First Report of Gender Based Violence as a Deterrent to Methadone Access Among Females Who Use Heroin in Dar es Salaam, Tanzania

High prevalence of human immunodeficiency virus (HIV) among females who use drugs in Dar es Salaam, Tanzania, contrasts strikingly with their low enrollment in HIV risk reduction services such as methadone assisted therapy (MAT). We conducted a case-control study to examine factors associated with non-enrollment in MAT, with a focus on gender-based violence. We interviewed 202 female heroin users not enrolled in MAT as cases and 93 females enrolled in MAT. We fitted logistic regression models with MAT enrollment as the outcome of interest. The likelihood of MAT enrollment decreased upon being in a violent relationship [odds ratio (OR) 0.23; 95 % CI 0.11-0.40], with experience of discrimination by a healthcare provider (OR 0.11; 95 % CI 0.04-0.35), and having a partner who also uses drugs (OR 0.05; 95 % CI 0.01-0.26). The results indicate that violence and discrimination are major impediments to MAT enrollment, necessitating implementation of interventions to address them.

From Systematic Review to Call for Action

INTRODUCTION

Intimate partner violence (IPV) is a global public health and criminal justice concern with significant impacts; especially high rates are seen among rural Hispanic American (HA) communities, the fastest growing population in the United States. They experience additional barriers to care including extreme poverty, lesser education, gender norms, and language and immigration issues.

METHOD

A systematic literature review was conducted using Cooper's framework to identify evidence supporting associations between interventions and prevention, reduction, and elimination of IPV among rural HA women. Searches conducted on databases including CINAHL, PubMed, Medline, Women's Studies International, MedicLatina, and JSTOR used the MeSH terms Hispanic Americans (Latino/a and Hispanic), domestic violence, and intimate partner violence. Selected studies were published between January 1, 2000, and January 1, 2014.

RESULTS

Of the 617 yielded articles, only 6 met the inclusion criteria. Of these, none closely examined rurality or provided valid and reliable measures of outcomes, instead reporting program descriptions and suggested interventions. We identify key findings to guide program, screening, and tool development.

CONCLUSION

Our study identifies a gap in knowledge, research, and effective practices and issues a call for action to create evidence-based tools to prevent, reduce, and eliminate IPV in these underserved populations.

The unique associations of sexual assault and intimate partner violence with PTSD symptom clusters in a traumatized substance-abusing sample

OBJECTIVE

There is a high occurrence of sexual assault (SA) and intimate partner violence (IPV) among people with substance use disorders and an established association between substance use and posttraumatic stress disorder (PTSD), but no research has examined associations between combinations of these traumas and PTSD symptom profiles among people who abuse substances. Thus, this study aimed to examine how combinations of SA and IPV histories contribute to the severity of symptoms within PTSD symptom clusters above and beyond the impact of exposure to other traumas in a substance abusing population.

METHOD

Participants were men and women (N = 219) with trauma histories seeking treatment in a substance abuse facility. Multivariate analyses of covariance examined differences on Clinician Administrated PTSD Scale cluster scores in people with experiences of SA and/or IPV in comparison to people with other types of trauma, controlling for number of PTSD criterion A events.

RESULTS

SA was associated with increased symptom severity across all 3 PTSD symptom clusters, whereas IPV was not associated with differences in cluster scores. In addition, survivors of IPV had consistent levels of avoidance symptoms regardless of whether they had also experienced SA, but people who had not experienced IPV only evidenced increased avoidance symptoms when they had experienced SA. Follow-up analyses testing gender differences indicated that these findings were largely similar for men and women.

CONCLUSIONS

SA should be assessed in people in substance use treatment settings to conceptualize their unique presentations of PTSD symptoms and inform treatment planning. (PsycINFO Database Record

College Students' Definitions of Intimate Partner Violence: A Comparative Study of Three Chinese Societies

Although a large number of studies have been conducted worldwide to examine various aspects of intimate partner violence (IPV), comparative study of people's views on such violence in Chinese societies has been scarce. Using survey data collected from more than 850 college students in China, Hong Kong, and Taiwan, this study specifically assessed the impact of attitudes toward gender role and violence, personal and vicarious experience, demographic characteristics, and locality on students' definitions of IPV. The Taiwanese students were most likely to define a broader range of abusive behavior as IPV, followed by Hong Kong and Beijing students. Gender role and violence attitudes appeared to be most important predictors of IPV definitions. College students who supported the notion of male dominance were more likely to have a narrower definition of IPV, whereas those who viewed domestic violence as crime were more inclined to have a broader definition of IPV. Implications for future research and policy were discussed.

