Food insecurity and intimate partner violence against women: results from the California Women's Health Survey

Healthy lifestyle factors and male perpetration of intimate partner violence: a cross-sectional study in Mwanza, Tanzania

BACKGROUND

In Tanzania, nearly half of ever-married women have experienced some form of intimate partner violence (IPV), yet little knowledge of IPV from the male perspective exists.

OBJECTIVE

To explore the role of essential healthy lifestyle factors, diet, sleep, and exercise, and their potential role in IPV perpetration.

METHODS

A cross-sectional survey was conducted with 1,002 young men (ages 18-24), 754 of which were in an intimate relationship in the previous year. The study took place in Mwanza, Tanzania and used multivariable logistic regression models to explore associations between male perpetration of IPV and diet, sleep, and exercise.

RESULTS

Six types of IPV perpetration were investigated separately and the prevalence of controlling behaviours (79.4%), economic abuse (30.6%), emotional abuse (47.3%), physical violence (16.4%), sexual violence (23.3%), and combined physical and/or sexual violence (32.1%) were obtained. Regular exercise demonstrated a protective effect for economic abuse perpetration; the chance of mildly active individuals perpetrating economic abuse was 38% less than their inactive counterparts (p = 0.003). Associations with sleep were varied and did not show a clear directional relationship. Diet, defined as poor food variety, was positively associated with every IPV type except physical violence and was significant in sexual violence perpetration (aOR:1.57, 95%CI:1.21-2.05).

CONCLUSIONS

The results from this study indicate that considering healthy lifestyle behaviours - diet, sleep, and exercise - in the design of intervention programmes may be beneficial in reducing IPV perpetration in Tanzania, and that they should be considered alongside previously established evidence-based risk factors.

Examining Pathways from Food Insecurity to Safer Sex Efficacy Among Northern and Indigenous Adolescents in the Northwest Territories, Canada

BACKGROUND

Food insecurity is a social determinant of health linked with elevated HIV exposure. Safer sex efficacy (SSE), the ability to navigate sexual decision-making and condom use, is an important marker of sexual wellbeing. Pathways from food insecurity to SSE are understudied, particularly among adolescents in Arctic regions who are at the nexus of food insecurity and sexual health disparities. We examined pathways from food insecurity to SSE among adolescents in the Northwest Territories (NWT), Canada.

METHODS

We implemented cross-sectional surveys with adolescents aged 13-18 recruited through venue-based sampling in 17 NWT communities. We conducted multivariable logistic regression to assess socio-demographic factors associated with food insecurity. We then conducted structural equation modeling (SEM) using maximum likelihood estimation to assess direct effects of food insecurity on SSE and indirect effects via resilience, depression, and relationship power inequity. We assessed both condom use SSE (e.g., confidence in using condoms) and situational SSE (e.g., SSE under partner pressure).

RESULTS

Most participants (n = 410) identified as Indigenous (79%) and 45% reported experiencing food insecurity. In SEM, we did not find a significant direct effect from food insecurity to SSE; however, we found indirect effects from food insecurity to condom use SSE through resilience and depression and from food insecurity to situational SSE through resilience.

CONCLUSIONS

Findings call for structural interventions to address food insecurity, alongside resilience-focused strategies that address the intersection of sexual and mental health. Sexual health strategies focused on individual behavior change are insufficient to address larger contexts of poverty among Northern youth.

Is household food insecurity associated with social attitudes accepting of physical intimate partner violence against women in Nigeria? A population-level cross-sectional study

OBJECTIVES

Although prior research suggests that household food insecurity (HFI) is associated with intimate partner violence against women (IPVAW), there is a paucity of research regarding its impact on attitudes accepting of IPVAW. We examined whether individuals experiencing HFI are more likely to accept physical IPVAW, whether the association varies by gender and whether it persists when models are adjusted for other confounders.

DESIGN

Population-level cross-sectional analysis.

SETTING

This study used the round 6 of the UNICEF-supported Multiple Indicator Cluster Survey (MICS) conducted in Nigeria.

PARTICIPANTS

The sample included 23 200 women and 7087 men, aged 15-49 years, who were currently married or in union and responded to the attitudes towards domestic violence and HFI modules in the MICS.

OUTCOME MEASURES AND STATISTICAL ANALYSIS

Attitudinal acceptance of physical IPVAW (specific forms and overall). We conducted weighted multivariable logistic regression to estimate the OR and their corresponding 95% CIs of the associations of food insecurity (FI) with attitudinal acceptance of physical IPVAW, adjusting for potential confounders.

RESULTS

Multivariable results indicate that severe HFI was positively associated with attitudinal acceptance physical IPVAW in at least one of the scenarios presented (aOR=1.11; 95% CI: 1.01 to 1.22). Individuals experiencing severe HFI had higher odds of physical IPVAW acceptance when wife neglects the children (aOR=1.15; 95% CI: 1.02 to 1.31). The likelihood of physical IPVAW acceptance if wife burns the food was lower for women experiencing moderate HFI (aOR=0.86; 95% CI: 0.74 to 0.99). Stratified analyses indicated heterogeneity in the association between HFI and attitudinal acceptance of physical IPVAW by gender.

CONCLUSION

Our findings indicate that, depending on the severity, FI status may be associated with attitudinal acceptance of physical IPVAW, with potential variations based on gender. The public health implications are discussed.

Toward Ending Violence Against Women: The Association of Intimate Partner Violence With Food Security Status Among Ever-Married Women in Cameroon

Despite an extensive body of literature that explores potential mechanisms explaining the factors associated with intimate partner violence (IPV) experienced by women, very few studies have studied the association of food security status with women's experience of IPV in sub-Saharan Africa countries, including Cameroon. Using data from the 2018 Cameroon Demographic and Health Survey (n = 4,690), we explore the association between food security status and three distinct forms of IPV (i.e., emotional, sexual, and physical IPV) among ever-married women in Cameroon. Adjusting for socioeconomic, demographic, and attitudinal and behavioral characteristics, we found that women with severe (odds ratio [OR] = 2.09, p < .01), moderate (OR = 1.88, p < .05), and mild (OR = 1.76, p < .05) food insecurity were more likely to experience sexual IPV, compared to those without any food insecurity, whereas women with severe food insecurity were more likely to experience physical IPV (OR = 1.89, p < .001). Although women with severe (OR = 1.51, p < .01) and moderate (OR = 1.67, p < .001) food insecurity had a higher likelihood of experiencing emotional IPV at a bivariate level, we found that these associations became no longer significant in our adjusted model. These findings suggest that food insecurity is a critical risk factor for IPV among ever-married women in Cameroon. Addressing IPV requires a comprehensive strategy that places special emphasis on households experiencing food insecurity. There is also an urgent need to implement educational programs to increase awareness of the interconnection between food insecurity and IPV and to allocate resources to community-based initiatives that empower women both economically and socially.

