Sandra L Martin

University of North Carolina at Chapel Hill, North Carolina, United States

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Publications (108)347.03 Total impact

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    ABSTRACT: To evaluate whether an alcohol harm reduction intervention was associated with reduced interpersonal violence or engagement in sex work among female sex workers (FSWs) in Mombasa, Kenya.
    No preview · Article · Jan 2016
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    ABSTRACT: Planned interventions and/or natural conditions often effect change on an ordinal categorical outcome (e.g., symptom severity). In such scenarios, it is sometimes desirable to assign a priori scores to observed changes in status, typically giving higher weight to changes of greater magnitude. We define change indices for such data based upon a multinomial model for each row of a c × c table, where the rows represent the baseline status categories. We distinguish an index designed to assess conditional changes within each baseline category from two others designed to capture overall change. One of these overall indices measures expected change across a target population. The other is scaled to capture the proportion of total possible change in the direction indicated by the data, so that it ranges from -1 (when all subjects finish in the least favorable category) to +1 (when all finish in the most favorable category). The conditional assessment of change can be informative regardless of how subjects are sampled into the baseline categories. In contrast, the overall indices become relevant when subjects are randomly sampled at baseline from the target population of interest, or when the investigator is able to make certain assumptions about the baseline status distribution in that population. We use a Dirichlet-multinomial model to obtain Bayesian credible intervals for the conditional change index that exhibit favorable small-sample frequentist properties. Simulation studies illustrate the methods, and we apply them to examples involving changes in ordinal responses for studies of sleep deprivation and activities of daily living. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.
    No preview · Article · Jul 2015 · Statistics in Medicine
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    ABSTRACT: Objective: Sexual assault is a common global problem and is associated with poor mental health. Given the high prevalence of sexual assault, it is important to understand which interventions may help survivors. This systematic review examines the effectiveness of mental health interventions for adult female survivors of sexual assault, focusing on 1) methods used to study the interventions; 2) effectiveness of interventions compared to no treatment; and 3) comparative effectiveness of interventions. Methods: Published scientific literature was searched to identify manuscripts that investigated the effects of mental health interventions on adult female survivors of sexual assault. Articles were included if they: were in English, Spanish, or French; were published between January 1985 and December 2012; evaluated a mental health intervention; implemented the intervention with adult female survivors of sexual assault; evaluated the effectiveness of the intervention on mental health symptoms or diagnoses; and included a comparison group. Findings: Cognitive-behavioral interventions, exposure interventions, and eye movement desensitization and reprocessing interventions were typically more effective at improving mental health than no treatment. Statistical tests of comparative effectiveness did not demonstrate that one intervention was significantly more effective than another. Conclusions: Health providers should refer survivors of sexual assault to mental health treatments shown to be effective. Additional research on comparative effectiveness of mental health interventions is warranted.
    No preview · Article · Jul 2015 · Aggression and Violent Behavior
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    Full-text · Article · Apr 2015 · Journal of Clinical Epidemiology
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    ABSTRACT: This practice note presents findings from a statewide survey of domestic violence and sexual assault agency directors (n = 80; 77% response rate), regarding their opinions about the outcome information that should be collected from victims during evaluations of five commonly provided services: legal advocacy, medical advocacy, group services, individual counseling, and shelter. The findings showed that four information types were repeatedly ranked among the most important to collect to understand whether services helped victims including victims' satisfaction with services, victims' progress toward meeting their goals, changes in the extent of violence and/or trauma that victims experienced, and changes in victims' knowledge. © The Author(s) 2015.
