The Framing Safety Project

This article describes the Framing Safety Project that the author developed to do collaborative, community action/education research with battered women about the meaning of safety in their lives. The project is built on the use of participant-generated photographs and photo-elicitation interviews as methods for exploring with women, in support group settings, the meanings of violence in their lives and their approaches to creating safer spaces. Although visual sociologists have used variations of these methods, particularly to study the experiences of children, the author combines them in a uniquely feminist approach that leads from the women’s photography and interviews to a community education and action component. The author describes the process of developing and implementing this project with Mexican and South Asian immigrant women and discusses the ways in which its methodological approach serves to amplify the voices of silenced women, and to offer opportunities for community education and social action.

Challenging Despair

In this article, the author describes an approach to teaching about violence against women that balances discussion of violence with information about women’s individual and collective resistance. This strategy addresses two concerns about traditional approaches to this topic: that focusing only on victimization disempowers students and that it provides only a partial view of the reality of violence in women’s lives. To address these problems, the author integrates discussion of resistance into the class’s working definition of violence, assigned readings, guest speakers, and course assignments. The author concludes with a discussion of the positive effects of this approach.

How domestic abuse affects the wellbeing of older women

AIM

The aim of this study was to explore older women's experience of domestic abuse and its effect on their health and lives.

METHOD

A qualitative research design was used and data were collected using in-depth interviews with 16 participants.

FINDINGS

The consequences of domestic abuse for older women have a significant effect on their long-term health and emotional wellbeing.

CONCLUSION

There are little available data about older women and domestic abuse. This is increasingly being recognised as a significant deficit in awareness and understanding in society as a whole, and more particularly for those responsible for support and care provision.

What causes domestic abuse and how can nurses effectively support abused women?

Domestic abuse is a significant public health problem in the UK, primarily perpetrated against women. Nurses can play a vital role in identifying patients who have experienced abuse, and in offering them emotional, psychological and practical support. This article explores the causes of domestic abuse, and nurses' role in caring for those affected. It emphasises the need for enhanced nurse education and awareness to enable nurses to provide holistic care for women.

Prevalence estimate of intimate partner violence in Jordan

This study examined the prevalence of intimate partner violence in Jordan among a sample of 517 reproductive health clinic attendees. Intimate partner violence was measured using the World Health Organization's domestic violence questionnaire which was modified by the results of focus group discussions conducted in Amman. The percentages of women experiencing at least 1 form of control or violence since marriage were: control, 97.2%; psychological violence, 73.4%; physical violence, 31.2%; and sexual violence, 18.8%. Modifications of the WHO questionnaire were needed to measure control and psychological violence in Jordan. Similar modifications might be required when conducting research in the Region.

Prediction of women's utilization of resistance strategies in a sexual assault situation: a prospective study

The present study prospectively explored the predictors of resistance strategies to a sexual assault situation. Participants were assessed at the beginning of an academic quarter on a number of variables, including past history of sexual victimization, perceived risk of sexual victimization, and intentions to use specific types of resistance strategies. Only women who reported being victimized over the interim (N=68) were included in the analyses, which suggested that women's Time 1 intentions to utilize assertive resistance strategies (e.g., physically fight, run away) and offender aggression predicted women's use of assertive resistance strategies in response to the assault that occurred over the follow-up. Women's utilization of nonforceful verbal resistance (e.g., reason, plead, quarrel) was predicted by perpetrator aggression and previous sexual victimization. Women's immobility (e.g., turn cold, freeze) during the assault that took place over the interim was predicted by experiences of childhood sexual victimization and previous sexual victimization.

Care for emergency department patients who have experienced domestic violence: a review of the evidence base

AIMS

A literature review was conducted to identify and evaluate the research base underpinning care for emergency department patients who have experienced domestic violence.

BACKGROUND

The extent of domestic violence in the general population has placed it high on health and social policy agendas. The Department of Health has recognized the role of health care professionals to identify and provide interventions for patients who have experienced domestic violence.

METHOD

Systematic review.

RESULTS

At least 6% of emergency department patients have experienced domestic violence in the previous 12 months although actual prevalence rates are probably higher. Simple direct questioning in a supportive environment is effective in facilitating disclosure and hence detecting cases of abuse. Although routine screening is most effective, index of suspicion screening is the current mode of practice in the UK. Index of suspicion screening is likely to contribute to under-detection and result in inequitable health care. Patients with supportive networks have reduced adverse mental health outcomes. Women will have negative perceptions of emergency care if their abuse is minimalized or not identified. Women want their needs and the needs of their children to be explored and addressed. Access to community resources is increased if patients receive education and information.