The Association Between Food Insecurity and Intimate Partner Violence Among U.S. Army Soldiers

Food insecurity in the military ranges between 25% and 33%, significantly higher than the 10.5% for civilians reported by the U.S. Department of Agriculture. The primary objective of this study is to analyze the association between food insecurity and intimate partner violence (IPV) victimization among U.S. Army Soldiers. The secondary objective is to determine if there are any moderating effects in the relationship between food insecurity and IPV victimization by demographic, financial, and mental health covariates. A cross-sectional, online survey was administered by the U.S. Army Public Health Center at an Army installation in 2019; 56% of respondents reported that they were married or in a relationship (n = 2,740). The main predictor was the two-item food insecurity screener (Hunger Vital Signs), which measures marginal food insecurity (encompassing marginal, low, and very low food security). The main outcome was IPV victimization as measured by the Hurt, Insult, Threaten, Scream scale. Multiple logistic regression was used to assess the association between marginal food insecurity and IPV victimization, controlling for demographic, financial, and mental health covariates. In a multivariable model, marginally food insecure respondents had 2.05-fold greater adjusted odds of reporting any IPV victimization when compared to highly food secure respondents (95% confidence interval [1.40, 3.00]). The only interaction that was statistically significant was between anxiety and food insecurity on IPV victimization (p = .0034). Interactions by soldier's military rank, birth sex, and race and ethnicity were not statistically significant. IPV has implications for the emotional and physical health of survivors. In addition, service members who are food insecure may experience similar decrements in emotional and physical health due to suboptimal nutrient intake. By addressing both food insecurity and IPV, the military has the potential to increase the overall well-being of its service members and their dependents.

Domestic violence patterns in postpartum women who delivered during the COVID-19 pandemic

OBJECTIVE

To longitudinally assess domestic violence (DV) during the postpartum period, identifying types, patterns and determinants of DV, according to mothers' reports in Fortaleza, Brazil.

METHODS

Data from the Iracema-COVID cohort study interviewed at home mothers who gave birth in the first wave of COVID-19, at 18 and 24 months after birth. Patterns of reported DV were classified as follows: no DV, interrupted DV, started DV and persistent DV. Adjusted multinomial logistic regressions were used to assess factors associated with persistent DV.

RESULTS

DV was reported by 19 and 24% of the mothers at 18 and 24 months postpartum, respectively, a 5 percentage points increase. Persistent DV was present in 11% of the households in the period. The most frequent forms of DV were verbal aggression, reported by 17-20% of the mothers at 18 and 24 months, respectively; drunkenness or use of drugs at home, present in 3-5% of the households; physical aggression, reported by 1.2-1.6% of the mothers. Households with two or more forms of DV increased from 2 to 12% in the period. Adjusted factors associated with persistent DV were maternal common mental disorder, family headed by the mother and head of family's poor schooling. Food insecurity was associated with starting DV.

CONCLUSION

Prevalence of DV was considerably high in the postpartum period. DV prevention policies should rely on improving care to women's mental health; preventing food insecurity; and fostering the educational level of young people of both sexes.

Lower Perceived Neighborhood Collective Efficacy Indirectly Influences the Association Between Perceived Maternal Exposure to Community Violence and Household Food Insecurity

BACKGROUND AND OBJECTIVES

Individuals of color and of low socioeconomic status are at greater risk of experiencing community violence and food insecurity, which are both influenced by neighborhood conditions. We evaluated neighborhood collective efficacy as a linkage between community violence exposure and household food insecurity.

METHODS

Mothers from the Future of Families and Child Wellbeing Study who completed phone surveys when the child was 3 (time 1, T1) and 5 years old (time 2, T2) were included (n = 2068). A covariate-adjusted structural equation model estimated direct and indirect effects of community violence exposure on household food insecurity. A covariate-adjusted multiple mediator model estimated the indirect effects of the 2 neighborhood collective efficacy subscales (informal social control; social cohesion and trust).

RESULTS

At T1, 40% of mothers reported community violence exposure; 15% experienced food insecurity at T2. Mean neighborhood collective efficacy (range 1-5) at T1 was 2.44 (SD = 0.94). Neighborhood collective efficacy indirectly influenced the association between community violence exposure and food insecurity (indirect effect = 0.022, 95% CI = 0.007 to 0.040). Only social cohesion and trust contributed independent variance to the indirect effect model (indirect effect = 0.028, 95% CI = 0.001 to 0.056).

CONCLUSIONS

Community-based efforts to reduce household food insecurity should emphasize building social cohesion and trust in communities experiencing violence.

The Link Between Intimate Partner Violence and Food Insecurity: A Review of Quantitative and Qualitative Studies

Intimate partner violence (IPV) and food insecurity are global health issues that affect millions of people worldwide. Numerous studies show that IPV and food insecurity are linked; however, there is a lack of synthesis of this research. Using a systematic search and review, we examined the international quantitative and qualitative research published on the link between IPV and food insecurity. We searched for peer-reviewed, English-language articles with participants above the age of 16 in 4 large online databases. Fifty-six studies were included from around the world that discussed the link between food insecurity and IPV perpetration and/or victimization. We found evidence in both qualitative and quantitative studies for a meaningful connection between these two global health isues. We also reviewed the literature on moderators and mediators (e.g., mental health). Our findings indicate the importance of implementing IPV prevention strategies which also address household food insecurity, and the potential for food insecurity resources to provide IPV resources. Future research should focus more frequently on IPV perpetration as opposed to victimization, and further examine the moderating and mediating mechanisms that inform the link between IPV and food insecurity.

Association of Food Insecurity With Multiple Forms of Interpersonal and Self-Directed Violence: A Systematic Review

Economic stress, broadly defined, is associated with an increased likelihood of multiple forms of violence. Food insecurity is a distinct economic stressor and material hardship that is amenable to programmatic and policy intervention. To inform intervention and identify gaps in the current evidence base, we conducted a systematic review to synthesize and critically evaluate the existing literature regarding the association between food insecurity and five forms of interpersonal and self-directed violence: intimate partner violence (IPV), suicidality, peer violence and bullying, youth dating violence, and child maltreatment, in high-income countries. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and searched six electronic databases from their start date through February of 2022. We included studies that examined food insecurity as the exposure and an outcome measure of IPV, suicide, suicidality, peer violence, bullying, youth dating violence, or child maltreatment; were peer-reviewed and published in English; reported quantitative data; and took place in a high-income country. We identified 20 relevant studies. Nineteen studies found that food insecurity was associated with an increased likelihood of these forms of violence. Results highlight the potential for programs and policies that address food insecurity to function as primary prevention strategies for multiple forms of violence and underscore the importance of trauma-informed approaches in organizations providing food assistance. Additional theory-driven research with validated measures of food insecurity and clearly established temporality between measures of food insecurity and violence is needed to strengthen the existing evidence base.

