as the Uniform Crime Reports, often use categories that do not provide the details necessary to understand the relationships among the victims and offenders.12 For example, if an ex-husband kills his ex-wife’s new partner, the new partner may be categorized as an acquaintance. Furthermore, same-sex intimate partners are categorized as acquaintances in lieu of a more specific designation (e.g., romantic partner, domestic partner). At state and local levels, investigations conducted by fatality review boards may reveal the proportion of collateral victims resulting from IPV, but those figures are often not widely reported.We examined IPH data gathered between 2003 and 2009 by the National Violent Death Reporting System (NVDRS), a state-based surveillance system. Our objective was to extend the existing literature on the frequency and characteristics of IPH and on corollary homicides that occur in the context of IPV and IPH.     

Who gets protection orders for intimate partner violence?

BACKGROUND: It is unknown how victims of intimate partner violence (IPV) who seek civil protection orders differ from IPV victims who do not. METHODS: To compare characteristics of women with and without protection orders, 448 women with police or court contact for an IPV incident in Seattle, Washington, were interviewed. Data collected included demographic characteristics of the subject and her abuser, abuse history, and the subject's mental and physical health. RESULTS: IPV victims who obtained protection orders were more likely than victims without protection orders to be employed full-time, be pregnant, be married, aged over 24, and less likely to be involved with perpetrator at index incident. The perpetrators for both groups were similar, and the majority had a current or previous alcohol/drug problem and a previous criminal history. Both groups of victims had been psychologically and physically abused during the previous year and nearly all had symptoms of depression. However, at the index incident, women who sought protection orders were less likely to be physically assaulted or injured, but more likely to have family members or friends physically assaulted. CONCLUSIONS: Financial independence and abuse of family or friends are important factors associated with the decision to seek a protection order in IPV.     

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.     

Linkages Between Gender Equity and Intimate Partner Violence Among Urban Brazilian Youth

Purpose

Gender inequity is a risk factor for intimate partner violence (IPV), although there is little research on this relationship that focuses on youth or males. Using survey data collected from 240 male and 198 female youth aged 15–24 in Rio de Janeiro, Brazil, we explore the association between individual-level support for gender equity and IPV experiences in the past 6 months and describe responses to and motivations for IPV.

Methods

Factor analysis was used to construct gender equity scales for males and females. Logistic and multinomial logistic regression models were used to examine the relationship between gender equity and IPV.

Results

About half of female youth reported some form of recent IPV, including any victimization (32%), any perpetration (40%), and both victimization and perpetration (22%). A total of 18% of male youth reported recently perpetrating IPV. In logistic regression models, support for gender equity had a protective effect against any female IPV victimization and any male IPV perpetration and was not associated with female IPV perpetration. Female victims reported leaving the abusive partner, but later returning to him as the most frequent response to IPV. Male perpetrators said the most common response of their victims was to retaliate with violence. Jealousy was the most frequently reported motivation of females perpetrating IPV.

Conclusion

Gender equity is an important predictor of IPV among youth. Examining the gendered context of IPV will be useful in the development of targeted interventions to promote gender equity and healthy relationships and to help reduce IPV among youth.     

Physical and mental health effects of intimate partner violence for men and women

BACKGROUND: Few population-based studies have assessed the physical and mental health consequences of both psychological and physical intimate partner violence (IPV) among women or men victims. This study estimated IPV prevalence by type (physical, sexual, and psychological) and associated physical and mental health consequences among women and men. METHODS: The study analyzed data from the National Violence Against Women Survey (NVAWS) of women and men aged 18 to 65. This random-digit-dial telephone survey included questions about violent victimization and health status indicators. RESULTS: A total of 28.9% of 6790 women and 22.9% of 7122 men had experienced physical, sexual, or psychological IPV during their lifetime. Women were significantly more likely than men to experience physical or sexual IPV (relative risk [RR]=2.2, 95% confidence interval [CI]=2.1, 2.4) and abuse of power and control (RR=1.1, 95% CI=1.0, 1.2), but less likely than men to report verbal abuse alone (RR=0.8, 95% CI=0.7, 0.9). For both men and women, physical IPV victimization was associated with increased risk of current poor health; depressive symptoms; substance use; and developing a chronic disease, chronic mental illness, and injury. In general, abuse of power and control was more strongly associated with these health outcomes than was verbal abuse. When physical and psychological IPV scores were both included in logistic regression models, higher psychological IPV scores were more strongly associated with these health outcomes than were physical IPV scores. CONCLUSIONS: Both physical and psychological IPV are associated with significant physical and mental health consequences for both male and female victims.     