    No preview · Article · Mar 2015 · Violence Against Women
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    ABSTRACT: Many domestic violence and sexual assault survivors seeking help from domestic violence/sexual assault (DV/SA) programs have multiple health/social needs that may interfere with their ability to recover from violence experiences. Thus, DV/SA service providers should be well-trained in how to identify each survivor’s unique needs and resources so that an individualized plan of services/referrals can be delivered. Offering needed services in this wide range of topics will not only address survivors’ multiple concerns, but also will help survivors enhance their ability to recover from and prevent further violence. Unfortunately, there is a dearth of empirical information to inform training curricula for DV/SA service providers. To address this knowledge gap, this research examines NC DV/SA agencies’ current training practices and needs. We surveyed all NC DV/SA program directors (n=103) to assess staff training practices and needs (74% responded). Most directors reported that providers received at least some training in five areas: violence/safety (96%), emotional health (96%), disability (86%), physical health (79%), and substance use (77%). However, they also reported that many staff were not skillful in identifying and responding to multiple survivors’ needs, with 23% reporting that more than half of their program staff required additional training in violence/safety, 27% in physical health, 27% in emotional health, 33% in disability, and 42% in substance use. This statewide study is among the first to identify training practices/needs of DV/SA programs, with findings suggesting that there is a need for standardized, comprehensive, skill-based training curricula that address the many needs of survivors.
    No preview · Conference Paper · Nov 2014
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    ABSTRACT: Intimate partner violence (IPV) is a significant public health problem in South Africa. However, limited research exists on IPV during pregnancy and the postpartum period in South Africa. The purpose of this study is to describe the prevalence, rates and correlates of IPV among South African women during pregnancy and the first 9 months postpartum. Data are from a longitudinal study with women recruited during pregnancy between 2008 and 2010 at a public clinic in Durban. We used a modified version of the World Health Organization's IPV scale to estimate prevalence and rates of IPV during pregnancy, at 4 months postpartum and 9 months postpartum and we used logistic regression to assess the correlates of IPV during this time. More than 20 % of all women experienced at least one act of physical, psychological or sexual IPV during pregnancy. Nearly one-quarter of all women experienced at least one act of physical, psychological or sexual IPV during the first 9 months postpartum. Psychological IPV was the most prevalent type of IPV during pregnancy and the first 4 months postpartum. Age and previous violence within the relationship were associated with IPV during pregnancy and IPV during the postpartum period. The high levels of IPV during pregnancy and the postpartum period highlight the need to develop screening and intervention strategies specifically for this time. Further, women should be screened not only for physical violence but also psychological violence given that psychological violence may result in distinct negative consequences.
    Full-text · Article · Jun 2014 · Maternal and Child Health Journal
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    ABSTRACT: Population sexual mixing patterns can be quantified using Newman's assortativity coefficient (r). Suggested methods for estimating the SE for r may lead to inappropriate statistical conclusions in situations where intracluster correlation is ignored and/or when cluster size is predictive of the response. We describe a computer-intensive, but highly accessible, within-cluster resampling approach for providing a valid large-sample estimated SE for r and an associated 95% CI. We introduce needed statistical notation and describe the within-cluster resampling approach. Sexual network data and a simulation study were employed to compare within-cluster resampling with standard methods when cluster size is informative. For the analysis of network data when cluster size is informative, the simulation study demonstrates that within-cluster resampling produces valid statistical inferences about Newman's assortativity coefficient, a popular statistic used to quantify the strength of mixing patterns. In contrast, commonly used methods are biased with attendant extremely poor CI coverage. Within-cluster resampling is recommended when cluster size is informative and/or when there is within-cluster response correlation. Within-cluster resampling is recommended for providing valid statistical inferences when applying Newman's assortativity coefficient r to network data.
