Context.-The majority of prior studies examining intimate partner abuse in the emergency department (ED) setting have been conducted in large, urban tertiary care settings and may not reflect the experiences of women seen at community hospital EDs, which treat the majority of ED patients in the United States. Objective.-To determine the prevalence of intimate partner abuse among female patients presenting for treatment in community hospital EDs and describe their characteristics. Design.-An anonymous survey conducted from 1995 through 1997 inquiring about physical, sexual, and emotional abuse. Setting.-Eleven community EDs in Pennsylvania and California. Participants.-All women aged 18 years or older who came to the ED during selected shifts. Main Outcome Measures.-Reported acute trauma from abuse, past-year physical or sexual abuse, and lifetime physical or emotional abuse. Results.-Surveys were completed by 3455 (74%) of 4641 women seen. The prevalence of reported abuse by an intimate partner was 2.2% (95% confidence interval [CI], 1.7%-2.7%) for acute trauma from abuse, 14.4% (95% CI, 13.2%-15.6%) for past-year physical or sexual abuse, and 36.9% (95% CI, 35.3%-38.6%) for lifetime emotional or physical abuse. California had significantly higher reported rates of past-year physical or sexual abuse (17% vs 12%, PϽ.001) and lifetime abuse (44% vs 31%, PϽ.001) than Pennsylvania. Logistic regression modeling identified 4 risk factors for reported physical, sexual, or acute trauma from abuse within the past year: age, 18 to 39 years (odds ratio [OR], 2.2; 95% CI, 1.7-3.0); monthly income less than $1000 (OR, 1.7; 95% CI, 1.3-2.1); children younger than 18 years living in the home (OR, 2.0; 95% CI, 1.5-2.6); and ending a relationship within the past year (OR, 7.0; 95% CI, 5.5-8.9). Conclusion.-If the prevalence of abuse in community hospitals throughout the United States is similar to the range of prevalence estimates found in this study, then heightened awareness of intimate partner abuse is warranted for patients presenting to the ED.
Objective Rural public health system leaders struggle to access and use data for understanding local health inequities and to effectively allocate scarce resources to populations in need. This study sought to determine these rural public health system leaders’ data access, capacity, and training needs. Materials and Methods We conducted qualitative interviews across Alaska, Idaho, Oregon, and Washington with individuals expected to use population data for analysis or decision-making in rural communities. We used content analysis to identify themes. Results We identified 2 broad themes: (1) challenges in accessing or using data to monitor and address health disparities and (2) needs for training in data use to address health inequities. Participants faced challenges accessing or using data to address rural disparities due to (a) limited availability or access to data, (b) data quality issues, (c) limited staff with expertise and resources for analyzing data, and (d) the diversity within rural jurisdictions. Participants also expressed opportunities for filling capacity gaps through training—particularly for displaying and communicating data. Discussion Rural public health system leaders expressed data challenges, many of which can be aided by informatics solutions. These include interoperable, accessible, and usable tools that help capture, access, analyze, and display data to support health equity efforts in rural communities. Conclusion Informatics has the potential to address some of the daunting data-related challenges faced by rural public health system leaders working to enhance health equity. Future research should focus on developing informatics solutions to support data access and use in rural communities.
Background Public health leaders lack evidence for making decisions about the optimal allocation of resources across local health department (LHD) services, even as limited funding has forced cuts to public health services while local needs grow. A lack of data has also limited examination of the outcomes of targeted LHD investments in specific service areas. Purpose This study used unique, detailed LHD expenditure data gathered from state health departments to examine the influence of maternal and child health (MCH) service investments by LHDs on health outcomes. Methods A multivariate panel time-series design was used in 2013 to estimate ecologic relationships between 2000–2010 LHD expenditures on MCH and county-level rates of low birth weight and infant mortality. The unit of analysis was 102 LHD jurisdictions in Washington and Florida. Results Results indicate that LHD expenditures on MCH services have a beneficial relationship with county-level low birth weight rates, particularly in counties with high concentrations of poverty. This relationship is stronger for more targeted expenditure categories, with expenditures in each of the three examined MCH service areas demonstrating the strongest effects. Conclusions Findings indicate that specific LHD investments in MCH have an important effect on related health outcomes for populations in poverty and likely help reduce the costly burden of poor birth outcomes for families and communities. These findings underscore the importance of monitoring the impact of these evolving investments and assuring that targeted, beneficial investments are not lost but expanded upon across care delivery systems.
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