Adverse Health Conditions and Health Risk
Behaviors Associated with Intimate Partner
Violence in US Virgin Islands
Grant Support: National Center on Minority Health and Health Disparities , NIH (# P20MD002286).
CERC Presentations
NBNA SYMPOSIUM
SAN DIEGO
AUGUST 4, 2010
Intimate partner violence (IPV)
• IPV is violence that occurs between a victim and
perpetrator who are current or former spouses or partners.
• The violence can be physical, sexual and psychological in
nature and includes threats of physical or sexual violence
against a partner and stalking a partner (CDC).
• Women are more likely than men to be repeatedly abused,
injured, or die as a result of partner violence.
• In addition to the risk for death and injury, IPV has been
associated with certain adverse health conditions and
health risk behaviors.
CERC Presentations
NBNA SYMPOSIUM
SAN DIEGO
AUGUST 4, 2010
The Behavioral Risk Factor Surveillance System (BRFSS)
• The BRFSS is a collaborative project of the Centers for
Disease Control and Prevention (CDC) and the United
States (U.S.) and territories.
• The BRFSS, administered and supported by CDC's
Behavioral Surveillance Branch, is an ongoing data
collection program designed to measure behavioral risk
factors of adults living in households.
• The BRFSS was initiated in 1984, with personnel from 15
states collecting surveillance data on risk behaviors through
monthly telephone interviews.
CERC Presentations
NBNA SYMPOSIUM
SAN DIEGO
AUGUST 4, 2010
The Behavioral Risk Factor Surveillance System (BRFSS)
• Over time, the number of states participating in the survey
increased; by 2001, 50 states, the District of Columbia,
Puerto Rico, Guam, and the US Virgin Islands were
participating in the BRFSS.
• Data collected annually consist of
– identifying demographic variations in health related
behaviors,
– addressing emergent and critical health issues,
– measuring progress in health objectives, and
– linking findings to a framework, the social determinants of
health.
NBNA SYMPOSIUM
SAN DIEGO
AUGUST 4, 2010
Purpose
• The purpose of this study is to
describe the results of 2005 and
2006 BRFSS survey on IPV and
selected health conditions and
health risk behaviors among the
resident of the US Virgin Island.
Table 1. Number and Percent of Adults Ages ≥ 18 Years Residing in US Virgin Island with a Lifetime History of Intimate Partner
Violence Victimization by Sex, Age Group, Race/Ethnicity, Annual Household Income, Education Level, and Marital Status
– Behavioral Risk Factor Surveillance System, 2005.
Women
Men
Characteristics
No
%
95% CI
No
%
95% CI
Age Group (Years)
18–24
23
7.25
24–34
79
20.34
35–44
94
21.97
45–54
98
20.43
55–64
80
17.14
≥65
56
12.86
Hispanic/Latino
Yes
71
19.51
No
365
80.49
Race/Ethnicity
White
66
16.73
Black or African American
262
76.50
Other
21
6.77
Annual Household Income ($)
Less than 15,000
66
18.54
15,000 – 24,999
84
23.78
25,000 – 34,999
58
13.66
35,000 – 49,999
83
22.13
50,000 or More
88
21.89
Education Level
Did Not Graduate High School
69
17.35
High School Graduate
151
37.55
Some College
106
23.22
College Graduate
115
21.88
Marital Status
Married
126
37.26
Divorced
111
21.20
Widowed
38
7.66
Separated
21
3.74
Never Married
129
25.95
A Member of an Unmarried Couple
19
4.19
Note: % and 95% CI (Confidence Interval) are weighted estimates.
