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

Does alcohol make a difference? Within-participants comparison of incidents of partner violence

Episodes of husband-to-wife violence in which the husband consumed alcohol were compared with episodes of husband-to-wife violence, reported by the same individuals, in which the husband was not drinking. Among this community sample of newlyweds, wife reports, but not husband reports, indicated that violent episodes in which the husband was drinking included more acts of violence and were more likely to involve severe violence. Both wife and husband reports indicated that wives were more likely to be physically aggressive in husband drinking episodes compared to sober episodes. However, whereas wives reported that their aggressive behavior was a response to husband aggression, husbands reported that wives were more likely to initiate violence in these episodes. Violent episodes that include alcohol may be more severe and more mutually violent than sober episodes. Discrepancies between husband and wife reports may reflect differences in recall or self-serving biases.

Victimization and Substance Abuse among Women: Contributing Factors, Interventions, and Implications

Although the literature indicates that there is an association of victimization with substance abuse, there has been limited research focused on understanding and synthesizing the factors that have been identified as contributing to victimization and substance abuse and on interventions designed to address these contributing factors. The purposes of this article are to (a) review the literature on factors related to victimization and substance abuse, (b) review interventions and outcomes, and (c) discuss clinical implications for interventions and research. Results suggest that there is a high rate of co-occurrence of victimization and substance abuse among women, that the factors contributing to victimization and substance abuse are complex, and that there is a lack of treatment models addressing victimization and substance abuse.

Socioeconomic inequalities in injury: critical issues in design and analysis

Injuries continue to place a tremendous burden on the public's health and rates vary widely among different groups in the population. Increasing attention has recently been given to the effects of socioeconomic status (SES) as a determinant of health among both individuals and communities. However, relatively few studies have focused on the influence of SES and injuries. Furthermore, those that have, and the other injury studies that have included measures of SES in their analysis, have varying degrees of conceptual and methodological rigor in their use of this measure. Recent advances in data linkage and analytic techniques have, however, provided new and improved methods to assess the relationship between SES and injuries. This review summarizes the relevant literature on SES and injuries, with particular attention to study design, and the measurement and interpretation of SES. We found that increasing SES has a strong inverse association with the risk of both homicide and fatal unintentional injuries, although the results for suicide were mixed. However, the relationship between SES and nonfatal injuries was less consistent than for fatal injuries. We offer potential explanatory mechanisms for the relationship between SES and injuries and make recommendations for future research in this area.

The mediating roles of perceived social support and resources in the self-efficacy-suicide attempts relation among African American abused women

The authors examined whether self-efficacy among African American abused women decreased their risk of suicide attempts through the mediating influences of perceived social support from friends, perceived social support from family, and perceived effectiveness for obtaining material resources. The sample consisted of 100 women who presented to a hospital following a suicide attempt and 100 women who presented to the same hospital for nonemergency medical problems. Results revealed that the association between self-efficacy and suicide attempt status was partially accounted for by the mediating roles of perceived social support from friends and family, and perceived effectiveness at obtaining resources. Findings suggest that interventions to increase abused women's self-efficacy should focus on increasing their capacity to obtain social and material resources.

Intimate partner violence and high-risk sexual behaviors among female patients with sexually transmitted diseases

BACKGROUND

Victimization by intimate partner violence (IPV) may play an important role in sexual decision-making, increasing the risk for sexually transmitted diseases (STDs) and HIV.

GOAL

To explore the relationship between IPV and high-risk sexual behaviors, substance abuse, partners who had sex outside the relationship, and history of STD among women attending an STD clinic.

STUDY DESIGN

A self-administered survey of patients attending a public STD clinic in San Francisco was conducted from October 1996 to March 1997. Topics included STD history, sexual risk behaviors, partner violence history, partner characteristics, and demographics. Logistic regression analysis was used to assess the independent effect of IPV on STD risk factors.

RESULTS

Overall, 2115 patients participated, for a response rate of 96%. Data were analyzed for a subgroup of 409 female patients who reported recent male sexual partners. Among these women, 11% reported IPV in the past 12 months; lifetime history of IPV was 24%. A history of IPV was associated with a self-reported history of STD (adjusted odds ratio [OR], 2.15; 95% CI, 1.23-3.77). IPV in the past 12 months was associated with alcohol or drug use before sex (adjusted OR, 2.36; 95% CI, 1.17-4.77) and main partners who had sex outside the relationship (adjusted OR, 3.75; 95% CI, 1.94-7.26).

CONCLUSIONS

IPV is common among female STD patients and is associated with risk behaviors and partner factors that increase patients' risk of contracting STD and HIV. Screening and referral for IPV should be routinely conducted for female patients attending STD clinics.

Psychological distress among abused minority women with sexually transmitted diseases

PURPOSE

To describe psychological distress among abused minority women with sexually transmitted diseases (STDs) and to identify needs for psychotherapeutic intervention for reduction in abuse, sexual risk behavior and STD.

