Intimate partner violence and sexual assault in Native American communities

Previous studies indicate that Native American women experience the highest rate of violence of any ethnic or racial group in the United States. This article addresses the prevalence of intimate partner violence and sexual assault among Native Americans. We present significant substantive and methodological issues that inform research on violence in the lives of Native Americans, as well as existing interventions. Interventions discussed in this article fall within three major categories including those that are community based, those grounded in the public health and health care systems, and those grounded in federal and national organizations. We provide some examples of interventions from each of these three levels of direct service, including a brief discussion of barriers to service accessibility. We conclude with substantive and methodological recommendations for research and practice.     

Intimate partner sexual assault against women and associated victim substance use, suicidality, and risk factors for femicide

In order to establish the frequency of substance use, following and attributed to sexual assault, and describe the danger for femicide and suicidality for women physically and sexually abused compared to physically-abused only women, a personal interview of 148 African-American, Hispanic, and white English and Spanish-speaking abused women was completed. Women who reported more than one sexual assault were 3.5 (95% CI, 0.9, 13.4) times more likely to report beginning or increasing substance use compared to women who reported only one sexual assault. Sexually assaulted women reported significantly (p=.002) more risk factors for femicide compared to physically- abused only women. Specific to suicide, women reporting sexual assault were 5.3 (95% CI, 1.3, 21.5) times more likely to report threatening or attempted suicide within a 90-day period compared to physically-abused only women. The health assessment and intervention of intimate partner violence must extend beyond injury to include behavior risk sequelae of substance abuse and suicidality.     

Immediate care for women after sexual and physical assault

The management of recent sexual and physical assault in women has two aims: to provide medical and psychological care for the victim and to prevent possible health consequences of the trauma on one hand, and to facilitate the forensic assessment with regard to the perpetrator's prosecution on the other. The victim should always be encouraged to report an offence to the police and forensic medicine should be called in to assist in the victim's examination, whenever possible. In addition, emergency contraception and prophylactic measures against sexually transmitted infections (STI), especially HIV, must be offered. The profound emotional impact of sexual and physical assault requires knowledgeable and sensitive crisis intervention on the part of the counsellor and referral for ongoing counselling and support must be made available. A well trained and competent sexual assault care team with a sympathetic and non-judgemental attitude can contribute profoundly to the assaulted woman's regaining control over her life and being able to overcome the experienced trauma.     

Intimate partner and sexual violence screening practices of college health care providers

BackgroundFemale college students experience higher rates of intimate partner violence (IPV) and sexual violence (SV) compared to men of all ages, older women and young women who are not attending college. Experts and medical organizations have issued recommendations that health care providers should routinely screen women for IPV and SV. However, most female college students report they are not being screened for IPV and SV at college health centers.AimThis exploratory study sought to examine the IPV and SV screening practices of college health care providers and identify individual and organizational influences using a cross-sectional, quantitative survey design.MethodsSixty-four health care providers (physicians, nurse practitioners and registered nurses) from five colleges and universities in the northeastern U.S. were invited to participate in an anonymous, web-based survey about their IPV/SV-related screening practices and beliefs, and organizational characteristics of their college health centers.ResultsTwenty-six health care providers completed surveys (56% response rate). The median reported IPV/SV screening rate was 15%. More IPV/SV screening was reported by nurse practitioners, providers at state colleges, and by those in health centers that prioritized IPV/SV screening and had greater organizational capacity for change.ConclusionsCollege health centers represent unique, yet often missed, opportunities to screen for IPV/SV in a high-risk population. Provider- and organization-level influences should be incorporated into future interventions to improve IPV/SV screening in college health centers. Future studies with larger numbers of colleges and providers are needed to better understand organizational influences and identify mediators and moderators of effects.     

