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Studies on routine inquiry about violence victimization and alcohol consumption in youth clinics
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Objectives: Violence victimization is common in youth, and the association between victimization and ill-health is well established. Youth is also the period when alcohol risk drinking is most prevalent. At youth clinics in Västernorrland, Sweden, a randomized controlled intervention was conducted examining health outcomes and risk drinking after implementing routine inquiry about violence victimization and alcohol consumption.

Methods: Participants in the intervention group underwent routine inquiry about violence victimization and alcohol consumption. Victimized participants received empowering strategies and were offered further counseling. Risk drinkers received motivational interviewing (MI). All participants answered questionnaires about sociodemography and health at baseline, at 3 months and at 12 months. Of 1,445 eligible young women, 1,051 (73%) participated, with 54% of them completing the 12-month follow-up. Males were excluded from the quantitative analysis owing to the low number of male participants. Fifteen research interviews examining the experience of routine inquiry were conducted.

Results: Violence-victimized young women reported more ill health than non-victimized women did. This was especially evident for those who had been multiply victimized. There were no differences in health outcomes between the baseline and the 12-month follow-up for the intervention group and for the control group. Of the victimized women in the intervention group, 14% wanted and received further counseling. There was a significant decrease in risk drinking from baseline to follow-up, but no differences between the MI group and the controls. There was a large intra-individual mobility in the young women’s drinking behavior.

In interviews, the participants described how questions about violence had helped them to process prior victimization. For some, this initiated changes such as leaving a destructive relationship or starting therapy. The participants considered risk drinking in terms of consequences and did not find unit-based guidelines useful.

Conclusion: Violence victimization, especially multiple victimization, was strongly associated with ill health in young women. Routine inquiry about violence and subsequent follow-up led to a high degree of disclosure but did not improve self-reported health. However, victimized participants described talking about prior victimization as very helpful. Participants viewed risk drinking in terms of consequences rather than in quantity or frequency of alcohol, which may render unit-based drinking guidelines less useful when addressing risk drinking in youth.  

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. , p. 90
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1279
Keywords [en]
Violence victimization, Youth, Alcohol consumption, Routine Inquiry, Screening, Youth friendly health care, Randomized controlled study, Qualitative study
Keywords [sv]
Våldsutsatthet, Unga, Alkohol, Rutinfrågor, Screening, Ungdomsmottagning, Randomiserad studie, Kvalitativ studier
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-307393ISBN: 978-91-554-9756-9 (print)OAI: oai:DiVA.org:uu-307393DiVA, id: diva2:1049232
Public defence
2017-01-12, Rosensalen, Akademiska sjukhuset, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-12-21 Created: 2016-11-14 Last updated: 2016-12-28
List of papers
1. Violence victimisation: a watershed for young women's mental and physical health
Open this publication in new window or tab >>Violence victimisation: a watershed for young women's mental and physical health
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2016 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 26, no 5, p. 861-867Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The association between victimisation and adverse health in children is well established but few studies have addressed the effect of victimisation, especially multiple victimisations, in older adolescents and young adults. The aim of this study was to assess self-reported health in young women (15-22 years) victimised to one or more types of violence, compared with non-victimised.  METHODS: Young women visiting youth health centres in Sweden answered a questionnaire constructed from standardised instruments addressing violence victimisation (emotional, physical, sexual and family violence), socio-demographics, substance use and physical and mental health. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and attributable risk (AR) were assessed.  RESULTS: Of 1051 women (73% of eligible women), 25% were lifetime victims of one type of violence and 31% of two or more types of violence. Sexual-minority young women were more victimised than heterosexual women. Violence victimisation increased the risk for adverse health outcomes, especially evident for those multiply victimised. Victims of two or more types of violence had AOR 11.8 (CI 6.9-20.1) for post-traumatic stress symptoms, 6.3 (CI 3.9-10.2) for anxiety symptoms and 10.8 (CI 5.2-22.5) for suicide ideation. The AR of victimisation accounted for 41% of post-traumatic stress symptoms, 30% of anxiety symptoms and 27% of suicide ideation. Stratified analyses showed that lower economic resources did not influence health negatively for non-victimised, whereas it multiplicatively reinforced ill-health when combined with violence victimisation.  CONCLUSION: Violence victimisation, and particularly multiple victimisations, was strongly associated with mental ill-health in young women, especially evident in those with low economic resources.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-273973 (URN)10.1093/eurpub/ckv234 (DOI)000386451800030 ()26743590 (PubMedID)
Available from: 2016-01-19 Created: 2016-01-19 Last updated: 2017-05-07Bibliographically approved
2. No Differences in Health Outcomes After Routine Inquiry Into Violence Victimization in Young Women: A Randomized Controlled Study in Swedish Youth Health Centers
Open this publication in new window or tab >>No Differences in Health Outcomes After Routine Inquiry Into Violence Victimization in Young Women: A Randomized Controlled Study in Swedish Youth Health Centers
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(English)In: Journal of Interpersonal Violence, ISSN 0886-2605, E-ISSN 1552-6518Article in journal (Refereed) In press
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-307391 (URN)
Available from: 2016-11-14 Created: 2016-11-14 Last updated: 2017-11-29
3. How do youth perceive routine inquiry about violence victimization and alcohol consumption in Swedish youth clinics? A qualitative study
Open this publication in new window or tab >>How do youth perceive routine inquiry about violence victimization and alcohol consumption in Swedish youth clinics? A qualitative study
(English)Article in journal (Refereed) Submitted
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-307392 (URN)
Available from: 2016-11-14 Created: 2016-11-14 Last updated: 2016-11-23
4. Motivational interviewing does not affect risk drinking among young women: A randomised, controlled intervention study in Swedish youth health centres
Open this publication in new window or tab >>Motivational interviewing does not affect risk drinking among young women: A randomised, controlled intervention study in Swedish youth health centres
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2016 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 44, no 6, p. 611-618Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to analyse risk and binge drinking at 12-month follow-up in young women with risk drinking who received motivational interviewing compared with controls.

Methods: Young women attending Swedish youth health centres were randomised into intervention or control groups. The intervention group members were asked about their alcohol consumption by a midwife/social worker using the Alcohol Use Disorders Identification Test Consumption. A score of 5 was used as the cut-off value for risk drinking. Participants with risk drinking in the intervention group received motivational interviewing within the same visit. Participants in the control group had a regular visit with a midwife/social worker and answered the same questions about alcohol consumption in a questionnaire after their visit. A questionnaire with the same questions was administered to participants 12 months after baseline.

Results: Of 1445 eligible young women, 1051 (73%) consented to randomisation and were enrolled in the study. The follow-up rate was 54%. There was a significant decrease in risk- and binge drinking, from baseline to follow-up, in both the intervention and the control groups. Generalised estimating equation analyses demonstrated no significant effect between groups. Of participants who did not have risk drinking at baseline, about 20% in both groups had developed high-risk drinking by the 12-month follow-up.

Conclusions: No significant differences in risk drinking between young women who received motivational interviewing and controls were found. There was a large intra-individual mobility in young women's risk drinking behaviour. This highlights the importance of finding reliable screening tools that can capture the mobility in drinking behaviour in youth. More research is needed before recommendations can be made.

Keywords
Alcohol drinking, binge drinking, risk drinking, youth, adolescents, motivational interviewing, brief alcohol intervention, randomised controlled trial, treatment outcome
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-302695 (URN)10.1177/1403494816654047 (DOI)000380308800013 ()27289105 (PubMedID)
External cooperation:
Available from: 2016-09-14 Created: 2016-09-08 Last updated: 2017-11-21Bibliographically approved

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