Violence and injury in marital arguments: risk patterns and gender differences

An examination of dependence power, father involvement, and judgments about violence in an at-risk community sample of mothers

Individuals sometimes remain in dysfunctional, and even violent, relationships due to a perceived dependence on a partner. We examined the influence of dependence power judgments (defined by a combined assessment of mother commitment, perceived father commitment, and perceived father alternatives) in a community sample of mothers potentially bound to a relationship with the father of her child. We also considered the influence of perceived father involvement in the child's life on judgments related to dependence power. Using a survey design with a sample of 100 mothers (age: 16-43, M = 29.16, SD = 7.17 years old) enrolled in a local Early Head Start/Head Start program, we observed that a mother's perceived father involvement was positively associated with judgments of her dependence power. Furthermore, we observed that her assessment of dependence power was negatively associated with her tolerance for both physical and psychological violence as well as the use of destructive child discipline tactics.

Meeting the mental health needs of low-income immigrants in primary care: a community adaptation of an evidence-based model

Low-income, uninsured immigrants are burdened by poverty and a high prevalence of trauma exposure and thus are vulnerable to mental health problems. Disparities in access to mental health services highlight the importance of adapting evidence-based interventions in primary care settings that serve this population. In 2005, the Montgomery Cares Behavioral Health Program began adapting and implementing a collaborative care model for the treatment of depression and anxiety disorders in a network of primary care clinics that serve low-income, uninsured residents of Montgomery County, Maryland, the majority of whom are immigrants. In its 6th year now, the program has generated much needed knowledge about the adaptation of this evidence-based model. The current article describes the adaptations to the traditional collaborative care model that were necessitated by patient characteristics and the clinic environment.

Abuse victimization and risk of breast cancer in the Black Women's Health Study [corrected]

Few studies have examined the relation between abuse victimization and breast cancer, and results have been inconclusive. Using data from 35,728 participants in the Black Women's Health Study, we conducted multivariable Cox regression to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CI) for the association of abuse across the life span (childhood, adolescence, and adulthood) with breast cancer. Incident breast cancer diagnoses were reported during 1995-2009, and abuse histories were reported in 2005. No associations were found between abuse victimization in either childhood or adolescence and breast cancer. We found a weak positive association between abuse in adulthood and breast cancer (IRR = 1.18, 95% CI = 1.03-1.34). IRRs for physical abuse only, sexual abuse only, and both physical and sexual abuse in adulthood, relative to no abuse, were 1.28 (95% CI = 1.09-1.49), 0.96 (95% CI = 0.76-1.20), and 1.22 (95% CI = 1.00-1.49), respectively. IRRs for low, intermediate, and high frequencies of physical abuse in adulthood, relative to no abuse, were 1.28 (95% CI = 1.07-1.52), 1.37 (95% CI = 1.04-1.79), and 1.24 (95% CI = 0.95-1.62), respectively. Our data suggest an increased risk of breast cancer among African-American women who reported physical abuse in adulthood, but there was little evidence of a dose-response relation. These results require confirmation in other studies.

Rates of femicide in women of different races, ethnicities, and places of birth: Massachusetts, 1993-2007

To describe the epidemiology of intimate partner violence (IPV) homicide in Massachusetts, an IPV mortality data set developed by the Massachusetts Department of Public Health was analyzed. The rates of death were estimated by dividing the number of decedents over the aged-matched population and Poisson regression was used to estimate the contribution of race, ethnicity, and foreign-born status to the risk of dying from IPV. Out of the total 270 women whose deaths were associated with IPV, 239 (89%) were killed by a male partner. Black women had a risk of dying from IPV of 16.2 per 1,000,000 person-years. Hispanic women also had a higher risk of dying from IPV than non-Hispanic women; incidence risk ratio of 9.7 (Poisson regression 95% confidence interval 6.8-13.8). IPV femicide disproportionately affected Black and Hispanic women. Agencies must consider the importance of providing culturally appropriate services to IPV survivors and their community.

Intimate partner violence among HIV-positive persons in an urban clinic

While the intersection of HIV/AIDS and intimate partner violence (IPV) has gained increased attention, little focus has been given to the relationship among minority men and men who have sex with men (MSM). This pilot study, conducted at an urban clinic, explores the IPV experiences of HIV-positive persons involved in both heterosexual and homosexual relationships. Fifty-six HIV-positive individuals were interviewed to assess for verbal, physical, and sexual IPV, and for HIV-related abuse and attitudes regarding routine IPV screening. Approximately three quarters (73%) of the sample reported lifetime IPV and 20% reported current abuse. Physical IPV (85%) was cited the most by abused participants. IPV rates were highest among African-Americans and MSM. More than one-fourth (29%) of those abused felt the abuse was related to their HIV status. A majority of participants favored IPV screening by providers, but felt it might increase risk of IPV. IPV and its association to HIV are significant issues among this sample. Findings support the need for developing new programs that address these epidemics simultaneously.

"You don't go tell White people nothing": African American women's perspectives on the influence of violence and race on depression and depression care

OBJECTIVES

We sought to understand how African American women's beliefs regarding depression and depression care are influenced by racism, violence, and social context.

METHODS

We conducted a focus group study using a community-based participatory research approach. Participants were low-income African American women with major depressive disorder and histories of violence victimization.

RESULTS

Thirty women participated in 4 focus groups. Although women described a vicious cycle of violence, depression, and substance abuse that affected their health, discussions about health care revolved around their perception of racism, with a deep mistrust of the health care system as a "White" system. The image of the "strong Black woman" was seen as a barrier to both recognizing depression and seeking care. Women wanted a community-based depression program staffed by African Americans that addressed violence and drug use.

