1. Adverse Health Conditions and Health Risk Behaviors Associated with Intimate Partner Violence in US Virgin Islands Grant Support: National Center on Minority Health and Health Disparities, NIH (# P20MD002286).

2. CERC Presentations NBNA SYMPOSIUM SAN DIEGO AUGUST 4, 2010 Intimate partner violence (IPV) IPV is violence that occurs between a victim and perpetrator who are current or former spouses or partners. The violence can be physical, sexual and psychological in nature and includes threats of physical or sexual violence against a partner and stalking a partner (CDC). Women are more likely than men to be repeatedly abused, injured, or die as a result of partner violence. In addition to the risk for death and injury, IPV has been associated with certain adverse health conditions and health risk behaviors.

3. CERC Presentations NBNA SYMPOSIUM SAN DIEGO AUGUST 4, 2010 The Behavioral Risk Factor Surveillance System (BRFSS) The BRFSS is a collaborative project of the Centers for Disease Control and Prevention (CDC) and the United States (U.S.) and territories. The BRFSS, administered and supported by CDC's Behavioral Surveillance Branch, is an ongoing data collection program designed to measure behavioral risk factors of adults living in households. The BRFSS was initiated in 1984, with personnel from 15 states collecting surveillance data on risk behaviors through monthly telephone interviews.

4. CERC Presentations NBNA SYMPOSIUM SAN DIEGO AUGUST 4, 2010 The Behavioral Risk Factor Surveillance System (BRFSS) Over time, the number of states participating in the survey increased; by 2001, 50 states, the District of Columbia, Puerto Rico, Guam, and the US Virgin Islands were participating in the BRFSS. Data collected annually consist of –identifying demographic variations in health related behaviors, –addressing emergent and critical health issues, –measuring progress in health objectives, and –linking findings to a framework, the social determinants of health.

5. NBNA SYMPOSIUM SAN DIEGO AUGUST 4, 2010 Purpose The purpose of this study is to describe the results of 2005 and 2006 BRFSS survey on IPV and selected health conditions and health risk behaviors among the resident of the US Virgin Island.

6. Table 1. Number and Percent of Adults Ages ≥ 18 Years Residing in US Virgin Island with a Lifetime History of Intimate Partner Violence Victimization by Sex, Age Group, Race/Ethnicity, Annual Household Income, Education Level, and Marital Status – Behavioral Risk Factor Surveillance System, 2005. Characteristics WomenMen No%95% CINo%95% CI Age Group (Years) 18–24 24–34 35–44 45–54 55–64 ≥65 23 79 94 98 80 56 7.25 20.34 21.97 20.43 17.14 12.86 6.76 – 7.75 19.56 – 21.11 21.18 – 22.77 19.66 – 21.21 16.42 – 17.87 12.22 – 13.50 15 21 36 48 35 20 11.67 19.27 20.06 24.42 16.20 8.37 10.94 – 12.41 18.36 – 20.18 19.14 – 20.99 23.43 – 25.41 15.35 – 17.05 7.73 – 9.00 Hispanic/Latino Yes No 71 365 19.51 80.49 18.75 – 20.27 79.73 – 81.25 20 156 12.67 87.33 11.90 – 13.44 86.56 – 88.10 Race/Ethnicity White Black or African American Other 66 262 21 16.73 76.50 6.77 15.92 – 17.55 75.57 – 77.42 6.22 – 7.32 47 94 9 26.83 67.06 6.11 25.72 – 27.94 65.88 – 68.24 5.51 – 6.71 Annual Household Income ($) Less than 15,000 15,000 – 24,999 25,000 – 34,999 35,000 – 49,999 50,000 or More 66 84 58 83 88 18.54 23.78 13.66 22.13 21.89 17.74 – 19.35 22.89 – 24.66 12.95 – 14.38 21.27 – 22.98 21.03 – 22.75 21 26 21 26 51 15.86 18.32 15.57 18.79 31.47 14.94 – 16.78 17.34 – 19.29 14.65 – 16.48 17.80 – 19.77 30.29 – 32.64 Education Level Did Not Graduate High School High School Graduate Some College College Graduate 69 151 106 115 17.35 37.55 23.22 21.88 16.63 – 18.08 36.62 – 38.47 22.41 – 24.03 21.09 – 22.68 34 64 28 46 20.23 40.75 15.15 23.88 19.28 – 21.17 39.60 – 41.90 14.31 – 15.99 22.88 – 24.88 Marital Status Married Divorced Widowed Separated Never Married A Member of an Unmarried Couple 126 111 38 21 129 19 37.26 21.20 7.66 3.74 25.95 4.19 36.34 – 38.18 20.42 – 21.98 7.15 – 8.17 3.38 – 4.10 25.12 – 26.79 3.81 – 4.57 84 33 4 7 45 5 48.34 12.24 1.44 4.03 31.59 2.36 47.20 – 49.48 11.49 – 12.99 1.17 – 1.71 3.35 – 4.48 30.52 – 32.65 2.02 – 2.71 Note: % and 95% CI (Confidence Interval) are weighted estimates.

