Prevalence, Types, Risk Factors, and Course of Intimate Partner Violence in Appalachian Pregnant ...

128 Pages·2015·4.55 MB·English

by  Tifani Fletcher

East Tennessee State University
Digital Commons @ East
Tennessee State University
Electronic Theses and Dissertations Student Works
5-2014
Prevalence, Types, Risk Factors, and Course of
Intimate Partner Violence in Appalachian Pregnant
Women
Tifani Fletcher
East Tennessee State University
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Recommended Citation
Fletcher, Tifani, "Prevalence, Types, Risk Factors, and Course of Intimate Partner Violence in Appalachian Pregnant Women" (2014).
Electronic Theses and Dissertations.Paper 2371. https://dc.etsu.edu/etd/2371
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Prevalence, Types, Risk Factors, and Course of Intimate Partner Violence in Appalachian
Pregnant Women

_____________________

A dissertation

presented to

the faculty of the Department of Psychology

East Tennessee State University

In partial fulfillment

of the requirements for the degree

Doctor of Philosophy in Psychology

_____________________

by

Tifani Renee Fletcher

May, 2014

_____________________

Andrea Clements, Ph.D., Chair

Beth A. Bailey, Ph.D.

William T. Dalton, Ph.D.

Brooke E. Foulk, M.D.

Matthew McBee, PhD.

Keywords: Pregnancy, Intimate Partner Violence, Appalachia, HITS, Rural
ABSTRACT
Prevalence, Types, Risk Factors, and Course of Intimate Partner Violence in Appalachian
Pregnant Women
by
Tifani Renee Fletcher
Intimate partner violence (IPV) during pregnancy can lead to a myriad of poor physical and
psychological outcomes for both mother and child. There is a paucity of research examining IPV
risk factors for rural pregnant women and on information regarding the course of the specific
types of IPV throughout pregnancy. The current project was an investigation of the prevalence of
IPV and IPV risk factors for different types of IPV in an Appalachian pregnant sample that
contained women from both rural and nonrural locations (Study 1), and was an examination of
the occurrence of any IPV and the different types of IPV throughout the course of pregnancy
(Study 2). Study 1 included 1,063 pregnant women participating in the Tennessee Intervention
for Pregnant Smokers (TIPS) research project. IPV prevalence rates during pregnancy, measured
using a modified HITS IPV screen, were approximately 26% for psychological violence, 2% for
physical violence, and 1% for sexual violence. Chi-squared analysis indicated that rural pregnant
women were not significantly more likely to experience any of the types of IPV compared to
nonrural pregnant women. Additionally, logistic regression analysis supported previous literature
findings that pregnant women who are unmarried, younger, have an unplanned pregnancy, have
high levels of stress, and have low levels of social support are at a greater risk of experiencing
any type of IPV during pregnancy compared to pregnant women not possessing those risk
factors. However, rural status was not a significant predictor or modifier of IPV. Study 2
participants included a subsample of 337 pregnant women who indicated they had experienced
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IPV at any time during the course of their pregnancy. Generalized estimating equation logistic
models indicated that women who experienced IPV at some point during pregnancy were more
likely to experience IPV during the third trimester. Both studies support the importance of
screening for specific types of IPV throughout pregnancy. Information obtained from the current
research is valuable to health care providers because it is important they are aware of IPV risk
factors and that different types of IPV, especially psychological IPV, can occur at any time
during pregnancy.

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DEDICATION
This dissertation is dedicated to the women who participated in the Tennessee
Intervention for Pregnant Smokers program and to my family. I was amazed and humbled by the
resilience and stories that I had the privilege of hearing while working for the TIPS program. I
wish all the women health and happiness for themselves and their families. This is also dedicated
to my husband Andy, who encouraged me every step of the way and kept Asa and Patience
entertained while I was writing. He is truly the reason why I was able to succeed in graduate
school: SHMILY +1.

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ACKNOWLEGMENTS
I wish to acknowledge the assistance of all of my committee members in completion of
this project. Dr. Andrea Clements, my chair and mentor, took a chance on me as her first
doctoral student. Dr. Clements assisted in renewing my faith and introduced me to Surrender. I
appreciate her generosity; her door (and email!) was always open to me. Dr. Beth Bailey has
been integral in my research and writing experiences in graduate school, and I appreciate her
allowing me to be a part of the TIPS staff. No matter the scope of a project or paper, for class or
for a presentation, Dr. Will Dalton continuously takes the time to give specific and thoughtful
feedback, which is greatly appreciated. Dr. Brooke Foulk not only served on my committee and
gave an OBGYN’s perspective; she safely delivered both of my children and has become a
trusted friend. Dr. Foulk will be missed at ETSU, and I hope Knoxville realizes and appreciates
what a great doctor and teacher that they are receiving. Dr. Matt McBee always has extreme
patience and understanding in teaching new quantitative skills, and he has inspired me to
continue to learn new techniques and concepts. Dr. McBee, along with Samantha Fields, a fellow
graduate student, graciously allowed me to work with them in their lab, and I could not have
asked for better colleagues. Additionally, I would like to thank the Psychology Department, both
faculty and staff. The department has created a supportive and encouraging environment for all
psychology students. Lastly, I would to express appreciation for the camaraderie of all of my
fellow psychology graduate students, both clinical and experimental. Specifically, Beth
Cummins-Freeman, Lyndsay Nelson, and Bri Sheppard, who read, listened, and gave feedback
to almost all of my papers and presentations.

