Ascertainment of intimate partner violence in women seeking legal protection

History of dating violence and the association with late adolescent health

BACKGROUND

The present investigation expands upon prior studies by examining the relationship between health in late adolescence and the experience of physical/sexual and non-physical dating violence victimization, including dating violence types that are relevant to today's adolescents (e.g., harassment via email and text messaging). We examined the relationship between physical/sexual and non-physical dating violence victimization from age 13 to 19 and health in late adolescence/early adulthood.

METHODS

The sample comprised 585 subjects (ages 18 to 21; mean age, 19.8, SD = 1.0) recruited from The Ohio State University who completed an online survey to assess: 1) current health (depression, disordered eating, binge drinking, smoking, and frequent sexual behavior); and 2) dating violence victimization from age 13 to 19 (retrospectively assessed using eight questions covering physical, sexual, and non-physical abuse, including technology-related abuse involving stalking/harassment via text messaging and email). Multivariable models compared health indicators in never-exposed subjects to those exposed to physical/sexual or non-physical dating violence only. The multivariable models were adjusted for age and other non-dating abuse victimization (bullying; punched, kicked, choked by a parent/guardian; touched in a sexual place, forced to touch someone sexually).

RESULTS

In adjusted analyses, compared to non-exposed females, females with physical/sexual dating violence victimization were at increased risk of smoking (prevalence ratio = 3.95); depressive symptoms (down/hopeless, PR = 2.00; lost interest, PR = 1.79); eating disorders (using diet aids, PR = 1.98; fasting, PR = 4.71; vomiting to lose weight, PR = 4.33); and frequent sexual behavior (5+ intercourse and oral sex partners, PR = 2.49, PR = 2.02; having anal sex, PR = 2.82). Compared to non-exposed females, females with non-physical dating violence only were at increased risk of smoking (PR = 3.61), depressive symptoms (down/hopeless, PR = 1.41; lost interest, PR = 1.36), eating disorders (fasting, PR = 3.37; vomiting, PR = 2.66), having 5+ intercourse partners (PR = 2.20), and having anal sex (PR = 2.18). For males, no health differences were observed for those experiencing physical/sexual dating violence compared to those who did not. Compared to non-exposed males, males with non-physical dating violence only were at increased risk of smoking (PR = 3.91) and disordered eating (fasting, using diet aids, vomiting, PR = 2.93).

CONCLUSIONS

For females, more pronounced adverse health was observed for those exposed to physical/sexual versus non-physical dating violence. For both females and males, non-physical dating violence victimization contributed to poor health.

Prevalence of abuse and violence before, during, and after pregnancy in a national sample of Canadian women

OBJECTIVES

We describe the prevalence of abuse before, during, and after pregnancy among a national population-based sample of Canadian new mothers.

METHODS

We estimated prevalence, frequency, and timing of physical and sexual abuse, identified category of perpetrator, and examined the distribution of abuse by social and demographic characteristics in a weighted sample of 76,500 (unweighted sample = 6421) Canadian mothers interviewed postpartum for the Maternity Experiences Survey (2006-2007).

RESULTS

Prevalence of any abuse in the 2 years before the interviews was 10.9% (6% before pregnancy only, 1.4% during pregnancy only, 1% postpartum only, and 2.5% in any combination of these times). The prevalence of any abuse was higher among low-income mothers (21.2%), lone mothers (35.3%), and Aboriginal mothers (30.6%). In 52% of the cases, abuse was perpetrated by an intimate partner. Receiving information on what to do was reported by 61% of the abused mothers.

CONCLUSIONS

Large population-based studies on abuse around pregnancy can facilitate the identification of patterns of abuse and women at high risk for abuse. Before and after pregnancy may be particularly important times to monitor risk of abuse.

Intimate partner survivors' help-seeking and protection efforts: a person-oriented analysis

Domestic violence advocates and researchers advocate for a survivor-centered approach for assisting women experiencing intimate partner violence (IPV), with individualized safety plans and services; yet little empirical work has been done to determine IPV survivors' specific combinations of vulnerabilities and assets that might inform such an approach. Using latent profile analysis of a cohort of 448 survivors, five distinct subgroups were previously identified in terms of biopsychosocial asset and vulnerability profiles. The purpose of the current study was to apply person-oriented methodology for survivor-centered investigation of differences in help-seeking and protective actions according to subgroup membership within this cohort. Though not differing demographically, the subgroups were found to differ significantly and meaningfully in their patterns of IPV help-seeking and protective actions. Thus, reliance on population-aggregate linear relationships between IPV exposure and safety efforts may risk overlooking important variation by vulnerability and asset profile, and knowledge of distinct clusters among functioning profiles may help with understanding of survivors' coping strategies.The authors outline service-need considerations across the subgroups and provide guidance for targeted outreach, locating IPV survivors and matching services to their needs.

