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Telomere Shortening in Formerly Abused and Never Abused Women

Janice Humphreys, Elissa S. Epel, Bruce A. Cooper, Jue Lin, Elizabeth H. Blackburn and Kathryn A. Lee
Biol Res Nurs published online 8 March 2011
DOI: 10.1177/1099800411398479
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1999). RN. 2008). NP. USA 4 Department of Biochemistry and Biophysics. San Francisco. Brackley. CA. King. The investigation used a cross-sectional design to study telomere length in women with a history of IPV exposure and control women who reported no prior exposure to IPV. McMahon. & Ryan. Coker. CA. 2012 . Bethea.. CA 94143. PhD. UCSF. Jansen. Department of Family Health Care Nursing. 2001).g. PhD3. Epel.sagepub. & Williams. Numerous studies suggest that women who experience IPV have poorer overall health. Abused women often experience symptoms that appear unrelated to IPV and have an unspecified origin (Katon. the type of IPV that is particularly problematic involves a pattern of coercive control that is deliberate. Findings from this descriptive study suggest a link between IPV exposure. women often attribute their health problems to IPV (Queen. between 8% and 14% of women of all ages have reported physical assault in the previous year by a husband. and suicidal ideation) lasting long after the violence ended and that IPV interferes with even simple activities of daily life (Garcia-Moreno. University of California. 99) ¼ 10. IPV of all types is a potent source of chronic stress (Woods et al. Thompson et al. PhD4. boyfriend. NP. The purpose of this exploratory study was to examine telomeric DNA length in women who have experienced chronic stress related to IPV. IPV is most often committed by men against women (Breiding et al. UCSF. Bruce A. PhD4. 2009). San Francisco. Telomeres are protective components that stabilize the ends of chromosomes and modulate cellular aging. Fanslow. 2006). duration of IPV-related stress. 1999. the lifetime prevalence of IPV was between 25 and 30% (Breiding. & Watts. School of Nursing. Smith. Box 0606. Nurse. Blackburn.com Janice Humphreys. and telomere length molecular mechanisms that regulate cellular aging. FAAN1. USA 2 Department of Psychiatry. 2005). Advertisements and public notices were used to recruit a convenience sample of healthy women. Mean leukocyte telomere length was measured in DNA samples from peripheral blood mononuclear cells (PBMCs) by a quantitative polymerase chain reaction assay (qPCR). repetitive. and prolonged (Humphreys & Campbell. p ¼ . San Francisco. Black. When asked directly. CA. San Francisco.. 2 Koret Way. The World Health Organization noted that 20–50% of women who experienced IPV reported that it resulted in physical injury and deleterious health effects (e. Women exposed to intimate partner violence (IPV) experience chronic stress and report worse health.humphreys@nursing. In North American population-based surveys.sagepub. Length of time in the abusive relationship and having children were associated with telomere length after controlling for age and body mass index (BMI) (F(2. University of California. FAAN.1177/1099800411398479 http://brn. USA 3 School of Nursing. School of Nursing.23. Sullivan. Ellsberg. p < . We hypothesized that IPV exposure would be associated with shorter telomere length. & 1 Department of Family Health Care Nursing. telomere length.001). however. Goodman. Physical abuse is one of the most common causes of injury in women (Rand. 1997). Jue Lin. and Kathryn A. & Bybee. however. RN. Lee. Elizabeth H. Elissa S.Telomere Shortening in Formerly Abused and Never Abused Women Biological Research for Nursing 000(00) 1-9 ª The Author(s) 2011 Reprints and permission: sagepub.edu Downloaded from brn. Sullivan. San Francisco. research has also documented the negative effects of psychological and emotional IPV on women’s health (Arias & Pape.com at UCSF LIBRARY & CKM on March 2. Dutton. Health care providers often characterize the complex array of symptoms as manifestations of stress and find these women difficult to diagnose and treat (Sutherland. & McKeown. memory loss.. USA Corresponding Author: Janice Humphreys. IPV can occur in all kinds of intimate relationships. Although severity can vary.4. Cooper. problems walking. Keywords intimate partner violence. broken bones. Telomere length was significantly shorter in the 61 formerly abused women compared to the 41 controls (t ¼ 2. chronic stress Intimate partner violence (IPV) refers to physical or sexual violence (with the use of physical force) or the threat of such violence or psychological/emotional abuse and/or coercive tactics when there has been prior physical and/or sexual violence between persons who are partners or former partners (Saltzman. 2008. & Walker. & Shelley. USA Email: Janice. It is often presumed that the stress of IPV may be causing greater morbidity.. or ex-partner. Heise. 2001). University of California.ucsf. PhD2. CA.02). 2011). PhD.com/journalsPermissions. 2000.nav DOI: 10. PhD1 Recent studies suggest that chronic psychological stress may accelerate aging at the cellular level. 2005).