    No preview · Article · Jan 2014 · Sexually transmitted infections
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    ABSTRACT: Background and Purpose: Intimate partner violence (IPV) and sexual assault (SA) survivors are negatively affected by the aftermath of violence both physically and mentally (Campbell, 2002) and also experience financial and social impairments subsequent to victimization (Briere & Jordan, 2004). To address such needs, many survivors seek help from local IPV/SA agencies, which offer an array of services: individual counseling, legal and medical advocacy; safety planning; support groups, and shelter to provide a safe living environment (Riger et al., 2002). IPV/SA service providers have the challenging task of assessing survivors’ needs and tailoring service plans to meet those needs. With a range of available services, IPV/SA service providers need considerable expertise to design individualized service plans to best meet survivors’ needs. Accordingly, IPV/SA service providers require training to develop such expertise. Unfortunately, there is a lack of consensus regarding the content and extent of training required for effective IPV/SA service provision (Macy et al., 2009). Moreover, there is a dearth of research to inform standardized training curricula for IPV/SA service providers. To help build the knowledge base in these areas, we investigated IPV/SA agencies’ current training and technical practices, as well as their training needs. Methods: Our research team surveyed all IPV/SA agencies in North Carolina by developing a database of all IPV/SA agencies and their directors from the Websites of the three statewide IPV/SA organizations. We then confirmed the accuracy of the information by contacting each agency to obtain a final sample of 103 agency directors. With guidance from an expert panel of IPV/SA statewide leaders, we developed a survey to collect information regarding typical IPV/SA staff training practices and training needs. The web-based survey was administered over 13 weeks. Of those invited, 74% started the survey and 65% completed most or all of the survey. We then conducted descriptive analyses to assess training levels and ongoing training needs among all participating agencies. Results: The majority of respondents reported that personnel received initial trainings in five key areas of survivor concerns: violence/safety (95.5%), emotional health (95.5%), disability (86.4%), physical health (78.8%), and substance use (77.3%). However, respondents reported that more than half of their staff required additional training in violence/safety (22.7%), physical health (26.9%), emotional health (27.3%), disability (33.3%), and substance use (42.4%). Notably, there were no statistically significant differences (p=0.05) in training needs when comparing agencies that provided orientation trainings in each area with those that did not. Implications: This study is among one of the first to examine the training practices and needs of IPV/SA agencies. Respondents reported continuing educational needs in five key areas of survivor concerns regardless of whether agencies provided orientation trainings. Such findings suggest that there are critical training needs across IPV/SA advocates and agencies. Based on this research’s findings, we offer recommendations for standardized training curricula for IPV/SA service providers that address the complex needs of IPV/SA survivors.
    No preview · Conference Paper · Jan 2014
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    ABSTRACT: Background: Population-level mixing patterns can be quantified using Newman's assortativity coefficient r. Suggested methods for estimating the standard error for r may lead to inappropriate statistical conclusions in situations where intra-cluster correlation is ignored and/or when cluster size is predictive of the response. Methods: We describe a computer-intensive within-cluster resampling approach for providing a valid large-sample estimated standard error for r and an associated 95% confidence interval. Network data and a simulation model were employed to compare within-cluster resampling to standard methods when cluster size is informative. Results: For the analysis of network data, when cluster size is informative, simulations studies demonstrate that within-cluster resampling produces valid statistical inferences about Newman's assortativity coefficient, a popular statistic used to quantify the strength of mixing patterns. In contrast, commonly used methods are biased with attendant extremely poor confidence interval coverage. Within-cluster resampling is recommended when cluster size is informative and/or when there is within-cluster response correlation. Conclusions: Within-cluster resampling is recommended for providing valid statistical inferences when applying Newman's assortativity coefficient r to network data.
    No preview · Conference Paper · Nov 2013
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    ABSTRACT: Introduction: Community-based Domestic Violence/Sexual Assault (DV/SA) programs exist nationwide, with 100 in North Carolina (NC). NC DV/SA programs serve over 75,000 persons annually, with many DV/SA survivors receiving longer-term services (shelter, individual/group counseling). Although DV/SA survivors have many needs (health, etc.), there are no standardized assessment instruments/procedures used by all DV/SA programs to: identify needs of survivors entering longer-term services (so appropriate wrap-around services/referrals may be put into place); and re-assess survivors at service-end to determine how well needs were met (service effectiveness). The goal of this 4-year collaboration with NC DV/SA survivors and programs was to develop/pilot-test standardized assessment instruments/procedures to address this service gap. Methods: To identify topics for the instruments, focus groups were conducted with NC DV/SA survivors and all NC DV/SA programs were surveyed (77% responded). Using these findings, instruments were drafted to assess survivors' goals, violence/legal experiences, safety, physical/emotional health, substance use, coping, and social support. Staff at 4 NC DV/SA programs piloted the instruments with survivors to assess feasibility/usefulness. Survivors' instrument responses also were analyzed. Results: The instruments: were acceptable to survivors; took 15-minutes to administer; were feasible to use; and identified important issues that staff could help survivors address. Analysis of survivors' instrument responses at service-entry showed that most survivors experienced high levels of violence, had high levels of physical/emotional health/substance abuse symptoms, and had low levels of coping and social support. All these improved significantly after DV/SA services. Conclusion: Standardized assessment procedures can be very useful to DV/SA programs and survivors.