6.76 – 7.75
19.56 – 21.11
21.18 – 22.77
19.66 – 21.21
16.42 – 17.87
12.22 – 13.50
15
21
36
48
35
20
11.67
19.27
20.06
24.42
16.20
8.37
10.94 – 12.41
18.36 – 20.18
19.14 – 20.99
23.43 – 25.41
15.35 – 17.05
7.73 – 9.00
18.75 – 20.27
79.73 – 81.25
20
156
12.67
87.33
11.90 – 13.44
86.56 – 88.10
15.92 – 17.55
75.57 – 77.42
6.22 – 7.32
47
94
9
26.83
67.06
6.11
25.72 – 27.94
65.88 – 68.24
5.51 – 6.71
17.74 – 19.35
22.89 – 24.66
12.95 – 14.38
21.27 – 22.98
21.03 – 22.75
21
26
21
26
51
15.86
18.32
15.57
18.79
31.47
14.94 – 16.78
17.34 – 19.29
14.65 – 16.48
17.80 – 19.77
30.29 – 32.64
16.63 – 18.08
36.62 – 38.47
22.41 – 24.03
21.09 – 22.68
34
64
28
46
20.23
40.75
15.15
23.88
19.28 – 21.17
39.60 – 41.90
14.31 – 15.99
22.88 – 24.88
36.34 – 38.18
20.42 – 21.98
7.15 – 8.17
3.38 – 4 .10
25.12 – 26.79
3.81 – 4.57
84
33
4
7
45
5
48.34
12.24
1.44
4.03
31.59
2.36
47.20 – 49.48
11.49 – 12.99
1.17 – 1.71
3.35 – 4.48
30.52 – 32.65
2.02 – 2.71
Table 2. Weighted Prevalence of Selected Health Conditions and Risk Behaviors among Adults ≥ 18 years, Residing in US Virgin
Island, by Sex and Life History of Intimate Partner Violence (IPV) Victimization – Behavioral Risk Factor Surveillance
System, 2005.
Women
Men
IPV
No IPV
IPV
No IPV
Health Condition/
%
95% CI
%
95% CI
%
95% CI
%
95% CI
Risk Behavior
Health Condition
Diabetes
9.29
8.73 – 9.84
11.28
10.95 – 11.62
5.54
5.02 – 6.07
7.47
7.18 – 7.76
Disability Equipment
5.81
5.36 – 6.26
4.37
4.16 – 4.59
2.90
2.50 – 3.29
2.58
2.41 – 2.76
Arthritis
25.08
24.24 – 25.93
19.18
18.76 – 19.60
14.10 13.27 – 14.93
12.39 12.03 – 12.76
Current Asthma
12.87
12.24 – 13.51
9.05
8.75 – 9.36
7.09
6.50 – 7.69
7.27
6.99 – 7.56
Activity Limitations
13.04
12.39 – 13.69
8.92
8.62 – 9.22
11.58 10.82 – 12.33
9.33
9.01 – 9.65
Stroke
1.86
1.60 – 2.12
1.74
1.60 – 1.88
1.40
1.13 – 1.68
2.01
1.86 – 2.16
High Cholesterol
36.20
35.16 – 37.24
36.37
35.78 – 36.95
37.66 36.31 – 39.01
34.42 33.80 – 35.04
High Blood Pressure
32.54
31.65 – 33.43
27.20
26.73 – 27.67
19.62 18.70 – 20.54
21.73 21.28 – 22.18
Heart Attack
2.92
2.59 – 3.24
1.91
1.76 – 2.05
1.41
1.14 – 1.68
1.72
1.58 – 1.86
Heart Disease
1.53
1.29 – 1.76
1.86
1.72 – 2.00
0.37
0.23 – 0.51
2.19
2.03 – 2.36
Risk Behavior
HIV or STD
9.09
8.43 – 9.75
5.50
5.23 – 5.77
Current Smoking
9.45
8.90 – 10.01
4.94
4.71 – 5.17
Heavy drinking
6.53
6.06 – 7.00
3.89
3.69 – 4.10
(BMI) > 25
63.89
62.94 – 64.84
64.09
63.57 – 64.61
Note: % and 95% CI (Confidence Interval) are weighted estimates.
11.47
15.88
24.20
61.40
10.55 – 12.40
15.03 – 16.73
23.18 – 25.23
60.25 – 62.54
5.67
9.32
17.99
61.69
5.38 – 5.95
9.00 – 9.64
17.56 – 18.42
61.15 – 62.23
Table 3. Association between Lifetime History of Intimate Partner Violence Victimization and Selected Health Conditions and
Risk Behaviors among Adults ≥ 18 years, Residing in US Virgin Island, by Sex – Behavioral Risk Factor Surveillance System,
2005.