Cahill. The University of California. Given that age and obesity (Kim et al. We also used these data to make the final determination of a participant’s status as either a formerly abused or never abused woman. San Francisco. & Warren. p ¼ .4. & Bullock. including partner abuse. and had a single venipuncture blood sample taken. Wijma. & Penn. Kananen and colleagues (2010) also reported that childhood adversity was associated with telomere shortening in adults. 2004). Advertisements stated that the purpose of the study was to better understand how stressful events. Committee on Human Research approved this study. & DeVellis. we also included these two variables in exploring the association between IPV exposure and telomere length. and injury experience. The Beck Depression Inventory. 2007) and individuals with major depression (Simon et al. Measurements Intimate partner violence. is a 21-item self-report instrument for measuring the severity of depression (Beck. In qualitative studies abused women have described experiencing IPV as being ‘‘crushed in a corner’’ or ‘‘smothered under a big black cloud’’ and ‘‘stripped of dignity’’ (Wuest & Merritt-Gray.. Recently. In the present study. with particular concern for IPV-associated risks and the rights of study participants.sagepub. This association has also been documented in elderly dementia caregivers (Damjanovic et al. 1996). completed questionnaires.2 Biological Research for Nursing 000(00) Bennett. & Brown. and English-speaking. Trained members of the research team carried out all procedures. may affect women even after the abuse has ended. These 39 items were scored into four conflict resolution subscales: psychological aggression. nonsmokers. 2007). This finding was not due to effects of age. we gave each participant a community resource card that provided 24-hr domestic violence hotlines and other IPV contact information.03). and a critical minimum telomere length triggers cell senescence. Items are rated from 0 to 3. we recruited a convenience sample of women who reported a history of IPV (n ¼ 66) and women who reported no history of IPV (n ¼ 46) in the western United States using newspaper and web-based advertisements and other public notices. In this study. premenopausal.. 2005) may influence telomere length. 2006).. Women contacted the study coordinator to learn more about the study. Participants had to be at least 18 years of age. Steer. We further explained study procedures to eligible participants. The CTS2 has been demonstrated to be a valid and reliable measure of IPV in multiple community-based studies (Straus et al. 2001. It is postulated that excess accumulation of senescent cells may attenuate normal function throughout the body.com at UCSF LIBRARY & CKM on March 2. For the purposes of this screening. or other demographic factors known to be associated with shortened telomeres. 2012 . 2003). Hamby. partner’s behavior toward them and injuries suffered as a result). in good health. body mass index (BMI). Formerly abused women had to have a history of experiencing IPV as an adult ("16 years of age) but also to have been out of the abusive relationship for at least 1 year. we examined telomere length in peripheral blood mononuclear cells (PBMCs) in women who had been exposed to IPV as a chronic form of stress. 1995). The BDI-II is widely used to estimate severity of depression and has strong psychometric properties in the general population (Segal. 2008). we used only items that assessed women’s experiences (i. 283). Downloaded from brn. 2009. we met them in a research office where we confirmed their initial telephone screenings and conducted further screening for IPV status using the Women’s Experience with Battering (WEB) scale. One physiological response to chronic stress such as IPV appears to be changes in telomere length. leading to chronic inflammation and age-related diseases. Never abused women had no experience with IPV. Depression.. we only asked women whether or not they had experienced any of the 10 items. Ilmonen. Chronic stress in female mice has been associated with telomere shortening (Kotrschal. smoking. We assessed health status and smoking history using a detailed questionnaire and determined initial IPV history over the phone using the Abuse Assessment Screen (McFarlane. 