Exploring the association between segregation and physical intimate partner violence in Lima, Peru: The mediating role of gender norms and social capital

The relationship between neighborhood social capital and health from a biopsychosocial perspective: A systematic review

BACKGROUND

The Social Determinants of Health (SDH) influence the health of people throughout their lives, and can be positive, protective or risk factors for the population and, in turn, biological, psychological, or social. The social environment conditions the health status of the neighborhood, population, and social group, which can be a health asset due to its strong psychosocial and socio-cultural influence. Social capital is a community asset of the healthy neighborhood that must be known in order to promote community health.

OBJECTIVES

The objective is to determine the relationship between social capital and neighborhood biopsychosocial health.

METHODS

A systematic review was conducted based on PRISMA: PubMed, Wos, Scopus, Embase, and Cochrane databases. The search was conducted from January to March 2023. Three authors independently extracted data using a structured form.

RESULTS

Out of 527 records, 17 results passed the inclusion and exclusion criteria. The positive and statistically significant relationship between neighborhood social capital (NSC) and the physical and mental health of neighbors is confirmed, that is, the higher the NSC, the more exercise, better oral health in children and physical health in pregnant women, lower tobacco consumption and lower prevalence of human immunodeficiency virus. At the psychological level, greater NSC leads to better mental health, mental well-being, life satisfaction, quality of life, self-perceived health, higher cognitive function, and less depression.

CONCLUSIONS

In conclusion, social capital is an important SDH and health asset that influences neighborhood biopsychosocial health and should be known and researched for health promotion in community settings. More evidence is needed to support the results obtained.

Women's Autonomy and Intimate Partner Violence in Peru: Analysis of a National Health Survey

To assess the association between women's autonomy and intimate partner violence (IPV) against women of childbearing age. Secondary analysis of the 2019 Demographic and Family Health Survey (ENDES-acronym in Spanish) was carried out. The study population was women aged 15-49 years who are currently married or living with a partner. A Poisson family generalized linear regression model was estimated to calculate adjusted prevalence ratios (aPR) for the association between women's autonomy and IPV with their respective 95% confidence intervals (CI). Data from 18,621 women were analyzed. The highest proportion of women had low autonomy (low: 42%; moderate: 39.2%; high: 18.8%). A prevalence of IPV of 40.1% was found (psychological/verbal: 38.8%; physical: 8.8%; sexual: 2.3%). The adjusted model found that women with a low level of autonomy (aPR: 1.15, 95%CI: 1.01-1.31) had a higher prevalence of IPV compared to women with high autonomy. This association was also found for the specific case of psychological/verbal violence (aPR: 1.15, 95%CI: 1.01-1.31). No association was found between women's level of autonomy and physical or sexual violence by a partner. Four out of 10 women of childbearing age have experienced IPV in the last 12 months. In general, women with lower levels of autonomy are more likely to present IPV compared to women with high autonomy.

Physical abuse in childhood and intimate partner violence in Peruvian women: A population-based survey, 2019

Intimate partner violence (IPV) is a global health problem and a violation of individual rights. The objective of this study was to assess the association between physical child abuse and current IPV in women of childbearing age in Peru. An analytical cross-sectional analysis of the data from the 2019 Demographic and Family Health Survey was carried out. IPV was constituted by emotional, physical and sexual violence, while physical child abuse was constructed from variables related to physical punishment that women of childbearing age experienced during childhood. Poisson's family generalized linear models were used for the crude and adjusted analyses to determine the association between physical child abuse and IPV. Data from a total of 21,518 women of childbearing age were included. 67.1% of women experienced physical abuse in childhood, while 57.7% experienced intimate partner violence. After adjusting for the characteristics of the woman, the partner or husband, marriage or relationship and the home, it was observed that having experienced physical abuse during childhood increased the probability of experiencing emotional (adjusted prevalence ratio [aPR] 1.15; 95% confidence interval [CI]: 1.09-1.21), physical (aPR 1.33; 95% CI: 1.20-1.47), sexual (aPR 1.57; 95% CI: 1.26-1.96) and any type of violence (aPR 1.15; 95% CI: 1.09-1.21) in adulthood. In conclusion, physical abuse during childhood is a public health issue in Peru. This study shows that women aged 15 to 49 who experienced physical abuse in childhood are more likely to experience intimate partner violence.

A cluster randomised controlled trial to evaluate the impact of a gender transformative intervention on intimate partner violence against women in newly formed neighbourhood groups in Tanzania

INTRODUCTION

Violence against women is a global public health concern; around a quarter of women will experience intimate partner physical or sexual violence during their lifetime. We assessed the impact of a gender transformative intervention for women designed to prevent intimate partner violence (IPV).