DATA SOURCES

A controlled randomized trial of the effects of a behavioral intervention on STD recurrence. Eligibility was limited to English speaking Mexican-American and African-American women with a current non-viral STD confirmed by laboratory testing (gonorrhea, chlamydia, syphilis or trichomonas). All eligible women who could be contacted were recruited from public-health clinics in San Antonio. T-tests, Chi square and correlation were used to analyze the data.

CONCLUSIONS

Women with STD and a history of abuse reported more symptoms of current psychological distress than nonabused women. This psychological distress was present in all dimensions of the SCL-90-R, including somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism. Increased current psychological distress and correlation was found not only for women with reports of sexual abuse but also forms of physical or psychological abuse. The majority of abuse was reportedly experienced during a relationship with a boyfriend or friend/acquaintance.

IMPLICATIONS FOR PRACTICE

Abused women with STD may benefit from the identification and assessment of abuse history and psychological distress so that appropriate psychological treatment can accompany medical treatment. The prevalence of woman abuse within a population of women with STD mandates the inclusion of violence in STD prevention programs.

Risk and protective factors for suicidal behavior in abused African American women

This study examined risk and protective factors that differentiate low-income, abused African American women (N = 200) who attempted suicide from those who had never made a suicide attempt. Results from multivariate analyses revealed that numerous and/or severe negative life events, a history of child maltreatment, high levels of psychological distress and depression, hopelessness about the future, and alcohol and drug problems were factors associated with attempter status. Protective factors associated with nonattempter status included hopefulness, self-efficacy, coping skills, social support, and effectiveness in obtaining material resources. Culturally competent intervention approaches for abused women should target increasing their protective factors and reducing their risk factors to decrease the likelihood that these women engage in suicidal behavior.

Female victims of intimate partner physical domestic violence (IPP-DV), California 1998

BACKGROUND

This study was conducted to identify factors associated with adult female victims of intimate partner physical domestic violence (IPP-DV) in California and to estimate statewide IPP-DV prevalence.

METHODS

We analyzed data from the 1998 California Women's Health Survey, a random, computer-assisted telephone interview (CATI) survey of 4006 California women aged > or = 18, conducted by the California Department of Health Services.

RESULTS

Data from the survey indicated that 6% of the women reported that in the previous 12 months, their intimate partners threw objects at them, or hit them with an object, or kicked, pushed, slapped, choked, beat up, or threatened them with a gun or a knife. Odds ratio (OR) analyses controlling for age and race/ethnicity suggest that a large number of factors are associated statistically with IPP-DV victims. These factors include feelings of ill physical and mental health; pregnancies at early age; smoking status; nutritional needs; low income; participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program; having children aged < 18 in the household; and limited access to health care. Among the non-U.S.-born respondents, IPP-DV victims were significantly younger when they entered the United States than their nonvictim counterparts. A multiple logistic regression model identified the following factors as main correlates with IPP-DV: feelings of being overwhelmed in the past 30 days (OR = 3.4, 95% confidence interval [CI] = 2.5-4.6); aged 18 to 44 (OR = 2.8, 95% CI = 1.9-4.1); current smoking status (OR = 2.1, 95% CI = 1.5-2.9); participation in WIC in the previous 2 years (OR = 1.8, 95% CI = 1.2-2.6); and being out of work (OR = 1.4, 95% CI = 1.1-1.9).

CONCLUSIONS

The above findings suggest that a variety of venues (e.g., schools, mental and physical health care providers, WIC, immigration programs, and social services) will be needed in order to identify/gain access to IPP-DV victims, provide referral resources, and implement any future prevention efforts.

Partner violence among adolescents in opposite-sex romantic relationships: findings from the National Longitudinal Study of Adolescent Health

OBJECTIVES

This report examines (1) the prevalence of psychological and minor physical violence victimization in a nationally representative sample of adolescents and (2) associations between sociodemographic factors and victimization.

METHODS

Analyses are based on 7500 adolescents who reported exclusively heterosexual romantic relationships in the National Longitudinal Study of Adolescent Health. Items from the Conflict Tactics Scale were used to measure victimization. Associations between victimization patterns and sociodemographic characteristics were assessed with polytomous logistic regression.

RESULTS

One third of adolescents reported some type of victimization, and 12% reported physical violence victimization. Although most sociodemographic characteristics were significantly associated with victimization, patterns varied by sex and type of victimization.

CONCLUSIONS

Psychological and minor physical violence victimization is common in opposite-sex romantic relationships during adolescence. The sex-specific associations between sociodemographic characteristics and patterns of partner violence victimization underscore the importance of pursuing longitudinal, theory-driven investigations of the characteristics and developmental histories of both partners in a couple to advance understanding of this public health problem.

