Intimate partner violence and cervical neoplasia

HPV self-collection for cervical cancer screening among survivors of sexual trauma: a qualitative study

Intimate partner violence affects 20-30% of women in the United States. Disparities in routine cervical cancer surveillance have been demonstrated in certain populations, including victims of intimate partner violence (IPV). This study examined and assessed the acceptability of high-risk HPV (hrHPV) self-collection among individuals who have experienced IPV. We conducted an observational study using qualitative data collection and analysis. We interviewed individuals with a history of IPV and who currently reside in Oregon. This study identified key themes describing knowledge and attitudes towards cervical cancer screening for individuals who have experienced IPV. They include: guideline knowledge, prior office-based cervical cancer screening experience, barriers to cervical cancer screening, at-home hrHPV self-collection experience, and testing confidence. Participants experienced fewer barriers and expressed increased comfort and control with hrHPV self-collection process. Individuals with a history of IPV have lower rates of cervical cancer screening adherence and higher rates of cervical dysplasia and cancer than other populations. The patient-centered approach of hrHPV self-collection for cervical cancer screening can reduce barriers related to the pelvic exam and empower patients to reduce their risks of developing cervical cancer by enabling greater control of the testing process.

Intimate partner violence in women with cancer: An integrative review

Objective

This study aims to estimate the incidence of intimate partner violence (IPV) among women cancer survivors and identify associated factors.

Methods

Using Whittemore and Knafl's integrative review method, we synthesized literature on the association between IPV and cancer in women.

Results

We conducted a comprehensive search of literature published between 2003 and 2024 across eight databases, resulting in 24 English-language articles. These articles included qualitative, quantitative, and mixed-method studies. Our synthesis identified several factors influencing the relationship between IPV and cancer, including sociodemographic factors (e.g., age and income), health-related factors, lifestyle-related factors (such as life experiences and interpersonal relationships), cancer-related factors (including type and treatment), and cancer screening behaviors.

Conclusions

The study highlights that various factors contribute to the prevalence of IPV among women with cancer. Particularly vulnerable are younger patients, those with lower incomes, and those with more severe disease manifestations. Healthcare professionals should assess for IPV risk during medical consultations and ensure access to appropriate support services.

Examining the Burden of Self-Blame Attribution Among Women With Cervical Cancer

Background:Self-blame for past sexual behaviors or for the personal character may be associated with the development of cervical cancer. Purpose: Aims were to understand the burden of self-blame attribution (SBA) among women with cervical cancer by (1) examining relationships between SBA, psychological distress (PD), and spiritual well-being (SWB); (2) determining differences between behavioral (BSB) and characterological self-blame (CSB) attribution; and (3) describing associations between SBA and unwanted past sexual experiences. Methods: Women attending a cancer center in the southeastern United Stats (N = 106) completed an online survey including a demographic questionnaire and three instruments: (1) SBA for Cancer Scale; (2) Psychological Distress Subscale of the Psychological Adjustment to Cancer Scale-Self Report; and (3) Functional Assessment of Cancer Therapy-Spiritual Well-being. Results: Women with cervical cancer, 26-64 years of age, identified moderate levels of SBA, PD, and SWB. Relationships were found between PD, BSB and CSB, and unwanted sexual experiences. Significant inverse correlations between religious faith, BSB, unwanted sexual experiences, and SWB were noted. Unwanted sexual experiences were a significant predictor of SBA. Conclusion: SBA places women at risk for increased burden. Recognizing SBA in vulnerable cancer survivors is important to providing holistic nursing care.

The Relationship Between Contraceptive Method Use and Return of Fecundity Among Women Attempting Pregnancy in Low- and Middle-Income Countries

One of the most common barriers to using effective family planning methods is the belief that hormonal contraceptives and contraceptive devices have adverse effects on future fertility. Recent evidence from high-income settings suggests that some hormonal contraceptive methods are associated with delays in return of fecundity, yet it is unclear if these findings generalize to low- and middle-income populations, especially in regions where the injectable is widely used and pressure to bear children is significant. Using reproductive calendar data pooled across 47 Demographic and Health Surveys, we find that the unadjusted 12-month probability of pregnancy for women attempting pregnancy after discontinuing traditional methods, condoms, the pill, and the IUD ranged from 86% to 91%. The 12-month probability was lowest among those who discontinued injectables and implants, with approximately 1 out of 5 women not becoming pregnant within one year after discontinuation. Results from multivariable analysis showed that compared with users of either periodic abstinence or withdrawal, users of the pill, IUD, injectable, and implant had lower fecundability following discontinuation, with the largest reductions occurring among women who used injectables and implants. These findings indicate that women's concerns about potential short-term reductions in fecundity following contraceptive use are not unfounded.

Persistent disparities of cervical cancer among American Indians/Alaska natives: Are we maximizing prevention tools?

BACKGROUND

Cervical cancer incidence and mortality disparities experienced by American Indian/Alaska Native (AI/AN) women have persisted for decades. Pap smear screening and HPV vaccination are powerful tools to prevent cervical cancer. We evaluated the utilization of these tools among AI/ANs living in the Pacific Northwest (PNW).

METHODS

The Indian Health Service (IHS) National Data Warehouse's Epi Data Mart was analyzed using all healthcare visits from 2010 to 2020 from IHS, Tribal, and Urban Indian clinics in the PNW. Women ages 21-64 were included and considered up-to-date on pap smears if they had either cytology within 3 years or cytology with HPV testing within 5 years of the most recent clinical encounter. HPV vaccination rates for both sexes were calculated for individuals ages 9-26. HPV vaccination was considered complete if: two vaccines were received prior to age 15 or after three vaccinations if initiated after age 15.

FINDINGS

Cervical cancer screening rates are below the national average of 73.5% ranging between 57.1% - 65.0%. Sub-analysis of age groups shows substantially lower rates of up-to-date pap smear screening in the 50-64 age group. HPV vaccination rates have increased over time for both sexes across all age groups. However, the current vaccination rate of 58.6% is well below the Healthy People 2030 goal of 84.3%.

INTERPRETATION

Cervical cancer screening and HPV vaccination are the cornerstones of cervical cancer prevention and early detection. These tools are underutilized and public health efforts can be strengthened to improve cervical cancer disparities in AI/AN women.

FUNDING

Author ASB: Funding for this project has been provided through the Robert Wood Johnson Foundation Harold Amos Minority Faculty Development Grant and the National Cancer Institute K08 Mentored Clinical Scientist Development Award.

Intimate partner violence in women with breast and gynaecologic cancers: A systematic review

AIM

The current study aimed to systematically review the data obtained from studies on women with breast and gynaecologic cancers subjected to Intimate Partner Violence (IPV).

DESIGN

Systematic review without meta-analysis.

DATA SOURCES

PubMed, ProQuest, Google Scholar, Scopus, Web of Science; databases were searched without time limit.

REVIEW METHOD

The PRISMA model was guided the systematic literature search using Boolean keywords and operators. PICO statement was used to develop a question of this review. Studies examining women with breast and gynaecologic cancers subjected to IPV were included in the study after the quality of the articles was reviewed.

