african-caribbean & african american women’s study
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African-Caribbean & African American Women’s Study
Intimate Partner Violence, Substance Use, and PTSD:
Women of African Heritage in Baltimore and the U.S. Virgin Islands
Phyllis Sharps, PhD, RN, FAANJohns Hopkins University School of Nursing
Team MembersUnited States
Jacquelyn Campbell, PhD, RN, FAANPhyllis Sharps PhD, RN, FAANRichelle Bolyard, MSNJamila Stockman, PhD, MPHMarguerite Baty, PhD, MPH, RNJessica Draughon, PhD (c), MSN, RNMary Paterno, BSN, RN, SNMAkosoa McFadgion, MS, MSWGeorgette Cox, MPHSharon O’Brien, PhDAshley ChappellNaa Ayele Amponsah, BAChris KunselmanHossein Yarandi, PhD
US Virgin IslandsDoris Campbell, PhD, ARNP FAANGloria Callwood, PhD, RNDesiree Bertrand, MSN, RNJanis Valmond, MPHCatherine Coverston, PhD, RNCLorna Sutton, MPATyra DeCastroPrincess Oneida-Stuard, BSN stdMelanie Ruiz, BSN stdNatasha Caines, BSN stdJose Negron & Romeo Richardson
Prevalence of Intimate Partner Violence
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 actual prevalence in US Virgin Islands never determined.
Health disparities for African American women – including maternal child health disparities & HIV/AIDS also associated with IPV (Sharps & Campbell, 2006; Campbell et al., 2008).
Intersecting Epidemics of IPV, Substance Use
and Mental HealthAbused women found to have increased
risks of psychosocial and mental health illnesses such as substance use, family and social problems, depression, and anxiety/neuroses compared to never-abused women (Bonomi et al., 2009).
Substance use by both the woman and her partner has been found to independently predict IPV; social support moderated the effect of women’s substance use (Golinelli, et al, 2009).
PurposeTo examine the association between
intimate partner violence (IPV) and substance use among Afro Caribbean women in the US Virgin Islands and African American women in Baltimore city, Maryland.
To assess post-traumatic stress disorder as a mediating variable in the relationship between IPV and substance use among Afro Caribbean and African American women.
MethodsComparative case (N = 150 in each site) control (N = 150 in
each site) study
Eligibility criteriaWomen aged 18-55 yearsSelf-identify as Afro Caribbean or African AmericanReport of a male sex 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 - an important methodological strategy
For women of low literacyFor sensitive informationAlerts interviewer if high score on DA or suicidality Allows increased recruitment among Spanish speaking Recording in Spanish & English by USVI residents for increased cultural appropriateness
Study period 12/1/09 to present
Measures Intimate Partner Violence (IPV) in one’s
lifetime assessed using the Abuse Assessment Screen (McFarlane & Helton - www.nnvawi.org) Pushed, slapped, hit, kicked, or physically
hurt &/OR Forced sex &/OR Pushed, slapped, hit, kicked, or physically
hurt while currently pregnant Any of the above by current or former
husband, boyfriend, or male or female partner
MeasuresSubstance Use
Drug use in past yr (street, over the counter, non- prescription drugs)
Alcohol use in past month Cases with history of sexual violence –
they or abusive partner under influence of alcohol or drugs during last forced sex incident
Cases – recent abusive partner drug user
Post-traumatic Stress Disorder (PTSD)Assessed using 4-item Primary Care-PTSDScores summed; cutoff of 3 or more =
PTSD+
Baltimore City, MDUS Virgin Islands
Study Population1,201 screened from both sites
1,025 eligible
n=727 n=298
333 cases
88 contro
ls 119 cases
104 contro
ls
As of 9/10/10
306 unselect
ed controls
75 unselect
ed controls
Population-based Prevalence of Lifetime
Intimate Partner Violence
Population-based Prevalence of Lifetime Psychological Abuse Only
Psychological abuse (above cutoff on WEB (Women’s Experiences of Battering) – being afraid &/or controlled by a current or ex-intimate partner
Population-based Prevalence of Intimate Partner Violence
in the Past 2 years
n=63
Perpetrator of IPV in the Past 2 years
DemographicsAge Employment
Demographics - Education
USVI
X 2 =3.63, p=0.30
Baltimore
X 2 =2.42, p=0.49
Demographics – Marital StatusUSVI
X 2 =8.62, p<0.05
Baltimore
X 2 =1.10, p=0.78
Proportion of women reporting drug and alcohol use (452 cases
and 192 controls)
*in the past year;**in the past month
X 2 =12.74, p<0.001
X 2 =0.044, p=0.83
Does PTSD Mediate the Association Between IPV
and Drug Use?Step 1: Is IPV associated with drug use?
OR: 3.93; 95% CI: 1.76-8.78Step 2: Is IPV associated with PTSD
(mediator)? OR: 3.88; 95% CI: 2.19-6.88
Step 3: Is PTSD associated with drug use, adjusting for IPV?
OR: 3.06; 95% CI: 1.69-5.51Step 4: Significance testing using the Sobel
Test p<0.013
Proportion of women reporting substance use involvement during last forced sex among those with
histories of sexual violence(n=135)
Proportion of abused women reporting a recent substance-
using partner (n=452)
Note: These women 2 times were more likely to have PTSD symptoms in the past month (AdjOR: 2.09; 95% CI: 1.27-3.43).
Conclusions High rates of IPV, substance use and PTSD
among women of African heritage in Baltimore and USVI High rates of drug use for both abuser and
victim in context of forced sex High rate of drug use by abusers
IPV is associated with drug use but not alcohol use
PTSD mediates the relationship between IPV and victim drug use – self medication hypothesis Abused women w/substance using abuser
more likely to have PTSD Use of substances as a way to cope with Sx
of PTSD
Implications Women disclosing substance use and PTSD
need further assessment to include IPV
Women in substance abuse Tx need assessment and interventions for IPV & PTSD
Women disclosing IPV need further assessment to include substance use and PTSD
Interventions targeting abusive partners should take into account substance abuse history
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