Examining the Role of Substance Abuse in Elder Mistreatment: Results from Mistreatment Investigations

Substance abuse has long been identified as a risk factor for elder mistreatment, yet research on the topic remains sparse. 

This study tested hypotheses whether perpetrator and victim substance use problems were associated with financial exploitation, physical abuse, emotional abuse, and neglect versus no abuse. Cross-sectional data were collected on 948 cases with yes/no substantiation decisions where 357 cases had no abuse in elder mistreatment investigations. Hypotheses were tested using odds ratios, bivariate, and multiple linear regression analyses including a control for victim vulnerability. 

Of 948 alleged victims, 42 (4.4%) exhibited signs of substance use problems. Among the 323 alleged perpetrators, 87 (26.9%) were reported to have substance use problems. Substance use problems by alleged perpetrators were associated (p< .01) with financial exploitation, physical abuse, and emotional abuse but not neglect. Substance use problems by alleged victims were associated with neglect, but not the other types. Alleged perpetrators with substance use problems tended to commit multiple forms of abuse, were male and not caregivers. Except for the findings on neglect, the associations with elder mistreatment were stronger for alleged perpetrators with substance use problems, than for alleged victims. 

Clarification of the role of perpetrator risk factors such as substance abuse should improve risk identification and subsequent intervention.

Purchase full article at:   http://goo.gl/xzkm6J

By:  Conrad KJ1, Liu PJ2, Iris M3.

• 1University of Illinois at Chicago, IL, USA Chestnut Health Systems, Normal, IL, USA kjconrad@uic.edu.
• 2University of California, San Francisco, CA, USA.
• 3Leonard Schanfield Research Institute, Chicago, IL, USA. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Disclosure of Abuse among Female Patients within General Psychiatric Care

BACKGROUND:

Experiences of abuse are common among women in general psychiatric care. Even so, there are to our knowledge no previous national or international studies exploring disclosure in a general psychiatric setting of female patient's experiences of abuse to staff or to formal and informal networks. This study aimed to explore women's disclosure of experiencing physical, emotional and/or sexual abuse during their most recent contact with staff at a general psychiatric clinic. The study also aimed to determine whether the women have previously disclosed abuse to anyone.

METHODS:

A consecutive sampling of eligible female patients at a general psychiatric clinic in an urban area of southern Sweden answered the NorVold Abuse Questionnaire, NorAQ, a self-administrated questionnaire. NorAQ has previously been used and further developed to compare the prevalence of abuse in women present in gynecological outpatient settings in the five Nordic countries. Seventy-seven women with experiences of abuse participated in the research. Descriptive statistics were used to analyse the data.

RESULTS:

Most respondents did not disclose their experiences of abuse to staff at the general psychiatric clinic. Women with experiences of physical abuse (n = 40), emotional abuse (n = 37) and sexual abuse (n = 37) chose not to disclose their experiences. Respondents disclosed abuse more often to others than to staff.

CONCLUSIONS:

Our findings indicated the importance of including routine questions concerning abuse experiences as a natural part of female patients' medical history.

Disclosure of abuse among female patients in general psychiatric care (n=77)

Disclosure of abuse during most recent contact with staff at a general psychiatric clinic (n = 77)	Disclosure of Physical abuse (n = 72)	Disclosure of emotional abuse (n = 61)	Disclosure of sexual abuse (n = 55)
No	40 (55 %)	23 (38 %)	37 (67 %)
Yes, he/she knew already	2 (3 %)	2 (3 %)	3 (5 %)
Yes, when he/she asked about it	9 (12 %)	17 (28 %)	6 (11 %)
Yes, I Told him/her spontaneously	18 (25 %)	18 (29 %)	7 (13 %)
Unknown	3 (4 %)	1 (2 %)	2 (4 %)
Disclosure of abuse to others then staff at the most recent contact in a general psychiatric clinic (n = 77)
No	8 (11 %)	3 (5 %)	11 (20 %)
Yes, partly	44 (61 %)	44 (72 %)	34 (62 %)
Yes, about all of it	18 (25 %)	14 (23 %)	10 (18 %)
Unknown	2 (3 %)	0 (0 %)	0 (0 %)

Full article at:  http://goo.gl/NLRF2O

By:  Örmon K1, Sunnqvist C2, Bahtsevani C2, Levander MT3.