RESULTS

Eight studies that met the inclusion criteria and were conducted between 2000 and 2021 were included in the study.

CONCLUSIONS

Studies confirm the effect of IPV on the severity and consequences of breast and gynaecologic cancers. Having a history of IPV can indirectly lead to breast and gynaecologic cancers. On the other hand, women suffering from IPV are more likely than other women to delay screening or not perform screening for cancer.

IMPACT

The dimensions and nature of violence and the disclosure or non-disclosure of violence in vulnerable women are strongly affected by society's culture. Therefore, researchers need to have sufficient knowledge of the culture and social factors governing the community to achieve reliable findings related to IPV in qualitative, quantitative, and psychometric studies and the design of IPV assessment tools. It is recommended that IPV screening teams, that is, multidisciplinary teams of trained physicians, nurses and social workers, participate in two-way screening programmes: IPV screening for women with gynaecological cancer and screening for gynaecological cancer in women with IPV.

Signs and symptoms of intimate partner violence in women attending primary care in Europe, North America and Australia: a systematic review and meta-analysis

BACKGROUND

Intimate partner violence (IPV) is a prevalent yet underdiagnosed health issue, and primary care practitioners are in a unique front-line position to provide care and counsel for the victims.

OBJECTIVE

To identify the signs and symptoms of women exposed to IPV who attended primary care, regardless motive of consultation.

METHODS

Systematic review and meta-analysis on Cochrane, PubMed, Embase and CINAHL between 1946 and 2020. Eligible studies had to be original quantitative research, on women aged >15 years, attending primary care settings in Europe, North America and Australia and interviewed on their status as victims of IPV and on their signs and symptoms.

RESULTS

Of 1791 articles identified, 57 were selected. Associations were found between IPV and signs and symptoms of depression [19 studies: overall odds ratio (OR) = 3.59, 95% confidence interval (CI; 2.7-4.7, I2 = 94.6%)], anxiety [9 studies: overall OR = 2.19, 95% CI (1.75-2.73, I2 = 84%)], gynaecological and/or sexually transmitted infections [6 studies: overall OR = 2.82, 95% CI (2.1-3.8, I2 = 41%)] and combination of somatic symptoms [5 studies: standard mean deviation = 0.795, 95% CI (0.62-0.97, I2 = 0%)].

CONCLUSIONS

Women exposed to IPV may present with clinical symptoms and signs other than bodily injury. Policy implications knowing these symptoms presented by women victims of IPV can help GPs identify and treat them.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018089857.

"We Can Be Oppressed but That Does Not Mean We Cannot Fight Oppression": Narratives of Resilience and Advocacy From Survivors of Intimate Partner Violence

Helping others has been identified as an important component in recovery and resilience for women following intimate partner violence (IPV). However, little is known about the experiences of women who are IPV survivors and who also engage in formal and informal violence against women (VAW) advocacy work, such as supporting IPV survivors in a social work role or volunteering on VAW advocacy committees. Using in-depth semistructured interviews with nine "survivor-advocates" who were part of a larger study on IPV and resilience, this study extends the existing literature to examine the multidirectional relationship between IPV, advocacy work, and resilience using narrative analysis. Three distinct narratives were identified in survivor-advocates' accounts of their experiences of abuse and advocacy work. The working through the abuse narrative focused on using the knowledge and experience from advocacy work that began prior to IPV to critically reflect on the abuse and its meaning for women. The second narrative, helping others, focused on using personal experiences of abuse to help other IPV survivors. The third narrative, personal strength, focused on a personal identity as a lifelong advocate and inner strength and determination as central to resilience. The findings of this study demonstrate the multitude of ways that engaging in advocacy work interacts with abuse experiences and women's recovery and resilience processes. The findings of this study can inform approaches for promoting resilience and recovery for IPV survivors and highlight the importance of cultivating a critical understanding of abuse to support resilience and recovery following IPV.

Factors Affecting Behaviors of Women with Breast Cancer Facing Intimate Partner Violence Based on PRECEDE-PROCEED Model

Introduction: More than half of women in Iran experience intimate partner violence (IPV). This study aimed to explore IPV in women with breast cancer (BC) in Ardabil, Iran. Moreover, the predictors of violence and women’s reactions against violence were examined.

Methods: Using a convenient sampling method, the current cross-sectional study was performed on 211 women with BC in northwest of Iran. To collect data, a questionnaire consisting of demographic characteristics and items based on PRECEDE-PROCEED model and women's reaction to violence was used. Data were analyzed using SPSS Ver. 20 and descriptive and inferential statistics.

Results: In this study, 190 (90%) subjects reported that they had experienced IPV in the preceding year. Only 27(12.8%) women were familiar with all forms of violence. Moreover, 141 (66.8%) and 160 (75.8%) women had no access to counseling centers and life skill training courses, respectively. Women mostly had adopted emotion-oriented coping strategies when facing IPV. The results of multivariate regression analysis indicated that enabling factors and knowledge were predictors of problem-oriented coping strategies in women.

Conclusion: Empowered women, for the most part, were better educated and had more access to social resources than others. Therefore, empowering women can help reduce the amount of violence they might have to encounter. It is essential that supporting and empowering centers for women be established in the society and efficient laws be enacted to fight IPV.

Intimate partner violence, circulating glucose, and non-communicable Disease: Adding insult to injury?

Analyzing data from the 2015-2016 Indian Demographic and Health Survey (N = 41,768), we investigate how women's circulating glucose varies with the severity of intimate partner violence (IPV) they have experienced in the last year and how their likelihoods of corresponding noncommunicable diseases vary with IPV severity in their lifetime. Consistent with a physiological stress response, women who have recently experienced severe IPV exhibit higher glucose levels and are more likely to have extremely high levels-forewarning of disease development-than women who have not experienced IPV. Correspondingly, women who have ever experienced severe IPV in their lifetime have 33%-200% higher probabilities of diabetes, heart disease, thyroid disorders, and cancer and are 70% more likely to have any of these diseases and 175% more likely to have multiple than women who have experienced none.

Sexuality post gynaecological cancer treatment: a qualitative study with South African women

OBJECTIVES

This study investigated women's experiences of their sexuality post gynaecological cancer treatment. Using a holistic sexuality framework, the study explored how women felt their sexual functioning, sexual relationships and sexual identity had been affected by treatment.

DESIGN

The study was qualitative in nature and made use of an interpretive descriptive design. Data were analysed using thematic analysis.

SETTING

Data collection took place at a follow-up clinic within the gynaeoncology unit at a public-sector tertiary hospital in Cape Town, South Africa.

PARTICIPANTS

Purposive sampling was used to recruit participants, and the final sample consisted of 34 women aged 29-70 ([Formula: see text]=52). All women had received a gynaecological cancer diagnosis and had been treated with either surgery, chemotherapy, radiation or a combination of these. On average, the participants were between 12 and 30 months post treatment.

RESULTS

Women expressed how their sexual functioning post treatment was both nuanced and complex, how heteronormative gender expectations influenced their intimate relationships, and how they experienced a re-embodiment of their sexual subjectivity post treatment. Participants felt that more sexual functioning information from healthcare providers, as well as peer support groups, would assist them in navigating the sexuality changes they experienced.

