Understanding the association of biomedical, psychosocial and behavioral risks with adverse pregnancy outcomes among African-Americans in Washington, DC

This study investigates the relationship between adverse pregnancy outcomes in high-risk African American women in Washington, DC and sociodemographic risk factors, behavioral risk factors, and the most common and interrelated medical conditions occurring during pregnancy: diabetes, hypertension, preeclampsia, and Body Mass Index (BMI). Data are from a randomized controlled trial conducted in 6 prenatal clinics. Women in their 1st or 2nd trimester were screened for behavioral risks (smoking, environmental tobacco smoke exposure, depression, and intimate partner violence) and demographic eligibility. 1,044 were eligible, interviewed and followed through their pregnancies. Classification and Regression Trees (CART) methodology was used to: (1) explore the relationship between medical and behavioral risks (reported at enrollment), sociodemographic factors and pregnancy outcomes; (2) identify the relative importance of various predictors of adverse pregnancy outcomes; and (3) characterize women at the highest risk of poor pregnancy outcomes. The strongest predictors of poor outcomes were prepregnancy BMI, preconceptional diabetes, employment status, intimate partner violence, and depression. In CART analysis, preeclampsia was the first splitter for low birthweight; preconceptional diabetes was the first splitter for preterm birth (PTB) and neonatal intensive care admission; BMI was the first splitter for very PTB, large for gestational age, Cesarean section and perinatal death; employment was the first splitter for miscarriage. Preconceptional factors strongly influence pregnancy outcomes. For many of these women, the high risks they brought into pregnancy were more likely to impact their pregnancy outcomes than events during pregnancy.     

An Integrated Randomized Intervention to Reduce Behavioral and Psychosocial Risks: Pregnancy and Neonatal Outcomes

While biomedical risks contribute to poor pregnancy and neonatal outcomes in African American (AA) populations, behavioral and psychosocial risks (BPSR) may also play a part. Among low income AA women with psychosocial risks, this report addresses the impacts on pregnancy and neonatal outcomes of an integrated education and counseling intervention to reduce BPSR, as well as the contributions of other psychosocial and biomedical risks. Subjects were low income AA women ≥18 years living in the Washington, DC, metropolitan area and seeking prenatal care. Subjects (n = 1,044) were screened for active smoking, environmental tobacco smoke exposure (ETSE), depression, or intimate partner violence (IPV) and then randomized to intervention (IG) or usual care (UCG) groups. Data were collected prenatally, at delivery, and postpartum by maternal report and medical record abstraction. Multiple imputation methodology was used to estimate missing variables. Rates of pregnancy outcomes (miscarriage, live birth, perinatal death), preterm labor, Caesarean section, sexually transmitted infection (STI) during pregnancy, preterm birth (<37 weeks), low birth weight (<2,500 g), very low birth weight (<1,500 g), small for gestational age, neonatal intensive care unit (NICU) admission, and >2 days of hospitalization were compared between IG and UCG. Logistic regression models were created to predict outcomes based on biomedical risk factors and the four psychosocial risks (smoking, ETSE, depression, and IPV) targeted by the intervention. Rates of adverse pregnancy and neonatal outcomes were high and did not differ significantly between IG and UCG. In adjusted analysis, STI during the current pregnancy was associated with IPV (OR = 1.41, 95% CI 1.04–1.91). Outcomes such as preterm labor, caesarian section in pregnancy and preterm birth, low birth weight, small for gestational age, NICU admissions and >2 day hospitalization of the infants were associated with biomedical risk factors including preexisting hypertension and diabetes, previous preterm birth (PTB), and late initiation of prenatal care, but they were not significantly associated with active smoking, ETSE, depression, or IPV. Neither the intervention to reduce BPSR nor the psychosocial factors significantly contributed to the pregnancy and neonatal outcomes. This study confirms that biomedical factors significantly contribute to adverse outcomes in low income AA women. Biomedical factors outweighed psychosocial factors in contributing to adverse pregnancy and neonatal outcomes in this high-risk population. Early identification and management of hypertension, diabetes and previous PTB in low income AA women may reduce health disparities in birth outcomes.     

