Partner interfering behaviors affecting cancer quality of life.

OBJECTIVE: Because partners are an important and unpaid resource in cancer care, understanding how destructive, controlling or interfering partner behaviors influence women's cancer care may be particularly relevant for health care providers seeking to provide cancer care and enhance recovery. Using a new measure of partner interfering behaviors in cancer care (PIB-C), we investigated whether women with a recent cancer diagnosis who additionally endorsed any PIB-C would report (a) more symptoms of depression and stress, and (b) lower Functional Assessment of Cancer Therapy (FACT-G) and lower Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-SP) scale scores indicating poorer quality of life (QOL). METHODS: Women aged 18-79 included in cancer registries as having an incident, primary, biopsy-confirmed cancer in the past 12 months were eligible for this study. Consenting women completed a phone interview 9-12 months following cancer diagnosis between 2009 and 2015. Interviews provided data to measure outcomes (perceived stress and depressive symptoms, FACIT-SP and FACT-G scores), partner supportive and interfering behaviors, and other potentially confounding factors. RESULTS: Of the 2376 women in a relationship at cancer diagnosis, 14.7% endorsed one or more of 14 PIB-C items. Women endorsing any PIB-C item reported more symptoms of depression and stress and lower FACT-G and FACIT-SP scores than partnered women reporting no PIB-C even when controlling for partner supportive behaviors and lifetime intimate partner violence. Increasing PIB-C scores were also correlated, in a dose-response pattern, with these same outcomes. CONCLUSIONS: Partner interfering behaviors during cancer care impact patients' QOL across multiple domains. © 2016 The Authors. Psycho-Oncology Published by John Wiley & Sons Ltd.

Intimate partner violence and women's cancer quality of life.

PURPOSE: Because intimate partner violence (IPV) may disproportionately impact women's quality of life (QOL) when undergoing cancer treatment, women experiencing IPV were hypothesized to have (a) more symptoms of depression or stress and (b) lower QOL as measured with the Functional Assessment of Cancer Therapy (FACT-B) and Functional Assessment of Chronic Illness Therapy-Spiritual Well-being (FACIT-SP) Scales relative to those never experiencing IPV. METHODS: Women, aged 18-79, who were included in one of two state cancer registries from 2009 to 2015 with a recent incident, primary, invasive biopsy-confirmed cancer diagnosis were recruited and asked to complete a phone interview, within 12 months of diagnosis. This interview measured IPV by timing (current and past) and type (physical, sexual, psychological), socio-demographics, and health status. Cancer registries provided consenting women's cancer stage, site, date of diagnosis, and age. RESULTS: In this large cohort of 3,278 women who completed a phone interview, 1,221 (37.3%) disclosed lifetime IPV (10.6% sexual, 24.5% physical, and 33.6% psychological IPV). Experiencing IPV (particularly current IPV) was associated with poorer cancer-related QOL defined as having more symptoms of depression and stress after cancer diagnosis and lower FACIT-SP and FACT scores than women not experiencing IPV and controlling for confounders including demographic factors, cancer stage, site, and number of comorbid conditions. Current IPV was more strongly associated with poorer QOL. When compared with those experiencing past IPV (and no IPV), women with cancer who experienced current IPV had significantly higher depression and stress symptoms scores and lower FACIT-SP and FACT-G scores indicating poorer QOL for all domains. While IPV was not associated with being diagnosed at a later cancer stage, current IPV was significantly associated with having more than one comorbid physical conditions at interview (adjusted rate ratio = 1.35; 95% confidence interval 1.19-1.54) and particularly for women diagnosed with cancer when <55 years of age. CONCLUSIONS: Current and past IPV were associated with poorer mental and physical health functioning among women recently diagnosed with cancer. Including clinical IPV screening may improve women's cancer-related QOL.

Psychometric evaluation of novel measures of partner interfering and supportive behaviors among women with cancer.

PURPOSE: The aim of this study was to evaluate the psychometric properties of complementary and novel measures of partner interfering and partner supportive behaviors in cancer care (PIB-C and PSB-C). METHODS: Structured telephone interviews were conducted with 378 women (aged 18-79) in partnered relationships and recruited from the Kentucky Cancer Registry. Psychometric analyses of PIB-C and PSB-C were used to determine scale reliability, and scale construct and predictive validity (correlations with indicators of partner abuse, symptoms of depression, anxiety, and stress after cancer). RESULTS: Cronbach's alpha and split-half calculations indicated excellent internal consistency of the 20-item PIB-C (0.936 and 0.87, respectively) and 12-item PSB-C (0.930 and 0.89). Three thematic clusters for the PIB-C and two for the PSB-C were identified through factor analyses. Regarding construct validity, higher PIB-C and lower PSB-C scores were associated with a measure of psychological impacts from abuse. Predictive validity was suggested through (1) lower PSB-C associated with depression, (2) higher PIB-C associated with anxiety, and (3) higher perceived stress associated with higher PIB-C/lower PSB-C scores. CONCLUSION: Both PIB-C and PSB-C have strong psychometric properties and distinguish partner behaviors more likely to negatively impact women's depression, anxiety, and stress during cancer care/recovery. Use of these measures may assist clinical teams in comprehensively assessing women patients' home environment to best ensure cancer care/recovery. Copyright © 2015 John Wiley & Sons, Ltd.