CONCLUSIONS

Although violence and drug use were central to our participants' understanding of depression, racism was the predominant issue influencing their views on depression care. Providers should develop a greater appreciation of the effects of racism on depression care. Depression care programs should address issues of violence, substance use, and racism.

Sex disparities in attitudes towards intimate partner violence against women in sub-Saharan Africa: a socio-ecological analysis

BACKGROUND

Attitudes towards intimate partner violence against women (IPVAW) has been suggested as one of the prominent predictor of IPVAW. In this study, we take a step back from individual-level variables and examine relationship between societal-level measures and sex differences in attitudes towards IPVAW.

METHODS

We used meta-analytic procedure to synthesize the results of most recent data sets available from Demographic and Health Survey (DHS) of 17 countries in sub-Saharan Africa conducted between 2003 and 2007. Pooled odds ratio (OR) and 95% confidence intervals (CI) were computed for all countries. Test of heterogeneity, sensitivity analysis, and meta-regression were also carried out.

RESULTS

Women were twice as likely to justify wife beating than men (pooled OR = 1.97; 95% CI 1.53- 2.53) with statistically significant heterogeneity. The magnitude in sex disparities in attitudes towards IPVAW increased with increasing percentage of men practicing polygamy in each country. Furthermore, magnitude in sex disparities in attitudes towards IPVAW decreased monotonically with increasing adult male and female literacy rate, gender development index, gross domestic product and human development index.

CONCLUSION

This meta-analysis has provided evidence that women were more likely to justify IPVAW than men in sub-Saharan Africa. Our results revealed that country's socio-economic factors may be associated with sex differential in attitudes towards IPVAW.

Predictors of family conflict at the end of life: the experience of spouses and adult children of persons with lung cancer

PURPOSE

Guided by an explanatory matrix of family conflict at the end of life, the purpose of this article was to examine the correlates and predictors of family conflict reported by 155 spouses and adult children of persons with lung cancer.

DESIGN AND METHODS

A cross-sectional statewide survey of family members of persons who died from lung cancer was conducted as part of the larger study on the Assessment of Cancer CarE and SatiSfaction in Wisconsin.

RESULTS

Significant bivariate correlations were found between family conflict and family context variables (i.e., a history of conflict, younger respondent age, race, and specified end-of-life care wishes of the patient), conditions (i.e., greater physical and psychological clinical care needs of the patient), and contributing factors (i.e., communication constraints and family asserting control). In the multivariate model, significant predictors of family conflict included prior family conflict, race, communication constraints, and family members asserting control; the model explained 72% of the variance in conflict.

IMPLICATIONS

Implications for routine assessment and screening to identify families at risk and recommendations for the development and testing of interventions to facilitate shared decision making and enhance open communication among at-risk families are highlighted.

Neighborhoods, alcohol outlets and intimate partner violence: addressing research gaps in explanatory mechanisms

Indices of heavy drinking have consistently been linked with increased risk for intimate partner violence (IPV) among couples in the general household population. Because IPV is a 'private' event, most IPV research has focused on individual-level risk factors, but current social ecological theory suggests that alcohol outlets can act with neighborhood conditions to increase risks for IPV. This paper reviews the theoretical and empirical literatures relevant to identifying specific social mechanisms linking IPV to alcohol use in community settings, and discusses three social mechanisms relevant to these effects: greater numbers of alcohol outlets within a neighborhood may (1) be a sign of loosened normative constraints against violence; (2) promote problem alcohol use among at-risk couples, and; (3) provide environments where groups of persons at risk for IPV may form and mutually reinforce IPV-related attitudes, norms, and problem behaviors. Understanding these mechanisms is of critical public health importance for developing environmental strategies aimed at prevention of IPV, such as changes in zoning, community action and education, and policing.

An overview of intimate partner violence among Latinos

This article reviews the existing literature on intimate partner violence (IPV) among Latinos to put the findings of this special issue into context. This review of the literature suggests that IPV occurs as frequently among Latinos as among non-Latinos when confounders are controlled for. There is also some preliminary evidence that Latinas experience similar forms of IPV and suffer similar consequences. Many of the risk factors associated with its occurrence are the same as those observed among non-Latinos, except that beliefs approving IPV and alcohol-drinking patterns may not have much explanatory value for the occurrence of IPV among Latinos. Role strain, especially as a result of immigration and acculturation, might be unique to Latinos, and its importance, and the importance of male dominance among Latinas experiencing IPV, deserve more research.

Marriageable Women: A Focus on Participants in a Community Healthy Marriage Program

Although disadvantaged women are the targets of marriage programs, little attention has been paid to women's marriage constraints and their views of marriage. Drawing on an exchange framework and using qualitative data collected from single women participating in a marriage initiative, we introduce the concept of marriageable women-the notion that certain limitations may make women poor marriage partners. Like their male counterparts, we find women also possess qualities that are not considered assets in the marriage market, such as economic constraints, mental and physical health issues, substance use, multiple partner fertility, and gender distrust. We also consider how women participating in a marriage program frame their marriage options, whereas a few opt out of the marriage market altogether.