Very Preterm Birth is Reduced in Women Receiving an Integrated Behavioral Intervention: A Randomized Controlled Trial

This study examines whether an integrated behavioral intervention with proven efficacy in reducing psycho-behavioral risks (smoking, environmental tobacco smoke exposure (ETSE), depression, and intimate partner violence (IPV)) in African-Americans is associated with improved pregnancy outcomes. A randomized controlled trial targeting risks during pregnancy was conducted in the District of Columbia. African-American women were recruited if reporting at least one of the risks mentioned above. Randomization to intervention or usual care was site and risk specific. Sociodemographic, health risk and pregnancy outcome data were collected. Data on 819 women, and their singleton live born infants were analyzed using an intent-to-treat approach. Bivariate analyses preceded a reduced logistical model approach to elucidate the effect of the intervention on the reduction of prematurity and low birth weight. The incidence of low birthweight (LBW) was 12% and very low birthweight (VLBW) was 1.6%. Multivariate logistic regression results showed that depression was associated with LBW (OR = 1.71, 95% CI = 1.12–2.62). IPV was associated with preterm birth (PTB) and very preterm birth (VPTB) (OR 1.64, 95% CI = 1.07–2.51, OR = 2.94, 95% CI = 1.40–6.16, respectively). The occurrence of VPTB was significantly reduced in the intervention compared to the usual care group (OR = 0.42, 95% CI = 0.19-0.93). Our study confirms the significant associations between multiple psycho-behavioral risks and poor pregnancy outcomes, including LBW and PTB. Our behavioral intervention with demonstrated efficacy in addressing multiple risk factors simultaneously reduced VPTB within an urban minority population.     

Risk factors for femicide in abusive relationships: results from a multisite case control study

OBJECTIVES: This 11-city study sought to identify risk factors for femicide in abusive relationships. METHODS: Proxies of 220 intimate partner femicide victims identified from police or medical examiner records were interviewed, along with 343 abused control women. RESULTS: Preincident risk factors associated in multivariate analyses with increased risk of intimate partner femicide included perpetrator's access to a gun and previous threat with a weapon, perpetrator's stepchild in the home, and estrangement, especially from a controlling partner. Never living together and prior domestic violence arrest were associated with lowered risks. Significant incident factors included the victim having left for another partner and the perpetrator's use of a gun. Other significant bivariate-level risks included stalking, forced sex, and abuse during pregnancy. CONCLUSIONS: There are identifiable risk factors for intimate partner femicides.     

孕前体重指数及其孕期增加对妊娠结局的影响

目的:定量评价孕前体重指数及孕期体重指数增加情况对我国北方孕妇妊娠结局的影响。方法:收集2007～2009年在沈阳3家医院分娩的3741名单胎妊娠初产妇,按照孕前体重指数(BMI)分为4组:低体重组(BMI18.5kg/m2)、正常体重组(18.5kg/m2≤BMI24kg/m2)、超重组(24kg/m2≤BMI28kg/m2)和肥胖组(BMI≥28kg/m2)。按照孕期BMI增加情况分为3组:A组(BMI增加4)、B组(BMI增加4～6)、C组(BMI增加6)。Logistic回归评估不良妊娠结局的危险度,结果用RR和95%CI表示。结果:①和正常体重组相比,孕前低体重、超重和肥胖组的孕妇患子痫前期的RR分别为0.53(95%CI0.29～0.97)、2.84(95%CI2.05～3.94)和5.35(95%CI3.47～8.49);患妊娠期糖尿病的RR分别为0.35(95%CI0.16～0.78)、3.40(95%CI2.44～4.75)和4.95(95%CI2.91～7.06);剖宫产和出生大于胎龄儿(LGA)的风险也随孕前体重的增加而增加。②和B组相比,C组增加了子痫前期(RR1.85,95%CI1.40～2.44)、妊娠期糖尿病(RR1.39,95%CI1.05～1.86)、剖宫产(RR1.37,95%CI1.15～1.63)及出生LGA(RR1.98,95%CI1.44～2.73)的相对危险性,但降低了出生SGA的风险。A组降低了子痫前期、剖宫产和出生LGA的风险,但增加了早产(34周)和出生SGA的风险。结论:孕前体重指数过高及孕期体重指数增加过度可以明显增加孕妇子痫前期、妊娠期糖尿病和剖宫产的风险。应加强健康教育,适度控制孕期体重,合理营养减少肥胖,对预防妊娠并发症,改善妊娠结局是有必要的。     

Intimate Partner Violence Among Economically Disadvantaged Young Adult Women: Associations With Adolescent Risk-Taking and Pregnancy Experiences

