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African-Caribbean & African- American Women’s Study

African-Caribbean & African- American Women’s Study. Associations Between Intimate Partner Abuse and Reproductive Outcomes Among Women of African Descent. Desiree Bertrand, MSN, RN Doris Campbell, PhD, ARNP, FAAN Ashley Chappell, BS, RN Jamila Stockman, PhD

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African-Caribbean & African- American Women’s Study

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  1. African-Caribbean & African- American Women’s Study Associations Between Intimate Partner Abuse and Reproductive Outcomes Among Women of African Descent Desiree Bertrand, MSN, RN Doris Campbell, PhD, ARNP, FAAN Ashley Chappell, BS, RN Jamila Stockman, PhD Phyllis Sharps, PhD, RN, FAAN Jacquelyn Campbell, PhD, RN, FAAN Mary T. Paterno, PhD(c), MSN, CNM

  2. Acknowledgements This research supported by a subcontract with the Caribbean Exploratory NIMHD Research Center of Excellence (CERC),  University of the Virgin Islands, Grant # P20MD002286, National Institutes of Health

  3. ACAAWS Team Members United States Jacquelyn Campbell, PhD, RN, FAAN Phyllis Sharps PhD, RN, FAAN RichelleBolyard, MHS Jamila Stockman, PhD, MPH Marguerite B. Lucea, PhD, MSN, MPH, RN Bushra Sabri, PhD, LMSW, ACSW AkosoaMcFadgion, MS, MSW, PhD student Kaitlan Gibbons, PsyD(c) Mary Paterno, MSN, CNM, RN, PhD (c) Sharon O’Brien, PhD SachiMana-ay, BSN student Jessica Draughon, MSN, RN, PhD (c) Charmayne M. Dunlop-Thomas, MS Callie Simkoff, BSN, RN GyasiMoscou-Jackson, MHS, BSN, RN Chris Kunselman Ayanna Johnson, MPH Ashley Chappell, BSN, RN Lucine Francis, BSN, RN NaaAyeleAmponsah, MPH HosseinYarandi, PhD US Virgin Islands Doris Campbell, PhD, ARNP, FAAN Gloria Callwood, PhD, RN, FAAN Desiree Bertrand, MSN, RN Lorna Sutton, MPA TyraDeCastro Alexandria Bradley, RNSally Browne, RNEdris Evans, RNYvonne Francis, RNNaomi Joseph, BSN studentJennifer King, RNSuzette Lettsome, MSPHN, RNJulie Matthew, RNKenice Pemberton, ASN studentJ'Nique Smith, BSN studentJaslene Williams, MSW

  4. Introduction • Intimate partner abuse - increased risk for: • Adverse neonatal outcomes • Adverse maternal outcomes • Sexually transmitted infections (STI) (Coker, 2007; Sarkar, 2008; Seth et al., 2010; Sharps et al., 2007; Shah & Shah, 2010; Silverman et al., 2006; Wu et al., 2003) • African heritage – increased risk for: • Adverse neonatal outcomes • Adverse maternal outcomes • Sexually transmitted infections (CDC, 2010, 2011; Curry et al., 1998; Hogue & Silver, 2011; Martin et al., 2011; McFarlane et al., 1996)

  5. Study Purpose Examine differences in maternal and neonatal reproductive outcomes comparing women with history of intimate partner abuse (IPA) to never-abused women

  6. Methods • Comparative case-control study (randomly selected controls) • Study period 2009-2011 • Eligibility criteria • Women aged 18-55 years • Self-identify as Afro Caribbean or African American • Report intimate partner in the past two years • Women recruited from primary care, prenatal or family planning clinics • Questionnaire administered on a touch screen computer with optional headphones • Medical record abstraction for health outcomes

  7. Study Definitions • CASES = Intimate Partner Abuse (IPA) • Intimate Partner Violence (IPV - physical/sexual abuse) & psychological abuse (threats/emotional abuse/controlling behavior ) • IPV assessed using the Abuse Assessment Screen (AAS, McFarlane & Helton - www.nnvawi.org) • Pushed, slapped, hit, kicked, or physically hurt &/OR • Forced sex • Psychological abuse: <19 on WEB (Women’s Experiences of Battering – Hall-Smith) • Controlled, in fear of current/former intimate partner • Any of the above by current or former intimate partner • Past 2 Year and Lifetime IPV (Physical/Sexual)—subgroups within cases • Exclusive of emotional/controlling abuse • Reported as Lifetime and Past-two-year • CONTROLS = Women never abused by anyone in their lifetime • Not eligible (if meeting age, race, and language requirements) • Women experiencing abuse only from someone other than an intimate partner or ex-partner. • Women reporting no partner within 2 years prior to survey

  8. 1579 screened from both sites 34 ineligible race; duplicates Baltimore City, MD US Virgin Islands Lifetime IPA Total 621/1545=40% B’more 179/488=37% USVI 442/1059=42% n=486 n=1059 No partner past 2 yrs= 25 No partner past 2 yrs= 96 n=461 n=963 Past 2-year IPV Total 382/1424= 27% B’more 119/461= 26% USVI 263/963= 26% Didn’t meet case /control criteria= 39 Didn’t meet case /control criteria = 70 1315 fully eligible women Non-selected control = 74 Non-selected control =329 Screened as case; no full survey=11 Final Participants n=348 n=553 159 cases 189 controls 384 cases 169 controls