7. Table 2. Weighted Prevalence of Selected Health Conditions and Risk Behaviors among Adults ≥ 18 years, Residing in US Virgin Island, by Sex and Life History of Intimate Partner Violence (IPV) Victimization – Behavioral Risk Factor Surveillance System, 2005. Health Condition/ Risk Behavior WomenMen IPVNo IPVIPVNo IPV %95% CI% % % Health Condition Diabetes Disability Equipment Arthritis Current Asthma Activity Limitations Stroke High Cholesterol High Blood Pressure Heart Attack Heart Disease 9.29 5.81 25.08 12.87 13.04 1.86 36.20 32.54 2.92 1.53 8.73 – 9.84 5.36 – 6.26 24.24 – 25.93 12.24 – 13.51 12.39 – 13.69 1.60 – 2.12 35.16 – 37.24 31.65 – 33.43 2.59 – 3.24 1.29 – 1.76 11.28 4.37 19.18 9.05 8.92 1.74 36.37 27.20 1.91 1.86 10.95 – 11.62 4.16 – 4.59 18.76 – 19.60 8.75 – 9.36 8.62 – 9.22 1.60 – 1.88 35.78 – 36.95 26.73 – 27.67 1.76 – 2.05 1.72 – 2.00 5.54 2.90 14.10 7.09 11.58 1.40 37.66 19.62 1.41 0.37 5.02 – 6.07 2.50 – 3.29 13.27 – 14.93 6.50 – 7.69 10.82 – 12.33 1.13 – 1.68 36.31 – 39.01 18.70 – 20.54 1.14 – 1.68 0.23 – 0.51 7.47 2.58 12.39 7.27 9.33 2.01 34.42 21.73 1.72 2.19 7.18 – 7.76 2.41 – 2.76 12.03 – 12.76 6.99 – 7.56 9.01 – 9.65 1.86 – 2.16 33.80 – 35.04 21.28 – 22.18 1.58 – 1.86 2.03 – 2.36 Risk Behavior HIV or STD Current Smoking Heavy drinking (BMI) > 25 9.09 9.45 6.53 63.89 8.43 – 9.75 8.90 – 10.01 6.06 – 7.00 62.94 – 64.84 5.50 4.94 3.89 64.09 5.23 – 5.77 4.71 – 5.17 3.69 – 4.10 63.57 – 64.61 11.47 15.88 24.20 61.40 10.55 – 12.40 15.03 – 16.73 23.18 – 25.23 60.25 – 62.54 5.67 9.32 17.99 61.69 5.38 – 5.95 9.00 – 9.64 17.56 – 18.42 61.15 – 62.23 Note: % and 95% CI (Confidence Interval) are weighted estimates.

