1. Partner Violence and Health: Focus on Women in Kentucky Ann L. Coker, PhD MPH [email protected]
Verizon Wireless, Endowed Chair
in the Center for Research on Violence Against Women,
University of Kentucky,
Departments of Obstetrics & Gynecology and Epidemiology
3. Kentucky Data Sources Kentucky Women’s Health Registry
Kentucky based health survey begun in 2006 for women 18 or older.
Purpose: understand how risk and protective behavioral factors may differentially affect women’s health and give interested women the chance to participate in medical research.
10 yr goal: enroll over 25,000 Kentucky women
To date over 8000 women have completed at least 1 survey.
4. Define IPV Physical
Intimate partner hit, kicked, punched, or otherwise hurt you?
Intimate Partner used force hitting, holding down, or using a weapon to make you have sex.
5. Chronic Diseases Cancer
6. IPV & Cervical Dysplasia or Cancer Reviewed peer reviewed studies with at least 500 subjects.
All three studies to address IPV and having an abnormal pap test noted a significant association. (John 2004; Vos 2006; Coker 2003)
All three studies investigating IPV and invasive cervical cancer found a statistically significant association.(Coker 2003; Coker, In press; Loxton 2006)
7. In Kentucky†: IPV and Cervical Cancer
8. IPV & Cardiovascular Disease IPV & hypertension: 1 of 4 studies (Black, 2008; Coker 2000; Loxton, 2006; Lown, 2001}
IPV & diabetes: 0 of 5 studies (Black, 2008; Coker, 2000; Diaz-Olavarrieta, 2002; Loxton, 2006; Lown, 2001)
IPV & high cholesterol: One study noted high cholesterol assoc w/ IPV in women yet not men. (Black 2008)
IPV & obesity: 0 of 2 studies (Loxton, 2006; Black, 2008)
IPV & cardiopulmonary symptoms: 3 of 4 studies. (Loxton, 2006; Lown, 2001; Coker, 2000; Diaz-Olavarrieta, 2002)
IPV & stroke or symptoms consistent with a stroke: 2 of 3 studies (Black, 2008; Lown, 2001; Loxton, 2006)
9. In Kentucky†: IPV and CVD
10. IPV & other chronic diseases IPV has consistently been assoc w/ gastrointestinal disorders including irritable bowel syndrome (Drossman, 1990 ; Coker, 2000; Diaz-Olavarrieta, 2002; Lown, 2001; Loxton, 2006; Talley, 1998; Talley, 1995)
Neither of the 2 studies to investigate an assoc w/ IPV and more common cancers (breast and lung) found an association. (Loxton, 2006; Diaz-Olavarrieta, 2002)
11. In Kentucky†: IPV and GI disorders
12. IPV & Chronic Pain: Lit Review IPV & chronic fatigue syndrome: 2 of 2 noted a significant ? in risk assoc w/ IPV (Doyle, 1999; Patel 2005)
One small study (<200 subjects) found a significant (p=0.05) assoc w/ IPV & fibromyalgia. (Boisset-Pioro 1995 )
IPV & arthritis: 2 of 3 studies found an assoc w/ IPV and arthritis (Black, 2008; Coker, 2000; Lown, 2001).
13. In Kentucky†: IPV & Fatigue or Pain syndromes
14. IPV and Disabilities / Quality of Life All 8 studies which explored IPV and either physical or mental disabilities found a significant increase in disabilities among those experiencing IPV. (Black & Breiding, 2008; Carbone-Lopez et al 2006; Casteel,et al. 2008; Coker et al 2005; Hathaway et al., 2000; Martin et al., 2008; Weinbaum et al., 2001; Zlotnick 2006)
All 8 studies that evaluated IPV and some measure of current quality of life found that lifetime IPV was assoc w/ at least one index of poorer quality of life independent of the type of IPV experienced.(Coker, 2000; Bonomi, 2007; Carbone-Lopez, 2006; Hathaway, 2000; Leung, 2005; Martin, 2008; Tiwari, 2008; Zlotnick, 2006)
15. In Kentucky? Disability and Limitations due to poor health
16. IPV & Reproductive Health: Lit Review IPV = physical, sexual, or psychological abuse during pregnancy or in the past 12 mon.
Perinatal mortality (death between 28 weeks gestation to 28 days after delivery): Five of 8 studies found a significant ? in perinatal mortality assoc w/ IPV. (Coker, Sanderson, & Dong, 2004; Janssen et al., 2003; Leung et al 2001; Lipsky et al 2004; Pikarinen 2007; Taft & Watson, 2008; Webster et al. 1996; Yost et al. 2005)
LBW (<2500 grams): Seven of 12 studies to address IPV and LBW found a significant ? in LBW assoc w/ IPV (Campbell et al., 1999; Coker et al., 2004; Cokkinides,et al. 1999; Curry, et al. 1998; Janssen et al., 2003; Leung et al., 2001; Lipsky et al., 2004; Parker, et al., 1994; Silverman, et al , 2006; Tiwari et al., 2008; Webster et al., 1996; Yost et al., 2005)
Preterm delivery (<37 weeks): Two of 8 studies noted a significant ? in preterm delivery assoc w/ IPV. (Campbell et al., 1999; Coker et al., 2004; Cokkinides et al., 1999; Leung et al., 2001; Lipsky et al., 2004; Silverman et al., 2006; Tiwari et al., 2008; Webster et al., 1996)
17. IPV & Maternal / Infant complications: Lit Review 12 of 14 studies found a significant ?in maternal / infant complications assoc w/ IPV. (Brett, 2008; Certain, 2008; Cokkinides et al., 1999; Curry et al., 1998; Janssen et al., 2003; Kearney et al., 2003; Leung et al., 2001; Lipsky et al., 2004; Parker et al., 1994; Silverman et al., 2006; Taft & Watson, 2008; Tiwari et al., 2008; Webster et al., 1996; Yost et al., 2005)
Outcomes associated with IPV include
Postpartum depressive symptoms.
