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Background: Gender-based violence exposure is associated with smoking. Both gender-based violence and smoking are independent risk factors in the development of cervical cancer. Women living in Ohio Appalachia experience cervical cancer at disproportionately high rates and smoke at higher rates than women living in other regions of Ohio. However, little is known about 1) women’s exposure to gender-based violence, throughout the life course, in Ohio Appalachia, or 2) the association between gender-based violence exposures, contextual factors, and smoking behaviors among women in the region.Objective: This dissertation examined the relationship between sexual and intimate partner gender-based violence exposures and smoking, among women in Ohio Appalachia, within a socio-contextual health disparities framework. The goal of this investigation was: 1) to understand if disparate smoking rates of women in Ohio Appalachia, compared to other parts of Ohio, are associated with gender-based violence in the region, and 2) to examine the context of smoking behavior among women exposed to intimate partner and/or sexual gender-based violence in Ohio Appalachia. In addition, a set of gender-based violence constructs for use in effective abuse assessment among this underserved population were identified. Method: A two-phase address-based sampling approach was used to recruit a random sample of women, 18 years of age or older, from 1 of 3 selected Ohio Appalachian counties, to participate in an observational, interview administered, cross-sectional survey from August 2012 through October 2013. The analytic sample for this analysis comprised 398 participants, of the 408 women completing interviews, who provided complete gender-based violence exposure histories. All analyses were conducted in SAS or LISREL, including correlation, regression, and confirmatory factor analysis. Results: Intimate partner and sexual gender-based violence is a notable public health concern in Ohio Appalachia--impacting nearly 6 out of 10 women in the region. Cumulative gender-based violence exposure was associated with smoking among women in Ohio Appalachia, controlling for other known risk factors. Significant differences existed between current and past smokers with gender-based violence exposure histories regarding: perceived stress, exposure to fear invoking control (a type of intimate partner violence), perception of social status, discrimination, adult socioeconomic position, perception of number of smokers in the social environment, and home smoking restrictions. In addition, an eight mechanistic factor model of intimate partner and sexual gender-based violence exposure was validated. Conclusions: Among this population, where abuse exposure is high and where access to health services are scarce, assessment for eight types of gender-based violence may open opportunities for more targeted intervention and referral. Due to the unique safety concerns for this population, the social context of a gender-based violence survivor’s smoking behaviors and cessation attempts must be considered when adapting cessation programs to this population. Findings from this study suggest that it may be factors within a survivor’s environment causing stress—a culture tolerant of gender-based violence, discrimination, social economic standing, and smoking bans within the home—which must be addressed in concert with intrapersonal factors, like self-control and affect regulation, to help women exposed to gender-based violence succeed in smoking cessation. |