8. Table 3. Association between Lifetime History of Intimate Partner Violence Victimization and Selected Health Conditions and Risk Behaviors among Adults ≥ 18 years, Residing in US Virgin Island, by Sex – Behavioral Risk Factor Surveillance System, 2005. Health Condition/ Risk Behavior WomenMen AOR95% CIAOR95% CI Health Condition Diabetes Use of disability Equipment Arthritis Current Asthma Current Activity Limitations Stroke High Cholesterol High Blood Pressure Heart Attack Heart Disease 1.25 0.80 0.53 * 0.52 * 1.56 * 1.68 * 0.66 1.28 * 1.25 * 1.29 * 0.58 – 2.45 0.33 – 1.96 0.34 – 0.81 0.30 – 0.91 1.34 – 1.93 1.10 – 2.57 0.43 – 1.00 1.01 – 1.75 1.03 – 1.78 1.09 – 1.79 0.80 1.41 0.79 0.70 0.92 1.01 1.12 0.92 1.15 1.16 0.22 – 2.89 0.29 – 6.89 0.36 – 1.74 0.24 – 2.00 0.51 – 1.66 0.61 – 1.35 0.51 – 2.46 0.74 – 1.12 0.89 – 1.49 0.90 – 1.51 Risk Behavior Risk Factors for HIV or STD Current Smoking Heavy drinking Body Mass Index > 25 0.32 1.11 1.06 1.01 0.17 – 0.60 0.90 – 1.37 0.88 – 1.27 0.90 – 1.12 0.54 1.30 1.07 0.93 0.20 – 1.45 0.96 – 1.71 0.93 – 1.23 0.75 – 1.15 Note: AOR -- Adjusted odds ratio for age, race/ethnicity, annual household income, and educational level. * -- Statistically significant (p < 0.05) by Wald Chi-square test.

9. Table 4. Number and Percent of Adults Ages ≥ 18 Years Residing in US Virgin Island with a Lifetime History of Intimate Partner Violence Victimization by Sex, Age Group, Race/Ethnicity, Annual Household Income, and Education Level – Behavioral Risk Factor Surveillance System, 2006. Characteristics WomenMen No%95% CINo%95% CI Age Group (Years) 18–24 24–34 35–44 45–54 55–64 ≥65 36 93 103 120 111 90 12.25 18.30 17.63 18.65 16.81 16.05 11.93 – 13.20 17.56 – 19.04 16.89 – 18.36 17.90 – 19.40 16.10 – 17.53 15.35 – 16.76 14 36 51 55 53 43 10.57 19.92 22.29 18.35 17.43 11.44 5.35 – 8.20 11.38 – 15.23 18.13 – 22.70 19.18 – 23.84 19.26 – 23.92 14.30 – 18.50 Hispanic/Latino Yes No 89 479 18.77 81.23 18.03 – 19.51 80.49 – 81.97 45 208 25.83 74.17 24.82 – 26.84 73.16 – 75.18 Race/Ethnicity White Black or African American 37 158 18.95 81.05 13.43 – 24.46 75.54 – 86.57 25 86 17.38 82.62 7.44 – 21.12 77.72 – 87.72 Annual Household Income ($) Less than 15,000 15,000 – 24,999 25,000 – 34,999 35,000 – 49,999 50,000 or More 91 101 79 81 131 19.26 19.58 17.56 16.37 27.23 17.02 – 22.49 17.34 – 22.72 16.76 – 18.36 15.59 – 17.15 25.80 – 29.67 33 49 42 27 59 17.10 22.55 24.28 10.76 26.32 15.68 – 18.51 20.95 – 24.34 23.19 – 25.38 9.97 – 11.55 24.15 – 28.69 Education Level Did Not Graduate High School High School Graduate Some College College Graduate 102 180 116 169 17.43 36.08 21.11 25.38 16.23 – 18.62 35.17 – 37.00 20.33 – 21.88 24.55 – 26.21 82 42 44 31.35 32.11 16.55 19.99 29.56 – 33.15 31.03 – 33.19 15.69 – 17.41 19.06 – 20.91 Note: % and 95% CI (Confidence Interval) are weighted estimates.

