CERC Presentations NBNA SYMPOSIUM SAN DIEGO AUGUST 4, 2010

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.



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.



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


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.


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


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.


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


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.


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

http://www.nnvawi.org/

Documents

CERC Presentations NBNA SYMPOSIUM SAN DIEGO AUGUST 4, 2010