cerc presentations nbna symposium san diego august 4, 2010
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Adverse Health Conditions and Health Risk Behaviors Associated with Intimate Partner
Violence in US Virgin Islands
Grant Support: National Center on Minority Health and Health Disparities , NIH (# P20MD002286).
CERC PresentationsNBNA SYMPOSIUM
SAN DIEGOAUGUST 4, 2010
Intimate partner violence (IPV)
• IPV is violence that occurs between a victim and perpetrator who are current or former spouses or partners.
• The violence can be physical, sexual and psychological in nature and includes threats of physical or sexual violence against a partner and stalking a partner (CDC).
• Women are more likely than men to be repeatedly abused, injured, or die as a result of partner violence.
• In addition to the risk for death and injury, IPV has been associated with certain adverse health conditions and health risk behaviors.
CERC PresentationsNBNA SYMPOSIUM
SAN DIEGOAUGUST 4, 2010
The Behavioral Risk Factor Surveillance System (BRFSS)
• The BRFSS is a collaborative project of the Centers for Disease Control and Prevention (CDC) and the United States (U.S.) and territories.
• The BRFSS, administered and supported by CDC's Behavioral Surveillance Branch, is an ongoing data collection program designed to measure behavioral risk factors of adults living in households.
• The BRFSS was initiated in 1984, with personnel from 15 states collecting surveillance data on risk behaviors through monthly telephone interviews.
CERC PresentationsNBNA SYMPOSIUM
SAN DIEGOAUGUST 4, 2010
The Behavioral Risk Factor Surveillance System (BRFSS)
• Over time, the number of states participating in the survey increased; by 2001, 50 states, the District of Columbia, Puerto Rico, Guam, and the US Virgin Islands were participating in the BRFSS.
• Data collected annually consist of – identifying demographic variations in health related
behaviors,
– addressing emergent and critical health issues,
– measuring progress in health objectives, and
– linking findings to a framework, the social determinants of health.
NBNA SYMPOSIUMSAN DIEGO
AUGUST 4, 2010
Purpose
• The purpose of this study is to describe the results of 2005 and 2006 BRFSS survey on IPV and selected health conditions and health risk behaviors among the resident of the US Virgin Island.
Table 1. Number and Percent of Adults Ages ≥ 18 Years Residing in US Virgin Island with a Lifetime History of Intimate Partner Violence Victimization by Sex, Age Group, Race/Ethnicity, Annual Household Income, Education Level, and Marital Status – Behavioral Risk Factor Surveillance System, 2005.
CharacteristicsWomen Men
No % 95% CI No % 95% CIAge Group (Years)18–2424–3435–4445–5455–64 ≥65
237994988056
7.2520.3421.9720.4317.1412.86
6.76 – 7.7519.56 – 21.1121.18 – 22.7719.66 – 21.2116.42 – 17.8712.22 – 13.50
152136483520
11.6719.2720.0624.4216.208.37
10.94 – 12.4118.36 – 20.1819.14 – 20.9923.43 – 25.4115.35 – 17.05
7.73 – 9.00
Hispanic/LatinoYesNo
71365
19.5180.49
18.75 – 20.2779.73 – 81.25
20156
12.6787.33
11.90 – 13.4486.56 – 88.10
Race/EthnicityWhiteBlack or African AmericanOther
6626221
16.7376.506.77
15.92 – 17.5575.57 – 77.42
6.22 – 7.32
47949
26.8367.066.11
25.72 – 27.9465.88 – 68.24
5.51 – 6.71
Annual Household Income ($)Less than 15,00015,000 – 24,99925,000 – 34,99935,000 – 49,99950,000 or More
6684588388
18.5423.7813.6622.1321.89
17.74 – 19.3522.89 – 24.6612.95 – 14.3821.27 – 22.9821.03 – 22.75
2126212651
15.8618.3215.5718.7931.47
14.94 – 16.7817.34 – 19.2914.65 – 16.4817.80 – 19.7730.29 – 32.64
Education LevelDid Not Graduate High SchoolHigh School GraduateSome CollegeCollege Graduate
69151106115
17.3537.5523.2221.88
16.63 – 18.0836.62 – 38.4722.41 – 24.0321.09 – 22.68
34642846
20.2340.7515.1523.88
19.28 – 21.1739.60 – 41.9014.31 – 15.9922.88 – 24.88
Marital StatusMarriedDivorcedWidowedSeparatedNever MarriedA Member of an Unmarried Couple
1261113821
12919
37.2621.207.663.74
25.954.19
36.34 – 38.1820.42 – 21.98
7.15 – 8.173.38 – 4 .10
25.12 – 26.793.81 – 4.57
843347
455
48.3412.241.444.03
31.592.36
47.20 – 49.4811.49 – 12.99
1.17 – 1.713.35 – 4.48
30.52 – 32.652.02 – 2.71
Note: % and 95% CI (Confidence Interval) are weighted estimates.
