[Show abstract][Hide abstract] ABSTRACT: Background:
No prior study has empirically characterized the association between health risks and reading popular fiction depicting violence against women. Fifty Shades--a blockbuster fiction series--depicts pervasive violence against women, perpetuating a broader social narrative that normalizes these types of risks and behaviors in women's lives. The present study characterized the association between health risks in women who read and did not read Fifty Shades; while our cross-sectional study design precluded causal determinations, an empirical representation of the health risks in women consuming the problematic messages in Fifty Shades is made.
Females ages 18 to 24 (n=715), who were enrolled in a large Midwestern university, completed a cross-sectional online survey about their health behaviors and Fifty Shades' readership. The analysis included 655 females (219 who read at least the first Fifty Shades novel and 436 who did not read any part of Fifty Shades). Age- and race-adjusted multivariable models characterized Fifty Shades' readers and nonreaders on intimate partner violence victimization (experiencing physical, sexual and psychological abuse, including cyber-abuse, at some point during their lifetime); binge drinking (consuming five or more alcoholic beverages on six or more days in the last month); sexual practices (having five or more intercourse partners and/or one or more anal sex partner during their lifetime); and using diet aids or fasting for 24 or more hours at some point during their lifetime.
One-third of subjects read Fifty Shades (18.6%, or 122/655, read all three novels, and 14.8%, or 97/655, read at least the first novel but not all three). In age- and race-adjusted models, compared with nonreaders, females who read at least the first novel (but not all three) were more likely than nonreaders to have had, during their lifetime, a partner who shouted, yelled, or swore at them (relative risk [RR]=1.25) and who delivered unwanted calls/text messages (RR=1.34); they were also more likely to report fasting (RR=1.80) and using diet aids (RR=1.77) at some point during their lifetime. Compared with nonreaders, females who read all three novels were more likely to report binge drinking in the last month (RR=1.65) and to report using diet aids (RR=1.65) and having five or more intercourse partners during their lifetime (RR=1.63).
Problematic depictions of violence against women in popular culture-such as in film, novels, music, or pornography-create a broader social narrative that normalizes these risks and behaviors in women's lives. Our study showed strong correlations between health risks in women's lives-including violence victimization-and consumption of Fifty Shades, a fiction series that portrays violence against women. While our cross-sectional study cannot determine temporality, the order of the relationship may be inconsequential; for example, if women experienced adverse health behaviors first (e.g., disordered eating), reading Fifty Shades might reaffirm those experiences and potentially aggravate related trauma. Likewise, if women read Fifty Shades before experiencing the health behaviors assessed in our study, it is possible that the book influenced the onset of these behaviors by creating an underlying context for the behaviors.
Journal of Women's Health 08/2014; 23(9). DOI:10.1089/jwh.2014.4782 · 2.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Women veterans experience high rates of lifetime intimate partner violence (IPV) and suffer a variety of trauma-related health conditions. The purpose of this study was to identify health status and health risk behaviors associated with experiences of psychological, physical, or sexual IPV among women veterans receiving care at a Veterans Affairs (VA) medical center. We conducted surveys with 249 women veteran patients and examined health factors associated with each form of violence. Sexual IPV victimization had the most pronounced associations with adverse health. In multivariate analysis, controlling for age, race, and income, women veterans who experienced sexual violence victimization were close to or more than three times as likely as those who experienced no IPV to report poor or fair overall health, a diagnosis of post-traumatic stress disorder or depression, bipolar disorder, or anxiety, difficulty sleeping, cigarette smoking, and problem drinking. Those who reported psychological violence only (without physical or sexual violence) also reported greater odds of self-rated poor or fair health. These findings are consistent with findings from studies with non-veteran populations and serve to further identify the unique contributions of sexual IPV to health outcomes. The integrated VA health care system offers opportunities for IPV identification and response including a coordinated team-based care model with social work integrated within primary care.
