Selecting statistical measures can be challenging because each situation may be different. As you review your learning resources this week, you will become familiar with several statistical measures such as measures of central location, variability, standard deviation, box plots and much more.

For this Assignment, revisit the journal article below. 

Gilbert, L., et al. (2016). Efficacy of a Computerized Intervention on HIV and Intimate Partner Violence Among Substance-Using Women in Community Corrections: A Randomized Controlled Trial. AmJ Public Health, 106: 1278?1286. doi:10.2105/AJPH.2016.303119

The Assignment (1?2 pages)

• Summarize the major results of the study
• Describe the information presented in tables and/or graphs 
• Briefly summarize the major conclusions of the study

Intimate Partner Violence Among Substance-Using

Women in Community Corrections: A Randomized

Controlled Trial

Louisa Gilbert, PhD, Dawn Goddard-Eckrich, MS, Timothy Hunt, MS, Xin Ma, MS, Mingway Chang, PhD, Jessica Rowe, MDes, Tara McCrimmon,

MPH, Karen Johnson, PhD, Sharun Goodwin, BS, Maria Almonte, MSW, and Stacey A. Shaw, PhD

Objectives. To test the ef?cacy of a computerized, group-based HIV and intimate

partner violence (IPV) intervention on reducing IPV victimization among substance-using

women mandated to community corrections.

Methods. Between November 2009 and January 2012, we randomly allocated 306

women from community corrections in New York City to 3 study arms of a computerized

HIV and IPV prevention trial: (1) 4 group sessions intervention with computerized

self-paced IPV prevention modules (Computerized Women on the Road to Health

[WORTH]), (2) traditional HIV and IPV prevention intervention group covering the same

HIV and IPV content as Computerized WORTH without computers (Traditional WORTH),

and (3) a Wellness Promotion control group. Primary outcomes were physical, injurious,

and sexual IPV victimization in the previous 6 months at 12-month follow-up.

Results. Computerized WORTH participants reported signi?cantly lower risk of

physical IPV victimization, severe injurious IPV victimization, and severe sexual IPV victimization at 12-month follow-up when compared with control participants. No significant differences were seen between Traditional WORTH and control participants for any

IPV outcomes.

Conclusions. The ef?cacy of Computerized WORTH across multiple IPV outcomes

highlights the promise of integrating computerized, self-paced IPV prevention modules

in HIV prevention groups. (Am J Public Health. 2016;106:1278?1286. doi:10.2105/

AJPH.2016.303119) T he intersecting epidemics of intimate

partner violence (IPV) victimization and

HIV are heavily concentrated among women

who use drugs or alcohol (herein de?ned

as substance-using women) in community

corrections (i.e., probation, parole, drug

treatment courts, community courts, and

alternative-to-incarceration programs).1?4

Rates of experiencing physical or sexual IPV

in the past year range between 32% and 56%

for substance-using women on probation

and are 2 to 5 times higher than rates found

among nationally representative samples of

women.5 Additionally, HIV prevalence

rates among substance-using women mandated to community corrections in New

York City range from 13% to 17%, which are 1278 Research Peer Reviewed Gilbert et al. comparable to rates found among women in

sub-Saharan Africa.6,7 Despite the elevated

rates of IPV victimization, HIV, and other

sexually transmitted infections (STIs) among

this population of women, as well as accumulating research linking IPV victimization

to HIV and STIs,4,8 HIV prevention interventions that integrate IPV prevention among substance-using women remain scarce

in community corrections settings.

Currently, about 1 million women are

on probation, parole, or other types of

community corrections nationwide, 70%

of whom have a history of drug use.9,10

Community corrections settings represent

an untapped venue to reach numerous

dif?cult-to-reach substance-using women

who are at risk for both IPV victimization

and HIV. Growing research has documented multiple ?entwined and mutually

enhancing? biological and behavioral

mechanisms linking substance abuse, violence, and AIDS (SAVA) that are fueled by

social and economic inequities, which has

been conceptualized as the SAVA

syndemic.4,11?13 Substance-using women

in community corrections have been disproportionately affected by the SAVA

syndemic, because they often live in

low-income urban communities that have

concentrated HIV epidemics and high rates

of violence and incarceration. Incarceration disrupts intimate relationships and

pushes households into poverty, increasing

the likelihood of women having multiple

sex partners and engaging in survival

sex.14,15 Substance-using women in

community corrections also are more

likely to experience sexual assault, further ABOUT THE AUTHORS

Louisa Gilbert, Dawn Goddard-Eckrich, Timothy Hunt, Xin Ma, Mingway Chang, Tara McCrimmon, Karen Johnson, and