• 1Department of Care Science, Faculty of Health and Society, Malmö University, 205 06, Malmö, Sweden. Karin.ormon@mah.se.
• 2Department of Care Science, Faculty of Health and Society, Malmö University, 205 06, Malmö, Sweden.
• 3Department of Criminology, Faculty of Health and Society, Malmö University, Malmö, Sweden. 
• BMC Psychiatry. 2016 Mar 24;16(1):79. doi: 10.1186/s12888-016-0789-6.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Abuse Characteristics and Individual Differences Related to Disclosing Childhood Sexual, Physical, and Emotional Abuse and Witnessed Domestic Violence

Many adult survivors of childhood abuse hide their victimization, avoiding disclosure that could identify perpetrators, end the abuse, and bring help to the victim. 

We surveyed 1,679 women undergraduates to understand disclosure of childhood sexual, physical, and emotional abuse, and, for the first time, witnessed domestic violence, which many consider to be emotionally abusive. 

A substantial minority of victims failed to ever disclose their sexual abuse (23%), physical abuse (34%), emotional abuse (20%), and witnessed domestic violence (29%). Overall, abuse-specific factors were better predictors of disclosure than individual-level characteristics. 

Disclosure of sexual abuse was related to experiencing more frequent abuse (by the same and by multiple perpetrators), being more worried about injury and more upset at the time of the abuse, and self-labeling as a victim of abuse. 

Disclosure of physical abuse was related to experiencing more frequent abuse (by the same and multiple perpetrators), being less emotionally close to the perpetrator, being older when the abuse ended, being more worried and upset, and self-labeling as a victim. 

Disclosure of emotional abuse was associated with being older when the abuse ended, and being more worried and upset. Disclosure was unrelated to victim demographic characteristics or defensive reactions (dissociative proneness, fantasy proneness, repressive coping style, and temporary forgetting), except that among physical and emotional abuse victims, repressors were less likely to disclose than non-repressors. Disclosure of witnessing domestic violence was not significantly related to any factors measured.

Purchase full article at:   http://goo.gl/gK2HvQ

By:  Bottoms BL1, Peter-Hagene LC2, Epstein MA2, Wiley TR2, Reynolds CE2, Rudnicki AG2.

• 1University of Illinois, Chicago, IL, USA bbottoms@uic.edu.
• 2University of Illinois, Chicago, IL, USA. 
• J Interpers Violence. 2016 Apr;31(7):1308-39. doi: 10.1177/0886260514564155. Epub 2014 Dec 29.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Violence and Abuse Against Women Who Have Attempted Suicide by Deliberate Self-Poisoning: A 2-Year Follow-Up Study in Iran

Sources of data about the occurrence of domestic violence are scarce in Iran. The aim of this study was to evaluate the behavioral effects of different types of domestic violence on women who had attempted suicide by deliberate self-poisoning (DSP). 

A total of 195 women who had attempted suicide by DSP in response to "violence and abuse" were followed up for 2 years. The most common type of violence, as mentioned by the women themselves as the motive of self-poisoning, was physical abuse (92%) followed by verbal abuse (2.1%), multi-abuses (2.1%), emotional abuse (1.6%), and sexual abuse (1.1%). Suicidal ideation and attempt were more common in those who were consulted sometime after they had initially presented to the hospital with DSP or those who had suffered repeated domestic abuse. 

It was concluded that invention of methods other than the current consultation system is necessary to prevent repeated suicide attempts among abused women in Iran.

Purchase full article at:   http://goo.gl/sFtlr6

By:  Hassanian-Moghaddam H1, Zamani N2, Sarjami S3.