Intimate Partner Violence and the Rural-Urban-Suburban Divide: Myth or Reality? A Critical Review of the Literature

The author of this article presents a review of the published empirical and theoretical literature to date on similarities and differences in intimate partner violence (IPV) in rural locales compared to urban and suburban locales. A review of 63 studies indicates that (1) the rates of IPV are generally similar across rural, urban, and suburban locales, although some groups of rural women (e.g., multiracial and separated/divorced) may be at increased risk for IPV compared to similar groups of urban women, and rates of intimate partner homicide may be higher in rural locales than urban and suburban locales; (2) IPV perpetrator and victim characteristics in rural locales are generally similar to IPV perpetrator and victim characteristics in other locales with the exception of some demographic characteristics that can generally be accounted for by broader rural-urban-suburban demographic differences; (3) IPV perpetrators in rural locales, compared with perpetrators in urban locales, may perpetrate more chronic and severe IPV, which could be due to the higher rates of substance abuse and unemployment documented among rural perpetrators; (4) IPV victims in rural locales may have worse psychosocial and physical health outcomes due to the lack of availability, accessibility, and quality of IPV services; and (5) attitudes about IPV vary to some extent across locales, with individuals in rural locales generally supporting less governmental involvement in IPV issues than in urban locales. Limitations of the literature are reviewed and suggestions for research are provided as well as implications for practice and policy efforts, which primarily center on improving availability, accessibility, and quality of IPV services in rural locales.

Types and Number of Traumas Associated With Suicidal Ideation and Suicide Attempts in PTSD: Findings From a U.S. Nationally Representative Sample

Posttraumatic stress disorder (PTSD) is associated with suicidal ideation and suicide attempt; however, research has largely focused on specific samples and a limited range of traumas. We examined suicidal ideation and suicide attempt relating to 27 traumas within a nationally representative U.S. sample of individuals with PTSD. Data were from the National Epidemiologic Survey of Alcohol and Related Conditions (N = 34,653). Participants were assessed for lifetime PTSD and trauma history, suicidal ideation, and suicide attempt. We calculated the proportion of individuals reporting suicidal ideation or suicide attempt for each trauma and for the number of unique traumas experienced. Most traumas were associated with greater suicidal ideation and suicide attempt in individuals with PTSD compared to individuals with no lifetime trauma or with lifetime trauma but no PTSD. Childhood maltreatment, assaultive violence, and peacekeeping traumas had the highest rates of suicidal ideation (49.1% to 51.9%) and suicide attempt (22.8% to 36.9%). There was substantial variation in rates of suicidal ideation and suicide attempt for war and terrorism-related traumas. Multiple traumas increased suicidality, such that each additional trauma was associated with an increase of 20.1% in rate of suicidal ideation and 38.9% in rate of suicide attempts. Rates of suicidal ideation and suicide attempts varied markedly by trauma type and number of traumas, and these factors may be important in assessing and managing suicidality in individuals with PTSD.

The effects of social capital and neighborhood characteristics on intimate partner violence: a consideration of social resources and risks