Physical aggression in a community sample of at-risk young couples: gender comparisons for high frequency, injury, and fear

The associations of frequent physical aggression, injury, and fear were examined for a community-based sample of at-risk young couples who were dating, cohabiting, or married. It was hypothesized that frequent physical aggression toward a partner, in the range of shelter samples, is largely caused by antisocial behavior and mutual couple conflict and, thus, that there would be greater similarity across genders in such behavior than has previously been supposed. It was also predicted that levels of injury and fear would be higher in women but that some men would experience these impacts. Findings indicated similarity across genders both in the prevalence of frequent aggression and in its association with antisocial behavior. Furthermore, such aggression was likely to be bidirectional in couples. Contrary to the hypothesis of the study, rates of injury and fear for the women were not significantly higher than for the men.

PTSD symptoms and partner abuse: low income women at risk

Aspects of partner abuse (types, severity, chronicity, treatment of injury, fear, etc.) were addressed with low income community women, half of whom scored above the cutoff on the Crime Related PTSD scale. Using this cutoff 47% of women who sustained moderate violence were high in CR-PTSD symptoms. If their partner also raped them, the rate (63%) was similar to women who sustained severe violence (65%) or severe violence and rape (71%). No ethnic differences were found for rates or severity of CR-PTSD symptoms. A MANCOVA by ethnicity (African Americans, Euro-Americans, Mexican Americans) and CR-PTSD symptoms (low vs. high) identified ethnic differences only on total sexual aggression and recent threats of violence. The high symptom group reported more abuse on all measures. Results from the CR-PTSD and the general lack of ethnic differences support the notion that SES contributes more to women's vulnerability to abuse and stress symptoms than does ethnicity.

Sexual abuse and sexual risk behaviors of minority women with sexually transmitted diseases

The relationship between sexual abuse and sexually transmitted disease (STD) represents an important and underinvestigated context of domestic violence. This study examined the association between sexual abuse, sexual risk behaviors, and risk for reinfection and HIV among minority women with STD. Mexican American and African American women (n = 617) with active STD entered a randomized study of behavioral intervention to reduce STD recurrence. Each underwent questioning at entry regarding sexual abuse and sexual risk behaviors. Comparisons of these behaviors using chi-square, t tests, and logistic regression were made by history of sexual abuse. Sexually abused women were more likely to have lower incomes, earlier coitus, STD history, currently abusive partners, new sex partners, anal sex, and bleeding with sex, placing them at increased risk for STD reinfection and HIV. Due to this association with sexual risk behavior, assessment for sexual abuse is essential in programs focusing on STD/HIV prevention.

Intimate partner violence and drinking patterns among white, black, and Hispanic couples in the U.S

PURPOSE

Using reports from both partners, this study estimated prevalence rates of intimate partner violence (IPV) among white, black, and Hispanic couples in the U.S., and assessed the contribution of drinking patterns, psychosocial, and other sociodemographic factors to the risk of partner violence.

METHODS

A multistage area probability sample consisting of 555 white, 358 black, and 527 Hispanic couples in the U.S. household population was interviewed in 1995. Logistic regression analyses revealed that predictors of IPV vary by ethnicity.

RESULTS

Rates of male-to-female (MFPV) and female-to-male partner violence (FMPV) were highest among black couples (23% and 30%), followed by Hispanic (17% and 21%), and white couples (12% and 16%). Between 27 percent and 41 percent of the men, and 4 percent and 24 percent of the women were drinking at the time of the violent incident.

IMPLICATIONS

Black and Hispanic couples are at higher risk for IPV than white couples and should be targeted for prevention intervention. The interrelationships among IPV, alcohol consumption, and ethnicity are complex. These findings suggest that future attempts at modeling IPV should be ethnically sensitive and, ideally, include separate analyses of each ethnic group.

Prevalence and predictors of physical partner abuse among Mexican American women

OBJECTIVES

This study determined the lifetime prevalence of physical abuse by a current partner among women of Mexican origin and assessed factors associated with abuse.

METHODS

Data are for a subsample of 1155 women with current partners from a larger population-based cross-sectional survey of US residents of Mexican origin.

RESULTS

The self-reported prevalence of physical abuse by a current partner was 10.7%. In multivariate analysis, factors associated with physical abuse included US birthplace (odds ratio = 2.1; 95% confidence interval = 1.24, 3.56), young age, urban residence, and having 4 or more children. Social support and regular church attendance were protective.

CONCLUSIONS

The self-reported prevalence of physical abuse among Mexican American women is high. US birth is associated with increased risk of abuse. Community-based prevention efforts should be aimed at this population.

Alcohol-related intimate partner violence among white, black, and Hispanic couples in the United States

Intimate partner violence (IPV) is a major public health problem in the United States. Results from a 1995 national study indicated that 23 percent of the black couples, 11.5 percent of the white couples, and 17 percent of the Hispanic couples surveyed reported an incident of male-to-female partner violence in the 12 months preceding the survey. The rate of female-to-male partner violence was also high: 15 percent among white couples, 30 percent among black couples, and 21 percent among Hispanic couples. The higher prevalence of IPV among ethnic minorities, compared with whites, cannot be explained by any single factor, but seems to be related to risk factors associated with the individual, the type of relationship between partners, and factors in the environment. Alcohol plays an important part in IPV. The study found that 30 to 40 percent of the men and 27 to 34 percent of the women who perpetrated violence against their partners were drinking at the time of the event. Alcohol-related problems were associated with IPV among blacks and whites, but not among Hispanics. Alcohol's role in partner violence may be explained by people's expectations that alcohol will have a disinhibitory effect on behavior or by alcohol's direct physiological disinhibitory effect. It is also possible that people consciously use alcohol as an excuse for their violent behavior or that alcohol appears to be associated with violence because both heavier drinking and violence have common predictors, such as an impulsive personality.