    No preview · Conference Paper · Nov 2013
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    ABSTRACT: The objective of this study is to examine the association between physical and sexual violence exposure and somatic symptoms among female adolescents. We studied a nationally representative sample of 8,531 females, aged 11-21 years, who participated in the 1994-1995 Wave I of the National Longitudinal Study of Adolescent Health (Add Health). Female adolescents were asked how often they had experienced 16 specific somatic symptoms during the past 12 months. Two summary categorical measures were constructed based on tertiles of the distributions for the entire female sample: (a) total number of different types of symptoms experienced, and (b) number of frequent (once a week or more often) different symptoms experienced. Groups were mutually exclusive. We examined associations between adolescents' violence exposure and somatic symptoms using multinomial logistic regression analyses. About 5 % of adolescent females reported both sexual and non-sexual violence, 3 % reported sexual violence only, 36 % reported non-sexual violence only, and 57 % reported no violence. Adolescents who experienced both sexual and non-sexual violence were the most likely to report many different symptoms and to experience very frequent or chronic symptoms. Likelihood of high symptomatology was next highest among adolescents who experienced sexual violence only, followed by females who experienced non-sexual violence only. Findings support an exposure-response association between violence exposure and somatic symptoms, suggesting that symptoms can be markers of victimization. Treating symptoms alone, without addressing the potential violence experienced, may not adequately improve adolescents' somatic complaints and well-being.
    Full-text · Article · Jan 2013 · Maternal and Child Health Journal
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    ABSTRACT: Women who experience intimate partner violence (IPV) during pregnancy also tend to experience depressive symptoms. Unfortunately, little is known about how victimized women's levels of depressive symptoms change longitudinally before pregnancy, during pregnancy, and after infant delivery. In addition, few studies have used a comparison group of women to determine if levels of depressive symptoms among victimized women differ from depressive symptom levels in women who have not experienced IPV. To help address these knowledge gaps, we examined longitudinal trends in levels of depressive symptoms among a sample of 76 women who did (n = 33) and did not (n = 43) experience physical IPV during pregnancy. Using multilevel analysis, we estimated the relationship of physical IPV victimization and women's depressive symptom levels across six time periods: (a) the year before pregnancy, (b) first and second trimesters, (c) third trimester, (d) the first month postpartum, (e) Months 2 to 6 postpartum, and (f) Months 7 to 12 postpartum. Women who experienced physical IPV victimization during pregnancy had significantly higher levels of depressive symptoms during each time period (p < .05). No significant difference between the two groups was found in the rate of change in levels of depressive symptoms over time. These findings point to the importance of screening for IPV within health care settings and suggest that women physically abused during pregnancy need safety interventions that are coordinated with interventions targeting symptoms of depression.