Intimate partner violence (IPV) is a growing public health problem, and gaps exist in knowledge with respect to appropriate prevention and treatment strategies. A growing body of research evidence suggests that beyond individual factors (e.g., socio-economic status, psychological processes, substance abuse problems), neighborhood characteristics, such as neighborhood economic disadvantage, high crime rates, high unemployment and social disorder, are associated with increased risk for IPV. However, existing research in this area has focused primarily on risk factors inherent in neighborhoods, and has failed to adequately examine resources within social networks and neighborhoods that may buffer or prevent the occurrence of IPV. This study examines the effects of neighborhood characteristics, such as economic disadvantage and disorder, and individual and neighborhood resources, such as social capital, on IPV among a representative sample of 2412 residents of Toronto, Ontario, Canada. Using a population based sample of 2412 randomly selected Toronto adults with comprehensive neighborhood level data on a broad set of characteristics, we conducted multi-level modeling to examine the effects of individual- and neighborhood-level effects on IPV outcomes. We also examined protective factors through a comprehensive operationalization of the concept of social capital, involving neighborhood collective efficacy, community group participation, social network structure and social support. Findings show that residents who were involved in one or more community groups in the last 12 months and had high perceived neighborhood problems were more likely to have experienced physical IPV. Residents who had high perceived social support and low perceived neighborhood problems were less likely to experience non-physical IPV. These relationships did not differ by neighborhood income or gender. Findings suggest interesting contextual effects of social capital on IPV. Consistent with previous research, higher levels of perceived neighborhood problems can reflect disadvantaged environments that are more challenged in promoting health and regulating disorder, and can create stressors in which IPV is more likely to occur. Such analyses will be helpful to further understanding of the complex, multi-level pathways related to IPV and to inform the development of effective programs and policies with which to address and prevent this serious public health issue.

Perpetration and Victimization of Intimate Partner Aggression Among Rural Mothers

Intimate partner aggression is a leading cause of injury among women of child-bearing age. Research suggests that pregnancy and the postpartum period are times of increased vulnerability to aggression. Since rural women are at an increased risk of intimate partner aggression, research is needed to examine the role of pregnancy and the presence of children on intimate partner aggression among this vulnerable population. The purpose of this study is to examine the association between young children and intimate partner aggression victimization and perpetration among a rural sample. This analysis utilized data from biologic females of child-bearing age from the Keokuk County Rural Health Study, a cohort study of over 1,000 rural families conducted from 1994 to 2011. Crude and adjusted logistic regression was used to determine the relationship between having a young child and experiencing four forms of intimate partner aggression: verbal aggression perpetration, verbal aggression victimization, physical aggression perpetration, and physical aggression victimization. Having young children was significantly associated with increased odds of perpetrating verbal aggression but not victimization of verbal aggression or perpetration and victimization of physical aggression. This significant relationship persisted after adjustment for education, employment, or location of residence but not age or marital status. The increased odds of perpetrating verbal aggression among mothers in a rural area highlight the need for interventions designed for rural parents. One method of reducing intimate partner aggression may be to incorporate intimate partner aggression prevention activities into existing child abuse intervention activities.

Does neighborhood environment differentiate intimate partner femicides from other femicides?

We examined the association between neighborhood-level factors and intimate partner femicide (IPF) using Wisconsin Violent Death Reporting System (WVDRS) data and Wisconsin Coalition Against Domestic Violence (WCADV) reports, in concert with neighborhood-level information. After controlling for individual characteristics, neighborhood-level disadvantage was associated with a decreased likelihood of IPF status, as compared with other femicides, whereas neighborhood-level residential instability was associated with an increased likelihood of IPF status. Neighborhood plays a role in differentiating IPFs from other femicides in our study area. Our findings demonstrate the importance of multilevel strategies for understanding and reducing the burden of intimate partner violence.

Neighborhood environment and intimate partner violence: a systematic review

Intimate partner violence (IPV) is an important global public health problem, affecting women across the life span and increasing risk for a number of unfavorable health outcomes. Typically conceptualized as a private form of violence, most research has focused on individual-level risk markers. Recently, more scholarly attention has been paid to the role that the residential neighborhood environment may play in influencing the occurrence of IPV. With research accumulating since the 1990s, increasing prominence of the topic, and no comprehensive literature reviews yet undertaken, it is time to take stock of what is known, what remains unknown, and the methods and concepts investigators have considered. In this article, we undertake a comprehensive, systematic review of the literature to date on the relationship between neighborhood environment and IPV, asking, "what is the status of scholarship related to the association between neighborhood environment and IPV occurrence?" Although the literature is young, it is receiving increasing attention from researchers in sociology, public health, criminology, and other fields. Obvious gaps in the literature include limited consideration of nonurban areas, limited theoretical motivation, and limited consideration of the range of potential contributors to environmental effects on IPV--such as built environmental factors or access to services. In addition, explanations of the pathways by which place influences the occurrence of IPV draw mainly from social disorganization theory that was developed in urban settings in the United States and may need to be adapted, especially to be useful in explaining residential environmental correlates of IPV in rural or non-U.S. settings. A more complete theoretical understanding of the relationship between neighborhood environment and IPV, especially considering differences among urban, semiurban, and rural settings and developed and developing country settings, will be necessary to advance research questions and improve policy and intervention responses to reduce the burden of IPV.