Correlates of intimate partner violence among men and women in an inner city emergency department

The current study surveyed medical or injured patients (men and women) in an inner city emergency department to examine the rates and correlates of intimate partner violence, including substance use patterns. Over a 2-year period, participants (n = 10,744) self-administered a computerized health survey during their emergency department visit that included screening items regarding past year history of intimate partner violence (including victimization and aggression). Overall, rates of any intimate partner violence involvement in past year were 8.7% (7.3% victimization and 4.4% aggression); however, women were more likely than men to report intimate partner violence. When examining participants' substance use patterns, participants who reported using both alcohol and cocaine were most likely to report intimate partner violence. Predictors of partner aggression and victimization were remarkably similar. This article provides unique data regarding correlates of past year intimate partner violence history among a comprehensive sample of male and female emergency department patients presenting for medical complaints or injury.

Pathways linking intimate partner violence and posttraumatic disorder

Intimate partner violence (IPV), which includes physical violence, sexual violence, and psychological or emotional abuse, is a significant public health threat. The Centers for Disease Control and Prevention (CDC) estimate that each year 1.5 million women are physically assaulted and/or raped by an intimate partner. However, because many victims of IPV are repeatedly abused, a more accurate accounting of the extent of violence suggests that approximately 4.8 million intimate partner physical assaults and rapes are perpetrated annually against women in the United States. The article discusses a survey involving 3,429 English-speaking women enrolled in a health maintenance organization (HMO) for 3 or more years. The findings are 46% of participants who were screened reported a lifetime history of any IPV and 14.7% reported a history within the past 5 years, including physical, sexual, and nonphysical types.

Prevalence and demographic correlates of intimate partner violence in Asian Americans

This study provides the first national estimates of the prevalence and correlates of intimate partner violence (IPV) among Asian Americans. Population estimates are based on data from 1470 Asian Americans interviewed for the National Latino and Asian American Study. Interviews were conducted in English, Chinese, Tagalog, or Vietnamese. Results suggest that rates of IPV among Asian Americans are low compared to the general U.S. population. Minor violence victimization by a current intimate partner was reported by 10.2% of women and 12.0% of Asian American men. Notably, a greater proportion of participants admitted having perpetrated IPV than having been a victim. Predictors of IPV included younger age, higher SES, alcohol- and substance-use disorders, depression, ethnicity, and being U.S.-born. Results suggest the need for additional research to examine the interactions between gender, ethnicity, and acculturation to develop group-specific models of IPV risk and resilience within diverse Asian American groups.

Agreement on intimate partner violence among a sample of blue-collar couples

This study assessed agreement level about the occurrence of past-year male-to-female partner violence (MFPV) and female-to-male partner violence (FMPV) among a sample of 897 blue-collar couples. Intimate partner violence (IPV) was measured with the Physical Assault subscale of the revised Conflict Tactics Scales (CTS2). Agreement level was assessed with Cohen's kappa statistic. Lower-bound estimates (based on couple agreement that an IPV event occurred) and upper-bound estimates (based on uncorroborated reports from either partner that an IPV event occurred) were calculated. Results indicated low agreement for most IPV behaviors (kappa < .40). Estimated lower- and upper-bound rates for MFPV were 6.7% and 21.2%, for FMPV, 7.1% and 24.2%, and for any IPV, 10.1% and 30.2%. Findings suggest that single-point IPV prevalence estimates are biased; lower- and upper-bound estimates using collateral reports should be calculated when possible. In addition, findings underscore the importance of conducting IPV research among understudied populations, such as working-class couples, that may be at elevated IPV risk.

Partnering With Community-Based Organizations to Reduce Intimate Partner Violence

Latinas experiencing intimate partner violence (IPV) often avoid formal resources due to fear, distrust, and cultural and language barriers, yet little research addresses culturally appropriate interventions for abused Latinas. To develop effective interventions, we must include abused Latinas' voices in research and collaborate with the community-based organizations (CBOs) that serve them. This article's team of academics and CBOs used a community-based participatory research (CBPR) approach to inform development of a culturally and linguistically appropriate IPV intervention for Latinas. The authors were able to reach abused Latinas ( n = 114) with a relatively low mean acculturation level in a state that is only 8% Latino. The authors share six recommendations from their successful experience to engage, enhance, and sustain research partnerships with CBOs, including strategies to share power and knowledge, and demonstrate accountability to the partnership and the community.

Problem Drinking, Unemployment, and Intimate Partner Violence among a Sample of Construction Industry Workers and their Partners

The purpose of this study is to determine the contribution of male unemployment and each partner's problem drinking to risk for male-to-female partner violence (MFPV) and female-to-male partner violence (FMPV) among a sample of construction industry workers and their spouses/partners. Participants in the sample (n=848 couples) completed cross-sectional health behavior surveys. Multivariate logistic regression models of MFPV and FMPV, with adjustment for demographic and psychosocial variables, were developed. Approximately 20% of couples reported MFPV, and 24% reported FMPV. Results indicated that couples in which the male was a problem drinker, and in which the male worker reported being currently unemployed, were at risk for MFPV. Number of months unemployed by the male worker was significantly associated with FMPV, but problem drinking was not associated with this outcome. Male and female impulsivity were significantly associated with risk for MFPV and FMPV, and the male's report of adverse childhood events was associated with increased likelihood of MFPV. There was no evidence for the effects of unemployment being moderated (exacerbated) by problem drinking. Workplace-based prevention efforts may be a feasible and important strategy to reduce problem drinking and partner violence among high-risk occupational groups.

Children's adjustment problems in families characterized by men's severe violence toward women: does other family violence matter?

OBJECTIVE

This research examined whether additional forms of family violence (partner-child aggression, mother-child aggression, and women's intimate partner violence [IPV]) contribute to children's adjustment problems in families characterized by men's severe violence toward women.