CONCLUSION

Domestic violence is an indisputable health issue for many emergency department patients. Practitioners face challenges from ambiguity in practice guidelines and the paucity of research to support interventions. Recommendations for practice based on the current evidence base are presented.

RELEVANCE TO CLINICAL PRACTICE

The nursing care for patients in emergency and acute health care settings who have experienced domestic violence should focus on three domains of: (1) Providing physical, psychological and emotional support; (2) Enhancing safety of the patient and their family; (3) Promoting self-efficacy.

Family violence and associated help-seeking behavior among older African American women

OBJECTIVE

Little is known about how older African American women define family violence (FV) and what FV survivors might expect from their healthcare providers. The purpose of this study was to understand how these women define FV, where they seek help for FV, and what barriers they face in these efforts.

METHODS

We conducted 6 focus groups with 30 African American women over the age of 50, including some FV survivors, at a large, inner-city public hospital.

RESULTS

Participants defined FV broadly, citing examples of abuse (physical, sexual, emotional and financial) and neglect. Spiritual sources were cited over physicians as being available to help FV survivors. Barriers to receiving assistance included negative encounters with physicians, lack of trust in the system and dearth of age-appropriate resources.

CONCLUSIONS

For older African American women, FV takes many forms of which many may not be obvious during the clinical encounter. Like younger FV survivors, they expect physicians to serve as a resource for FV.

PRACTICE IMPLICATIONS

Physicians caring for older African American women need to remember to ask them about FV, and when making referrals for abuse and neglect, consider offering referrals to pastoral care if appropriate.

Abused African American women's processes of staying healthy

Fifteen African American women with a history of intimate partner violence (IPV) were interviewed to examine (a) the ways in which poor, urban African American women stay healthy, and particularly how they protected themselves from sexually transmitted diseases and HIV while in abusive relationships; and (b) the roles of intersecting contextual factors such as lifetime experiences of violence, mental health symptoms, and substance use in women's processes of maintaining their health. Data were analyzed using a qualitative descriptive approach. Women were managing numerous, complex problems as they actively worked to maintain their mental and physical health and that of their children. The turning point at which women made substantial changes came when women were "tired" and believed that a new beginning was needed. Racism, poverty, multiple experiences of violence, and health and mental health problems influenced women's health care decisions. Women's health maintenance strategies were often not visible to health care providers and included some behaviors that may place women at greater risk of violence or disease from the point of view of the health care provider.

Development of an evidence-based domestic violence guideline: supporting perinatal women-centred care in Japan

OBJECTIVE

to develop an evidenced-based, women-centred care clinical guideline designed to assist midwives and other health-care providers in Japanese hospitals, clinics and midwifery offices, in identifying and supporting potential or actual perinatal victims of domestic violence.

DESIGN

systematic review and critical appraisal of extant research; structured assessment of clinical guideline development.

METHOD

systematic and comprehensive literature search. Appraisal of Guidelines for Research and Evaluation (AGREE) was used to assess the guideline development for purposes of assuring methodological quality.

FINDINGS

electronic searches of medical and nursing databases between February and December 2003 retrieved 2392 articles. Selected as evidence were 157 articles yielding 28 recommendations aligned to clinical assessment questions.

KEY CONCLUSIONS

using expert consensus and external reviews, recommendations were generated that provided the at-risk perinatal group with the best possible practice available to prevent further harm.

IMPLICATIONS FOR PRACTICE

the evidenced-based clinical guideline fosters a supportive environment for educating health-care providers on domestic violence, and to improve clinic access for at-risk perinatal women. Information on domestic violence and a negotiated midwife-client safety plan can be initiated for potential or actual victims of domestic violence, and is achieved through understanding the risks of the woman and her fetus or baby, while respecting the woman's intention.

Loneliness and intimate partner violence:antecedents of alienation of abused women

This study explored the perceived causes of loneliness of abused women. Eighty women, victims of domestic abuse, were compared with 84 women from the general population, who have had no history of abusive relationships. A 30-item-yes/no loneliness questionnaire was utilized in order to compare the causes of loneliness in the two samples. The factors that comprise the causes of loneliness are: Personal inadequacies, Developmental deficits, Unfulfilling intimate relationships, Relocation/significant separations, and Social marginality. Results confirmed the hypothesis that abused women, indeed, perceived the causes of their loneliness significantly differently than women in the general population do. The abused women scored significantly higher on all the subscales.

Domestic violence: the Lebanese experience

OBJECTIVES

To estimate the prevalence of domestic violence among women presenting to primary health care facilities in Lebanon; to identify presenting symptoms and responses to varied forms of violence; and to examine variables associated with domestic violence.