Racial and Ethnic Disparities in Food Insufficiency in Families with Children During the COVID-19 Pandemic: the Role of Risk and Protective Factors

BACKGROUND

Black and Hispanic households are at elevated risk of food insecurity and insufficiency-correlates of adverse outcomes in areas such as health and mental health-relative to White households in the USA. The COVID-19 pandemic and its economic shock threatened to further exacerbate these issues. Research has identified a number of risk and protective factors for food insecurity and insufficiency. These could relate to racial and ethnic disparities in two ways-through aggregate differences in the distribution of characteristics such as educational attainment and employment or through differences in the degree of risk or protection associated with a factor. We examined the relationship between four factors-household head age, educational attainment, single mother household composition, and employment-and disparities in food insufficiency between White, Black, and Hispanic households with children during the COVID-19 pandemic to consider these pathways.

METHODS

We analyzed data from the Census Bureau's Household Pulse Survey using bivariate statistics, multivariable regression, and decomposition methods to understand differences in the prevalence and consequences of underlying risk and protective factors for food insufficiency in households with children.

RESULTS

Consistent with prior literature, we documented higher rates of food insufficiency among Black and Hispanic households compared to White households. Differences in the distributions of education and employment accounted for a substantial fraction of the disparities in risk. Both the distribution and degree of risk associated with single mother household composition also related to disparities, but these differences were muted after accounting for economic resources. Much, though not all, of the relationship between the distributions of education and disparate risk of food insufficiency were also captured by differences in economic resources.

CONCLUSION

This study provides insight into the structure underlying racial and ethnic disparities in food insufficiency during the COVID-19 pandemic, highlighting the importance of human capital, income, and assets.

Food Insecurity and Intimate Partner Violence in Mwanza, Tanzania: A Longitudinal Analysis

INTRODUCTION

Food insecurity is a potential predictor of intimate partner violence. This study (1) describes the prevalence of food insecurity and various forms of intimate partner violence experience among women in Mwanza, Tanzania; and (2) assesses the effect of food insecurity and hunger on various forms of women's experience of intimate partner violence longitudinally.

METHODS

Women (aged 18-70 years) who reported being in a relationship in the past 12 months, who had participated in the control arms of two randomized controlled trials conducted as part of the MAISHA study were interviewed at four time points (N=1,004 at baseline in 2017). Analyses were conducted in 2022. Associations between food insecurity exposures and intimate partner violence outcomes were assessed, and univariate random effect logistic models were conducted to identify relevant sociodemographic variables (including age, education level, and SES) that were statistically significant. Multivariable random effects logistic models were conducted, including time as a fixed effect, to calculate odds ratios indicating associations between food insecurity exposures and intimate partner violence outcomes.

RESULTS

Prevalence of food insecurity was 47.7%, 55.6%, 47.2%, and 50.8% for each of the 4 waves, respectively, with significant difference in proportion of food insecurity between baseline and Wave 2. Multivariable random effects models indicated that food insecurity was associated with increased odds of exposure to all forms of intimate partner violence outcomes, and hunger was significantly associated with increased odds of experience of all intimate partner violence outcomes, apart from controlling behaviors.

CONCLUSIONS

Results from this longitudinal analysis of food insecurity and women's reports of intimate partner violence experience in a low- and middle-income country setting indicate that food insecurity is significantly associated with all forms of intimate partner violence, apart from controlling behaviors, among women in this sample in Mwanza, Tanzania. Policy and programmatic implications include the need for integrated intimate partner violence prevention programming to take into account household food needs.

Economic Hardship Predicts Intimate Partner Violence Victimization During Pregnancy

Objective

Intimate partner violence (IPV) during pregnancy is associated with negative physical and mental health consequences for both mothers and infants. Economic hardship is often exacerbated during pregnancy and is associated with increased rates of IPV in non-pregnant samples. However, temporal associations between economic hardship and IPV victimization have not been well characterized during pregnancy. The present study used data collected at the weekly level to examine the interindividual and intraindividual effects of economic hardship on IPV victimization during pregnancy and determine whether longitudinal changes in IPV across pregnancy vary based on level of economic hardship.

Method

Two hundred ninety-four women reported on weekly experiences of IPV and economic hardship (i.e., food insecurity and other money problems) during weeks 17-40 of pregnancy. Participants were oversampled for low income and IPV exposure. Binary logistic multilevel models were used to test study hypotheses.

Results

Greater economic hardship on average during pregnancy predicted increased odds of IPV victimization. Within-person increases in economic hardship also predicted increased odds of IPV victimization in the same week. Although IPV victimization tended to decrease on average over the course of pregnancy, there was a significant time by economic hardship interaction such that IPV decreased more gradually for women reporting high levels of economic hardship.

Conclusions

The present study examined weekly patterns of IPV victimization across pregnancy in a low-income community sample. Results suggest that policies aimed at increasing families' economic security during the perinatal period may reduce the individual and societal burden of IPV.

Prevalence and Correlates of Non-Dating Sexual Violence, Sexual Dating Violence, and Physical Dating Violence Victimization among U.S. High School Students during the COVID-19 Pandemic: Adolescent Behaviors and Experiences Survey, United States, 2021

The COVID-19 pandemic created an environment of disruption and adversity for many adolescents. We sought to establish the prevalence of non-dating sexual violence, sexual dating violence, and physical dating violence victimization among adolescents during the COVID-19 pandemic and to investigate whether experiences of disruption and adversity placed adolescents at greater risk for these forms of interpersonal violence. We conducted a secondary analysis of data from the Adolescent Behavior and Experiences Survey, collected January to June 2021 from a nationally representative sample of U.S. high school students (N = 7,705). Exposures included abuse by a parent; economic, housing, and food and nutrition insecurity; interpersonal connectedness; and personal well-being. Among female students, 8.0% experienced non-dating sexual violence; 12.5% experienced sexual dating violence; and 7.7% experienced physical dating violence. Among male students, 2.2% experienced non-dating sexual violence; 2.4% experienced sexual dating violence; and 4.9% experienced physical dating violence. Among female students, both emotional and physical abuse by a parent was related to non-dating sexual violence, emotional abuse was related to sexual dating violence, and physical abuse was related to physical dating violence. Among males, emotional abuse by a parent was related to physical dating violence and physical abuse by a parent was related to sexual dating violence. Hunger was associated with sexual and physical dating violence among female students and homeless was associated with physical dating violence among male students. Although there were differences by sex, abuse by a parent, hunger, and homelessness created precarity that may have increased the likelihood that adolescents would be exposed to risky peer or dating relationships. Adolescents need support that stops and prevents experiences of non-dating sexual and dating violence connected to interventions that address adversities experienced during the COVID-19 pandemic.

