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Learn More. To assess the prevalence of intimate partner violence IPV and associations with health care-seeking patterns among female patients of adolescent clinics, and to examine screening for IPV and IPV disclosure patterns within these clinics. IPV prevalence was equally high among those visiting clinics for reproductive health concerns as among those seeking care for other reasons. IPV victimization is pervasive among female adolescent clinic attendees regardless of visit type, yet IPV screening by providers appears low.
Intimate partner violence and health care-seeking patterns among female users of urban adolescent clinics
Patients reporting poor health status and foregone care are more likely to have experienced IPV. IPV screening and interventions tailored for female patients of adolescent clinics are needed. Physical and sexual violence by male intimate partners affects an estimated one in four U.
Consequently, the medical profession has developed policy and programmatic efforts to identify and assist abused women in such settings [ 19 — 21 ]. However, the potential utility of such an approach to assist the large population of adolescents victimized by partners has not been examined. Epidemiologic studies demonstrate that the greatest risk for IPV occurs for females in mid to late adolescence [ 222 — 24 ], with one in five high school girls reporting physical or sexual IPV victimization during their high school years [ 4 ].
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Recent studies with adolescents and young adults document elevated rates of health risks and disease among IPV victims as compared to those without such IPV histories [ 425 — 30 ], suggesting that clinical settings may represent a critical opportunity for reaching this population.
However, IPV among adolescents is reported to be rarely identified by health care providers, and descriptions of IPV care-seeking patterns among adolescents remain limited [ 2931 ]. As adolescent health care utilization patterns differ ificantly from those of adults [ 32 ], clinics specifically serving adolescents are strategic sites for adolescent health promotion, prevention, and intervention.
Located in schools and community settings, primarily in low-income communities, adolescent clinics provide comprehensive adolescent health services, eliminating important barriers to health care faced by adolescents, such as concerns about confidentiality, lack of health insurance, and limited knowledge of the health care system [ 32 — 34 ].
Thus, adolescent clinics serve large s of adolescents who otherwise might not come into contact with health care providers. Consistent with adolescent health care utilization patterns, the majority of clients served in these adolescent clinics are female [ 3536 ].
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These data suggest that clinics serving adolescents may be critical access points for identifying and assisting adolescent IPV victims. Experiencing IPV may result in particular health concerns that affect health care-seeking patterns, such as need for pregnancy testing or sexually transmitted infection treatment. Another possibility emerging from the adolescent health literature is that youth who seek care at adolescent clinics may simply represent a sub-sample of teens experiencing a range of poor health behaviors including IPV.
Examining the prevalence and characteristics of IPV among the broader population of adolescent females seeking care in adolescent clinics, as well as care-seeking patterns associated with such violence, is necessary to guide the development of IPV identification and intervention programs in this setting and to inform whether such programs should be targeted e.
The purpose of the current study was to 1 assess the prevalence of IPV and associations with health care-seeking among a diverse sample of female patients of urban adolescent clinics, and 2 examine prevalence of IPV screening by and disclosure to clinical providers. The current study was conducted via an anonymous, cross-sectional survey of English and Spanish-speaking females ages 14—20 years seeking health care in five clinics providing confidential services to adolescents in urban neighborhoods of Greater Boston. Two clinics were located in public schools, one was located within a community health center, and two were based in other community settings a post office building and a youth center.
Upon arrival to the clinic, adolescent females seeking health services of any type were screened for age eligibility by trained research staff. Those ages 14—20 years and indicating an interest in participating were escorted to a private area of the clinic for consent procedures and survey administration; consent was obtained verbally to protect participant anonymity. As participants were receiving confidential clinic services, parental consent for participation was waived.
Data were collected via ACASI Audio Computer Assisted Survey Instrumenta self-administered computer program that allows participants to complete surveys on a laptop computer with questions read aloud to them over headphones. With demonstrated ability to improve data collection concerning sensitive behaviors [ 4142 ], ACASI is recommended as the best method for obtaining valid and reliable data on IPV [ 43 ]. Following survey completion, all participants were asked by the research assistant whether they had any concerns that emerged while answering the survey questions and whether they would like to speak with a clinic provider.
On-site counseling was available at all participating clinics, however, no participants indicated survey-related distress. Each participant also received a list of local relevant resources e. All consent and data collection materials were conducted and provided in English or Spanish based on the preference of the participant.
Research assistants recruited participants a few times a week over a 3—4 month period at each site. Data collection took place from April to December The primary reason for non-participation was lack of time. Of the9 participants indicated that they would not provide honest answers based on a screener question shown to improve data quality in psychiatric surveys [ 44 ], and 38 provided incomplete data regarding outcomes of interest, resulting in a final analytic sample of Lifetime histories of physical and sexual violence victimization by current or former intimate partners were assessed via six items for each of these two forms of IPV i.
Assessments included items modified from the conflict tactics scales-2 CTS-2 [ 48 ] and the sexual experiences survey [ 49 ] see Table 1.
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Additional single items were utilized to assess whether a doctor or nurse had ever asked the participant about IPV and, for those who had experienced IPV, whether they had disclosed this to the health care provider. Participants were also asked whether they thought health care providers should ask their adolescent patients about IPV experiences.