"I Just Keep My Antennae Out": How Rural Primary Care Physicians Respond to Intimate Partner Violence

Women in rural communities who are exposed to intimate partner violence (IPV) have fewer resources when seeking help due to limited health services, poverty, and social isolation. Rural primary care physicians may be key sources of care for IPV victims. The objective of this study was to assess the opinions and practices of primary care physicians caring for rural women with regard to IPV identification, the scope and severity of IPV as a health problem, how primary care providers respond to IPV in their practices, and barriers to optimized IPV care in their communities. Semistructured interviews were conducted with 19 internists, family practitioners, and obstetrician-gynecologists in rural central Pennsylvania. Interview transcripts were analyzed for major themes. Most physicians did not practice routine screening for IPV due to competing time demands, lack of training, limited access to referral services as well as low confidence in their effectiveness, and concern that inquiry would harm the patient-doctor relationship. IPV was considered when patients presented with symptoms of mood, anxiety, or somatic disorders. Responses to IPV included validation, danger assessment, safety planning, referral, and follow-up planning. Perceived barriers to rural women seeking help for IPV included traditional gender roles, lower education, economic dependence on the partner, low self-esteem, and patient reluctance to discuss IPV. To overcome barriers, physicians created a "safe sanctuary" to discuss IPV and suggested improved public health education and referral services. Interventions to improve IPV-related care in rural communities should address barriers at multiple levels, including both physicians' and patients' comfort with discussing IPV. Provider training, community education, and improved access to referral services are key areas in which IPV-related care should be improved in rural communities. Our data support routine screening to better identify IPV and a more pro-active stance toward screening and counseling.

Community matters: intimate partner violence among rural young adults

Drawing on social disorganization theory, the current study examined the extent to which community-level poverty rates and collective efficacy influenced individual reports of intimate partner violence (IPV) perpetration, victimization, and bystander intervention among a sample of 178 young adults (18-24; 67.4% women) from 16 rural counties across the eastern US who completed an online survey that assessed demographic information, IPV perpetration, victimization, bystander intervention, and collective efficacy. We computed each county's poverty rate from the 2007-2011 American Community Survey. Generalized estimating equations demonstrated that after controlling for individual-level income status, community-level poverty positively predicted IPV victimization and perpetration for both men and women. Collective efficacy was inversely related to IPV victimization and perpetration for men; however, collective efficacy was unrelated to IPV victimization and perpetration for women. Whereas IPV bystander intervention was positively related to collective efficacy and inversely related to individual-level income status for both men and women, community-level poverty was unrelated to IPV bystander intervention for both men and women. Overall, these findings provide some support for social disorganization theory in explaining IPV among rural young adults, and underscore the importance of multi-level IPV prevention and intervention efforts focused around community-capacity building and enhancement of collective efficacy.

Prevalence of Intimate Partner Violence Across Medical and Surgical Health Care Settings

Intimate partner violence (IPV) is a serious health problem and a leading cause of nonfatal injury in North American females. Prevalence of IPV has ranged from less than 20% to more than 50% across primary care, emergency medicine, and family medicine. We conducted a systematic review and meta-analysis of the literature to examine best estimates of IPV prevalence as opportunities for targeted interventions in health care specialties. We included 37 articles in this study. Based on our pooled data, best estimates of the lifetime prevalence of any type of IPV were 38% in family medicine and 40% in emergency medicine.

Gender-based violence in Egypt: analyzing impacts of political reforms, social, and demographic change

Over recent decades, Egypt has witnessed developments in gender equality. This article discusses recent changes relating to violence against women within this context. Statistical data from the Egyptian DHS surveys is used to describe trends in reported violence and in attitudes toward marital abuse, as well as to examine the survey tools used to measure violence. While findings reflect a growing awareness regarding the issue, the number of women reporting spousal violence remained stable during the study period. The results are contextualized within the political and social debate in which NGO's and women's rights activists play a central role.