2003).. Participants choose the alternative that best describes how they felt during the past 2 weeks. Parker. & O’Riley. with higher scores reflecting increased depressive severity. If women were still interested. were measured for height and weight. 1999. a 10-item measure that operationalizes the experiences of abused women (Smith. p. compared to women who reported no history of IPV.e. gender. Method Sample For this exploratory study. Samelius. Wingren. Telomeres shorten in response to chronic stress. Coolidge. Participants reporting a history of maltreatment had significantly shorter telomeres than those who did not report such maltreatment (t ¼ 2. Soeken. Duration of caregiving for a child with a chronic condition has been associated with shorter telomere length and dampened telomerase activity in young healthy women (Epel et al. physical assaults. 1992). We scored the prevalence for type of conflict as the percentage of women who reported at least one instance of that type of IPV during the last year of her relationship. Valdes et al. 2007). All data collection occurred in a private research office. Earp. We initially assigned women with an IPV history and controls to each group based on this measure. Upon completion of questionnaires.. The Revised Conflict Tactics Scale (CTS2) is a 72-item measure that asks participants to indicate which tactics they and their partners use to resolve a conflict and how often they use those tactics (Straus. and a total score can range from 0 to 63. & Wijma.. Likewise. which may be a useful marker of biological age and thus a predictor of early morbidity and early mortality across many health problems. Eligible women gave verbal consent. sexual coercion. Tyrka and colleagues (2009) evaluated the effects of childhood adversity in a community-based sample of 31 men and women with and without a history of childhood maltreatment. second edition (BDI-II).

The telomere thermal cycling profile consisted of the following steps: Cycling for T (telomic) PCR: denature at 96# C for 1 s. and we used the average normalizing factor for all eight samples to correct DNA samples to get the final T/S ratio.4 $ Syber Green I. 0. 22 ng Escherichia coli DNA per reaction. demographic variables. Therefore. 50 mM KCl.324. followed by denature at 96# C for 1 s. Typically. We ran each concentration of the reference DNA as quadruplets and samples as triplicates. The Wheaton Social Stress Inventory is a 51-item checklist of social.20 with telomere length into a simultaneous regression model and removed variables with a p value ". 0. The longer the telomeres are in each sample. 3 Perceived stress. We measured the T/S ratio for each sample twice. BMI. We collected demographic data using a questionnaire that has been used in previous women’s health research to assess the following variables: age. we entered variables other than age and BMI that met initial criteria of a Pearson correlation ". anneal/extend at 54# C for 60 s. Examples of items include. we ran the sample a third time and reported the two closest values. uncontrollable. Kamarck. we followed this conservative approach for each Downloaded from brn.4.sagepub. The primers for the single copy gene (human b-globin) PCR were hbg1 (50 -GCTTCTGACA CAACTGTGTTCACTAGC-30 ) used at a final concentration of 300 nM and hbg2 (50 -CACCAACTTCATCCACGTTCACC-30 ) used at a final concentration of 700 nM. UMUC3. and overwhelming. Cycling for S (single copy gene) PCR: denature at 95# C for 15 s. marital and parenthood status. Participants indicate to what extent various situations are ongoing in their lives. relationship. 200 mM each dNTP. We used descriptive statistics to present the demographic characteristics of the sample.5–10 ng of genomic DNA. The interassay coefficient of variation for telomere length measurement was 3. We examined remaining predictors to determine if any p value exceeded . Statistical Analysis We analyzed data using SPSS for Windows (version 15. pH 8. The primers for telomere PCR were tel1b (50 -CGGT TT(GTTTGG)5GTT-30 ) used at a final concentration of 100 nM and tel2b (50 -GGCTTG(CCTTAC)5CCT-30 ) used at a final concentration of 900 nM.5% for this study. extend at 72# C for 20 s. work. Lin et al. length of the relationship. 