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Severity of abuse before and during pregnancy for african american, hispanic, and anglo women

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Abstract

Objective: To describe timing and severity of abuse before and during pregnancy for African American, Hispanic, and white Anglo American women.

Findings: Among 199 abused women, 18.1% of the women were abused during pregnancy but not the year before, 30.2% were abused the year before but not during pregnancy, and 51.8% were abused both the year before and during pregnancy. The timing of abuse did not vary by ethnicity. The three (ethnicity) by three (timing) factorial analysis of variance showed severity of abuse to vary by timing of abuse. Women reporting abuse both before and during pregnancy reported greater severity of abuse on each of the five measures than did women abused only before pregnancy or only during pregnancy.

Conclusions: Over half (51.8%) of the women reported abuse before and during pregnancy with these women reporting greater severity of abuse on all five severity scores. Timing and severity of abuse did not vary by ethnic group. The majority of women abused during pregnancy were also abused prior to pregnancy, indicating the need for universal screening of all women during each health encounter.

Section snippets

Materials and methods

The descriptive data presented in this report is part of a larger study that measured the effectiveness of an intervention protocol for pregnant abused women (20). Following human subject approval, the study was completed in public clinics in two geographic settings offering a variety of services for women and children. To recruit subjects for the study, all pregnant women were assessed for abuse by the investigators using the Abuse Screen. See Appendix. If the woman answered yes to questions

Abuse screen

The Abuse Screen consists of five questions to determine timing of abuse and perpetrator within a defined period of time. See Appendix. The Abuse Screen was derived from the Abuse Assessment Screen, which was developed by the Nursing Research Consortium on Violence and Abuse (21). Content validity was established for the Abuse Assessment by comparing responses with scores on the ISA and DAS (22).

Index of spouse abuse

The Index of Spouse Abuse (ISA) is a 30-item, self-report scale designed to measure the severity or

Sample

This report is based on a study of 199 abused women, of whom 35% (n = 70) are African American, 33% (n = 66) Hispanic (primarily Mexican and Mexican American), and 32% (n = 63) are white Anglo American women. (Hispanic was defined as non-Anglo and non-African American and of Spanish speaking decent.) The women were between the ages of 14 and 42 years, with a mean age of 23.2 years (SD = 5.6); 29.6% were teenagers (ie, 19 years or less). This was the first pregnancy for 35% of the women; 65%

Analysis plan

Analysis consisted of examining the demographic characteristics as well as severity and timing of abuse for their relationship to ethnicity. χ2 Analysis was used for nominal level data (eg, living with partner) and one-way analysis of variance (ANOVA) was used for interval level data (eg, age or severity of abuse). To explore the relationship of both ethnicity and timing of abuse to the severity of abuse, a three (ethnicity) by three (timing) factorial ANOVA was used with each of the severity

Results

Table 1 summarizes the demographic characteristics of the sample by ethnic group. The groups are similar except in two areas: Hispanic women had significantly less education than African American or white Anglo American women, and white Anglo American women had significantly fewer children than the others. Ninety-three percent of the white Anglo American women had two or fewer children as compared to 74% of the African American and 73% of the Hispanic women.

Based on entry visit data, 157 women

Discussion

Among this group of 199 abused women, over half (51.8%) of the women reported abuse both before and during pregnancy with no significant difference by ethnicity. Although two severity scores (ISA-NP and Threat of Violence) differed by ethnicity, once ethnicity was controlled, it was the timing of abuse that accounted for significant differences in all severity scores. Regardless of ethnicity, women reporting abuse both before and during pregnancy reported greater severity of abuse on each of

Implications and conclusions

Healthy People 2000: National Health Promotion and Disease Prevention Objectives (35) denotes prevention of violence as one of the 21 priority objectives for the United States. Healthy People 2000: Midcourse Review and 1995 Revisions (36) calls for the training of health care professionals to address the needs of victims of violence. Violence in America: A Public Health Approach recommends the “establishment and implementation of model protocols for early identification and referral of abuse

Acknowledgements

This research was supported by Grant Number R49/CCR309832 from the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. Its contents are solely the responsibility of the authors and do not necessarily reflect the official views of the CDC.

Judith McFarlane is the Parry Chair in Health Promotion and Disease Prevention at Texas Woman’s University, College of Nursing in Houston, Texas, USA. Dr. McFarlane began doing research on abuse during pregnancy in the early 1980s and has since authored seminal research on the effect of abuse on maternal and infant health.

Barbara Parker is a professor at the University of Virginia, School of Nursing, Charlottesville, VA, USA and Director of Research and Director of the Doctoral Program. Dr.

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  • Cited by (0)

    Judith McFarlane is the Parry Chair in Health Promotion and Disease Prevention at Texas Woman’s University, College of Nursing in Houston, Texas, USA. Dr. McFarlane began doing research on abuse during pregnancy in the early 1980s and has since authored seminal research on the effect of abuse on maternal and infant health.

    Barbara Parker is a professor at the University of Virginia, School of Nursing, Charlottesville, VA, USA and Director of Research and Director of the Doctoral Program. Dr. Parker began doing research with Dr. McFarlane in the 1980s and together they have developed and tested assessment and intervention models for the care of abused pregnant women.

    Karen Soeken is a statistician and associate professor at the University of Maryland, School of Nursing, Baltimore, MD, USAand has authored many publications on abuse during pregnancy.

    Concepcion Silva is an associate professor in the School of Nursing, University of Texas at GalvestonGalveston, TX, USA. Dr. Silva completes research in therapeutic touch and the experience of abuse to Hispanic women.

    Sally Reel is a nurse practitioner in rural West Virginia and Assistant Professor at the University of Virginia, School of Nursing, Charlottesville, VA, USA.

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