CONCLUSIONS

The findings of this study broaden conceptualisations of sexuality post treatment by detailing the ways that it is complex, nuanced, relational and ever shifting. More research is needed about how to incorporate holistic psychosexual support post treatment into the public healthcare system in South Africa.

The impact of intimate partner violence on breast and cervical cancer survivors in an integrated, safety-net setting

PURPOSE

Characterize prevalence of intimate partner violence (IPV) among breast and cervical survivors receiving care in an urban safety-net healthcare system; Examine the relationship between IPV and clinical characteristics, receipt of cancer treatment, and guideline-recommended survivorship care.

METHODS

From 2010 to 2017, breast and cervical cancer survivors were identified and recruited from a large, integrated, safety-net hospital system. Electronic health records (EHR; to measure survivorship care), cancer registry (to measure clinical characteristics), and patient telephone surveys (to measure IPV) were triangulated among 312 survivors. Bivariate and multivariable models assessed the relationship between victimization and clinical characteristics, cancer treatment, and guideline-recommended survivorship care.

RESULTS

Among the 312 participants, 54% identified as IPV+. Among breast cancer, IPV+ cancer participants were twice more likely to develop estrogen receptor negative ER- and/or progesterone receptor negative PR- tumor receptors compared with IPV- cancer participants (AOR = 2.31; 95% CI, 1.20, 4.44). IPV+ breast cancer participants were less likely to have surgery and less likely to have hormone therapy as a first course of treatment compared with IPV- participants. There was no relationship between IPV and adherence to guideline-recommended cancer survivorship care.

CONCLUSIONS

This study expands our current knowledge on how victimization, and specifically IPV, impact health among specialty care. Future research should determine the feasibility of implementing Trauma-Informed Care in oncology practices to better optimize care.

IMPLICATIONS FOR CANCER SURVIVORS

At integrated hospital systems, IPV+ cancer participants should utilize social workers, within their oncology clinics, to connect to victim services.

Determination of Psychological Stress, Serum Immune Parameters, and Cortisol Levels in Patients With Human Papilloma Virus

PURPOSE

Because the results of studies investigating the relation between human papilloma virus (HPV) infection and the effects of psychological stress are inconsistent, this study was conducted to expand on previous research by analyzing patient stress levels, serum immune parameters, and cortisol levels in patients with clinical HPV manifestations. It also looked for differences in clinical manifestations of HPV depending on patient level of experienced stress.

METHODS

This cross-sectional study included 213 subjects (94 women and 119 men aged ≥18 years; average age, 41 years) with clinical manifestations of HPV infection (165 subjects with extragenital manifestations and 48 with genital manifestations) who were treated at the Department of Dermatovenerology, Karlovac General Hospital, from January 1, 2012, to December 31, 2015. Psychological, neurohormonal and immune parameters (serum values of leukocytes, alpha₂-globulins, beta-globulins, albumins, and proteins), and serum cortisol levels were analyzed. Questionnaires were used to determine patients' perception of stress: the Recent Life Changes Questionnaire, the Perceived Stress Scale, and the Brief Cope Test. One group of subjects had confirmed stressful experiences, defined by the Recent Life Changes Questionnaire as a period of 1 year with at least 500 life change units; the control group included patients with no significant stressful experiences.

FINDINGS

Patients with confirmed significant stress experience had a statistically significant higher degree of perception of stress. There were no statistically significant differences in terms of the impact of stress on clinical HPV manifestations (genital and extragenital), sex, lesional duration, or recurrence. In patients with significant stress experience, significantly higher values of leukocytes (6.68 × 10⁹/L), alpha₂-globulins (6.85 g/L), and beta-globulins (7.33 g/L) were observed. Adaptive coping and a lower perception of stress significantly reduced the chances of having extragenital manifestations by 2.63 times. A higher perception of stress significantly increased the likelihood of genital manifestations.

IMPLICATIONS

Although this study found that stress increased the values of leukocytes, alpha₂-globulins, and beta-globulins, no evidence was found that it affected clinical manifestations of HPV infection. The redundancy of the immune system could account for this finding. This study is among the first to investigate the correlation between psychological, neurohormonal, and immune indicators of stress.

Differential Predictors of Intimate Partner Sexual Coercion Versus Physical Assault Perpetration

The current study attempted to strengthen existing literature regarding predictors of perpetrating intimate partner sexual violence to determine if there are unique predictors of sexual violence that differentiate it from physical abuse. It was hypothesised that men's controlling, dominant and jealousy behaviours, and verbal aggression would significantly predict increased intimate partner sexual coercion and physical assault perpetration. These predictors were expected to be more predictive of sexual coercion than physical assault perpetration. Couples were recruited from the community (N = 159) in a cross-sectional study recruiting couples with a violent male partner. Results demonstrated that men's controlling behaviour was a significant predictor of sexual coercion and physical assault perpetration and behavioural jealousy was a significant predictor of sexual coercion perpetration. No predictors studied better predicted sexual coercion more than physical assault perpetration. These findings suggest that sexual coercion may be another type of physical assault without unique predictors.

The role of gender-based violence, health worries, and ambivalent sexism in the development of women's gynecological symptoms

This article explored the role of a lifetime history of gender-based violence, ambivalent sexism, and gynecological health worries in the development of reproductive and sexual symptoms among women in Kyrgyzstan. Non-pregnant women who were patients of gynecological clinics (N = 143) participated in the study. A positive relationship between the experience of any type of violence (physical, sexual, and emotional) and number of gynecological symptoms was found. Hostile sexism was found to be a predictor of the number of reported symptoms. The number of gynecological health worries was found to fully mediate the relationship between history of gender-based violence and number of gynecological symptoms.

Lifetime Spousal Violence Victimization and Perpetration, Physical Illness, and Health Risk Behaviours among Women in India

The aim of this study was to assess the association between lifetime spousal violence victimization, spousal violence perpetration, and physical health outcomes and behaviours among women in India. In the 2015⁻2016 National Family Health Survey, a sample of ever-married women (15⁻49 years) (N = 66,013) were interviewed about spousal violence. Results indicate that 29.9% of women reported lifetime spousal physical violence victimization and 7.1% lifetime spousal sexual violence victimization (31.1% physical and/or sexual violence victimization), and 3.5% lifetime spousal physical violence perpetration. Lifetime spousal violence victimization and lifetime spousal violence perpetration were significantly positively correlated with asthma, genital discharge, genital sores or ulcers, sexually transmitted infections (STIs), tobacco use, alcohol use, and termination of pregnancy, and negatively associated with daily consumption of dark vegetables. In addition, lifetime spousal violence victimization was positively associated with being underweight, high random blood glucose levels, and anaemia, and negatively correlated with being overweight or obese. Lifetime spousal violence perpetration was marginally significantly associated with hypertension. The study found in a national sample of women in India a decrease of lifetime physical and/or sexual spousal violence victimization and an increase of lifetime spousal physical violence perpetration from 2005/5 to 2015/6. The results support other studies that found that, among women, lifetime spousal physical and/or sexual spousal violence victimization and lifetime spousal physical violence perpetration increase the odds of chronic conditions, physical illnesses, and health risk behaviours.