Rural-Urban Disparities in Child Abuse Management Resources in the Emergency Department

Purpose: To characterize differences in child abuse management resources between urban and rural emergency departments (EDs). Methods: We surveyed ED directors and nurse managers at hospitals in Oregon to gain information about available abuse-related resources. Chi-square analysis was used to test differences between urban and rural EDs. Multivariate analysis was performed to examine the association between a variety of hospital characteristics, in addition to rural location, and presence of child abuse resources. Findings: Fifty-five Oregon hospitals were surveyed. A smaller proportion of rural EDs had written abuse policies (62% vs 95%, P= .006) or on-site child abuse advocates (35% vs 71%, P= .009). Thirty-two percent of rural EDs had none of the examined abuse resources (vs 0% of urban EDs, P= .01). Of hospital characteristics studied in the multivariate model, only rural location was associated with decreased availability of child abuse resources (OR 0.19 [95% CI, 0.05-0.70]). Conclusions: Rural EDs have fewer resources than urban EDs for the management of child abuse. Other studied hospital characteristics were not associated with availability of abuse resources. Further work is needed to identify barriers to resource utilization and to create resources that can be made accessible to all ED settings.     

Maternal outcomes of intimate partner violence during pregnancy: study in Iran

Objectives

To investigate the prevalence of intimate partner violence (IPV) against pregnant women and its relationship with adverse maternal outcomes, including preterm labour, abortion, caesarean section, antenatal hospitalization and vaginal bleeding, in the West Azerbaijan, Iran.

Study design

Cross-sectional design.

Methods

In total, 1300 pregnant women, aged 18–39 years, who were referred to hospitals in the Iranian cities of Miandoab and Mahabad in the province of West Azerbaijan in 2009–2010 were recruited for this study by a convenience sampling method. Participants were asked to share their experiences of IPV during pregnancy and adverse maternal outcomes.

Results

Of these pregnant women, 945 (72.8%) reported that they had experienced IPV during their last pregnancy. A significant association was found between IPV and preterm labour [adjusted odds ratio (adjOR) 1.54, 95% confidence interval (CI) 1.16–2.03], caesarean section (adjOR 11.84, 95% CI 6.37–22.02), antenatal hospitalization (adjOR 6.34, 95% CI 3.82–10.52) and vaginal bleeding (adjOR 1.51, 95% CI 0.9–2.3).

Discussion

This study demonstrated a high prevalence of IPV during pregnancy, and found that IPV was associated with adverse maternal outcomes including preterm labour, caesarean section, antenatal hospitalization and vaginal bleeding. This adds to the existing literature and can be used to inform healthcare practices in developing countries. Medical, health and surgical services for pregnant women should consider screening for IPV, and providers should be aware that IPV victims are at increased risk for adverse outcomes. Services should also develop links with the Battered Women's Movement; such programmes now exist in many countries.     