    No preview · Article · Jan 2013 · Journal of Interpersonal Violence
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    ABSTRACT: The objective of this study is to examine the association between physical and sexual violence exposure and somatic symptoms among female adolescents. We studied a nationally representative sample of 8,531 females, aged 11–21 years, who participated in the 1994–1995 Wave I of the National Longitudinal Study of Adolescent Health (Add Health). Female adolescents were asked how often they had experienced 16 specific somatic symptoms during the past 12 months. Two summary categorical measures were constructed based on tertiles of the distributions for the entire female sample: (a) total number of different types of symp-toms experienced, and (b) number of frequent (once a week or more often) different symptoms experienced. Groups were mutually exclusive. We examined associations between adolescents' violence exposure and somatic symptoms using multinomial logistic regression analyses. About 5 % of adolescent females reported both sexual and non-sexual violence, 3 % reported sexual violence only, 36 % reported non-sexual violence only, and 57 % reported no violence. Adolescents who experienced both sexual and non-sexual violence were the most likely to report many different symptoms and to experience very frequent or chronic symptoms. Likelihood of high symptomatology was next highest among adolescents who experienced sexual violence only, followed by females who experienced non-sexual violence only. Findings support an exposure– response association between violence exposure and somatic symptoms, suggesting that symptoms can be markers of victimization. Treating symptoms alone, without addressing the potential violence experienced, may not adequately improve adolescents' somatic complaints and well-being.
    Full-text · Dataset · Jan 2013
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    ABSTRACT: Introduction:South Africa has high rates of intimate partner violence (IPV) directed against women. However, we know little about the scope of IPV during pregnancy and the postpartum period despite significant negative consequences. The purpose of this study is to describe the prevalence and severity of IPV that South African women experience before pregnancy, during pregnancy, three and nine months postpartum. Methods:Data come from a longitudinal study with 745 women recruited between May 2008 and June 2010 at a public clinic in Durban. We used a modified version of the World Health Organization's intimate partner violence scale to estimate prevalence and the proportion of women who experienced severe violence. Results:The prevalence of IPV decreased from 39% before pregnancy to 23% during pregnancy. Approximately 25% of women experienced IPV postpartum. The proportion of women who experienced severe violence also dropped from 13% to 3% during pregnancy; however, nearly 10% of women experienced severe violence postpartum. Conclusion:While the proportion of women who experienced IPV decreased during pregnancy, a quarter of all women still experienced some type of IPV during pregnancy, which is higher than most pregnancy-specific prevalence estimates in sub-Saharan Africa. Further, the high proportion of women who experience severe violence postpartum suggests that some women who experience severe IPV may only find a short period of respite from violence. Therefore, IPV prevention interventions are needed in both the prenatal and postnatal period to reduce the public health burden of IPV and particularly severe IPV during this time.
    No preview · Conference Paper · Oct 2012
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    ABSTRACT: Presenting continuous outcomes in Summary of Findings tables presents particular challenges to interpretation. When each study uses the same outcome measure, and the units of that measure are intuitively interpretable (e.g., duration of hospitalization, duration of symptoms), presenting differences in means is usually desirable. When the natural units of the outcome measure are not easily interpretable, choosing a threshold to create a binary outcome and presenting relative and absolute effects become a more attractive alternative. When studies use different measures of the same construct, calculating summary measures requires converting to the same units of measurement for each study. The longest standing and most widely used approach is to divide the difference in means in each study by its standard deviation and present pooled results in standard deviation units (standardized mean difference). Disadvantages of this approach include vulnerability to varying degrees of heterogeneity in the underlying populations and difficulties in interpretation. Alternatives include presenting results in the units of the most popular or interpretable measure, converting to dichotomous measures and presenting relative and absolute effects, presenting the ratio of the means of intervention and control groups, and presenting the results in minimally important difference units. We outline the merits and limitations of each alternative and provide guidance for meta-analysts and guideline developers.
    No preview · Article · Oct 2012 · Journal of clinical epidemiology

  • No preview · Article · Sep 2012 · CHANCE
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    ABSTRACT: We investigated agency directors' perspectives about how service goals should be prioritized for domestic violence and sexual assault service subtypes, including crisis, legal advocacy, medical advocacy, counseling, support group, and shelter services. A sample of 97 (94% response rate) North Carolina domestic violence and/or sexual assault agency directors completed a survey asking participants to rank the importance of service goals. Overall, participants considered emotional support provision to be a critical service goal priority across all service types. Social support and self-care service strategies were deemed less important. However, prioritization of other service goals varied depending on the service type. Statistically significant differences on service goal prioritization based on key agency characteristics were also examined, and agency characteristics were found to relate to differences in service goal prioritization.