Food Insecurity: A Barrier to Reproductive Justice Globally

Objective: Reproductive Justice identifies three core reproductive rights for all people: (1) the right to not have a child; (2) the right to have a child; and (3) the right to parent children in safe and healthy environments. We aim to illustrate that food insecurity infringes upon on all three of these rights and so is a pressing issue for reproductive justice and for sexual and reproductive health more broadly. Methods: Using a phenomenological approach, we outline potential pathways between food insecurity and reproductive justice. Results: There are numerous potential pathways between food insecurity and reproductive justice, including entry into sexual relationships for material support, links to sexually transmitted infections and infertility, structural violence, prioritization and spending tradeoffs between food and other basic necessities, biological impacts of malnutrition, restricted reproductive choices, population control measures, and social stigma and exclusion. Marginalized people are disproportionately impacted by food insecurity and its consequences, with implications for sexual health and pleasure and for reproductive justice. Conclusions:Meaningful and equitable collaboration between people with lived experience of food insecurity, human rights and reproductive justice activists, and academics is critical to sensitively contextualize this work and mobilize broader social change.

Association between public health emergencies and sexual and reproductive health, gender-based violence, and early marriage among adolescent girls: a rapid review

BACKGROUND

As COVID-19 continues to impact lives and livelihoods around the world, women and girls are disproportionately affected. Crisis situations and related response measures, such as lockdowns, school closures, and travel restrictions, often exacerbate the adversities and human rights violations faced by adolescent girls. We conducted a rapid review to synthesise evidence on the impact of public health emergencies (PHEs) related to gender-based inequalities among adolescent girls.

METHODS

We systematically searched five major databases. Records were imported into the online screening tool Rayyan, and 10% of the records were triple screened for eligibility. We included qualitative, mixed-methods, and quantitative studies that assessed the relationship between PHEs and any of the following outcomes: (1) gender-based violence, (2) early/forced marriage, and (3) sexual and reproductive health. Due to the heterogeneity of included study designs, no meta-analysis was performed, and studies were summarised narratively.

FINDINGS

Out the initial 6004 articles, 11 studies met our eligibility criteria. Five of these assessed the impact of natural disasters and six were focused on consequences of the COVID-19 pandemic. Seven studies focused on the impact of PHEs on gender-based violence, three focused on sexual and reproductive health, and only one study looked at early marriage. The main impacts highlighted by the studies included (1) increases in physical, psychological, and sexual abuse, (2) increase in the occurrence of teenage pregnancy, (3) poor menstruation hygiene management, and (4) occurrence of early marriages. Mechanisms underlying these impacts were PHE-specific response strategies like home confinement, closure of schools, the worsening of families' financial situation such as the inability to pay for school fees or day-to-day living costs, and the disempowerment of and increased workloads for adolescent girls.

CONCLUSION

Although evidence on the impact of COVID-19 on gender-based violence, sexual and reproductive health, and especially forced or early marriage of adolescent girls is limited, results from studies on other PHEs indicate that during crises, these detrimental outcomes are exacerbated. Findings from our review have important implications for policies and programs providing life skills training, financial literacy training, credit support, and safe spaces for adolescent girls.

Early Educational Interventions to Prevent Gender-Based Violence: A Systematic Review

BACKGROUND

Gender-based violence is a worldwide public health problem that is increasingly occurring at younger ages. This investigation aims to analyze effective interventions to prevent and to face gender-based violence beginning in early childhood in order to ensure quality education for all children through violence-free schools.

METHODS

This research has conducted a systematic review of interventions that have demonstrated a positive impact on the prevention and reduction of gender-based violence from early ages up to 12 years, inclusive, in schools. An extensive search in scientific databases (WoS, SCOPUS, ERIC, PsycINFO) was conducted from 2007 to 2022.

RESULTS

Thirteen articles were selected and analyzed in-depth to identify the success factors of these interventions, which (a) are integrated into the school curriculum; (b) promote active participation of students and community; (c) are based on scientific evidence; and (d) make relevant adaptations to a specific group and context.

CONCLUSIONS

The programs analyzed have had a positive impact on raising awareness of gender violence, overcoming stereotypes, improving relationships in the classroom and reducing violent behavior, as well as empowering the most vulnerable people.

Assessment of Microfinance Interventions and Intimate Partner Violence: A Systematic Review and Meta-analysis

IMPORTANCE

An estimated 27% of ever-partnered women aged 15 to 49 years have experienced intimate partner violence (IPV) in their lifetimes, which has been associated with a wide range of both acute and chronic illness. Poverty is thought to be a major driver of IPV, and economic empowerment programs may reduce violence.

OBJECTIVE

To evaluate whether microfinance interventions are associated with reductions in various forms of IPV.

DATA SOURCES

On August 3, 2022, PubMed, CINAHL, Embase, Web of Science, EconLit, and 5 global health databases were searched from inception.

STUDY SELECTION

Included studies were randomized clinical trials evaluating the effect of microfinance interventions vs control on exposure to IPV. This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline.

DATA EXTRACTION AND SYNTHESIS

Authors independently assessed study eligibility, extracted prespecified data, and evaluated risk of bias using the Cochrane Risk of Bias tool.

MAIN OUTCOMES AND MEASURES

Outcome measures of interest were exposure to overall IPV and 4 World Health Organization-designated IPV domains: physical, psychological and emotional, sexual, and controlling behaviors. Univariate meta-analyses using a random effects model were used to calculate the standardized mean differences (SMDs) and 95% CIs for each IPV outcome. The Grading of Recommendations Assessment, Development, and Evaluation method was used to rate the certainty of findings.

RESULTS

Overall, 10 randomized clinical trials met inclusion criteria, with a total of 16 136 participants, of whom 98% identified as women, with a mean age of 28.9 years. Compared with no intervention, participation in microfinance was associated with lower rates of psychological and emotional violence (SMD, 0.87; 95% CI, 0.80-0.95; I2 = 46%; high certainty), sexual violence (SMD, 0.76; 95% CI, 0.63-0.90; I2 = 44%; low certainty), and controlling behaviors (SMD, 0.82; 95% CI, 0.74-0.92; I2 = 54%; high certainty). There was no significant association with physical violence (SMD, 0.89; 95% CI, 0.76-1.04; very-low certainty).

CONCLUSIONS AND RELEVANCE

This systematic review and meta-analysis of microfinance interventions found a reduction in exposure to psychological and emotional IPV as well as controlling behaviors among participants receiving microfinance interventions, with high certainty evidence. Further work is needed to evaluate which types of microfinance interventions are most effective at reducing the various forms of IPV.

Burden of and risk factors for sexual violence among women with and without disabilities in two sub-Saharan African countries

Background

Available data suggest that women with disabilities have an increased risk of sexual violence, but little is known about the situation of those women living in resource-limited settings.

Objectives

To assess the burden and examine the drivers of sexual violence among women with disabilities.