Violence against women increases cancer diagnoses: Results from a meta-analytic review

The purpose of this project was to assess the magnitude of the relationship between violence against women and cancer; to identify the exposures and cancers for which this relationship was particularly robust; to identify the effect of violence exposure on cancer screening. We conducted a meta-analysis of 36 studies to determine the relationship between violence against women and cancer outcomes, including screening, in 2017. Results from this review provide evidence of a significant, positive relationship between violence and cancer diagnoses, particularly for cervical cancer. Women who were victims of intimate partner violence and sexual abuse were more likely to be diagnosed with cancer compared with non-victims. Violence against women did not appear to be related to cancer screening practices and routine clinical service utilization; however, violence was associated with greater odds of abnormal pap test results. Victims of intimate partner violence and women who suffered physical abuse were more likely to have abnormal pap test results. In conclusion, use of screening tools for violence against women in clinical settings may improve the breadth and quality of research on violence against women and cancer. Investigators should consider how to creatively apply case-control and retrospective cohort designs to investigate the complex mechanisms and moderators of the relationship between violence against women and cancer.

Abuse, cancer and sexual dysfunction in women: A potentially vicious cycle

More than 30% of women have a history of abuse. Women with cancer may be at substantially increased risk for abuse, but this issue is rarely discussed in the course of oncology care. Women with a history of abuse who present for cancer care commonly have a high prevalence of co-morbid illness. Sexual dysfunction, a highly prevalent but under-recognized condition among women of all ages, is also more common among both women with a history of abuse and women with cancer. Although common after cancer, sexual dysfunction, like abuse, can be stigmatizing and often goes undiagnosed and untreated. This review first examines the literature for evidence of a relationship between any history of abuse and cancer among women, addressing two questions: 1) How does abuse promote or create risk for developing cancer? 2) How does cancer increase a woman's susceptibility to abuse? We then examine evidence for a relationship between abuse and female sexual dysfunction, followed by an investigation of the complex relationship between all three factors: abuse, sexual dysfunction and cancer. The literature is limited by a lack of harmonization of measures across studies, retrospective designs, and small and idiosyncratic samples. Despite these limitations, it is imperative that providers integrate the knowledge of this complex relationship into the care of women with cancer.

An Exploration of the Mediators Between Childhood Maltreatment and Intimate Partner Violence

Intimate partner violence (IPV) is associated with numerous long-term consequences and warrants significant clinical attention. Recent theoretical models and empirical research have suggested that several factors play a role in the development of IPV perpetration, including childhood maltreatment, early maladaptive schemas, anger, and difficulties in emotion regulation. This study investigated the relationship between childhood maltreatment and IPV, specifically examining the mediation of this relationship by several variables thought to be related to this pernicious problem, including early maladaptive schemas, the experience of anger, and emotion regulation difficulties. In a young adult collegiate sample of 110 women in relationships, results of a bootstrapped multiple mediation analysis supported the hypothesis that childhood maltreatment predicted physical aggression within intimate partner relationships and found that the total indirect effect of childhood maltreatment on physical aggression through the 3 proposed mediators was significant. However, consistent with recent empirical findings, only difficulties in emotion regulation significantly mediated the relationship between childhood maltreatment and physical aggression within the sample.

Violence Victimization, Social Support, and Papanicolaou Smear Outcomes: A Longitudinal Study from Adolescence to Young Adulthood

BACKGROUND

African American youth are among those at greatest risk for experiencing violence victimization. Notably, the mortality rate of cervical cancer for African American women is also twice that of white women. To date, we know of no literature using longitudinal data to examine how violence victimization relates to Papanicolaou (Pap) smear results or cervical cancer in this population. Our study examines how violence victimization during adolescence (age 15 to 18) influences psychological distress, perceived social support, heavy substance abuse, and sexual risk behaviors during emerging adulthood (age 20 to 23), and subsequent Pap smear outcomes during young adulthood (age 29 to 32).

METHOD

This study is based on 12 waves of data collected in a longitudinal study of 360 African American women from mid-adolescence (ninth grade, mean age = 14.8 years) to young adulthood (mean age = 32.0 years). We used structural equation modeling analysis to examine the hypothesized model.

RESULT

Violence victimization during adolescence had a direct effect on decreased social support, increased psychological distress, and increased heavy cigarette use during emerging adulthood. Better social support was also associated with fewer sexual partners during emerging adulthood and lower odds of abnormal Pap smear results during young adulthood. The effect of violence victimization on abnormal Pap smear was mediated by social support.

CONCLUSION

Our results show that violence victimization during adolescence has long-term negative effects through multiple pathways that persist into adulthood. Our findings also suggest that social support may help to compensate against other risk factors. Interventions designed to address the perceived support may help victims cope with their experience.

The Association Between Unwanted Sexual Experiences and Early-Onset Cervical Cancer and Precancer by Age 25: A Case-Control Study

BACKGROUND

We examined the association between unwanted sexual experiences and cervical cancer, cervical intraepithelial neoplasia 3, adenocarcinoma in situ, diagnosed ≤25 years of age.

METHODS

A case-control study of women ≤55 years who attended gynecological hospitals in Australia between 1983 and 2007. Cases were ≤25 years when diagnosed with disease, control group 1 were "older women" >25 years at diagnosis; control group 2 were "well women" ≤25 years attending preventive health clinics. A self-administered postal survey was utilized. The main outcome measures were prevalence of childhood sexual abuse (<16 years) and unwanted adolescent sexual experiences (between 16 and 18 years) in cases compared to controls.

RESULTS

Of 400 contactable subjects, 251 participated (62.8%). Prevalence of childhood sexual abuse in cases (26.6% [25/94]) was similar to other groups. Prevalence of childhood genital contact abuse in cases with cervical cancer was 45.5% [5/11], compared to older women (20% [10/50], p = 0.08) and well women (13.8% [8/58], p = 0.01), and was marginally more common compared to well women when adjusted for other lifestyle factors (odds ratio [OR]: 4.7 [1.0-22.6], p = 0.05). Prevalence of unwanted adolescent sexual experiences in cases was 28.9% [33/114]. Prevalence of adolescent penile-genital contact experiences in cervical cancer cases was 46.7% [7/15], compared to older women (9.4%, [6/64], p < 0.001) and well women (13.7%, [10/73], p = 0.003), and was more common compared to well women when adjusted for lifestyle (OR: 5.9 [1.4-24.9], p = 0.02) and sexual health risk factors (OR: 5.6 [1.4-22.1] p = 0.01).

CONCLUSIONS

Unwanted sexual experiences with genital contact were a risk factor for invasive cervical cancer ≤25 years, likely due to a complex interplay of biological and environmental factors.

Intimate Partner Violence and Barriers to Cervical Cancer Screening: A Gynecologic Oncology Fellow Research Network Study

OBJECTIVES

The aims of the study were to examine barriers to cervical cancer screening among women who have experienced intimate partner violence (IPV) and accessed domestic violence shelters, to compare barriers among those up-to-date (UTD) and not UTD on screening, and to evaluate acceptability of human papillomavirus self-sampling.

