1. African-Caribbean & African- American Women’s Study Desiree Bertrand, MSN, RN Doris Campbell, PhD, ARNP, FAAN Ashley Chappell, BS, RN Jamila Stockman, PhD Phyllis Sharps, PhD, RN, FAAN Jacquelyn Campbell, PhD, RN, FAAN Mary T. Paterno, PhD(c), MSN, CNM

2. Acknowledgements This research supported by a subcontract with the Caribbean Exploratory NIMHD Research Center of Excellence (CERC), University of the Virgin Islands, Grant # P20MD002286, National Institutes of Health

3. ACAAWS Team Members United States Jacquelyn Campbell, PhD, RN, FAAN Phyllis Sharps PhD, RN, FAAN Richelle Bolyard, MHS Jamila Stockman, PhD, MPH Marguerite B. Lucea, PhD, MSN, MPH, RN Bushra Sabri, PhD, LMSW, ACSW Akosoa McFadgion, MS, MSW, PhD student Kaitlan Gibbons, PsyD(c) Mary Paterno, MSN, CNM, RN, PhD (c) Sharon O’Brien, PhD Sachi Mana-ay, BSN student Jessica Draughon, MSN, RN, PhD (c) Charmayne M. Dunlop-Thomas, MS Callie Simkoff, BSN, RN Gyasi Moscou-Jackson, MHS, BSN, RN Chris Kunselman Ayanna Johnson, MPH Ashley Chappell, BSN, RN Lucine Francis, BSN, RN Naa Ayele Amponsah, MPH Hossein Yarandi, PhD US Virgin Islands Doris Campbell, PhD, ARNP, FAAN Gloria Callwood, PhD, RN, FAAN Desiree Bertrand, MSN, RN Lorna Sutton, MPA Tyra DeCastro Alexandria Bradley, RN Sally Browne, RN Edris Evans, RN Yvonne Francis, RN Naomi Joseph, BSN student Jennifer King, RN Suzette Lettsome, MSPHN, RN Julie Matthew, RN Kenice Pemberton, ASN student J'Nique Smith, BSN student Jaslene Williams, MSW

4. Introduction Intimate partner abuse - increased risk for: Adverse neonatal outcomes Adverse maternal outcomes Sexually transmitted infections (STI) (Coker, 2007; Sarkar, 2008; Seth et al., 2010; Sharps et al., 2007; Shah & Shah, 2010; Silverman et al., 2006; Wu et al., 2003) African heritage – increased risk for: Adverse neonatal outcomes Adverse maternal outcomes Sexually transmitted infections (CDC, 2010, 2011; Curry et al., 1998; Hogue & Silver, 2011; Martin et al., 2011; McFarlane et al., 1996)

5. Study Purpose Examine differences in maternal and neonatal reproductive outcomes comparing women with history of intimate partner abuse (IPA) to never-abused women

6. Methods  Comparative case-control study (randomly selected controls)  Study period 2009-2011  Eligibility criteria  Women aged 18-55 years  Self-identify as Afro Caribbean or African American  Report intimate 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  Medical record abstraction for health outcomes

7.  CASES = Intimate Partner Abuse (IPA)  Intimate Partner Violence (IPV - physical/sexual abuse) & psychological abuse (threats/emotional abuse/controlling behavior )  IPV assessed using the Abuse Assessment Screen (AAS, McFarlane & Helton - www.nnvawi.org) www.nnvawi.org  Pushed, slapped, hit, kicked, or physically hurt &/OR  Forced sex  Psychological abuse: <19 on WEB (Women’s Experiences of Battering – Hall-Smith)  Controlled, in fear of current/former intimate partner  Any of the above by current or former intimate partner  Past 2 Year and Lifetime IPV (Physical/Sexual)—subgroups within cases  Exclusive of emotional/controlling abuse  Reported as Lifetime and Past-two-year  CONTROLS = Women never abused by anyone in their lifetime  Not eligible (if meeting age, race, and language requirements)  Women experiencing abuse only from someone other than an intimate partner or ex-partner.  Women reporting no partner within 2 years prior to survey Study Definitions

8. Final Participants 1579 screened from both sites n=486n=1059 169 controls 159 cases 189 controls n=553 n=461n=963 384 cases US Virgin IslandsBaltimore City, MD n=348 34 ineligible race; duplicates No partner past 2 yrs= 96 No partner past 2 yrs= 25 Didn’t meet case /control criteria = 70 Didn’t meet case /control criteria= 39 Non-selected control =329 Non-selected control = 74 Screened as case; no full survey=11 Lifetime IPA Total 621/1545=40% B’more 179/488=37% USVI 442/1059=42% Past 2-year IPV Total 382/1424= 27% B’more 119/461= 26% USVI 263/963= 26% 1315 fully eligible women