Prevalence and determinants of intimate partner abuse among public hospital primary care patients

OBJECTIVE

To determine the prevalence, sociodemographic determinants, and depression correlates of intimate partner abuse among an ethnically diverse population of women patients.

DESIGN

Cross-sectional telephone survey in English and Spanish of a random sample of women patients aged 18 to 46 years.

SETTING

Three public hospital primary care clinics (general internal medicine, family medicine, and obstetrics/gynecology) in San Francisco, Calif.

PARTICIPANTS

We interviewed 734 (74%) of the 992 eligible participants. Thirty-one percent were non-Latina white, 31% African American, and 36% Latina.

MEASUREMENTS AND MAIN RESULTS

Using questions adapted from the Abuse Assessment Screen, we determined recent and lifetime history of physical, sexual, and psychological abuse. Overall, 15% reported recent abuse by an intimate partner (in the preceding 12 months); lifetime prevalence was 51%. Recent abuse was more common among women aged 18 to 29 years (adjusted odds ratio [OR] 2.1; 95% confidence interval [CI], 1.2 to 3.7), non-Latinas (adjusted OR, 1.7; 95% CI, 1.0 to 2.9), and unmarried women (adjusted OR, 1.65; 95% CI, 1.0 to 2.7). The prevalence of abuse did not differ by education, employment, or medical insurance status of the women. Compared with women with no history of abuse, a greater proportion of recently abused women reported symptoms of depression (adjusted OR, 3.5; 95% CI, 2.2 to 5.5).

CONCLUSIONS

Because a substantial proportion of women patients in primary care settings are abused, screening for partner abuse and depression is indicated. In contrast to other studies, lower socioeconomic status was not associated with partner abuse history.

Sex differences in aggression between heterosexual partners: a meta-analytic review

Meta-analyses of sex differences in physical aggression to heterosexual partners and in its physical consequences are reported. Women were slightly more likely (d = -.05) than men to use one or more act of physical aggression and to use such acts more frequently. Men were more likely (d = .15) to inflict an injury, and overall, 62% of those injured by a partner were women. The findings partially support previous claims that different methods of measurement produce conflicting results, but there was also evidence that the sample was an important moderator of effect size. Continuous models showed that younger aged dating samples and a lower proportion of physically aggressive males predicted effect sizes in the female direction. Analyses were limited by the available database, which is biased toward young dating samples in the United States. Wider variations are discussed in terms of two conflicting norms about physical aggression to partners that operate to different degrees in different cultures.

Neighborhood poverty as a predictor of intimate partner violence among White, Black, and Hispanic couples in the United States: a multilevel analysis

PURPOSE

This study assessed the contribution of neighborhood poverty, measured at the census tract level, to the risk of male-to-female and female-to-male partner violence (MFPV, FMPV) among white, black, and Hispanic couples in the United States.

METHODS

As part of the 1995 National Alcohol Survey, a representative sample of married/cohabiting couples was obtained through a multistage, multicluster household probability sampling frame. The outcome variables, MFPV and FMPV, were measured through the Conflict Tactics Scale, Form R. Sociodemographic, psychosocial, and alcohol consumption covariates that were statistically significant through bivariate analysis were retained as individual-level predictors. Neighborhood poverty, indicating residence in a census tract where greater than 20% of the population lived below the Federal poverty line, was assessed by appending 1990 Census data to the primary data set. Multilevel logistic regression models were constructed, with separate analyses performed for each outcome (MFPV, FMPV) among the white, black, and Hispanic couples.

RESULTS

Couples residing in impoverished neighborhoods are at increased risk for both MFPV and FMPV. The association between residence in an impoverished neighborhood and MFPV was statistically significant for black couples (Odds Ratio [OR] 2.87; 95% Confidence Interval [CI] 1.36, 6.07). The association between residence in an impoverished neighborhood and FMPV was statistically significant for black couples and white couples.

CONCLUSIONS

Characteristics of the socioenvironment, such as neighborhood poverty, are associated with the risk of partner violence, particularly among black couples. Policies aimed at reducing community poverty may contribute to effective partner violence prevention strategies.