Stacey A. Shaw are with Social Intervention Group, Columbia University, New York, NY. Jessica Rowe is with Columbia

Center for New Media Teaching and Learning, New York, NY. Sharun Goodwin is with The New York City Department

of Probation, New York, NY. Maria Almonte is with Bronx Community Solutions, Center for Court Innovation, Bronx, NY.

Correspondence should be sent to Louisa Gilbert, PhD, Social Intervention Group, Columbia University School of Social

Work, 1255 Amsterdam Ave, Room 832, New York, NY 10027 (e-mail: [email protected]). Reprints can be ordered at

http://www.ajph.org by clicking the ?Reprints? link.

This article was accepted February 4, 2016.

doi: 10.2105/AJPH.2016.303119 AJPH July 2016, Vol 106, No. 7 AJPH RESEARCH increasing their risk for HIV. 16 Despite the

large and growing population of women in

community corrections programs in the

United States affected by the SAVA syndemic, a recent systematic review identi?ed only 4 interventions that reduced HIV

risk behaviors for women in community

corrections and none that reduced physical

or sexual IPV. 16

A recent meta-analysis identi?ed sexual

IPV as an independent risk factor for HIV

infection among women.17 Biologically, the

risk of HIV acquisition increases during

forced sex with HIV-positive partners as

a result of vaginal and anal lacerations and an

altered stress response from the immune

system.18 Multiple structural, biological, and

behavioral syndemic mechanisms link IPV

victimization to substance misuse and a wide

range of HIV transmission risks.4,12 Strong

bidirectional associations have been

established between use of different drugs

and alcohol and all types of IPV victimization

among women, including sexual IPV.19,20

Among substance-using women, IPV victimization not only has been found to increase the likelihood of sharing injection

drug equipment,21 having multiple sexual

partners,8 exchanging sex for money or

drugs,15 acquiring STIs,8 and not using

condoms8 but also is associated with not

getting tested for HIV, not accessing HIV

care, not adhering to antiretroviral medication, and failing to achieve viral load

suppression.12,22 Taken together, this research underscores the need for integrated

behavioral HIV and IPV prevention interventions that can ef?ciently target the

unique syndemic risks among

substance-using women.

A small but growing body of research

indicates that integrated behavioral IPV and

HIV interventions are ef?cacious in reducing sexual HIV risks among women at risk

for experiencing IPV.4,23 Although the IPV

prevention content in these HIV interventions has ranged in type, intensity, and

modality, common components include

raising awareness of IPV, screening for IPV,

safety planning, identifying IPV service

needs and referrals, and increasing sexual

negotiation skills.4 A recent systematic review of 44 best-evidence US-based HIV

prevention interventions identi?ed by the

Centers for Disease Control and July 2016, Vol 106, No. 7 AJPH Prevention23 ascertained 5 HIV interventions that addressed IPV and reduced 1

or more HIV risks. To our knowledge,

however, only 2 integrated interventions

have been found to be ef?cacious in reducing

IPV among women.24,25 To date, no integrated interventions have emerged that

have shown ef?cacy in reducing the syndemic risk of sexual IPV (i.e., forced sex by

an intimate partner) among substance-using

women.

Emerging literature suggests the promise

of brief computerized self-paced IPV prevention intervention tools that may be

integrated in HIV interventions for

substance-using women.4 Compared with

human-delivered interventions, computerized self-paced IPV prevention interventions have been found to be more

effective in identifying and addressing IPV

among women in health care settings.26

Integrating computerized self-paced IPV

prevention modules into group-based HIV

interventions may have several advantages

in addressing IPV among substance-using

women over the traditional group format,

including a greater likelihood of ensuring

that all group members will complete IPV

prevention activities, resulting in higher

?delity and precision of implementation. A

computerized self-paced module also may

ensure greater con?dentiality and privacy

among substance-using women who may

fear legal or social consequences from disclosing IPV in a group setting.26 To our

knowledge, however, no integrated HIV

and IPV prevention interventions have used

computerized self-paced IPV prevention

modules among substance-using women or

women in general.

