Erin E Duterte Amy E Bonomi, Ph.D., MPH Mary A Kernic, Ph.D., MPH Melissa Schiff, MD, MPH

1. Correlates of Medical and Legal Help-Seeking among Women Who Have Experienced Intimate Partner Violence Erin E Duterte Amy E Bonomi, Ph.D., MPH Mary A Kernic, Ph.D., MPH Melissa Schiff, MD, MPH Group Health Cooperative Center for Health Studies and University of Washington’s Department of Health Services, Maternal and Child Health Program

2. Objective • To describe the relationship between IPV type, severity, and duration and self-reported use of medical and legal services among a large population-based sample of abused women

3. Factors related to seeking medical and legal help • Self-reported severity of all IPV types and IPV-related injury positively associated with medical and legal help- seeking • Women with physical or sexual IPV were 1.5 times as likely to visit the doctor >10 times in the past year compared to other women, (Coker, et al. 2000). • Women who experienced severe physical IPV, severe psychological IPV, or IPV-related injuries were 1.7, 1.8, and 1.9 times as likely to call the police, respectively, compared to other abused women, (Bonomi, et al. year).

4. Hypothesis • It was hypothesized that physical and sexual IPV exposure, higher levels of perceived severity of IPV, and longer duration of IPV would be positively associated with a woman’s propensity to seek medical and legal help.

5. Subjects and data collection • 3,429 randomly sampled adult women from Group Health Cooperative (GHC) membership files • Cross-sectional telephone survey • Study dates from July, 2003 through August, 2005 • Response rate 57.5% • Any lifetime IPV according to the Behavioral Risk Factor Surveillance System (BRFSS)

6. Intimate partner violence exposure groups Women N=3,429 Excluded No IPV in adult lifetime n=1,838 Any IPV in adult lifetime n=1,509 Physical IPV n=1,038 Sexual IPV n=454 Non-physical IPV only n=339 Sev. Dur. Sev. Dur. Sev. Dur.

7. Outcome • Medical or legal help • Medical help • Hospital, physician, dental, ambulance, urgent care, physical therapy, mental health counseling • Legal help • Ever sought a protection order • Called the police because of physical abuse or forced sex in the past five years

8. Statistical Methods • Bivariate analysis • to examine socio-demographic and abuse factors that could be associated with help-seeking status • Binary outcomes: Multiple Poisson regression was used • to calculate RR and 95% CI for IPV types associated with medical and legal help-seeking • Model 1: Medical or legal (45%) • Model 2: Medical (35%) • Model 3: Legal (19%) • in a sub-analysis to examine the contribution of IPV severity and duration • Model 1: physical IPV • Model 2: sexual IPV • Model 3: non-physical IPV

9. Characteristics of Abused Women by Help-Seeking Status

10. Characteristics of Abused Women by Help Seeking Status

11. Medical or legal help seeking by IPV type* *Adjusted for age, race/ethnicity, educational level, physical/sexual abuse as a child, witnessed IPV as a child, and children witnessed IPV

12. Medical help seeking by IPV type* *Adjusted for age, race/ethnicity, educational level, physical/sexual abuse as a child, witnessed IPV as a child, and children witnessed IPV

13. Legal help seeking by IPV type* *Adjusted for age, race/ethnicity, educational level, physical/sexual abuse as a child, witnessed IPV as a child, and children witnessed IPV

14. Medical or Legal Help Seeking by IPV Severity and Duration* *adjusted for age, race/ethnicity, educational level, physical/sexual abuse as a child, witnessed IPV as a child, and children witnessed IPV

15. Medical or Legal Help Seeking by IPV Severity and Duration* *adjusted for age, race/ethnicity, educational level, physical/sexual abuse as a child, witnessed IPV as a child, and children witnessed IPV

16. Medical or Legal Help Seeking by IPV Severity and Duration* *adjusted for age, race/ethnicity, educational level, physical/sexual abuse as a child, witnessed IPV as a child, and children witnessed IPV

17. Summary • Physical and sexual IPV associated with medical or legal help-seeking • ‘Dose-response’ effect with increasing severity of physical IPV associated with greater likelihood of seeking medical or legal help • Longer duration of IPV associated with increased help-seeking efforts

18. Comments • Cannot assess temporality • Legal help-seeking restricted • IPV exposure did not include related injury • Large population-based sample of women • Broad definition of IPV exposure

19. Significance • First study to empirically determine that longer duration of physical IPV was associated with help-seeking in medical and legal venues • Additional efforts must be mounted to improve women’s agency and improve the health care system’s and legal system’s response to IPV

20. Acknowledgements • Thesis Committee • Amy E Bonomi, Ph.D., MPH • Mary A Kernic, Ph.D., MPH • Melissa Schiff, MD, MPH • Agency for Healthcare and Research Quality (AHRQ), Robert S. Thompson, 1 RO1HS/MH 10909-01A1, Long tem healthcare effects of domestic violence, Group Health Cooperative. • This work was funded in part by a grant from the U.S. Department of Health and Human Services, Health Resources and Services Administration's Maternal and Child Health Bureau (Title V, Social Security Act), grant #T76MC00011-21-00. • Family and friends