Health Condition/
Risk Behavior
Health Condition
Diabetes
Use of disability Equipment
Arthritis
Current Asthma
Current Activity Limitations
Stroke
High Cholesterol
High Blood Pressure
Heart Attack
Heart Disease
Risk Behavior
Risk Factors for HIV or STD
Current Smoking
Heavy drinking
Body Mass Index > 25
Women
Men
AOR
95% CI
AOR
95% CI
1.25
0.80
0.53*
0.52*
1.56*
1.68*
0.66
1.28*
1.25*
1.29*
0.58 – 2.45
0.33 – 1.96
0.34 – 0.81
0.30 – 0.91
1.34 – 1.93
1.10 – 2.57
0.43 – 1.00
1.01 – 1.75
1.03 – 1.78
1.09 – 1.79
0.80
1.41
0.79
0.70
0.92
1.01
1.12
0.92
1.15
1.16
0.22 – 2.89
0.29 – 6.89
0.36 – 1.74
0.24 – 2.00
0.51 – 1.66
0.61 – 1.35
0.51 – 2.46
0.74 – 1.12
0.89 – 1.49
0.90 – 1.51
0.32
1.11
1.06
1.01
0.17 – 0.60
0.90 – 1.37
0.88 – 1.27
0.90 – 1.12
0.54
1.30
1.07
0.93
0.20 – 1.45
0.96 – 1.71
0.93 – 1.23
0.75 – 1.15
Note: AOR -- Adjusted odds ratio for age, race/ethnicity, annual household income, and educational level. * -- Statistically
significant (p < 0.05) by Wald Chi-square test.
Table 4. Number and Percent of Adults Ages ≥ 18 Years Residing in US Virgin Island with a Lifetime
History of Intimate Partner Violence Victimization by Sex, Age Group, Race/Ethnicity, Annual Household Income, and
Education Level – Behavioral Risk Factor Surveillance System, 2006.
Women
Men
Characteristics
No
%
95% CI
No
%
95% CI
Age Group (Years)
18–24
36
12.25
11.93 – 13.20
14
10.57
5.35 – 8.20
24–34
93
18.30
17.56 – 19.04
36
19.92
11.38 – 15.23
35–44
103
17.63
16.89 – 18.36
51
22.29
18.13 – 22.70
45–54
120
18.65
17.90 – 19.40
55
18.35
19.18 – 23.84
55–64
111
16.81
16.10 – 17.53
53
17.43
19.26 – 23.92
≥65
90
16.05
15.35 – 16.76
43
11.44
14.30 – 18.50
Hispanic/Latino
Yes
89
18.77
18.03 – 19.51
45
25.83
24.82 – 26.84
No
479
81.23
80.49 – 81.97
208
74.17
73.16 – 75.18
Race/Ethnicity
White
37
18.95
13.43 – 24.46
25
17.38
7.44 – 21.12
Black or African American
158
81.05
75.54 – 86.57
86
82.62
77.72 – 87.72
Annual Household Income ($)
Less than 15,000
91
19.26
17.02 – 22.49
33
17.10
15.68 – 18.51
15,000 – 24,999
101
19.58
17.34 – 22.72
49
22.55
20.95 – 24.34
25,000 – 34,999
79
17.56
16.76 – 18.36
42
24.28
23.19 – 25.38
35,000 – 49,999
81
16.37
15.59 – 17.15
27
10.76
9.97 – 11.55
50,000 or More
131
27.23
25.80 – 29.67
59
26.32
24.15 – 28.69
Education Level
Did Not Graduate High School
102
17.43
16.23 – 18.62
82
31.35
29.56 – 33.15
High School Graduate
180
36.08
35.17 – 37.00
82
32.11
31.03 – 33.19
Some College
116
21.11
20.33 – 21.88
42
16.55
15.69 – 17.41
College Graduate
169
25.38
24.55 – 26.21
44
19.99
19.06 – 20.91
Note: % and 95% CI (Confidence Interval) are weighted estimates.
Table 5. Weighted Prevalence of Selected Health Conditions and Risk Behaviors among Adults ≥ 18 years,
Residing in US Virgin Island, by Sex and Life History of Intimate Partner Violence (IPV) Victimization – Behavioral Risk
Factor Surveillance System, 2006.
Women
Men
IPV
No IPV
IPV
No IPV
Health Condition/
%
95% CI
%
95% CI
%
95% CI
%
95% CI
Risk Behavior
Health Condition
Diabetes
13.2
10.7–15.7
9.3
8.9–9.6
9.8
9.1–10.5
9.0
8.6–9.2
Use of disability Equipment
4.5
4.1–4.8
3.8
3.6–4.0
4.5
4.0–5.0
4.1
3.8–4.3
Current Asthma
7.8
7.3–8.3
4.1
3.9–4.3
3.4
3.0–3.9
3.8
3.8–4.1
Current Activity Limitations
12.7
12.0–13.28
8.5
8.1–8.8
10.0
9.3–10.7
10.3
10.0–10.7
Stroke
2.4
2.0–2.4
1.7
1.5–1.9
3.2
2.8–3.6
1.9
1.7–2.1
Heart Attack
2.0
1.7–2.3
1.2
1.0–1.4
1.5
1.2–1.8
2.5
2.3–2.4
Heart Disease
3.1
2.7–3.4
1.7
1.5–1.9
1.1
0.8–1.3
1.9
1.7–2.1
Risk Behavior
HIV/AIDS Test
54.1
52.9–55.2
51.9
51.3–52.5
54.2
52.8–55.6
48.7
48.1–49.3
Current Smoking
8.2
7.7–8.8
5.1
4.8–5.4
15.3
14.5–16.2
10.5
10.2–10.9
Heavy drinking
11.8
11.3–12.5
6.1
5.8–6.4
23.2
22.3–24.2
14.5
14.1–14.9
Body Mass Index > 25
61.6
60.7–62.3
61.9
61.4–62.4
62.3
61.2–63.5
61.4
60.9–62.0
Note: % and 95% CI (Confidence Interval) are weighted estimates.