Antecedents of physical and sexual victimization among homeless women: a comparison to homeless men

Homeless women experience extensive health risks including physical and sexual victimization. Few studies that have gathered information on homeless persons have reported results separately for women or have compared them directly with men. Research that both investigates antecedents of victimization among homeless women and compares them to those for men is necessary to determine whether prevention efforts must be different for each group. We investigated potential antecedents of recent (past 30 days) physical and sexual victimization in a probability sample of 394 homeless women and compared findings to those for 1159 homeless men. As hypothesized, mental disorder, substance dependence, and engaging in economic survival strategies significantly predicted victimization among homeless women. With few dissimilarities, these characteristics also predicted victimization among homeless men. Although differences in the needs and experiences of homeless women and men must be recognized, both women and men require assistance to establish and maintain safe residences, treatment of any substance use and mental disorder, and alternatives to economic survival strategies that place them at risk for victimization.

Partner violence, social support, and distress among inner-city African American women

This study examined the role of social support in the partner violence-psychological distress relation in a sample of African American women seeking medical care at a large, urban hospital (n = 138). Results from bivariate correlational analyses revealed that partner violence was related to lower perceived social support and greater psychological distress, and lower social support was related to more distress. Furthermore, findings based on path analysis indicated that low levels of social support helped account for battered women's increased distress. Findings point to the need for service providers to screen for partner violence in nontraditional sites, such as hospital emergency rooms, and to address the role of social support resources in preventive interventions with African American battered women.

Gender differences in depression and antidepressant pharmacokinetics and adverse events

OBJECTIVE

To review data generated by studies examining gender differences in the prevalence of depression, as well as in antidepressant pharmacokinetics, pharmacodynamics, and adverse events.

DATA SOURCES

Published articles and abstracts were identified through MEDLINE (January 1966-April 1999) using the following search terms: antidepressant, response, gender, pharmacokinetic, pharmacodynamic, female, side effect, and adverse events. All articles that assessed gender differences in antidepressant response, pharmacokinetics, and adverse events, as well as articles that evaluated postulated mechanisms for these differences, were reviewed. Additional articles were identified from bibliographies of retrieved articles.

STUDY SELECTION AND DATA EXTRACTION

All relevant abstracts, studies, and review articles were evaluated.

DATA SYNTHESIS

Gender differences in the prevalence of depression have been reported and may result from the interaction of several factors. Women have been shown to have a higher incidence of depression, which may be due to artifact, social, or biologic reasons. Studies suggest that the pharmacokinetic disposition of popular antidepressants varies between men and women, and women taking antidepressants may exhibit a different adverse event profile. Only one study specifically evaluated gender differences in antidepressant treatment response.

CONCLUSIONS

Further research elucidating gender differences in response to antidepressant treatment and on depression prevalence is needed. Some studies report that the pharmacokinetics of antidepressants may vary between men and women. Therefore, clinicians should be aware that potential differences in antidepressant pharmacokinetics may exist, and a dosage adjustment may be necessary for women to ensure a favorable drug response, compliance, and decreased incidence of adverse events.

Risk factors for injury to women from domestic violence

BACKGROUND

Domestic violence is the most common cause of nonfatal injury to women in the United States. To identify risk factors for such injuries, we examined the socioeconomic and behavioral characteristics of women who were victims of domestic violence and the men who injured them.

METHODS

We conducted a case-control study at eight large, university-affiliated emergency departments. The 256 intentionally injured women had acute injuries resulting from a physical assault by a male partner. The 659 controls were women treated for other conditions in the emergency department. Information was collected with a standardized questionnaire; no information was obtained directly from the male partners.

RESULTS

The 256 intentionally injured women had a total of 434 contusions and abrasions, 89 lacerations, and 41 fractures and dislocations. In a multivariate analysis, the characteristics of the partners that were most closely associated with an increased risk of inflicting injury as a result of domestic violence were alcohol abuse (adjusted relative risk, 3.6; 95 percent confidence interval, 2.2 to 5.9); drug use (adjusted relative risk, 3.5; 95 percent confidence interval, 2.0 to 6.4); intermittent employment (adjusted relative risk, 3.1; 95 percent confidence interval, 1.1 to 8.8); recent unemployment (adjusted relative risk, 2.7; 95 percent confidence interval, 1.2 to 6.5); having less than a high-school-graduate's education (adjusted relative risk, 2.5; 95 percent confidence interval, 1.4 to 4.4); and being a former husband, estranged husband, or former boyfriend (adjusted relative risk, 3.5; 95 percent confidence interval, 1.5 to 8.3).

CONCLUSIONS

Women at greatest risk for injury from domestic violence include those with male partners who abuse alcohol or use drugs, are unemployed or intermittently employed, have less than a high-school-graduate's education, and are former husbands, estranged husbands, or former boyfriends of the women.

The effectiveness of an abuse assessment protocol in public health prenatal clinics

OBJECTIVES

This study evaluated whether incorporation of an abuse assessment protocol into the routine procedures of the prenatal clinics of a large urban public health department led to increased referral for and assessment, identification, and documentation of abuse.

METHODS

Evaluation was conducted at 3 matched prenatal clinics serving a total of 12,000 maternity patients per year. Two clinics used the abuse protocol and 1 did not. An audit was performed at the clinics on a randomly selected sample of 540 maternity patient charts for the 15 months before the protocol was initiated and of 540 records for the 15 months after the protocol was introduced. Ninety-six percent of the patients represented in the sample were Latina.

