Violence Against Women in Sierra Leone: Frequency and Correlates of Intimate Partner Violence and Forced Sexual Intercourse

Violence against women is a significant public health problem which impacts women, men, and children. Little is known about the frequency or correlates of violence against women in Africa. In this cross-sectional study, we found that 66.7% of 144 women surveyed in a study of AIDS knowledge, attitude, and behaviours, report being beaten by an intimate male partner and 50.7% report having ever been forced to have sexual intercourse; 76.6% of women report either forced sex or intimate partner violence. Circumcised women were most likely to report intimate partner violence and forced sexual intercourse. To improve the health of women worldwide, violence against women must be addressed

Primary Prevention Programs in Educational Settings

What we will cover Brief review of programs with efficacy to reduce IPV / SV in educational settings. Story of EMPOWER to Green Dot: Practice to Research and back Testing a primary prevention bystander based intervention in statewide randomized intervention trial in 26 high schools UK and KASAP partnershi

Experiencing Physical Violence During Pregnancy: Prevalence and Correlates

Violence during pregnancy directly impacts the mental and physical health of pregnant women. We assessed the prevalence and correlates of physical violence around the time of pregnancy in a representative sample of 6,718 women in South Carolina. Physical violence, defined as being physically hurt by husband or partner or being involved in a physical fight was reported by 10.9% of recently pregnant women. These were correlates of violence: experiencing increased numbers of stressful life events, being unmarried, having increased parity, being on Medicaid, and having an unwanted pregnancy. Screening to identify violence in pregnancy in health care settings is vital to maternal and child health. However, identifying violence is not enough; community resources and clinic-based support are needed to help women deal with violence in their lives

Patients as Subjects for Research: Ethical Dilemmas for the Primary Care Clinician-Investigator

Background: Past studies suggested an association between human papillomavirus (HPV) and cervical intraepithelial neoplasia (CIN). In 1987, University of North Carolina (UNC) Hospitals Family Practice Center clinicians were approached for a control population to study this association. Methods: One hundred fives patients attending the UNC Hospitals Neoplasia Clinic with biopsy-proven CIN 2 or 3 and 268 control patients attending the UNC Family Practice Center for a routine Papanicolaou smear were enrolled in this case-control study. Case and control patients consented to having an additional cervical specimen taken and to being interviewed. The cervical specimens were classified by the Southern blot and polymerase chain reaction techniques for HPV. Resuilts: Early results suggested the control patients who had HPV were at high risk of developing CIN. Interventions were made to inform these patients of this risk and need for closer follow-up, causing a wide range of patient reactions. The final results showed no association of HPV with CIN, indicating the early interventions were premature. Conclusions: Physicians engaged in research need to be prepared to deal with the discovery of health risks in the otherwise normal control patients. They bear the ethical responsibility of scrutinizing study design and methods and planning communications with patients from the inception of a study

Oral Contraceptives and Reproductive Cancers: Weighing the Risks and Benefits

The hypothetical incidence of reproductive cancers resulting from oral contraceptive use was estimated in several models comparing the cumulative lifetime incidence of cancer of the breast, cervix, ovary and endometrium expected in pill users with the incidence expected in nonusers. The potential number of cancer-free days that would be gained or lost by pill users was com- pared with similar estimates among nonusers. If five years or more of pill use were associated with a 20% increase in the risk of breast cancerbeing diagnosed before age 50, a 20% increase in cervical cancer risk and a 50% reduction in the risks of ovarian and endometrial cancers, then every 100,000 pill users would experience 44 fewer reproductive cancers during their lifetime than would nonusers, and would gain one more day free of cancer. If higher estimates of the five-yearpill-associated risks of breast and cervical cancer are used-a 50% increased risk of each, for example-then pill users would experience more reproductive cancers than nonusers and would have 11 fewer cancer-free days of life

Intimate Partner Violence and Disabilities among Women Attending Family Practice Clinics

