Predictors of Relationship Power among Drug-involved Women

1. Predictors of Relationship Power among Drug-involved Women • Aimee N. C. Campbell, Ph.D.1, Susan Tross, Ph.D. 1, Mei-Chen Hu, Ph.D.2, Martina Pavlicova, Ph.D.3, Edward V. Nunes, M.D.1 • New York State Psychiatric Institute, Department of Psychiatry, Columbia University (2) Department of Psychiatry, Columbia University (3) Department of Biostatistics, Columbia University CONCLUSIONS & IMPLICATIONS ABSTRACT Measures Relationship Power: Sexual Relationship Power Scale (SRPS; Pulerwitz et al.): comprised of two subscales assessing relationship control (power to – personal) and decision-making dominance (power over – interpersonal). The control subscale consists of 15 items (e.g., “When my partner and I are together, I’m pretty quiet”) and the decision-making dominance subscale consists of 8 items (e.g., “Who usually has more say about what you do together?”). Predictors: Labor: Age (<40 vs. ≥40), race/ethnicity, education, economic dependence (majority of support) Power: history of physical/sexual violence with current main male partner, substance use (days used past 30) Cathexis: BEM Sex Role Inventory (BSRI; Bem, 1974; masculine, feminine, androgynous, undifferentiated), sexual concurrency (more than 1 partner in the 90 days prior to baseline) • Findings provide partial support for theoretically-derived predictors of gender-based power within women’s heterosexual relationships. Partner abuse was significantly associated with less power on both subscales; less feminine sex role categorization was significantly associated with more power on both subscales. Thus, women who identify with feminine sex-types might be more concerned with “keeping the peace” within a relationship and maintaining emotional bonds – this may be especially important to women who have fewer social supports. • Several findings were not in the hypothesized direction. Younger women and women with only one partner reported significantly higher relationship control scores. African American and Latina women reported significantly higher decision-making dominance scores. Older, drug-involved women may need additional assistance or specific types of support and may also adhere to more conventional gender norms. • On average, women significantly increased relationship power scores over time suggesting the promising role of substance abuse treatment in promoting women’s power within their heterosexual relationships. More work is needed to elucidate factors which may increase drug-involved women’s personal and interpersonal power and reduce HIV sexual risk. • No significant association was detected for intervention assignment and relationship power; this suggests that improvement in sexual relationship power, especially among multiply stressed and economically challenged drug-involved women, requires more than a brief, skills-focused group intervention. Integrating services and providing more comprehensive or structural HIV prevention interventions may produce larger shifts in relationship power. Gendered relationship power is commonly linked to women’s capacity to reduce sexual risk behaviors which can lead to the transmission of HIV/AIDS. Drug involved women have rarely been the focus of research on relationship power; however the interaction of gender, poverty, cumulative stress, and sexuality may uniquely impact this group. This study offers one of the first explorations of predictors of relationship power over time, as measured by the multidimensional and theoretically grounded Sexual Relationship Power Scale (SRPS; Pulerwitz et al., 2000). The SRPS is comprised of two subscales: relationship control and decision-making dominance. Predictor variables were selected based on Wingood and DiClemente’s (2000) application of the Theory of Gender and Power (Connell, 1987). A repeated measures analysis using generalized mixed effect models was used to test eight predictors of relationship power among 514 women enrolled in a multi-site HIV risk reduction intervention trial. Significant predictors of higher relationship control scores included being younger, having a non-abusive main male partner and only one male partner, and being categorized as androgynous on the BEM Sex Role Inventory. Decision-making dominance was predicted by identifying as African American or Latina, being in a non-abusive relationship, and endorsing traditional masculine sex role attributes. Findings contribute to the understanding of relationship power among this population, influence the refinement and development of relationship power measures, and inform potential HIV prevention intervention components that target heterosexual power dynamics. Data Analysis: A repeated measures analysis using mixed effect models was used to account for the random effect of site, intervention cohort, and subject (Diggle et al., 2002). Predictor variables and intervention assignment were tested separately and then in a full adjusted model. Time and predictor-by-time interactions were included (if significant at 5% level). Analyses were based on all available SRPS data from participants with at least one assessment time point. RESULTS About half the sample was 40 or older (45.8%). The majority identified as White (57.9%) or African American (24.3%). 28.2% had less than a HS education, 37.6% had a HS diploma or equivalent, and 34.2% had more than a HS education. Almost half reported no substance use in the 30 days prior to baseline (45.3%); 35.1% used 1-12 days and 19.6% used 13 or more days. Half reported depending on someone for the majority of their support (46.5%). Over a quarter (28.6%) reported a history of sexual or physical abuse with their current main male partner and 35.4% indicated they had more than one male partner. The sample was categorized into the following BSRI orientations: 29.2% feminine, 17.5% masculine, 30.5% androgynous, and 22.8% undifferentiated. THEORETICAL CONCEPTUALIZATION Connell’s Theory of Gender and Power identifies determinants of relationship power through a social structural conceptualization of the origination of gender-specific power inequities. Wingood and DiClemente applied Connell’s three structures to HIV prevention and outlined exposure and risk factors. REFERENCES Bem, S. L. (1974). The measurement of psychological androgyny. Journal of Consulting and Clinical Psychology, 42(2), 155-162. Connell, R. W. (1987). Gender and power. Stanford, CA: Stanford University Press. Diggle, P., Heagerty, P., Liang, K., & Zeger, S. (2002). Analysis of longitudinal data. New York, NY: Oxford University Press. Pulerwitz, J., Gortmaker, S. L., & De Jong, W. (2000). Measuring sexual relationship power in HIV/STD research. Sex Roles, 42(7/8), 637-660. Wingood, G. M., & DiClemente, R. J. (2000). Application of the Theory of Gender and Power to examine HIV-related exposures, risk factors, and effective interventions for women. Health Education and Behavior, 27(5), 539-565. GRANT SUPPORT & CONTACT INFORMATION METHODS Participants were 514 women taking part in NIDA’s National Drug Abuse Treatment Clinical Trials Network Safer Sex Study at 12 outpatient substance abuse treatment programs. Eligible participants were: 1) 18 or older, 2) had reported at least one unprotected sexual occasion with a male partner in the prior 6 months, 3) not pregnant or planning to get pregnant, and 4) English-speaking. Participants were randomized to one of two groups: five 90-minute gender-specific Safer Sex Skills Building sessions (SSB) or a single 60-minute HIV education session reflecting HIV prevention treatment as usual. Assessment occurred at baseline and 3- and 6-months post intervention. This research was supported by grants from the National Institute on Drug Abuse (NIDA): U10 DA13035 (CTN; Edward V. Nunes, MD & John Rotrosen, MD) and K24 DA022412 (Edward V. Nunes, MD). We would like to acknowledge the commitment and effort of clinical and research staff at participating treatment programs, and the 515 women who took part in the study. The authors have no conflict of interest to report. Inquiries should be directed to the lead author: Aimee Campbell, Ph.D. | Phone: 212-740-3503 | Email: anc2002@columbia.edu