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Research ArticleOriginal Research

Mothers’ Comfort with Screening Questions about Sensitive Issues, Including Domestic Violence

Therese Zink, Linda Levin, Peter Wollan and Frank Putnam
The Journal of the American Board of Family Medicine July 2006, 19 (4) 358-367; DOI: https://doi.org/10.3122/jabfm.19.4.358
Therese Zink
MD, MPH
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Linda Levin
PhD
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Peter Wollan
PhD
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Frank Putnam
MD
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  • Article
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Article Figures & Data

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    Table 1.

    Demographic Characteristics of Participants (n = 200)

    CharacteristicMean (Range)
    Age in years34 (19–54)
    Number of children/mother2.5 (1–6)
    Number (percentage of 200)
    Currently pregnant7 (4%)
    Currently in a relationship154 (77%)
    Marital Status
        Single/divorced/widowed74 (37%)
        Married126 (63%)
    Current or past experience of intimate partner violence/abuse78 (39%)
    Ethnicity/Race
        White93 (47%)
        African American61 (31%)
        Latina46 (23%)
    Education
        ≤12th grade110 (55%)
        >12th grade90 (45%)
    Income/year
        <$20,00093 (47%)
        $20,000 to 40,00044 (22%)
        >$40,00062 (31%)
    • View popup
    Table 2.

    Mean comfort response and percentage of comfort (very comfortable and somewhat comfortable responses) with children and alone, for each sensitive question by individual questions and question category

    QuestionWith Child Mean ComfortAlone Mean ComfortWith Child Percentage of ComfortAlone Percentage of Comfort
    General DV questions3.23.781.294.2
        Do you feel safe in your current relationship?3.33.784.593.5
        In general how would you describe your relationship?3.03.777.094.0
        How do you and your partner work out arguments?3.13.776.592.5
        How is your partner treating you and the kids?3.43.885.594.5
        Considering your current partners or friends or any past partners or friends is there anyone who is making you feel unsafe now?3.33.881.596.5
    Sexual risk questions2.23.652.085.0
        Have you had 2 or more sexual partners in the past 10 years?2.03.550.589.0
        Have you ever had a sexually transmitted disease such as gonorrhea, syphilis, chlamydia, genital warts, or genital herpes?2.33.645.590.0
    Substance abuse questions3.33.883.295.7
        Have you injected street drugs, steroids, or vitamins with a needle?3.53.887.096.5
        Have you used drugs for other than those required for medical reasons?3.13.876.595.0
        How often do you have more than 4 alcohol drinks in a day?3.43.886.095.5
    Depression2.93.670.590.0
        In the past year, have you had 2 weeks or more during which you felt sad, blue or depressed or lost pleasure in things that you usually cared about or enjoyed?2.93.670.590.0
    Speeding/shop lifting questions3.43.785.393.2
        Have you had a speeding ticket?3.63.692.096.0
        Have you ever shoplifted?3.23.878.590.5
    • Participants were presented 2 questions: How comfortable are you answering this question in front of your children? How comfortable are you answering this question alone?

      Responses options: very comfortable (5)/somewhat comfortable (4)/neither (3)/somewhat uncomfortable (2)/very uncomfortable (1).

      Median comfort was 4 for all questions except ′Sexual risk′ questions (medians 2,3, respectively).

      Percentage of comfort was significantly different for ′alone′ and ′with child′ in all question categories (P < .001) and for all individual questions (P < .01) using McNemar’s statistic.

    • View popup
    Table 3.

    Factors associated with discomfort on any of the domestic violence questions. Results from logistic regression.

    CharacteristicsCategoriesOdds Ratio (95% CI)P Value
    EthnicityLatina
        (Compared with White as baseline)    Alone4.84 (1.78, 13.19).002
        With child2.53 (1.22, 5.24).01
    African American
        Alone0.86 (0.24, 3.08).82
        With child0.63 (0.31, 1.27).19
    African American
        Alone0.86 (0.24, 3.08).82
        With child0.63 (0.31, 1.27).19
    IncomeHigh (>$40,000)
        Alone0.76 (0.25, 2.28).62
        With child0.78 (0.37, 1.63).50
    (Compared to low (>$20,000 as baseline)Medium ($20,000 to $40,000)
        Alone0.65 (0.23, 1.82).41
        With child0.92 (0.48, 1.77).80
    Education>12th grade
        Alone2.19 (0.87, 5.55).10
        With child0.80 (0.45, 1.41).44
    Current relationshipYes
        Alone0.88 (0.33, 2.37).80
        With child1.06 (0.54, 2.08).87
    DV experienceYes
        Alone1.08 (0.44, 2.60).87
        With child1.10 (0.61, 1.98).75
    • View popup
    Table 4.

    Typical quotes from mothers (n = 40) about general DV questions

    QuestionPositiveNegative
    How do you and your partner work out arguments?I can be euphemistic and give coded answers.Use disagreement instead of argument, kids might be embarrassed by the answer.
    Gives the physician an idea about how problems are solved.
    One day it might be terrible and 3 days later it might be fine, but it’s not necessarily abuse.
    Seems intrusive … is that any of your business?
    In general how do you describe your relationship?No trigger words; opens the door to learning more.Your relationship should not be discussed in front of the kids.
    Too general to find out about domestic violence.
    There are a lot of euphemisms you can use to describe a relationship that’s not going well.You can’t give one-word answers.
    How is your partner treating you and the kids?For domestic violence this would be the true question.What does that mean? Like does he buy me a diamond …
    Good way to open up.Like is he a good provider?
    We’re a package, if you like me you’ve got to like my kids.Separate the you and kids.
    This gets at child abuse.Seems too nosey, too straightforward.
    Do you feel safe in your current relationship?It’s all about safety.Safe is a red flag in our house. It’s mommy’s job to keep you safe.
    Can just give a one-word answer—yes or no.Kids will understand safe, maybe stable or secure Perhaps stressed instead of safe…
    Good question, it is the follow-up that might cause problems.Safety, that’s admitting vulnerability. There may even be some pride involved.
    Considering your current partners or friends or any past partners or friends, is there anyone who is making you feel unsafe now?Can admit something wrong without having to say exactly.Too vague
    So convoluted, kids won’t understand.Kids understand safe and unsafe.
    If you are not in a current relationship you still could have a past person that is causing problems.Instead of partners and friends, say people. You know how kids think … it depends on how a parent introduces their kids to people they date. It might be somebody the kid didn’t like
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The Journal of the American Board of Family Medicine: 19 (4)
The Journal of the American Board of Family Medicine
Vol. 19, Issue 4
July-August 2006
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Mothers’ Comfort with Screening Questions about Sensitive Issues, Including Domestic Violence
Therese Zink, Linda Levin, Peter Wollan, Frank Putnam
The Journal of the American Board of Family Medicine Jul 2006, 19 (4) 358-367; DOI: 10.3122/jabfm.19.4.358

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Mothers’ Comfort with Screening Questions about Sensitive Issues, Including Domestic Violence
Therese Zink, Linda Levin, Peter Wollan, Frank Putnam
The Journal of the American Board of Family Medicine Jul 2006, 19 (4) 358-367; DOI: 10.3122/jabfm.19.4.358
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