CONTEXT: Intimate partner violence negatively impacts the health of substantial proportions of young women in economically disadvantaged communities, where sexual initiation, aggressive behaviors, unintended pregnancies and childbearing are common among adolescents. It is therefore important to assess how adolescent risk behaviors and pregnancy experiences are linked to such violence during young adulthood.
METHODS: Data from 526 participants in the Reach for Health Longitudinal Study who were surveyed during middle school (in 1995–1996 and 1996–1997) and at ages 22–25 (in 2005–2007) provided information on adolescent risk behaviors and pregnancy experiences, as well as experiences of intimate partner violence during young adulthood. Bivariate and multivariate analyses were conducted to identify correlates of intimate partner violence involvement.
RESULTS: As young adults, 29% of women reported having been victims of intimate partner violence in the past 12 months; 21% reported having perpetrated such violence. In multivariate analyses, victimization and perpetration in the last year are positively associated with aggressive behavior in middle school (odds ratios, 1.9 and 2.5, respectively), lifetime number of sex partners (1.3 for both) and having a history of unintended pregnancy or pregnancy problems (1.3 for both). Perpetration also is associated with early sexual initiation (0.5) and living with a partner (1.8).
CONCLUSIONS: It is important to consider women's pregnancy histories in programs aimed at preventing the adverse outcomes of relationship violence and in screening for partner violence in sexual and reproductive health services. Early intervention may help women develop the skills needed for resolving conflicts with peers and partners.     

The Impact of Gestational Weight Gain on the Risks of Adverse Maternal and Infant Outcomes among Normal BMI Women with High Triglyceride Levels during Early Pregnancy

A high maternal triglyceride (mTG) level during early pregnancy is linked to adverse pregnancy outcomes, but the use of specific interventions has been met with limited success. A retrospective cohort study was designed to investigate the impact of gestational weight gain (GWG) on the relationship between high levels of mTG and adverse pregnancy outcomes in normal early pregnancy body mass index (BMI) women. The patients included 39,665 women with normal BMI who had a singleton pregnancy and underwent serum lipids screening during early pregnancy. The main outcomes were adverse pregnancy outcomes, including gestational hypertension, preeclampsia, gestational diabetes, cesarean delivery, preterm birth, and large or small size for gestational age (LGA or SGA) at birth. As a result, the high mTG (≥2.05mM) group had increased risks for gestational hypertension ((Adjusted odds ratio (AOR), 1.80; 95% CI, 1.46 to 2.24)), preeclampsia (1.70; 1.38 to 2.11), gestational diabetes (2.50; 2.26 to 2.76), cesarean delivery (1.22; 1.13 to 1.32), preterm birth (1.42, 1.21 to 1.66), and LGA (1.49, 1.33 to 1.68) compared to the low mTG group, after adjustment for potential confounding factors. Additionally, the risks of any adverse outcome were higher in each GWG subgroup among women with high mTG than those in the low mTG group. High mTG augmented risks of gestational hypertension, preeclampsia, preterm birth, and LGA among women with 50th or greater percentile of GWG. Interestingly, among women who gained less than the 50th percentile of GWG subgroups, there was no relationship between high mTG level and risks for those pregnancy outcomes when compared to low mTG women. Therefore, weight control and staying below 50th centile of the suggested GWG according to gestational age can diminish the increased risks of adverse pregnancy outcomes caused by high mTG during early pregnancy.     

Intimate partner violence, depression, and PTSD among pregnant Latina women

PURPOSE We undertook a study to describe factors related to depression and posttraumatic stress disorder (PTSD) among pregnant Latinas who were or were not exposed to intimate partner violence.METHODS We interviewed 210 pregnant Latinas attending prenatal clinics located in Los Angeles, California. Latinas who did and did not have histories of intimate partner violence were recruited. We then assessed the women for strengths, adverse social behavioral circumstances, posttraumatic stress disorder (PTSD), and depression.RESULTS Significantly more women exposed to intimate partner violence scored at or above the cutoff point for depression than women who were not (41% vs 18.6%; P<.001). Significantly more women exposed to intimate partner violence scored at or above the cutoff point for PTSD than women who were not (16% vs 7.6%; P <.001). Lack of mastery, which measures feelings of being in control of forces that affect life (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.62–0.84), a history of trauma not associated with intimate partner violence (OR, 1.33; 95% CI, 1.08–1.63), and exposure to intimate partner violence (OR, 2.43; 95% CI, 1.16–5.11) were associated with depression after adjusting for age, language of interview, and site effects. Stress (OR, 1.72; 95% CI, 1.34–2.2) and a history of trauma (OR, 1.45; 95% CI, 1.03–2.04) were independently associated with PTSD, whereas higher income was associated with decreased risk of PTSD (OR, 0.10; 95% CI, 0.02–0.63), after adjusting for age, language of interview, and site effects.CONCLUSIONS Intimate partner violence was significantly associated with depression and PTSD but was associated with depression only after controlling for other factors in the multivariate model. The risk for depression declined with greater mastery but increased with a history of trauma or exposure to intimate partner violence. Stress, a history of trauma not associated with intimate partner violence, and lower income were all independently associated with increased risk for PTSD.     