0. While controlling for age and BMI. 1995). All endorsed items are summed with possible scores ranging from 0 to 51.Humphreys et al.108 ng of a reference DNA (from Hela cancer cells) in each PCR run so that we could determine the quantity of targeted templates in each sample relative to the reference DNA sample by the standard curve method. financial status. 2. anneal at 58# C for 1 s. harvested at various population doublings after infection) in each run. extend at 72# C for 20 s. age at the time of the abusive relationship.10 and removed those one at a time until all variables remaining in the model had a p value %. For each item. we included eight control DNA samples from cancer cell lines (including 293T. eight cycles. 30 cycles. To control for interassay variability. We measured height in centimeters and weight in kilograms and used these to calculate BMI using the following formula: weight (kg) / height (cm2). 2010).97. Wheaton. Scores range from 0 to 40. H1299. and financial difficulties that may cause stress other than that due to IPV (Turner. 1983). depression. 2012 . When the duplicate T/S value and the initial value varied by more than 7%. & Mermelstein. 1% DMSO. In each batch. routine medication use. Following recommendations of Hosmer and Lemeshow (2000). The 10-item version of the Perceived Stress Scale is a valid and reliable measure of the degree to which participants find their lives to be unpredictable.) per 11 µl reaction. health status.9. perceived stress measures.com at UCSF LIBRARY & CKM on March 2. 8. we categorized all potential predictors listed in Tables 1–3 into three subsets (age and BMI. & Lloyd. anneal at 58# C for 1 s. and smoking history. We adapted the telomere length measurement assay in this study from the published original method by Cawthon (2002.). educational background.0) software (SPSS. with fluorescence data collection. ‘‘How often have you felt that you were unable to control the important things in your life?’’ and ‘‘How often have you felt that you were on top of things?’’ The questions are of a general nature and hence relatively free of content specific to any clinical population.75. Given the small sample size for this exploratory study. Sources of stress other than IPV.. about 15% of samples need to be assayed a third time. Research has shown that premenopausal women and women of lower socioeconomic status (SES) have higher mean scores compared to men (Cohen. The final reaction mix contained 20 mM Tris-HCl. participants indicate on a 5-point Likert Scale how often in the previous month (‘‘never’’ to ‘‘very often’’) they experienced various thoughts and feelings.10. and UMUC3 cells infected with a lentiviral construct containing the telomerase RNA gene to extend telomeres. there was insufficient statistical power to examine all potential predictors in a single multiple regression analysis. the more PCR products will be generated in PCR reactions using primers specific for the telomeric DNA. and variables associated with IPV) for independent analyses. employment status.4 units of Platinum Taq DNA polymerase (Invitrogen Inc. This was done for all eight samples. We included tubes containing 26. and IPV parameters. 35 cycles. Inc. Telomere length. and 0. We tested group differences in telomere length with an independent samples t-test and used Pearson correlations to examine mean telomere length and associations with age.10 from the regression model. 0. we divided the T/S ratio of each control DNA by the average T/S for the same DNA from 10 runs to get a normalizing factor. Demographic data. hold at 83# C for 5 s with data collection. Mean telomere length is measured as the ratio of telomeric product/single copy gene (T/S) obtained using a quantitative polymerase chain reaction (qPCR). Investigators have used it extensively in ethnically diverse adult samples. 0.