Social Work in Mental Health 02/2014; DOI:10.1080/15332985.2013.870104
[Show abstract][Hide abstract] ABSTRACT: This investigation used a longitudinal design to examine the relationship between neighborhood-level income, individual-level predictors, and police-reported intimate partner violence in 5,994 urban couples followed over 2 years. At the baseline abuse incident, intimate partner violence rates were highest in the poorest neighborhoods (13.8 per 1,000 women in the lowest income quartile, followed by 12.1, 8.2, and 5.0 in the respective higher income quartiles). However, in the longitudinal analysis, weapon use at the baseline abuse event was a much stronger predictor of repeat abuse (incident rate ratios ranging from 1.72 for physical abuse to 1.83 for non-physical abuse) than neighborhood income.
Violence Against Women 01/2014; 20(1). DOI:10.1177/1077801213520580 · 1.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present investigation expands upon prior studies by examining the relationship between health in late adolescence and the experience of physical/sexual and non-physical dating violence victimization, including dating violence types that are relevant to today's adolescents (e.g., harassment via email and text messaging). We examined the relationship between physical/sexual and non-physical dating violence victimization from age 13 to 19 and health in late adolescence/early adulthood.
The sample comprised 585 subjects (ages 18 to 21; mean age, 19.8, SD = 1.0) recruited from The Ohio State University who completed an online survey to assess: 1) current health (depression, disordered eating, binge drinking, smoking, and frequent sexual behavior); and 2) dating violence victimization from age 13 to 19 (retrospectively assessed using eight questions covering physical, sexual, and non-physical abuse, including technology-related abuse involving stalking/harassment via text messaging and email). Multivariable models compared health indicators in never-exposed subjects to those exposed to physical/sexual or non-physical dating violence only. The multivariable models were adjusted for age and other non-dating abuse victimization (bullying; punched, kicked, choked by a parent/guardian; touched in a sexual place, forced to touch someone sexually).
In adjusted analyses, compared to non-exposed females, females with physical/sexual dating violence victimization were at increased risk of smoking (prevalence ratio = 3.95); depressive symptoms (down/hopeless, PR = 2.00; lost interest, PR = 1.79); eating disorders (using diet aids, PR = 1.98; fasting, PR = 4.71; vomiting to lose weight, PR = 4.33); and frequent sexual behavior (5+ intercourse and oral sex partners, PR = 2.49, PR = 2.02; having anal sex, PR = 2.82). Compared to non-exposed females, females with non-physical dating violence only were at increased risk of smoking (PR = 3.61), depressive symptoms (down/hopeless, PR = 1.41; lost interest, PR = 1.36), eating disorders (fasting, PR = 3.37; vomiting, PR = 2.66), having 5+ intercourse partners (PR = 2.20), and having anal sex (PR = 2.18). For males, no health differences were observed for those experiencing physical/sexual dating violence compared to those who did not. Compared to non-exposed males, males with non-physical dating violence only were at increased risk of smoking (PR = 3.91) and disordered eating (fasting, using diet aids, vomiting, PR = 2.93).
For females, more pronounced adverse health was observed for those exposed to physical/sexual versus non-physical dating violence. For both females and males, non-physical dating violence victimization contributed to poor health.
BMC Public Health 09/2013; 13(1):821. DOI:10.1186/1471-2458-13-821 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
While intimate partner violence (IPV) affects 25% of women and impairs health, current societal conditions-including the normalization of abuse in popular culture such as novels, film, and music-create the context to support such violence. Fifty Shades of Grey, a best-selling novel, depicts a "romantic" and "erotic" relationship involving 28-year-old megamillionaire, Christian Grey, and a 22-year-old college student, Anastasia Steele. We argue that the relationship is characterized by IPV, which is harmful to Anastasia.
