Original Articles
A Prevalence Survey of Abuse and Screening for Abuse in Urgent Care Patients 1

Presented in part at the 44th Annual Clinical Meeting of the American College of Obstetricians and Gynecologists, Denver, Colorado, April–May, 1996.
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Abstract

Objective: To determine the prevalence of physical and sexual abuse in pregnant and nonpregnant women in an urgent care obstetrics and gynecology triage unit and the frequency with which these patients recall being screened by their health care provider.

Methods: We carried out a structured survey of 255 pregnant and 142 nonpregnant women presenting to an urban New England urgent care obstetrics and gynecology unit between February 1995 and September 1995. Patients in advanced stages of labor or unable to participate due to a language barrier were excluded. The survey consisted of 22 questions, seven of which were modified from the abuse assessment screen.

Results: Among 397 participants with complete data, we found that 184 (46%) reported a history of physical or sexual abuse in the past, and 38 (10%) reported recent abuse. Young age and insurance status (Medicaid or uninsured) were associated significantly with recent abuse after we controlled for race, education, and pregnancy status. Only 18% of women recalled being asked about abuse by a health care provider. Young women were more likely to report being asked about abuse. Among women reporting recent abuse, white women were significantly more likely to report being asked about abuse than nonwhite women (P = .02). The majority of women reporting a history of abuse did not recall being screened for violence by a health care provider.

Conclusion: Women of all ages, income, and ethnic backgrounds reported a history of domestic violence or sexual assault. Providers should incorporate routine screening into the assessment of all women.

Section snippets

Materials and Methods

This survey was conducted in the Women & Infants Hospital urgent care-triage area between February 1995 and September 1995. The interviews were administered by hospital volunteers who received 8 hours of training from the investigators and from area rape crisis and domestic violence victim service providers. The Institutional Review Board waived the informed consent requirement because this was considered an extension of routine clinical care.

Women were screened with this survey if they

Results

Of the 397 women in this sample, 255 (64%) were pregnant. Two hundred forty-two (61%) were white, 71 (18%) were black, 61 (15%) were Hispanic, and 23 (6%) were from other ethnic backgrounds. Two hundred thirty-six (59%) were privately insured or members of a health maintenance organization, 161 (41%) received Medicaid or had no insurance. Two hundred twenty-one (56%) had at least a high school education.

One hundred eighty-four women (46%) reported a lifetime history of physical or sexual abuse.

Discussion

Our results support previous work1, 2, 3, 4, 5, 6, 7, 8, 15, 16that reveals a high prevalence of domestic violence and sexual assault in pregnant and nonpregnant female patients with a wide range of presenting complaints. We disagree with other reports11, 12claiming that pregnancy is a risk factor for violence. We found that nonpregnant women report a slightly higher prevalence of abuse than pregnant women. Although some studies11, 12have implicated pregnancy as a risk factor for violence, we

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    1

    Funded in part by the Echoing Green Foundation, Public Service Fellowship, New York.

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