“… he always slaps me on my ears”: the health consequences of intimate partner violence among a group of patrilineal women in Ghana

Intimate partner violence has implications for women’s health globally. Patrilineal women have been shown to have increased risk of experiencing intimate partner violence, yet, the health consequences of intimate partner violence in patrilineal women have not been thoroughly explored or documented. This study used qualitative in-depth interviews to explore the health effects of intimate partner violence among 15 ever-partnered Ghanaian patrilineal women. Participants attributed violence to several factors including gendered domestic relations, cultural and marital rites and alcohol use, among other factors. Abused women reported health problems such as feelings of worthlessness, sleeplessness, suicidal ideation, eye injuries, bodily weakness, hypertension, genital sores and the premature termination of pregnancy. Policy makers should pay particular attention to intimate partner violence-related health consequences in designing health interventions for abused women.     

Association of physical violence by an intimate partner around the time of pregnancy with inadequate gestational weight gain

Intimate partner violence has been previously examined in relation to a variety of pregnancy, labor and delivery outcomes. We evaluated whether women who experienced physical violence by their intimate partners around the time of pregnancy were less likely to achieve weight gain according to the US Institute of Medicine (IOM) guidelines. A cross-sectional study was conducted using the 2000-2006 Oklahoma Pregnancy Risk Assessment Monitoring Survey (PRAMS) data for post-partum women, 20 years and older. Physical violence perpetrated by an intimate partner before and/or during pregnancy was prevalent in nearly 6.5% of women. Weight gain was adequate in 38.8%, deficient in 28.4% and excessive in 32.8% of these women, respectively. After adjusting for maternal age, marital status, education, pregnancy intention, stressful life events, third-trimester use of tobacco and alcohol and gestational age at delivery, physical violence by an intimate partner around the time of pregnancy was positively but non-significantly associated with excessive (but not deficient) gestational weight gain. After stratifying by age group, positive and significant associations between physical violence by an intimate partner around the time of pregnancy and inadequate gestational weight gain were observed only among women 35 years and older. With the exception of mothers ≥ 35 years of age, deficient and excessive gestational weight gains were not significantly related to experiences with physical violence by an intimate partner prior to delivery. Prospective cohort studies are needed to establish whether other forms of violence, including emotional and sexual abuse, can affect gestational weight gain and whether gestational weight gain can mediate the effect of physical, sexual and emotional abuse on pregnancy, labor and delivery outcomes.     

Intimate Partner Violence and Consistent Condom Use Among Drug-Using Heterosexual Women in New York City

The present study examined the associations of relationship factors, partner violence, relationship power, and condom-use related factors with condom use with a main male partner among drug-using women. Over two visits, 244 heterosexual drug-using women completed a cross-sectional survey. Multivariate logistic regression models indicated that women who expected positive outcomes and perceived lower condom-use barriers were more likely to report condom use with their intimate partners. The findings suggest that future interventions aiming at reducing HIV risk among drug-using women should focus on women's subjective appraisals of risks based on key relationship factors in addition to the occurrence of partner violence.     