STUDY DESIGN/METHODS

A cross-sectional survey of all women presenting to four primary health care centres in different geographic areas of Lebanon from September 2002 to October 2002. A questionnaire was administered in interview format. The following information was collected from participants: demographic characteristics, perceived health status, prior exposure and responses to domestic violence, and characteristics of the perpetrators.

RESULTS

Of the 1418 participants, 494 (35%) reported experiencing domestic violence and 307 (22%) had family members who had been exposed to domestic violence. Among the women exposed to violence, verbal abuse or insult was most common (88%) followed by physical violence (66%); 57% reported their experiences to family, friends or authorities, whereas the remainder kept silent. Women who were exposed to domestic violence had higher frequencies of reported physical symptoms than those who were not exposed. Generally, the perpetrators were spouses who had demographic backgrounds comparable to their wives. Multiple regression analyses showed that women's education levels, work status, health status, and familial violence predicted domestic violence.

CONCLUSIONS

Women readily talk about their abuse when asked. The rate of domestic violence is high among Lebanese women and is a significant health issue. Additional research is needed to better understand the extent of the problem and to develop more effective reporting methods.

Grassroots efforts of Japanese women to promote services for abused women

The purpose of this study was to identify and describe the personal experiences of six Japanese female volunteers who formed a support group to provide services for abused women. The interpretation of the women's stories also increased understanding about the process of forming and developing a grassroots organization to take needed action. The interpretive phenomenological approach guided the study. The findings illustrate that a group of community volunteers can identify and effectively address a significant social issue on their own initiative.

Understanding behavior change for women experiencing intimate partner violence: mapping the ups and downs using the stages of change

OBJECTIVE

For women who are experiencing intimate partner violence (IPV), making changes toward safety is often a gradual process. When providing counseling and support, health care providers may benefit from better understanding of where women are in their readiness to change. Our objective was to apply the transtheoretical model's stages of change to the experiences of women who experienced IPV and map their experiences of change as they moved toward increased safety.

METHODS

A multi-disciplinary team designed a qualitative interview process with 20 women who had current or past histories of IPV in order to explore their experiences.

RESULTS

The women in our study (1) moved through stages of readiness generally in a nonlinear fashion, with varying rates of progression between safe and nonsafe situations, (2) were able to identify a "turning-point" in their situations, (3) attempted multiple "action" steps and (4) were influenced by internal and external factors.

CONCLUSIONS

Our study suggests that focusing on the transtheoretical model to develop stage-based interventions for IPV may not be the most appropriate given the nonsequential movement between stages and influence of external factors.

PRACTICE IMPLICATIONS

The "change mapping" technique can be used as an educational and counseling tool with patients, as well as a training tool for health care providers.

Nurse case management for pregnant women experiencing or at risk for abuse

OBJECTIVE

To determine whether individualized nursing case management can decrease stress among pregnant women at risk for or in abusive relationships.

DESIGN

A multisite randomized controlled trial.

SETTING

Two prenatal clinics in the Pacific Northwest and rural Midwest.

PARTICIPANTS

1,000 women who spoke English and were 13 to 23 weeks pregnant at time of recruitment.

INTERVENTION

All intervention group women (N = 499) were offered an abuse video and had access to a nurse case manager 24/7. Additionally, participants at risk for or in abusive relationships received individualized nursing care management throughout the pregnancy.

RESULTS

The most frequent nursing care management activities were providing support (38%) and assessing needs (32%). The nursing care management group received an average of 22 contacts, most (80%) by telephone and had a significant reduction in stress scores as measured by the Prenatal Psychosocial Profile. Compared to the control group, the differences were in the predicted direction, but not statistically different. A major finding was the choice by abused women to focus on basic needs and their pregnancies rather than the abuse, although all received safety planning.

CONCLUSIONS

Pregnant women at risk for or in abusive relationships experience very stressful and complex lives. Nurses need to focus on the needs they identify, which may not be the abusive relationship.

Domestic violence screening: implications for surgical nurses

Domestic violence is a learned pattern of behaviors used by one person in a relationship to control the other partner through physical, sexual, or emotional abuse. Four million women are abused every year in the United States, or about one every 15 seconds (OCCCADV, 2005). Each year, more than one million women seek medical care for injuries caused by domestic violence, with an associated cost of $5 billion (CDC, 2003). One in five victims report to the emergency center, but only 10% are identified as victims of abuse (Jones, 1993). Nurses in the surgical setting are in a position to assess for abuse, to provide physical treatment if needed and also provide patients with support and resources. Careful documentation and photographs of any injuries can assist with successful prosecution of the perpetrator.