Table 2. Weighted Prevalence of Selected Health Conditions and Risk Behaviors among Adults ≥ 18 years, Residing in US Virgin Island, by Sex and Life History of Intimate Partner Violence (IPV) Victimization – Behavioral Risk Factor Surveillance System, 2005.
Health Condition/ Risk Behavior
Women Men
IPV No IPV IPV No IPV% 95% CI % 95% CI % 95% CI % 95% CI
Health ConditionDiabetesDisability EquipmentArthritisCurrent AsthmaActivity LimitationsStrokeHigh CholesterolHigh Blood PressureHeart AttackHeart Disease
9.295.81
25.0812.8713.041.86
36.2032.542.921.53
8.73 – 9.845.36 – 6.26
24.24 – 25.9312.24 – 13.5112.39 – 13.691.60 – 2.12
35.16 – 37.2431.65 – 33.432.59 – 3.241.29 – 1.76
11.284.37
19.189.058.921.74
36.3727.201.911.86
10.95 – 11.624.16 – 4.59
18.76 – 19.608.75 – 9.368.62 – 9.221.60 – 1.88
35.78 – 36.9526.73 – 27.67
1.76 – 2.051.72 – 2.00
5.542.90
14.107.09
11.581.40
37.6619.621.410.37
5.02 – 6.072.50 – 3.29
13.27 – 14.936.50 – 7.69
10.82 – 12.331.13 – 1.68
36.31 – 39.0118.70 – 20.541.14 – 1.680.23 – 0.51
7.472.58
12.397.279.332.01
34.4221.731.722.19
7.18 – 7.762.41 – 2.76
12.03 – 12.766.99 – 7.569.01 – 9.651.86 – 2.16
33.80 – 35.0421.28 – 22.18
1.58 – 1.862.03 – 2.36
Risk BehaviorHIV or STDCurrent SmokingHeavy drinking(BMI) > 25
9.099.456.53
63.89
8.43 – 9.758.90 – 10.016.06 – 7.00
62.94 – 64.84
5.504.943.89
64.09
5.23 – 5.774.71 – 5.173.69 – 4.10
63.57 – 64.61
11.4715.8824.2061.40
10.55 – 12.4015.03 – 16.7323.18 – 25.2360.25 – 62.54
5.679.32
17.9961.69
5.38 – 5.959.00 – 9.64
17.56 – 18.4261.15 – 62.23
Note: % and 95% CI (Confidence Interval) are weighted estimates.
Table 3. Association between Lifetime History of Intimate Partner Violence Victimization and Selected Health Conditions and Risk Behaviors among Adults ≥ 18 years, Residing in US Virgin Island, by Sex – Behavioral Risk Factor Surveillance System, 2005.