Predictors of intimate partner violence in a sample of multiethnic urban young adults

The purpose of the present study was to investigate risk and protective factors for intimate partner violence (IPV) victimization in a high-risk sample of predominantly minority young adults from low-income urban communities. Participants were 1,130 individuals (57.9% women) ages 21 to 26 who participated in a telephone interview assessing IPV victimization, violence-related behaviors, and sexual behaviors. Results indicated that about 20.9% of participants reported experiencing one or more IPV incidents in their lifetime. Based on previous research, we examined lifetime violence, lifetime number of sexual partners, number of children, education, and religious service attendance as predictors of IPV. Results from a multivariate logistic regression showed that lifetime violence-related behaviors, number of lifetime sexual partners, and number of children were significant risk factors for IPV. The link between children and IPV risk: (a) was moderated by education for women and men and (b) was stronger for women (vs. men). These findings suggest that training for coping with stress and anger, endorsement of safe sex practices, and greater support for education may be effective strategies for preventing and reducing IPV among high-risk populations.

Intimate partner violence victimization and cigarette smoking: a meta-analytic review

The current meta-analytic review represents the first comprehensive empirical evaluation of the strength of the relationship between intimate partner violence (IPV) victimization and cigarette smoking. Thirty-nine effect sizes, drawn from 31 peer-reviewed publications, determined the existence of a small to medium composite effect size for the victimization-smoking relationship (d = .41, 95% confidence interval = [.35, .47]). Results indicate that victims of IPV are at greater smoking risk than nonvictims. Subsequent moderator analyses indicated that the association between victimization and smoking is moderately stronger among pregnant compared to nonpregnant victims. The strength of the victimization-smoking relationship did not differ by relationship type or ethnicity. More research is needed on the smoking behavior of male victims, victims of psychological violence, and victims who identify as Latino/Latina. It would be useful for professionals working with IPV victims to assess for smoking and incorporate smoking prevention and cessation skills in intervention settings.

Dyadic, Partner, and Social Network Influences on Intimate Partner Violence among Male-Male Couples

Introduction: Despite a recent focus on intimate partner violence (IPV) among men who have sex with men (MSM), the male-male couple is largely absent from the IPV literature. Specifically, research on dyadic factors shaping IPV in male-male couples is lacking.

Methods: We took a subsample of 403 gay/bisexual men with main partners from a 2011 survey of approximately 1,000 gay and bisexual men from Atlanta. Logistic regression models of recent (<12 month) experience and perpetration of physical and sexual IPV examined dyadic factors, including racial differences, age differences, and social network characteristics of couples as key covariates shaping the reporting of IPV.

Results: Findings indicate that men were more likely to report perpetration of physical violence if they were a different race to their main partner, whereas main partner age was associated with decreased reporting of physical violence. Having social networks that contained more gay friends was associated with significant reductions in the reporting of IPV, whereas having social networks comprised of sex partners or closeted gay friends was associated with increased reporting of IPV victimization and perpetration.

Conclusion: The results point to several unique factors shaping the reporting of IPV within male-male couples and highlight the need for intervention efforts and prevention programs that focus on male couples, a group largely absent from both research and prevention efforts.

Characteristics of the residential neighborhood environment differentiate intimate partner femicide in urban versus rural settings

PURPOSE

A growing body of work examines the association between neighborhood environment and intimate partner violence (IPV). As in the larger literature examining the influence of place context on health, rural settings are understudied and urban and rural residential environments are rarely compared. In addition, despite increased attention to the linkages between neighborhood environment and IPV, few studies have examined the influence of neighborhood context on intimate partner femicide (IPF). In this paper, we examine the role for neighborhood-level factors in differentiating urban and rural IPFs in Wisconsin, USA.

METHODS

We use a combination of Wisconsin Violent Death Reporting System (WVDRS) data and Wisconsin Coalition Against Domestic Violence (WCADV) reports from 2004 to 2008, in concert with neighborhood-level information from the US Census Bureau and US Department of Agriculture, to compare urban and rural IPFs.