Methods

This is a pooled analysis of two population-based surveys conducted in Cameroon and Burundi. Adults with and without disabilities were randomly recruited from the general population. Structured interviews were conducted at both sites to collect data on participants’ functional limitations, life-course history of sexual violence, education, employment, and resources. Only women with disabilities whose impairments started before the age of 10 years (n = 359) and women without disabilities (n = 720) are included in this analysis. The age-adjusted prevalence of violence was computed, and risk factors were assessed using a discrete survival regression and mediation analysis.

Results

At both sites, the participants with disabilities had a lower education level and had an increased risk of food insecurity. The pooled age-adjusted prevalence of lifetime sexual violence was 19.8% (95%CI:15.3–24.3) among women with disabilities and 11.7% (95%CI:9.3–14.1) among those without disabilities (OR_ap: 2.0, 95%CI:1.4–2.8). Women with cognitive limitations and those with visual impairments had the highest risk of sexual violence (OR_ap: 3.5 (95%CI:2.0–6.3) and 2.7 (95%CI:1.4–5.0), respectively). Over the life course, the risk of sexual violence was especially high among women with disabilities who had lived with an intimate partner before the age of 25 years (p < 0.001). Education level mediated approximately one-third of the total association between disability and sexual violence (p = 0.001). There was no evidence of an indirect effect through food insecurity.

Conclusion

This study provides evidence of the high burden of sexual violence among women with disabilities who live in urban African contexts. The social environment and access to education may be key contributors to this vulnerability.

A Descriptive Systematic Review of Food Insecurity and Intimate Partner Violence in Southern Africa

Food insecurity and intimate partner violence are important determinants of health and wellbeing in southern Africa. However, very little research has attempted to investigate the association between them even though food insecurity is anticipated to increase in the region, mostly owing to climate change. The objective of this paper was to descriptively review peer reviewed studies that investigated the relationship between food insecurity and intimate partner violence in southern Africa. Literature searches were carried out in Scopus, Web of Science and PubMed databases without any time restriction. A total of five studies that investigated the association between food insecurity and intimate partner violence were identified in South Africa and Swaziland. Of these four studies used a cross-sectional design, and one employed a longitudinal design. Samples varied from 406 to 2479 individuals. No empirical studies were found for the remaining southern African countries of Angola, Botswana, Malawi, Namibia, Zambia, Zimbabwe, Lesotho, and Mozambique. Moreover, the reported findings indicated that there was an association between food insecurity and interpersonal violence (i.e., physical, psychological, and emotional) in the sub-region regardless the fact that the five studies used diverse measurements of both food insecurity and intimate partner violence.

Exploring intimate partner violence among pregnant Eswatini women seeking antenatal care: How agency and food security impact violence-related outcomes

Women with agency (i.e. the ability to make choices and act on them) may experience reduced food insecurity (FI) and intimate partner violence (IPV). Reducing FI and IPV among women are global goals; however, research focused on agency among Eswatini women has been overlooked, though they experience high rates of FI and IPV. We analysed cross-sectional data from 406 Swazi women who sought care at one rural and one urban-public antenatal clinic in 2013-2014 to understand how FI and agency, our independent variables, are associated with IPV. We assessed the incidence rate ratio (IRR) of number of violent events (including emotional, physical and sexual IPV) in the previous 12 months using Poisson regressions. We found significant relationships between FI and IPV, where higher levels of FI were associated with IPV risk (weekly: IRR = 2.18, 95% CI = 1.82-2.61; Daily: IRR = 3.53, 95% CI = 2.89-4.32) and constrained agency increased women's risk of IPV (IRR = 1.44; 95% CI = 1.22-1.70). Our findings suggest that FI and agency independently impact women's experience(s) of IPV. Interventions focused on women simultaneously experiencing severe FI and constrained agency may have the highest impact; however, providing focused and moderate FI relief (e.g. reducing FI daily to monthly) could potentially reduce women's risk of experiencing violence.

Association between poor food production and intimate partner violence among smallholder farmers in northwestern Benin

Rates of intimate partner violence (IPV) remain concerningly high in Benin, particularly in the predominantly rural region of Atacora in the northwest. In the context of increasing food insecurity, concerns have been raised regarding the role that lack of food in the household may be playing in increasing the rate of IPV in this context. This study aims to investigate the association between household food production and IPV in Atacora, Benin. Using a social ecological model and drawing from family stress theory, we analysed data from a cross-sectional survey of 300 women in the study region. Logistic regression and sequential modelling results show that after controlling for individual, household and community level factors, insufficient food production is positively associated with women's likelihood of experiencing physical (adjusted OR=6.50 [2.48, 17.04], p < .01) and sexual violence (adjusted OR=4.49 [1.68, 11.99], p < .01). We conclude that production-oriented interventions in rural farming communities may reduce women's risk of IPV by increasing households' access to food and reducing family stress. Long term interventions would do well to focus on improving women's access to land and building capacity in the management of marital conflict without violence.

Food security for survivors of intimate partner violence: Understanding the role of food in survivor well-being

Intimate partner violence (IPV) and food security are two leading public health issues that disproportionately impact women in the United States. Despite this connection, the relationship between IPV and food security has been relatively unexplored. While food security is a known factor in increased well-being, it is not often explicitly included in care for survivors. As part of a larger study on survivors of domestic violence who are receiving services from a domestic violence and sexual assault agency in the Southern United States, we analysed participant responses (n = 26) to various scales (i.e. depression, anxiety, PTSD, disability, well-being, hope, food security) to determine the relationships between mental health and food-related variables. Importantly, findings from our study show that survivors experience low food security at higher rates (53.8%) than the U.S. national average (11.5%). Additionally, the proportion of survivors in our sample who are receiving some form of food aid and remain food insecure is high (26.9%), leading to questions about the adequacy of food aid. Finally, our results underpin the relationship between food security and mental health for survivors, as low food security is positively correlated with depression, PTSD, disability, trouble concentrating, lack of hope and decreased well-being. These findings have implications for how we evaluate food security and the role it plays in well-being for survivors.

Consensus from an expert panel on how to identify and support food insecurity during pregnancy: A modified Delphi study

BACKGROUND

Food insecurity and hunger during pregnancy have significant implications for the health of the mother and baby. Assisting clinicians when they encounter women who are experiencing hunger or food insecurity during their pregnancy will increase the opportunity for better birth and pregnancy outcomes. At present there are no guidelines for Australian clinicians on how to do this.

METHODS

This study uses a modified Delphi technique, allowing diverse participation in the process, to create consensus on the ways to address and respond to food insecurity during pregnancy. This modified Delphi collected data via two rounds of consensus. The opinions collected from the first round were thematically categorised and grouped. The topics were integrated into the survey for the second round and circulated to participants. During the second round, priorities were scored by giving five points to the topic considered most important, and one point to the least important.