As shown in Table 2.3) 19 (28.4) 7 (10. two global measures of stress.7) 7 (10.151 1.8) (19.000 (1. whereas 32 of the 66 (49%) formerly abused women had a BMI >30 (Division of Nutrition.001 w2 ¼ 21.sagepub. p ¼ .001 w2 ¼ 1.3 (19–54) 42 (37.0.2 (5–10) 27.001 . formerly abused women were similar to women who never experienced IPV on current employment status but had lower income.5) 0 (0. Physical Activity and Obesity.9) 17 (37.1 + 9.01 . Cramer’s V ¼ . We could not obtain blood samples on 10 participants (five formerly abused women and five never abused women). p < .1) (26.325 (600.3 25. Only two women in the never abused group were categorized as obese.3 9.9 + 1.0) 15 (32. Formerly abused women were older and less educated.909) 8. We entered variables meeting the criterion from each subset simultaneously into a final regression model and evaluated them using the same procedure until the final model contained only those variables with p values %.8 (17–52.9) 13 (19.4 + 8.3. Results Table 1 lists detailed demographic characteristics for the 112 women in this sample.6) 14 (21.3) 11 (23.6) (60.1 + 9. 75%)b Global rating of health (mean + SD [range]) Body mass index (mean + SD) Median Range 100 Cigarettes—lifetime (n [%]) Cigarette pack years (mean + SD) Lifetime trauma exposures (mean + SD [range]) Total Sample (N ¼ 112) Never Abused (n ¼ 46) Formerly Abused (n ¼ 66) 32.8 (18–52) 35.0 (17–32.4 + 1.5) 11 (16. 80% also reported severe physical assaults.8 (0–23) 23.0 + 5.6) 22 (33.10. ¼ 3.01 w2 ¼ 22.1 (6–10) 1. As shown.7 + 4. and mean telomere length. p < .3) (14.1 + 3. formerly abused women reported varied exposure to IPV.3) 17 (15. b subset of variables.6) 31 (67.001 .3) 3 (6.4 + 5.2) (32.5) 25 (22.5) 6.9) 13 (11.02c t ¼ 4.8) 5 (7.0.36.001 t t t t ¼ 5.5 12.9) 5.657 2.0) 12 (26.6 (18.5) 36 (59.001 w2 ¼ 14. Latino. ¼ 4. and were more likely to be Black.3 (18–54) 27. 2.8 (4–23) (6. 2012 .001 a N ¼ 111.4.8 + 3.7) Statistics t ¼ 4.700) 8.2 (5–10) 2. Demographic Characteristics for the Total Sample and for the Two Study Groups of Never-Abused and Formerly Abused Women Study Groups Demographic Characteristic Age (mean + SD [range]) years Ethnicity (n [%]) White Black Asian Latino Native American Multiracial Unknown Had children (n [%]) Educational preparation (n [%])a Some high school High school grad or GED Some college College grad Postgraduate study Employed (n [%]) Monthly income ($) Mean Median (25%.0) 7 16 36 30 22 68 2 (4.7) 1 (1. National Center for Chronic Disease Prevention and Health Promotion.7 5.4) 38 (33.1.9.7 (0–15) 30.1) 3 (6. c Mann-Whitney U test.8 + 7.6) 4 (3.800 1. 2.200) 8.6) 1 (1.6 24. p < .000 (576.6) 7 (10. or multiracial compared to women who reported no past experience with IPV.7.1) 2.1 + 1.0) 2 (4.23 Z ¼ 2.6) 37 (56. p < . p ¼ . Formerly abused women also reported more lifetime trauma exposures and were more likely to have a history of smoking cigarettes.4 Biological Research for Nursing 000(00) Table 1. While all of the women in this group reported psychological aggression.com at UCSF LIBRARY & CKM on March 2.000. Formerly abused women were more depressed and reported more stress on both the Perceived Stress Scale and the Wheaton Social Stress Inventory compared to women who had never been abused.6) 6 (13) 2.4) 32 (48. 2009).6 + 5.5. 58% severe physical injuries. Downloaded from brn.5) 6 (13.6) 42 (37.8–52.9) 1 (0.3. ¼ 9.2) 25 (37.01. 3.0 + 1.5) 6 (14.1.2) 10 (8. and 50% severe sexual coercion.7 + 7.5) 20 (43. p < . BMI for formerly abused women was significantly higher than BMI for women who had never experienced IPV. were more likely to have children. p p p p < < < < . p ¼ .4.0 28. The formerly abused women and never abused women were significantly different on each of these measures. N ¼ 110. Table 3 summarizes the results for the two groups on the BDI.

