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A Randomized Trial of Screening for Intimate Partner Violence in Young Women

A Randomized Trial of Screening for Intimate Partner Violence in Young Women. Leslie Davidson +, Niki Palmetto +, Kathleen Jones+, Vaughn Rickert+, Vicki Breitbart #, Jini Tanenhaus #, Tamu Aljuani #, Melissa Forbes #, Michelle Zeitler +, Lynn Stephens^

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A Randomized Trial of Screening for Intimate Partner Violence in Young Women

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  1. ARandomized Trial of Screening for Intimate Partner Violence in Young Women Leslie Davidson +, Niki Palmetto +, Kathleen Jones+, Vaughn Rickert+, Vicki Breitbart #, Jini Tanenhaus #, Tamu Aljuani #, Melissa Forbes #, Michelle Zeitler +, Lynn Stephens^ (+Mailman School of Public Health, Columbia University, #Planned Parenthood of NYC, ^Boston University) Supported by the Columbia Center for the Prevention of Youth violence . Funded as and ACE center by the CDC.

  2. BACKGROUND • IPV rates are highest among 16-24 year olds • No evidence of effectiveness of screening, nor of potential risks to young women • Lack of validated screen instruments for adolescents

  3. Our Prior Research Anonymous A-CASI survey of 645 ethnically diverse women (15-23yr) found: • 46% of young women reported physical or sexual violence in current relationship • Did not mind being asked • Health provider was best person to ask • Most supported universal screening • Requested screen begin with positive questions • Equal proportion women reported participation

  4. Randomized Trial of Three IPV Screens 3 Screen Types: • “Basic” • “Healthy Relationship” • “Mutual”

  5. Study Goals Primary: • Physical violence by partner EVER in life and/or • Sexual violence by anyone EVER in life Secondary: • Current Physical violence and/or Sexual Violence (in past year) • Women’s Experience with screens • Provider’s Experience with screens

  6. The “Basic” Screen(5 questions) In the Past Year:(Never, Seldom, Sometimes, Often, Always) • My partner is suspicious that I am unfaithful • My partner forced me to have sex when I didn’t want to. • My partner hit, slapped, or physically hurt me on purpose Ever in your lifetime:(Yes / No) • Have you ever been slapped, hit, or otherwise physically hurt by any partner? • Has anyone ever raped you or forced you into a sexual act?

  7. The “Healthy Relationship” Screen(7 Questions) “Basic” Screen PLUS: • My partner respects me • My partner treats me well Responses: Never, Seldom, Sometimes, Often, Always

  8. The “Mutual” Screen(8 questions) “Basic” Screen PLUS: in the past year • I am suspicious that my partner is unfaithful • I forced my partner to have sex when s/he didn’t want to • I hit, slapped, or physically hurt my partner on purpose Responses: Never, Seldom, Sometimes, Often, Always

  9. Screen Results EVER IPV PREVALENCE By Screen Type * All non-significant *

  10. Screen Results Current IPV PREVALENCE By Screen Type **p <0.04

  11. We asked the women: How comfortable were you answering the questions? Did you answer questions honestly? Were you worried about computer confidentiality? How comfortable were you discussing violence with your provider? * All non-significant

  12. We asked the providers: Did the screen enable you to do a better job as a clinician? How helpful was screen in identifying IPV? Did the screen make the visit more efficient? How comfortable were you talking about violence? * All non-significant

  13. CONCLUSIONS • No screening approach performed better than the others • Given a higher baseline prevalence found previously in the same population, more work is needed to increase disclosure rates • Intriguing finding that mutual screen elicited a higher prevalence of current physical violence - better understanding of participation in violence required before further trials

  14. Columbia University: Leslie Davidson, M.D. Vaughn Rickert, PsyD Kathleen Jones, MPH Michelle Zeitler, MPH Boston University: Lynn Stevens Planned Parenthood: Vicki Breithart Jini Tanenhaus Tamu Aljuani Melissa Forbes Acknowledgements Supported by the Columbia Center for the Prevention of Youth Violence. Funded as an ACE center by the CDC

  15. ScreenSensitivity and Specificity Sensitivity: 98% (150/153) Specificity: 90% (469/521)

  16. AGREEMENT

  17. Discussion and Assessment

  18. Comfort and Honesty (mean scores) More favorable Less favorable

  19. Confidentiality(mean scores) More favorable Less favorable

  20. Prevalence of violence • Anonymous computer survey CADRI: 43% • Confidential computer screening: 30% • Provider assessed: 23%

  21. Our Prior Research Anonymous A-CASI survey of 645 ethnically diverse women (15-23yr) found: • 46% of young women reported physical or sexual violence in current relationship • 84% did not mind being asked • 78% considered health provider the best person to ask them about violence • Most thought universal screening should occur in a healthcare setting

  22. Print out of screen responses Women Providers

  23. POWER • Sample size calculated based on an estimated current IPV prevalence of ~ 45%, and an expected risk difference of ~14% • Our study found a screening prevalence of current IPV = ~ 12%, and ~ 5% difference between Basic and Mutual • Therefore, we would have needed 460 women in each arm to achieve 80% Power

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