METHODS

Participants were 258 children and their mothers recruited from domestic violence shelters. Mothers and children completed measures of men's IPV, women's IPV, partner-child aggression, and mother-child aggression. Mothers provided reports of children's internalizing and externalizing behavior problems; children provided reports of their appraisals of threat in relation to interparent conflict.

RESULTS

After controlling for sociodemographics and men's IPV: (1) each of the additional forms of family violence (partner-child aggression, mother-child aggression, and women's IPV) was associated with children's externalizing problems; (2) partner-child aggression was associated with internalizing problems; and (3) partner-child aggression was associated with children's threat appraisals. The relation of mother-child aggression to externalizing problems was stronger for boys than for girls; gender differences were not observed for internalizing problems or threat appraisals.

CONCLUSIONS

Men's severe IPV seldom occurs in the absence of other forms of family violence, and these other forms appear to contribute to children's adjustment problems. Parent-child aggression, and partner-child aggression in particular, are especially important. Systematic efforts to identify shelter children who are victims of parental violence seem warranted.

PRACTICE IMPLICATIONS

Men's severe IPV seldom occurs in the absence of other forms of family violence (partner-child aggression, mother-child aggression, and women's IPV), and these different forms of family violence all contribute to children's adjustment problems. Treatment programs for children who come to domestic violence shelters should address these different forms of family violence, especially parent-child aggression.

Childhood family violence and perpetration and victimization of intimate partner violence: findings from a national population-based study of couples

PURPOSE

We sought to examine the relation between childhood family violence and intimate partner violence (IPV).

METHODS

We surveyed 1615 couples from the U.S. household population by using multistage cluster sampling. Childhood family violence measures included moderate and severe child physical abuse and witnessing interparental threats or physical violence. IPV was categorized as nonreciprocal male-to-female partner violence (MFPV), nonreciprocal female-to-male partner violence (FMPV), reciprocal IPV (MFPV and FMPV), and no IPV. We used multinomial logistic regression to estimate unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) between childhood family violence and IPV.

RESULTS

Men who experienced moderate (adjusted OR [AOR] 3.9, 95% CI, 1.3-11.8) or severe (AOR 4.5, 95% CI: 1.1-19.3) child physical abuse were at increased risk of nonreciprocal MFPV; a male history of severe childhood physical abuse or witnessing interparental violence was associated with a twofold increased risk of reciprocal IPV. Women who witnessed interparental threats of violence (AOR 1.9, 95% CI, 0.8-4.6) or interparental physical violence (AOR 3.4, 95% CI, 1.5-7.9) in childhood were at increased risk of nonreciprocal FMPV. Women exposed to any type of childhood family violence were more than 1.5 times as likely to engage in reciprocal IPV. Many strong positive ORs had CIs compatible with no association.

CONCLUSION

We provide new evidence that childhood family violence is associated with an increased risk of nonreciprocal and reciprocal IPV. Treatment providers and policy makers should consider childhood family violence history in both men and women in the context of IPV.

Differences in female and male victims and perpetrators of partner violence with respect to WEB scores

Measurements of intimate partner violence (IPV) based on acts of violence have repeatedly found substantial bilateral violence between intimates. However, the context of this violence is not well defined by acts alone. The objective of this research was to compare differences in women and men within each IPV status category (victim, perpetrator, and both) with respect to levels of battering as defined by their scores on the Women's Experience With Battering Scale (WEB), which asks gender-neutral questions about the abuse of power and control and fear in an intimate relationship. In our study, women disclosed higher levels of battering on the WEB, despite IPV status (victimization or both victimization and perpetration). In addition, female IPV victims were 5 times more likely than their male counterparts to disclose high rates of battering on the WEB. Depressive symptoms, symptoms of posttraumatic stress disorder, African American race, and IPV victimization were independently associated with higher WEB scores.

Intimate partner violence among men prevalence, chronicity, and health effects

CONTEXT

The breadth and depth of intimate partner violence (IPV) experienced by men have not been fully documented.

OBJECTIVES

To describe the prevalence, chronicity, and severity of IPV, and the health outcomes associated with IPV, in adult men with healthcare insurance.

DESIGN

A retrospective telephone cohort study conducted from 2003 to 2005. The setting was an integrated healthcare system in Washington State and Idaho.

PARTICIPANTS

English-speaking men aged 18 and older (N=420) enrolled in the healthcare system for 3 or more years.

MAIN OUTCOME MEASURES

Physical, psychological, and sexual IPV were assessed using five questions from the Behavioral Risk Factor Surveillance Survey. Health was measured using the Short Form-36, version 2 (SF-36v2) survey, the Center for Epidemiological Studies Depression Scale, and the National Institute of Mental Health Presence of Symptoms Survey.

RESULTS

Men experienced IPV at a rate of 4.6% in the past year, 10.4% in the past 5 years, and 28.8% over their lifetimes. While overall rates of physical and nonphysical IPV were similar, men aged 18-55 were twice as likely to be recently abused (14.2%, SE=2.6%) than were men aged 55 and older (5.3%, SE=1.6%). Abuse was typically nonviolent or mildly violent, occurred on multiple occasions, and was initiated by only one intimate partner. Compared to men with no IPV, older men who experienced IPV had more depressive symptoms (prevalence ratios=2.61 and 2.80 for nonphysical and physical abuse) and had lower SF-36v2 mental health subscales (range=-3.21 to -5.86).

CONCLUSIONS

Men experience IPV at moderate rates, and poor mental health outcomes are associated with such experiences.

