The Association between Exposure to Intimate Partner Violence and having an Abnormal Pap Test and HPV Infections among Women in a Low-Income, Urban Area
Btoush, Rula M.
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Session presented on Monday, July 27, 2015: Purpose: The purpose of this presentation is to examine the association between intimate partner violence (IPV) and abnormal Papanicolaou (Pap) test results, including human Pepillomavirus (HPV) infection and cellular abnormality. As well as the interaction of exposure to IPV with smoking, psychosocial stress and risky sexual behaviors on abnormal Pap test results. Intimate partner violence (IPV) affects 20-50% of women in the United States sometime in their lives. An estimated 40% of IPV victims seek medical treatment for their injuries. The National Center for Injury Prevention and Control has reported that 33% of all female homicides are perpetrated by current or ex intimate partners and IPV results in 550,000 injuries requiring medical attention every year. The same report estimated the total annual cost of IPV at around $3.9-7.6 billion in the United States. Professional organizations recommend routine screening of all female patients for IPV; however, IPV is significantly underreported, unidentified, and mismanaged by health care providers. It places victims at higher risk for physical injuries, psychosocial problems, Maternal complications, and death. Studies have reported a higher prevalence of IPV among poor women and women from ethnic minority groups; and these groups also had higher rates of many of the health consequences associated with IPV. According to the National Cancer Institute, 12,170 women will be diagnosed with cervical cancer in 2012 with a projected death rate of 4, 220 women. Further, high-risk, human Pepillomavirus (HR-HPV) is a major risk factor for cervical cancer and is associated with 95%-100% of squamous and 75%-95% of intraepithelial cervical cancers. The rate of HPV-associated cervical cancer was significantly higher among Black and Hispanic women compared to their White counterparts. In 2009, the national age-adjusted cervical cancer incidence rates (per 100,000) for Black and Hispanic women (10.0 and 10.9, respectively) were dramatically higher than the rate for White women (7.6). Also, the national age-adjusted cervical cancer mortality rate (per 100,000) for Black women (4.2) is dramatically higher than the rates for Hispanic and White women (2.9 and 2.1, respectively). In addition to race and ethnicity, the incidence rate of cervical cancer increases with higher poverty. Intimate Partner Violence is associated with all the known risk factors for cervical cancer, including smoking, stress, risky sexual behaviors, and HPV infection. Exposure to IPV and the control imposed by the abusive partner may influence the risk for cervical cancer by restricting the woman's ability to seek cervical cancer screening services and screening for cancer at recommended intervals. Exposure to IPV and fear in a relationship interferes with receiving follow-up care among women with abnormal Pap test results as well treatment of cervical cancer. Women exposed to IPV have many of the factors that impact access to health services such as being under or uninsured, living in poverty, lower education, poor employment opportunities, and lower access to transportation. Methods: This prospective, descriptive, correlational study consists of 400 women between the ages of 21 and 50 years recruited from an urban community health center. The majority of women are Black (81%), single (84%), and insured (76%). The study outcomes include exposure to IPV, history of smoking, psychological stress, and risky sexual behaviors. Study participants completed a 20-minute survey about their IPV history, smoking, stress, and risky sexual behaviors. Recent Pap test results and HPV infection status were collected from their health records. Results: Past year exposure to IPV was 13% for physical, 4% for sexual, and 21% for psychological IPV. Lifetime exposure to IPV was 38% for physical, 19% for sexual, and 37% for psychological IPV. A substantial number of women reported current or past smoking (24% and 10%) respectively. The mean number of years of smoking was 7 (SD=6.1). Prevalent risky sexual behaviors included not using a condom (24%), ever having any STIs (40%), and having an intimate partner who has had sex with more than one partner. The average number of sexual partners was 8 in a lifetime (SD=6) and 1.6 in the past year (SD=1.4). Women reported relatively high levels of perceived stress such as often feeling nervous and stressed (56%), upset due to unexpected life events (45%), and angered because things were outside their control (39%). A substantial number of women reported never feeling that things were going their way (16%), able to control irritations in your life (11%), and confident about their ability to handle personal problems (11%). Physical, sexual, and psychological IPV were significantly associated with smoking history, ever having any STI, number of sexual partners, and perceived stress. Having an abnormal Pap test was significantly associated with past year exposure to physical (30.8% vs. 7.1%), sexual (66>7% vs. 8.4%), and psychological IPV (26.7 % vs. 7.2%). Having a positive HPV infection was associated with past year exposure to physical (33.3% vs. 2.0%) and sexual IPV (50.0% vs. 3.8%). Having an abnormal Pap test or a positive HPV infection was not associated with lifetime exposure to IPV. Additional results will be presented about the association between exposure to IPV and each of the mediating cervical cancer risk factors (smoking, perceived stress, and risky sexual behaviors) in a multivariate analysis with calculated adjusted odds ratios and 95% confidence intervals. Conclusion: Exposure to IPV is detrimental to women's gynecologic health. Women exposed to IPV may feel that the Pap test is threatening and a reminder of the abuse and violence. Therefore, in cervical cancer screening, it is important to routinely ask about history or exposure to abuse and apply the strategies of trauma informed care when working with women. On a global level, the World Health Organization (WHO) identified that 1 out of 3 women throughout the world will experience physical or sexual violence by a partner or sexual violence by a non-partner. This study has potential for engaging in scholarly conversations with global partners regarding best practices for women exposed to violence and the impact on cervical abnormalities and HPV infections. The study has received funding from the New Jersey Foundation Grant.