Secondary prevention of intimate partner violence: a randomized controlled trial

BACKGROUND

Despite the recognition of intimate partner violence (IPV) against women as a global health issue associated with significant morbidity and mortality, evidence-based treatment strategies for primary care settings are lacking.

OBJECTIVE

To assess the comparative safety behaviors, use of community resources, and extent of violence following two levels of intervention.

METHODS

A randomized, two-arm, clinical trial was completed in urban public primary care clinics with 360 abused women who assessed positive for physical or sexual abuse within the preceding 12 months. Two interventions were tested: a wallet-sized referral card and a 20-minute nurse case management protocol. Outcome measures were differences in the number of threats of abuse, assaults, danger risks for homicide, events of work harassment, safety behaviors adopted, and use of community resources between intervention groups over a 24-month period.

RESULTS

Two years following treatment, both treatment groups of women reported significantly (p <.001) fewer threats of abuse (M = 14.5; 95% CI 12.6, 16.4), assaults (M = 15.5, 95% CI 13.5, 17.4), danger risks for homicide (M = 2.6; 95% CI 2.1, 3.0), and events of work harassment (M = 2.7; 95% CI 2.3, 3.1), but there were no significant differences between groups. Compared to baseline, both groups of women adopted significantly (p <.001) more safety behaviors by 24 months (M = 2.0; 95% CI 1.6, 2.3); however, community resource use declined significantly (p <.001) for both groups (M = -0.2; 95% CI -0.4,-0.2). There were no significant differences between groups.

DISCUSSION

Disclosure of abuse, such as what happens with abuse assessment, was associated with the same reduction in violence and increase in safety behaviors as a nurse case management intervention. Simple assessment for abuse and offering of referrals has the potential to interrupt and prevent recurrence of IPV and associated trauma.

Spousal Abuse Against Women and Its Consequences on Reproductive Health: A Study in the Urban Slums in Bangladesh

OBJECTIVES

Spousal violence is common and results in costly problems both for society and for the reproductive health of women. Despite the recognition that violence may be associated with serious consequences for women's reproductive health, our understanding of the relationship between the two remains limited. In this study, we assessed the association between spousal violence and women's reproductive health.

METHODS

Data from an interviewer-administered questionnaire assessing socioeconomic, demographic, behavioral profiles, and spousal violence-related information was collected from 496 women. Subjects were chosen from eight randomly selected urban slums from four metropolitan cities.

RESULTS

Spousal violence was significantly higher amongst the group of less educated women who had been in several marriages; indicating that the social and behavioral traits of women act as catalysts for spousal violence. Abusive husbands also had been married several times and were more likely to be addicted to alcohol or drugs. This demonstrates that the behavioral traits of husbands were also responsible for spousal violence. Spousal violence injuries adversely affect the health and well-being of women. More than three-quarters of physically violated women suffered injuries as a result of this violence. About 50% of these injuries were minor and about 10% serious. Sexual violence adversely affected women's health; more than 80% of sexually violated women complained of pelvic pain, more than 50% reported reproductive tract infections, and more than 50% reported symptoms of irritable bowel syndrome. Abused women suffered from gynecological problems at the time of pregnancy significantly more than non-abused women (p<0.05) and abused women suffered from reproductive tract infections significantly more than non-abused women (p<0.01). Abusive husbands suffered from sexually transmitted diseases (STD) significantly more than non-abusive husbands (p<0.05). Abused women used contraception significantly less than non-abused women (p<0.01). Logistic regression analysis suggested that spousal violence was the most important contributing factor for reproductive health problems in women.

CONCLUSIONS

The findings of this study may enhance our understanding of the impact of spousal violence against women and their reproductive health and therefore highlight the importance of spousal violence prevention measures. Increasing the awareness and understanding of the relationship between violence against women and reproductive health could be achieved if lawyers, researchers, clinicians, practitioners, and government workers from multiple disciplines and agencies worked together.

Asking about intimate partner violence: advice from female survivors to health care providers

Understanding the perspectives of women who have experienced IPV will allow us to identify specific techniques of addressing IPV that increase patient comfort and willingness to disclose and/or seek help. Our study objective was to identify what advice women who had experienced IPV would give health providers regarding how to ask about and discuss the issue of IPV. The women in our study advised that providers (1) give a reason for why they are asking about IPV to reduce women's suspicions and minimize stigma, (2) create an atmosphere of safety and support, (3) provide information, support and access to resources regardless of whether the woman discloses IPV. They emphasized that a provider's asking about IPV is an opportunity to raise patient awareness of IPV, communicate compassion and provide information and not merely a screening test to diagnose a pathologic condition.