Intimate partner violence injuries--Oklahoma, 2002

Intimate partner violence (IPV) is a serious public health problem in the United States and a common cause of injury. Prevalence rates of IPV vary by the surveillance methods and definitions used. National data from the 1995 National Violence Against Women Survey indicate that 22.1% of women and 7.4% of men experience IPV during their lifetimes and that 1.3% of women and 0.9% of men experience IPV annually. IPV results in an estimated 4.1 billion dollars each year in direct medical and mental health-care costs, including 159 million dollars in emergency department (ED) treatments for IPV physical assaults. IPV might constitute as much as 17% of all violence-related injuries treated in EDs. To determine the magnitude of the IPV problem in Oklahoma, including IPV-related injuries and medical service utilization, researchers analyzed injury surveillance data from ED medical records and data from the Oklahoma Women's Health Survey (OWHS). This report summarizes the findings, which indicated that, during 2002 in Oklahoma, approximately 16% of all ED visits for assaults were for IPV injuries, including 35% of assault visits among females and 3% of assault visits among males. In addition, results of the OWHS for 2001-2003 indicated that 5.9% of surveyed Oklahoma women aged 18-44 years sustained an IPV injury during the preceding year. Overall, IPV resulted in a substantial number of injuries, particularly to women, many of whom required treatment in EDs. Medical recognition and documentation of IPV are important for identification of persons in need of services.     

The role of intimate partner violence, race, and ethnicity in help-seeking behaviors

Objective . Women experiencing intimate partner violence (IPV) have multiple health and social service needs but many, especially Hispanic, women may not access these resources. This research sought to examine the relationship between IPV and health and social services utilization (help-seeking behaviors), with a focus on racial and ethnic disparities.

Design . Case-control study from an urban US emergency department population in which cases (women with IPV) and controls (women without IPV) were frequency matched by age group and race/ethnicity. Logistic regression analyses were performed to examine the relationship between IPV and help-seeking behaviors and between help-seeking behaviors and race/ethnicity among abused women. In addition, a stratified analysis was conducted to examine the relationship between acculturation and help-seeking behaviors among Hispanic women.

Results . The sample included 182 cases and 147 controls. Among the health services, alcohol program, emergency department, and hospital utilization were significantly increased among IPV victims compared to non-victims after taking demographic and substance use factors into account. Similarly, IPV victims were more likely to access social/case worker services and housing assistance compared to non-victims. Specific help-seeking behaviors were significantly associated with race and ethnicity among IPV victims, with non-Hispanic white and black women more likely to use housing assistance and emergency department services and black women more likely to use police assistance compared to Hispanic women. Among all Hispanic women, low acculturation was associated with decreased utilization of social services overall and with any healthcare utilization, particularly among abused women.

Conclusions . Social service and healthcare workers should be alerted to and screen for IPV among all clients. The need for increased outreach and accessibility of services for abused women in Hispanic communities in the USA should be addressed, with cultural and language relevance a key component of these efforts.     

Intimate partner violence among men prevalence, chronicity, and health effects

CONTEXT: The breadth and depth of intimate partner violence (IPV) experienced by men have not been fully documented. OBJECTIVES: To describe the prevalence, chronicity, and severity of IPV, and the health outcomes associated with IPV, in adult men with healthcare insurance. DESIGN: A retrospective telephone cohort study conducted from 2003 to 2005. The setting was an integrated healthcare system in Washington State and Idaho. PARTICIPANTS: English-speaking men aged 18 and older (N=420) enrolled in the healthcare system for 3 or more years. MAIN OUTCOME MEASURES: Physical, psychological, and sexual IPV were assessed using five questions from the Behavioral Risk Factor Surveillance Survey. Health was measured using the Short Form-36, version 2 (SF-36v2) survey, the Center for Epidemiological Studies Depression Scale, and the National Institute of Mental Health Presence of Symptoms Survey. RESULTS: Men experienced IPV at a rate of 4.6% in the past year, 10.4% in the past 5 years, and 28.8% over their lifetimes. While overall rates of physical and nonphysical IPV were similar, men aged 18-55 were twice as likely to be recently abused (14.2%, SE=2.6%) than were men aged 55 and older (5.3%, SE=1.6%). Abuse was typically nonviolent or mildly violent, occurred on multiple occasions, and was initiated by only one intimate partner. Compared to men with no IPV, older men who experienced IPV had more depressive symptoms (prevalence ratios=2.61 and 2.80 for nonphysical and physical abuse) and had lower SF-36v2 mental health subscales (range=-3.21 to -5.86). CONCLUSIONS: Men experience IPV at moderate rates, and poor mental health outcomes are associated with such experiences.     