Hospitalization during pregnancy
Bleeding during pregnancy
Pregnancy induced hypertension
Infant NICU stays
Lower Apgar scores
18. In Kentucky†: IPV and maternal complications
19. IPV and STIs Sexually transmitted infections (Lifetime or current) 17 of 19 studies found that lifetime IPV was assoc w/ ever having an STI yet the association was not as strong for current STI. (Campbell 2002; Champion 2004; Champion 2001; Coker 2004; Coker 2000; Garcia-Moreno 2006; Johnson 2002; King 2000; Loxton 2006; Martin 1999a; Martin 1999b; Muelleman, 1998; Parish 2004; Plichta 1996; Roberts 2005; Tubman 2004; Vos 2006; Weinbaum 2001; Wu 2006)
Three studies reported that sexual IPV was more strongly assoc w/ having a history of an STI than was physical or psychological abuse. (Campbell 2002; Coker 2000; Martin 1999)
20. In Kentucky†: IPV & Sexually Transmitted Infections (STI)
21. IPV and Pelvic pain IPV has been associated with an increased risk of chronic pelvic or abdominal pain in all five studies (Campbell 2002; Champion, 2004; Coker 2000; John, 2004; Pikarinen 2007)
IPV and particularly sexual IPV was assoc w/ painful intercourse or dyspareunia in all of the four studies to address this association. (Campbell et al., 2002; Champion 2004; Champion 2001; Lown & Vega, 2001)
All three studies to explore assoc w/ IPV and lack of sexual pleasure or sexual dysfunction noted that IPV increased the risk of this outcome.(Kovac, Klapow, Kroenke, Spitzer, & Williams, 2003; Parish et al., 2004; Pikarinen et al., 2007)
22. In Kentucky†: IPV & Pelvic Pain
23. IPV and Menstrual Pain / Irregularity IPV assoc w/ painful menses or dysmenorrhea in 6 of 8 studies. (Champion 2004; Champion 2001; John 2004; Lown & Vega, 2001; Loxton 2006; Pikarinen 2007)
Similarly IPV was associated with menstrual irregularly including excessive bleeding and/or endometriosis in all 3 studies to evaluate this association.(Champion 2004; Lown & Vega, 2001; Plichta & Abraham, 1996)
Both of the studies to evaluate IPV and hysterectomies noted an association. (Coker 2000; Loxton, 2006)
Only one study addressed IPV and uterine fibroids and found no assoc. (Campbell 2002)
24. In Kentucky†: IPV and Menstrual disorders or irregularities
25. In Kentucky†: IPV & other gynecologic conditions
26. IPV & Mental Health IPV & PTSD: Consistent evidence that IPV is assoc w/ PTSD. (Kessler, 1995; Resnick, 1993; Kemp, 1995; Golding, 1999).
IPV & depression: Consistent evidence that IPV is assoc w/ depression. (Golding, 1999 meta analysis)
Several authors’ work appeared to establish a temporal link between IPV and depression (Orava, 1996; Surtees, 1995; Campbell, 1995)
27. IPV & Risk Behaviors IPV & alcohol abuse or dependence: weighted OR = 5.6 (Golding, 1999 meta analysis)
IPV & drug abuse/dependence: weighted OR = 5.6 (McCauley, 1995; meta analysis)
IPV & smoking: Women who experienced psychological, physical, or sexual abuse are consistently more likely to smoke than non-abused women. Also true for pregnant women. Jun 2008, Gerger 2005; Stueve 2007, Weinbaum 2001; CDC 2008; Clouthier 2002; Lemon 2002
28. In Kentucky†: IPV & Mental Health
29. Gaps in literature / Future Directions Need more comprehensive measurement of IPV (e.g. overlapping types, frequency, duration, age at first experience) to establish dose-response.
Need cohort studies to establish correct temporal sequence.
Need studies to determine factors that may mediate or moderate the effect of IPV on health. (resiliency and risk)
Need biologic markers to evaluate how IPV adversely affects health. Examples may include measure of immune functions, neuroendocrine response and measures of vascular response.
Need to confirm or validate health outcomes with medical records or biologic testing when possible.
Need more replication of studies particularly for chronic disease.
30. And the good news is? Knowledge is power (Value of KWHR)
Screening for IPV is feasible and acceptable. (UK OB conducting screening since Mar 08)
Early evidence that screening and referral can reduce the impact of IPV on health.
Kentucky has a comprehensive and effective domestic violence and rape crisis programs with law enforcement support (911 system).
Need to move toward primary prevention.