"For us it is like living in the dark": Ethiopian women's experiences with domestic violence

This article discusses the experiences of domestic violence among Ethiopian refugees and immigrants in the United States. A subset (n=18) of the larger study sample (N=254) participated in three focus groups with Amharic-speaking survivors of domestic violence who were currently in or had left abusive relationships. The research was conducted through a public health department, University, and community agency partnership. Findings show domestic violence as taking place within a context of immigration, acculturation, and rapid changes in family and social structure. Participants expressed a need for language and culture-specific domestic violence support and advocacy as well as education programs regarding U.S. laws and resources.

"Like a bird in a cage": Vietnamese women survivors talk about domestic violence

In recent years, a growing literature has emerged that explores the role of culture in domestic violence for ethnic minority populations, including immigrants and refugees. This article presents qualitative data collected from Vietnamese refugee women through a research project in partnership with the Refugee Women's Alliance in Seattle, Washington. Through the women's stories, their own self-awareness of domestic violence as Vietnamese women residing in the United States is available for reflection and review. Issues of acculturation, changing gender roles, examples of strength, and cultural persistence constitute the thematic structure within which these women articulate their needs for creating and sustaining a life free of abuse for themselves and their children.

"No way out": Russian-speaking women's experiences with domestic violence

This article explores the experience of domestic violence and utilization of domestic violence resources among immigrant women who were Russian speaking. Participants, many of whom came to the United States as so-called mail-order brides, reported diverse forms of abuse, including isolation and financial restrictions, and were reluctant to get outside help because of embarrassment about their circumstances. Survivors stressed the importance of language- and culture-appropriate outreach and services and urged that women receive information about domestic violence services and laws on immigration. Assistance with housing, child care, and job searches is integral to safe transitions out of abusive relationships.

"Women must endure according to their karma": Cambodian immigrant women talk about domestic violence

Asian populations living in the United States share similar cultural values that influence their experiences with domestic violence. However, it is critical to recognize how differential cultural beliefs in the context of immigration and adjustment to life in the United States affect attitudes, interpretations, and response to domestic violence. This article discusses findings from community-based participatory action research that explores how Cambodian immigrant women talk about domestic violence, what forms of abuse contribute to domestic violence, and what strategies they use to cope with and respond to abuse in their lives. The richness of this research lies in the stories that immigrant women tell about their struggle and their strength in addressing domestic violence.

Intimate Partner Violence in the Latino Community and Its Effect on Children

This article reports two sequential studies of intimate partner violence (IPV) in the Latino community. The first part described how data were collected from Latino men and women through focus groups to identify what their beliefs are about IPV, what triggers it, and what role the Mexican culture plays in the phenomenon. From these data, a children's book was developed to address alternative anger management strategies, the second part. Titled Hitting Is Bad, So Talk When You're Mad, the book was piloted with 33 children, asking what they did at present when they were mad, what they could do after they read the book, and the likelihood of their doing so.

Physical abuse against pregnant aborigines in Taiwan: prevalence and risk factors

The purpose of this study was to estimate the prevalence of, and to investigate the risk factors for physical abuse against pregnant aborigines in Taiwan. A cross-sectional survey was conducted. Aboriginal women who had just given birth in hospitals were recruited from January to December 2003. The women were interviewed with a structured questionnaire about the physical abuse and substance use experiences. Participants were 1143 aboriginal women who had just given birth in hospitals. About 175/1143 of the women (15.3%) had ever experienced physical abuse from a husband or intimate partner, and 79/1143 of the women (6.9%) had experienced it during their recent pregnancy. Multiple logistic regression analysis revealed that the women who were more likely to have been physically abused during their pregnancy were: had fewer years of education, husbands who were unemployed, with a patriarchal family situation and had alcohol, cigarette and non-prescription drug use. Based on these results, we suggest that health care professionals provide adequate support and health education, develop interventions, and use referrals in concert with routine prenatal care in order to reduce and prevent the physical abuse of aboriginal women in Taiwan.

Understanding abuse of women with physical disabilities: an overview of the abuse pathways model

The purpose of this article is to provide an overview of an empirically based theoretical model of abuse of women with physical disabilities. The Abuse Pathways model was developed from a critical disability life history research study conducted with 37 women who had simultaneously experienced abuse and physical disability. The model begins to address the complexity of abuse of women with physical disabilities by identifying the interactive components of the phenomenon. These components include (1) the social context of disability; (2) women's abuse trajectories; and (3) vulnerability factors for abuse. The article concludes by discussing potential applications and limitations of the model.