Purpose: To estimate the frequency and type of disabilities preventing work among those experiencing intimate partner violence (IPV) compared with those never experiencing IPV. Methods: We used a large cross-sectional survey of women, ages 18–65, attending family practice clinics from 1997 through 1998. Participation included a 5–10-minute in-clinic survey assessing IPV experience and a longer telephone survey assessing health status and chronic disabilities that prevented work outside the home or housework. Results: Of 1,152 eligible women surveyed, 54% experienced some type of IPV, and 24% were currently in a violent relationship. Women who had ever experienced IPV were more than twice as likely to report a disability (adjusted odds ratio [aOR] _ 2.2, 95% confidence interval [CI] 1.6, 3.0). The most commonly reported disabilities were those associated with heart or circulatory disease (4.9%), followed by back problems (3.5%), chronic pain (3.4%), arthritis (3.0%), nerve system damage (2.4%), asthma or another respiratory problem including emphysema (1.7%), and either depression (1.6%) or another mental illness (1.0%). Women ever experiencing IPV were more likely to report a disability due to generalized chronic pain (aOR _ 2.5, 95% CI 1.5, 4.3) and mental illness (aOR _ 4.5, 95% CI 1.5, 13.1). IPV-related injuries were associated in a dose-dependent manner with having any disability and with disability from chronic pain, asthma and other respiratory diseases, mental illness, and chronic diseases. Conclusions: Primary care-based efforts to screen for IPV and effectively intervene to reduce the impact of IPV on women’s lives must be a public health priority to reduce the shortterm and long-term health effects, including disabilities

Sexual Coercion and Sexual Violence at First Intercourse Associated with Sexually Transmitted Infections

BACKGROUND: Violence against women has been associated with subsequent risky sexual behaviors and sexually transmitted infections (STIs). We explored whether sexual coercion or violence at first intercourse was associated with self-reported STIs. METHODS: Using nationally representative data from the 2006 to 2010 National Survey of Family Growth, we analyzed female respondents aged 18 to 44 (n = 9466) who answered questions on coercion at first intercourse (wantedness, voluntariness, and types of force used) and STIs using logistic regression analyses. We explored degrees of coercion, which we label as neither, sexual coercion (unwanted or nonphysical force), or sexual violence (involuntary or physical force). RESULTS: Eighteen percent of US women reported sexual coercion, and 8.4% experienced sexual violence at first intercourse. Compared with women who experienced neither, the odds of reporting an STI was significantly greater for women who experienced sexual coercion (odds ratio, 1.27; 95% confidence interval, 1.01-1.60), after controlling for all variables. The association between sexual violence at first intercourse and STIs (odds ratio, 1.20; 95% confidence interval, 0.91-1.57) seemed to be attenuated by subsequent sexual violence. CONCLUSIONS: Understanding that women who reported a variety of coercive sexual experiences are more likely to have contracted an STI may indicate a need to focus on the broader continuum of sexual violence to fully understand the impact of even subtle forms of violence on women\u27s health. In addition, focusing on subsequent sexual behaviors and other negative consequences remains important to improve the sexual health of women who have experienced coercive sexual intercourse

Measurement of Bystander Actions in Violence Intervention Evaluation: Opportunities and Challenges

Purpose of Review This review discusses design and methodological challenges specific to measuring bystander actions in the evaluation of bystander-based violence prevention programming. “Bystanders” are defined as people who are present immediately before, during and/or after a violent event, but are not a perpetrator nor the intended victim. Bystander-based violence prevention programs seek to prevent or mitigate violent events by empowering bystanders to intervene on acts of violence and social norms that promulgate violence. Recent Findings Effective bystander-based violence prevention programs demonstrate increased bystander intentions, actions, and attitudes [Bringing in the Bystander: Banyard et al. J Community Psychol. 2007;35:463-481; iSCREAM: McMahon et al. Health Education Research. 2015;30(4):554-568; The Men\u27s Project: Gidycz et al. Violence Against Women. 2011;7(6):720-742; and Green Dot: Coker et al. Violence Against Women 2011;17:777-796] lowered violence acceptance scores (Coker et al. Violence Against Women 2011;17:777-796; Banyard et al. J Coll Stud Dev 2009;50(4)446-457; Cares et al. Violence Against Women. 2015;21:65-87; McMahon et al. Health Education Research. 2015;30(4):554-568; Moynihan et al. J Interper Viol. 2015;30:110-132) and reduce sexual violence perpetration and victimization (Coker et al. Am J Prev Med. 2017;52(5):566-578; Millet et al. Am J Prev Med 2013;45(1):108-112; Gidcyz et al. Violence Against Women. 2011;7(6):720-742). However, bystander-based violence prevention programs are methodologically challenging to evaluate, due to the wide diversity of programs being implemented and the multifactorial and contextual nature of acts of violence. Summary Measures of bystander actions temporally-connected to specific, high-risk opportunities are recommended approaches to capture bystander experiences and address the methodological challenges in measuring bystander actions and evaluating violence prevention programming