1. r, Ph D, RN, PNP BC Co-Investigator Preventative Health Screening amongst Women who have Experienced Intimate Partner Violence (IPV) American Public Health Association Chicago, Illinois November 2, 2015 Texas Woman’s University, College of Nursing, Houston, Texas Anne Koci, PhD, RN, APRN, FNP-BC Texas Woman’s University, College of Nursing, Houston, TexasCo-Investigators: Sandy Cesario, PhD, RN; Fuqin Liu, PhD, RN; Heidi Gilroy, MSN, APHN- BC, Judith McFarlane, DrPH, RN; John Maddoux, MA

2. 7-Year Mother-Child Study Research Team Bold=team members on this presentation Judith McFarlane (PI)Faculty Brenda Binder Faculty Sandra CesarioFaculty Nina Fredland Faculty Anne KociFaculty Fuquin LuiFaculty Angeles Nava Post-Doc Fellow Ann Bianchi Doctoral Student Heidi Gilroy Doctoral Student Rene Paulson Biostatistician Jackie Pennings Biostatistician John Maddoux Doctoral Student, Biostatistician Funding Source: Houston Endowment

3. Acknowledgements The Dedication, Assistance and Support of: 5 Harris County shelters Administrators and staff of 5 Harris County shelters Harris County District Attorney’s Chief and staff of Harris County District Attorney’s Office, Family Criminal Law Division. 300 women 300 women who take emotional and physical risks to record their survival journey, pain and recovery and their children who journey with them.

4. Background & Significance Intimate partner violence: – affects 1 in 3 women (global estimates 1 in 2) – linked to higher rates of women’s cancers – linked with increased utilization of health care services but preventative health care is comparably low – research suggests + association b/w IPV & ca

5. Background & Significance Scant evidence of the association between violence and health screening behaviors: – Pap testing, – Mammography – Clinical breast exams (CBEs) – Self-breast exams (SBEs)

6. Purpose To identify engagement of abused women in preventive health screening behaviors.

7. Methods Design: Cross-sectional study… 24 month data of a 7-year prospective study to examine treatment efficacy of the 2 models most often offered to abused women (shelter vs protection order). (Interviews q 4 mos) Instruments: Demographic information. Data on health promotion behaviors collected via investigator designed instrument.

8. Methods Participants: 284 abused women (median age: 30 y/o, range 18-52 y/o) with children. 79% Hispanic, 37% immigrant status. Data analysis: Self-reported data for descriptive & chi square analysis.

9. Results In this sample of abused women: More likely to have Pap, MMG, & do SBE than general population of women in US/66.5% received MMG (40% in last 12 mo)/99.6% pap in lifetime/60.3% in last 12 mo Higher reported incidence of STIs than general 70.7% reported abnormal pap results Immigrants reported less abnormal paps

10. Conclusions The higher incidence of STIs & abnormal paps warrants continued promotion of health screening for abused women. Recommend HPV testing & bimanual pelvic exams for abused women. Need vigilance to maintain screening & thorough follow up for abnormal findings.

11. Implications for Practice Women seeking gynecological services such as pap smears and treatment for STIs should be screened for intimate partner violence (IPV). USPSTF recommends screening instruments for diagnostic accuracy.

12. Website for resources Website has information about IPV with links to national and state resources http://www.acf.hhs.gov/programs/ fysb/programs/family-violence- prevention-services

13. Questions? Thank You for your kind attention.