MATERIALS AND METHODS

This is a cross-sectional survey in which domestic violence shelters in Ohio were identified and women completed an anonymous survey assessing UTD screening status, barriers related to screening, history of IPV, intention to follow up on abnormal screening, and acceptability of self-sampling. Characteristics of UTD and not UTD women were compared using Mann-Whitney U tests.

RESULTS

A total of 142 women from 11 shelters completed the survey. Twenty-three percent of women were not UTD. Women who were not UTD reported more access-related barriers (mean = 2.2 vs 1.8; p = .006). There was no difference in reported IPV-related barriers between women who were not UTD and those who are UTD (mean = 2.51 in not UTD vs 2.24 in UTD; p = .13). Regarding future screening, of the women who expressed a preference, more women not UTD preferred self-sampling than UTD women (32% vs 14%; p = .05).

CONCLUSIONS

In this study, access-related barriers were more commonly reported among women not UTD with screening. Addressing these barriers at domestic violence shelters may improve screening among not UTD women. Self-sampling may also be one feasible approach to support screening in this population.

History of Domestic Violence and Physical Health in Midlife

The association between domestic violence and physical health in middle-aged Australian women is investigated via a cross-sectional survey of 14,100 women (45 to 50 years old) who responded to the first Australian Longitudinal Study on Women's Health survey. After adjustment for demographic and health behavior characteristics and menopause status in multivariate analyses, various physical conditions (allergies or breathing problems, pain or fatigue, bowel problems, vaginal discharge, eyesight and hearing problems, low iron, asthma, bronchitis or emphysema, cervical cancer) were associated with domestic violence. The results highlight the link between health and domestic violence in middle-aged women and underscore the need for health professionals to take a full social history from women presenting with physical symptoms.

Measures for screening for intimate partner violence: a systematic review

WHAT IS KNOWN ON THE SUBJECT?: Intimate partner violence (IPV) has a significant impact on the onset, duration and recurrence of mental health problems. Prevalence rates of IPV are significantly higher in mental health services, but the studies are limited. Accurate assessment of IPV is important for decision making in risk assessment and safety planning within mental health nursing. Psychometrically tested tools are the most accurate way to identifying all areas of IPV abuse: physical, sexual and psychological. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Ten IPV screening tools were identified in healthcare and three tools; Women Abuse Screen Tool (WAST), Abuse Assessment Screen (AAS) and Humiliation, Afraid, Rape and Kick (HARK) were identified as having strong psychometric values as they assessed all areas of IPV and were validated against an appropriate reference standard. None of the three IPV tools identified (WAST, AAS, HARK) were tested on men or in mental health settings impacting the gender sensitivities of the tools and the reliability of the prevalence rates of IPV in mental healthcare. Over seventy percent of the studies reviewed were conducted in America this impacts the cultural sensitivities of the IPV tools. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: IPV screening needs to be incorporated as a priority in mental health services in order to reduce the morbidity and mortality issues associated with this abuse. Psychometric tools to screen for IPV need to be incorporated to assist mental health professionals in decision making in risk assessment and safety planning. Further research is needed to improve the psychometric properties of IPV tools in mental health settings, to ensure they are culturally and gender sensitive.

ABSTRACT

Objective Intimate partner violence (IPV) is a public health priority due to the physical and mental impacts it has on health. No existing reviews have focused on the psychometric properties of IPV screening tools used to screen men and women within a mental health context. This review aimed to identify the best psychometrically tested screening tools available to assess all areas of IPV in men and women in mental health setting. Method Databases psycArticles, PsycINFO, Social Science, CINAHL, PubMed and Cochrane were searched from their starting date through to July 2015. Eligible studies were published in peer-reviewed publications in English. Results Thirty-six studies met the inclusion criteria. Ten IPV screening tools were identified. Three tools assessed all areas of IPV and were validated against an appropriate reference standard. One study tested IPV screening tool in a mental health setting. Conclusion Mental health nurses need to incorporate a psychometrically tested IPV tool as part of risk assessment and safety planning for clients. This review identified three tools that are suitable for identifying IPV in a mental health context. However, further research is necessary to validate IPV screening tools that are culturally sensitive and have been validated with men and women.

Adult Cancer Risk Behaviors Associated with Adverse Childhood Experiences in a Low Income Population in the Southeastern United States

OBJECTIVES

Adverse childhood experiences (ACE) can affect health in adulthood. We investigate the relationship between childhood experiences and adult cancer risk and screening behaviors in a racially diverse, low income population.

METHODS

Nearly 22,000 adults 40 years and older in the Southern Community Cohort Study were administered the ACE questionnaire. We estimated odds ratios (OR) for the prevalence of smoking, alcohol consumption, BMI and five cancer screening methods in relation to the ACE score.

RESULTS

Over half reported at least one ACE, with percentages higher for women (61%) than men (53%). Higher ACE scores were related to increased prevalence of smoking (ORs 1.25 (1.05-1.50) to 2.33 (1.96-2.77). Little association was seen between rising ACE score and alcohol consumption or BMI, except for a modest trend in morbid obesity (BMI ≥ 40 kg/m2). Mammography and cervical cancer screening decreased with rising ACE scores, but no trends were seen with prostate or colorectal cancer screening.

CONCLUSIONS

Adverse childhood experiences are strong predictors of adult cancer risk behaviors, particularly increased likelihood of smoking, and among women, lower mammography and Pap screening rates.

Factors Mediating the Relationship Between Intimate Partner Violence and Cervical Cancer Among Thai Women

Previous research suggests that intimate partner violence (IPV), particularly physical or sexual violence, was associated with cervical cancer. However, there is less work examining the mechanism of the relationship between IPV and cervical cancer. The purpose of this cross-sectional study was to examine psychosocial factors (e.g., stress, social support, self-esteem, and depressive symptoms) as mediators of the relationship between IPV and cervical cancer among 532 Thai women with gynecological problems. About 21.1% of participants reported any type of IPV (e.g., physical, sexual, or emotional violence) in the past year and 22.2% had cervical cancer. IPV was significantly positively associated with stress, depressive symptoms, and cervical cancer but negatively correlated with social support and self-esteem. Results from structural equation modeling indicated that not only did IPV exhibit significantly direct effects on social support, stress, and depressive symptoms, and indirect effects on self-esteem, but it also had a significant, positive, total effect on cervical cancer. IPV exhibited the significant indirect effect on cervical cancer through social support, self-esteem, stress, and depressive symptoms. The model fitted very well to the empirical data and explained 9% of variance. The findings affirmed that those psychosocial factors were mediators of the relationship between IPV and cervical cancer. Health care protocols for abused women should include screening for and treatment of IPV-related psychosocial factors. Interventions that provide social support and protect self-esteem should reduce stress and depressive symptoms among abused women, thereby reducing the risk of cervical cancer.

Domestic violence and its effect on oral health behaviour and oral health status

INTRODUCTION

Violence against women is one of the major public health and human rights problem in the world today. Hence, the present study was conducted with the aim to assess the effect of domestic violence on oral health behavior and oral health status of females attending community outreach programmes in and around Modinagar.