Helping women understand their risk in situations of intimate partner violence

Only approximately one-half of the 456 women who were killed or almost killed by a husband, boyfriend, or ex-husband or ex-boyfriend in a recent national study of homicide of women accurately perceived their risk of being killed by their abusive partner. Women are unlikely to overestimate their risk; however, many will underestimate the severity of the situation. From the same study, it was found that relatively few of the victims of actual or attempted intimate partner femicide were seen by domestic violence advocates during the year before they were killed; they were far more likely to be seen in the health care system. Implications are drawn as to innovative ways that women who are abused can be identified and with skilled assessment of the danger in their relationship helped make more informed plans for their safety.

Weapons in the lives of battered women

OBJECTIVES

We assessed weapon use in intimate partner violence and perspectives on hypothetical firearm policies.

METHODS

We conducted structured in-person interviews with 417 women in 67 battered women's shelters.

RESULTS

Words, hands/fists, and feet were the most common weapons used against and by battered women. About one third of the battered women had a firearm in the home. In two thirds of these households, the intimate partner used the gun(s) against the woman, usually threatening to shoot/kill her (71.4%) or to shoot at her (5.1%). Most battered women thought spousal notification/consultation regarding gun purchase would be useful and that a personalized firearm ("smart gun") in the home would make things worse.

CONCLUSIONS

A wide range of objects are used as weapons against intimate partners. Firearms, especially handguns, are more common in the homes of battered women than in households in the general population.

A hypothesized model of Korean women's responses to abuse

Many abused married Korean women have a strong desire to leave their abusive husbands but remain in the abusive situations because of the strong influence of their sociocultural context. The article discusses Korean women's responses to spousal abuse in the context of patriarchal, cultural, and social exchange theory. Age, education, and income as component elements share common effects on the emergent variable, sociostructural power. Gender role attitudes, traditional family ideology, individualism/collectivism, marital satisfaction, and marital conflict predict psychological-relational power as a latent variable. Sociostructural, patriarchal, cultural, and social exchange theories are reconceptualized to generate the model of Korean women's responses to abuse.

Increasing the Safety-Promoting Behaviors of Abused Women

OVERVIEW

Despite an epidemic of intimate-partner violence against women, and general agreement that women should be screened for it, few assessment and intervention protocols have been evaluated in controlled studies. To test a telephone intervention intended to increase the "safety-promoting behavior" of abused women, 75 women received six telephone calls over a period of eight weeks in which safety-promoting behaviors were discussed. A control group of 75 women received usual care. Women in both groups received follow-up calls to assess safety-promoting behaviors at three, six, 12, and 18 months after intake. Analysis showed that the women in the intervention group practiced significantly (P < 0.01) more safety-promoting behaviors than women in the control group at each assessment. On average, women in the intervention group practiced almost two more safety-promoting behaviors than they had at time of intake and nearly two more than women in the control group; the additional behaviors were practiced for 18 months. This nursing intervention requires only 54 minutes to complete (six nine-minute telephone calls) and can be integrated into any health care setting. Because less than one hour of professional nursing time is involved, the cost of the intervention is minimal. Future research should determine whether the adoption of safety-promoting behaviors by abused women averts trauma and its subsequent health care costs.

Synergy in practice: caring for victims of intimate partner violence

Intimate partner violence (IPV) is a significantly prevalent health issue that creates devastating effects for victims, their families, and the community IPV extends across social, religious, economical, geographical, and cultural groups. IPV has public health implications that affect current victims and may impact future generations. While all people are at risk for IPV, women are 5 times more likely to be victimized. Despite all of the literature regarding IPV, there is still a compliance issue regarding screening for IPV in health care settings. Utilizing the Synergy Model of Nursing Practice, this article demonstrates the care of victims of IPV by the clinical nurse specialist. The Synergy Model framework is described, and correlated with IPV The clinical nurse specialist plays a unique role that can improve patient outcomes through many domains including expert clinical practice, role modeling, education, global systems thinking, research, consultation, and holistic approaches to care. Current state of the science practice techniques and barriers to screening are discussed. The summary highlights suggestions for future research.

Contextualizing depression and physical functioning in battered women: adding vulnerability and resources to the analysis

This investigation examined the relationships between physical, psychological, and sexual abuse along with vulnerability appraisals, positive and negative social relations, and socioeconomic resources on battered women's depression symptomatology and physical functioning. Women were recruited following an incident of partner violence that resulted in a police-report or the filing of a protection order. Participants were surveyed using a standardized questionnaire. Bivariate correlations and multiple regressions were used to examine the relationships between predictors as well as the cumulative and unique contributions of each variable set in explaining depression and physical functioning. Findings indicate that vulnerability appraisals, social relations, and socioeconomic resources significantly explain women's depression and physical functioning over and above the unique effect of specific types of partner violence. Given that women's physical and mental health are important aspects of assisting women with safety planning and violence cessation strategies, implications for assessment and interventions for battered women are discussed.