Female victims of intimate partner physical domestic violence (IPP-DV), California 1998

BACKGROUND: This study was conducted to identify factors associated with adult female victims of intimate partner physical domestic violence (IPP-DV) in California and to estimate statewide IPP-DV prevalence. METHODS: We analyzed data from the 1998 California Women's Health Survey, a random, computer-assisted telephone interview (CATI) survey of 4006 California women aged > or = 18, conducted by the California Department of Health Services. RESULTS: Data from the survey indicated that 6% of the women reported that in the previous 12 months, their intimate partners threw objects at them, or hit them with an object, or kicked, pushed, slapped, choked, beat up, or threatened them with a gun or a knife. Odds ratio (OR) analyses controlling for age and race/ethnicity suggest that a large number of factors are associated statistically with IPP-DV victims. These factors include feelings of ill physical and mental health; pregnancies at early age; smoking status; nutritional needs; low income; participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program; having children aged < 18 in the household; and limited access to health care. Among the non-U.S.-born respondents, IPP-DV victims were significantly younger when they entered the United States than their nonvictim counterparts. A multiple logistic regression model identified the following factors as main correlates with IPP-DV: feelings of being overwhelmed in the past 30 days (OR = 3.4, 95% confidence interval [CI] = 2.5-4.6); aged 18 to 44 (OR = 2.8, 95% CI = 1.9-4.1); current smoking status (OR = 2.1, 95% CI = 1.5-2.9); participation in WIC in the previous 2 years (OR = 1.8, 95% CI = 1.2-2.6); and being out of work (OR = 1.4, 95% CI = 1.1-1.9). CONCLUSIONS: The above findings suggest that a variety of venues (e.g., schools, mental and physical health care providers, WIC, immigration programs, and social services) will be needed in order to identify/gain access to IPP-DV victims, provide referral resources, and implement any future prevention efforts.     

Intimate partner violence: prevalence, types, and chronicity in adult women

BACKGROUND: Most intimate partner violence (IPV) prevalence studies do not examine the relationships between IPV types and the chronicity and severity of abuse. OBJECTIVES: Delineate prevalence, chronicity, and severity of IPV among adult women. DESIGN: Retrospective cohort study conducted by telephone survey. Data were collected in 2003 to 2005 and analyzed contemporaneously. PARTICIPANTS: English-speaking women (n=3568) aged 18 to 64 years enrolled in a U.S. health maintenance organization for 3 or more years. Response rate was 56.4%. MAIN EXPOSURE: Physical, psychological, and sexual IPV were assessed using five questions from the Behavioral Risk Factor Surveillance Survey and ten items from the Women's Experience with Battering (WEB) scale. RESULTS: Most (3429) of the respondents had at least one intimate partnership as an adult. Of these, 14.7% reported IPV of any type in the past 5 years, and 45.1% of abused women experienced more than one type. Prevalence was 7.9% in the past year, while during a woman's adult lifetime, it was 44.0%. Depending on IPV type, 10.7% to 21.0% were abused by more than one partner; duration was <1 year to 5 median years; while in 5% to 13% of the instances, IPV persisted for >20 years. IPV rates were higher for younger women, women with lower income and less education, single mothers, and those who had been abused as a child. CONCLUSIONS: The high prevalence of IPV across women's lifetimes in the previous 5 years and the previous year are documented. The present investigation provides new information of IPV chronicity, severity, and the overlap of IPV types over a woman's adult life span.     