MATERIALS AND METHODS

A cross-sectional study was conducted through the community outreach programmes organized in Modinagar. A structured questionnaire was used to illicit information regarding socio demographic characteristics, oral health behavior and domestic violence. The dental health examination was done to record dental health status, intraoral and extraoral soft tissue injury, tooth fracture and tooth avulsion due to the injury.

RESULTS

Out of the total 304 women, 204(67.1%) reported positive domestic violence. Psychological violence was found to be severe whereas sexual violence was found to be mild in most of the cases. Significant difference was found between oral hygiene aids used , frequency of tooth brushing, periodontal status, missing teeth, intraoral soft tissue injuries and fractures between both the groups (p<0.05).

CONCLUSION

The present study confirmed that domestic violence had significant influence on oral health behavior and oral health status of women. Thus, the dental professionals also should make an attempt to help victims gain access to support and referral services and to provide adequate treatment to them so as to make a positive difference in their lives.

Intimate partner violence in an outpatient palliative care setting

Although a few studies have evaluated intimate partner violence (IPV) in the oncology setting, to our knowledge no studies exist of IPV among palliative care patients. IPV may be exacerbated at the end of life because patients and their caregivers often experience significant stressors associated with physical, emotional, social, and financial burdens. We discuss IPV in the palliative care setting using the example of a patient with advanced cancer who experienced IPV. A better understanding and awareness of IPV at the end of life could help clinicians support and counsel patients and ameliorate the suffering caused by this “unspoken” trauma. We further discuss 1) the prevalence and indicators of IPV, 2) how to initiate conversations about IPV, 3) the resources available to clinicians, and 4) various management strategies.

Relationship of intimate partner violence to health status, chronic disease, and screening behaviors

While victims of intimate partner violence (IPV) have increased risk of chronic disease, little is known about their preventive screening behaviors. The objective of this study was to relate IPV to health status, chronic disease, and preventive screening behaviors. We hypothesized that women who reported poorer health statuses, higher rates of HIV, no primary care, and less-frequent HIV testing, breast exams, and Pap smears would be more likely to experience IPV. Adult females who presented to three Emergency Departments (EDs) on weekdays from 11:00 a.m. to 7:00 p.m. over a 14-month period were asked to participate in a computerized survey. Women were excluded if they were critically ill, did not speak English, intoxicated, or psychotic. Validated measures were used, including the Universal Violence Prevention Screen and the Short Form-12. Patients were asked about their health statuses, HIV statuses, and testing, if they had a regular doctor, and how often they had received pap smears and breast exams. Logistic regression modeling was used to test associations between IPV and the predictor variables, adjusting for age, employment, and education. Out of 3,381 approached, 1,474 women (43.6%) agreed to be surveyed. Age averaged 39 years ± 12.3 (range = 18-65), and most participants were Black (n = 722, 86.8%). One hundred and fifty-three out of 832 women (18.4%) who had been in a relationship the previous year had experienced IPV. Compared with HIV-negative women, those with HIV were 5 times more likely to suffer IPV (adjusted odds ratio [AOR] = 5.113, p = .001), and women who were not sure of their HIV status were 9 times more likely to experience IPV (AOR = 8.818, p < .001). Women who performed monthly self-breast exams were 53% less likely to experience IPV as those who rarely examined themselves (AOR = 0.470, p = .010). Women who have HIV or are unsure of their status and those who rarely perform self-breast exams are at increased risk of IPV.

Increased Gender-based Violence Among Women Internally Displaced in Mississippi 2 Years Post–Hurricane Katrina

Objectives: Although different types of gender-based violence (GBV) have been documented in disaster-affected populations, no studies have documented a quantitative increase in rates of GBV among populations living in protracted displacement after a disaster. We aimed to assess the change in rates of GBV after Hurricane Katrina among internally displaced people (IDPs) living in travel trailer parks in Mississippi.

Methods: The study design included successive cross-sectional randomized surveys, conducted in 2006 and 2007, among IDPs in Mississippi using a structured questionnaire. We sampled 50 travel trailer parks in 9 counties in Mississippi in 2006, and 69 parks in 20 counties in 2007. A total of 420 female respondents comprised the final sample. We measured respondent demographics, forms of GBV including sexual and physical violence further subtyped by perpetrator, suicidal ideation, suicide attempt, and Patient Health Questionnaire-9–assessed depression.

Results: Respondents had a mean age of 42.7 years. The crude rate of new cases of GBV among women increased from 4.6/100,000 per day to 16.3/100,000 per day in 2006, and remained elevated at 10.1/100,000 per day in 2007. The increase was primarily driven by the increase in intimate partner violence. GBV experience was significantly associated with increased risk for poor mental health outcomes.

Conclusions: Overall, the rate of GBV, particularly intimate partner violence, increased within the year following Hurricane Katrina and did not return to baseline during the protracted phase of displacement. Disaster planning efforts should incorporate plans to decrease the incidence of GBV following a disaster, and to ensure adequate services to people with postdisaster GBV experience. (Disaster Med Public Health Preparedness. 2009;3:18–26)

Prospective association of intimate partner violence with receipt of clinical preventive services in women of reproductive age

BACKGROUND

Women who experience intimate partner violence (IPV) have a greater risk for adverse health outcomes, suggesting the importance of preventive services in this group. Little prior research has explored how IPV exposure impacts receipt of relevant preventive services. We assess the prospective association of IPV exposure with receiving specific preventive services.

METHODS

Women in the Central Pennsylvania Women's Health Study's longitudinal cohort study (conducted 2004-2007; n = 1,420) identified past-year exposure to IPV at baseline and receipt of IPV-relevant preventive services (counseling for safety and violence concerns, tests for sexually transmitted infections [STIs], counseling for STIs, Pap testing, counseling for smoking/tobacco use, alcohol/drug use, and birth control) at 2-year follow-up. Multiple logistic regression analysis assessed the impact of IPV on service receipt, controlling for relevant covariates.

FINDINGS

Women exposed to IPV had greater odds of receiving safety and violence counseling (adjusted odds ratio [AOR], 2.40; 95% confidence interval [CI], 1.25-4.61), and tests for STIs (AOR, 2.46; 95% CI, 1.41-4.28) compared with women who had not been exposed to IPV. Independent of other predictors, including IPV, women who saw an obstetrician-gynecologist were more likely to receive Pap tests, STI/HIV testing and counseling, and birth control counseling, compared with women who had not seen an obstetrician-gynecologist.

CONCLUSION

Overall rates of preventive service receipt for all women in the sample were low. Women exposed to IPV were more likely to receive safety and violence counseling and STI testing, and seeing an obstetrician-gynecologist increased the odds of receiving several preventive services.

Barriers to cervical screening in women who have experienced sexual abuse: an exploratory study

OBJECTIVES

To explore self-reported cervical screening history and barriers to attendance among women who have been sexually abused and to identify measures to improve the experience of cervical screening for these women.