FINDINGS

Rates of IPF vary based on degree of rurality, and bivariate analyses show differences between urban and rural victims in race/ethnicity, marital status, country of birth, and neighborhood characteristics. After controlling for individual characteristics, the nature of the residential neighborhood environment significantly differentiates urban and rural IPFs.

CONCLUSIONS

Our findings suggest a different role for neighborhood context in affecting intimate violence risk in rural settings, and that different measures may be needed to capture the qualities of rural environments that affect intimate violence risk. Our findings reinforce the argument that multilevel strategies are required to understand and reduce the burden of intimate violence, and that interventions may need to be crafted for specific geographical contexts.

The impact of neighborhoods on intimate partner violence and victimization

Research on intimate partner violence (IPV) and victimization is widespread across disciplines. To date, the majority of research underscores the importance of individual-level factors to explain IPV, thereby neglecting the significance of macro-level elements. Nevertheless, research suggests that the characteristics of the neighborhood where an individual lives are important for fully understanding IPV. This review focuses on the effects of neighborhoods and macro-level context on violence between intimate partners, specifically identifying empirical studies that have examined contextual predictors of IPV utilizing the major tenets of social disorganization theory. The authors note consistencies and differences across research results and describe study features that may influence the patterns of these findings. Finally, the authors provide both theoretical and methodological recommendations for future research.

A Systematic Review of Risk Factors for Intimate Partner Violence

A systematic review of risk factors for intimate partner violence was conducted. Inclusion criteria included publication in a peer-reviewed journal, a representative community sample or a clinical sample with a control-group comparison, a response rate of at least 50%, use of a physical or sexual violence outcome measure, and control of confounding factors in the analyses. A total of 228 articles were included (170 articles with adult and 58 with adolescent samples). Organized by levels of a dynamic developmental systems perspective, risk factors included: (a) contextual characteristics of partners (demographic, neighborhood, community and school factors), (b) developmental characteristics and behaviors of the partners (e.g., family, peer, psychological/behavioral, and cognitive factors), and (c) relationship influences and interactional patterns. Comparisons to a prior review highlight developments in the field in the past 10 years. Recommendations for intervention and policy along with future directions for intimate partner violence (IPV) risk factor research are presented.

Patterns of intimate partner violence: a study of female victims in Malawi

Background:

The term “intimate partner violence” (IPV) encompasses physical, sexual and psychological violence, or any combination of these acts, and globally is the most common type of violence against women. This study aims to examine the lifetime prevalence of different types of intimate partner violence (IPV) among Malawi women ages 15 to 49, and its association with age, education, and living in rural versus urban areas.

Methods:

Data was obtained from a cross-sectional study of data as part of the 2004 Malawi Demographic and Health Survey. Women were eligible for the study if they met the following criteria: 1) lived in one of the 15,041 households randomly selected from 522 rural and urban clusters located in 10 large districts of Malawi; 2) were married or cohabitating; and 3) were between the ages of 15 and 49 years. Consenting, eligible women responded to a comprehensive questionnaire covering demographic factors, health issues, as well as items related to physical, emotional and sexual IPV. To assess bivariate associations, chi-squared tests and multivariate logistic regressions were conducted.

Results:

Among the 8291 respondents, 13% reported emotional violence; 20% reported being pushed, shaken, slapped or punched; 3% reported experiencing severe violence, such as being strangled or burned, threatened with a knife, gun or with another weapon; and 13% reported sexual violence. Data showed women ages 15 to 19 were significantly less likely to report emotional IPV, women ages 25 to 29 were significantly more likely to report being pushed or shaken, slapped or punched (OR 1.35; CI: 1.05-1.73), and women ages 30 to 34 were significantly more likely to report sexual IPV, compared to women ages 45 to 49 (OR 1.40; CI: 1.03-1.90). Finally, women who had no ability to read were less likely to report sexual IPV than their counterparts who could read a full sentence (OR 0.76; CI: 0.66-0.87).

