1. Intimate Partner Violence Epidemiology

2. Why screen for IPV? One of the nation’s “Most Pressing Public Health Problems” Women are more likely to be repeatedly attacked, raped, injured, or killed by a male partner than any other perpetrator.

3. Physical Violence Range from minor to lethal Pushing, hitting, slapping, shoving Assault with hands, objects, or a weapon Acts or threats to maim or kill pets, partner, family members Common acts include strangulation, biting, burning, throwing down the stairs, sexual assault, and rape

4. Emotional Abuse and Coercion Restriction of routines, activities, relationships Forced isolation, restriction of access to medical or mental healthcare, stalking, threatened loss of valued things, threats to harm loved ones Economic abuse (restricted access to money and other financial support)

5. Verbal Abuse Name calling, degradation, insults, intense criticism, etc. How may IPV manifest within the University Pediatrics setting?

6. Pattern/Dynamics Abuse functions to maintain domination, power and control Why does it continue?—because it works. Perpetration is not an anger problem. Physical abuse tends to occur in conjunction with verbal and emotional abuse

7. Abuse tends to escalate in frequency and severity over time Perceived/actual separation results in an increased risk of assault and lethal outcomes. “Why doesn’t she just leave?”—actually most do –Leaving is a process, not an event –Most women leave 6x before leaving for good

8. Epidemiology 10 million American children witness IPV Lifetime rates for American women range from 21-34% during adulthood Dating violence: –32% prevalence in a large national college sample –13-25% found in high school dating relationships University Peds statistics: 8% endorsed IPV

9. Sociodemographic Correlates Main risk factor—being female Age: Younger women are at risk. Marital status: single, separated, and divorced women have higher rates SES: cuts across socioeconomic lines, but there are higher rates associated with poverty

10. Health Outcomes of IPV Immunization: –Children of mothers who experience IPV are less likely to complete immunizations, possible due to a partner’s control of health care access and health insurance –148 pairs of mothers and children in women’s shelters: 30% of children had incomplete immunization records

11. Sexual Behavior often forced or coerced into unwanted sexual activity, negatively impacting their reproductive health 1999 study: 40% of women with hx. of physical, sexual, or emotional abuse had been diagnosed with one or more STD’s 310 HIV+ women: 68% = physical abuse, 32% sexual abuse, 45% abuse after HIV diagnosis

12. Alcohol and Tobacco Use Of 2,000 prenatal patients, victims of violence were significantly more likely to use multiple substances before and during pregnancy Of 557 women, those endorsing IPV were 3x more likely to binge drink 1998: study of 2,043 women ages 18-59 found 50% who reported IPV were smokers compared to 23.5% of women who did not report IPV

13. Access to Healthcare IPV victims less likely to access preventative and injury-related care In over 2,000 women: 33% of victims had no health insurance in past yr. compared to 14% of women not reporting abuse 22% of abused teens did not begin prenatal care until their 3 rd trimester, compared to 7.5% of nonbattered teens Abused women were 2x more likely to begin their prenatal care in their 3 rd trimester compared to women not reporting abuse

14. Mental Health IPV victims have higher rates of depression, posttraumatic stress disorder, suicidality, alcohol and drug abuse, even years after the abuse. How might this affect patient compliance in this setting?

15. Take Home Points The dynamics of IPV extend beyond physical abuse. Screening for IPV is essential to both mother and child’s health, as it affects women across the lifespan.