Intimate partner violence during pregnancy: a pilot intervention program in Lima, Peru

This pilot study examined the effectiveness of standard care and an empowerment intervention for abused pregnant women. Severe psychological abuse was most prevalent (42.2%) among this sample of women. Compared with women in the standard care group at the postintervention survey, women in the empowerment group were more likely to hide money (44.6% vs. 34.3%), establish a code with family or friends (19.6% vs. 16.2%), ask neighbors to call police if violence began (6.9% vs. 1.0%), had available bank account numbers (17.1% vs. 3.1%), had valuable jewelry (8.4% vs. 3.8%), and had available a hidden bag with extra clothing (9.0% vs. 3.1%). However, there was no statistically significant difference in health-related quality of life, adoption of safety behaviors, and use of community resources between women in the two groups. Simply asking pregnant women about abuse and offering referral could potentially interrupt and prevent further abuse.

Partner abuse or violence, parenting and neighborhood influences on children's behavioral problems

We examined the relationship between neighborhood characteristics, parenting behaviors, experiences of intimate partner abuse or violence (IPV) and children's behavioral problems in a socioeconomically diverse sample of 383 families residing in an urban environment. Data were collected in the Fall/Winter of 2002. The census block group of residence was used as our measure of neighborhood. Census block groups typically contain 1500 residents on average. IPV was measured using a modified version of the HITS (physically Hurt, Insult, Threaten, and Screamed at) scale, a short four item tool assessing emotional and physical violence to which we added an item capturing domination or emotional control. IPV in the last year was reported by 50% of the sample with rates varying by socioeconomic position; families with the lowest and highest income reported the most IPV. Patterns of association between parenting, neighborhood and the children's behavioral problems differed for families who reported IPV in the last year compared to families who reported no IPV. While positive neighborhood characteristics such as high levels of Community Involvement with Children - based upon four scales capturing neighborhood levels of social interaction and collective socialization of children - were protective for high levels of behavioral problems among families not reporting IPV, this protective effect was not seen among families who did report IPV. Hypothesized interactions between negative neighborhood characteristics and IPV-namely that behavioral problems would be worse among families experiencing IPV in highly economically deprived or areas with negative social climates-were not supported by our data. These interactions between neighborhood factors and IPV were not explained by parental factors.

Ascertainment of intimate partner violence using two abuse measurement frameworks

OBJECTIVE

To estimate prevalence of intimate partner violence (IPV) according to two abuse ascertainment tools, and agreement between the tools.

METHODS

2504 women randomly selected from a health maintenance organization were asked about IPV exposure in their most recent intimate relationship using five questions on physical and sexual abuse, and fear due to partner's threats and controlling behavior from the Behavioral Risk Factor Surveillance Survey (BRFSS) and 10 questions from the Women's Experience with Battering (WEB) scale. IPV prevalence was estimated according to the BRFSS and WEB, and the proportion of women who were WEB+/BRFSS+, WEB-/BRFSS-, WEB-/BRFSS+, and WEB+/BRFSS-.

RESULTS

In their most recent relationship, 14.7% of women reported abuse of any type on the BRFSS versus 7.0% on the WEB scale. In direct comparisons of the WEB and BRFSS questions, a higher percentage of abused women reported any IPV on the five BRFSS questions (88.4%) compared to the 10 WEB questions (42.0%). However, both the BRFSS and WEB identified some women as abused that would have been missed by the other instrument.

CONCLUSIONS

Intimate partner violence prevalence depends on how women are asked about abuse. Resources permitting, more than one abuse ascertainment strategy (for example, both the BRFSS and WEB questions) should be tried in order to broadly identify as many women as possible who interpret themselves as abused.

Conversational silence, coercion, equality: the role of language in influencing who gets identified as abused

Various methods of ascertaining self-reported exposure to intimate partner violence (IPV) in health care and research settings have been evaluated to identify women who interpret themselves as abused for clinical and research intervention. However, few interpretive frameworks have been proposed to explain factors that may influence the success of this ascertainment process, including the contribution of language in facilitating women's interpretations of situations as abusive across social, cultural and historical contexts. This omission is substantial, given that IPV is context-specific, involving interaction between individuals of diverse linguistic and cultural backgrounds and their sociocultural environment. In the first part of this paper, we outline hermeneutics, one interpretive theoretical tradition to describe approaches to interpreting IPV. Hermeneutics is a linguistic philosophy that focuses on questions of how people understand spoken language, written text, and themselves through language across sociocultural environments. Hermeneutics acknowledges conditions and situations that facilitate opportunities for broad shared understanding and vocabularies about violence between communities, professionals and abused women, which in turn may reduce harm to women and negotiate action women may want to take in response to situations they interpret as abusive. In the second and third parts of the paper, we compare and contrast the strengths and limitations of three common approaches for asking women about IPV in health care and research settings, and outline a multi-dimensional IPV ascertainment tool that incorporates the three asking approaches to facilitate professionals bringing broad definitions of and vocabularies about abuse to encounters with women. This paper provides health care researchers, clinicians and policy makers with a framework for understanding the potential influence of language on women's interpretations of IPV, including the role of community and professional conversational silence, coercion and equality in influencing women's interpretations. We look at the influence of language about intimate partner violence in the United States on women's interpretations of abuse, although the basic constructs presented here could be applied in other countries and settings.