Conclusions:

The prevalence of different types of IPV in Malawi appears slightly lower than that reported for other countries in sub-Saharan Africa. Further studies are needed to assess the attitudes and behaviors of Malawi women towards acceptability and justification of IPV as well as their willingness to disclose it.

Attitudes toward police response to domestic violence: a comparison of Chinese and American college students

Domestic violence has emerged as a worldwide concern since the 1970s. Although a substantial amount of efforts have been devoted to assessing various aspects of domestic violence, a relatively small number of studies have empirically examined factors that shape public attitudes toward police response to such incidents. Even rarer is investigating the topic from an international, comparative perspective. Based on survey data gathered from approximately 550 college students in China and the United States, this study analyzes the effects of background characteristics, personal and vicarious experiences of crime, and perceptions of gender roles and violence on attitudes toward proactive and traditional police response to domestic violence. Compared to their American counterparts, Chinese students were less likely to favor proactive response and more likely to support traditional response. Chinese and American students' attitudes toward police response to domestic violence were shaped by some different and common factors. Implications for policy and future research are discussed.

Rural disparity in domestic violence prevalence and access to resources

OBJECTIVE

Intimate partner violence (IPV) against women is a significant health issue in the United States and worldwide. The majority of studies on IPV have been conducted in urban populations. The objectives of this study are to determine if prevalence, frequency, and severity of IPV differ by rurality and to identify variance in geographic access to IPV resources.

METHODS

A cross-sectional clinic-based survey of 1478 women was conducted to measure the 1-year prevalence of physical, sexual, and psychologic IPV. IPV intervention programs in the state were inventoried and mapped, and the distance to the closest program was estimated for each participant based on an innovative algorithm developed for use when only ZIP code location is available.

RESULTS

Women in small rural and isolated areas reported the highest prevalence of IPV (22.5% and 17.9%, respectively) compared to 15.5% for urban women. Rural women reported significantly higher severity of physical abuse than their urban counterparts. The mean distance to the nearest IPV resource was three times greater for rural women than for urban women, and rural IPV programs served more counties and had fewer on-site shelter services. Over 25% of women in small rural and isolated areas lived >40 miles from the closest program, compared with <1% of women living in urban areas.

CONCLUSIONS

Rural women experience higher rates of IPV and greater frequency and severity of physical abuse yet live much farther away from available resources. More IPV resources and interventions targeting rural women are needed.

A probabilistic sampling method (PSM) for estimating geographic distance to health services when only the region of residence is known

Background

The need to estimate the distance from an individual to a service provider is common in public health research. However, estimated distances are often imprecise and, we suspect, biased due to a lack of specific residential location data. In many cases, to protect subject confidentiality, data sets contain only a ZIP Code or a county.

Results

This paper describes an algorithm, known as "the probabilistic sampling method" (PSM), which was used to create a distribution of estimated distances to a health facility for a person whose region of residence was known, but for which demographic details and centroids were known for smaller areas within the region. From this distribution, the median distance is the most likely distance to the facility. The algorithm, using Monte Carlo sampling methods, drew a probabilistic sample of all the smaller areas (Census blocks) within each participant's reported region (ZIP Code), weighting these areas by the number of residents in the same age group as the participant. To test the PSM, we used data from a large cross-sectional study that screened women at a clinic for intimate partner violence (IPV). We had data on each woman's age and ZIP Code, but no precise residential address. We used the PSM to select a sample of census blocks, then calculated network distances from each census block's centroid to the closest IPV facility, resulting in a distribution of distances from these locations to the geocoded locations of known IPV services. We selected the median distance as the most likely distance traveled and computed confidence intervals that describe the shortest and longest distance within which any given percent of the distance estimates lie. We compared our results to those obtained using two other geocoding approaches. We show that one method overestimated the most likely distance and the other underestimated it. Neither of the alternative methods produced confidence intervals for the distance estimates. The algorithm was implemented in R code.

Conclusions

The PSM has a number of benefits over traditional geocoding approaches. This methodology improves the precision of estimates of geographic access to services when complete residential address information is unavailable and, by computing the expected distribution of possible distances for any respondent and associated distance confidence limits, sensitivity analyses on distance access measures are possible. Faulty or imprecise distance measures may compromise decisions about service location and misdirect scarce resources.