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46


Homelessness Is a Form of Structural Violence That Leads to Adverse Obstetrical Outcomes [Editorial]

Walsh, Madeleine; Varshneya, Avni; Beauchemin, Esther; Rahman, Lameya; Schick, Anna Beth; Goldberg, Madeleine; Ades, Veronica
PMCID:10568510
PMID: 37708426
ISSN: 1541-0048
CID: 5593382

Sex Trafficking in New York City and Vulnerabilities to Re-Trafficking

Chen, Victoria H; Beauchemin, Esther L; Cuan, Isabella T; Sadana, Annum; Olulola-Charles, Lolayemi; Leschi, Julia E; Ades, Veronica
Human trafficking occurs in a cycle of coercion and exploitation of vulnerable people; yet, little is known about those who are trafficked more than one time (re-trafficked). Our study sought to describe the trafficking experiences and explore vulnerabilities to re-trafficking in an urban, majority immigrant, population. This study is part of a parent cohort study that enrolls patients at the EMPOWER Center in New York City, which provides trauma-informed obstetric and gynecologic services to victims of sexual- and gender-based violence. Retrospective chart review was conducted on patients with a history of sex trafficking who were evaluated at the EMPOWER Center from February 2013 to January 2021. A total of 87 patients were enrolled in this study, 23 (26.4%) of whom had been re-trafficked. All were women. Most (88.5%) were victims of international trafficking, most often from Mexico or the Caribbean/Central America. Nine (10.3%) reported contraceptive use and six (6.9%) experienced forced substance use while trafficked. The most reported barriers that women faced in escaping trafficking were threat of violence (28.7%) and financial dependence (19.5%). Re-trafficked patients were more likely to have a history of being undocumented (odds ratio [OR] = 5.29; 95% confidence intervals [CI] [1.34, 20.94]) and experienced childhood sexual abuse (OR = 2.99; 95% CI [1.10, 8.16]), experienced childhood physical abuse (OR = 3.33; 95% CI [1.18, 9.39]), and lived with a non-parent family member (OR = 6.56; 95% CI [1.71, 25.23]). Although these vulnerabilities were no longer significant when analyzed in a parsimonious multivariate logistic regression model adjusting for the other significant variables, likely due to the limited sample size. Almost half (46.0%) reported ongoing emotional effects from being trafficked, which did not vary by re-trafficking status. Our study highlights potential pre-trafficking vulnerabilities, illustrates the complexity of the trafficking experience, and presents potential risk factors for being re-trafficked.
PMID: 37421223
ISSN: 1552-6518
CID: 5539542

Medical evidence in asylum applications: Medical versus legal approaches

Sadana, Annum; Gérard, Sasha Elisabeth; Tang, Ashley; Pardee, Lisa; Sher, Olivia; Foote, Ali; Ades, Veronica
The purpose of this narrative review is to elucidate the ways the clinicians working on forensic medical evaluations can engage with asylum proceedings. We compare the legal and medical perspectives on different aspects of forensic medical evidence, asylum evaluations, and asylum applications. As asylum seekers must demonstrate a well-founded fear of persecution in order to receive asylee status, legal and medical professionals often need to collaborate in asylum cases. Although significant evidence has demonstrated that an objective expert medical opinion can support asylum claims, few studies have analyzed how the medical professional's role complements or is at odds with the goals of the legal system. This review summarizes and compares key aspects of the medical and legal perspectives on trauma, credibility, autobiographical memory, and medical evidence to better comprehend the role that medical professionals can play in writing medical affidavits for asylum applications. We dissect legal misconceptions surrounding trauma and the consequences of such misunderstandings and make recommendations for medical evaluators who are working in a forensic capacity.
PMID: 37385206
ISSN: 1878-7487
CID: 5535202

COVID-19 transmissibility during labor and vaginal delivery [Letter]

Hawks, Rebecca J Mahn; Ades, Veronica; Roman, Ashley S; Penfield, Christina A; Goddard, Brian
PMCID:9554218
PMID: 36240987
ISSN: 2589-9333
CID: 5361262

Polyvictimization and Psychiatric Sequelae Associated with Female Genital Mutilation/Cutting (FGM/C)

