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1.  Adverse Childhood Experiences and Adult Health Outcomes Among Veteran and Non-Veteran Women 
Journal of Women's Health  2015;24(9):723-729.
Background: Women veterans represent a vulnerable population with unique health needs and disparities in access to care. One constellation of exposures related to subsequent poor health includes adverse childhood experiences (ACEs; e.g., physical and sexual child abuse), though research on impacts of ACEs among women veterans is limited.
Methods: Data were drawn from the 2010 Behavioral Risk Factor Surveillance System for the 11 states that included the ACE module (n=36,485). Weighted chi-squared tests and multivariable logistic regression were used to assess the prevalence of ACEs among women veterans compared with women non-veterans and differences in the following outcomes, controlling for ACEs: social support, inadequate sleep, life satisfaction, mental distress, smoking, heavy alcohol use, obesity, diabetes, cardiovascular disease symptoms, asthma, and disability.
Results: Women veterans (1.6% of the total sample) reported a higher prevalence of 7 out of 11 childhood adversities and higher mean ACE score than women non-veterans. Women veterans were more likely to be current smokers and report a disability, associations which were attenuated when controlling for ACE.
Conclusions: Despite women veterans' higher prevalence of ACE, their health outcomes did not differ substantially from non-veterans. Further research is needed to understand the intersections of traumatic experiences and sources of resilience over the lifecourse among women veterans.
PMCID: PMC4589327  PMID: 26390379
2.  Instructional Curriculum Improves Medical Staff Knowledge and Efficacy for Patients Experiencing Intimate Partner Violence 
Military medicine  2011;176(11):1260-1264.
Study Objectives
This study assesses VA mental health providers’ understanding of intimate partner violence (IPV) and the perception of patient benefit of routine inquiry and service referral. The impact of an instructional curriculum was also examined following an interactive training.
An evidence-based curriculum was offered to VA mental health providers. The curriculum utilized didactic methods, case scenarios, and resources regarding referrals and statutes regarding crimes related to violence and abuse. The participants completed pre- and post-training surveys to assess their perceptions about IPV and to evaluate the training.
Seventy-three individuals completed the training. Fifty-four of the participants were female, and thirty-three were over the age of 45. Fifty-one individuals completed both surveys. There were no differences between participants’ views of the seriousness of IPV in the community or their practices before or after the training. However, participants scored significantly higher on the knowledge and efficacy measures after the training (p<.001).
Following an educational intervention, providers demonstrate more knowledge and efficacy regarding routine inquiry and referral for IPV. Barriers to universal implementation still warrant attention.
PMCID: PMC4161012  PMID: 22165653
Intimate Partner Violence; Abuse; Domestic Violence; Medical Education
3.  Protection Orders Protect Against Assault and Injury: A Longitudinal Study of Police-Involved Women Victims of Intimate Partner Violence 
Journal of interpersonal violence  2012;27(14):2845-2868.
To measure the efficacy of protection orders (POs) in reducing assault and injury-related outcomes using a matched comparison group and tracking outcomes over time.
This study was a retrospective review of police, emergency department, family court and prosecutor administrative records for a cohort of police-involved female IPV victims; all events over a four-year study period were abstracted. Victims who obtained protection orders (POs) were compared to a propensity-score-based match group without POs over three time periods: Before, during, and after the issuance of a PO.
Having a PO in place was associated with significantly more calls to police for non-assaultive incidents, and more police charging requests that were multiple-count and felony-level. Comparing outcomes, PO victims had police incident rates that were more than double the matched group prior to the PO, but dropped to the level of the matched group during and after the order. ED visits dropped over time for both groups.
This study confirmed the protective effect of POs, which are associated with reduced police incidents and emergency department visits both during and after the order, and reduced police incidents compared to a matched comparison group.
PMCID: PMC4151113  PMID: 22491224
Battered women; legal intervention; domestic violence
4.  Sexual Victimization, Health Status, and VA Healthcare Utilization Among Lesbian and Bisexual OEF/OIF Veterans 
Journal of General Internal Medicine  2013;28(Suppl 2):604-608.
Many lesbian and bisexual (LB) women veterans may have been targets of victimization in the military based on their gender and presumed sexual orientation, and yet little is known regarding the health or mental health of LB veterans, nor the degree to which they feel comfortable receiving care in the VA.
The purpose of this study was to examine the prevalence of mental health and gender-specific conditions, VA healthcare satisfaction and trauma exposure among LB veterans receiving VA care compared with heterosexually-identified women veterans receiving.
Prospective cohort study of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) women veterans at two large VA facilities.
Three hundred and sixty five women veterans that completed a baseline survey. Thirty-five veterans (9.6 %) identified as gay or lesbian (4.7 %), or bisexual (4.9 %).
Main Measures
Measures included sexual orientation, military sexual trauma, mental and gender-specific health diagnoses, and VA healthcare utilization and satisfaction.
Key Results
LB OEF/OIF veterans were significantly more likely to have experienced both military and childhood sexual trauma than heterosexual women (MST: 31 % vs. 13 %, p < .001; childhood sexual trauma: 60 % vs. 36 %, p = .01), to be hazardous drinkers (32 % vs. 16 %, p = .03) and rate their current mental health as worse than before deployment (35 % vs. 16 %, p < .001).
Many LB veterans have experienced sexual victimization, both within the military and as children, and struggle with substance abuse and poor mental health. Health care providers working with female Veterans should be aware of high rates of military sexual trauma and childhood abuse and refer women to appropriate VA treatment and support groups for sequelae of these experiences. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country.
PMCID: PMC3695265  PMID: 23807072
lesbian; health services research; Veterans; women
5.  Recent and Past Intimate Partner Abuse and HIV Risk Among Young Women 
To examine the associations between past intimate partner abuse experienced during adolescence (verbal and physical), recent intimate partner abuse (verbal, physical, and sexual), and HIV risk (as indicated by lack of condom use) for sexually active young adult women in relationships with male partners.
Secondary data analysis of waves II and III of the National Longitudinal Study of Adolescent Health (Add Health).
The Add Health Study is a longitudinal, in-home survey of a nationally representative sample of adolescents.
Analyses involved 2,058 sexually active young adult women.
Main Outcome Measures
HIV risk was measured by consistent condom use over the past 12 months.
Physical and verbal abuse experienced in adolescence were associated with physical/verbal abuse experienced in young adulthood. Young, sexually active women experiencing no abuse in their relationships were more likely to consistently use condoms in the past 12 months than were their abused counterparts.
A causal pathway may exist between prior abuse, current abuse, and HIV risk.
PMCID: PMC3677848  PMID: 18336447
HIV; adolescent; risk taking; intimate partner violence; dating violence; sexually transmitted diseases

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