Changes in Incidents and Payment Methods for Intimate Partner Violence Related Injuries in Women Residing in the United States, 2002 to 2015

BackgroundViolence in interpersonal relationships is a substantial health and social problem in the United States and is associated with a myriad of immediate and long-term physical, behavioral, and neurocognitive impairments. The present study sought to determine the incidence of U.S. emergency department (ED)-attended intimate partner violence (IPV) from 2002 to 2015 and examine the differences in payment sources before and after implementation of the Affordable Care Act.MethodsWe analyzed ED visits among female patients aged 15 years or older between 2002 and 2015 from the National Hospital Ambulatory Medical Care Survey. Using International Classification of Disease, Ninth Revision, Clinical Modification, codes from patient visit records, we classified each ED visit to determine the frequency and estimate the relative proportion and national frequency of IPV visits. We explored bivariate and multivariate associations between IPV-related injuries with age, race, ethnicity, method of payment, and region, noting changes over time.ResultsBetween 2002 and 2015, female patients visited EDs an estimated 2,576,417 times for IPV-related events, and the proportion of ED visits for IPV increased during that time period. The percentage of ED visits for IPV-related events did not differ significantly by region, race, or ethnicity. Compared with women 25–44 years of age, women aged 65 to 74 (odds ratio, 0.15; 95% confidence interval, 0.05–0.43; p < .001) and 75 years and older (odds ratio, 0.20; 95% confidence interval, 0.08–0.53; p = .001) were less likely to visit an ED for IPV. Women were more likely to pay for IPV-related services out-of-pocket (i.e., self-pay) (odds ratio, 1.85; 95% confidence interval, 1.24–277; p = .003) before the enactment of the Affordable Care Act.ConclusionsThe increase in the percentage of IPV-related ED claims paid by private insurance suggests that the Affordable Care Act may have increased women's willingness and ability to seek medical attention for IPV-related injuries and disclose IPV as the source of injuries.     

Estado de salud y violencia contra la mujer en la pareja

Objective

To describe the prevalence of intimate partner violence (IPV) in Spain in the last year and at some point during the lifetime, to determine health status in women according to whether they had experienced IPV or not, and to analyze the individual variables associated with IPV in Spain.

Methods

A cross-sectional study was performed of the database, Macrosurvey on Gender Violence in Spain 2011. This database includes data on 7,898 women older than 18 years old. The dependent variables were IPV-last year, IPV-ever in life. Covariates consisted of sociodemographic characteristics, socioeconomic status, maternal experience of IPV, social support, and self-care. The measure of association used was the OR with its 95% confidence interval (95% CI).

Results

A total of 3.6% of women had experienced IPV-last year and 12.2% ever in life. Female victims of IPV had poorer health than women who had not experienced IPV. Immigrant women living in Spain for 6 years or more were more likely to experience IPV-ever in life than Spanish women [OR (95% CI): 1.95 (1.50, 2.53)]. An interaction was found between nationality and the existence of children under 18 years old. Among women with children under 18 years old, immigrant women were more likely to experience IPV-last year than Spanish women [OR (95% CI): 1.99 (1.25, 3.17)]. Other variables associated with IPV were age, low socioeconomic status, low social support and having a mother who had experienced IPV.

Conclusions

In Spain, some women have a higher probability of experiencing IPV. The variables associated with greater vulnerability to IPV should be taken into account when implementing measures to prevent or alleviate IPV.     

Partner violence intervention in the busy primary care environment

BACKGROUND: Few studies of intimate partner violence (IPV) interventions have been conducted in primary care settings. Based on recommendations, we implemented a multifaceted IPV intervention that included a sticker placed in medical charts listing screening questions, routine IPV screening by nursing staff, clinician follow-up for women screening positive, and referral to on-site services. METHODS: A prospective cohort study compared multiple measures collected at the intervention site and a center providing usual care. Measures included self-reported IPV, documented IPV screening and IPV experiences, and quantity of IPV materials taken from the centers. RESULTS: Of 746 charts reviewed in a random chart review conducted at the intervention site, 36.6% were tagged for IPV screening, and of those tagged, 86.1% had documentation of screening. Approximately 5% (11 of 235) of women screened positive for IPV; about half had documented clinician follow-up and referral to on-site services. Comparison of survey responses and medical record reviews (intervention site) indicated that the screening protocol primarily identified severely abused women (sensitivity 80%, specificity 98%), but rarely identified women experiencing low to moderate levels of abuse. IPV brochures were taken from the intervention site at a rate of 51 per 1000 visits versus 29 per 1000 visits taken from the control site. CONCLUSIONS: Utilizing screening as the only gateway to on-site services limited access for many IPV victims. The removal of IPV brochures from examination rooms suggests that providing contact information for self-referral to on-site services may improve access.     

