A Longitudinal Study Of Substance Use And Intimate Partner Violence Among Low-income, Urban Women Seeking Emergency Care

Background and Purpose: Growing evidence suggests intimate partner violence (IPV) and substance misuse are co-occurring problems that disproportionately affect low income urban women seeking care in emergency departments (EDs) and represent leading causes of injuries that result in ED visits. This paper aims to examine temporal associations between different types of drug and alcohol use and different types of IPV in a longitudinal NIMH funded study of low income, urban women receiving emergency care among a representative sample of 241 women was recruited from an ED in the Bronx, New York.

Methods: Eligibility criteria included female ED patients, aged 18 or over, who were admitted to the ED during a randomly selected time block and who reported having had relationship with boyfriend, husband or regular male sexual partner in the past year. Study participants completed repeated assessments administered in face-to-face interviews at baseline (wave1), 6-month follow-up (wave 2), 12-month follow-up (wave 3). The assessment covered substance use, IPV as measured by the Revised Conflict Tactics Scale, sociodemographics and selected risk and protective factors that served as covariates, including: homelessness, incarceration, childhood sexual abuse, psychological distress, coping, partner illicit drug use and binge drinking, financial dependency, relationship decision making power, unmet service need and social support. Propensity score matching and modified Poisson regression were used to examine the temporal associations between different types of drug and alcohol use and different types of IPV, adjusting and matching for socio-demographics and covariates.

Results: About four in ten participants (42%) reported experiencing any physical, injurious or sexual IPV in the past six months and 43% indicated any illicit drug use at wave 1. After adjusting and matching for socio-demographics and covariates, women who reported using heroin in the prior six months at wave 1 were twice as likely as women who did not report such heroin use to report any physical, injurious or sexual IPV (Relative Risk Ratio (RR)=2.1, CI=1.2, 3.6) and were 2.7 times more likely to indicate that they had sustained an injury from IPV (CI=1.1, 6.5) at subsequent waves. Women who reported crack or cocaine use in the past 6 months at wave 1 were 2.4 times more likely to report injurious IPV (CI=1.2, 4.7) and twice as likely to indicate severe verbal abuse (RR=2.0, CI=1.2, 3.3) at subsequent waves compared to women who did not report use of crack or cocaine at wave 1. Similarly, women who reported experiencing sexual IPV at wave 1 were more that three times as likely to indicate use of crack or cocaine (RR=3.3, CI=1.1, 9.5) subsequent waves, compared to women who did not report sexual IPV at wave1.

Conclusion: The high rates of recent IPV and substance use and multiple associations found linking these problems underscore the need for conducting routine screening for IPV and substance misuse among women in low income, urban EDs and improving linkages to services that will ultimately reduce the risk of morbidity, disability and mortality related to these co-occurring problems.