Sexual harassment victimization and perpetration among high school students.

This large, population-based study is one of the few to examine prevalence rates of sexual harassment occurring during the past 12 months by victimization and perpetration among adolescents. In this large, cross-sectional survey of students attending 26 high schools, sexual harassment was defined using three questions from the Sexual Experiences Questionnaire. Among 18,090 students completing the survey, 30% disclosed sexual harassment victimization (37% of females, 21% of males) and 8.5% reported perpetration (5% of females, 12% of males). Sexual harassment perpetration was highly correlated with male sex, minority race/ethnicity, same-sex attraction, bullying, alcohol binge drinking, and intraparental partner violence.

Victimization and perpetration of unwanted sexual activities among high school students: frequency and correlates.

The objective of this study was to report the frequency of perpetration and victimization of unwanted sexual activities (threatened to end relationship or other pressures to engage in sexual activities, threatened or actual physical force, and facilitated by drugs or alcohol) in a large, statewide sample of high school males and females. Among 18,030 students, 18.5% reported victimization and 8.0% perpetration in the past year. Although females were more likely to report unwanted sexual activities due to feeling pressured, there were no significant sex differences among those reporting physical force or unwanted sexual activities due to alcohol or drug use.

Dating violence victimization and perpetration rates among high school students.

This school-based sample provides the largest estimate of physical and psychological dating violence (DV) victimization and the only report of DV perpetration among high school students. Among 14,190 students in relationships, 33.4% disclosed DV by a partner (victimization) and 20.2% used these same behaviors against a partner (perpetration) in the past 12 months. Physical DV victimization (13%) was less frequently disclosed than psychological DV (23%). Rates of DV victimization and perpetration were highest among females, those receiving free or reduced-price meals, those not exclusively attracted to the opposite sex, students reporting parental or guardian partner violence, binge drinking, and bullying.

Statewide estimates of stalking among high school students in Kentucky: demographic profile and sex differences.

This large, statewide sample from 26 high schools provided the first population-based estimates of stalking victimization and perpetration among adolescent females and males. Our stalking definition required that pursuing tactics occurred at least 3 times in the past 12 months and included being followed, spied on, or monitored; someone showed up or waited for you when you did not want them to; and receiving unwanted messages. Among 18,013 students, 16.5% disclosed being stalked and 5.3% stalking; 2.8% disclosed both stalking victimization and perpetration. A majority of students reported being most afraid of a former boyfriend or girlfriend as the stalker.

Challenge and opportunity in evaluating a diffusion-based active bystanding prevention program: Green Dot in high schools.

Increasing attention has recently been paid to the development of prevention programs designed to actively engage bystanders in prevention efforts to reduce the risk of sexual and dating violence; yet, few evaluations have been conducted. Our proposed plan to rigorously evaluate a randomized intervention trial of the Green Dot bystander program as it is implemented in high schools across Kentucky is presented. We highlight the value of measuring violence victimization and perpetration outcomes, capturing actual and observed student bystander behaviors, and testing the diffusion of Green Dot training through students' social networks.

Association of intimate partner violence and childhood sexual abuse with cancer-related well-being in women.

BACKGROUND: Limited evidence suggests that intimate partner violence (IPV) may be associated with poorer cancer outcomes. We hypothesized that timing and type of IPV as well as childhood sexual abuse (CSA) may negatively affect depression, perceived stress, and cancer-related well-being. METHODS: This was a cross-sectional study of women diagnosed with either breast, cervical, or colorectal cancer in the prior 12 months included in the Kentucky Cancer Registry. Consenting women were interviewed by phone (n=553). Multivariate analysis of covariance (MANCOVA) was used to determine the association between IPV (37% lifetime prevalence) and type, timing, and the range of correlated cancer-related well-being indicators, adjusting for confounding factors. RESULTS: IPV (p=0.002) and CSA (p=0.03) were associated with the six correlated well-being indicators. Specifically, lifetime and current IPV were associated with lower Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) (p=0.006) and Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-SP) (p=0.03) scores, higher perceived stress at diagnosis (p=0.006), and depressive symptom scores at diagnosis (p<0.0001), whereas CSA was associated with lower FACT-B (p=0.02), increased number of comorbid conditions (p=0.03), and higher current stress levels (p=0.04). Current and past IPV, as well as psychologic abuse, were associated with poorer well-being among women with a recent cancer diagnosis. CONCLUSIONS: Our results provide evidence that both IPV and CSA negatively influence cancer-related well-being indicators. These data suggest that identification of lifetime IPV and other stressors may provide information that healthcare providers can use to best support and potentially improve the well-being of female cancer patients.