RESULTS

Through two rounds of consultation, the panel achieved consensus on how to identify food insecurity during pregnancy, with some clear items of consensus related to interventions that could be implemented to address food insecurity during pregnancy. Experts achieved consensus on items that have importance at the institution and policy level, as well as services that exist in the community. The consensus across the spectrum of opportunities for assistance, from the clinical, to community-provided assistance, and on to government policy and practice demonstrate the complexity of this issue, and the multipronged approach that will be required to address it.

CONCLUSION

This is the first time such a consultation with experts on hunger and food insecurity during pregnancy has been conducted in Australia. Items that achieved consensus and the importance of the issue suggest several ways forward when working with pregnant women who are hungry and/or food insecure.

Development of a Comprehensive Household Food Security Tool for Families with Young Children and/or Pregnant Women in High Income Countries

Despite increasing rates of food insecurity in high income countries, food insecurity and its related factors are inconsistently and inadequately assessed, especially among households with young children (0-6 years) and pregnant women. To fill this gap, researchers from the U.S. and Australia collaborated to develop a comprehensive household food security tool that includes the known determinants and outcomes of food insecurity among parents of young children and pregnant women. A five-stage mixed methods approach, including a scoping literature review, key informant interviews, establishing key measurement constructs, identifying items and scales to include, and conducting cognitive interviews, was taken to iteratively develop this new comprehensive tool. The resulting 78-item tool includes the four dimensions of food security (access, availability, utilization, and stability) along with known risk factors (economic, health, and social) and outcomes (mental and physical health and diet quality). The aim of this novel tool is to comprehensively characterize and assess the severity of determinants and outcomes of food insecurity experienced by households with young children and pregnant women.

Women's Economic Abuse Experiences: Results from the UN Multi-Country Study on Men and Violence in Asia and the Pacific

Economic abuse is a poorly understood form of intimate partner violence but may have far-reaching implications for the financial health of the survivor. Additionally, very little is known about whether depressive symptoms, education, employment, or attitudes about relations between men and women mediate or moderate the relationship between economic abuse and their financial circumstances. The purpose of this study was to answer these two research questions: (a) Is there a relationship between the experience of economic abuse and food insecurity (as a measure of poverty)? (b) Is the relationship between economic abuse and food insecurity impacted by women's education, women's and men's employment, women's attitudes towards gender relations, or women's depressive symptoms? We used quantitative data from the "UN Multi-Country Study on Men and Violence," analyzing data on 3,105 women aged 18-49 years who were interviewed. Initial logistic regressions were conducted followed by introducing moderators and mediators to the model using path analyses to test the relationship between economic abuse and food insecurity in the household. Significant predictors of food insecurity included several types of abuse and partners' employment, women's own employment, and education. The only type of IPV not associated with food insecurity was physical abuse. Experiences of economic abuse were associated with a 1.69 times greater likelihood of reporting food insecurity which was higher than experiences of psychological or sexual abuse. Additionally, women's experiences of economic abuse over their lifetime were significantly associated with an increase in depressive symptoms which in turn was associated with greater likelihood of experiencing food insecurity. Such relationships warrant attention to economic abuse and depressive symptoms as part of the interventions used when working with survivors. Additional research could also help further our understanding of how these variables interact together and how best to address its impact on survivors.

Factors Associated with Food Insecurity among Pregnant Women and Caregivers of Children Aged 0-6 Years: A Scoping Review

With a global focus on improving maternal and child nutrition through the 2030 Sustainable Development Goals, it is important to understand food insecurity in pregnant women and families with young children, as food insecurity at these life stages can have ongoing negative health consequences. However, factors that influence food insecurity among this population group are not well understood. This scoping review investigates the factors that influence food insecurity among pregnant women and households with young children aged 0–6 years living in high-income countries. A scoping literature review was conducted using four electronic databases. The search combined terms relevant to: food security, determinants, pregnancy and family and high-income countries. Only full text and English language articles were included. The search identified 657 titles and abstracts; 29 articles were included in the review. A majority (70%) of the studies were conducted in the United States and were mostly either cross-sectional or secondary data analysis of existing population data. Factors associated with food insecurity were identified and grouped into 13 constructs. These included social, economic and health risk factors, food access and utilization factors and health and dietary outcomes. This scoping review identifies the factors associated with food insecurity among pregnant women and families with young children that could be used to better measure and understand food insecurity, which could assist in developing program and policy responses. This review also highlights the lack of literature from high-income countries outside the US.

Influence of Social Adversity on Perceived Health Status and Depressive Symptoms among Portuguese Older People

This study aims to investigate how exposure to poverty, food insecurity, and abuse at older ages relates to health outcomes. A questionnaire collecting data on sociodemographic and economic characteristics, health status, depressive symptoms, food insecurity, and abuse was administered to a sample of 677 older adults. Logistic regression was used to quantify the association of poverty, food insecurity, and abuse with perceived health status and depressive symptoms. If the older person only reported experiences of abuse, it was more likely to report the presence of depressive symptoms, even after adjustment for covariates. If it was only reported the experience of food insecurity, it was more likely to report a worse health status. Older people exposed to at least two factors of vulnerability were significantly more likely to report (very) poor perceived health status (OR: 7.11, 95% CI: 2.77–18.25) and the presence of relevant depressive symptoms (OR: 4.34; 95% CI: 2.04–9.22). Thus, the combined effect of vulnerabilities was significantly associated with worse health among older people. Public health policies to mitigate these adverse exposures should be developed to promote health and well-being in this population.

Intimate partner violence among reproductive-age women in central Gondar zone, Northwest, Ethiopia: a population-based study

BACKGROUND

Violence against women is the most widespread kind of human rights violation, and it has been linked to a wide range of consequences. The most prominent psychosocial and mental health concern that has serious effects for women's physical and mental well-being. This study assessed the prevalence and associated factors of women's violence by intimate partner among women in the reproductive age group (15-49).

METHODS

Multistage community-based cross-sectional study was conducted among reproductive age group women in the central Gondar zone. We recruited 845 participants and interviewed by health extension workers using face-to-face interviews. We used a Women's Abuse Screening test to outcome variable; it has a total score ranges 0-16, a score > 1 indicates positive for the presence of intimate partner violence within a year. Variables were coded and entered to Epi data version 3.1 and exported to SPSS version 21 for analysis. Descriptive statistics and multivariate logistic regression analysis was run for data analysis. Adjusted odds ratios (AOR) with a 95% confidence level (CI) were declared significant.

RESULT

Among a total of 845 participants 804 responded to the interviews with a response rate of 95%. The prevalence rate of intimate partner violence is 391(48.6%). From multivariate logistic regression analysis women being married [AOR:3.85; 95% CI (2.38, 6.22)], high school and above educational status [(AOR: 0.43; 95% CI (0.30, 0.61), women's having > 3children [(AOR: 1.82, 95% CI (1.0, 3.1)], having a household food insecurity[(AOR: 2.09, 95% CI (1.51, 2.91)], having life threatening events [(AOR: 2.09; 95% CI (1.51, 2.91)], moderate social support [(AOR: 0.60; 95% CI (0.41, 0.83)], depression [(AOR: 3.12; 95% CI (1.60, 6.07) were significantly associated with violence by intimate partner at 95% CI .