This study addressed a critical gap in

HIV and IPV prevention research by testing

the ef?cacy of a group-based computerized

HIV and IPV prevention intervention

(WORTH?Women on the Road to

Health) in reducing the risk of IPV victimization among substance-using women in

community corrections. A recent publication

from this randomized controlled trial

found that WORTH, whether delivered in

a format with computerized self-paced and

interactive group modules (Computerized

WORTH) or in a traditional group format

(Traditional WORTH), was ef?cacious in

decreasing the number of unprotected sexual acts over the 12-month follow-up period,

which was the primary outcome of this

randomized controlled trial, compared with

a Wellness Promotion attentional control

group among 306 substance-using women in

community corrections.7 The primary aim of

this study was to examine whether Computerized WORTH was more ef?cacious in

reducing the risk of different types of IPV

victimization at the 12-month follow-up,

which was a secondary outcome of this

randomized controlled trial, when compared

with the Wellness Promotion control condition. We also examined whether Traditional WORTH was more ef?cacious

than Wellness Promotion in reducing risk

of IPV victimization at the 12-month

follow-up. METHODS

This randomized controlled trial was

conducted in New York City between

November 2009 and January 2012. We

have described detailed methods, sample

characteristics, and sample power

calculations elsewhere7 and included

the CONSORT study ?ow diagram

in Figure A (available as a supplement

to the online version of this article at

http://www.ajph.org). Recruitment and Eligibility

Research assistants actively recruited and

screened 1104 women from multiple community corrections sites by handing out

?yers and inviting women to be screened.

Of the 1104 women, 306 were eligible

and were enrolled in the study. Eligible

women reported

d

d d d d being aged 18 years or older;

being mandated to community corrections

(i.e., probation, parole, community court,

drug treatment court, or an alternative-toincarceration program) in the past 90 days;

using illicit drugs, binge drinking, or attending a substance abuse treatment program in the past 90 days;

engaging in unprotected vaginal or anal

intercourse within the past 90 days; and

having at least 1 other HIV risk factor. Gilbert et al. Peer Reviewed Research 1279 AJPH RESEARCH We conducted repeated assessments at 3-,

6-, and 12-month postintervention followups at a centrally located community research

of?ce, but IPV outcomes were assessed only at

6- and 12-month follow-ups. Participants

were reimbursed for completing assessments

and intervention sessions up to a maximum of

$265. More details on participant recruitment

and retention are described in a previous

publication.7 Randomization and Masking

A study investigator randomly assigned

groups of 4 to 9 women to 1 of 3 study

conditions; a computer-generated randomization algorithm was designed to balance

the number of women per study arm via

an adaptive, biased-coin procedure.27 A

total of 103 participants were assigned

to Computerized WORTH, 101 to Traditional WORTH, and 102 to Wellness

Promotion.

Investigators were masked to treatment

assignment until the ?nal 12-month followup assessment was completed in April 2013.

Data were locked in September 2013, after

which study arms were unmasked. Intervention and Control

Conditions

Traditional WORTH, consisting of

a 4-session group HIV and IPV prevention

intervention, is an evidence-based HIV intervention that was originally tested with

women in jail28 and in drug treatment.29 For

this study, we made minor modi?cations to

WORTH to make it more contextually

relevant for substance-using women in

community corrections, such as addressing

criminal justice?related triggers for unsafe sex

and IPV (e.g., resisting drug use with a partner

being released from prison).28,29 The intervention was informed by social cognitive

learning theory, which focuses on observation, modeling, and skill rehearsal through

role play and feedback from group members.30 Empowerment theory also guided

a strengths-based approach of WORTH to

build collective ef?cacy of women to negotiate safe relationships and counter stigma

that they face as women in community

corrections.31

Interventions were conducted at a community research site. A detailed description 1280 Research Peer Reviewed Gilbert et al. of IPV prevention content in Traditional

and Computerized WORTH is provided in

the box on the next page.7 IPV-related

components included risk reduction

problem-solving and negotiation skills,

awareness-raising of IPV, IPV triggers for

unsafe sex and drug use, IPV screening and

feedback, safety planning, social support to

increase safety, identi?cation of service needs

and linkage to services, and IPV prevention

goal setting.32 For Traditional WORTH, all

components, including IPV prevention activities, were conducted in a group setting.