Table 6. Association between Lifetime History of Intimate Partner Violence Victimization and Selected Health
Conditions and Risk Behaviors among Adults ≥ 18 years, Residing in US Virgin Island, by Sex – Behavioral
Risk Factor Surveillance System, 2006.
Women
Men
Health Condition/
AOR
95% CI
AOR
95% CI
Risk Behavior
Health Condition
Diabetes
1.88
0.55 – 1.41
4.97*
1.06 – 23.29
*
Use of disability Equipment
1.67
1.30 – 2.48
1.54
0.19 – 12.45
*
Current Asthma
3.09
1.80 – 5.31
0.72
0.13 – 3.81
*
Current Activity Limitations
1.46
1.30 – 1.70
0.79
0.23 – 2.68
Stroke
0.53
0.17 – 1.65
1.00
0.12 – 8.21
Heart Attack
0.38
0.12 – 1.21
1.46
0.19 – 11.46
Heart Disease
1.24*
1.10 – 1.62
2.30
0.27 – 19.35
Risk Behavior
HIV/AIDS Test
1.64*
1.44 – 1.92
0.64
0.33 – 1.21
*
*
Current Smoking
1.35
1.22 – 1.56
0.30
0.15 – 0.61
*
*
Heavy drinking
3.69
2.32 – 5.87
5.34
2.92 – 9.73
Body Mass Index > 25
0.87
0.63 – 1.23
1.33
0.68 – 2.58
Note: AOR -- Adjusted odds ratio for age, race/ethnicity, annual household income, and educational level.
* -- Statistically significant (p < 0.05) by Wald Chi-square test.
IPV Prevalence of Adult Women ≥ 18 between USVI and
USA, PRFSS 2005 & 2006
17%
16%
16%
15%
2005
USVI
2006
USA
Weighted Prevalence of Selected Health Conditions among
Adults Women ≥ 18 Years, Residing in USVI Reporting IPV
Victimization
13%
2005
2006
13%
9%
8%
2%
Diabetes
Asthma
Stroke
2%
3%
2%
Hearth Attack
Weighted Prevalence of Selected Health Conditions among
Adults women ≥ 18 Years, Residing in USVI and US Reporting
IPV, BRFSS, 2005
16%
USVI
USA
13%
9%
8%
2%
Diabetes
Asthma
Stroke
3%
3% 3%
Hearth Attack
Weighted Prevalence of Selected Health Conditions among
Adults Women ≥ 18 Years, Residing in USVI and US Reporting
IPV, BRFSS, 2005
36%
36%
USVI
37%
USA
33%
25%
23%
2%
Arthritis
Cholesterol
HBP
4%
Heart Disease
Discussion
• IPV prevalence similar in USVI as in mainland US
– At least 16% of women lifetime prevalence
(approximately 7-8% of men)
– Underestimated in this kind of survey (telephone,
health related, privacy not assured)
– In most surveys specifically inquiring about
victimization – lifetime prevalence approximately
25%
• Also finding similar prevalence btw USVI & US in
ACAAWS study - African American and AfroCaribbean women in clinics in Baltimore & USVI
– but higher than BRFSS – past two years 25%;
lifetime – 40%
Discussion
• Negative health outcomes also found in
ACAAWS study –
– E.g. significantly more neurological problems in
those abused versus never abused; significantly
more overall pain; significantly more wheezing
Conclusions
• Therefore, important in full understanding of
health disparities among women of color, that IPV
be taken into account
• Importance of clinical studies to complement
population based surveys to fully understand
health problems & health disparities
• Also important for appropriate diagnoses and
adequate treatment of women’s health problems
that routine assessment for IPV be conducted
(Abuse Assessment Screen – www.nnvawi.org)
– If don’t know underlying problem, will only treat
symptoms