In these data. 2009).sagepub. 99) ¼ 10. Even with BMI in the model. telomere-length results are for 102 women.8 3. Shim. we tested whether BMI might mediate or moderate the relationship between abuse history and telomere length. There was weak evidence for a difference between Whites and Asians (not controlling for age and BMI). Given the large group difference in BMI and known relationship between BMI and telomere length. but even that effect was less significant with the covariates. the indirect effect of abuse history on telomere length must be significant for mediation to exist. p < . We examined the possible differences in mean telomere length between ethnicity categories.171. Donelan. 75%) Length of time since abuse (years) Mean Median (25%.5) 4. 2009. Thus.187). with Blacks and Hispanics having shorter telomeres and telomere length that declines more rapidly with age (Roux et al. age and BMI were associated with telomere length. There was no evidence at all that Latinos or Blacks differed from Whites or any other groups on telomere length. there was no mediating effect of BMI in the association between abuse history and telomere length in this sample. & DesRoches. However. BMI was inversely related to telomere length in the women with a history of IPV (r ¼ &.045). abuse history still predicted telomere length and the effect was not reduced... We tested this simple mediation model using Mplus (Muthe´n & Muthe´n. 2007.0) 4.0) Note: Data on type of IPV were from participants’ scores on the Revised Conflict Tactics Scale. and abuse history was associated with BMI. Mediation and moderation analyses are best examined through path or structural equation models.7 2. if any. the indirect effect was trivial and not significant.0 (1.23. we controlled for age and BMI in our models. In other words. 6. F(2.com at UCSF LIBRARY & CKM on March 2. In addition to age and BMI. 2009). ethnicity was driving the differences in telomere length independent from IPV. using analysis of covariance (ANCOVA) analysis to control for age and BMI. There is considerable literature on the increased burden for women associated with mothering and caregiving (Berg & Woods.04. Therefore. 6. however. Linn.0 (1. Having children and length of time abused jointly predicted 17% of the variance in telomere length (R2 ¼ . Two conditions for mediation were met: abuse history predicted telomere length. Discussion Formerly abused women in our sample had significantly shorter mean telomere length than women who had never been abused. BMI was not associated with telomere length in women who had never been abused (r ¼ &. The group difference in age was statistically significant but clinically less meaningful than the group difference in BMI.0.7) 46 (69. they offered no contribution to the model once having children and length of time in the abusive relationship were included.02). and being a mother of a chronically ill child is associated with shortened telomere length (Epel et al. race/ethnicity has also been associated with telomere length. group assignment in this convenience sample of formerly abused and never abused women had a moderator effect.7% of the unique variance in telomere length and length of time of abuse in years accounted for 3. Falik. given abused women’s documented concerns about the effects of IPV on their children (Haight.Humphreys et al. and the difference between their two slopes was significant (t ¼ &2. Prevalence for type of violence is the percentage of women who reported at least one instance of that type of IPV during the last year of her relationship. Intimate Partner Violence (IPV) Exposure Among Formerly Abused Women (n ¼ 66) Type of Intimate Partner Violence Psychological aggression Minor Severe Sexual coercion Minor Severe Physical assault Minor Severe Injury Minor Severe Relationship to abuser (n [%]) Husband Boyfriend Girlfriend Acquaintance Length of time in abusive relationship (years) Mean Median (25%. we removed age and BMI from the model. 2012 . having children accounted for 6. The mean telomere length for formerly abused women was significantly shorter than for women who had never been abused. The effect of ethnicity was not significant. 5 Table 2. Furthermore. One unexpected finding was that age and BMI were not significant predictors of telomere length in this sample.7% of the unique variance. & Swinford. As expected from the literature.5. However. Table 4 summarizes salient variables correlated with telomere length (correlation coefficients ". As is shown in Table 5. 75%) Formerly Abused Women (%) 100 100 91 64 64 50 91 89 79 85 80 58 15 (22. we found that being a mother and length of time in the abusive relationship were the best predictors of telomere length.5) 2 (3. p ¼ . The final model contained only two variables: having children and length of time abused. Therefore. BMI predicted telomere length differently depending on abuse history. 2004). as shown in Figure 1. we conducted additional analysis to determine to what extent. Given that the formerly abused and never abused women in this study differed significantly based on self-reported ethnicity.20).001). Although age and BMI were weakly associated with telomere length when tested in a model by themselves. However. Thus. In addition. Downloaded from brn.7) 3 (4. there was no association between telomere length and BMI in the model. 2001).