Social information processing mediates the intergenerational transmission of aggressiveness in romantic relationships

This study explored the K. A. Dodge (1986) model of social information processing as a mediator of the association between interparental relationship conflict and subsequent offspring romantic relationship conflict in young adulthood. The authors tested 4 social information processing stages (encoding, hostile attributions, generation of aggressive responses, and positive evaluation of aggressive responses) in separate models to explore their independent effects as potential mediators. There was no evidence of mediation for encoding and attributions. However, there was evidence of significant mediation for both the response generation and response evaluation stages of the model. Results suggest that the ability of offspring to generate varied social responses and effectively evaluate the potential outcome of their responses at least partially mediates the intergenerational transmission of relationship conflict.

Drinking level, neighborhood social disorder, and mutual intimate partner violence

BACKGROUND

Intimate partner violence (IPV) remains a significant public health problem. The purpose of this study is to assess the contribution of drinking patterns to risk for mutual IPV among married/cohabiting adults in the general population, and to determine if the association between drinking level and mutual IPV varies by level of neighborhood social disorder.

METHODS

The study sample consists of 19,035 non-Hispanic black, Hispanic, and non-Hispanic white married/cohabiting adults who participated in the 2000 National Household Survey on Drug Abuse (NHSDA), and whose responses were available through the NHSDA public use file. Gender-specific multivariate logistic regression models of mutual IPV were developed to assess the association between drinking level and mutual IPV, and to test whether these associations vary by neighborhood social disorder.

RESULTS

Compared with men who are abstainers, men who are past-30 day heavy drinkers are at a more than 6-fold increased risk for mutual IPV. Men in less hazardous drinking categories are at a 2- to 3-fold increased risk of mutual IPV. Neighborhood disorder is independently associated with men's risk for mutual IPV (odds ratio=1.61). Except for women in the most hazardous drinking category, neighborhood disorder moderates the association between women's drinking level and risk of mutual IPV such that risk for mutual IPV significantly increases under conditions of high neighborhood disorder, and decreases to insignificant risk under conditions of low neighborhood disorder. Compared with abstainers, women who are past-30 day heavy drinkers are at an approximate 6-fold risk for mutual IPV regardless of level of neighborhood disorder.

CONCLUSIONS

Drinking level and neighborhood characteristics should be taken into account when assessing risk for mutual IPV among married/cohabiting men and women in the general population. An environmental approach to IPV prevention and intervention which addresses the neighborhood context in which couples reside may be a promising strategy for reducing IPV occurrence.

Musculoskeletal Manifestations of Physical Abuse After Intimate Partner Violence

BACKGROUND

Domestic violence is the most common cause of nonfatal injury to women in the United States, with an estimated cost of $50 billion annually. Little is known about the spectrum of musculoskeletal injuries in victims of domestic violence. We examined the characteristics of abused women, the prevalence of musculoskeletal injuries, and the variables associated with increasing frequency of physical violence against women.

METHODS

We identified all female survivors of intimate partner violence who were referred to the Minnesota Domestic Abuse Program from January 1, 2002, through December 31, 2003. Characteristics of each woman's background, abuse history, and injuries were obtained by a trained program therapist in an in-depth, 2-hour intake interview. Specific data forms were completed for each interview. Five forms of experienced abuse were explored (physical, emotional, psychological, sexual, and financial). Injuries were subcategorized as (1) head and neck, (2) musculoskeletal, (3) chest, (4) abdomen, and (5) skin (integumentary system). We conducted regression analyses to determine factors associated with the frequency of physical abuse.

RESULTS

Of 270 potentially eligible women, 263 (97%) with complete records were included. Women were commonly Caucasian (62%) in their third decade of life with one or more children (87%). A history of abuse was recalled by over half of the women (54%). The most prevalent forms of abuse were emotional (84%), psychological (68%), physical (43%), sexual (41%), and financial (38%). Child protective services were concomitantly involved in half of the women living in abusive relationships. Among those women who reported physical abuse, 36% sought medical attention. We identified 144 injuries in 218 physically abused women. Head and neck injuries were the most prevalent after intimate partner violence (40%). Musculoskeletal injuries were the second most common manifestation of intimate partner violence (28%). The spectrum of injuries included sprains (n = 21 injuries), fracture/dislocations (n = 17 injuries), and foot injuries (n = 2 injuries). Our analysis identified seven variables associated with increasing physical abuse frequency. These included (1) younger age (p = 0.04); (2) shorter length of relationship (p = 0.049); (3) emotional abuse (p = 0.02); (4) psychological abuse (p = 0.003); (5) sexual abuse (p = 0.004); (6) drug dependency (p = 0.05); and (7) alcohol dependency (p = 0.045).

CONCLUSIONS

Among women presenting to a domestic violence therapy program seeking counseling, head and neck and musculoskeletal injuries were most common. Frequency of physical abuse was most likely to be associated with younger women who are in short-term relationships, have chemical and alcohol dependency, and concomitant emotional, psychological, and sexual abuse. Recognizing musculoskeletal injuries in women as a potential result of intimate partner violence is warranted. Identifying children exposed to abusive situations may further alert treating surgeons to the potential for intimate partner violence in the mother.

Impact of PTSD comorbidity on one-year outcomes in a depression trial

Low-income African American, Latino, and White women were screened and recruited for a depression treatment trial in social service and family planning settings. Those meeting full criteria for major depression (MDD; N = 267) were randomized to cognitive-behavior therapy (CBT), antidepressant medication, or community mental health referral. All randomly assigned participants were evaluated by baseline telephone and clinical interview, and followed by telephone for one year. Posttraumatic stress disorder (PTSD) comorbidity was assessed at baseline and one-year follow-up in a clinical interview. At baseline, 33% of the depressed women had current comorbid PTSD. These participants had more exposure to assaultive violence, had higher levels of depression and anxiety, and were more functionally impaired than women with depression alone. Depression in both groups improved over the course of one year, but the PTSD subgroup remained more impaired throughout the one-year follow-up period. Thus, evidence-based treatments (antidepressant medication or structured psychotherapy) decrease depression regardless of PTSD comorbidity, but women with PTSD were more distressed and impaired throughout. Including direct treatment of PTSD associated with interpersonal violence may be more effective in alleviating depression in those with both diagnoses.