Comparative effects of sexual assault on sexual functioning of child sexual abuse survivors and others

This study quantitatively and qualitatively examined the effects of sexual assault on the sexual functioning of 37 sexually active women an average of 8.21 years postevent (Mdn = 4.08 years). More than 80% of the sample reported some sexual dysfunction with a partner as a result of the assault. Greatest impairment was reported by subjects who either had a history of child sexual abuse or had no prior sexual victimization before the current assault as compared with subjects who had prior sexual assaults. When data were examined by type of perpetrator, adverse effects were greatest for subjects assaulted by a health care professional. Qualitative analysis revealed that, for the total sample, greatest effects were in the area of adverse feeling states (part of desire dysfunction) as early response inhibitors, with subjects who had a history of child sexual abuse being the only group to report orgasmic dysfunction and guilt. There was no statistically significant difference in sexual dysfunction between subjects who filed civil suits and those who did not. Implications for treatment are discussed.     

Intimate partner physical and mental health after sudden cardiac arrest and receipt of an implantable cardioverter defibrillator

The purpose of this study was to describe the physical and mental health of the intimate partners of persons receiving an implantable cardioverter defibrillator (ICD). A prospective longitudinal repeated measures design was used, with data collected at hospital discharge, and at 1, 3, 6, and 12 months after implantation. Intimate partners' physical health, symptoms, and depression significantly declined over the first year. Although anxiety was significantly reduced over time, it remained elevated in partners after 1 year. The impact of implantation of the ICD on the intimate relationship and care demands was most dramatic at hospital discharge. Health care use was low throughout the year. Intimate partners could benefit from an intervention that would assist in their psychological adjustment and provide strategies for dealing with caregiving demands at home. © 2009 Wiley Periodicals, Inc. Res Nurs Health 32: 432–442, 2009     

Intimate partner violence and reproductive health of women in Kenya

Background:  Reproductive age represents an augmented risk of intimate partner violence (IPV) despite its occurrence in women of all ages. IPV has been associated with various reproductive health outcomes (e.g. terminated pregnancies and infant mortality), although multi-country studies indicate that the findings may not be consistent across all cultures.
Study aim and method:  The current work describes the association between IPV and reproductive health of women in Kenya using the Demographic and Health Survey of 2003.
Results:  A significant association between physical/emotional/sexual abuse of women and negative reproductive health outcomes such as terminated pregnancies and infant mortality was identified. In addition, IPV exposure was associated with use of family planning methods and high fertility.
Conclusion and recommendations:  Practitioners in the healthcare sector should inquire about abuse. Provision of counselling services and information regarding IPV effects on reproductive outcomes as well as referring abused women to relevant institutions is recommended in secondary prevention of IPV and to improve the reproductive health status of abused women.     

Intimate partner violence perpetration among men and emergency department use

>Background: Intimate partner violence (IPV) perpetration and emergency department (ED) use share common risk factors, such as risk-taking behaviors, but little is known about the relationship between IPV perpetration and ED use or the effect of risk-taking on this relationship. Study Objectives: This study examined the relationship between IPV perpetration, risk-taking, and ED utilization among men in the general U.S. population. Methods: This cross-sectional study utilized data from the 2002 National Survey on Drug Use and Health, focusing on non-Hispanic white, non-Hispanic black, and Hispanic male respondents 18–49 years of age cohabiting with a spouse or partner. Logistic regression was used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI). Results: Approximately 38% of IPV perpetrators reported ED use in the previous year, compared to 24% of non-perpetrators. Several risk-taking factors (e.g., perception of risk-taking, transportation-related risk-taking, and aggression-related arrest), alcohol and illicit drug use and abuse or dependence, and serious mental illness were positively associated with IPV perpetration. Men reporting IPV were 1.5 times (AOR 1.47, 95% CI 1.01–2.13) more likely than non-perpetrators to utilize the ED, after taking all factors into account. Drug abuse or dependence, transportation-related risk behaviors, and serious mental illness also were independently associated with ED use. Conclusions: The results indicate that men who perpetrate IPV are more likely than non-perpetrators to use ED services. These findings suggest that screening for IPV, as well as risk-taking and mental illness among men accessing ED services may increase opportunities for intervention and referral.     