All authors engaged in iterative readings of the text, and wrote narrative summaries to elucidate themes. Validity checks included double review of the first eight chapters of the novel to establish consistency in our analysis approach, iterative discussions in-person and electronically to arbitrate discrepancies, and review of our analysis with other abuse and sexual practice experts. To characterize IPV, we used the U.S. Centers for Disease Control and Prevention's definitions of emotional abuse (intimidation/threats; isolation; stalking; and humiliation) and sexual violence (forced sex acts/contact against a person's will, including using alcohol/drugs or intimidation/pressure). To characterize harm, we used Smith's conceptualizations of perceived threat, managing, altered identity, yearning, entrapment, and disempowerment experienced by abused women.
Emotional abuse is present in nearly every interaction, including: stalking (Christian deliberately follows Anastasia and appears in unusual places, uses a phone and computer to track Anastasia's whereabouts, and delivers expensive gifts); intimidation (Christian uses intimidating verbal and nonverbal behaviors, such as routinely commanding Anastasia to eat and threatening to punish her); and isolation (Christian limits Anastasia's social contact). Sexual violence is pervasive-including using alcohol to compromise Anastasia's consent, as well as intimidation (Christian initiates sexual encounters when genuinely angry, dismisses Anastasia's requests for boundaries, and threatens her). Anastasia experiences reactions typical of abused women, including: constant perceived threat ("my stomach churns from his threats"); altered identity (describes herself as a "pale, haunted ghost"); and stressful managing (engages in behaviors to "keep the peace," such as withholding information about her social whereabouts to avoid Christian's anger). Anastasia becomes disempowered and entrapped in the relationship as her behaviors become mechanized in response to Christian's abuse.
Our analysis identified patterns in Fifty Shades that reflect pervasive intimate partner violence-one of the biggest problems of our time. Further, our analysis adds to a growing body of literature noting dangerous violence standards being perpetuated in popular culture.
Journal of Women's Health 08/2013; 22(9). DOI:10.1089/jwh.2013.4344 · 2.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Prior longitudinal studies have shown high cumulative dating violence exposure rates among U.S adolescents, with 36 percent of males and 44 percent to 88 percent of females experiencing victimization across adolescence/young adulthood. Despite promising information characterizing adolescents’ dating violence experiences longitudinally, prior studies tended to concentrate on physical and sexual types of violence only, and did not report information on the number of times dating violence was experienced across multiple abusive partners. We used a method similar to the timeline follow-back interview to query adolescents about dating violence victimization from age 13 to 19—including dating violence types (physical, sexual, and psychological), frequency, age at first occurrence, and number of abusive partners.
A total of 730 subjects were randomly sampled from university registrar records and invited to complete an online survey, which utilized methods similar to the timeline follow-back interview, to retrospectively assess relationship histories and dating violence victimization from age 13 to 19 (eight questions adapted from widely-used surveys covering physical, sexual, and psychological abuse). Then, for each dating violence type, we asked about the number of occurrences, number of abusive partners, and age at first occurrence. Of 341 subjects who completed the survey, we included 297 (64 percent females; 36 percent males) who had a dating partner from age 13 to 19.
Fully 64.7 percent of females and 61.7 percent of males reported dating violence victimization between age 13 and 19, with most experiencing multiple occurrences. More than one-third of abused females had two or more abusive partners: controlling behavior (35.6 percent); put downs/name calling (37.0); pressured sex (42.9); insults (44.3); slapped/hit (50.0); and threats (62.5). Males also had two or more abusive partners, as follows: controlling behavior (42.1 percent); insults (51.2); put downs (53.3); threats (55.6); and unwanted calls/texts/visits (60.7). Among abused females, 44.7 percent first experienced controlling behavior between age 13 and 15, whereas the majority (62.5 percent) first experienced pressured sex between age 16 and 17. Among males, for most abuse types, 16 percent to 30 percent of victimization began before age 15.
Our study adds information to a substantial, but still growing, body of literature about dating violence frequency, age of occurrence, and number of abusive partners among adolescents.
BMC Public Health 08/2012; 12(1):637. DOI:10.1186/1471-2458-12-637 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We conducted a qualitative study to examine acute, situational factors and chronic stressors that triggered severe intimate partner violence (IPV) in women.