Ethnic differences in relations between family process and child internalizing problems

BACKGROUND

Family process variables have been linked to child problem behavior, but recent research suggests that child ethnicity may moderate relations between family process and child outcomes. The current study examined how ethnicity moderates relations between parent conflict, parent-child relationship quality, and internalizing problems.

METHODS

A sample of 101 mother-child dyads was drawn from a larger longitudinal study of childhood-onset depression. Maternal reports of family process factors were used with child reports of anxiety and depressive symptoms.

RESULTS

The results indicated a moderating effect of ethnicity for multiple indicators of internalizing symptoms, such that child-rearing disagreement and low levels of mother-child openness were associated with internalizing problems only for European American (not African American) children.

CONCLUSIONS

Findings suggest that ethnicity moderates the effects of family process factors on child psychopathology. Ethnic differences may be accounted for by the normativeness of family processes and the meaning that children of different ethnic backgrounds assign to these processes.

Domestic violence: a study among a group of Turkish women

OBJECTIVES

With this study we attempt to explore the reality of domestic violence, its prevalence, type and frequency among a group of Turkish women.

METHODS

This study was performed between October 2000 and May 2001 in the fourth largest city in Turkey. All women over the age of 15, who visited any of 50 health centres in different districts for different purposes, were asked to participate in the study. 506 of the participants who gave their consent were taken as a study group, and printed questionnaires were filled in during face-to-face interviews.

RESULTS

297 (58.7%) of the participants had experienced domestic violence at least once in their lifetime. The male partner was the primary violent person (49.5%), followed by mother and/or father (14.1%). The type of violence seen most was a combination of physical and psychological violence (45.5%). More than half of the women (58.6%) were experiencing domestic violence frequently and continuously. Reasons given for this violent behaviour were economic hardship (18.9%), followed by alcohol consumption by the violent person (18.5%), and inadequate family relations (15.8%). Of the victims 43.8% accepted this violence, but 26.6% reacted with violence. Women were not willing to abandon their relationships despite marital violence, because of their children (48.2%). Women's and men's higher educational attainments did indicate a decrease in the prevalence of domestic violence.

CONCLUSION

Reasons for continuing the abusive relationship and the effectiveness of the scarce support resources should be evaluated more seriously. The potential role of the primary healthcare provider in eliminating barriers for identification and assessment of domestic violence should not be forgotten. Otherwise, domestic violence will still remain a 'family matter', hidden and neglected.

Interpersonal violence among women seeking welfare: unraveling lives

OBJECTIVES

Exposure to violence is a widespread problem among women who receive welfare benefits. Research has focused on partner violence among women with children on Temporary Assistance for Needy Families (TANF), ignoring low-income women without dependent children who are eligible for General Assistance (GA).

METHODS

We report findings from a survey of 1235 women seeking TANF (N=1095) and GA (N=140) throughout a California county.

RESULTS

Estimates of recent physical, sexual, and severe violence were high in both populations. However, the highest rates occurred among women without children seeking GA, suggesting that they are at higher risk for sexual violence and more severe forms of physical violence, especially from intimate partners. This increased risk is partly accounted for by the co-occurrence of other serious health and social problems. In multivariate analyses, past-year violence was associated with substance use (adjusted odds ratio [AOR]=2.0, 95% confidence interval [CI] = 1.5, 2.9), recent homelessness (AOR = 1.9, 95% CI = 1.4, 2.6), family fragmentation including divorce or separation (AOR=3.1, 95% CI 1.8, 5.2), or foster care involvement (AOR=2.2, 95% CI=1.1, 4.5)

CONCLUSIONS

Welfare reform created TANF programs to address domestic violence. Women seeking GA may need similar services because of the high prevalence of violence.

Intimate partner violence, welfare receipt, and health status of low-income african american women: a lifecourse analysis

Although the association among intimate partner violence (IPV), welfare receipt, and health status has been well-established, little is known about the temporal sequencing of these events. In a random sample of low-income African American women in an urban Midwestern county, lifecourse data about IPV and welfare receipt were obtained using the Life History Calendar method (D. Freedman, A. Thornton, D. Camburn, D. Alwin, & L. Young-DeMarco, 1988), along with data about mental and physical health status. Controlling for relevant factors, longitudinal analyses found that previous experience of IPV increased women's odds of receiving welfare benefits in a given year, but previous welfare receipt did not. Cumulative IPV, but not cumulative welfare receipt, was associated with current and past-year health problems. These findings are consistent with the hypothesis that IPV leads women to turn to welfare assistance, and that compromised physical and mental health due to past cumulative IPV interferes with women's gainful employment.

Why are cohabiting relationships more violent than marriages?

In response to increases in cohabitation in the United States, researchers have recently focused on differences between cohabiting and marital unions. One consistent finding is a higher rate of domestic violence among cohabiting couples as compared with married couples. A prominent explanation for this finding is that cohabitation is governed by a different set of institutionalized controls than marriage. This article explores an alternative explanation, namely, that differences in selection out of cohabitation and marriage, including selection of the least-violent cohabiting couples into marriage and the most-violent married couples into divorce, lead to higher observed rates of violence among cohabiting couples in cross-sectional samples. Our results suggest that researchers should be cautious when making comparisons between married and cohabiting couples in which the dependent variable of interest is related to selection into and out of relationship status.

