African-Caribbean & African American Women’s Study

Intimate Partner Violence, Substance Use, and PTSD:

Women of African Heritage in Baltimore and the U.S. Virgin Islands

Phyllis Sharps, PhD, RN, FAANJohns Hopkins University School of Nursing

Team MembersUnited States

Jacquelyn Campbell, PhD, RN, FAANPhyllis Sharps PhD, RN, FAANRichelle Bolyard, MSNJamila Stockman, PhD, MPHMarguerite Baty, PhD, MPH, RNJessica Draughon, PhD (c), MSN, RNMary Paterno, BSN, RN, SNMAkosoa McFadgion, MS, MSWGeorgette Cox, MPHSharon O’Brien, PhDAshley ChappellNaa Ayele Amponsah, BAChris KunselmanHossein Yarandi, PhD

US Virgin IslandsDoris Campbell, PhD, ARNP FAANGloria Callwood, PhD, RNDesiree Bertrand, MSN, RNJanis Valmond, MPHCatherine Coverston, PhD, RNCLorna Sutton, MPATyra DeCastroPrincess Oneida-Stuard, BSN stdMelanie Ruiz, BSN stdNatasha Caines, BSN stdJose Negron & Romeo Richardson

Prevalence of Intimate Partner Violence

In the US, 29.7% of women (18-65 yrs) report lifetime IPV victimization with African Americans overrepresented (33%) (Coker et al., 2002).

High rates of IPV (30-66% ) have been reported in Afro-Caribbean countries (Krug, Dahlberg, Mercy et al., 2002), but actual prevalence in US Virgin Islands never determined.

Health disparities for African American women – including maternal child health disparities & HIV/AIDS also associated with IPV (Sharps & Campbell, 2006; Campbell et al., 2008).

Intersecting Epidemics of IPV, Substance Use

and Mental HealthAbused women found to have increased

risks of psychosocial and mental health illnesses such as substance use, family and social problems, depression, and anxiety/neuroses compared to never-abused women (Bonomi et al., 2009).

Substance use by both the woman and her partner has been found to independently predict IPV; social support moderated the effect of women’s substance use (Golinelli, et al, 2009).

PurposeTo examine the association between

intimate partner violence (IPV) and substance use among Afro Caribbean women in the US Virgin Islands and African American women in Baltimore city, Maryland.

To assess post-traumatic stress disorder as a mediating variable in the relationship between IPV and substance use among Afro Caribbean and African American women.

MethodsComparative case (N = 150 in each site) control (N = 150 in

each site) study

Eligibility criteriaWomen aged 18-55 yearsSelf-identify as Afro Caribbean or African AmericanReport of a male sex partner in the past two years

Women recruited from primary care, prenatal or family planning clinics

Questionnaire administered on a touch screen computer with optional headphones - an important methodological strategy

For women of low literacyFor sensitive informationAlerts interviewer if high score on DA or suicidality Allows increased recruitment among Spanish speaking Recording in Spanish & English by USVI residents for increased cultural appropriateness

Study period 12/1/09 to present

Measures Intimate Partner Violence (IPV) in one’s

lifetime assessed using the Abuse Assessment Screen (McFarlane & Helton - www.nnvawi.org) Pushed, slapped, hit, kicked, or physically

hurt &/OR Forced sex &/OR Pushed, slapped, hit, kicked, or physically

hurt while currently pregnant Any of the above by current or former

husband, boyfriend, or male or female partner

MeasuresSubstance Use

Drug use in past yr (street, over the counter, non- prescription drugs)

Alcohol use in past month Cases with history of sexual violence –

they or abusive partner under influence of alcohol or drugs during last forced sex incident

Cases – recent abusive partner drug user

Post-traumatic Stress Disorder (PTSD)Assessed using 4-item Primary Care-PTSDScores summed; cutoff of 3 or more =

PTSD+

Baltimore City, MDUS Virgin Islands

Study Population1,201 screened from both sites

1,025 eligible

n=727 n=298

333 cases

88 contro

ls 119 cases

104 contro

ls

As of 9/10/10

306 unselect

ed controls

75 unselect

ed controls

Population-based Prevalence of Lifetime

Intimate Partner Violence

Population-based Prevalence of Lifetime Psychological Abuse Only

Psychological abuse (above cutoff on WEB (Women’s Experiences of Battering) – being afraid &/or controlled by a current or ex-intimate partner

Population-based Prevalence of Intimate Partner Violence

in the Past 2 years

n=63

Perpetrator of IPV in the Past 2 years

DemographicsAge Employment

Demographics - Education

USVI

X 2 =3.63, p=0.30

Baltimore

X 2 =2.42, p=0.49

Demographics – Marital StatusUSVI

X 2 =8.62, p<0.05

Baltimore

X 2 =1.10, p=0.78

Proportion of women reporting drug and alcohol use (452 cases

and 192 controls)

*in the past year;**in the past month

X 2 =12.74, p<0.001

X 2 =0.044, p=0.83

Does PTSD Mediate the Association Between IPV

and Drug Use?Step 1: Is IPV associated with drug use?

OR: 3.93; 95% CI: 1.76-8.78Step 2: Is IPV associated with PTSD

(mediator)? OR: 3.88; 95% CI: 2.19-6.88

Step 3: Is PTSD associated with drug use, adjusting for IPV?

OR: 3.06; 95% CI: 1.69-5.51Step 4: Significance testing using the Sobel

Test p<0.013

Proportion of women reporting substance use involvement during last forced sex among those with

histories of sexual violence(n=135)

Proportion of abused women reporting a recent substance-

using partner (n=452)

Note: These women 2 times were more likely to have PTSD symptoms in the past month (AdjOR: 2.09; 95% CI: 1.27-3.43).

Conclusions High rates of IPV, substance use and PTSD

among women of African heritage in Baltimore and USVI High rates of drug use for both abuser and

victim in context of forced sex High rate of drug use by abusers

IPV is associated with drug use but not alcohol use

PTSD mediates the relationship between IPV and victim drug use – self medication hypothesis Abused women w/substance using abuser

more likely to have PTSD Use of substances as a way to cope with Sx

of PTSD

Implications Women disclosing substance use and PTSD

need further assessment to include IPV

Women in substance abuse Tx need assessment and interventions for IPV & PTSD

Women disclosing IPV need further assessment to include substance use and PTSD

Interventions targeting abusive partners should take into account substance abuse history