Our sample consisted of 17 heterosexual couples, where the male was in detention for IPV and made telephone calls to his female victim. We used up to 4 hours of telephone conversational data for each couple to examine the couple's understanding of (1) acute triggers for the violent event and (2) chronic stressors that created the underlying context for violence. Grounded theory guided our robust, iterative data analysis involving audiotape review, narrative summation, and thematic organization.
Consistently across couples, violence was acutely triggered by accusations of infidelity, typically within the context of alcohol or drug use. Victims sustained significant injury, including severe head trauma (some resulting in hospitalization/surgery), bite wounds, strangulation complications, and lost pregnancy. Chronic relationship stressors evident across couples included ongoing anxiety about infidelity, preoccupation with heterosexual gender roles and religious expectations, drug and alcohol use, and mental health concerns (depression, anxiety, and suicide ideation/attempts).
Disseminated models feature jealousy as a strategy used by perpetrators to control IPV victims and as a red flag for homicidal behavior. Our findings significantly extend this notion by indicating that infidelity concerns, a specific form of jealousy, were the immediate trigger for both the acute violent episode and resulting injuries to victims and were persistently raised by both perpetrators and victims as an ongoing relationship stressor.
Journal of Women's Health 06/2012; 21(9):942-9. DOI:10.1089/jwh.2011.3328 · 2.05 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study compared the healthcare utilization and costs for specific types of medical services among older adult women who currently drive and those who no longer drive.
This study included 347 women aged 65 or older who were either former (had stopped driving) or current drivers, randomly sampled from a large U.S. health plan to participate in a telephone survey, and who had automated health records with healthcare utilization and cost data. Bivariate analyses and generalized linear modeling were used to examine associations between driving status and healthcare utilization and costs.
Adjusting for age, income, and marital status, former drivers were more likely than current drivers to use mental health care services (RR=3.37; 95% CI: 1.03, 10.98). Former drivers also tended to use more inpatient (RR=1.85; 95% CI: 0.88, 3.87) and emergency services (RR=1.89; 95% CI: 0.96, 3.70), but results did not reach statistical significance. Total annual healthcare costs in 2005 were almost twice as high for former drivers compared with current drivers ($13,046 vs. $7,054; mean difference=$5,992; 95% CI: -$360, $12,344), although this relationship was not statistically significant (CR=1.61; 95% CI: 0.88, 2.96).
Former drivers were more than three times as likely as current drivers to use mental health services, and tended to use more emergency and inpatient services. Further research on factors that potentially mediate the relationship between driving status and health service use is warranted.
Journal of safety research 04/2012; 43(2):141-4. DOI:10.1016/j.jsr.2012.01.001 · 1.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Our study used live telephone conversations between domestic violence perpetrators and victims to answer novel questions about how and why victims arrive at their decision to recant and/or refuse prosecution efforts. From October 2008 to June 2011, we conducted a qualitative study involving 25 heterosexual couples, where the male perpetrator was being held in a Detention Facility (in the U.S.) for felony-level domestic violence and made telephone calls to his female victim during the pre-prosecution period. We used 30-192 min of conversational data for each couple to examine: 1) interpersonal processes associated with the victim's intention to recant; and 2) the couple's construction of the recantation plan once the victim intended to recant. We used constructivist grounded theory to guide data analysis, which allowed for the construction of a novel recantation framework, while acknowledging the underlying coercive interpersonal dynamic. Our results showed that consistently across couples, a victim's recantation intention was foremost influenced by the perpetrator's appeals to the victim's sympathy through descriptions of his suffering from mental and physical problems, intolerable jail conditions, and life without her. The intention was solidified by the perpetrator's minimization of the abuse, and the couple invoking images of life without each other. Once the victim arrived at her decision to recant, the couple constructed the recantation plan by redefining the abuse event to protect the perpetrator, blaming the State for the couple's separation, and exchanging specific instructions on what should be said or done. Our findings advance scientific knowledge through identifying, in the context of ongoing interactions, strategies perpetrators used--sympathy appeals and minimization--to successfully persuade their victim and strategies the couple used to preserve their relationship.Practitioners must double their efforts to hold perpetrators accountable for their actions, and efforts made to link victims to trusted advocates who can help them defend against perpetrators' sophisticated techniques.
