Health screening falls short on campuses

About one in four women experience some form of violence in a college setting, according to the Centers for Disease Control and Prevention.

So, it seems logical to assume that all college health centers screen women as part of routine health examinations, right?

Research conducted by Melissa Sutherland, professor of nursing and director of the PhD in nursing program at Decker College of Nursing and Health Sciences, shows they don’t.

“We assess height and weight,” she says. “We take blood pressures even though college students, in general, are not at risk for hypertension. We know college women are at high risk for interpersonal violence; yet, research has found that we’re not consistently asking students who come through the door about this issue.”

Sutherland ’97, MS ’01, says there are many reasons providers don’t screen for violence. One concern is the erroneous belief that asking patients about whether they’ve been abused might upset them. Some providers say they understand the importance of screening, but haven’t been given the tools to follow up with patients who reveal they’re experiencing violence. Time constraints are another frequently cited barrier.

Some providers view sexual violence as a private matter, not a healthcare issue. Sutherland emphatically says the opposite is true: Violence is a significant public health issue, with a trickle-down effect.

“Violence impacts children because it’s harder for them to learn in school if they’re in a home with violence. If adults experience violence at home, they’re probably less productive at work. Violence also costs the healthcare system money,” she says.

For more than 10 years, Sutherland, who also serves as director of Decker’s Kresge Center for Nursing Research (see sidebar), has been looking at sexual health outcomes for women who have experienced violence. She has found that women who are in relationships in which they are experiencing violence are at higher risk for sexually transmitted diseases and HIV.

“These women are also much more likely to access the healthcare system multiple times for injuries, headaches, stomachaches, depression, etc. We’re merely treating the symptoms without treating the underlying cause,” she says.

A nurse practitioner, Sutherland serves on a committee for the University’s Health Promotion and Prevention Services Office, where she advocates for providers to screen for violence.

“For example, asking ‘Are you safe at home?’ is not the best question because how one individual defines ‘safe at home’ may be very different from how another individual defines ‘safe at home,’” she says. “A better question would be, ‘Are you being hit or forced to have sex?’”

The focus of Sutherland’s current research is on college health centers throughout the nation.

“My work has found that organizational institutional factors are important. That means if the health center thinks screening is a priority, providers are more likely to screen.”

Sutherland stresses that there’s still a lot of work to be done, but she’s optimistic that awareness about interpersonal violence is growing.

“In the last five years, people have been talking more about violence in relationships, a lot more women have felt comfortable sharing those experiences and there’s more support when they disclose. There’s a positive movement forward,” she says.