Risk factors differ between recurrent and incident preeclampsia: a hospital-based cohort study

PurposeTo examine whether risk factors, including prepregnancy body mass index (BMI), differ between recurrent and incident preeclampsia.MethodsData included electronic medical records of nulliparas (n = 26,613) delivering 2 times or more in Utah (2002–2010). Modified Poisson regression models were used to examine (1) adjusted relative risks (RR) of preeclampsia and 95% confidence intervals (CI) associated with prepregnancy BMI; (2) maternal risk factor differences between incident and recurrent preeclampsia among primiparous women.ResultsIn the first pregnancy, compared with normal weight women (BMI: 18.5–24.9), preeclampsia risks for overweight (BMI: 25–29.9), obese class I (BMI: 30–34.9), and obese class II/III (BMI: ≥35) women were 1.82 (95% CI = 1.60–2.06), 2.10 (95% CI = 1.76–2.50), and 2.84 (95% CI = 2.32–3.47), respectively, whereas second pregnancy–incident preeclampsia risks were 1.66 (95% CI = 1.27–2.16), 2.31 (95% CI = 1.67–3.20), and 4.29 (95% CI = 3.16–5.82), respectively. Recurrent preeclampsia risks associated with BMI were highest among obese class I women (RR = 1.60; 95% CI = 1.06–2.42) without increasing in a dose-response manner. Nonwhite women had higher recurrence risk than white women (RR = 1.70; 95% CI = 1.16–2.50), whereas second pregnancy–incident preeclampsia risk did not differ by race.ConclusionPrepregnancy BMI appeared to have stronger associations with risk of incident preeclampsia either in the first or second pregnancy, than with recurrence risk. Nonwhite women had higher recurrence risk.     

Community level effects of gender inequality on intimate partner violence and unintended pregnancy in Colombia: testing the feminist perspective

Violence against women, especially by intimate partners, is a serious public health problem that is associated with physical, reproductive, and mental health consequences. The effect of intimate partner violence on women's ability to control their fertility and the mechanisms through which these phenomena are related merit further investigation. Building on findings from a previous analysis in which a statistically significant relationship between intimate partner violence and unintended pregnancy in Colombia was found, this analysis examines the effect of gender inequality on this association using data from the 2000 Colombian Demographic and Health Survey. Specifically, the objective of this analysis is to explore whether gender inequality (as measured by women's autonomy, women's status, male patriarchal control, and intimate partner violence) in municipalities partially explains the association between intimate partner violence and unintended pregnancy in Colombia. Results of logistic regression analysis with multi-level data show that living in a municipality with high rates of male patriarchal control significantly increased women's odds of having an unintended pregnancy by almost four times. Also, living in a municipality with high rates of intimate partner violence increased one's odds of unintended pregnancy by more than 2.5 times, and non-abused women living in municipalities with high rates of intimate partner violence were at a significantly increased risk of unintended pregnancy. In addition, abused women living in a municipality with high personal female decision-making autonomy had more than a fourfold increased risk of having an unintended pregnancy. These findings demonstrate the need for reproductive health programs to target areas at particularly high risk for unintended pregnancy by reducing intimate partner violence and gender inequality.     

Health status, health conditions, and health behaviors among Amish women. Results from the Central Pennsylvania Women's Health Study (CePAWHS).

We performed one of the first systematic, population-based surveys of women in Amish culture. We used these data to examine health status and health risks in a representative sample of 288 Amish women ages 18-45 living in Lancaster County, Pennsylvania, in particular for risks associated with preterm and low birthweight infants, compared with a general population sample of 2,002 women in Central Pennsylvania. Compared with women in the general population, Amish women rated their physical health approximately at the same level, but reported less stress, fewer symptoms of depression, and had higher aggregate scores for mental health. Amish women reported low levels of intimate partner violence, high levels of social support, and they perceived low levels of unfair treatment owing to gender compared with the general population. Amish women also reported higher fertility, fewer low birthweight babies, but the same number of preterm births as the general population. The findings suggest that these outcomes may be due to higher levels of social support and better preconceptional behavior among Amish women.     

Power, Control, and Intimate Partner Sexual Violence in Haiti

This study sought to determine how power and control in intimate relationships influenced women's exposure to sexual violence. Multilevel modeling was used to determine the risk of partner sexual violence in the past 12 months among 2240 women aged 15–49 years who were currently married or cohabiting. The data were drawn from the 2000 Haiti Demographic and Health Survey. Strong positive effects on intimate partner sexual violence were found for husband's jealousy and perpetration of controlling behavior and women's endorsement of traditional norms concerning a husband's rights to beat his wife. Female dominance in decision making about purchases for daily household needs was positively associated with intimate partner sexual violence but its effects were mediated by relationship quality. The effect of wife's education on intimate partner violence was nonlinear. The analysis also showed that high community female headship rates were independently associated with higher risks of partner sexual violence. The findings highlight the importance of adopting a multidimensional approach to the measurement of power in sexual relationships and the need for programs to work at multiple levels to address gender-based norms and the structural factors that put women at increased risk of sexual violence.     