• 1Department of Clinical Toxicology, Loghman-Hakim Clinical Research Development Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Excellent Center of Clinical Toxicology, Ministry of Health & Medical Education, Tehran, Iran Hassanian@sbmu.ac.ir.
• 2Department of Clinical Toxicology, Loghman-Hakim Clinical Research Development Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Excellent Center of Clinical Toxicology, Ministry of Health & Medical Education, Tehran, Iran.
• 3Child and Adolescent Psychiatrist, Private Clinic,Tehran, Iran.
• J Interpers Violence. 2016 Apr;31(7):1257-73. doi: 10.1177/0886260514564157. Epub 2014 Dec 29. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

The Impact of Specific and Complex Trauma on the Mental Health of Homeless Youth

This study investigates the relative impact of trauma experiences that occurred prior to and since becoming homeless on depressive symptoms, posttraumatic stress disorder (PTSD) symptoms, and self-injurious behaviors among a sample of homeless youth (N = 389). 

Youth (aged 13 to 25) who had been homeless or precariously housed in the past year completed a survey about housing history, experiences of violence and victimization, mental health, and service utilization. In addition to examining the impact associated with specific trauma types, we also considered the effect of "early-on" poly-victimization (i.e., cumulative number of reported traumas prior to homelessness) and the influence of a compound sexual trauma variable created to represent earlier complex trauma. This created-variable has values ranging from no reported trauma, single trauma, multiple non-sexual traumas, and multiple traumas that co-occurred with sexual abuse. 

Multivariate analyses revealed that specific traumatic experiences prior to homelessness, including sexual abuse, emotional abuse/neglect, and adverse home environment, predicted greater mental health symptoms. 

Poly-victimization did not add to the prediction of mental health symptoms after the inclusion of specific traumas. Results with early compound sexual trauma revealed significant differences between lower-order trauma exposures and multiple-trauma exposures. Specifically, experience of multiple traumas that co-occurred with sexual trauma was significantly more detrimental in predicting PTSD symptoms than multiple traumas of non-sexual nature. 

Findings support the utility of an alternate/novel conceptualization of complex trauma, and support the need to carefully evaluate complex traumatic experiences that occurred prior to homelessness, which can impact the design and implementation of mental health care and services for homeless youth.

Purchase full article at:   http://goo.gl/T9Dapa

By:  Wong CF1, Clark LF2, Marlotte L3.

• 1University of Southern California, Los Angeles, CA, USA Children's Hospital Los Angeles, CA, USA cawong@chla.usc.edu.
• 2University of Southern California, Los Angeles, CA, USA Children's Hospital Los Angeles, CA, USA.
• 3Children's Hospital Los Angeles, CA, USA. 
• J Interpers Violence. 2016 Mar;31(5):831-54. doi: 10.1177/0886260514556770. Epub 2014 Nov 11.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Suicide Attempts and Childhood Maltreatment among Street Youth

BACKGROUND:

Although suicide is a known leading cause of death among street youth, few prospective studies have explored childhood experiences as risk factors for future suicide attempt in this population. We examined the risk of attempted suicide in relation to childhood maltreatment among street youth.

METHODS:

From September 2005 to November 2013, data were collected from the At Risk Youth Study (ARYS), a prospective cohort of street youth in Vancouver, Canada. Inclusion criteria were age 14 to 26 years, past-month illicit drug use, and street involvement. Participants completed the Childhood Trauma Questionnaire, an instrument measuring self-reported sexual, physical, and emotional abuse and physical and emotional neglect. Suicide attempts were assessed semiannually. Using Cox regression, we examined the association between the 5 types of maltreatment and suicide attempts.

RESULTS:

Of 660 participants, 68.2% were male and 24.6% were Aboriginal. Median age was 21.5 years. The prevalence of moderate to extreme childhood maltreatment ranged from 16.8% (sexual abuse) to 45.2% (emotional abuse). Participants contributed 1841 person-years, with suicide attempts reported by 35 (5.3%) individuals (crude incidence density: 1.9 per 100 person-years; 95% confidence interval [CI]: 1.4-2.6 per 100 person-years). In adjusted analyses, types of maltreatment associated with suicide attempts included physical abuse (adjusted hazard ratio [HR]: 4.47; 95% CI: 2.12-9.42), emotional abuse (adjusted HR: 4.92; 95% CI: 2.11-11.5), and emotional neglect (adjusted HR: 3.08; 95% CI: 1.05-9.03).