  9. Sub-Sample Population Baltimore City, MD US Virgin Islands Final Participants n=348 n=553 159 cases 189 controls 384 cases 169 controls Pregnant at Survey 42 cases 64 controls 98 cases 54 controls n=258 Medical Record Abstraction 28 cases 49 controls 16 cases 8 controls n=101

  10. Variables • Dependent Variables • Pregnancy outcomes • Maternal antenatal outcomes • Maternal infections • Maternal behaviors • Neonatal outcomes • Independent Variable • Lifetime experience of IPA

  11. Analysis • Descriptive analysis • Chi-square , Fisher’s exact, and t-tests • Regression analysis • Generalized linear model • AIC values • Mediation test

  12. † Chi-square or Fisher’s exact test

  13. Pregnancy Outcomes

  14. Figure 3. Maternal Antenatal Outcomes (%) p <0.05 HTN = hypertension PROM = premature rupture of membranes PPROM = pre-term premature rupture of membranes

  15. Figure 4. Maternal Infection and Behavioral Outcomes (%)

  16. † Chi-square ,Fisher’s exact test, or t-test; SD=standard deviation

  17. † Adjusted for education, martial status, and income

  18. Discussion • No significant difference found for most variables • IPA associated with higher smoking and SGA infants • SGA may result in serious neonatal complications • Nurses should focus on smoking reduction among women of childbearing age experiencing IPA • Intervention research studies should test approaches to smoking cessation for women with IPA

  19. Limitations • Small sample size • Unable to differentiate based on type/timing of abuse • Homogenous population • Limited to participants who gave permission for medical record review

  20. Strengths • ACASI technology • Included participants from USVI • Longitudinal data • Included SGA as an outcome

  21. References Centers for Disease Control and Prevention. (2011). HIV surveillance report, 2009. Retrieved from http://www.cdc.gov/hiv/topics/surveillance/resources/reports/ Centers for Disease Control and Prevention. (2010). Sexually transmitted disease surveillance 2009. Retrieved from http://www.cdc.gov/std/stats Coker, A. L. (2007). Does physical intimate partner violence affect sexual health?: A systematic literature review. Trauma, Violence, & Abuse, 8, 149-177. doi:10.1177/1524838007301162 Curry, M. A., Perrin, N., & Wall, E. (1998). Effects of abuse on maternal complications and birth weight in adult and adolescent women. Obstetrics & Gynecology, 92, 530-534. Hogue, C. J. R., & Silver, R. M. (2011). Racial and ethnic disparities in United States: Stillbirth rates: Trends, risk factors, and research needs. Seminars in Perinatology, 35, 221-233. doi:10.1053/j.semperi.2011.02.019 MacFarlane, J., Parker, B., & Soeken, K. (1996). Abuse during pregnancy: Associations with maternal health and infant birth weight. Nursing Research, 45(1), 37-42.

  22. References Martin, J. A., Hamilton, B. E., Ventura, S. J., Osterman, M. J. K., Kirmeyer, S., Mathews, T. J., … Wilson, E. C. (2011). Births: Final data for 2009. National Vital Statistics Reports, 60(1), 1-72. Parker, B., & McFarlane, J. (1991). Identifying and helping battered pregnant women. MCN. The American Journal of Maternal Child Nursing, 16(3), 161-164. Sarkar, N. N. (2008). The impact of intimate partner violence on women’s reproductive health and pregnancy outcome. Journal of Obstetrics and Gynaecology, 28(3), 266-271. Seth, P., Raiford, J. L., Robinson, L. S., Wingood, G. M., & DiClemente, R. J. (2010). Intimate partner violence and other partner-related factors: Correlates of sexually transmissible infections and risky sexual behaviors among young adult African American women. Sexual Health, 7, 25-30. doi:10.1071/SH08075 Shah, P. S., & Shah, J. (2010). Maternal exposure to domestic violence and pregnancy and birth outcomes: A systematic review and meta-analyses. Journal of Women’s Health, 19(11), 2017-2031. doi:10.1089=jwh.2010.2051

  23. References Sharps, P. W., Laughon, K., & Giangrande, S. K. (2007). Intimate partner violence and the childbearing year. Trauma, Violence & Abuse, 8(2), 105-116. doi:0.1177/1524838007302594 Silverman, J. G., Decker, M. R., Reed, E., & Raj, A. (2006). Intimate partner violence victimization prior to and during pregnancy among women residing in 26 U.S. states: Associations with maternal and neonatal health. American Journal of Obstetrics & Gynecology, 195, 140-148. doi:10.1016/j.ajog.2005.12.052 Smith, P. H., Earp, J., & DeVellis, R. (1995). Measuring battering: Development of the women’s experience with battering (WEB) scale. Women’s Health: Research on Gender, Behavior, and Policy, 1(4), 273-288. Wu, E., El-Bassel, N., Witte, S. S., Gilbert, L., & Chang, M. (2003). Intimate partner violence and HIV risk among urban minority women in primary health care settings. AIDS and Behavior, 7(3), 291-301. doi:1090-7165/03/0900-0291/0

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