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


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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.

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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

objective
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
factors related to seeking medical and legal help
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).
hypothesis
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.
subjects and data collection
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)
intimate partner violence exposure groups
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.

outcome
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
statistical methods
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
medical or legal help seeking by ipv type
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

medical help seeking by ipv type
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

legal help seeking by ipv type
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

medical or legal help seeking by ipv severity and duration
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

medical or legal help seeking by ipv severity and duration1
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

medical or legal help seeking by ipv severity and duration2
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

summary
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
comments
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
significance
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
acknowledgements
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