CONCLUSIONS:

Childhood maltreatment is associated with subsequent risk of suicidal behavior among street youth. Suicide prevention efforts should be targeted toward this marginalized population and delivered from a trauma-informed perspective.

Below:  Associations of Childhood Maltreatment With Suicide Attempts During Follow-up: ARYS (Vancouver, British Columbia; 2005–2013)

Full article at:   http://goo.gl/roaQzI

By:   Hadland SE1, Wood E2, Dong H3, Marshall BD4, Kerr T2, Montaner JS2, DeBeck K5.

• 1Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;
• 2British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada;
• 3British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada;
• 4Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island; and.
• 5British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada; School of Public Policy, Simon Fraser University, Vancouver, British Columbia, Canada uhri-kd@cfenet.ubc.ca. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Past & Recent Abuse Is Associated with Early Cessation of Breast Feeding: Results from a Large Prospective Cohort in Norway

OBJECTIVE:

Breast feeding provides a wide range of health benefits for both infants and mothers. Few studies have examined the impact of past and recent abuse of women on breastfeeding behaviour. The aims of our study were to examine whether exposure to past and recent emotional, sexual or physical abuse was associated with early breastfeeding cessation, and to assess whether a potential association differed for known and unknown perpetrators.

PARTICIPANTS:

53 934 mothers participated in the Norwegian Mother and Child Cohort Study. We included mothers with singleton pregnancy who had responded to three questionnaires (weeks 18 and 30 in pregnancy, and 6 months postpartum) and had answered minimum one of the abuse questions in week 30.

MAIN OUTCOME MEASURE:

ORs were estimated by binary logistic regression with cessation of any (all) breast feeding before 4 months as the outcome, and abuse including subcategories of abuse, as the exposure.

RESULTS:

Nearly all women initiated breast feeding, but 12.1% ceased any breast feeding before 4 months and 38.9% ceased full breast feeding before 4 months, but continued partial breast feeding. Overall, 19% of the women reported any adult abuse and 18% reported any child abuse. The highest risk of any breast feeding cessation before 4 months was seen in women exposed to three types of adult abuse (emotional, sexual or physical), with adjusted OR being 1.47 (95% CI 1.23 to 1.76) compared with no abuse. Recent abuse and exposure from known perpetrator resulted in nearly 40% and 30% increased risk, respectively. The OR of any breast feeding cessation for women exposed to any child abuse was 1.41 (95% CI 1.32 to 1.50) compared with no abuse in childhood.

CONCLUSIONS:

Past and recent abuse of women is strongly associated with early cessation of breast feeding. Abused mothers comprise a key group to target for extra support and breastfeeding assistance.

Full article at:   http://goo.gl/B3Hqah

By:   Sørbø MF1, Lukasse M2, Brantsæter AL3, Grimstad H4.

• 1Faculty of Medicine, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Department of Physical Medicine and Rehabilitation, Aalesund Hospital, More and Romsdal Health Trust, Aalesund, Norway.
• 2Faculty of Medicine, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway Faculty of Health Sciences, Department of Health, Nutrition and Management, Oslo and Akershus University College of Applied Sciences, Oslo, Norway.
• 3Department of Exposure and Risk Assessment, Norwegian Institute of Public Health, Oslo, Norway.
• 4Faculty of Medicine, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. 

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

Mental Health and Functioning of Female Sex Workers in Chittagong, Bangladesh

Aim

To examine the mental health and functioning of female sex workers (FSW) in Chittagong, Bangladesh, a population that has commonly been neglected in mental health policy and research.

Methods

We included 259 women in the study (M age: 23.2 years; range: 11–48). The comprehensive Composite International Diagnostic Interview was used to assess their 12-month prevalence rates of DSM-IV mental disorders, and a comprehensive questionnaire was adapted to explore various factors, such as socio-demographics, working and living conditions, or experiences of abuse.