Chen, Victoria H; Caron, Jayne; Goddard, Brian; Eng, Shirley M; Ades, Veronica
Female Genital mutilation/cutting (FGM/C) is associated with enduring psychiatric complications. In this study, we investigate the rates of co-morbid abuses and polyvictimization experienced by survivors of FGM/C. This is a sub-analysis of a cohort study examining the patient population at the EMPOWER Center for Survivors of Sex Trafficking and Sexual Violence in New York City. A retrospective chart-review of electronic medical records was conducted for all consenting adult patients who had FGM/C and had an intake visit between January 16, 2014 and March 6, 2020. Of the 80 participants, ages ranged from 20 to 62 years with a mean of 37.4 (SD = 9.1) years. In addition to FGM/C, participants were victims of physical abuse (43; 53.8%), emotional abuse (35; 43.8%), sexual abuse (35; 43.8%), forced marriage (20; 25%), child marriage (13; 16.3%), and sex trafficking (1; 1.4%). There was a high degree of polyvictimization, with 41 (51.2%) experiencing 3 or more of the aforementioned abuses. Having FGM/C on or after age 13 or having a higher total abuse score was also found to be strong predictors of depression and PTSD. The high rates of polyvictimization among survivors of FGM/C are associated with development of depression and PTSD. Despite co-morbid abuses, patients still attribute substantial psychiatric symptoms to their FGM/C. Health care providers should understand the high risk of polyvictimization when caring for this patient population.
PMID: 35217978
ISSN: 1557-1920
CID: 5175222

Are Screening Tools for Identifying Human Trafficking Victims in Health Care Settings Validated? A Scoping Review

Hainaut, Mathilde; Thompson, Katherine J; Ha, Caryn J; Herzog, Hayley L; Roberts, Timothy; Ades, Veronica
OBJECTIVE/UNASSIGNED:Although many screening tools, resources, and programs for identifying victims of human trafficking exist, consensus is lacking on which tools are most useful, which have been validated, and whether they are effective. The objectives of this study were to determine what tools exist to identify or screen for victims of human trafficking in health care settings and whether these tools have been validated. METHOD/UNASSIGNED:We conducted a scoping review of the literature on human trafficking identification in health care settings following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) protocol for scoping reviews. We searched the MEDLINE, PsycInfo, Embase, and Scopus databases without language or date limitations. Two independent reviewers screened each citation. We included human research studies in English with populations of all ages, all genders, all geographic locations, and using quantitative and/or qualitative research methods. We excluded studies that were not conducted in a health care setting, review articles, and meta-analyses. We summarized additional screening tools available online and identified through hand-searching. RESULTS/UNASSIGNED:Database searches yielded 8730 studies, of which 4806 remained after removing duplicates. We excluded 4720 articles based on title/abstract review, we reviewed 85 full-text studies for eligibility, and we included 8 articles. Hand-searching revealed 9 additional screening tools not found in the literature. Through our search for validated screening tools, only 6 had been studied for validation in health care settings. CONCLUSIONS/UNASSIGNED:Few studies have evaluated screening tools for identifying victims of human trafficking in health care settings. The absence of a gold standard for human trafficking screening and lack of consensus on the definition of human trafficking make screening tool validation difficult. Further research is required for the development of safe, effective approaches to patient screening.
PMCID:9257487
PMID: 35775913
ISSN: 1468-2877
CID: 5278292

Perceptions of Female Genital Mutilation/Cutting (FGM/C) among Asylum Seekers in New York City

Martell, Sarah; Schoenholz, Reagan; Chen, Victoria H; Jun, Irene; Bach, Sonya Chemouni; Ades, Veronica
Female Genital Mutilation/Cutting (FGM/C) affects millions of girls and women globally each year despite widespread criminalization of the practice. Eradication efforts have focused on the health risks associated with FGM/C however, it is important to understand the sociocultural context in which this practice exists. We conducted a cross-sectional study using retrospective chart review and structured interviews with women recruited through the Bellevue/New York University Program for Survivors of Torture. Of the 43 participants enrolled in the study, 88.4% initially indicated there is no benefit of undergoing FGM/C but when prompted, agreed that social acceptance (16.3%), religious approval (11.6%), and better marriage prospects (9.3%) are possible benefits. More sexual pleasure for the women (46.5%), avoiding pain (30.2%), and fewer medical problems (16.3%) were stated as benefits of not undergoing FGM/C. Overall, 40 (93%) participants believed the practice should be discontinued. This study highlights that there may be a perception of social benefit of undergoing FGM/C. Although most participants believed the practice should be discontinued, the complex social milieu within which this practice exists must be addressed.
PMID: 33048334
ISSN: 1557-1920
CID: 4632622