Lifetime prevalence estimates of physical and sexual IPV were calculated, as well as prevalence of IPV in their current or most recent relationship. Crude and adjusted logistic regression models were constructed to assess the associations of IPV experiences both lifetime prevalence and IPV in current or most recent relationship with reason for clinic visit, foregone care, and self-reported health status; adjusted analyses included demographics associated with IPV in chi-square analyses.
Descriptive statistics were calculated for IPV screening and disclosure experiences within the health care setting. All logistic regression models included recruitment site as a potential confounder. Statistical analyses were conducted using SAS Version 9 [ 50 ].
The mean age of participants was These percentages were consistent with the overall patient demographic characteristics reported by the clinics. Seven percent reported living with their male partner.
In adjusted analyses, no statistically ificant differences in IPV prevalence were found based on reason for health care visit. Those reporting foregoing care were more likely to report having ever experienced IPV ever as well as in their current or most recent relationship compared with those who had not foregone care. Adolescent clinic users reporting fair to poor health were also more likely to report IPV ever than those reporting good or excellent health.
Those who had experienced IPV were ificantly more likely to support screening by health care providers. Two in five adolescent females attending adolescent clinics reported ever experiencing physical or sexual violence from an intimate partner. The prevalence of IPV in this clinical sample is approximately two-fold higher than estimates from community and school based samples. Further, among those who ever experienced IPV, just under half reported that violence occurred in their current or most recent relationship.
These underscore that adolescent clinics can serve as a critical site for identifying adolescent IPV, and for offering resources, referrals, and otherwise intervening to assist young women in danger. Approximately one in nine females reported having ever been choked, and one in seven having sustained an injury from a dating partner.
One in five were sexually victimized in the context of a relationship. These call for intensive education of health care providers caring for adolescents to prepare them to discuss IPV, including sexual violence, in the lives of their young patients and to provide care to minimize the likelihood of further abuse. In addition, over one-third of girls ages 14—15 years have experienced violence from a partner.
This suggests that interventions, both clinical and prevention programs, must begin prior to the high school years. Further, the high prevalence of IPV across age groups underscores the importance of screening for partner violence among all adolescents, including those of relatively young age.
Although, consistent with prior studies [ 243738 ], IPV prevalence was found to be high among girls seeking reproductive and sexual health services, such young women were not at greater risk for IPV as compared to those seeking care for other reasons. Thus, female users of adolescent clinics appear to be at high risk for IPV victimization regardless of reason for seeking care.
Based on the present findings, IPV intervention efforts in these settings should be broad-based, and not focused solely on reproductive or sexual health. Notably, those clinic users who reported past year foregone care or who rated their overall health as relatively poor were more likely to report having ever experienced IPV.
Those who reported foregoing care were also more likely to report IPV in their current or recent relationship. This underscores the potential importance of identifying those adolescents experiencing IPV as a means to provide needed clinical care and support services.
Thus, current findings provide little support for an IPV-specific clinical profile that would facilitate selection of those individuals who should be prioritized for screening. Further highlighting the need for improvements in this area of clinical practice, less than a third of female adolescent patients were ever screened by a health care provider for experiences of IPV.
However, the majority stated they would want their health care provider to ask about the topic. Interestingly, participants who had experienced IPV were more likely to report having been asked about IPV, although the percentage screened was still less than half. This may represent heightened sensitivity or recall towards IPV related questions based on their experiences, or actual selective screening by providers based on s of abuse. Regardless, these data point toward a critical unmet need regarding clinical care for adolescents experiencing IPV. The reasons for non-disclosure offered by participants, including fear of broader disclosure and embarrassment, also highlight the potential benefit of educating adolescent clinicians and clinic attendees regarding confidentiality, including limits of confidentiality, and the role of health care providers in providing supportive care.
The primary limitation for this study is the cross-sectional de i. The association of IPV to foregone care and poor health status in particular merits further study, that is, whether and how current IPV might influence adolescent health care-seeking patterns.
While the reliance on self-report of IPV experiences is likely to introduce biases in assessment, prior studies on sensitive topics including violence indicate that utilizing ACASI improves data collection and reliability of self-reports [ 4142 ]. In addition, respondents were asked at the start of the survey whether they would be able to answer honestly; those who responded that they would not answer honestly were not included in the analyses.
An additional study limitation is that the clinics chosen for this study were all from a single urban metropolitan area primarily serving clients from low income communities of color; thus, findings do not generalize to experiences of adolescent female clinic users from the broader population, particularly those living in rural or less impoverished areas. This study documents a high prevalence of IPV victimization among female users of adolescent health clinics. Clinical implications of current findings include the need to develop, evaluate and implement IPV screening and intervention protocols for this population at high risk for experiencing IPV.
In addition, health care providers who come in contact with adolescents should receive guidance to not only implement such protocols, but to also provide all adolescent clinic users with information on IPV and resources available for victims of such violence.
Such screening and clinical interventions should include connections to IPV support and advocacy resources to assure provision of longer-term, expert assistance for this population. Development of adolescent-relevant and accessible IPV support, advocacy, and assistance resources should be considered priorities within adolescent medicine and related social services.
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National Center for Biotechnology InformationU. Maternal and Child Health Journal. Matern Child Health J. Published online Sep Elizabeth Miller1 Michele R. Silverman 2. Michele R. Jay G. Author information Copyright and information Disclaimer. Corresponding author.