Universal psychosocial screening and adverse pregnancy outcomes in an academic obstetric clinic.

OBJECTIVE: To test the hypothesis that women screened for psychosocial factors, including partner abuse, as recommended by the American College of Obstetricians and Gynecologists would have higher neonatal birth weight, longer gestational age at delivery, higher Apgar scores, and fewer maternal complications. METHODS: We evaluated a universal psychosocial screening intervention using a retrospective cohort (n=881 prenatal care patients). Pregnancy outcomes among patients screened beginning in 2008 (n=464) were compared with outcomes among women receiving care before universal screening was implemented (n=417). Data were obtained from medical records between 2007 and 2009. Multivariable logistic regression and analysis of covariance were used to estimate the association between screening and pregnancy outcomes among singleton births adjusting for confounders (prior preterm births, insurance, and mode of delivery). RESULTS: Screened women were less likely than women not universally screened to have low birth weight neonates (4.5% of screened, 10.3% of unscreened; adjusted odds ratio [OR] 0.41, 95% confidence interval [CI] 0.23-0.73), preterm births (9.9% of screened, 14.9% of unscreened; adjusted OR 0.62, 95% CI 0.41-0.96), and any maternal complication (30.0% of screened, 41.2% of unscreened; adjusted OR 0.67, 95% CI 0.50-0.88). Newborn Apgar scores were higher (P=.01) among screened relative to unscreened mothers. CONCLUSION: Our results provide evidence that universal screening was associated with improved pregnancy outcomes. LEVEL OF EVIDENCE: II.

Evaluation of Green Dot: an active bystander intervention to reduce sexual violence on college campuses.

Using a cross-sectional survey of a random sample of 7,945 college undergraduates, we report on the association between having received Green Dot active bystander behavior training and the frequency of actual and observed self-reported active bystander behaviors as well as violence acceptance norms. Of 2,504 students aged 18 to 26 who completed the survey, 46% had heard a Green Dot speech on campus, and 14% had received active bystander training during the past 2 years. Trained students had significantly lower rape myth acceptance scores than did students with no training. Trained students also reported engaging in significantly more bystander behaviors and observing more self-reported active bystander behaviors when compared with nontrained students. When comparing self-reported active bystander behavior scores of students trained with students hearing a Green Dot speech alone, the training was associated with significantly higher active bystander behavior scores. Those receiving bystander training appeared to report more active bystander behaviors than those simply hearing a Green Dot speech, and both intervention groups reported more observed and active bystander behaviors than nonexposed students.

Violence against women and postpartum depression.

BACKGROUND: Violence against women (VAW), including intimate partner violence (IPV) in its various forms (sexual, physical, or stalking), and childhood violence (sexual or physical) are common and are associated with depressive symptoms. We examined the association between these violence exposures and self-reported history of postpartum depression (PPD). METHODS: Women from the Kentucky Women's Health Registry (KWHR) who reported at least one live birth were included in this study. Individual IPV and child abuse histories were examined for association with self-reported history of PPD. Multivariate regression analysis estimated adjusted risk ratios (aRR) and 95% confidence intervals (95% CI), controlling for age, obstetrical history, and substance abuse history. RESULTS: The 5380 women in the KWHR reporting at least one live birth were included in this study. Of these women, 2508 (46.6%) reported a history of any VAW. A history of adult VAW was associated with a history of PPD (aRR 1.48, 95% CI 1.12-1.95). Physical IPV (aRR 1.48, 95% CI 1.12-1.95) and stalking IPV (aRR 1.39, 95% CI1.03-1.87) were individually associated with PPD. Other types of violence were not individually associated with a history of PPD. The strength of association increased with each additional type of violence experienced (aRR1.17, 95% CI 1.06-1.30). CONCLUSIONS: Adult VAW is associated with self-reported history of PPD. With an increase in the number of types of abuse experienced, this association became stronger. Our findings highlight the need for thorough VAW screening in obstetrical populations.