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An Association among Intimate Partner Violence (IPV) Exposure, orofacial injuries, and Health Disparities.

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BACKGROUND & SIGNIFICANCE

• “Intimate partner violence (IPV) is the intentional use of physical force….which results in a high likelihood of injury”.1

• The problems: 

   1. IPV is a global public health epidemic.1

   2. State mandated reporting of IPV is limited to children and to the elderly. Victims between the ages of 18-64, however, are not protected by any state mandate.2

   3. Victims of IPV have an increased prevalence of health disparities affecting their lifespan; i.e. heart disease (CVD), stroke, depression and anxiety.3

   4. Little is known about the mechanisms linking IPV to these health problems which are sometimes fatal.1

• The predicted incremental cost to the health care system from violence and abuse ranges between $333 billion and $750 billion annually, or nearly 17% to 37.5% of the total health care dollar.4

 

HYPOTHESES

• The use of facial injuries and self-reported health disparities using a standardized health questionnaire will increase the identification of the victims of IPV as compared to the standard operating procedure (SOP) of our clinic.

• IPV will predispose victims to adverse health disparities; i.e. stress, CVD and perhaps other health disparities that can be shown by our questionnaires

 

SPECIFIC AIMS

• To estimate the prevalence of IPV in a sample of women who visits Oral Surgery Clinic in Meharry Medical College School of Dentistry (MMC-SOD).

• To compare the association of IPV exposure, facial injuries and health disparities between Afro-American and non-Afro-American women so that victims would benefit by the healthcare providers awareness of exposure to this harsh life event and its effect on the health of victims.

 

RESEARCH DESIGN & METHOD

• The Institutional Review Board (IRB) at Meharry Medical College approved this study  (Protocol number: 14-05-202).

• A cross-sectional study design was implemented by enrolling females who presented to MMC-SOD Oral Surgery Clinic.

• Each female was asked to participate in study to improve women’s oral health.

• Inclusion criteria: oriented to person, place, and time and ability to speak English.

• Exclusion criteria: incapable of communication/refuse to consent.

• Predictor variables were: injury location (Head, Neck, and Face (HNF) injury) + positive response to Partner Violence Screen (PVS) and Partner Abuse Symptom Scale (PASS).5

• The outcome variable was self-reported injury etiology categorized as IPV or other.

• Questionnaire 1 contains PVS which contains responses to three short questions that was proven to have good construct and content validity.6  In addition, Questionnaire 1 also lists the ten common chronic illnesses associated with the IPV.3

• Questionnaires 2; PASS was designed to measure long-term injuries resulting from abuse; i.e. chronic illness. 

• Other variables included age, race, economic background, presence or absence of health disparities (see Results).

• Statistical analysis was conducted using IBM SPSS 22. We used two and three way classifications as well as logistic regression to analyze the data.

• P<0.05 was considered significant (standard deviation; SD=0.05).


RESULTS

• Total of 58 participants (n=58), who qualified the criteria, were examined so far in this pilot study.

• The mean age of the participants were 41.9 (SD = 14.2).

• The prevalence of IPV was 55.2% (32/58).

• HNF injuries were seen in all (n=22; p<.001) IPV victims.

• Among the independent variables within the presented questionnaires, eight came out to be statistically significant: anxiety, stress/PTSD, past or present HNF injuries, heart palpitations, swollen and/ or painful joints, PVS, memory loss and missed or irregular menstrual period not due to pregnancy. However, different sets of variables were found significant when broken down into races. For the rest of the results, see Tables 1 and 2 and Figures 2 and 3.

• There were no statistical significant difference between the low (<$50,000) versus high annual income (>$50,000) in terms of the prevalence of IPV.

 

STUDY LIMITATIONS

• The current study size is 44 which limits its power (power of our study is n=80).  We are still collecting more data.

• Not both of the questionnaires  were presented to all the participants since some participants (27%) did not come back for the second visit to complete the study. 

• Selection bias.