Caring for long term health needs in women with a history of sexual trauma

Ades, Veronica; Goddard, Brian; Pearson Ayala, Savannah; Greene, Judy A
PMID: 31640984
ISSN: 1756-1833
CID: 4147352

A prospective cohort study comparing expulsion after post-placental insertion: the levonorgestrel versus the copper intrauterine device

Hinz, Erica K; Murthy, Amitasrigowri; Wang, Binhuan; Ryan, Nessa; Ades, Veronica
OBJECTIVES/OBJECTIVE:To compare the expulsion rate at 6months after post-placental insertion by intrauterine device type. STUDY DESIGN/METHODS:This prospective cohort included participants with a post-placental intrauterine device inserted after vaginal or cesarean delivery, aged 18-45 and≥24weeks gestation. Study enrollment took place after IUD selection and insertion. Participants returned for a postpartum visit and received a short message service survey regarding intrauterine device expulsion, removal, vaginal bleeding and breastfeeding weekly from weeks 0 to 5 and on weeks 12 and 24 postpartum. Multivariable logistic regression examined 6-month expulsion rate by intrauterine device type. adjusting for variables that differed between the groups at baseline and in the bivariate analyses. RESULTS:Of 114 participants, 75 (65.8%) chose a levonorgestrel 52 mg intrauterine device and 39 (34.2%) chose a copper intrauterine device; 58 (50.9%) had a vaginal delivery and 56 (49.1%) had a cesarean delivery. Groups were similar except that copper intrauterine device users had a higher median parity (3 vs. 2, p=.03) and a higher proportion of senior residents compared to junior residents had performed insertion (46.2% vs. 22.7%, p=.02). The expulsion rate at 6-months was similar between the levonorgestrel and copper groups (26.7% and 20.5%, respectively; p=.38). Multivariable logistic regression also demonstrated that the odds of expulsion did not differ by intrauterine device type (aOR 0.98, 95% CI 0.22-4.48). CONCLUSION/CONCLUSIONS:The expulsion rate at 6-months after post-placental insertion did not differ between the levonorgestrel and copper intrauterine device type. IMPLICATIONS/CONCLUSIONS:Prior studies demonstrate a wide range of expulsion after post-placental insertion and recent data suggest a higher expulsion rate for the levonorgestrel compared to the copper intrauterine device. However, many studies did not control for patient level factors or delivery route. We found that when controlling for these confounding variables, the expulsion rate at 6-months postpartum did not differ by intrauterine device type.
PMID: 31108053
ISSN: 1879-0518
CID: 3920312

Gynecological and Contraceptive Needs of Female Survivors of Sex Trafficking and Sexual Violence [Meeting Abstract]

Rajeev, P; Goddard, B; Pearson-Ayala, S; Bach, S C; Ades, V
INTRODUCTION: Survivors of sexual trauma need trauma-informed care, but their specific gynecologic needs have not been explored. This study aims to examine the gynecological and contraceptive needs among survivors who did present to a specialized gynecology clinic for trauma survivors. This data may help gynecologists who encounter patients with sexual trauma to better understand their medical needs.
METHOD(S): This is a retrospective cohort study of patients at the EMPOWER Clinic for Survivors of Sex Trafficking and Sexual Violence. IRB approval and patient informed consent were obtained. Data were abstracted from electronic medical records, and stored and analyzed using REDCap.
RESULT(S): Data were available for 232 patients. Most patients presented to the clinic for a routine gynecological exam or due to gynecological symptoms. The most common chief complaints were dysmenorrhea, menorrhagia, and abdominal pain. Seventy percent of childbearing age patients were not on any form of effective contraception at the time of their intake visit. However, more than half of these patients with whom family planning was discussed accepted a new form of contraception, with 50% of these patients choosing oral contraceptive pills.
CONCLUSION(S): Trauma survivors often present with routine gynecological complaints, and providers should be prepared to address these in addition to the trauma. Many patients were not using an effective form of contraception at intake, but a majority of patients who discussed family planning with the Ob/Gyn accepted a new form of contraception, suggesting that there may be a high unmet need for contraception in this population
EMBASE:633843892
ISSN: 1873-233x
CID: 4749402