Women's perceptions of their male batterers' characteristics and level of violence

This article describes the characteristics of male perpetrators of domestic violence and their relationship to the level of violence. The data about the male partners obtained from 151 battered women were used for this analysis. Using multiple regression, demographic variables and three behavioral indicators, including use of alcohol before a violent episode, history of arrests, and the generality of violence, were examined together for their relationship with the violence scores. With the level of violence as measured by the Conflict Tactics Scale (CTS) as the dependent variable, demographic variables explained 19.1% of the variability, with the behavioral indicators accounting for an additional 4.6% of the variability. Several research and clinical implications are addressed.

Evaluating intimate partner violence

PURPOSE

To describe the incidence, assessment, and management of intimate partner violence (IPV) from a cultural perspective emphasizing the values, strengths, and health care needs of African-American women.

DATA SOURCES

Review of the published scientific literature, U.S. Bureau of Justice Statistics and the National Crime Victimization Survey (NCVS) supplemented with hypothetical cases.

CONCLUSIONS

Violence is a social and public health emergency affecting over 10% of the population during their lives and 22% of women who are physically assaulted by an intimate. Roughly 3 million to 4.4 million women report being battered annually, although this is a low estimate. Neither gender nor age nor sexual orientation protects one from IPV. Violent crime causes 2.2 million known injuries with a huge cost in hospital days and other expenses.

IMPLICATIONS FOR PRACTICE

Women often hesitate to report violence; health care professionals detect as few as 5% of battered women. Women suffer for months and years before accurate diagnosis. Clinicians need to be vigilant in case finding, education, prevention, and treatment. Cultural differences in values and beliefs, and behavioral norms influence evaluation, treatment, and referral.

An intervention to increase safety behaviors of abused women: results of a randomized clinical trial

BACKGROUND

Although intimate partner violence is recognized as a major threat to women's health, few interventions have been developed or tested.

OBJECTIVE

To test an intervention administered to abused women in order to increase safety-seeking behaviors.

METHOD

A two-group clinical trial randomized 75 abused women to receive six telephone intervention sessions on safety behaviors. A control group of 75 women received standard care. Women in both groups were re-interviewed at 3 months and 6 months post-initial measurement.

RESULTS

Using repeated measures analysis of variance (ANOVA), we found significantly [F (2,146) 5.11, =.007] more adopted safety behaviors reported by women in the intervention group than by women in the control group at both the 3-month [F (91,74) = 19.70, <.001] and 6-month [F (1,74) = 15.90, <.001] interviews. The effect size (ES) of the intervention was large at 3 months (ES = 1.5) and remained substantial at 6 months (ES = 0.56).

DISCUSSION

These findings demonstrate that an intervention to increase safety behaviors of abused women is highly effective when offered following an abusive incident and remains effective for 6 months.

The relationship among demographics, reproductive characteristics, and intimate partner violence

OBJECTIVE

Our purpose was to examine the associations between demographics and reproductive characteristics on the occurrence of intimate partner violence (IPV) in young women.

STUDY DESIGN

An anonymous questionnaire was completed by 727 women between 14 and 26 years old who were seen in the family planning clinics in southeast Texas between March 1997 and February 1998 and who reported a current spouse or partner. Subjects completed a standardized measure of violence perpetrated by a partner and provided information on demographics and reproductive characteristics. Separate logistic regression analyses were used to analyze factors associated with physical and verbal violence.

RESULTS

Significant and positive associations with physical violence were found for race, employment, and parity (> or =1); risk of verbal abuse included employment, history of sexual abuse, and inconsistent condom and prescription contraceptive use. Protective factors for physical violence included education level, use of hormonal methods of contraception or condoms at last intercourse, and older age at first intercourse and at first childbirth; protection from verbal assault included dual contraceptive use, as well as barrier and hormonal contraception at last intercourse.

CONCLUSION

Different patterns of risk emerge between physical and verbal assault among young women seen in a publicly funded family planning clinic. Minority parous women with limited education, early onset of sexual activity, and who report no contraception use at last intercourse appear to be at highest risk for reporting physical violence, whereas history of sexual victimization, early sexual activity, and younger age at first child birth elevates risk for verbal abuse.

Multistate analysis of factors associated with intimate partner violence

BACKGROUND

Reports on prevalence estimates and risk factors of intimate partner violence (IPV) are limited in that they (1) focus on specific subgroup populations that are not representative of all women or (2) involve long questionnaires that are not useful as surveillance tools.