METHODS

Women visiting the website of the National Association for People Abused in Childhood (NAPAC), who had been sexually abused, were invited to complete a survey of their views and experiences of cervical screening. This included closed questions on demographic characteristics and cervical screening attendance, open questions on barriers to screening, and the opportunity to submit suggestions to improve this experience for women who have been sexually abused. Content analysis was used to code responses to the open questions. Four women also participated in a discussion group.

RESULTS

Overall, 135 women completed the closed questions and 124 provided open-ended responses. 77.5% of responding women who were eligible for cervical screening in England had ever attended, 48.5% at least once in the previous 5&emsp14;years, but 42.1% of women aged 25-49 within 3&emsp14;years. A total of nine higher order themes were identified related to barriers to screening, one related to intention to attend screening and five related to suggestions to improve screening.

CONCLUSIONS

This study supports the idea that women who have experienced sexual abuse are less likely to attend for regular cervical screening, with under half screened in the last 5&emsp14;years compared to the National Health Service Cervical Screening Programme figure of 78.6%. Suggestions to improve the experience for abused women focused on communication, safety, trust and sharing control. Further research in this area is warranted to ensure that this at-risk population is appropriately served by cervical screening.

Association of intimate partner violence and childhood sexual abuse with cancer-related well-being in women

BACKGROUND

Limited evidence suggests that intimate partner violence (IPV) may be associated with poorer cancer outcomes. We hypothesized that timing and type of IPV as well as childhood sexual abuse (CSA) may negatively affect depression, perceived stress, and cancer-related well-being.

METHODS

This was a cross-sectional study of women diagnosed with either breast, cervical, or colorectal cancer in the prior 12 months included in the Kentucky Cancer Registry. Consenting women were interviewed by phone (n=553). Multivariate analysis of covariance (MANCOVA) was used to determine the association between IPV (37% lifetime prevalence) and type, timing, and the range of correlated cancer-related well-being indicators, adjusting for confounding factors.

RESULTS

IPV (p=0.002) and CSA (p=0.03) were associated with the six correlated well-being indicators. Specifically, lifetime and current IPV were associated with lower Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) (p=0.006) and Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-SP) (p=0.03) scores, higher perceived stress at diagnosis (p=0.006), and depressive symptom scores at diagnosis (p<0.0001), whereas CSA was associated with lower FACT-B (p=0.02), increased number of comorbid conditions (p=0.03), and higher current stress levels (p=0.04). Current and past IPV, as well as psychologic abuse, were associated with poorer well-being among women with a recent cancer diagnosis.

CONCLUSIONS

Our results provide evidence that both IPV and CSA negatively influence cancer-related well-being indicators. These data suggest that identification of lifetime IPV and other stressors may provide information that healthcare providers can use to best support and potentially improve the well-being of female cancer patients.

Birth control sabotage and forced sex: experiences reported by women in domestic violence shelters

Women who experience intimate partner violence often experience birth control sabotage, forced sex, and partner's unwillingness to use condoms. We interviewed 53 women at four domestic violence shelters. Participants reported that their abusive partners frequently refused to use condoms, impeded them from accessing health care, and subjected them to birth control sabotage, infidelity, and forced sex. However, women also reported strategies to counteract these actions, particularly against birth control sabotage and attempts to force them to abort or continue a pregnancy. Domestic violence counselors can focus on these successful strategies to validate coping skills and build self-esteem.

Intimate Partner Violence and Posttraumatic Stress Disorder Among High-Risk Women: Does Pregnancy Matter?

Interviews from 655 women participating in the Chicago Women’s Health Risk Study (CWHRS) were used to assess prevalence and factors associated with intimate partner violence (IPV) and posttraumatic stress disorder (PTSD). Black women had the highest rate of IPV overall and among pregnant women, and had decreased odds of PTSD compared to Black nonpregnant women. Hispanic pregnant women, however, had decreased odds of IPV and PTSD compared to Hispanic nonpregnant women. Disparities in IPV by race/ ethnicity and pregnancy status complicate the study of IPV and PTSD and have implications for the public health community.

Methods for estimating medical expenditures attributable to intimate partner violence

This article compares three methods for estimating the medical cost burden of intimate partner violence against U.S. adult women (18 years and older), 1 year postvictimization. To compute the estimates, prevalence data from the National Violence Against Women Survey are combined with cost data from the Medical Expenditure Panel Survey, the Medicare 5% sample, and published studies and with relative risk estimates from published studies. Results are compared and reasons for difference are explored, including the advantages and disadvantages of each approach. Estimates of the medical cost burden of intimate partner violence within the first 12 months after victimization range from USD 2.3 billion to USD 7.0 billion, depending on the method used. Although limited to women victimized in the last year, each method reveals that intimate partner violence imposes a substantial burden on the health care system. Among the approaches, there is no clear gold standard nor any evidence of bias.

Intersections of Harm and Health

Eight focus groups of women with recent exposure to intimate partner violence (IPV) were conducted to elicit women's descriptions of how IPV affects their health. Their shared narratives reveal a complex relationship with three main points of intersection between IPV and health: IPV leading to adverse health effects; IPV worsening already compromised health; and women's illness or disability increasing dependency on abusive partners, thereby lengthening the duration of IPV exposure. Women describe bidirectional and cyclical ways through which IPV and health intersect over time. Service providers, including physicians, need to better understand the myriad ways that abuse affects women's health.

Gynaecological symptoms associated with physical and sexual violence

OBJECTIVE

The study aims to describe the prevalence of violent physical and sexual experiences in female outpatients and to identify specific gynaecological symptoms that are associated with a history of abuse.

STUDY DESIGN

We performed a cross-sectional study among native German women. The confidential self-administered questionnaire included items on physical and sexual abuse and on the patient's medical history. Of a total of 1941 eligible women, 730 (37.6%) participated in the survey. We calculated prevalence rates of physical and sexual abuse and compared victims and non-victims of violence with respect to specific symptoms and complaints. We developed multivariate models for pelvic pain and vaginal infection.

RESULTS

The lifetime prevalence of severe physical violence by any kind of perpetrator was 35.5%. 13.5% of participants reported a completed rape. The lifetime prevalence of physical and/or sexual intimate partner violence (IPV) was 28.3%. Physical and sexual abuse is significantly associated with irregular menstrual cycle, urinary tract infections and pelvic pain independent of menses.

CONCLUSIONS

Physical and sexual violence are associated with many gynecological symptoms. Especially gynecologists and general practitioners have to be aware that their patients might be victims of violence. This is important for adequate diagnosis and therapy and to avoid retraumatization in affected women.

The relationships among sexually transmitted infection, depression, and lifetime violence in a sample of predominantly African American women

This study was a secondary analysis of the relationships among lifetime experiences of violence, depressive symptoms, substance use, safer sex behaviors use, and past-year sexually transmitted infection (STI) treatment among a sample of 445 low income, primarily African American women (257 HIV-, 188 HIV+) reporting a male intimate partner within the past year. Twenty-one percent of HIV- and 33% of HIV+ women reported past-year STI treatment. Violence victimization increased women's odds of past-year STI treatment, controlling for HIV status and age. Depressive symptoms increased, and use of safer sex behaviors decreased, women's odds of past-year STI treatment. Results suggest that positive assessment for violence and/or depression indicates need for STI screening.

