title: Cross-sectional and longitudinal risk of physical impairment in a cohort of postmenopausal women who experience physical and verbal abuse.
abstract: BACKGROUND
  Exposure to interpersonal violence, namely verbal and physical abuse, is a highly prevalent threat to women's health and well-being. Among older, post-menopausal women, several researchers have characterized a possible bi-directional relationship of abuse exposure and diminished physical functioning. However, studies that prospectively examine the relationship between interpersonal abuse exposure and physical functioning across multiple years of observation are lacking. To address this literature gap, we prospectively evaluate the association between abuse exposure and physical functioning in a large, national cohort of post-menopausal women across 12 years of follow-up observation.
  
  
  METHODS
  Multivariable logistic regression was used to measure the adjusted association between experiencing abuse and physical function score at baseline in 154,902 Women's Health Initiative (WHI) participants. Multilevel modeling, where the trajectories of decline in physical function were modeled as a function of time-varying abuse exposure, was used to evaluate the contribution of abuse to trajectories of physical function scores over time.
  
  
  RESULTS
  Abuse was prevalent among WHI participants, with 11 % of our study population reporting baseline exposure. Verbal abuse was the most commonly reported abuse type (10 %), followed by combined physical and verbal abuse (1 %), followed by physical abuse in the absence of verbal abuse (0.2 %). Abuse exposure (all types) was associated with diminished physical functioning, with women exposed to combined physical and verbal abuse presenting baseline physical functioning scores consistent with non-abused women 20 years senior. Results did not reveal a differential rate of decline over time in physical functioning based on abuse exposure.
  
  
  CONCLUSIONS
  Taken together, our findings suggest a need for increased awareness of the prevalence of abuse exposure among postmenopausal women; they also underscore the importance of clinician's vigilance in their efforts toward the prevention, early detection and effective intervention with abuse exposure, including verbal abuse exposure, in post-menopausal women. Given our findings related to abuse exposure and women's diminished physical functioning at WHI baseline, our work illuminates a need for further study, particularly the investigation of this association in younger, pre-menopausal women so that the temporal ordering if this relationship may be better understood.
authors.affiliation: Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA. brad.cannell@unthsc.edu.
authors.forename: M Brad
authors.initials: MB
authors.lastname: Cannell
authors.affiliation: Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA. wjulie1@stanford.edu.|Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA. wjulie1@stanford.edu.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Weitlauf
authors.affiliation: Department of Public Health Sciences, University of California Davis, Davis, CA, USA. lgarcia@ucdavis.edu.
authors.forename: Lorena
authors.initials: L
authors.lastname: Garcia
authors.affiliation: School of Public Health, Oregon Health & Science University, Portland State University, Portland, OR, USA. andresee@ohsu.edu.
authors.forename: Elena M
authors.initials: EM
authors.lastname: Andresen
authors.affiliation: HealthPartners Institute for Education and Research, Minneapolis, MN, USA. karen.l.margolis@healthpartners.com.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Margolis
authors.affiliation: Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA. tmanini@aging.ufl.edu.
authors.forename: Todd M
authors.initials: TM
authors.lastname: Manini
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D017698:Postmenopause / Q000502:physiology* / Q000523:psychology*; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D013179:Spouse Abuse / Q000523:psychology; D016387:Women's Health / Q000592:standards*