Disclosures. Objectives. APNA 26th Annual Conference Session 4022: November 10, Jackson, Constantino 1

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1 Examining Mediators in Intimate Partner Violence & TMI as Primary Prevention Strategy in RV Prevention among CS Presented by: Lovie Jackson, PhD, MSW and Rose E. Constantino, PhD, JD, RN, FAAN, FACFE School of Nursing Department of Health of Promotion Health and Development Community Systems 1 Disclosures The Examining Mediators research was supported by the grants: DA05208 from the National Institute on Drug Abuse, and MH52400, 1K01MH72827, and 1 F31 MH from the National Institute of Mental Health The Text Messaging Intervention research is partially funded by the American Nurses Foundation grant and the International Association of Forensic Nurses 2 Objectives Understand factors related to feasibility of text messaging interventions (TMI) for educating adolescents and young adults at risk of intimate partner violence (IPV) Identify pre-post post intervention IPV knowledge, and satisfaction with a pilot TMI for adolescents/young adults Identify risk factors for female adolescent and young adult intimate partner victimization Discuss future directions for integrating the evidence base on adolescent/young adult IPV and TMI 3 Jackson, Constantino 1

2 Purpose 1. Examine the feasibility of TMI in helping CS build healthy relationships 2. Examine the acceptability of TMI as a tool in providing information to CS about the signs of RV 4 Specific Aims Evaluate text messaging as an effective communication tool to disseminate knowledge in building healthy relationships Explore college students knowledge of early warning signs and risks of relationship violence Assess safe strategies of disrupting and reducing the risk of relationship violence Research Questions Will TMI once a day (Monday to Friday) for four weeks increase participants awareness of potential RV behavior in a relationship? Will TMI once a day (Monday to Friday) for four weeks improve participants knowledge of the warning signs of RV? Will TMI once a day (Monday to Friday) for 4 weeks improve participants knowledge of strategies to disrupt or reduce RV? Jackson, Constantino 2

3 Primary Prevention Conceptual Framework Primary Prevention: to come before, forestall, or to lower the risk of experiencing IPV Cutting the Broad Street water pump to halt the London cholera epidemic Gordon suggests 3 population groups: Universal-largest group may or may not be at risk for RV Selective- higher than average risk of experiencing RV Indicated-has a manifest risk factor for RV 7 Primary Prevention Framework Indicated Selective INDICATED Sl Selective Universal Universal PRIMARY PREVENTION and TMI 1,2 Department of Health Promotion and Development 8 Text Messaging Intervention By 2025, five billion people will be texting Currently, most common method of communication Shapes the nature of relationships As a SHEILD to give attention, safety, comfort, love, and belongingness As a SWORD to control, abuse, punish, stalk, or coerce Jackson, Constantino 3

4 Text Messaging Manifesto Department of Health Promotion and Development 10 Methods Descriptive design -mixed methods data collection and data analysis-assess outcomes of 4 weeks of daily TMI with 20 female college students between age 18 and 24 years Use one-way ANOVA to compare pre to post TMI response to survey Process of corroboration to ensure consistency and guard against bias in the qualitative portion of the survey Department of Health Promotion and Development Specific Aims 1. Examine pathways of physical abuse on later psychosocial functioning in adolescent moms 2. Examine mediators of physical abuse on later risk for IPV in adolescent moms 12 Jackson, Constantino 4

5 Background Some studies show that adolescent mothers are at higher risk for problematic use of alcohol and other substances Increased alcohol or drug use is associated with multiple adverse consequences Less is known about potential pathways that account for problematic alcohol and other drug use among adolescent mothers Background One potential pathway that may increase the risk of alcohol and drug use is early victimization Adolescent mothers are at higher risk for experiencing victimization in intimate relationships than older mothers IPV and SA among adolescent and adult females has been associated with substance use disorders Furthermore, the cumulative yet discrete contribution of multiple types of victimization across the lifecourse of adolescent females on substance use has not been adequately documented Most research has been cross-sectional Background Little is known about the mediational pathways that link life course victimization with substance abuse Strong evidence exists for the association of IPV and SA with psychological distress among adolescent and adult females Psychological distress has been linked to use of alcohol and drugs, or drinking to cope Jackson, Constantino 5

6 Design and Methods Descriptive design-structural equation modeling using secondary data analysisassess outcomes across 3 years from unmarried pregnant adolescents 16 Conceptual Model Predicting Alcohol & Marijuana Use Parental Physical Child Abuse Early Impaired Psychosocial Functioning Young Adult Revictimization (IPV/SA) Impaired Psychosocial Functioning Sample Young Women s Health Study Longitudinal study of adolescent females who were pregnant and unmarried at age 17 years and younger Community-based sample Data collected from and High retention rate (N= 240); 92.1% of the original i sample Data collected every 6 months from age 18 through age 22 Racial/ethnic composition 53% Caucasian 28% African American 6% Native American 3% Asian American 10% Other races 8% Hispanic ethnicity Jackson, Constantino 6

7 Measures CPA: Retrospective; avg age 20.5 (T1) CA Conflict Tactics Scale (Straus, 1979) IPV: Asked every 6 months after asking about CPA (~ 4 years postpartum) (T2) IPV Conflict Tactics Scale SA Mean number of Yes responses to 4 questions (Boyer & Fine, 1992) Mediator: Early Psychosocial Impairment 6 months after victimization measure (T2) Depression, Anxiety Symptom Checklist 90-R (Derogatis, 1994) Alcohol use: Frequency and amount during past month Marijuana use: Frequency during past month (Johnston, O Malley, & Bachman, 1988) Outcomes: Depression, Anxiety, Alcohol, Marijuana: 24 months after mediators (T3) Results Victimization % Lifetime childhood physical abuse Intimate partner violence (between ages of 21.4 and 22.4) 47.9 Sexual assault in previous year 9.9 Results Psychological Distress Past Week Ages 20.9 & 22.9 Depression Mean.64;.67 Anxiety Mean.59;.67 Alcohol and Marijuana Use Past Month % Alcohol use (frequency) Alcohol use (amount) 2.05; 2.39 Marijuana use (frequency).41 Jackson, Constantino 7

8 Analytic Strategy: Structural Equation Modeling Structural equation modeling (SEM): encompasses aspects of confirmatory factor analysis, path analysis and regression models constructs as latent variables while capturing unreliability of measurement in the model simultaneously estimates relationships between multiple independent, dependent and latent variables. Adapted from Wikipedia (2007) Standardized coefficients from structural model (n=229) *p <.05, **p <.01, ***p <.001 Results Summary Early psychosocial problems predicted later psychosocial problems in vulnerable adolescents making early adolescence a prime time period for preventive interventions Psychological distress mediated the effects of early victimization (CPA) on later distress (depression and anxiety were chronic) Psychological distress increased risks for IPV and SA Marijuana use increased risk for IPV (not visa versa) IPV mediated the effects of psychological distress and marijuana use on later psychological distress and alcohol use IPV was associated with later alcohol use Jackson, Constantino 8

9 Contributors Dominique de la Cruz, Student Research Assistant Juhae Grace Hwang, Student Research Assistant Joseph Burroughs, Student Research Assistant Taryn Lindhorst, PhD Blair Beadnell, PhD Karen C. Fieland, PhD, MSW, MS Angela Lee, MSW Jackson, Constantino 9