Ann L. Coker's research while affiliated with University of Kentucky and other places

Background: Intimate partner violence (IPV), nonpartner sexual violence (SV), child sexual and physical abuse, and neglect have detrimental impacts on women's reproductive and sexual health. More empirical studies are needed to investigate the negative impacts of lifetime violence, including physical or sexual child abuse, nonpartner SV, physical, sexual, and psychological IPV on women's sexual health to better understand long-term impacts from IPV and physical or sexual child abuse. Materials and Methods: We used data from Wellness, Health and You, an ongoing health registry. A total of 1,213 women were included in data analysis. Our aim was to investigate the associations between lifetime IPV, nonpartner SV, child abuse, and women's current sexual health defined using Patient-Reported Outcomes Measurement Information System (PROMIS) measures of sexual health (e.g., sexual satisfaction, interest, and functioning), sexual assertiveness, female sexual subjectivity, and use of online resources to address sexual needs. Multivariate analysis of covariance was used to investigate demographic factors (e.g., age and current relationship) as potential correlates of current sexual health. Results: Women with lifetime experiences of physical, sexual, or psychological IPV, nonpartner SV, and child physical or sexual abuse reported lower sexual satisfaction compared to women with no history of lifetime violence (p < 0.0001). However, lifetime violence was not correlated with sexual interest, sexual functioning, sexual subjectivity, nor sexual assertiveness. Conclusion: Lifetime experiences of violence (i.e., IPV, nonpartner SV, child abuse) are associated with poorer sexual health. Asking questions about past sexual and physical violence/abuse in ways that support disclosure is important toward improving women's physical and sexual health and wellbeing.

Bystander intervention programs have established efficacy to increase bystander behaviors to prevent interpersonal violence (IPV). Little research has investigated intervention efficacy among latent risk classes among high school students. Data from a five-year randomized control trial were used to conduct multigroup path analyses to assess the association between type of training received and bystander outcomes moderated by risk groups identified via latent profile analysis (LPA). LPA was used to identify risk based on six indicators related to violence exposure, association with aggressive friends, and alcohol use. Bystander training received was the primary independent variable characterized as: no training, overview speech alone, or skills training. Outcomes included (a) observed bystander behaviors; (b) reactive bystander behaviors; or (c) proactive bystander behaviors. Three risk groups were identified via LPA: low risk, moderate risk witnesses of IPV, and highest risk victims and perpetrators. Of the bystander trainings received, overview speeches only increased reactive bystander behaviors among low risk students. The skills training was effective at increasing most bystander outcomes among all risk groups, with the largest effect sizes observed among the highest risk victims and perpetrators profile. Findings suggest that tailoring or modifying bystander training based on the risk profiles of youth may lead to greater potential to increase bystander behaviors to reduce risk of violence. Specifically, overview speech trainings should be targeted to low risk youth, while skills training primarily delivered to higher risk youth. These skills trainings could incorporate content related to trauma-informed care as well as associations with alcohol use, which may enhance their effectiveness further.

Introduction: Lifetime exposure to interpersonal violence or abuse (IVA) has been associated with several chronic diseases including adult-onset diabetes, yet this pattern has not been confirmed by sex and race within a large cohort. Methods: Data from the Southern Community Cohort Study collected 2002-2009 and 2012-2015 were used to explore the relationship between lifetime IVA and diabetes (n=25,251). Prospective analyses of lower income people living in the southeastern United States (U.S.) were conducted in 2022 to examine risk of adult-onset diabetes associated with lifetime IVA by sex and race. Lifetime IVA was defined as 1) physical or psychological violence, threats or abuse in adulthood (adult IVA), and/or 2) childhood abuse or neglect (CAN). Results: After adjustment for potentially confounding factors, adult IVA was associated with a 23% increased risk of diabetes (adjusted hazard ratio [aHR]=1.23; 95% confidence interval [CI]: 1.16-1.30). Diabetes risks associated with CAN were 15% (95% CI: 1.02-1.30) for neglect and 26% (95% CI: 1.19-1.35) for abuse. When combining adult IVA and CAN, the risk of diabetes was 35% higher (aHR=1.35; 95% CI: 1.26-1.45) than those experiencing no violence, abuse, or neglect. This pattern held among Black and White participants and among females and males. Conclusions: Both adult IVA and CAN increased the risk of adult-onset diabetes in a dose-dependent pattern for males and females and by race. Intervention and prevention efforts to reduce adult IVA and CAN could not only reduce risk of lifetime IVA but may also reduce one of the most prevalent chronic diseases, adult-onset diabetes.

Introduction Youth who witness parental intimate partner violence are at increased risk for sexual violence. Existing data from a cluster RCT were used to determine the effectiveness of Green Dot bystander intervention to reduce sexual violence among high-school students who did and did not witness parental intimate partner violence. Study Design A secondary analysis was conducted in 2021 of extant data from a 5-year cluster RCT. Setting/Participants A total of 26 high schools in Kentucky were randomized to intervention or control condition in 2010. A total of 15,863 surveys were analyzed from baseline, 30,014 from partial intervention implementation (Years 1 and 2), and 25,907 from full implementation (Years 3 and 4). The sample was stratified to include students who witnessed or did not witness parental intimate partner violence. Intervention The bystander intervention program was delivered in 2 stages. During partial implementation, a persuasive speech describing rates, risk factors, and bystander-based approaches to violence prevention was provided to most students in schools randomized to the intervention. During full implementation, an in-depth 5-hour skill-based bystander training was provided to popular opinion leaders among the students in intervention schools (10%–15%). Main Outcome Measures The primary outcome was sexual assault measured as perpetration and victimization. Secondary outcomes included sexual harassment and stalking, measured as victimization and perpetration. Results During full implementation, among students who witnessed parental intimate partner violence, the intervention was associated with significant reductions in sexual assault perpetration (β= −0.21, p<0.01), sexual harassment perpetration (β= −0.29, p<0.001), sexual assault victimization (β= −0.25, p<0.01), and sexual harassment victimization (β= −0.45, p<0.001). For students who did not witness parental intimate partner violence, the intervention was only associated with reductions in sexual harassment (β= −0.19, p<0.001) and stalking (β= −0.09, p<0.01) victimization. Conclusions As implemented in the parent RCT, the bystander training was more effective at reducing violent outcomes among those who witnessed parental intimate partner violence than in those who did not witness parental intimate partner violence. Trial Registration: This study is registered at www.ClinicalTrials.gov, under identifier NCT01878097.