RESULTS

At the clinics using the protocol, abuse assessment increased from 0 to 88%. Detection of abuse increased from 0.8% to 7%. There were no changes at the comparison clinic.

CONCLUSIONS

Incorporation of an abuse assessment protocol into the routine procedures of public health department prenatal clinics increases the assessment, identification, and documentation of and referral for abuse among pregnant women. An abuse protocol should be a routine part of maternity care.

Testing an intervention to prevent further abuse to pregnant women

Although violence against women is recognized as a major public health problem, few interventions have been developed to reduce abuse. In this study, 132 pregnant women received three counseling sessions that were designed to reduce further abuse. A comparison group of 67 abused women were offered wallet-sized cards listing community resources for abuse. Women in both groups were followed at 6 months and 12 months post-delivery. Using repeated measures MANCOVA with entry scores as a covariate, we found significantly less violence reported by women in the intervention group than by women in the comparison group.

Nonfatal physical violence, United States, 1994

OBJECTIVES

Most surveillance and research efforts focus on severe violence, especially on homicides. Because less extreme forms of violence may be precursors to more extreme forms, the authors analyzed data from a national survey to describe the extent of nonfatal physical violence in the US.

METHODS

The authors generated weighted national estimates from responses to a random-digit-dialed telephone survey. Respondents were asked if they had been "hit, slapped, pushed, or kicked by another person or hit with an object or weapon" in the preceding 12 months. Respondents were also asked how many times such incidents had occurred and, for the last such episode, their relationship with the perpetrator, whether they had been injured, and, if so, whether they had sought medical treatment.

RESULTS

The authors estimate that approximately 15 million people, or 8% of the US adult population, experienced nonfatal physical violence, as defined for this study, during a 12-month period. Male gender, the 18-24-year-old age group, never having been married, being out of work or a student, and heavy drinking were associated with a higher likelihood of being assaulted. An estimated 75% of assaults were by a known person and 26% by a stranger. Women were more likely than men to be assaulted by current or former intimate partners; men were more likely than women to be assaulted by strangers. An estimated 18% of incidents resulted in injuries, and an estimated 7% required medical attention.

CONCLUSIONS

Nonfatal physical violence is fairly common in the US and may lead to more than one million medical encounters each year.

Partner abuse and posttraumatic stress disorder as risk factors for suicide attempts in a sample of low-income, inner-city women

This study examined partner abuse and posttraumatic stress disorder (PTSD) as risk factors for suicidal behavior among women, and whether or not PTSD mediated the partner abuse-suicidal behavior association. Attempters (n = 119) were approximately three times more likely to be above clinical cut-points for physical partner abuse, nonphysical abuse, and PTSD than nonattempters (n = 85). Physical partner abuse, but not nonphysical partner abuse, was associated with an increased risk for PTSD. Further, PTSD mediated the link between physical partner abuse and suicidality, such that when PTSD was statistically controlled, the association between physical partner abuse and suicide attempt status was reduced to nonsignificance. Implications of findings for interventions for female victims of partner abuse, and women who make nonfatal suicide attempts are discussed.

Aggressive acts and assaults in intimate relationships: towards an understanding of the literature

Far more people in relationships are subjected to violent acts than those who receive injuries. The degree of damage sustained may not reflect the perpetrator's intent to deliberately harm a partner. Data documenting aggressive acts determines the population at risk and their prevention and early treatment requirements; whereas data focusing on harm and injury helps determine emergency medical and refuge services. Data from national crime surveys, police records, or clinical populations should not be generalized to the population at large. Even if men perpetrate the majority of serious partner attacks, addressing the issue of female violence will significantly reduce the overall level of domestic violence. Judicial, medical, and social services should take note that while male violence may be more problematic, violence is a relationship issue, not a male issue.

Rates of intimate partner violence in the United States

OBJECTIVES

Estimates of intimate partner violence in the United States based on representative samples have relied on data from one person per household or limited numbers of indicators from both partners. The purpose of this study was to estimate nationwide rates of intimate partner violence with data from both couple members by using a standardized survey instrument, the Conflict Tactics Scale.

METHODS

A multistage probability sampling design was used to conduct separate face-to-face interviews in respondents' homes with both members of 1635 representative couples living in the 48 contiguous states.

RESULTS

Both partners' reports were used to estimate the following lower- and upper-bound rates: 5.21% and 13.61% for male-to-female partner violence, 6.22% and 18.21% for female-to-male partner violence, and 7.84% to 21.48% for any partner-to-partner violence.

CONCLUSIONS

High rates of intimate partner violence in the United States corroborate previous claims that the amount of intimate partner violence is substantial.