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TABLE OF CONTENTS

Page
ABSTRACT .......................................................................................................................... 2
DEDICATION ...................................................................................................................... 4
ACKNOWLEDGEMENTS .................................................................................................. 5
LIST OF TABLES ............................................................................................................... 10
LIST OF FIGURES ............................................................................................................. 11

Chapter
1. INTRODUCTION ......................................................................................................... 12
Research Aims ........................................................................................................... 12
2. LITERATURE REVIEW .............................................................................................. 14
Defining IPV .............................................................................................................. 14
Types of IPV ........................................................................................................ 14
Physical IPV................................................................................................... 14
Sexual IPV ..................................................................................................... 15
Psychological IPV .......................................................................................... 15
Identifying IPV in Health Care Settings .................................................................... 16
IPV Identification During Pregnancy .................................................................. 17
Barriers to IPV Identification............................................................................... 18
IPV Prevalence in Women ......................................................................................... 19
General IPV Prevalence ....................................................................................... 19
Prevalence of IPV in Pregnancy .................................................................... 20
IPV Throughout Pregnancy ........................................................................... 22
Prevalence-Measurement Interaction ................................................................... 24
Health Outcomes Related to IPV ............................................................................... 25
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General Health Outcomes Related to IPV ........................................................... 25
Health Outcomes Related to IPV for Pregnant Women ..................................... 27
IPV Risk Factors for Women ..................................................................................... 30
Rural Status ......................................................................................................... 31
Rural Definitions ........................................................................................... 33
IPV Risk Factors for Pregnant Women ............................................................... 34
Current Project ........................................................................................................... 38
Research Aims and Hypothesis .................................................................... 39
Study 1 Aim 1 ................................................................................................ 39
Study 1 Aim 2 ................................................................................................ 39
Study 1 Aim 3 ................................................................................................ 39
Study 2 Aim 4 ................................................................................................ 40
3. METHODS ....................................................................................................................... 41
Data Source Description ........................................................................................... 41
Study 1Variables ........................................................................................................ 43
Demographic Information ................................................................................... 43
Marital Status ................................................................................................ 43
Age ................................................................................................................ 43
Education ...................................................................................................... 44
Pregnancy Planned Status ............................................................................. 44
Rural Status ................................................................................................... 44
Stress and Social Support..................................................................................... 44
IPV ...................................................................................................................... 45
Study 2 Variables ...................................................................................................... 47
IPV ...................................................................................................................... 47
Gestational Age ................................................................................................... 48
Data Analyses Plan .................................................................................................... 48
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Study 1 ................................................................................................................. 48
Study 2 ................................................................................................................ 50
Statistical Model ........................................................................................... 52
4. RESULTS ....................................................................................................................... 53
Study 1 ........................................................................................................................ 53
Study 1 Aim 1 ............................................................................................................ 54
Study 1 Aim 2 ............................................................................................................ 55
Aim 2.1 ............................................................................................................... 55
Aim 2.2 ............................................................................................................... 55
Aim 2.3 ............................................................................................................... 55
Aim 2.4 ............................................................................................................... 56
Study 1 Aim 3 ............................................................................................................ 57
Aim 3.1 ............................................................................................................... 57
Aim 3.2 ............................................................................................................... 60
Aim 3.3 ............................................................................................................... 61
Aim 3.4 ............................................................................................................... 63
Study 2 ........................................................................................................................ 64
Study 2 Aim 4 ............................................................................................................ 66
Aim 4.1 ............................................................................................................... 67
Aim 4.2 ............................................................................................................... 71
Aim 4.3 ............................................................................................................... 72
Aim 4.4 ............................................................................................................... 73
5. DISCUSSION ................................................................................................................... 76
Study 1 ........................................................................................................................ 76
Aim 1 ........................................................................................................................ 76
Aim 2 ........................................................................................................................ 78
Aim 3 ........................................................................................................................ 79
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Study 2 ........................................................................................................................ 80
Aim 4 ........................................................................................................................ 80
Strengths ...................................................................................................................... 82
Limitations .................................................................................................................... 83
Translational Implications ............................................................................................ 84
Conclusions ................................................................................................................... 85
REFERENCES ...................................................................................................................... 86
APPENDICES ....................................................................................................................... 109
Appendix A: IRB Initial Full Review for TIPS ........................................................ 109
Appendix B: IRB Modification ................................................................................. 112
Appendix C: Informed Consent Document .............................................................. 114
Appendix D: Demographic Questionnaire ................................................................ 119
Appendix E: Modified HITS screen ......................................................................... 124
Appendix F: Prenatal Psychosocial Profile Stress Scale .......................................... 125
Appendix G: Prenatal Psychosocial Profile Social Support of Others Scale............. 126
VITA ...……...………. ......................................................................................................... 127

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