Abused African American women's processes of staying healthy

Fifteen African American women with a history of intimate partner violence (IPV) were interviewed to examine (a) the ways in which poor, urban African American women stay healthy, and particularly how they protected themselves from sexually transmitted diseases and HIV while in abusive relationships; and (b) the roles of intersecting contextual factors such as lifetime experiences of violence, mental health symptoms, and substance use in women's processes of maintaining their health. Data were analyzed using a qualitative descriptive approach. Women were managing numerous, complex problems as they actively worked to maintain their mental and physical health and that of their children. The turning point at which women made substantial changes came when women were "tired" and believed that a new beginning was needed. Racism, poverty, multiple experiences of violence, and health and mental health problems influenced women's health care decisions. Women's health maintenance strategies were often not visible to health care providers and included some behaviors that may place women at greater risk of violence or disease from the point of view of the health care provider.

Adverse Impact of a History of Violence for Women With Breast, Cervical, Endometrial, or Ovarian Cancer

OBJECTIVE

The experience of physical and sexual violence (victimization) is common among U.S. women and is associated with adverse health consequences. The study objectives were to estimate the prevalence of victimization in women with cancer and to examine associations with demographics, cancer screening, and cancer stage.

METHODS

From 2004 to 2005, 101 women with breast, cervical, endometrial, or ovarian cancer were interviewed to collect demographics, cancer screening history, health care access/use, and violence history. Chi-square and Fisher exact tests were used test risk-factor associations. A multinomial logistic regression model was used for multivariable analysis.

RESULTS

The prevalence of a history of violence was 48.5% (49/101 women), and within that group, 46.9% (23/49) had a positive childhood violence screen, 75.5% (37/49) had a positive adult screen, and 55% (27/49) reported sexual violence at any age. Women with a positive violence screen differed significantly from women with a negative screen in that they were younger (P = .031), more often divorced (P = .012), more likely to smoke (P = .010), more often lacked commercial insurance (P = .036), and had more advanced stage of disease (P = .013), but they did not differ with regard to race, cancer type, education level, alcohol or drug use, or cancer screening compliance. Multivariable analysis revealed that only stage remained significant; women with a history of violence had a 2.6-fold increased chance of diagnosis in later stages (odds ratio 2.61, 95% confidence interval 1.03-6.59).

CONCLUSION

A history of violence in breast, ovarian, endometrial, and ovarian cancer patients was extremely common and correlated with advanced stage at diagnosis.

LEVEL OF EVIDENCE

II-2.

Life Stressors Are an Important Reason for Women Discontinuing Follow-up Care for Cervical Neoplasia

Although studies have addressed psychosocial factors associated with obtaining follow-up care for an abnormal Pap test, none have explored the effect of stressful life events in predicting the receipt of follow-up care for an abnormal Pap test. Data from a program (1995-2001) that provided free follow-up care for women with low-grade cervical lesions (n = 601) was used to determine whether life stressors increased risk of study discontinuation. Women were interviewed at baseline and offered follow-up at 4- to 6-month intervals for up to 24 months. Of the 556 women recruited and interviewed (92% response rate), 53 were referred out because they had high-grade cervical lesions and 33 had a health condition precluding follow-up. Among 470 women who began follow-up, 175 (37.2%) discontinued before completing three visits. Women who discontinued were significantly more likely to report more stressful life events in the past year [age-adjusted relative risk (aRR), 1.19; 95% confidence interval (95% CI), 1.08-1.30; 17-item scale]. Events most strongly associated with discontinuation included having a problem with a boss (aRR, 1.9; 95% CI, 1.5-2.4), severe physical partner violence (aRR, 1.7; 95% CI, 1.3-2.2), being homeless (aRR, 2.1; 95% CI, 1.6-2.8), and having an unplanned pregnancy (aRR, 1.5, 95% CI, 1.2-2.1). Life stressors may be important predictors of discontinuation of free follow-up care among women in need of immediate follow-up care to prevent lesion progression.

Delay in treatment of invasive cervical cancer due to intimate partner violence

BACKGROUND

Intimate partner violence (IPV) is underreported and creates a complex psychosocial medium that adversely affects the health of its victims. We present the first case report in the literature, though likely not the first time, in which a patient delayed her cancer treatment due to domestic abuse and her disease progressed.

CASE

A 41-year-old female with vaginal bleeding was diagnosed with cervical cancer. After several years of declining recommendations for treatment, she was questioned separate from her partner and she revealed a long-standing history of abuse.

CONCLUSIONS

Physicians must be aware of the signs of spousal abuse to lessen negative impact on the treatment of their patients. Once domestic violence is discovered, there are many resources available to help patients with their needs.

Coercive sexual experiences and subsequent human papillomavirus infection and squamous intraepithelial lesions in adolescent and young adult women

PURPOSE

The purpose of this study was to examine the associations between coercive sexual experiences and subsequent human papillomavirus (HPV) infection and/or squamous intraepithelial lesion (SIL) in adolescent and young adult women, and to determine whether risk behaviors mediate and sociodemographic factors moderate any observed associations.

METHODS

Data were obtained from a longitudinal cohort study of female university students (N = 608). chi2 and Wilcoxon rank-sum tests were used to determine associations between history of a coercive sexual experience and subsequent risk behaviors, and between risk behaviors and HPV or SIL. Logistic regression models were used to determine whether a coercive sexual experience was associated with HPV or SIL and whether the association was mediated by risk behaviors and/or moderated by sociodemographic factors.

RESULTS

Twenty-two percent of participants reported a prior coercive sexual experience. Report of a prior coercive sexual experience was associated with a higher lifetime number of sexual partners (p < .0001), which in turn was associated with subsequent HPV infection (p < .0001) and SIL (p < .0001). In logistic regression models, coercive sexual experience was associated significantly with HPV (odds ratio [OR], 1.84; 95% confidence interval [CI], 1.19-2.84) and at a marginal significance level with SIL (OR, 1.90; 95% CI, .97-3.70). When the number of sexual partners was included in the first model, the association between coercive sexual experience and HPV infection became nonsignificant and the beta coefficient decreased by 49%. Race and age did not appear to moderate the association between coercive sexual experience and HPV.

CONCLUSIONS

The number of sexual partners is an important mechanism through which adolescent and young adult women who report a coercive sexual experience acquire HPV.

The help-seeking strategies of female violent-crime victims: the direct and conditional effects of race and the victim-offender relationship

The author used national data to examine the help-seeking strategies of female crime victims. The research has two objectives. First, to determine whether help seeking exists as isolated choices or whether there is a discernable set of help-seeking strategies used by victims. Second, the author examined the effects of race and the victim-offender relationship on these help-seeking decisions. Findings identify three help-seeking strategies: (a) minimal or no help seeking, (b) family and friend help seeking, and (c) substantial help seeking (includes help from family, friends, psychiatrists, social service providers, and police). The author found that White women and victims of intimate partner violence are more likely to engage in increasing levels of help seeking. She also found that White women victimized by an intimate partner or other known offender are more likely (as compared to other victims) to seek increasing levels of help and social support.