    No preview · Article · Oct 2011 · Journal of Interpersonal Violence
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    ABSTRACT: The purpose of this study is to estimate rates of suicide and homicide death among pregnant, postpartum and non-pregnant/non-postpartum women ages 14-44, and to determine comparative rates of violent death for pregnant and/or postpartum women compared to non-pregnant/non-postpartum women. North Carolina surveillance and vital statistics data from 2004 to 2006 were used to examine whether pregnant or postpartum women have higher (or lower) rates of suicide and homicide compared to other reproductive-aged women. The suicide rate for pregnant women was 27% of the rate for non-pregnant/non-postpartum women (rate ratio= 0.27, 95% CI = 0.11-0.66), and the suicide rate for postpartum women was 54% of the rate for non-pregnant/non-postpartum women (rate ratio = 0.54, 95% CI = 0.31-0.95). Homicide rates also were lower for pregnant and postpartum women, with the homicide rate for pregnant women being 73% of the rate for non-pregnant/non-postpartum women (rate ratio = 0.73, 95% CI = 0.39-1.37), and the homicide rate for postpartum women being half the rate for non-pregnant/non-postpartum women (rate ratio = 0.50, 95% CI = 0.26-0.98). Although pregnant and postpartum women are at risk for homicide and suicide death, the highest risk group is non-pregnant/non-postpartum women. Violence prevention efforts should target all women of reproductive age, and pay particular attention to non-pregnant/non-postpartum women, who may have less access to health care services than pregnant and postpartum women.
    No preview · Article · Jul 2011 · Maternal and Child Health Journal
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    ABSTRACT: We sought to examine relationships between women's sexual orientations and their sexual assault experiences before and during university. Self-reported responses on a web-based survey of 5,439 female undergraduates who participated in the Campus Sexual Assault study were analyzed to compare three groups: bisexuals, lesbians, and heterosexuals. Groups were compared in terms of the prevalence of sexual assault before and during university, and the extent to which sexual assault before university predicted sexual assault during university. The prevalence of sexual assault before and during university was higher among bisexuals and lesbians compared with heterosexuals (25.4% of bisexuals, 22.4% of lesbians, and 10.7% of heterosexuals were sexually assaulted before university; 24.0% of bisexuals, 17.9% of lesbians, and 13.3% of heterosexuals were sexually assaulted during university). Sexual assault before university was highly predictive of sexual assault during university, especially among non-heterosexuals. Compared with heterosexuals not sexually assaulted before university (the referent group), previously assaulted non-heterosexuals (bisexuals/lesbians) had eight times the odds of sexual assault during university (adjusted odds ratio [AOR] = 8.75), whereas previously assaulted heterosexuals had four times the odds of sexual assault during university (AOR, 4.40). However, there was no difference in the odds of sexual assault during university between non-heterosexuals not sexually assaulted before university and heterosexuals not sexually assaulted before university. Bisexual and lesbian women are more likely than heterosexual women to be sexually assaulted before and during university. Sexual assault before university is linked to sexual assault during university for all women, with this association being especially pronounced among non-heterosexuals.
    Full-text · Article · May 2011 · Women s Health Issues

Publication Stats

3k Citations
347.03 Total Impact Points

Institutions

  • 1995-2016
    • University of North Carolina at Chapel Hill
      • Department of Maternal and Child Health
      North Carolina, United States
  • 2007
    • RTI International
      Durham, North Carolina, United States
  • 2005
    • Johns Hopkins Bloomberg School of Public Health
      • Department of Epidemiology
      Baltimore, MD, United States
  • 1999
    • University of Missouri
      • School of Social Work
      Columbia, MO, United States