Depression and Stress Scores and Telomere Length in Never Abused and Formerly Abused Women (mean + SD) Study Groups Variable Beck Depression Inventory scorea Perceived Stress Scale score Wheaton Social Stress Inventory score Total exposure Total severity Telomere length (t/s ratio [range])b a b Total Sample (N ¼ 112) Never Abused (n ¼ 41) Formerly Abused (n ¼ 61) Statistics (Unpaired t Test) 13.32 &. our findings lend support for the need for universal IPV screening.44 + . 2009).com at UCSF LIBRARY & CKM on March 2.15) 28.001 t ¼ 2.04 &.02 .04 Note: BMI ¼ body mass index. the chronic stress of mothering may take a unique toll in this population.21 .001 t ¼ 8.01 .001 t ¼ 4. The finding that telomere-length shortening was associated with motherhood and length of time in the abusive relationship even after the abuse had ended provides evidence for the need to pay particular attention to abused mothers and women who have experienced extended periods of IPV regardless of the type of abuse. & Watson.8 74.4 37.001 23. D’Argenio et al. we offer several implications for nurses and nurse scientists. Nurses who care for women experiencing IPV and women experiencing other sources of stress Table 4.51 + .9 13.03 .26 (0.22 &.23 . Furthermore. Ulrich. In this study. BMI was not associated with telomere length among women who had never been abused.2 + 8. results cannot be generalized to all women with a history of abuse. Second. Pederson & Wilson. p < .001 .006 <.5 1. assessment for IPV itself is a type of intervention that shortens the duration of abuse.02 .23 &. 2009.26 (0.4. might also have on formerly abused women’s health. With telomere length as an objective measure.02 . N ¼ 102. and in light of the buffering effects of physical exercise.89–2. First. p ¼ .2 + 10. another important issue that future investigations need to address is the use of PBMCs as the source for telomere length measurement. Since PBMCs consist of a mixed population of cell types (including T and B lymphocytes. Our findings indicate that the type of IPV is less important than how long the abuse persists. the relationship between exposure to abuse and elevated BMI needs further study. p < . Downloaded from brn. An unexpected finding in our study was that BMI predicted telomere length differently depending on abuse history. Groff.sagepub. Finally.2 17.02 N ¼ 111.3 + 10. 2009.26) t ¼ 6. Additional research is needed to explore this relationship.21 &.7 7. we are intrigued about the possible benefits that other welldocumented health-promoting behaviors.009 .3 + 28. however BMI was inversely related to telomere length in the women with a history of IPV. There is a growing body of empirical evidence that prior exposure to abuse in childhood is associated with adult obesity (Bentley & Widom. nurses who provide care to currently and formerly abused women now have additional evidence that women’s complex array of symptoms may be related to IPV and are indeed manifestations of the effects of this stress at a cellular level. In addition to advocating for universal assessment for IPV.9..001 . However.6 + 20.9 16. telomere length offers great promise as a relatively new and objective marker of physical and psychological stress. NK cells.5. considering the highly polymorphic nature of telomere length in humans. 2009.3 + 7. should consider offering advice about the benefits of physical activity as a means of preventing the cellular changes found in our study. p < . 