Exposure to violence and womens utilization of preventive healthcare

1
Exposure to violence and womens utilization of
preventive healthcare
Peter F. Cronholm, MD MSCE1,2,3,4, Douglas J.
Wiebe, PhD2,3,4 1Department of Family Practice
and Community Medicine, 2Center for Clinical
Epidemiology and Biostatistics, 3Firearm Injury
Center at Penn, 4Leonard Davis Institute of
Health Economics, University of Pennsylvania,
Philadelphia, Pennsylvania
Background
Conclusion
Results
Table 1 Sample Demographics

• Womens self-report of exposure to violence is
  associated with decreased rates of preventive
  health care utilization
• Women aged 35 and older who reported exposure to
  violence within the past year were 1.71 times
  more likely not to have had their cholesterol
  tested within the past five years.
• Women aged 40 and older who reported exposure to
  violence within the past year were 1.62 times
  more likely not to have had a mammogram within
  the past year.
• A womans minority status was associated with
  increased rates of breast exams, mammograms and
  colon cancer screening.
• Women with higher educational status had
  increased rates of breast exams, mammograms, and
  colon cancer screening

• Exposure to violence has been associated with
  increased rates of health care utilization.
• It remains unclear how exposure to violence are
  associated with preventive health care
  utilization.

• Womens self-report of exposure to violence is
  associated with decreased rates of preventive
  health care utilization for mammograms and
  cholesterol testing.
• A womans minority status and level of education
  predicted changes in preventive health services
  utilization for a variety of measures.

Objective

• To compare reports of preventive health care
  utilization among women who reported exposure to
  violence with women who reported no exposure to
  violence.

Practice, Research Policy Implications
Methods

• Primary care providers should be aware of the
  potential impact that exposure to violence can
  have on their patients ability to obtain
  age-appropriate preventative health care.
• Differing types of violence (community and
  interpersonal vs. domestic and intimate partner)
  may differentially impact health services
  utilization.
• There may be non-linear relationships that better
  describe the relationship between exposure to
  violence and health services utilization.
• Future steps include better characterizing the
  social and political factors that shape womens
  preventative health care utilization.

• Data from the Philadelphia Health Management
  Corporations Southeastern Pennsylvania Household
  Health Survey were used to identify our sample of
  women in Philadelphia and surrounding counties.
• Measures of self-reported preventive healthcare
  utilization timing of last cholesterol, blood
  pressure, Pap, breast exam, mammogram, colon
  cancer testing last Pneumovax and flu shots.
• Composite measure of violence reported
  victimization of physical violence, activities
  not performed because respondent did not feel
  safe, or health care evaluation for
  violence-related injuries.
• Logistic regression was used to compute adjusted
  odds ratios to estimate the association between
  exposure to violence and age-appropriate
  preventive healthcare utilization.

Table 2 Exposure to violence and womens
utilization of preventive healthcare