Intimate partner violence and interference with women's efforts to avoid pregnancy in Jordan

This study examines the association between intimate partner violence (IPV) and women's experience of interference with their attempts to avoid pregnancy among 353 women surveyed at reproductive health clinics throughout Jordan. Approximately 20 percent of respondents indicated that their husbands or someone else had interfered. Among those others than husbands who were identified, mothers-in-law were the most frequently mentioned, followed by the respondents' mothers and sisters-in-law. Multivariate logistic regression was used to control for potential confounders in determining whether each of the three measures of intimate partner violence (physical violence, sexual violence, and controlling behaviors) was significantly associated with having an increased risk of experiencing interference, as were several sociodemographic variables: nonconsanguineous marriage, residence with in-laws, and rural residence. Physicians, nurses, and family planning counselors must be made aware of the challenges that women may face from their families when they attempt to regulate their fertility.     

Prevalence and correlates of physical,psychological, and sexual intimate partner violence in Bolivia

Despite increasing awareness that domestic violence is a major public health problem, existing studies focus on physical and sexual violence and give little attention to psychological violence. This study uses data from the 2008 Bolivia Demographic and Health Surveys (BDHS) to examine the prevalence and correlates of physical, sexual, and psychological intimate partner violence in Bolivia. The results show that psychological intimate partner violence is extremely common (affecting nearly one in two women) and often occurs in addition to physical violence. While physical, psychological and sexual intimate partner violence have several common predictors, there are factors that only affect some types of violence. Common risk factors include urban residence, respondent's employment status and having witnessed interparental violence in childhood. Although marital status is not a risk factor for physical violence, unmarried cohabitation is a strong risk factor for psychological intimate partner violence. Our findings highlight the need for research to assess the potential consequences of psychological intimate partner violence, particularly for women's mental health.     

Pregnancy intentions and happiness among pregnant black women at high risk for adverse infant health outcomes

CONTEXT: Unintended pregnancy is associated with risk behaviors and increased morbidity or mortality for mothers and infants, but a woman's feelings about pregnancy may be more predictive of risk and health outcomes than her intentions. METHODS: A sample of 1,044 black women who were at increased risk were enrolled at prenatal care clinics in the District of Columbia in 2001-2003. Bivariate and multivariate analyses assessed associations between pregnancy intentions or level of happiness about being pregnant and multiple psychosocial and behavioral risk factors, and identified correlates of happiness to be pregnant. RESULTS: Pregnancy intentions and happiness were strongly associated, but happiness was the better predictor of risk. Unhappy women had higher odds than happy women of smoking, being depressed, experiencing intimate partner violence, drinking and using illicit drugs (odds ratios, 1.7-2.6). The odds of being happy were reduced among women who had other children or a child younger than two, who were single or did not have a current partner, who had had more than one sexual partner in the past year and who reported that the baby's father did not want the pregnancy (0.3-0.6). In contrast, the odds of being happy were elevated among women who had better coping strategies (1.03), who had not used birth control at conception (1.6) and who had 1-2 household members, rather than five or more (2.1). CONCLUSIONS: Additional psychosocial screening for happiness about being pregnant and for partner characteristics, particularly the father's desire to have this child, may help improve prenatal care services and prevent adverse health outcomes.     

Frequency and correlates of intimate partner violence by type: physical, sexual, and psychological battering

OBJECTIVES: This study estimated the frequency and correlates of intimate partner violence by type (physical, sexual, battering, or emotional abuse) among women seeking primary health care. METHODS: Women aged 18 to 65 years who attended family practice clinics in 1997 and 1998 took part. Participation included a brief in-clinic survey assessing intimate partner violence. Multiple polytomous logistic regression was used to assess correlates of partner violence by type. RESULTS: Of 1401 eligible women surveyed, 772 (55.1%) had experienced some type of intimate partner violence in a current, most recent, or past intimate relationship with a male partner; 20.2% were currently experiencing intimate partner violence. Among those who had experienced partner violence in any relationship, 77.3% experienced physical or sexual violence, and 22.7% experienced nonphysical abuse. Alcohol and/or drug abuse by the male partner was the strongest correlate of violence. CONCLUSIONS: Partner substance abuse and intimate partner violence in the woman's family of origin were strong risk factors for experiencing violence. Efforts to universally screen for partner violence and to effectively intervene to reduce the impact of such violence on women's lives must be a public health priority.