Results

On average, participants began their commercial sex work at 18.5 years old (range: 10–45). Their main motives for sex work were coercion (49.4%) and the necessity to financially support families (54.8%). In total, 224 FSW (86.5%) wanted to quit commercial sex work. A mental disorder within the past 12 months was reported by 100 FSW (38.6%), with drug abuse clearly being the most prevalent diagnosis (15.4%). Sexual, physical, and emotional abuse were very common among the FSW, and substance use disorders (SUD) were significantly more prevalent in persons who experienced emotional abuse (OR = 2.2). Prevalence rates of any mental disorder and SUD were higher in women who did sex work to support their family, whereas mood disorders were more frequent in those who needed the money to pay debts. Participants with any disorder were significantly older than those without (M age: 24.4 vs. 22.5 years) and had started significantly later in the sex business (M age: 19.7 vs. 17.7 years).

Conclusion

Our study revealed that FSW in Chittagong are very vulnerable and highly impaired, as expressed by high rates of abuse and mental disorders. Coercion is very common and many FSW are required to work in the sex business because they need the money to support their families. FSW are a very marginalized population, especially in the developing countries where awareness for mental health is low and the availability of mental health services is insufficient.

Below:  Self-reported abuse

Below:  Relationship between quality of life and occurrence of any mental disorder

Below:  Association of age with number of co-occurring mental disorders (error bars indicate 95% confidence intervals)

Full article at:  http://goo.gl/nOlX6l

By:   Michael P. Hengartner,1 Md Nazrul Islam,2 Helene Haker,3 and Wulf Rössler4,5,*

¹Department of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland

²Rehabilitation Centre for Prostitutes and Rootless Children (PARC), Chittagong, Bangladesh

³Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and ETH Zurich, Zurich, Switzerland

⁴Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland

⁵Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil

Edited by: Shervin Assari, University of Michigan, USA

Reviewed by: Taiwo Lateef Sheikh, Federal Neuropsychiatric Hospital, Nigeria; Mohammadreza Mokhtari, Hartford Hospital, USA; Masoumeh Dejman, University of Social Welfare and Rehabilitation Sciences, Iran

*Correspondence: Wulf Rössler, Email: hc.hzu@relsseor.fluw

  

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health

Latino Mother/Daughter Dyadic Attachment as a Mediator for Substance Use Disorder & Emotional Abuse

To date, no studies have investigated emotional abuse of adult Latina women by their mothers despite evidence that emotional maternal abuse may significantly contribute to the emotional abuse experienced by Latina women in their lifetime. 

Cross-sectional data including 316 women was analyzed using mediation and logistic regression. Overall, 7.1 % of mothers and 24.1 % of daughters abused drugs; and, 19.5 % of daughters were emotionally abused by their mothers. 

Mother's attachment to her daughter mediated the association between mother's drug abuse and emotionally abusing her adult daughter (indirect effect: 0.863). Latina women can serve as perpetrators of emotional abuse of their adult children. Since drug-abusing daughters are more likely to be victims of emotional abuse by their mothers and drug-abusing mothers are more likely to abuse their daughters, drug-rehabilitation practitioners should incorporate a family abuse component into rehabilitation programs.

Purchase full article at:   http://goo.gl/GDxxDg

By:  Kanamori M1, Weissman J2, De La Rosa M2, Trepka MJ2, Rojas P2, Cano MA3, Melton J2, Unterberger A4.

• 1Center for Research on U.S. Latinos HIV/AIDS and Drug Abuse, Florida International University, 11200 SW 8th Street. AHC5 422, Miami, FL, 33199, USA. mkanamor@fiu.edu.
• 2Center for Research on U.S. Latinos HIV/AIDS and Drug Abuse, Florida International University, 11200 SW 8th Street. AHC5 422, Miami, FL, 33199, USA.
• 3Department of Epidemiology, College of Public Health and Social Work, Florida International University, Miami, FL, USA.
• 4Center for Labor Research and Studies, Florida International University, Miami, FL, USA. 

More at:  https://twitter.com/hiv_insight

And:        http://twitter.com/Prison_Health

The Impact of Emotional, Physical & Sexual Abuse on Contraceptive Method Selection & Discontinuation

We evaluated the impact of exposure to emotional, physical, or sexual abuse on contraceptive method selection and discontinuation.

We performed a secondary analysis of 7170 women enrolled in the Contraceptive CHOICE Project in St. Louis, Missouri, a prospective cohort study in which 9256 women were provided their preferred method of contraception at no cost from 2007 to 2011. We defined contraceptive discontinuation as device removal or nonuse for at least 4 weeks within the first 12 months after initiation.