Criminal history and assaults on intimate partners by Mexican American and non-Mexican White college students

This study analyzed a sample of 348 college students to examine the role that criminal history and Mexican ethnicity play in predicting intimate partner violence. Respondents who committed crimes in the past (before the age of 15) had a higher probability of severely physically assaulting a partner than those respondents who had committed crime later in life (after the age of 15). A history of property crime was found to be a better predictor of severe partner assault than a history of violent crime. The results support a generalist perspective on crime, which states that most individuals typically do not commit one type of crime solely but commit a variety of different crimes (property and violent). This study also found differences between Mexican American and non-Mexican White students in reference to minor assaults on a partner.

Factors associated with spousal physical violence in Albania: cross sectional study

OBJECTIVE

To describe the prevalence of intimate partner violence and associated factors among married women in Albania.

DESIGN

Cross sectional study.

SETTING

Tirana, the capital city of Albania.

PARTICIPANTS

A representative sample of 1039 married women aged 25-65 living in Tirana and recorded in the 2001 census.

METHODS

Questionnaire on intimate partner violence and social and demographic characteristics of the women and their husbands.

MAIN OUTCOME MEASURE

Women's experience within the past year of being hit, slapped, kicked, or otherwise physically hurt by the husband.

RESULTS

More than a third (37%, 384/1039) of women had experienced violence. Risk was greatest among women aged 25-34 (odds ratio 1.47, 95% CI 1.04 to 2.09), women with tertiary education (3.70, 2.04 to 6.67), women in white collar jobs (4.0, 1.59 to 10.0), women with least educated husbands (5.01, 2.91 to 8.64), and women married to men raised in rural areas (3.31, 2.29 to 4.80). Women were at higher risk if they were more educated than their husbands (4.76, 2.56 to 9.09).

CONCLUSIONS

In transitional Albania, the risk of spousal violence is high, and more empowered women are at greater risk.

Physical and mental health outcomes of women in nonviolent, unilaterally violent, and mutually violent relationships

Despite equivocal findings on whether men or women are more violent, the negative impact of violence is greatest for women. To determine how gender asymmetry in perpetration affects women's health status, we conducted a study in two phases with 835 African American, Euro-American, and Mexican American low-income women in Project

HOW

Health Outcomes of Women. In Phase 1, we used severity and frequency of women's and male partners' violence to create six groups: nonviolent (NV), uni-directional male (UM) perpetrator, uni-directional female (UF) perpetrator and, when both partners were violent, symmetrical (SYM), male primary perpetrator (MPP), and female primary perpetrator (FPP). The MPP group sustained the most threats, violence, sexual aggression, and psychological abuse. They also reported the most fear. Injury was highest in the MPP and FPP groups. In Phase 2, we examined group differences in women's health status over time for 535 participants, who completed five annual interviews. Surprisingly, women's health in the MPP and FPP violence groups was similar and generally worse than if violence was uni-directional.

Intimate partner violence in the U.S. general population: progress and future directions

This article reviews survey research on intimate partner violence (IPV) in the U.S. general population. Results from survey research conducted over the past quarter century are briefly summarized. Three additional national studies related to injuries, crime victimization, and homicide among intimate partners in the United States are also considered. The article emphasizes the progress that has been made in general population survey research related to IPV. It concludes with a discussion of the current controversies and future directions for survey research of IPV in the U.S. general population.

Trauma and violence research: taking stock in the 21st century

Thirty years after the first national estimates of intimate partner violence were published, the field has reached such a level of maturity that complex questions can be posed and sophisticated research studies can be designed to answer them. Out of this body of research, one of the most important things that researchers have learned is that violence and trauma are experienced in different ways by different individuals and as a result, require different types of prevention and intervention approaches. With this greater understanding of the problems of violence and trauma, together with a commitment to inclusive and practical research, the field is poised to move forward toward the ultimate goal of violence prevention.

Black women and intimate partner violence: new directions for research

African American women are at elevated risk for nonfatal and lethal intimate partner violence (IPV). Accordingly, the purpose of this article is to review our current knowledge, with a focus on the sociodemographic factors that make this population particularly vulnerable to abuse. Future research directions include using more diverse Black samples, considering how living at the intersection of multiple forms of oppression shapes Black women's experience with violence, exploring the influence of historical events and oppressive images on victimization, and focusing on survivors' resilience and activism.

Ethnic differences in intimate partner violence in the U.S. general population: the role of alcohol use and socioeconomic status

This article reviews cross-sectional and longitudinal research on ethnic differences related to intimate partner violence (IPV) in the U.S. general population and the role of alcohol use and socioeconomic characteristics. Evidence indicates that significant ethnic differences exist in the prevalence of IPV. Although ethnic minorities report higher rates of IPV, differences in crude rates are reduced after controlling for socioeconomic circumstances and alcohol use. However, Black couples appear to be at greater risk of IPV than their White or Hispanic counterparts even after controlling for such risk factors. Overall, socioeconomic characteristics,demographic characteristics, and alcohol use appear to play important roles in the occurrence of IPV. These findings suggests that IPV continues to be a significant public health problem and represents an area of health disparity for ethnic minorities.

Acculturation, ethnic identity, and dating violence among Latino ninth-grade students

BACKGROUND

Studies of dating violence among Latino men and women have found that victims who are less acculturated have lower rates of dating violence. None of these studies have focused on adolescents. We assessed acculturation, ethnic identity, and dating violence victimization among Latino ninth-grade students.

