1. Afro-Caribbean and African American Women’s Study

2. Team Members United States Jacquelyn Campbell, PhD, RN, FAAN Phyllis Sharps PhD, RN, FAAN Richelle Bolyard Jamila Stockman, PhD, MPH Ayanna Johnson, BA Marguerite Baty, PhD(c), MSN, MPH, RN Jessica Draughon, PhD (c) Callie Simkoff, BSN Gyasi Moscou-Jackson, MHS, BSN, RN Mary Paterno, BSN, RN Lareina LaFlair, PhD (c) Chris Kunselman Hossein Yarandi, PhD US Virgin Islands Doris Campbell, PhD, ARNP FAAN Gloria Callwood, PhD, RN, FAAN Tyra DeCastro Lorna Sutton Catherine Coverston, PhD, RN Desiree Bertran Suzanne Darrow Princess Oneida-Stuard, BSN std Melanie Ruiz, BSN std Natasha Caines, BSN std

3. Background Prevalence of Intimate Partner Violence(IPV): In the US, 29.7% of women (18-65 yrs) report lifetime IPV victimization with African Americans overrepresented (33%) (Coker et al., 2002). High rates of IPV (30-66% ) have been reported in Afro-Caribbean countries (Krug, Dahlberg, Mercy et al, 2002)., but the actual prevalence of a sample of women in the US Virgin Islands has never been determined. Health-related Consequences of IPV Loss of appetite, digestive problems, headaches, seizures, abnormal vaginal bleeding, UTIs and STDs. IPV is the leading cause of premature death from homicide and non-lethal injury among African American women (15–24 yrs) (Rennison & Welchans, 2002).

4. Purpose  To examine the prevalence of intimate partner abuse in a territory (the US Virgin Islands) where there are reports of it being a serious problem but no systematically collected data.  To examine the relationship of IPV to several conditions where there are health disparities between women of African heritage and white women in both the US and in the US Virgin Islands.  To examine the role of intimate partner sexual assault in relationship to condom use, STD’s and HIV/AIDS.

5. Methods Comparative case (N = 150 in each site) control (N = 150 in each site) study Participants must be age 18-55 and identify as African American or Afro-Caribbean Women attending primary care, prenatal or family planning clinics will be approached and asked to participate in a research study involving relationships with an intimate partner Questionnaire administered on a touch screen computer with optional headphones - an important methodological strategy For women of low literacy For sensitive information Medical records review and an in- depth interview will be completed on women who agree to participate in the records review and interview Each participant who completes the questionnaire receives $20

6. Challenges and Issues Ethical considerations Child abuse Suicidality – associated with IPV Self reported ethnic identity – especially in the USVI “Women of African heritage” Dominican and Puerto Rican women consider selves Hispanic but not “Black” or “African American” or “Afro- Caribbean”

7. Preliminary Findings Data collection is currently underway at US Virgin Islands and Baltimore sites. The data below is cumulative from both sites, as of 7/28/2009. Cases: 169 (goal 300) Controls: 33 (goal 300) Originally calculated on a 15% prevalence (randomly selected 1 in 6 non-abused as controls) but because prevalence is 43%, we are accruing cases faster than controls - have adjusted – reprogrammed to a 1:3 selection to catch up Ineligible: 78 Non selected non-abused: 151 Total screened: 431 Pregnant: N = 100 (23%) plus 14 not sure of those pregnant – 62% planned 38% unplanned 8 (21% of unplanned) pregnant b/c of forced sex 12.5% abused during current pregnancy

8. Demographics

12. Preliminary Findings on IPV Prevalence of ever abused – abused according to Abuse Assessment Screen – pushing, shoving, hitting – &/or ever physically or emotionally abused by husband, partner or someone important to you &/or above cutoff on WEB (Women’s Experiences of Battering) Physical abuse from partner or ex - past 2 years 87/353 = 24.6% Ever emotionally or physically abused 169/353 = 47.8% Of those (N = 169) abused – Perpetrator: Husband – 10% Ex-husband - 9% Boyfriend – 39% Ex-Boyfriend – 17.9% Same sex partner – 1.1% (n = 2) Other family member = 16.7%

16. Conclusions High rates of IPV among women of African heritage – in the USVI and inner city Baltimore ACASI system may facilitate reporting IPV Significant health problems amongst sample – e.g. 25 (12%) eye injuries; 6 broken jaws; 14 knocked unconscious; 26 (12%) attempted suicides; 49 (25%) STI’s; sexual risk behaviors (inconsistent condom use) But not yet enough controls to know if significant difference between abused and not abused