One third of women experienced some abuse in their lifetimes. Women with an abuse history were as likely as those without to select a long-acting reversible contraceptive method and more likely to choose a contraceptive injection, the patch, or the ring. When we compared women who were abused to those who were not, rates of discontinuation at 12 months were higher among women who selected long-acting reversible contraception (17% vs 14%; P = .04) and significantly higher among women who selected non–long-acting methods (56% vs 47%; P < .001). Type of abuse did not alter the association between abuse and contraceptive continuation.

Previous experiences of abuse are associated with both contraceptive method selection and continuation.

Method of Contraception Chosen at Baseline by Women: Contraceptive CHOICE Project by Lifetime History of Abuse, St. Louis, MO, 2007–2011

		Prevalence of Baseline Chosen Contraceptive Method, %
Type of Abuse	No.	LARC	PPR	DMPA	LARC vs non-LARC, RR (95% CI)	DMPA vs PPR, RR (95% CI)
Childhood (aged < 14 y)
None	5631	72	20	7	1.00 (Ref)	1.00 (Ref)
Any	1532	75	16	8	1.04 (1.01, 1.08)	1.28 (1.09, 1.51)
Emotionala	896	76	17	8	1.04 (1.00, 1.09)	1.18 (0.96, 1.45)
Physicala	641	78	14	8	1.08 (1.03, 1.13)	1.37 (1.09, 1.73)
Sexual	763	75	15	10	1.03 (0.99, 1.08)	1.47 (1.21, 1.78)
≥ 2 types	609	78	13	8	1.08 (1.03, 1.13)	1.42 (1.13, 1.78)
Adult (aged ≥ 14 y)
None	5854	73	20	7	1.00 (Ref)	1.00 (Ref)
Any	1307	74	18	8	1.02 (0.98, 1.06)	1.14 (0.95, 1.36)
Emotionala	964	74	18	8	1.03 (0.98, 1.07)	1.11 (0.91, 1.36)
Physicala	453	74	18	8	1.02 (0.97, 1.08)	1.12 (0.85, 1.49)
Sexual	484	73	18	9	1.00 (0.94, 1.06)	1.22 (0.94, 1.57)
≥ 2 types	496	74	18	9	1.01 (0.96, 1.07)	1.20 (0.93, 1.55)
Lifetime
None	5078	72	20	7	1.00 (Ref)	1.00 (Ref)
Any	2092	74	18	8	1.03 (0.99, 1.06)	1.22 (1.04, 1.41)
Emotionala	1353	75	17	7	1.04 (1.00, 1.07)	1.10 (0.91, 1.31)
Physicala	898	76	16	8	1.05 (1.01, 1.09)	1.28 (1.05, 1.56)
Sexual	1044	74	16	10	1.02 (0.98, 1.06)	1.39 (1.16, 1.65)
≥ 2 types	931	76	16	8	1.05 (1.01, 1.10)	1.28 (1.05, 1.56)

Note. CI = confidence interval; DMPA = depot medroxyprogesterone acetate contraceptive injection; LARC = long-acting reversible contraception (intrauterine device or hormonal implant); non-LARC = contraceptive pill, patch, ring, or injection; PPR = contraceptive pill, patch, or ring; RR = relative risk. The sample size was n = 7170.

aEmotional and physical abuse classified as abuse if more than a single occurrence of abuse.

Below:  Cumulative discontinuation rates by contraceptive method and experience of abuse for (a) childhood abuse and (b) adult abuse: Contraceptive CHOICE Project, St. Louis, MO, 2007–2011.

Note. LARC = long-acting reversible contraception (intrauterine device or hormonal implant); non-LARC = contraceptive pill, patch, ring, or injection.

Full article at: http://goo.gl/vqeJ8G

By: Jenifer E. Allsworth, PhD, Gina M. Secura, PhD, MPH, Qiuhong Zhao, MS, Tessa Madden, MD, MPH, and Jeffrey F. Peipert, MD, PhD

The authors are with Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO.

More at:  https://twitter.com/hiv_insight