Social Science [?] Medicine 07/2011; 73(7):1054-61. DOI:10.1016/j.socscimed.2011.07.005 · 2.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: To describe processes leading to victim recantation in court-involved domestic abuse. Methods: We used audio-taped telephone conversations between 20 incarcerated perpetrators of domestic violence and their victim taped over the length of the perpetrator's jail stay. We examined three areas: 1) when did the victim indicate her intention to recant; 2) what was the couple discussing leading up to the recantation decision; and 3) what strategies did the couple use to ensure the victim's follow through to recant. We used family systems and attachment theories to elucidate interpersonal processes related to the intimacy needs of the perpetrator and victim in producing recantation decisions. Significantly, these theoretical approaches were considered within a larger coercive interpersonal dynamic, acknowledging the perpetrator's manipulation of the couple's interpersonal process to ensure recantation. Results: In most couples, the victim's intention to recant was apparent in the first or second conversation (I'll just say we were in a car accident or something.). Interpersonal processes that led up to the victim's decision to recant included: reminding each other of aloneness/vulnerability without each other, and jointly calling up the need to restore romance and family. Perpetrators used additional strategies to facilitate these processes and the recantation decision, including: appealing to the victim's sympathy, blaming/minimizing the abuse, and threatening the victim. Strategies commonly used by both members of the couple to ensure victim follow-through included jointly blaming the State/others for the couple's separation. Conclusions: These results elucidate complex interpersonal dynamics that go beyond perpetrator threats in influencing victim recantation.
138st APHA Annual Meeting and Exposition 2010; 11/2010
[Show abstract][Hide abstract] ABSTRACT: Associations between child abuse and/or witnessing intimate partner violence (IPV) during childhood and women's health, adult IPV exposure, and health care use were examined. Randomly sampled insured women ages 18-64 (N = 3,568) completed a phone interview assessing childhood exposure to abuse and witnessing IPV, current health, and adult IPV exposure. Women's health care use was collected from automated health plan databases. Poor health status, higher prevalence of depression and IPV, and greater use of health care and mental health services were observed in women who had exposure to child abuse and witnessing IPV during childhood or child abuse alone, compared with women with no exposures. Women who had witnessed IPV without child abuse also had worse health and greater use of health services. Findings reveal adverse long-term and incremental effects of differing child abuse experiences on women's health and relationships.
Violence and Victims 06/2010; 25(3):291-305. DOI:10.1891/0886-6708.25.3.291 · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Research has documented greater health care costs attributable to intimate partner violence (IPV) among women during and after exposure. However, no studies have determined whether health care costs for abused women return to baseline levels at some point after their abuse ceases.
We examine whether health care costs among women exposed to IPV converge with those of non-abused women during a 10-year period following the end of exposure.
Retrospective cohort analysis.
Group Health Cooperative, a large integrated health care system in the Pacific Northwest.
Random sample of English-speaking women aged 18-64 enrolled within Group Health and who participated in a telephone survey between June 2003 and August 2005.
Total health care costs over an 11-year period from January 1, 1992 to December 31, 2002 were compiled using automated health plan data and comparisons made among women exposed to IPV since age 18 and those who never experienced IPV. IPV included physical, sexual, or psychological violence involving an intimate partner, and was assessed using five questions from the Behavioral Risk Factor Surveillance System.
Relative to women with no IPV history, total health care costs were significantly higher during IPV exposure, costs that were sustained for 3 years following the end of exposure. By the 4th year following the end of exposure to IPV, health care costs among IPV-exposed women were similar to non-abused women, and this pattern held for the remainder of the 10-year study period.
