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Am Fam Physician. 1998;58(2):518-521

Violence against women is a significant public health problem, the prevalence of which is difficult to quantify. Surveys of women presenting to obstetric clinics and emergency departments indicate that up to 22 percent of female patients are victims of domestic violence. McGrath and colleagues administered a survey to determine the prevalence of physical and sexual abuse in women presenting to an urgent care clinic and the frequency with which they recalled being asked by their health care providers about abuse.

Women who presented to an urgent care clinic during an eight-month period were included in this study unless they were too ill to participate, had language or communication difficulties, or could not be interviewed alone. Interviews consisted of 22 questions asked by specially trained staff members. If abuse was disclosed, the patient was referred to a social worker for crisis intervention and counseling.

A total of 397 women were included in the study. Approximately 61 percent (242) were white, 18 percent (71) were black and 15 percent (61) were Hispanic. Forty-one percent (161) received Medicaid or had no insurance, and 56 percent (221) had at least a high school education. Sixty-four percent of the women were pregnant. A lifetime history of physical or sexual abuse was reported by 184 (46 percent) of the women. Recent physical or sexual abuse was reported by 10 percent (38). Recent abuse was significantly associated with young age and being uninsured or being insured with Medicaid. Pregnant patients included in this study reported lower rates of recent abuse than nonpregnant patients.

Only 18 percent of the women surveyed recalled being asked about abuse by a physician or nurse. Of the women who reported recent abuse, 71 percent reported never having been screened for abuse. This situation differed significantly by race. Fifty percent of recently abused women who were white recalled being screened for abuse, compared with only 10 percent of women who were not white. Insurance status did not appear to be associated with a history of being screened for abuse.

The authors conclude that women who presented to this urgent care clinic reported a high prevalence of physical and sexual abuse, including recent abuse. Although some studies have implicated pregnancy as a risk factor for violence, these authors found that young age was more highly associated with abuse. They urge health care professionals to routinely screen all women for physical and sexual abuse during routine visits.

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Copyright © 1998 by the American Academy of Family Physicians.

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