Prospective association of Intimate
Partner Violence (IPV) with receipt of
clinical
li i l preventive
i services
i
iin women off
reproductive
p
age
g
Jennifer McCall-Hosenfeld, MD, MSc
Pennsylvania State University College of Medicine
Departments of Medicine and Public Health Sciences
AcademyHealth
A
d
H lh
Annual Research Meeting 2010
Boston, MA
06.27.2010
Acknowledgements
g

Cynthia H. Chuang, MD, MSc

NIH NICHD K23 HD051634

Carol S
S. Weisman
Weisman, PhD

NIH ORWH BIRCWH 5 K12 HD05582-03

CePAWHS: PA Dept. of Health 4100020719
IPV survivors mayy need increased
attention to preventive services.



National consensus guidelines recommend
safety planning.
IPV is associated with increased risk for
sexually transmitted infections (STIs)
(STIs),
unintended pregnancy, and substance abuse.
Primar care pro
Primary
providers
iders sho
should
ld approach
counseling and screening for these issues
among IPV survivors
i
with
ith heightened
h i ht
d
attention.
Unclear if IPV survivors gget recommended
preventive services in primary care.




IPV often undetected in primary care settings.
Gi
Given
llack
k off d
detection,
t ti
d
do IPV survivors
i
receive appropriate services?
Objective: to determine whether exposure to
IPV predicts receipt of clinical preventive
services.
services
Demographic factors.
Population
p
under studyy

The Central Pennsylvania Women´s
Women s
Health Study




a longitudinal survey off a population-based
sample of women of reproductive age.
women ages 18-45 residing in a 28-county
region of Central Pennsylvania.
interviews conducted in 2004-2005.
follow-up interviews were conducted two years
later (n=1,420).
Independent
p
variable - IPV

Affirmative response to anyy of eight
g items
assessing physical and sexual partner
violence exposure
p
in the p
past 12 months.








Threats of hitting, throwing
Throwing objects
Pushing, grabbing, shoving, slapping
Kicking biting,
Kicking,
biting hitting
Beaten up
Choked
Forced sex
Threats with weapon
Dependent
p
variables – clinical
preventive services








counseling for safety and violence concerns
tests for STIs including
g HIV
counseling for STIs
pap testing
t ti
blood p
pressure testing
g
counseling for smoking or tobacco use
counseling for alcohol or drug use
birth control counseling
Statistical methods




Bivariate
a ate a
analysis.
a ys s
Multivariable models investigated the
independent contribution of IPV to receipt of
each of the services.
Logistic regression.
Controlled for age,
g , educational status,,
poverty, and continuous health insurance
coverage in the past 12 months
months.
Results
IPV=5%
N=1420
Results – demographics
g p
IPV
No IPV
70%
60%
50%
40%
30%
20%
10%
0%
p=0.26
p<0 001
p<0.001
p<0.001
p=0
p
0.04
04
Results – p
preventive services
100%
90%
80%
70%
p<0.001
60%
p=0.02
50%
40%
30%
20%
10%
0%
p=0.01
p=0.05
IPV
No IPV
Results – p
preventive services
IPV
No IPV
NS
100%
NS
90%
80%
70%
p<0.001
60%
p=0.02
50%
NS
40%
30%
20%
10%
0%
p=0.01
p=0.05
NS
Multivariable results - IPV
Odds of receipt of preventive services for women with IPV
compared to women without IPV
Controlling for age, education, poverty, and insurance gaps
Counseling
safety/violence counseling
STI/HIV tests
STI counseling
STI counseling
pap testing
blood pressure test
smoking/tobacco counseling*
alcohol/drug counseling**
birth control counselingg
aOR
2.4
2.4
15
1.5
1.5
2.6
1.6
1.4
1.0
95% confidence
95%
confidence intervals
1.3
4.7
1.4
4.2
07
0.7
30
3.0
0.7
3.3
0.6
11.1
1.0
2.6
0.7
2.7
0.6
1.7
*results similar when controlling for smoking
**results
results similar when controlling for binge drinking and drug use
similar when controlling for binge drinking and drug use
Multivariable results – insurance gaps
g p
Odds of receipt of preventive services for women with
insurance gaps compared to women without insurance gaps
Controlling for age, education, poverty, and IPV
Counseling
safety/violence counseling
STI/HIV tests
STI
STI counseling
li
pap testing
blood pressure test
smoking/tobacco counseling*
alcohol/drug counseling**
birth control counseling
birth control counseling
aOR
0.6
1.3
10
1.0
0.4
0.4
1.0
0.8
0.9
*results similar when controlling for smoking
**results similar when controlling for binge drinking
**results similar when controlling for binge drinking
95% confidence
95%
confidence intervals
0.3
1.0
0.9
1.8
06
0.6
16
1.6
0.3
0.5
0.2
0.7
0.8
1.4
0.5
1.3
0.6
1.3
Conclusions




Increased odds of reporting safety and violence
counseling among women with IPV.
Overall rate of safety counseling among women
g y low.
with IPV ((20%)) is alarmingly
Other key services for such as substance abuse
or contraceptive counseling may be overlooked.
Lack of continuous health insurance reduced
odds of several services including safety
counseling.
Limitations




Self-reported recollection of preventive
counseling.
Unclear how often services should be
offered.
offered
Discussing a factor with a doctor does not
mean that appropriate co
counseling
nseling occ
occurred
rred
No data on IPV detection.
Implications
p



Healthcare providers should improve rates of
providing safety counseling to IPV survivors.
Better evidence and improved guidelines for
identification of and response to IPV needed.
I
Importance
t
off continuous
ti
health
h lth insurance
i
coverage for the provision of appropriate
primary healthcare.
Thank you
y


Questions?
Email: jsm31@psu.edu
j
@p