Policy makers should consider the ongoing needs of victims following abuse exposure. Interventions to reduce the prevalence of IPV or to mitigate the impact of IPV have the potential to reduce the rate of growth of health care costs.
Journal of General Internal Medicine 04/2010; 25(9):920-5. DOI:10.1007/s11606-010-1359-0 · 3.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study sought to determine if the recent secular decrease in reported intimate partner violence (IPV) in women was due to cohort or period effects. Women ages 18 to 64 were interviewed about IPV during their adult lifetimes. The lifetime prevalence of any IPV was 42%. Regardless of birth cohort, IPV was most common among women in their mid-20s to early 30s. After adjusting for cohort and period effects, women 26 to 30 had the highest risk of any IPV; risk decreased with age. Younger birth cohorts were at decreased risk for IPV. The estimated risk is lowest for those born between 1966 and 1975, with 31% lower risk of IPV than those born in 1946-1955. There was a substantial drop in IPV for all age-groups beginning in the 1990s.
Violence and Victims 10/2009; 24(5):627-38. DOI:10.1891/0886-6708.24.5.627 · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There are many factors that influence older adults' travel choices. This paper explores the associations between mode of travel choice for a short trip and older adults' personal characteristics.
This study included 406 drivers over the age of 64 who were enrolled in a large integrated health plan in the United States between 1991 and 2001. Bivariate analyses and generalized linear modeling were used to examine associations between choosing to walk or drive and respondents' self-reported general health, physical and functional abilities, and confidence in walking and driving.
Having more confidence in their ability to walk versus drive increased an older adult's likelihood of walking to make a short trip by about 20% (PR=1.22; 95% CI: 1.06-1.40), and walking for exercise increased the likelihood by about 50% (PR=1.53; 95% CI=1.22-1.91). Reporting fair or poor health decreased the likelihood of walking, as did cutting down on the amount of driving due to a physical problem.
Factors affecting a person's decision to walk for exercise may not be the same as those that influence their decision to walk as a mode of travel. It is important to understand the barriers to walking for exercise and walking for travel to develop strategies to help older adults meet both their exercise and mobility needs. Impact on Industry: Increasing walking over driving among older adults may require programs that increase confidence in walking and encourage walking for exercise.
Journal of safety research 10/2009; 40(5):395-8. DOI:10.1016/j.jsr.2009.09.001 · 1.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We characterized the relative risk of a wide range of diagnoses in women with a history of intimate partner violence (IPV) compared with never-abused women.
The sample comprised 3568 English-speaking women who were randomly sampled from a large US health plan and who agreed to participate in a telephone survey to assess past-year IPV history using questions from the Behavioral Risk Factor Surveillance System (physical, sexual, and psychological abuse) and the Women's Experience with Battering Scale. Medical and psychosocial diagnoses in the past year were determined using automated data from health plan records. We estimated the relative risk of receiving diagnoses for women with a past-year IPV history compared with women with no IPV history.
In age-adjusted models, compared with never-abused women, abused women had consistently significantly increased relative risks of these disorders: psychosocial/mental (substance use, 5.89; family and social problems, 4.96; depression, 3.26; anxiety/neuroses, 2.73; tobacco use, 2.31); musculoskeletal (degenerative joint disease, 1.71; low back pain, 1.61; trauma-related joint disorders, 1.59; cervical pain, 1.54; acute sprains and strains, 1.35); and female reproductive (menstrual disorders, 1.84; vaginitis/vulvitis/cervicitis, 1.56). Abused women had a more than 3-fold increased risk of being diagnosed with a sexually transmitted disease (3.15) and a 2-fold increased risk of lacerations (2.17) as well as increased risk of acute respiratory tract infection (1.33), gastroesophageal reflux disease (1.76), chest pain (1.53), abdominal pain (1.48), urinary tract infections (1.79), headaches (1.57), and contusions/abrasions (1.72).
Past-year IPV history was strongly associated with a variety of medical and psychosocial conditions observed in clinical settings.