METHODS

Students from 13 high schools representing 24% of ninth-grade students in the Texas Lower Rio Grande Valley during 2000-2001 completed questionnaires. This analysis is restricted to students age 14 years or older who self-identified as Hispanic or Latino (n = 4,525). Logistic regression was performed to estimate the risk of dating violence associated with measures of acculturation and ethnic identity.

RESULTS

Latino female adolescents were more likely to report dating violence victimization in the past 12 months (8.7%) than were males (6.4%). Parental birthplace outside of the United States was significantly associated with a reduced likelihood of dating violence victimization among females. Reporting a great deal of ethnic discrimination was strongly associated with increased dating violence victimization among females.

CONCLUSIONS

These findings suggest that greater acculturation may be associated with greater prevalence of dating violence victimization among females. Understanding those aspects of Latino culture that may impact risk of dating violence could have important public health implications.

Clinically abusive relationships in an unselected birth cohort: men's and women's participation and developmental antecedents

In an unselected birth cohort (N=980, age 24-26 years), individuals in abusive relationships causing injury and/or official intervention (9% prevalence) were compared with participants reporting physical abuse without clinical consequences and with control participants who reported no abuse, on current characteristics and prospective developmental risks. In nonclinically abusive relationships, perpetrators were primarily women. In clinically abusive relationships, men and women used physical abuse, although more women needed medical treatment for injury. Women in clinically abusive relationships had childhood family adversity, adolescent conduct problems, and aggressive personality; men had disinhibitory psychopathology since childhood and extensive personality deviance. These findings counter the hibitory assumption that if clinical abuse was ascertained in epidemiological samples, it would be primarily man-to-woman, explained by patriarchy rather than psychopathology.

A path model of risk factors for intimate partner violence among couples in the United States

The present study was designed to identify the impact of drinking problems, impulsivity, and a history of childhood physical abuse on both male-to-female (MFIPV) and female-to-male intimate partner violence (FMIPV). The data were collected in 1995 from a representative national sample of couples living in the contiguous 48 states. Using a multistage probability sampling design, face-to-face interviews were conducted in respondent' homes, privately with each member of 1, 635 couples. A complex path model building on earlier work was tested for African American, Hispanic, and White couples separately. Multiple-group path analysis demonstrated that impulsivity, alcohol problems, and childhood physical abuse were differentially associated with reports of MFIPV and FMIPV as a function of ethnicity. This study suggests that a history of being physically harmed by parental figures during childhood, impulsivity, and drinking problems are all risk factors for intimate partner violence in the general household population in the United States.

Do responses to an intimate partner violence screen predict scores on a comprehensive measure of intimate partner violence in low-income black women?

STUDY OBJECTIVES

Screening for intimate partner violence has been advocated as an emergency department (ED) procedure. This study aimed to ascertain whether a 5-item intimate partner violence screening questionnaire could be used effectively in the ED with low-income black women to accurately predict partner abuse status.

METHODS

Data were collected from 200 black women who answered in the affirmative to at least 1 item on the intimate partner violence screener questionnaire, the Universal Violence Prevention Screening Protocol. The women completed a comprehensive battery of measures, including the Index of Spouse Abuse, a commonly used and psychometrically sound measure of intimate partner violence.

RESULTS

Bivariate logistic regression analyses revealed that, compared with women below the physical-intimate partner violence cut point on the Index of Spouse Abuse, women above the cut point on physical-intimate partner violence on the Index of Spouse Abuse were more likely to answer yes to Universal Violence Prevention Screening Protocol screening questions related to physical, sexual, and emotional abuse; threats to be harmed physically; and being afraid. Compared with women below the nonphysical-intimate partner violence cut point on the Index of Spouse Abuse, women above the cut point on nonphysical intimate partner violence on the Index of Spouse Abuse were more likely to answer yes to each screening question on the Universal Violence Prevention Screening Protocol. The 2 Universal Violence Prevention Screening Protocol screening items related to physical abuse best predicted the 2 Index of Spouse Abuse scales. Accurate prediction of physical and nonphysical abuse on the Index of Spouse Abuse required affirmative responses to 4 or more screening questions on the Universal Violence Prevention Screening Protocol.

CONCLUSION

A brief intimate partner violence screening device in the emergency care setting can identify abused, low-income, black women. The study is limited by the fact that universal screening was not conducted, the inclusion of only women who acknowledged some form of intimate partner violence, a reliance on retrospective self-reports, and the questionable generalizability of the findings to groups other than low-income black women.

Use of the Interpersonal Support Evaluation List (ISEL) to guide intervention development with women experiencing abuse

Effective intervention strategies for abused women must be developed that match women's perceived needs. The purpose of this study was to examine the associations among age, race, employment status, education levels, and women's perceptions of social support. Women (n = 40) from 19 to 68 years of age in a family court setting or domestic violence shelter completed the Interpersonal Support Evaluation List (ISEL), which was used to measure subscales of companionship, self-esteem, emotional support, and instrumental support. Abuse was documented by patient reports and protocols of the referring agencies. Significant associations were found between age and self-esteem (r = 0.47, p = 0.002) companionship (r = 0.29, p = 0.07) and emotional support (r = 0.27, p = 0.09). Also significant were the associations between race and self-esteem (r = 0.27, p = 0.10) and employment and instrumental support (r = -0.32, p = 0.08). These significant findings may aid in the development of interventions for abused women that are matched to their social support needs, particularly if the findings are consistent in larger studies.