CONCLUSION

Intimate partner violence is common among reproductive-age women. Married, women with several children, food insecurity, life-threatening events, and depression were all found to be significant predictors of violence. Measures should be taken to raise community awareness, particularly among intimate partners, their families, and government officials.

The link between food insecurity and psychological distress: The role of stress exposure and coping resources

This study examines the association between food insecurity and mental health over a 3-year period. It also assesses the salience of life stressors and psychosocial coping resources for this association. We utilize data from a two-wave community survey of Miami-Dade County, Florida residents (N = 1488). Findings from SEM analysis reveal that greater food insecurity at W1 is associated with greater depressive symptoms at W2, lending credence to characterizations of food insecurity as a chronic stressor. This association is partly mediated by variation over the study period in social support and mastery. However, no significant mediating effects are observed for the social stress indicators assessed. Food insecurity is associated with diminished psychosocial coping resources, which leads to greater psychological distress. We discuss how these findings extend a stress and coping model of food insecurity, and implications for research and practice.

Independent and combined associations of intimate partner violence and food insecurity on maternal depression and generalized anxiety disorder

While research has investigated intimate partner violence (IPV) and food insecurity (FI) as independent experiences on mental health, research is lacking on the possible longitudinal associations of combined experiences of IPV and FI on maternal depression and generalized anxiety disorder (GAD). Using data from the Fragile Families and Child Wellbeing study (n = 1440), the current study examined the independent and combined associations of IPV and FI mothers experienced 3-5 years after their child's birth on depression and GAD at Year 15. Five mutually exclusive dichotomous variables were created based on IPV and FI experiences during Year 3 and Year 5. Depression and GAD were measured at Year 15 using the Composite International Diagnostic Interview-Short Form. According to the covariate-adjusted logistic regression models, exposure to IPV and FI, both concurrently and independently predicted greater depression at Year 15. Mothers in all IPV and FI categories had greater odds of having GAD at Year 15 compared to those with no exposure. Compared to the independent effect of IPV and FI, the combined effect of IPV and FI was highly associated with maternal GAD, but not depression. Using a trauma-informed approach to counseling in combination with food assistance programs might be an effective strategy in preventing mental health symptoms.

Applying a Health Access Framework to Understand and Address Food Insecurity

The prevalence of food insecurity (FI) in United States households has fluctuated between 10% and 15% for the past two decades, well above the Healthy People 2030 goal. FI is associated with increased use of healthcare services and the prevalence of multiple health conditions. Our current efforts to address FI may be limited by measures that lack granularity, timeliness, and consideration of larger food access barriers (e.g., availability of food providers and lack of knowledge regarding where to obtain food). If the Healthy People 2030 goal of reducing FI to 6% is to be met, we need better and faster methods for monitoring and tracking FI in order to produce timely interventions. In this paper, we review key contributors of FI from an access barrier perspective, investigate the limitations of current FI measures, and explore how data from one nonprofit organization may enhance our understanding of FI and facilitate access to resources at the local level. We also propose a conceptual framework illustrating how nonprofit organizations may play an important role in understanding and addressing FI and its intertwined social needs, such as housing and healthcare problems.

Food insecurity and men's perpetration of partner violence in a longitudinal cohort in South Africa

BACKGROUND

Although food insecurity has been associated with intimate partner violence (IPV), few studies examine it longitudinally or among male perpetrators.

METHODS

We used secondary data from a trial that followed 2479 men in a peri-urban settlement in South Africa (February 2016-August 2018). Men self-completed questionnaires at baseline (T0), 12 months (T1) and 24 months (T2) on food security, household type, relationship status, childhood abuse exposure, alcohol use, and perpetration of physical and/or sexual IPV. Cross-lagged dynamic panel modelling examines the strength and direction of associations over time.

RESULTS

At baseline, rates of IPV perpetration (52.0%) and food insecurity (65.5%) were high. Food insecure men had significantly higher odds of IPV perpetration at T0, T1 and T2 (ORs of 1.9, 1.4 and 1.4, respectively). In longitudinal models, food insecurity predicted men's IPV perpetration 1 year later. The model had excellent fit after controlling for housing, relationship status, age, childhood abuse and potential effect of IPV on later food insecurity (standardised coefficient=0.09, p=0.031. root mean squared error of approximation=0.016, comparative fit index=0.994). IPV perpetration did not predict later food security (p=0.276).

CONCLUSION

Food insecurity had an independent, longitudinal association with men's IPV perpetration in a peri-urban South African settlement. These findings suggest food security could be a modifiable risk factor of partner violence.

TRIAL REGISTRATION NUMBER

NCT02823288.

Factors Associated with Domestic Violence in Rural Bangladesh

Women's experience of domestic violence has adverse consequences on women's health globally and is itself affected by several factors. This study aims to determine the factors that are associated with experience of any form of domestic violence in rural Bangladesh. Data were derived from the baseline survey database of Suchana, a large-scale nutrition program in Bangladesh. Data of 5,440 women from poor households in rural areas were analyzed. Descriptive statistics were used to summarize the data. Multilevel logistic regression analysis was conducted to determine the factors that were significantly associated with experiencing any form of domestic violence. The prevalence of women experiencing domestic violence was found to be 35% and household food insecurity was 86%. Of the women's characteristic domain, age at marriage, lack of any support from household members, visit from non-governmental organizations (NGO) health professionals, number of children, and decision-making power of women at the household level were significantly associated with reporting of domestic violence. Of the household characteristic domain, the associated factors were having a male household head, increased household size, low socio-economic status, having a loan, experience of at least one crisis event, and household food insecurity. The strength of association between household food insecurity and domestic violence was higher among poor families. Experience of domestic violence is inevitably associated with women's decision-making power and household food insecurity. Behavioral change communication interventions may help to positively affect decision-making power but a holistic approach needs to be undertaken to reduce food insecurity, for which the underlying mechanism of food insecurity in Bangladesh needs to be explored further.

Risk Factors for Veteran Food Insecurity: Findings from a National US Department of Veterans Affairs Food Insecurity Screener

Objective:

Food insecurity is associated with numerous adverse health outcomes. The US Veterans Health Administration (VHA) began universal food insecurity screening in 2017. This study examined prevalence and correlates of food insecurity among Veterans screened.

Design:

Retrospective cross-sectional study using VHA administrative data. Multivariable logistic regression models were estimated to identify sociodemographic and medical characteristics associated with a positive food insecurity screen.

Setting:

All US Veterans Administration (VA) medical centres (n 161). Participants: All Veterans were screened for food insecurity since screening initiation (July 2017–December 2018).