Archives of internal medicine 10/2009; 169(18):1692-7. DOI:10.1001/archinternmed.2009.292 · 17.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To explore the association between women's self-reports of having witnessed intimate partner violence (IPV) as a child and their children witnessing IPV.
Retrospective cohort study. Data were collected by telephone survey from December 2003 to August 2005.
Group Health Cooperative, Seattle, Washington, a health maintenance organization.
English-speaking women (N = 1288) aged 18 to 64 years enrolled at Group Health Cooperative for at least 3 years. Measures Abused women with children were asked about their history of having witnessed IPV as a child (1 question). Abused women were identified using 5 questions from the Behavioral Risk Factor Surveillance System Survey and using 10 items from the Women's Experience With Battering Scale. Abused women were asked if their children had ever witnessed IPV.
Adjusting for mothers' race/ethnicity and education level, children of women who had witnessed IPV during childhood had 1.29 times higher odds of witnessing IPV than children of women who did not witness IPV during childhood.
Children of women who had witnessed IPV during childhood are more likely to witness IPV than children of women who did not witness IPV.
[Show abstract][Hide abstract] ABSTRACT: To estimate health care utilization and costs associated with the type of intimate partner violence (IPV) women experience by the timing of their abuse.
A total of 3,333 women (ages 18-64) were randomly sampled from the membership files of a large health plan located in a metropolitan area and participated in a telephone survey to assess IPV history, including the type of IPV (physical IPV or nonphysical abuse only) and the timing of the abuse (ongoing; recent, not ongoing but occurring in the past 5 years; remote, ending at least 5 years prior). Automated annual health care utilization and costs were assembled over 7.4 years for women with physical IPV and nonphysical abuse only by the time period during which their abuse occurred (ongoing, recent, remote), and compared with those of never-abused women (reference group).
Mental health utilization was significantly higher for women with physical or nonphysical abuse only compared with never-abused women-with the highest use among women with ongoing abuse (relative risk for those with ongoing abuse: physical, 2.61; nonphysical, 2.18). Physically abused women also used more emergency department, hospital outpatient, primary care, pharmacy, and specialty services; for emergency department, pharmacy, and specialty care, utilization was the highest for women with ongoing abuse. Total annual health care costs were higher for physically abused women, with the highest costs for ongoing abuse (42 percent higher compared with nonabused women), followed by recent (24 percent higher) and remote abuse (19 percent higher). Women with recent nonphysical abuse only had annual costs that were 33 percent higher than nonabused women.
Physical and nonphysical abuse contributed to higher health care utilization, particularly mental health services utilization.
Health Services Research 07/2009; 44(3):1052-67. DOI:10.1111/j.1475-6773.2009.00955.x · 2.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The use of menopausal hormone therapy (HT) has significantly declined since the release of the Women's Health Initiative findings, but to what extent physicians' and women's concerns about breast cancer contributed to this change is unknown. Our study explored physicians' and women's beliefs about hormone therapy and breast cancer risk.
We conducted qualitative in-depth interviews with 22 primary care physicians and 45 female patients at two large integrated health care delivery systems in Washington State and Massachusetts.
Concerns about breast cancer risk weighed into the decision-making process for physicians and women in initiating and continuing hormone therapy. For women, control of menopausal symptoms was important and possibly outweighed their concerns about the potential risks of breast cancer. Though concerned about its association with increasing breast cancer risk, physicians were willing to consider hormone therapy to manage women's menopausal symptoms but were frustrated about the lack of available non-hormone therapy alternatives. Most physicians and some women were aware of the Women's Health Initiative, and its findings appeared to influence their beliefs about hormone therapy and breast cancer risk, though doubts remained among both groups about the study findings and implications.
Our qualitative study suggests that after the Women's Health Initiative, concerns about breast cancer risk weighed into decisions to initiate and continue hormone therapy for both physicians and women, but menopausal symptoms often directed use.
Women & Health 06/2009; 49(4):280-93. DOI:10.1080/03630240903158446 · 1.05 Impact Factor