Comparisons of Intimate Partner Violence Among Partners in Same-Sex and Opposite-Sex Relationships in the United States

Using 2005–2007 Behavioral Risk Factor Surveillance System data, we examined intimate partner violence (IPV) by same-sex and opposite-sex relationships and by Metropolitan Statistical Area status. Same-sex victims differed from opposite-sex victims in some forms of IPV prevalence, and urban same-sex victims had increased odds of poor self-perceived health status (adjusted odds ratio = 2.41; 95% confidence interval = 1.17, 4.94). Same-sex and opposite-sex victims experienced similar poor health outcomes, underscoring the need both of inclusive service provision and consideration of sexual orientation in population-based research.Intimate partner violence (IPV) remains a significant public health problem, but IPV in same-sex relationships is not universally acknowledged, thus inhibiting treatment of its victims.^1,2 Reasons for this disparate acknowledgment range from lack of statutes in some jurisdictions legitimizing same-sex relationships to perceptions that deemphasize the severity of same-sex IPV.^3,4 Previous studies have found higher rates of same-sex IPV than of opposite-sex IPV.^5,6 However, few studies have explored whether these higher IPV rates disproportionately affect health outcomes among victims of same-sex IPV. Additionally, research has shown urban–rural differences in the severity of IPV,^7,8 but none has examined how these differences affect same-sex IPV victims.Using population-based data, we examined the prevalence of different forms of IPV among same-sex and opposite-sex victims and differences in health and quality-of-life indicators by place of residence (Metropolitan Statistical Area vs non–Metropolitan Statistical Area, hereafter referred to as urban and rural areas, respectively).     

Releasing pre-adoption birth records: the impact of Oregon's experience on its vital records department

OBJECTIVE: In November 1998, Oregon voters passed Ballot Measure 58, which allowed Oregon adoptees > or = 21 years of age access to their original birth records, which are sealed at adoption. The objective of this study was to evaluate the impact of the measure on the Oregon Health Division (since renamed Oregon Health Services) by assessing procedures used and resources needed after implementation of Measure 58. METHODS: Vital records employees were interviewed about processing, storage, and archive retrieval procedures for pre-adoption birth records before, during, and after the implementation of Measure 58 and the effect on their usual workload. Personnel time, space, and fiscal resources used to process requests for pre-adoption records were also calculated. RESULTS: The Oregon Health Division began to receive requests from adoptees immediately following the passage of Measure 58 in November 1998, but due to legal challenges, they could not be processed until May 31, 2000. From June 2, 2000, through October 20, 2000, 12 staff members and two supervisors issued more than 4,700 pre-adoption birth records while also processing their normal workload, which averages more than 135,400 vital record orders annually. Due to the need for retrieval from archives, requests for pre-adoption birth records were estimated to take 75 hours to process vs. 2-3 minutes for standard requests. Each batch of approximately 75 pre-adoption birth records required approximately 12.5 person-hours from vital records staff and 3-4 person-hours from archive personnel; in addition, supervisors spent time responding to incomplete orders, informing the public and the media, and responding to concerns of adoptees, birth parents, and adoptive parents. Fewer than 1% of requests went unfilled. CONCLUSIONS: Implementation of Measure 58 utilized substantial resources of the Oregon Health Division. States contemplating similar legislation should consider increasing personnel and resources, preparing for intense public and media interest, and reorganizing the storage of adoptees' original birth records so they are easily retrieved.