The associations between health and domestic violence in older women: results of a pilot study.

This study examined the association of domestic violence (DV) with the general physical and mental health of older women. This pilot cross-sectional survey studied 257 women, aged 50-79, who came for screening visits to the Observational Study arm of the Women's Health Initiative's (WHI) Newark, NJ, site between June 1995 and August 1996. A 27-item, interviewer-administered questionnaire was used to detect DV. To measure overall health status, we used questions from the Medical Outcomes Study Short Form 36. Of the 257 women interviewed, 82 (31.9%) had experienced DV at some point in their life; 51 (22.6%) had been threatened, and 31 (15%) had experienced physical assault. Women who were either physically assaulted or threatened had lower mental component summary (MCS) scores (50.0 versus 53.7). Women who had only been threatened had a mean MCS score of 49.7 compared with 53.8 for nonthreatened women. Both of these MCS scores indicate poorer mental health. DV, which about 1 in 4 women experience over their lifetime, has a negative relationship to health status. Women who have experienced DV have lower MCS scores than those who have not. They also tend to have lower physical component summary scores. These findings suggest the importance that detection and prevention of DV have for women's health.

Physician use of diagnostic codes for child and adult abuse.

OBJECTIVE: To report on physician use of diagnostic codes for child and adult abuse according to national medical care utilization data. METHODS: Secondary data analysis was performed on the National Ambulatory Medical Care Survey (NAMCS) of office-based physician visits and the National Hospital Ambulatory Medical Care Survey (NHAMCS) of visits to hospital emergency and outpatient departments for 1993 to 1996. Both databases describe physician, patient, and visit characteristics, and variables include up to three diagnoses per visit. RESULTS: Only 93 diagnoses of child or adult abuse were coded for 351,359 patient visits during the four years. As we would expect, child abuse was diagnosed more often than adult abuse (67 v 26), and the majority of cases (n = 57) were visits to emergency departments. CONCLUSION: Diagnostic codes for abuse are not often used. Because these codes represent an important tool for reporting the prevalence and incidence of abuse, such documentation could lead to greater support for health care policies and resource allocation for victims of abuse. Lack of awareness about the diagnostic codes for abuse may be one explanation for underuse, but other barriers are also discussed.

Domestic violence education in family practice residencies.

BACKGROUND AND OBJECTIVES: This study evaluated the extent of domestic violence (DV) education in US family practice residency programs and compared the results to those of a prior study of the same topic. METHODS: We mailed a four-page survey to the directors of all US family practice residency programs. The survey asked the extent to which the topic of DV in particular and other areas of violence in general are included in the curriculum. RESULTS: Surveys were returned from 298 (65.9%) programs, of which 69.4% of respondents indicated that the extent to which violence education is a formal part of their curriculum is either somewhat or a great deal, and 79.9% responded similarly about DV education specifically. On average, programs provide 4-5 hours of training each year, mostly through didactic lectures. Compared to a previous study, our findings demonstrate an increase in violence education in these programs. CONCLUSION: Our findings demonstrate that family medicine educators have increased the amount of residency curricular time devoted to training on DV.

Survey of curriculum on homosexuality/bisexuality in departments of family medicine.

BACKGROUND AND OBJECTIVES: This study assesses what US departments of family medicine are doing to teach undergraduate medical students about homosexuality/bisexuality and the care of gay, lesbian, and bisexual patients. METHODS: A two-page, 14-item, self-administered questionnaire was sent to predoctoral directors at all US medical schools with departments of family medicine (n = 116). The questionnaire asked about teaching methods and curriculum hours, whether other departments address the topic, and if there is a gay/lesbian/bisexual student group at the medical school. RESULTS: Of the 116 predoctoral directors surveyed, 95 (82%) responded. The mean number of departmental curriculum hours devoted to this topic was 2.5 hours for all 4 years of undergraduate medical school. About half (50.6%) of respondents reported that their department spent zero hours teaching about homosexuality/bisexuality. There were no differences in time spent by geographic region, size of school, or between public and private institutions. The most frequently cited teaching method was lectures in medical ethics, followed closely by lectures in human sexuality. CONCLUSIONS: About half of the responding family medicine departments did not include this topic in their curricula. Homosexuality/bisexuality should be included in family medicine's curriculum to ensure that future primary care physicians can properly care for all of their patients. Recommendations for curriculum modifications are provided.

Barriers to black women's participation in cancer clinical trials.

This study examines attitudes that may deter black women from participating in cancer research. Subjects were recruited from women who did not respond to the initial recruitment mailing for the Women's Health Initiative. Each subject was administered a 7- to 10-minute telephone survey. One third (29) of the 80 subjects were black. Fifty-six percent of black women and 71% of white women had positive attitudes toward cancer clinical trials. More than 80% of the women surveyed agreed that clinical research benefits society and increases medical knowledge. However, almost one third of the black women agreed that scientists cannot be trusted while only 4% of whites responded similarly. Additionally, 29% of black women agreed that researchers did not care about them compared with 14% of white women. Only 28% of black women felt that clinical research in the United States was ethical, and 37% had a preference to be treated by a black scientist compared with 2% of whites. Controlling for other covariates, black women had more negative altitudes overall to clinical trials than white women. These findings support the likelihood that barriers exist for the participation of blacks and other minorities in clinical research. These barriers may impact the involvement of black women in cancer clinical trials. Improving trust and creating a perception of a caring attitude from investigators are important to overcoming these barriers. The inclusion of more black scientists as leaders of cancer clinical trials also may help improve these participation rates.