Severe intimate partner physical violence as a risk factor for inadequate cervical cancer screening

Rafael, Ricardo de Mattos Russo; Moura, Anna Tereza Miranda Soares de

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ARTICLE • Cad. Saúde Pública 33 (12) • 2017 • https://doi.org/10.1590/0102-311X00074216 copy

Severe intimate partner physical violence as a risk factor for inadequate cervical cancer screening

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

With the aim of assessing the occurrence of severe intimate partner physical violence as a risk factor for inadequate screening of uterine cervical cancer, a case-control study was performed with a multidimensional questionnaire in a sample of 640 users of the Family Health Strategy in the Municipality of Nova Iguaçu, Rio de Janeiro State, Brazil. Cases were defined as women who had not had a cervical cytology test in the previous three years. The results showed that severe physical violence against the woman (_adjustedOR = 2.2; 95%CI: 1.1-4.4) and co-occurrence of the event in the couple (_adjustedOR = 3.8; 95%CI: 1.4-9.8) were risk factors for inadequate screening. Alcohol abuse by the woman was an effect modifier for not having the test among victims of violence (_adjustedOR = 10.2; 95%CI: 1.8-56.4) and in cases of co-occurrence of violence (_adjustedOR = 8.5; 95%CI: 1.4-50.7). In addition to known causal factors for intimate partner violence, the results point to a risk association between women’s exposure to abuse and inadequate screening. The findings call for an expanded view of women’s absenteeism from screening, since this indicator can represent unmet demands not readily detected by health teams.

Keywords:
Uterine Cervical Neoplasms; Mass Screening; Domestic Violence; Violence Against Women; Primary Health Care

Variables	Distribution		_c OR (95%CI)	p-value
Variables	n	% (95%CI)
Woman’s age bracket (years)
< 30	89	14.0 (11.5-16.9)	1.0	-
30-39	166	26.1 (22.8-29.7)	1.3 (0.7-2.5)	0.419
40-49	154	24.2 (21.1-27.7)	1.3 (0.7-2.5)	0.447
50-59	173	27.2 (23.9-30.8)	2.0 (1.1-3.8)	0.029
≥ 60	53	8.3 (6.4-10.8)	3.2 (1.5-7.0)	0.003
Woman’s race/color
White	260	40.6 (36.9-44.5)	1.0	-
Black/Brown (= Black)	259	56.1 (52.2-59.9)	1.3 (0.9-1.9)	0.138
Asian-descendant/Indigenous	21	3.3 (2.1-4.9)	0.6 (0.2-1.6)	0.396
Conjugal status
Married	370	57.8 (53.9-61.6)	1.0
Other	270	42.2(38.4-46.1)	1.0 (0.7-1.4)	0.995
Woman’s schooling (years)
≤ 8	355	55.5 (51.6-59.3)	1.0	-
> 8	285	44.5 (40.7-48.4)	0.5 (0.4-0.8)	0.002
Woman’s economic class
A/B	129	20.2 (17.2-23.5)	1.0	-
C	452	70.7 (67.1-74.1)	0.9 (0.6-1.4)	0.639
D/E	58	9.1 (7.1-11.5)	1.5 (0.7-2.9)	0.258
Housing conditions
Good	100	15.6 (13.0-18.7)	1.0
Bad	639	84.4 (81.3-86.9)	0.7 (0.4-1.2)	0.185
Woman’s alcohol abuse
No	580	90.6 (88.1-92.6)	1.0
Yes	60	9.4 (7.3-11.9)	1.5 (0.9-2.7)	0.153
Male partner’s alcohol abuse
No	453	70.8 (67.1-74.2)	1.0
Yes	187	29.2 (25.8-32.9)	0.9 (0.6-1.5)	0.769

Variables	Distribution		_c OR (95%CI)	_a OR (95%CI) *
Variables	n	% (95%CI)
Intimate partner violence against woman
No	603	94.2 (92.1-95.7)	1.0	1.0
Yes	37	5.8 (4.2-7.9)	2.1 (1.1-4.1)	2.2 (1.1-4.4)
p-value			0.036	0.027
Co-occurrence of intimate partner violence
No	620	96.9 (95.2-98.0)	1.0	1.0
Yes	20	3.1 (2.0-5.0)	3.0 (1.2-7.4)	3.8 (1.4-9.8)
p-value			0.015	0.006
Situation of intimate partner violence
No	586	91.6 (89.1-93.5)	1.0	1.0
Yes	54	8.4 (6.5-10.9)	1.5 (0.8-2.7)	1.6 (0.8-2.9)
p-value			0.178	0.142

Variables	> 8 years of schooling *		Alcohol abuse *
	> 8 years of schooling *		By woman		By male partner
	Yes	No	No	Yes	No	Yes
Intimate partner violence against woman
No	1.0	1.0	1.0	1.0	1.0	1.0
Yes	0.7 (0.1-3.4)	3.8 (1.5-9.5)	1.2 (0.5-2.8)	10.2 (1.8-56.4)	1.4 (0.5-3.7)	5.7 (1.8-18.1)
p-value	0.685	0.004	0.725	0.008	0.546	0.003
Co-occurrence of intimate partner violence
No	1.0	1.0	1.0	1.0	1.0	1.0
Yes	1.0 (0.1-9.0)	6.3 (1.8-22.1)	1.8 (0.4-7.5)	8.5 (1.4-50.7)	3.9 (0.7-20.5)	6.3 (1.6-24.1)
p-value	0.991	0.004	0.416	0.019	0.108	0.007
Situation of intimate partner violence
No	1.0	1.0	1.0	1.0	1.0	1.0
Yes	0.4 (0.1-2.0)	2.7 (1.3-5.7)	0.9 (0.4-2.0)	5.3 (1.2-22.8)	1.1 (0.4-2.5)	3.9 (1.3-11.5)
p-value	0.282	0.010	0.876	0.025	0.875	0.012

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[1] * Correspondence R. M. R. Rafael Universidade do Estado do Rio de Janeiro. Boulevard Vinte e Oito de Setembro, 157, Rio de Janeiro, RJ 20551-030, Brasil. prof.ricardomattos@gmail.com