Alcohol availability and domestic violence

The purpose of this study was to examine the relationship among sociodemographic variables, alcohol outlet density, and rate of domestic violence in New Jersey. Data were obtained for the 223 largest municipalities in the state and were examined using factor analysis and bivariate and multivariate analyses. Three sociodemographic factors were extracted through factor analysis. These explained 58% of the variance among municipalities in rates of domestic violence. One factor--termed social disadvantage--explained the greatest amount of unique variance (42%). Alcohol outlet density added nothing to the sociodemographic model and did not interact with any of the three sociodemographic factors. The findings show that, in the state of New Jersey, higher levels of alcohol outlet density are not geographically associated with higher rates of domestic violence. These findings may be due to limitations in the data sets employed in the study, limitations of the macrolevel analysis employed, and/or the complex nature of the relationship between alcohol use and domestic violence.

Correlates of injury to women with partners enrolled in batterer treatment programs

OBJECTIVES

This study examined correlates of injury in a cohort of women who were partners of men enrolled in batterer treatment programs.

METHODS

Cross-sectional data of 670 pairs of battered women and their partners were analyzed. Prevalence rates of women's self-reports of injury due to their partners' abusive behavior were computed and compared by couples' demographic and behavioral characteristics.

RESULTS

Men's use of severe tactics of abuse was the characteristic most significantly associated with injury (odds ratio = 15.47; 95% confidence interval = 9.02, 26.55).

CONCLUSIONS

Our findings underscore the need to obtain information on the specific tactics used by couples to settle their disputes during universal screening by practitioners.

Characteristics of sexual abuse against pregnant Hispanic women by their male intimates

There have been few research reports on sexual abuse of Hispanic women by their intimate male partners. This study examined the frequency of six types of sexual abuse of 329 pregnant Hispanic women identified during routine prenatal care in public health clinics as physically abused. Threats of abuse, physical abuse, and sexual abuse were measured with the 46-item Severity of Violence Against Women Scale. Comparisons were made between women reporting sexual abuse and those who did not. Thirty-two percent (n = 105) of the women reported sexual abuse by their male partner at least once during the prior 12 months. Sexually abused women reported significantly higher levels of threats of abuse and physical abuse than women not sexually abused. Among the sexually abused women, not living with the abuser was correlated with higher threats of abuse, physical violence, and sexual abuse scores. The results of this study support previous research proposing a continuum of violence and possible escalation of violence when an abused woman leaves her abuser. Additional longitudinal research is needed on psychosocial and behavioral characteristics of sexually abused women, particularly among ethnic minority women.

Violence and HIV sexual risk behaviors among female sex partners of male drug users

OBJECTIVE

Violence and HIV are emerging as interconnected public health hazards among drug users and their families. The purposes of this study are to (1) determine the prevalence of sexual and physical abuse of non-drug-using female sex partners of male drug users, and (2) ascertain the association between such violence and HIV-related risk behaviors.

METHODS

From 11/93 to 11/95, 208 female sex partners of injection drug or crack users in Collier County, FL, Tucson, AZ, and Portland, OR, were interviewed as part of a NIDA-funded HIV risk reduction project. Their mean age was 30 years (range 18-54); 21% were White, 6% African American, 7% Native American, and 63% Hispanic.

RESULTS

Of the 208 women, 28% reported being sexually molested and 20% raped before age 13; 41% reported being raped at least once in their lifetime. Forty-two percent of the women were physically assaulted by their sex partners; 36% had been threatened with assaulted by their sex partners. Those who were raped or threatened with assault were more likely to have multiple sex partners and engage in unprotected anal sex; there was a trend for women who had been physically assaulted to be more likely to engage in unprotected anal sex.

DISCUSSION

Rape, assault and the threat of assault are commonplace in the histories of female sex partners of male drug users. Experiences of violence and threats of violence are associated with heightened risk for the sexual transmission of HIV. Providers of HIV prevention need to understand the sequelae of violence, and design interventions which empower women to protect themselves from sexual transmission of HIV.

Severity of abuse to pregnant women and associated gun access of the perpetrator

To investigate the relationship between abuse to pregnant women and gun access by the abuser, an ethnically stratified cohort of 199 pregnant abused women (70 African-Americans, 63 non-Hispanic Anglo-American, and 66 Hispanic women were interviewed using: (1) The Index of Spouse Abuse, a measure of the severity of physical and nonphysical abuse; (2) The Danger Assessment Scale, a measure of potential danger of homicide; and (3) The Severity of Violence Against Women Scale, a measure of threats of violence and actual violence. There were no significant differences by ethnicity among the 41.2% of the abused women who reported that their male partner had access to a gun. Among these same women reporting gun access, 17% reported the abuser kept the gun on his body. Women reporting gun access by the abuser reported higher level of abuse on all scaled instruments (P = < 0.01). To protect women's safety and prevent further trauma and potential homicide, routine assessment for abuse and gun access is recommended. Additionally, policy initiatives to remove firearms from abuse perpetrators may reduce the severity of violence experienced by abused women.