Two facilitators led group activities face-toface once per week, with sessions lasting

from 90 to 120 minutes.

Computerized WORTH also consisted of

4 weekly group sessions lasting 90 to

120 minutes, led by 2 facilitators. Computerized

WORTH covered the same core components as Traditional WORTH, while

employing group and individual interactive

computerized games, video enhancements,

and visual tools.32 During each session, participants used individual laptops to independently view video vignettes of 4

?ctional role models to promote identi?cation and emotional engagement. Computerized self-paced modules covered the same

IPV screening, prevention, and service referral activities that were conducted in the

Traditional WORTH arm. Some activities

(e.g., safety plan and IPV service referrals)

were recorded in an electronic log that was

printed for participants.

The Wellness Promotion control arm also

consisted of 4 weekly group sessions lasting

between 90 and 120 minutes, designed to

control for modality and dosage. Core

components of this psychoeducational intervention were adapted from an evidencebased wellness promotion intervention33 and

included maintaining a healthy diet, promoting ?tness in daily routines, addressing

tobacco use, learning stress-reduction exercises including guided meditation, and setting

and achieving personal health goals.33

None of the Wellness Promotion activities

focused on IPV prevention. Measures

IPV victimization outcomes. The primary

outcomes for this study focused on different

types of IPV victimization in the past 6 months. These outcomes were assessed at

baseline, 6-month follow-up, and 12-month

follow-up with a shortened 8-item version of

the Revised Con?ict Tactics Scale,34 which

includes 3 subscales measuring any sexual,

physical, and injurious IPV within the past

6 months (responses were dichotomized as

yes or no). These subscales contained items

that assessed minor or severe IPV by type of

IPV. Internal consistency of the Revised

Con?ict Tactics Scale subscales ranges between 0.79 and 0.95.35

Sociodemographic variables. Participants

self-reported sociodemographic characteristics including gender, age, ethnicity, marital

status, years of education, employment,

monthly income, homelessness, the types of

community corrections settings where they

had enrolled in the past 90 days, and the

number of times they had been arrested or

incarcerated in jail or prison.

Current and past substance use. We used the

Risk Behavior Assessment36 to assess use

of illicit drugs ever and within the past

90 days. To assess binge drinking, we asked

whether participants consumed 4 or more

alcoholic drinks within a 6-hour period.37 Analysis Plan

Consistent with the intent-to-treat approach, we estimated intervention effects

by analyzing participant responses based on

their experimental assignment. Because

some missing data were the result of loss to

follow-up at postintervention assessments, we

used all available data at any follow-up visit

in the statistical models. The 87% or higher

retention rate at each follow-up did not

differ signi?cantly by condition. Attrition

analyses, which compared sociodemographic

characteristics of those who completed all

follow-up assessments (completers) with

those who missed 1 or more follow-up assessments (noncompleters), identi?ed that

completers on average were older (42 vs

39 years) and less likely to report homelessness

(8% vs 18%). We estimated that with a sample

of 112 women per arm, the study would

have 80% statistical power, assuming an a

level of .05, 2-sided hypothesis testing, no

covariance adjustment, and intraclass correlations of 0.05 for the primary study outcomes

previously published.7 AJPH July 2016, Vol 106, No. 7 AJPH RESEARCH WOMEN ON THE ROAD TO HEALTH (WORTH) INTIMATE PARTNER VIOLENCE (IPV) PREVENTION INTERVENTION

COMPONENTS

Aim of WORTH Activity Traditional WORTH Activity Enhance sexually transmitted infection (STI) Facilitator uses myth or fact statements Computerized WORTH Activity

Participants play interactive game, and HIV knowledge and perceived risk and reading of case studies to transfer watch culturally tailored videos, and respond and identify attitudes toward safer knowledge and correct misperceptions. to questions on a computer screen. sex and condom use.