Health Condition/ Risk Behavior
Women Men
AOR 95% CI AOR 95% CI
Health ConditionDiabetesUse of disability EquipmentArthritisCurrent AsthmaCurrent Activity LimitationsStrokeHigh CholesterolHigh Blood PressureHeart AttackHeart Disease
1.250.800.53*
0.52*
1.56*
1.68*
0.661.28*
1.25*
1.29*
0.58 – 2.450.33 – 1.960.34 – 0.810.30 – 0.911.34 – 1.931.10 – 2.570.43 – 1.001.01 – 1.751.03 – 1.781.09 – 1.79
0.801.410.790.700.921.011.120.921.151.16
0.22 – 2.890.29 – 6.890.36 – 1.740.24 – 2.000.51 – 1.660.61 – 1.350.51 – 2.460.74 – 1.120.89 – 1.490.90 – 1.51
Risk BehaviorRisk Factors for HIV or STD Current SmokingHeavy drinkingBody Mass Index > 25
0.321.111.061.01
0.17 – 0.600.90 – 1.370.88 – 1.270.90 – 1.12
0.541.301.07 0.93
0.20 – 1.450.96 – 1.710.93 – 1.230.75 – 1.15
Note: AOR -- Adjusted odds ratio for age, race/ethnicity, annual household income, and educational level. * -- Statistically significant (p < 0.05) by Wald Chi-square test.
Table 4. Number and Percent of Adults Ages ≥ 18 Years Residing in US Virgin Island with a LifetimeHistory of Intimate Partner Violence Victimization by Sex, Age Group, Race/Ethnicity, Annual Household Income, and Education Level – Behavioral Risk Factor Surveillance System, 2006.
CharacteristicsWomen Men
No % 95% CI No % 95% CIAge Group (Years)18–2424–3435–4445–5455–64 ≥65
36 93103120111 90
12.2518.3017.6318.6516.8116.05
11.93 – 13.2017.56 – 19.0416.89 – 18.3617.90 – 19.4016.10 – 17.5315.35 – 16.76
14 36 51 55 53 43
10.5719.9222.2918.3517.4311.44
5.35 – 8.2011.38 – 15.2318.13 – 22.7019.18 – 23.8419.26 – 23.9214.30 – 18.50
Hispanic/LatinoYesNo
89479
18.7781.23
18.03 – 19.5180.49 – 81.97
45208
25.8374.17
24.82 – 26.8473.16 – 75.18
Race/EthnicityWhiteBlack or African American
37158
18.9581.05
13.43 – 24.4675.54 – 86.57
25
86
17.3882.62
7.44 – 21.1277.72 – 87.72
Annual Household Income ($)Less than 15,00015,000 – 24,99925,000 – 34,99935,000 – 49,99950,000 or More
91101 79 81131
19.2619.5817.5616.3727.23
17.02 – 22.4917.34 – 22.7216.76 – 18.3615.59 – 17.1525.80 – 29.67
33 49 42 27 59
17.1022.5524.2810.7626.32
15.68 – 18.5120.95 – 24.3423.19 – 25.389.97 – 11.55
24.15 – 28.69
Education LevelDid Not Graduate High SchoolHigh School GraduateSome CollegeCollege Graduate
102180116169
17.4336.0821.1125.38
16.23 – 18.6235.17 – 37.0020.33 – 21.8824.55 – 26.21
82 82 42 44
31.3532.1116.5519.99
29.56 – 33.1531.03 – 33.1915.69 – 17.4119.06 – 20.91
Note: % and 95% CI (Confidence Interval) are weighted estimates.
Table 5. Weighted Prevalence of Selected Health Conditions and Risk Behaviors among Adults ≥ 18 years, Residing in US Virgin Island, by Sex and Life History of Intimate Partner Violence (IPV) Victimization – Behavioral Risk Factor Surveillance System, 2006.