METHODS

We conducted a cluster randomised controlled trial in Mwanza city, Tanzania, among women in newly formed neighbourhood groups to evaluate a 10-session participatory intervention that aims to empower women, prevent IPV and promote healthy relationships. Following a baseline interview, groups were randomly assigned (1:1 ratio) to the intervention or control arm. An intention-to-treat analysis was conducted to assess the impact of the intervention on the main outcomes, assessed 24 months postintervention. These included past-year physical IPV and sexual IPV (primary); past-year emotional abuse; and acceptability and tolerance of IPV.

RESULTS

Between September 2015 and February 2017, 1265 women were recruited in 66 neighbourhoods and randomly allocated to intervention (n=627 women in 33 neighbourhoods) or control (n=638 women in 33 neighbourhoods). Assessment of outcomes was completed for 551 (88%) intervention and 575 (90%) control women. Among intervention women, 113 (21%) reported physical IPV compared with 117 (20%) control women (adjusted OR (aOR) 0.98, 95% CI 0.72 to 1.33, p=0.892), and 109 (20%) intervention women reported sexual IPV compared with 121 (21%) control women (aOR 0.98, 95% CI 0.72 to 1.32, p=0.881). Intervention women reported less emotional abuse (aOR 0.74, 95% CI 0.56 to 0.98, p=0.035), and were less likely to express attitudes accepting of IPV (aOR 0.49, 95% CI 0.36 to 0.66, p<0.001), and beliefs that IPV is a private matter (aOR 0.54, 95% CI 0.38 to 0.78, p=0.001), or should be tolerated (aOR 0.48, 95% CI 0.34 to 0.66, p<0.001).

CONCLUSION

These results indicate that the intervention was effective in reducing emotional abuse and positively impacting attitudes and beliefs condoning IPV, but was not sufficient to reduce physical or sexual IPV.

TRIAL REGISTRATION NUMBER

NCT02592252.

Intimate partner violence against reproductive-age women and associated factors in Peru: evidence from national surveys, 2015-2017

PURPOSE

We aimed to evaluate the factors associated with intimate partner violence (IPV) against reproductive-age women in Peru.

METHODS

Secondary analysis of the ENDES 2015-2017. ENDES is a multi-stage survey with a probabilistic sampling design for the urban and rural areas of the 25 regions of Peru. A total of 62,870 women of reproductive age (15-49 years) were included. IPV was defined as any report of violence (physical, psychological or sexual) committed by the last partner of the women. Categorical variables were described using absolute frequencies and weighted proportions. We used generalized linear models with Poisson family and log link function to calculate prevalence ratios (PR) for the associated factors with their respective 95% confidence intervals.

RESULTS

The overall IPV was 38.7%. The prevalence of sexual, psychological and physical IPV was 6.9%, 26.8%, and 31.2%, respectively. The frequency of any IPV was lower in younger women, those living with their intimate partners or married, and those living in a coastal region different from Lima. IPV was more frequent among women with a low educational level, or with a partner with low educational level, with children, with a partner with alcohol habit, in women with a history of violence by the father against the mother and living in the highlands or the jungle.

CONCLUSIONS

In Peru, IPV affects nearly four in ten women (physical and psychological types were the most frequent). The factors associated with IPV can be useful markers to identify the most vulnerable groups for implementing interventions intended to decrease the prevalence of IPV.

Firearm homicide mortality is influenced by structural racism in US metropolitan areas

INTRODUCTION

Metropolitan cities in the United States suffer from higher rates of gun violence. However, the specific structural factors associated with increased gun violence are poorly defined. We hypothesized that firearm homicide in metropolitan cities would be impacted by Black-White segregation index.

METHODS

This cross-sectional analysis evaluated 51 US metropolitan statistical areas (MSAs) using data from 2013 to 2017. Several measures of structural racism were examined, including the Brooking Institute's Black-White segregation index. Demographic data were derived from the US Census Bureau, US Department of Education, and US Department of Labor. Crime data and firearm homicide mortality rates were obtained from the Federal Bureau of Investigation and the Centers for Disease Control. Spearman ρ and linear regression were performed.

RESULTS

Firearm mortality was associated with multiple measures of structural racism and racial disparity, including White-Black segregation index, unemployment rate, poverty rate, single parent household, percent Black population, and crime rates. In regression analysis, percentage Black population exhibited the strongest association with firearm homicide mortality (β = 0.42, p < 0.001). Black-White segregation index (β = 0.41, p = 0.001) and percent children living in single-parent households (β = 0.41, p = 0.002) were also associated with higher firearm homicide mortality. Firearm legislation scores were associated with lower firearm homicide mortality (β = -0.20 p = 0.02). High school and college graduation rates were not associated with firearm homicide mortality and were not included in the final model.

CONCLUSION

Firearm homicide disproportionately impacts communities of color and is associated with measures of structural racism, such as White-Black segregation index. Public health interventions targeting gun violence must address these systemic inequities. Furthermore, given the association between firearm mortality and single-parent households, intervention programs for at-risk youth may be particularly effective.

LEVEL OF EVIDENCE

Epidemiological level II.