9. Sub-Sample Population Baltimore City, MDUS Virgin Islands Pregnant at Survey 42 cases 64 controls 98 cases 54 controls n=258 28 cases 49 controls 16 cases 8 controls Medical Record Abstraction n=101 Final Participants 169 controls 159 cases 189 controls n=553 384 cases n=348

10. Variables Dependent Variables Pregnancy outcomes Maternal antenatal outcomes Maternal infections Maternal behaviors Neonatal outcomes Independent Variable Lifetime experience of IPA

11. Analysis Descriptive analysis Chi-square, Fisher’s exact, and t-tests Regression analysis Generalized linear model AIC values Mediation test

12. Table 1. Demographic Characteristics of Sub-Sample, n(%) Overall (n=101) Cases (n=44) Controls (n=57) P-value † Age, years < 20 20-24 25-29 30+ 23 (22.8) 42 (41.6) 21 (20.8) 15 (14.8) 10 (22.7) 21 (47.7) 8 (18.2) 5 (11.4) 13 (22.8) 21 (36.8) 13 (22.8) 10 (17.4) 0.66 Education Level < High School High School Some College Completed College 34 (34.4) 41 (41.4) 13 (13.1) 11 (11.1) 12 (27.3) 21 (47.7) 8 (18.2) 3 (6.8) 22 (40) 20 (36.4) 5 (9.1) 8 (14.5) 0.19 Marital Status Single Partnered Married Other 49 (48.5) 37 (36.6) 12 (11.9) 3 (3) 24 (54.5) 12 (27.3) 5 (11.4) 3 (6.8) 25 (43.9) 7 (12.2) 0 0.10 Income, monthly < $400 $400-$1200 ≥ $1201 42 (43.3) 41 (42.3) 14 (14.4) 19 (43.2) 6 (13.6) 23 (43.4) 22 (41.5) 8 (15.1) 0.98 Health Insurance86 (85)35 (79.6)51 (89.5)0.16 Employed33 (32.7)17 (38.6)16 (28.1)0.26 † Chi-square or Fisher’s exact test

13. Pregnancy Outcomes

14. Figure 3. Maternal Antenatal Outcomes (%) HTN = hypertension PROM = premature rupture of membranes PPROM = pre-term premature rupture of membranes p <0.05

15. Figure 4. Maternal Infection and Behavioral Outcomes (%)

16. Table 2. Neonatal Outcomes, n(%) Overall (n=101) Cases (n=44) Controls (n=57) P-value † Gestation at Delivery < 32 32-36 37+ 2 (2.1) 11 (11.6) 82 (86.3) 1 (2.4) 5 (12.2) 35 (85.4) 1 (1.9) 6 (11.1) 47 (87.0) 1.0 Pre-Term Birth13 (13.7)6 (14.6)7 (13.0)0.81 Birth Weight in grams (mean, SD) 3075 (610)3028 (562)3112 (646)0.51 Low Birth Weight12 (13)5 (12.5)7 (13.5)0.74 Very Low Birth Weight2 (2.2)1 (2.5)1 (1.9)0.72 Small Gestational Age9 (9.7)6 (15)3 (5.7)0.11 NICU Admission7 (7.3)5 (11.9)3 (3.7)0.13 † Chi-square,Fisher’s exact test, or t-test; SD=standard deviation

17. Table 3. Odds Ratio for Select Outcomes, Baltimore cases vs. controls (n=74) VariableOdds Ratio (95% CI) Adjusted Odds Rati0* (95% CI) Small for Gestational Age6.3 (1.2-33.8)7.5 (1.2-46.6) Smoking3.4 (1.2-9.6)3.2 (1.1-9.2) NICU Admission5.1 (0.9-28.5)4.0 (0.66-24.4) † Adjusted for education, martial status, and income

18. Discussion No significant difference found for most variables IPA associated with higher smoking and SGA infants SGA may result in serious neonatal complications Nurses should focus on smoking reduction among women of childbearing age experiencing IPA Intervention research studies should test approaches to smoking cessation for women with IPA

19. Limitations Small sample size Unable to differentiate based on type/timing of abuse Homogenous population Limited to participants who gave permission for medical record review

20. Strengths ACASI technology Included participants from USVI Longitudinal data Included SGA as an outcome

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