OBJECTIVES

To report prevalence estimates and identify demographic and lifestyle factors associated with IPV in a large population-based sample of U.S. women using surveillance data.

METHODS

Behavioral Risk Factor Surveillance System (BRFSS) data from eight U.S. states were analyzed individually and as a pooled sample (N=18,415). Multivariate logistic regression models were used to examine associations between IPV and the factors of interest.

RESULTS

Factors consistently associated with IPV across the majority of states and in the pooled analysis included young age (pooled adjusted odds ratio [aOR], 3.07), single marital status (pooled aOR, 2.89), divorced/separated marital status (pooled aOR, 4.67), and annual household income <$25,000 (pooled aOR, 1.89). In addition, lack of health insurance, receipt of Medicaid, cigarette smoking, presence of children in the home, self-reported fair/poor health, and frequent mental distress were associated with IPV after adjustment for covariates.

CONCLUSIONS

This study provides population-based estimates of IPV prevalence and factors associated with IPV using surveillance data. By pooling BRFSS data from individual states, the resulting large sample has adequate power to detect significant associations and has increased precision in the estimates of IPV risk. In addition, this study identifies high-risk populations to target for education and intervention programs and demonstrates the need for improved IPV surveillance.

Battering and breastfeeding in a WIC population

The study reported in this paper was based on the hypothesis that women who are victims of domestic violence may be less likely to select breastfeeding than women who are not abused. Informed consent was obtained from 212 women at 2 Women, Infants and Children (WIC) Nutritional Supplemental Program clinics in the Midwestern United States. The Abuse Assessment Screen was administered by interview and women were also questioned about intended feeding choice and whether they had breastfed any previous children. No association was found between present or previous abuse and infant-feeding choice. Nevertheless, the findings of this study can be considered important, for two reasons: (1) this was an initial inquiry examining the relationship between having been abused and ability to choose the feeding method of a newborn; and (2) women in the sample who reported present or current abuse were able to breastfeed their infants in the same proportion as those who did not report abuse, which suggests that a woman's concern for her child overcomes her possible fears of control by the batterer.

The effects of children's presence on woman abuse

The association between the presence of children and woman abuse was investigated. Data were collected from 419 women who had called the police because of an abusive incident involving their male partner. Minor children were present in the home in 3/4 of the cases and were frequent witnesses to the abusive incident. In more than 1/2 of the cases, children had witnessed the assault according to the victims; 2/3 of the victims reported that children had seen the police when they arrived. There was almost no association between the presence of children in the home and assault on women: the presence of children was not associated with cumulative incidence of abuse, severity of abuse, degree of injury, or the victim's decision-making process in calling the police. However, police were more likely to provide information and referrals to shelters when children were present.

Reducing violence using community-based advocacy for women with abusive partners

An intensive community-based advocacy intervention was designed and evaluated by randomly assigning 278 battered women to an experimental or control condition. Participants were interviewed 6 times over a period of 2 years. Retention rate averaged 95% over the 2 years. The 10-week postshelter intervention involved providing trained advocates to work 1-on-1 with women, helping generate and access the community resources they needed to reduce their risk of future violence from their abusive partners. Women who worked with advocates experienced less violence over time, reported higher quality of life and social support, and had less difficulty obtaining community resources. More than twice as many women receiving advocacy services experienced no violence across the 2 years postintervention compared with women who did not receive such services.

Partner violence and sexual HIV-risk behaviors among women in an inner-city emergency department

This study examines the relationship between partner violence and sexual risk behaviors in a sample of predominantly Latina and African American women who sought medical care from a New York City hospital emergency department. Eligibility criteria selected women between the ages of 18 and 55, who were sexually active in the past 90 days, and were triaged to nonemergency care. The interview addressed demographics, partner violence, childhood abuse, sexual behavior, and drug and alcohol use. Multiple logistic regression analysis was used to assess the association between partner violence and history of having a sexually transmitted disease (STD) and of having sex with a risky partner. Nearly one half of the 143 respondents (46.1%, n = 66) reported that they had experienced physical, sexual, or life-threatening abuse by a boyfriend or spouse in the past and 17.5% reported that abuse had occurred within the past year. In the univariate analyses, abused women were more likely than nonabused women to report having had an STD; engaging in sex with a risky partner; having more than one sexual partner; and being tested for HIV. After controlling for confounding variables, abused women were almost five times more likely than their counterparts to have reported an STD and four times more likely to engage in sex with a risky sexual partner. The relationship between partner violence and sexual risk behaviors among women seeking treatment in an emergency department suggests the need for the development of HIV-risk reduction strategies that address the needs of women in abusive relationships.