Sexual Partnership-Level Correlates of Intimate Partner Violence Among Men Who Have Sex with Men and Transgender Women in Lima, Peru

To improve understanding of factors associated with intimate partner violence (IPV) and explore its role in sexually transmitted infection (STI) acquisition, we analyzed partnership-level correlates of IPV among men who have sex with men (MSM) and transgender women (TW) in Peru. In a 2017 cross-sectional study of rectal STI screening and HIV prevention, MSM/TW completed a sociobehavioral survey addressing demographic characteristics, sexual risk behaviors, and substance use, and were tested for rectal gonorrhea and chlamydia, syphilis, and HIV. Generalized estimating equations estimated individual- and partner-level correlates of IPV. Of 576 participants (median age, 27 years), 7.9% (36/456) of MSM and 15.0% (18/120) of TW reported IPV with ≥ 1 of their last three partners. MSM/TW reporting IPV were more likely to meet criteria for an alcohol use disorder (74.1%) than participants reporting no IPV (56.7%; p < .01). Physical violence (4.5% MSM; 9.2% TW) was associated with stable partnerships (aPR 3.79, 95% CI 1.79-8.04), partner concurrency (4.42, 1.19-16.40), and participant alcohol (4.71, 1.82-12.17) or drug use (5.38, 2.22-13.02) prior to sex. Psychological violence (4.5% MSM; 5.0% TW) was associated with stable partnerships (2.84, 1.01-7.99). Sexual IPV was reported by 1.1% of MSM and 5.0% of TW. Physical, psychological, and sexual IPV were reported in sexual partnerships of Peruvian MSM and TW, particularly with stable partners and in conjunction with substance use.

Measuring the psychological drivers of participation in collective action to address violence against women in Mumbai, India

Background: A growing number of global health interventions involve community members in activism to prevent violence against women (VAW), but the psychological drivers of participation are presently ill-understood. We developed a new scale for measuring three proposed drivers of participation in collective action to address VAW in the context of urban informal settlements in Mumbai, India: perceived legitimacy, perceived efficacy, and collective action norms. Methods: We did a household survey of 1307 men, 1331 women, and 4 trans persons. We checked for 1) social desirability bias by comparing responses to self-administered and face-to-face interviews, 2) acquiescence bias by comparing responses to positive and negatively worded items on the same construct, 3) factor structure using confirmatory factor analysis, and 4) convergent validity by examining associations between construct scores and participation in groups to address VAW and intent to intervene in case of VAW. Results: Of the ten items, seven showed less than five percentage point difference in agreement rates between self-administered and face-to-face conditions. Correlations between opposite worded items on the same construct were negative (p<0.05), while correlations between similarly worded items were positive (p<0.001). A hierarchical factor structure showed adequate fit (Tucker-Lewis index, 0.919; root mean square error of approximation, 0.036; weighted root mean square residual, 1.949). Comparison of multi-group models across gender, education, caste, and marital status showed little evidence against measurement invariance. Perceived legitimacy, efficacy and collective action norms all predicted participation in groups to address VAW and intent to intervene in case of VAW, even after adjusting for social capital (p<0.05). Conclusion: This is the first study to operationalize a measure of the psychological drivers of participation in collective action to address VAW in a low- and middle-income context. Our novel scale may provide insight into modifiable beliefs and attitudes community mobilisation interventions can address to inspire activism in similar low-resource contexts.

Measuring the psychological drivers of participation in collective action to address violence against women in Mumbai, India

Background: A growing number of global health interventions involve community members in activism to prevent violence against women (VAW), but the psychological drivers of participation are presently ill-understood. We developed a new scale for measuring three proposed drivers of participation in collective action to address VAW in the context of urban informal settlements in Mumbai, India: perceived legitimacy, perceived efficacy, and collective action norms. Methods: We did a household survey of 1307 men, 1331 women, and 4 trans persons. We checked for 1) social desirability bias by comparing responses to self-administered and face-to-face interviews, 2) acquiescence bias by comparing responses to positive and negatively worded items on the same construct, 3) factor structure using confirmatory factor analysis, and 4) convergent validity by examining associations between construct scores and participation in groups to address VAW and intent to intervene in case of VAW. Results: Of the ten items, seven showed less than five percentage point difference in agreement rates between self-administered and face-to-face conditions. Correlations between opposite worded items on the same construct were negative (p<0.05), while correlations between similarly worded items were positive (p<0.001). A hierarchical factor structure showed adequate fit (Tucker-Lewis index, 0.920; root mean square error of approximation, 0.035; weighted root mean square residual, 1.952). Perceived legitimacy, efficacy and collective action norms all predicted participation in groups to address VAW and intent to intervene in case of VAW, even after adjusting for social capital (p<0.05). Conclusion: This is the first study to operationalize a measure of the psychological drivers of participation in collective action to address VAW in a low- and middle-income context. Our novel scale may provide insight into modifiable beliefs and attitudes community mobilisation interventions can address to inspire activism in similar low-resource contexts.