Sexual coercion, domestic violence, and negotiating condom use among low-income African American women

Coercion to engage in unwanted sex places women at risk for human immunodeficiency virus (HIV) infection. A survey of 125 women living in low-income housing developments in Fulton County, Georgia, showed that 53 (42%) women had engaged in unwanted sex because a male partner threatened to use force or used force to obtain sexual access. Women who had been sexually coerced were more likely to have used marijuana and crack cocaine and to have abused alcohol. Coerced women were more likely to have been physically abused by a domestic partner. These women were also more likely to perceive that requesting male partners to use condoms would create a potentially violent situation. These results suggest that women experience an interactive constellation of social problems that create risks for HIV infection and, therefore, that efforts to prevent HIV infection among women will require multifaceted intervention strategies to reach both men and women at risk.

Emergency department-based study of risk factors for acute injury from domestic violence against women

STUDY OBJECTIVES

To evaluate the associations between selected socioeconomic risk factors and acute injury from domestic violence against women.

METHODS

We conducted a preliminary matched case-control study to measure the association of selected predictor variables with acute injury from domestic, violence against women. Patients identified as cases were Hispanic or white female emergency department patients, 16 to 65 years of age, with acute injury sustained from physical assault by an intimate male partner. Cases were selected for inclusion in the study if they reported or admitted acute physical assault by their male partners. Controls were selected from non-case female ED patients so as to represent the base population of the cases and enhance comparability. Two controls were matched to each case. The socioeconomic predictor variables examined were the education level, employment status, history of alcohol abuse, and history of drug abuse of the male partner and the education level and cohabitation status of the female partner.

RESULTS

Forty-six cases were identified and included in the study. The age range was 16 to 51 years (mean, 33 years). There were 26 (57%) Hispanic and 20 (43%) white cases. The strongest predictor for acute injury from domestic violence in these patients was a history of alcohol abuse by the male partner, as reported by the female partner (odds ratio, 12.9). The remaining predictor variables were weakly associated or not associated with domestic violence. One half of the cases stated that their male partners were intoxicated with alcohol at the time of assault.

CONCLUSION

Of the socioeconomic variables examined in this preliminary study, a history of alcohol abuse by the male partner, as reported by the female partner, was the strongest predictor for acute injury from domestic violence. A large-scale, multicenter, ED-based study is needed to clarify the relation between alcohol abuse, other socioeconomic factors, and acute physical assaults against women by their intimate male partners.

Violence against ex-wives: anger and advocacy

Researchers on violence against women have failed to reveal any studies that provide definitive explanations for the violent behaviors of certain males. However, violence against women has been known to occur as a result of unusually potent situational stressors, regardless of the male's propensity toward violence. Some of these situational stressors occur during the process of marital separation and divorce, particularly in relation to disputes over child custody, support, and access. In this paper I report on a second-level analysis of a set of studies in Australia aimed at examining the experience of separating parents who did not gain custody of their children. One of the dominant themes that emerged in the initial analysis from the male cohort was the real or vicarious violence that pervaded the men's interactions with their ex-spouses. These men, from a range of socioeconomic backgrounds and age groups, freely discussed episodes in which they had either planned, executed, or fantasized about violence against their spouses in retaliation for real or perceived injustices related to child custody, support, and/or access. In many cases, these thoughts and actions were reinforced by the encouragement of other males. To a lesser extent, women also reported violent inclinations induced by the situation. The implications for those advocating for women and families are clear. There is a need to understand the experience of marital separation from the perspective of both spouses as a basis for family counseling. We must also heighten awareness of the need to educate young people away from an "ownership" model of marriage and relationships, which is counterproductive to the personal development of both partners. Equally important is the need for all health professionals to advocate for changes that would help to correct injustices in the family court system, many of which are related to gender issues.

Geographic concentration of violence between intimate partners

OBJECTIVES

To explore geographic patterns of violence between intimate partners in a metropolitan area with one of the highest injury mortality rates in the nation-Duval County, Florida, which includes the city of Jacksonville.

METHODS

Using police reports of all serious violent incidents in Duval County in 1992 excluding robberies, the authors analyzed patterns in the location of the incidents. Only cases for which the relationship between the offender and victim was recorded were used.

RESULTS

Thematic maps reveal that census tracts with rates above the 75th percentile of assaultive violence between intimates are clustered in certain parts of the city. Concentrated poverty tracts had median rates of violence between intimate nine times higher than other tracts.

CONCLUSIONS

The finding that violence between intimate partners is concentrated in central city poverty neighborhoods opens up avenues for prevention.

Violence against women. Examining ethnic differences and commonalities

Ethnic differences and commonalities rarely have been the focus of community-based research on violence against women. The few existing studies typically used survey instruments developed on and used with Anglos and simply applied them to members of other ethnic groups. The proposed conceptual framework is based on a review of the published literature and on information gleaned from focus groups conducted with women and men from four ethnic groups (Black, White, Asian, and Latino). Ethnicity and culture--along with broad social factors and institutions, gender role definitions, kin and friendship networks, and individual life-course factors--influence what behaviors are acceptable in an intimate relationship. The intersection of gender and ethnicity is hypothesized to influence the options that a woman perceives, the help she seeks, and the nature and scope of violence she experiences in an intimate relationship. Observations relevant to research, policy, and service provision are offered.