• Misclassification (false positives and false negatives). Measuring IPV injury etiology at one point in time can result in these two types of misclassifications: underestimation of sensitivity.  However, it should have a minimal effect in specificity.

• Although we have calibrated our research assistants, there is still possibilities for varied interpretation of the questions being asked to the participants.

 

CONCLUSIONS

• The prevalence of IPV female victims in MMC-SOD clinic was significantly greater when compared with the U.S.(19.5% to 35.0%).9

• HNF injuries and PVS were found to be a significant predictive variables (p<.001) which was supported by previous studies (P<.001).10

• IPV is prevalent in both high and low income families with no statistical significance between these groups.

• Certain chronic diseases (anxiety, stress/PTSD, palpitations, swollen/painful joints, memory loss and missed/irregular menstrual cycle not due to pregnancy) are statistically associated amongst the victims of IPV.

• PVS and PASS is statistically significant at screening for IPV.

• Stress/PTSD and difficulty concentration are more significant in Afro-American (AA) female IPV victims than its non-AA counterparts.

 

FUTURE IMPLICATIONS

• This is the first study to compute the prevalence of female IPV victims at MMC-SOD.

• The oral health provider is most pivotal at identifying IPV since 75% of the injuries of IPV are present in HNF.7

• By sampling women in this health-poor community of Nashville we expect the achieve the following:

• The use of these predictor variables will help to understand the mechanistic pathway of how exposure to IPV precipitates/exacerbates significant health disparities in victims, and to uncover victims who would benefit by the health provider’s awareness of exposure to this harsh life event (and how it manifests itself with poor health). 

• We expect to increase the awareness of IPV and health consequences, provides a Segway for healthcare to combine with community resources to decrease the burden of health disparities suffered by their patients and improve health-related quality-life. 

• Salivary sampling, now in progress, may provide a risk index/non-invasive assessment of mechanisms of how IPV exposure affects poor health. This can be used as a baseline for intervention and resolution of future IPV-related injuries.

• It is hoped that this protocol will provide a tool for screening victims by health-care providers in the state.

 

ACKNOWLEDGEMENT

• Funding for this project was provided by the Robert Wood Johnson Foundation Mini-Pilot Project Program (Principal Investigator: Dr. Leslie Halpern).

 

REFERENCES

1. World Health Organization (2011). Violence. Geneva, Switzerland: Author.  <http://www.who.int/topics/violence/en/>, accessed 3 March 2011.

2. Thompson LA, Tavares M, Ferguson-Young D ,Halpern, L. Violence and Abuse: core competencies for identification and access to care. Dent Clin NA,2013;57(2):281-299.

3. Campbell J, Jones AS, Dienemann J et al. Intimate partner violence and physical health consequences. Arch Intern Med 2002;162:1157-1163.

4. Dolezal T, McCollum D, Callahan M. Hidden costs in health care: the economic impact of violence and abuse. Academic on Violence and Abuse; 2009.

5. Halpern LR, Parry B, Hayward G, Peak D, Dodson TB. A comparison of 2 protocols to detect intimate partner violence. JOMS  2009;67: 1453-1459.

6. Halpern LR, Dodson, TB. A predictive model for diagnosing victims of intimate partner violence. JADA 2006; 137: 604-609.

7. Halpern LR. Orofacial injuries as markers for intimate partner violence. Oral Maxillofac Clin NA 2010;22(2):239-246.

8. Dolezal T, McCollum D, Callahan M. Hidden Costs in Health Care: The Economic Impact of Violence and Abuse. Eden Prairie, MN: The Academy on Violence and Abuse; 2009.

9. Breiding MJ, Black MC, Ryan GW. Prevalence and risk factors o fintimate partner violence in eighteen US states/territories. American Journal of Preventive Medicine, 2005:34(2):112-118.

10. Wu V, Harold H, Bhandari M. Pattern of physical injury associated with intimate partner violence in women presenting to the emergency department: a systematic review and meta-analysis. Trauma, Violence, & Abuse, 2010;11(2):71-82.

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