2000. p < . Given the ever increasing and appropriate concern about overweight and obesity in North America. recent research by Puterman and colleagues (2010) offers evidence for the buffering effects of vigorous physical activity on telomere length among women experiencing high stress.7 59. as has been suggested (Gerbert et al.6 Biological Research for Nursing 000(00) Table 3. regardless of the type of IPV experienced. based on our findings.02 . length of time in the abusive relationship.2 + 31.2 1. 1991). If. 2006). 2012 . Furthermore.. future research will be required to address these questions.8 t ¼ 5. Data amassed over the past 20 years demonstrate the physical and psychological health consequences that result from all types of IPV.7 + 9.24 (1.0.25 &.6 + 6.9 19. Brien.4 + 7.0 + 7.0 1. McFarlane. was also a significant predictor of telomere length.27 .20 . only a longitudinal analysis can definitively tell whether experience of IPV accelerates loss of telomere length in PBMCs. In this initial study with a nonrandom sample and a crosssectional design.39 + .26 &.20 in Absolute Value (N ¼ 102) Variable Subset 1 Age BMI Subset 2 Health rating Had children Smoked 100 cigarettes ever Subset 3 Length of time abused Time since abuse Psychological aggression—minor Physical assault—minor Injury—minor Sexual coercion—severe Total lifetime trauma exposures Telomere Length (Units) p &.13–2. Kelly.9 + 7. Bivariate Correlations Between Telomere Length and Salient Variables Equal to or Greater than 0.23 &.37 . such as adequate sleep and good nutrition.9.89–2.26) 17.

never abused (0).421 &. our findings provide evidence of the sustained negative effects of IPV for women even when they are no longer in the abusive relationship.10 . While there was only weak evidence of a difference between Whites and Asians (broadly defined) in our sample (when not controlling for age and BMI). Understanding whether IPV has an impact on the composition of PBMCs and whether IPV is correlated with short telomeres in each cell type would provide more information. an extensive body of literature describes immense physical and psychological health consequences resulting from IPV.82 &2.05 .sagepub. The relationship between ethnicity/race and telomere length deserves further examination.47 &2.001 . Figure 1.17 (N ¼ 102.067 . p < .com at UCSF LIBRARY & CKM on March 2. it is possible the short telomeres found in PBMCs could be due to the shortening of telomeres in one or more types of cells or the increased relative proportion of certain types of cells with short telomeres. 7 Table 5.045 &. Furthermore. Another important area requiring further study is the question of the relationship between race/ethnicity and telomere length. Multiple Regression Analysis Summary Table for Two Variables Predicting Telomere Length Unstandardized Coefficients Model Constant Have children Length of time abused in years 95% Confidence Interval for B B Standard Error t p Lower Bound Upper Bound Part r2 1.037 Note: R2 ¼ .01 .038 1. Thus.23 &.257 &. Scatterplot of associations between mean-centered body mass index (BMI) and mean telomere length by group: formerly abused (D).Humphreys et al.11 . In summary.031 &.006 .024 1. Nevertheless.15 &. and monocytes).05 12. 2009). Both of these findings lend support for the routine screening for IPV in all health care settings.001). the moderating effect of abuse on BMI in the subsample of abused women is intriguing. It is often presumed that the stress of IPV Downloaded from brn. there is a need for larger and longitudinal studies of formerly and never abused women who are randomly selected from a broader community of women across the United States..000 . others have reported that Blacks and Hispanics have shorter telomeres and more rapid decline in telomere length with age (Roux et al. 2012 .

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