Identify and avoid unsafe sex

and drug-related risks. In group format, participants discuss triggers,

including fear of IPV and substance use; Participants review potential triggers for

unsafe sex, which include fear of IPV and share experiences; and read a case example substance misuse, and identify own triggers to apply problem solving to reduce risks for unsafe sex or risky drug use on their for unsafe sex. computer (self-paced activity). Using a video

model, the group applies a problem-solving

model to avoid triggers and reduce risks. Practice sexual negotiation, sexual safety

planning, and problem-solving skills. Facilitator discusses steps of negotiating Video scenarios model sexual negotiation condom use, reads a case example, skills and sexual safety planning to and facilitates role play. avoid risky sexual encounters. Group

identi?es steps in negotiation and engages

in role-play practice. Improve linkage to services and promote

HIV testing and care. Reduce IPV and enhance supportive network. Facilitator reviews HIV testing options, Computerized demonstration of HIV testing provides resource manual, encourages and exposure window assessment assists participants to identify psychosocial needs, in prioritizing psychosocial needs and links and uses manual to contact organizations to to Web-based information to access community address HIV, IPV, and other services, facilitating services (self-paced activity). Facilitators can group discussion about barriers to service access. access logs and assist in addressing barriers to

accessing services for HIV, IPV, and other issues. Facilitator raises awareness about different Participants use a video and audio tool to learn types of IPV and supports the completion about different types of IPV, con?dentially of individual IPV assessment and safety planning identify IPV risks, provide feedback on IPV to reduce IPV risks. Participants are asked to risks, and develop a safety plan to reduce identify sources of social support and service IPV risks (self-paced activity). Computerized, referrals that may reduce their IPV risks. interactive tool helps women to identify

sources of social support and IPV services that

may help them reduce their IPV risks

(self-paced activity). We used logistic regression models with

random effects to evaluate the effects of the

intervention arms on IPV victimization in

the past 6 months at each follow-up. All

random-effects regression models included

the dummy codes for intervention and

modality effects and the baseline measure

of the outcome of interest to estimate the

effects for the follow-up period; we added

the follow-up assessment time (in months)

and interaction terms between time and

dummy codes to yield the effects for each

follow-up assessment. We grouped

membership and repeated measures of

a participant at each time point. We used July 2016, Vol 106, No. 7 AJPH a bootstrapping strategy that calculates

estimates? SEs and P values to compensate

for multiple comparisons. 38 The data were

resampled 2000 times for each regression

model. We used SAS version 9.3 (SAS

Institute, Cary, NC) for all analyses. We

reported odds ratios (ORs) and 95% con?dence intervals (CIs) for these effects. RESULTS

Sociodemographic, substance use,

HIV, and lifetime IPV victimization characteristics of participants are reported in Table 1. The mean age of participants

was 41.5 (SD = 10.5). A total of 208 participants (68%) identi?ed as Black or

African American, and 47 (15.4%) identi?ed

as Latina. Two thirds (n = 202; 66.0%)

were single and never married. Only 25

women (8.2%) were employed, and 278

(90.8%) had ever been in prison or jail. Of

the women, 194 (63.4%) reported using

illicit drugs in the past 90 days. About one

quarter (n = 81; 26.5%) tested positive for an

STI, and 43 (14.1%) tested positive for HIV.

We did not ?nd signi?cant differences in

any of the characteristics by study condition

(Table 1). Gilbert et al. Peer Reviewed Research 1281 AJPH RESEARCH TABLE 1?Background Characteristics and Intimate Partner Violence (IPV) Prevalence, by Study Arm: New York City, 2009?2012

Total (n = 306),

Mean 6SD or No. (%) Wellness (n = 102),

Mean 6SD or No. (%) Traditional (n = 101),

Mean 6SD or No. (%) Computerized (n = 103),

Mean 6SD or No. (%) 41.5 610.5 42.1 69.7 41.9 610.8 40.5 610.9 Black 208 (68.0) 68 (66.7) 67 (66.3) 73 (70.9) Latina 47 (15.4) 15 (14.7) 17 (16.8) 15 (14.6) Other 51 (16.7) 19 (18.6) 17 (16.8) 15 (14.6) 176 (57.5) 55 (53.9) 66 (65.3) 55 (53.4) 202 (66.0) 66 (64.7) 70 (69.3) 66 (64.1) 49 (16.0)

