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ABUSE, WOMEN'S SELF-CARE, AND PREGNANCY OUTCOMES

虐待、女性自我护理和怀孕结果

基本信息

批准号：
2036017
负责人：
JOELLEN W HAWKINS
金额：
$ 11.92万
依托单位：
BOSTON COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
1996
资助国家：
美国
起止时间：
1996-09-30 至 2001-09-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/2036017
关键词：
clinical research female gestational age health behavior human birth weight human pregnant subject human subject interview low birth weight infant human mother /infant health care newborn human (0-6 weeks) obstetric nursing pregnancy prenatal care self care spouse abuse women's health

项目摘要

Violence against women is the leading cause of death in women of childbearing age and has been linked to inadequate prenatal care and low birth weight. In a recent study, 21% of teens and 14% of adult women reported being abused during pregnancy (Parker, McFarlane & Soeken, 1994). In the present study we will deepen our understanding of the effect of abuse on pregnancy outcomes. We will consider for the first time the effects of emotional abuse and abuse severity on birth outcomes, the influence of women's appraisal of abuse on their prenatal health behaviors, and the relationships among abuse severity, appraisal, and health behaviors and their direct and indirect effects on the outcomes of pregnancy. If women's appraisal of abuse severity affects health behaviors, or if these behaviors explain the effect of abuse on birth outcomes, health care providers can target appraisal and self-care for prenatal intervention. The aims of this prospective descriptive study are: (l) to determine the prevalence of abuse during pregnancy in selected diverse prenatal care sites and re-examine whether abuse increases the relative risk of poor birth outcomes (birth weight less than 2500 gms., gestational age less than 37 weeks, and 5-minute Apgar score less than 7), taking into consideration other obstetrical and social risks; (2) to determine whether severity of abuse affects the impact of abuse on birth outcomes when pre-existing risks are controlled; and (3) to determine whether pregnant women's appraisal of the risk of abuse-related harm explains their health and self-care behaviors (prenatal care, weight gain, substance abuse reduction), which in turn may act as mediators of the effect of abuse on birth outcomes. At eight prenatal care settings including HMOs, public clinics, and group practices, serving women from a variety of ethnic backgrounds, nurses have agreed to screen all pregnant women using the well-tested 5- item Abuse Assessment Screen (Parker & McFarlane, 1991) and refer to the research team women who report abuse and are interested in the study. Clinicians and researchers will offer abused women appropriate support and referrals. We will calculate abuse prevalence in all pregnant women screened over the study period. Logistic regression analysis of chart review data will determine the relative risk of low birth weight, preterm birth, and low 5-minute Apgar score in women with and without prenatal abuse, while controlling for pre-existing risks. In addition, we will interview a sample of 196 women who have experienced emotional or physical abuse during pregnancy. After careful informed consent, a single structured interview will be conducted in English or Spanish to administer the Severity of Violence Against Women Scale (Marshall, 1992) and the Appraisal of Violent Situations (Dutton, 1992) and to determine health behaviors during pregnancy (weight gain and substance abuse reduction). Other data, including prenatal care adequacy, will be gathered from medical records. Within the abused sample, multiple regression will be used to evaluate a path model in which abuse appraisal and health behaviors are proposed to mediate the effects of abuse severity and pre-existing risks on birth weight, gestational age, and Apgar score.

针对妇女的暴力是导致妇女死亡的主要原因生育年龄，与产前护理不足和低生育率有关出生体重。在最近的一项研究中，21% 的青少年和 14% 的成年女性据报道在怀孕期间受到虐待（Parker、McFarlane 和 Soeken， 1994）。在本次研究中，我们将加深对虐待对妊娠结局的影响。我们会首先考虑情绪虐待和虐待严重程度对出生的影响的时间结果，妇女对虐待的评价对其产前的影响健康行为，以及虐待严重程度、评价、和健康行为及其对健康的直接和间接影响妊娠的结果。如果女性对虐待严重程度的评估会影响健康行为，或者这些行为是否可以解释虐待对健康的影响出生结果，医疗保健提供者可以有针对性地进行评估和自我护理用于产前干预。这项前瞻性描述性研究的目的是： (l) 确定在某些不同的产前护理中，怀孕期间虐待的发生率网站并重新检查虐待行为是否会增加贫困人口的相对风险出生结果（出生体重小于2500克，孕龄小于小于 37 周，且 5 分钟阿普加评分小于 7），考虑到考虑其他产科和社会风险； (2)确定虐待的严重程度是否会影响虐待对出生结果的影响当预先存在的风险得到控制时； (3) 判断是否孕妇对虐待相关伤害风险的评估解释他们的健康和自我保健行为（产前护理、体重增加、减少药物滥用），这反过来又可以充当虐待对出生结果的影响。在八个产前护理机构，包括 HMO、公共诊所和团体实践，为来自不同种族背景的女性提供服务，护士已同意使用经过充分测试的 5- 筛查所有孕妇项目滥用评估屏幕（Parker & McFarlane，1991）并参考研究小组中举报虐待行为并对这项研究感兴趣的女性。临床医生和研究人员将为受虐妇女提供适当的支持和推荐。我们将计算所有孕妇的虐待发生率在研究期间进行筛选。图表Logistic回归分析审查数据将确定低出生体重的相对风险，早产以及患有和不患有早产的女性 5 分钟 Apgar 评分较低产前虐待，同时控制预先存在的风险。此外，我们将采访 196 名经历过情感经历的女性样本或怀孕期间的身体虐待。在仔细知情同意后，单一结构化面试将以英语或西班牙语进行管理针对妇女的暴力行为严重程度（Marshall，1992）和暴力局势评估（Dutton，1992）并确定怀孕期间的健康行为（体重增加和药物滥用减少）。其他数据，包括产前护理充分性，将从医疗记录中收集。在被滥用的样本中，多个回归将用于评估滥用的路径模型建议评估和健康行为来调节虐待的严重程度以及出生体重、胎龄、和阿普加评分。