PC2094: The Toxic Relationships of Domestic Violence: Assessing the Relationships Between Intimate Partner Violence and Social Determinates of Health

Background: The AAP has characterized intimate partner violence (IPV) as a pediatric problem that should be screened for at every well-child visit. Unfortunately, many pediatricians do not screen for IPV with barriers including underreporting, lack of documentation, lack of training, and insufficient knowledge of community resources. Pediatricians have a professional responsibility to screen for domestic violence because most abused patients do not seek medical care for themselves but do seek medical care for their children. Therefore, the pediatrician may be the victim's only opportunity for identification and intervention programs. Furthermore, exposure to IPV is associated with risk factors for leading causes of death as an adult including suicide attempts, depression, and severe obesity. Knowing which socioeconomic and environmental risk factors are associated with IPV will help physicians better recognize families at risk for IPV and empower pediatricians to provide more relevant resources. This study aimed to (1) test the null hypothesis that patients with and without a positive IPV screen have the same social determinant risk factors and (2) evaluate if a patient's neighborhood influences their risk for IPV.

Methods: Our population consisted of patients visiting community health clinics in San Bernardino and Riverside County, CA, during 2021 who screened positive for nine SDOH categories using EPIC social risk factors questionnaires. Patients answered questionnaires as self or caregiver (patient < 18 yr). In the at-risk group, 79% were female, the mean age was 37.89 and 8.6% did not choose English as their first language. Chi-square test, degrees of freedom, p-value, and Cramer’s statistical analysis was performed to assess whether a significant statistical relationship existed between any of the nine SDOH and IPV (Table 1). The at-risk group's zip code information was used to measure their neighborhood's Child Opportunity Index (COI) category for education, socioeconomic, health, environment, and overall.

Results: The p-value for all the SDOH besides physical activity was significant therefore rejecting the null hypothesis. Financial strain and transportation were the most at-risk variables with the strongest correlations followed by stress, food insecurity, tobacco, and alcohol. Social isolation was protective against IPV likely because being in a relationship increased a patient's social integration score. In evaluating neighborhood opportunity, each of the 5 COI categories (e.g., high, moderate) represents 20% of the census tract. In the at-risk group for IPV greater than 60% live in the lowest 20% scoring census tract (Graph 1).

Conclusion: IPV is insufficiently screened, sub-optimally addressed, and subsequently underreported. Understanding the relationships between IPV and SDOH will enable physicians to provide more applicable resources and adapt their clinical examination to better identify families at risk for IPV. This knowledge will then reinforce the need for providers to carefully screen to properly treat and prevent IPV.