55 (18.0) 18 (17.6)

18 (17.6) 12 (11.9)

19 (18.8) 19 (18.4)

18 (17.5) 25 (8.2) 9 (8.8) 7 (6.9) 9 (8.7) Age, y

Race/ethnicity High school or general equivalency diploma

Marital status

Single

Married

Divorced/separated/widowed

Employment

Homeless, past 90 d 29 (9.5) 9 (8.8) 8 (7.9) 12 (11.7) In inpatient drug treatment facility, past 90 d 63 (20.6) 23 (22.5) 15 (14.9) 25 (24.3) Hospitalized for mental health or health reasons, past 90 d 40 (13.1) 13 (12.7) 9 (8.9) 18 (17.5) Incarcerated in jail or prison, past 90 d 73 (23.9) 22 (21.6) 24 (23.8) 27 (26.2) 278 (90.8) 92 (90.2) 95 (94.1) 91 (88.3) Ever in jail or prison

Community court, past 90 d 70 (22.9) 28 (27.5) 21 (20.8) 21 (20.4) 107 (35.0) 33 (32.4) 34 (33.7) 40 (38.8) On parole, past 90 d 40 (13.1) 19 (18.6) 12 (11.9) 9 (8.7) Drug court, past 90 d 47 (15.4) 13 (12.7) 16 (15.8) 18 (17.5) Alternative-to-incarceration program, past 90 d 23 (7.5) 9 (8.8) 6 (5.9) 8 (7.8) On probation, past 90 d Ever used heroin 65 (21.2) 32 (31.4) 17 (16.8) 16 (15.5) Used heroin, past 90 d 30 (9.8) 18 (17.6) 6 (5.9) 6 (5.8) Ever used crack/cocaine 246 (80.4) 84 (82.4) 81 (80.2) 81 (78.6) Used crack/cocaine, past 90 d 118 (38.6) 46 (45.1) 40 (39.6) 32 (31.1) Ever used marijuana 267 (87.3) 85 (83.3) 90 (89.1) 92 (89.3) Used marijuana, past 90 d 117 (38.2) 36 (35.3) 42 (41.6) 39 (37.9) 69 (22.5) 32 (31.4) 19 (18.8) 18 (17.5) Injected drugs, past 90 d 22 (7.2) 11 (10.8) 5 (5.0) 6 (5.8) Ever used any illicit drug 300 (98.0) 99 (97.1) 99 (98.0) 102 (99.0) Used any illicit drug, past 90 d 194 (63.4) 67 (65.7) 63 (62.4) 64 (62.1) Ever engaged in binge drinking 174 (56.9) 54 (52.9) 64 (63.4) 56 (54.4) 93 (30.4) 25 (24.5) 36 (35.6) 32 (31.1) Ever injected drugs Engaged in binge drinking, past 90 d

HIV positive 43 (14.1) 13 (12.7) 12 (11.9) 18 (17.5) Any sexually transmitted infection 81 (26.5) 29 (28.4) 23 (22.8) 29 (28.2) Ever experienced

Any physical IPV 185 (60.5) 58 (56.9) 66 (65.3) 61 (59.2) Any injurious IPV 177 (57.8) 51 (50.0) 67 (66.3) 59 (57.3) Any sexual IPV 166 (54.2) 54 (52.9) 62 (61.4) 50 (48.5) Severe physical IPV 170 (55.6) 53 (52.0) 62 (61.4) 55 (53.4) Severe injurious IPV 151 (49.3) 44 (43.1) 54 (53.5) 53 (51.5) Severe sexual IPV 117 (38.2) 40 (39.2) 37 (36.6) 40 (38.8) 1282 Research Peer Reviewed Gilbert et al. AJPH July 2016, Vol 106, No. 7 AJPH RESEARCH TABLE...

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