Negotiating the challenges of multidisciplinary responses to sexual assault victims: sexual assault nurse examiner and victim advocacy programs

The purpose of this study was to examine Sexual Assault Nurse Examiner (SANE) programs' relationships with victim advocacy organizations. A national telephone survey was conducted of randomly selected SANE programs, all of which served adults, and some of which also served adolescents and children. Nearly one-third of 231 participants reported that SANEs in their program had experienced conflicts related to roles and boundaries with victim advocacy organizations at some point during the program's history. The most frequently mentioned conflicts involved professional autonomy, control, or turf issues. Future researchers should address personnel, organizational, and structural factors that facilitate collaborative relationships between SANE and victim advocacy organizations.     

Community cooperatives combat sexual assault and domestic violence

The effectiveness of the SANE program is borne out by the following testimonies: "The emotional support required by these victims is best rendered by a SANE. This frees the ED nurse to care for other patients, while sexual assault victims receive a high level of care," says Nancy Donel, RN manager at St. Thomas Hospital ED. "The DOVE program benefits not only the emergency physician, but the EMS system as well. It gives us a resource and a specifically identified program with well-trained, qualified providers. Through their training and knowledge, SANEs not only help victims, but also increase the number of legal convictions that take assailants off the streets. This improves the health and safety of the communities in which we live and serve," says Michael Mackan, MD, of the Summa Health System.     

Intimate partner homicide: review and implications of research and policy

Current rates of intimate partner homicide of females are approximately 4 to 5 times the rate for male victims, although the rates for both have decreased during the past 25 years. The major risk factor for intimate partner homicide, no matter if a female or male partner is killed, is prior domestic violence. This review presents and critiques the evidence supporting the other major risk factors for intimate partner homicide in general, and for intimate partner homicide of women (femicide) in particular, namely guns, estrangement, stepchild in the home, forced sex, threats to kill, and nonfatal strangulation (choking). The demographic risk factors are also examined and the related phenomena of pregnancy-related homicide, attempted femicide, and intimate partner homicide-suicide.     

Sexual assault nurse examiner and sexual assault response team (SANE/SART) program

Guided by the Center for Advanced Nursing Practice Evidence-Based Practice Model, under the leadership of a Clinical Nurse Specialist for Women's Health, in response to focused community needs assessment, a SANE/SART program was developed, implemented, and evaluated. The SANE/SART program brings quality improvement across the entire women's health program. Currently, the program scope is expanding to include the pediatric population and is extending into rural communities throughout the state. The model will continue to be the catalyst for future program initiatives and advancing best practice.     

Preventing rape and sexual assault of people with learning disabilities

This article will explore the increased prevalence of rape and sexual assault among people with a learning disability and identify factors that exist which increase this client group's vulnerability to becoming a victim of sexual abuse. There is significant under-reporting of such incidents and very few cases end up in prosecution. Within the nursing profession, there is much more that can be done to help decrease the level of vulnerability of people with a learning disability and to work with other agencies to advocate for legal justice and therapeutic redress for individuals.     

Intimate partner violence and the childbearing year: maternal and infant health consequences

Intimate partner violence (IPV) against women is a significant public health problem with negative physical and mental health consequences. Pregnant women are not immune to IPV, and as many as 4% to 8% of all pregnant women are victims of partner violence. Among pregnant women, IPV has been associated with poor physical health outcomes such as increased sexually transmitted diseases, preterm labor, and low-birth-weight infants. This article focuses on the physical health consequences of IPV for mothers and their infants. The purpose of this review is therefore to examine timely research ranging from 2001 to 2006 on IPV during pregnancy, the morbidity and mortality risks for mothers and their infants, and the association between IPV and perinatal health disparities. It will also identify gaps in the published empirical literature and make recommendations for practice, policy, and research.