10. Table 5. Weighted Prevalence of Selected Health Conditions and Risk Behaviors among Adults ≥ 18 years, Residing in US Virgin Island, by Sex and Life History of Intimate Partner Violence (IPV) Victimization – Behavioral Risk Factor Surveillance System, 2006. Health Condition/ Risk Behavior WomenMen IPVNo IPVIPVNo IPV %95% CI% % % Health Condition Diabetes Use of disability Equipment Current Asthma Current Activity Limitations Stroke Heart Attack Heart Disease 13.2 4.5 7.8 12.7 2.4 2.0 3.1 10.7–15.7 4.1–4.8 7.3–8.3 12.0–13.28 2.0–2.4 1.7–2.3 2.7–3.4 9.3 3.8 4.1 8.5 1.7 1.2 1.7 8.9–9.6 3.6–4.0 3.9–4.3 8.1–8.8 1.5–1.9 1.0–1.4 1.5–1.9 9.8 4.5 3.4 10.0 3.2 1.5 1.1 9.1–10.5 4.0–5.0 3.0–3.9 9.3–10.7 2.8–3.6 1.2–1.8 0.8–1.3 9.0 4.1 3.8 10.3 1.9 2.5 1.9 8.6–9.2 3.8–4.3 3.8–4.1 10.0–10.7 1.7–2.1 2.3–2.4 1.7–2.1 Risk Behavior HIV/AIDS Test Current Smoking Heavy drinking Body Mass Index > 25 54.1 8.2 11.8 61.6 52.9–55.2 7.7–8.8 11.3–12.5 60.7–62.3 51.9 5.1 6.1 61.9 51.3–52.5 4.8–5.4 5.8–6.4 61.4–62.4 54.2 15.3 23.2 62.3 52.8–55.6 14.5–16.2 22.3–24.2 61.2–63.5 48.7 10.5 14.5 61.4 48.1–49.3 10.2–10.9 14.1–14.9 60.9–62.0 Note: % and 95% CI (Confidence Interval) are weighted estimates.

11. Table 6. Association between Lifetime History of Intimate Partner Violence Victimization and Selected Health Conditions and Risk Behaviors among Adults ≥ 18 years, Residing in US Virgin Island, by Sex – Behavioral Risk Factor Surveillance System, 2006. Health Condition/ Risk Behavior WomenMen AOR95% CIAOR95% CI Health Condition Diabetes Use of disability Equipment Current Asthma Current Activity Limitations Stroke Heart Attack Heart Disease 1.88 1.67 * 3.09 * 1.46 * 0.53 0.38 1.24 * 0.55 – 1.41 1.30 – 2.48 1.80 – 5.31 1.30 – 1.70 0.17 – 1.65 0.12 – 1.21 1.10 – 1.62 4.97 * 1.54 0.72 0.79 1.00 1.46 2.30 1.06 – 23.29 0.19 – 12.45 0.13 – 3.81 0.23 – 2.68 0.12 – 8.21 0.19 – 11.46 0.27 – 19.35 Risk Behavior HIV/AIDS Test Current Smoking Heavy drinking Body Mass Index > 25 1.64 * 1.35 * 3.69 * 0.87 1.44 – 1.92 1.22 – 1.56 2.32 – 5.87 0.63 – 1.23 0.64 0.30 * 5.34 * 1.33 0.33 – 1.21 0.15 – 0.61 2.92 – 9.73 0.68 – 2.58 Note: AOR -- Adjusted odds ratio for age, race/ethnicity, annual household income, and educational level. * -- Statistically significant (p < 0.05) by Wald Chi-square test.

16. Discussion IPV prevalence similar in USVI as in mainland US –At least 16% of women lifetime prevalence (approximately 7-8% of men) –Underestimated in this kind of survey (telephone, health related, privacy not assured) –In most surveys specifically inquiring about victimization – lifetime prevalence approximately 25% Also finding similar prevalence btw USVI & US in ACAAWS study - African American and Afro- Caribbean women in clinics in Baltimore & USVI –but higher than BRFSS – past two years 25%; lifetime – 40%

17. Discussion Negative health outcomes also found in ACAAWS study – –E.g. significantly more neurological problems in those abused versus never abused; significantly more overall pain; significantly more wheezing

18. Conclusions Therefore, important in full understanding of health disparities among women of color, that IPV be taken into account Importance of clinical studies to complement population based surveys to fully understand health problems & health disparities Also important for appropriate diagnoses and adequate treatment of women’s health problems that routine assessment for IPV be conducted (Abuse Assessment Screen – www.nnvawi.org)www.nnvawi.org –If don’t know underlying problem, will only treat symptoms