Health Condition/ Risk Behavior
Women Men
IPV No IPV IPV No IPV% 95% CI % 95% CI % 95% CI % 95% CI
Health ConditionDiabetesUse of disability EquipmentCurrent AsthmaCurrent Activity LimitationsStrokeHeart AttackHeart Disease
13.24.57.8
12.72.42.03.1
10.7–15.74.1–4.87.3–8.3
12.0–13.282.0–2.41.7–2.32.7–3.4
9.33.84.18.51.71.21.7
8.9–9.63.6–4.03.9–4.38.1–8.81.5–1.91.0–1.41.5–1.9
9.84.53.4
10.03.21.51.1
9.1–10.54.0–5.03.0–3.9
9.3–10.72.8–3.61.2–1.80.8–1.3
9.04.13.8
10.31.92.51.9
8.6–9.23.8–4.33.8–4.1
10.0–10.71.7–2.12.3–2.41.7–2.1
Risk BehaviorHIV/AIDS TestCurrent SmokingHeavy drinkingBody Mass Index > 25
54.18.2
11.861.6
52.9–55.27.7–8.8
11.3–12.560.7–62.3
51.95.16.1
61.9
51.3–52.54.8–5.45.8–6.4
61.4–62.4
54.215.323.262.3
52.8–55.614.5–16.222.3–24.261.2–63.5
48.710.514.561.4
48.1–49.310.2–10.914.1–14.960.9–62.0
Note: % and 95% CI (Confidence Interval) are weighted estimates.
Table 6. Association between Lifetime History of Intimate Partner Violence Victimization and Selected Health Conditions and Risk Behaviors among Adults ≥ 18 years, Residing in US Virgin Island, by Sex – Behavioral Risk Factor Surveillance System, 2006.
Health Condition/ Risk Behavior
Women Men
AOR 95% CI AOR 95% CI
Health ConditionDiabetesUse of disability EquipmentCurrent AsthmaCurrent Activity LimitationsStrokeHeart AttackHeart Disease
1.881.67*
3.09*
1.46*
0.530.381.24*
0.55 – 1.411.30 – 2.481.80 – 5.311.30 – 1.700.17 – 1.650.12 – 1.211.10 – 1.62
4.97*
1.540.720.791.001.462.30
1.06 – 23.290.19 – 12.450.13 – 3.810.23 – 2.680.12 – 8.21
0.19 – 11.460.27 – 19.35
Risk BehaviorHIV/AIDS TestCurrent SmokingHeavy drinkingBody Mass Index > 25
1.64*
1.35*
3.69*
0.87
1.44 – 1.921.22 – 1.562.32 – 5.870.63 – 1.23
0.640.30*
5.34*
1.33
0.33 – 1.210.15 – 0.612.92 – 9.730.68 – 2.58
Note: AOR -- Adjusted odds ratio for age, race/ethnicity, annual household income, and educational level.* -- Statistically significant (p < 0.05) by Wald Chi-square test.
Discussion
• IPV prevalence similar in USVI as in mainland US– At least 16% of women lifetime prevalence
(approximately 7-8% of men)– Underestimated in this kind of survey (telephone,
health related, privacy not assured)– In most surveys specifically inquiring about
victimization – lifetime prevalence approximately 25%
• Also finding similar prevalence btw USVI & US in ACAAWS study - African American and Afro-Caribbean women in clinics in Baltimore & USVI– but higher than BRFSS – past two years 25%;
lifetime – 40%
Discussion
• Negative health outcomes also found in ACAAWS study – – E.g. significantly more neurological problems in
those abused versus never abused; significantly more overall pain; significantly more wheezing
Conclusions• Therefore, important in full understanding of health
disparities among women of color, that IPV be taken into account
• Importance of clinical studies to complement population based surveys to fully understand health problems & health disparities
• Also important for appropriate diagnoses and adequate treatment of women’s health problems that routine assessment for IPV be conducted (Abuse Assessment Screen – www.nnvawi.org) – If don’t know underlying problem, will only treat
symptoms
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