Results:

Of 3 304 702 Veterans screened for food insecurity, 44 298 were positive on their initial screen (1·3 % of men; 2·0 % of women). Food insecurity was associated with identifying as non-Hispanic Black or Hispanic. Veterans who were non-married/partnered, low-income Veterans without VA disability-related compensation and those with housing instability had higher odds of food insecurity, as did Veterans with a BMI < 18·5, diabetes, depression and post-traumatic stress disorder. Prior military sexual trauma (MST) was associated with food insecurity among both men and women. Women screening positive, however, were eight times more likely than men to have experienced MST (48·9 % v. 5·9 %).

Conclusions:

Food insecurity was associated with medical and trauma-related comorbidities as well as unmet social needs including housing instability. Additionally, Veterans of colour and women were at higher risk for food insecurity. Findings can inform development of tailored interventions to address food insecurity such as more frequent screening among high-risk populations, onsite support applying for federal food assistance programs and formal partnerships with community-based resources.

Women's dual centrality in food security solutions: The need for a stronger gender lens in food systems' transformation

Food insecurity remains a critical issue worldwide. The current COVID-19 crisis has exposed how vulnerable the global food systems are and that urgent measures need to be taken, especially in the Global South. Despite increased recognition that women are among the most food insecure yet major contributors to local and global food security over the recent years, there has not been a systemic change needed in the current food security paradigm. This paper argues that, in developing countries, a stronger gender lens ought to be at the center to the food systems' debate as women are critical to agriculture and food systems' sustainability and resilience. Women are central to food systems, both as primary food producers and as primary caretakers of the household. Three key recommendations are put forward in this article for establishing inclusive, sustainable and resilient food systems: One, ensuring a stronger gender lens in food systems and food security paradigms; by working with accurate sex-disaggregated data and beyond on individuals' level. Two, promoting and supporting alternative strategies to agriculture as a means of livelihood for women. Three, ensuring that women are central in food security solutions by not only listening to their concerns and needs, but also building on their resilience, knowledge, and practices.

Factors Associated with Attitude towards Wife-Beating among Married Women of the Reproductive Ages in Arba Minch Town, Southern Ethiopia: A Community-Based Cross-Sectional Study

Evidence from demographic and health surveys in various countries and Ethiopia too showed that more women are generally believed to justify intimate partner violence (IPV) than men do. An attitude that justifies IPV is one of the factors affecting victimization and perpetration from IPV. However, women's justification about the violence and factors affecting the justification are not well documented, particularly by addressing household factors such as household food conditions. Therefore, the present study aims to fill this gap among married women of childbearing age so that evidence can be drawn for holistic interventions. A community-based cross-sectional study was conducted among 696 currently married women of childbearing age (15–49) by using a multistage cluster sampling technique to obtain the women from 11 kebeles (the smallest administrative unit in the government structure of Ethiopia) of Arba Minch town, Southern Ethiopia. Data were collected using a pretested and structured questionnaire. Logistic regression was performed using IBM SPSS version 20. The odds ratio with its 95% confidence interval was used to show the degree of association between the outcome variable and explanatory variables. Nearly two-thirds (59.5%) of the study women justified wife-beating in at least one of the five conditions. A higher odds of justification of wife-beating was observed among women whose marriage was arranged by any other person than the couples themselves, from food-insecure households, with a family size of 5 and above, in the age group of 30–39 years, and whose partner was in the age range of 31–39 years. In contrast, lower odds of justification of wife-beating was observed among women having an age difference of 10 or more years with their partner and those in a household wealth index of middle and higher category. Despite great efforts in realizing gender equality in the country, a higher proportion of women were having the attitude that justifies wife-beating in the five conditions specified to them. Interventions targeting the improvement of women's attitude towards wife-beating should target against the traditional norms of arranged marriage, improve household food conditions, and decrease family size.

Intersections of food insecurity, violence, poor mental health and substance use among US women living with and at risk for HIV: Evidence of a syndemic in need of attention

Background

Food insecurity and intimate partner violence (IPV) are associated with suboptimal HIV prevention and treatment outcomes, yet limited research has explored how food insecurity and IPV intersect to influence HIV-related behaviors. To fill this gap, we conducted a qualitative study with women living with or at risk for HIV in the United States.

Methods

We conducted 24 in-depth interviews with women enrolled in the San Francisco and Atlanta sites of the Women’s Interagency HIV study (WIHS). Participants were purposively sampled so half were living with HIV and all reported food insecurity and IPV in the past year. Semi-structured interviews explored experiences with food insecurity and IPV, how these experiences might be related and influence HIV risk and treatment behaviors. Analysis was guided by an inductive-deductive approach.

Results

A predominant theme centered on how food insecurity and IPV co-occur with poor mental health and substance use to influence HIV-related behaviors. Women described how intersecting experiences of food insecurity and IPV negatively affected their mental health, with many indicating using substances to “feel no pain”. Substance use, in turn, was described to perpetuate food insecurity, IPV, and poor mental health in a vicious cycle, ultimately facilitating HIV risk behaviors and preventing HIV treatment adherence.

Conclusions

Food insecurity, IPV, poor mental health and substance use intersect and negatively influence HIV prevention and treatment behaviors. Findings offer preliminary evidence of a syndemic that goes beyond the more widely studied “SAVA” (substance use, AIDS, and violence) syndemic, drawing attention to additional constructs of mental health and food insecurity. Quantitative research must further characterize the extent and size of this syndemic. Policies that address the social and structural drivers of this syndemic, including multi-level and trauma-informed approaches, should be implemented and evaluated to assess their impact on this syndemic and its negative health effects.

COVID-19-Related Assault on Asians: Economic Hardship in the United States and India Predicts Diminished Support for Victim Compensation and Assailant Punishment

Background: There has been an alarming increase in discrimination and violence towards Asians during the coronavirus (COVID-19) pandemic amid reports that the virus was first detected in China. In an incident involving a COVID-19-related physical assault, this study examined whether economic hardship experienced by participants during the pandemic and the race of the victim (Chinese, White) would influence support to compensate a victim and punish the assailant. The study also explored whether the perception that the victim experienced emotional and physical suffering due to the assault would mediate the relationships. Method: Participants in India and the United States reported on their own economic hardship due to the pandemic. They then read about an incident in which an innocent person suffered a COVID-19-related physical and verbal attack, and indicated if they would support punishing the assailant and financially compensating the victim. Results: When the victim was Chinese, participants experiencing a high degree of COVID-19 economic hardship were less likely to support financially compensating the victim or punishing the assailant compared to when the victim was White. Furthermore, when the victim was Chinese, the negative associations between economic hardship and financially compensating the victim and punishing the assailant were mediated by reduced recognition that the victim suffered emotional trauma and pain as a result of the attack. Conclusions: COVID-19-driven economic hardship experienced by participants predicted an array of reactions that reflected reduced recognition of the civil and human rights of a victim of a COVID-19-related assault. These findings have significant implications for mental health, public health, and the justice system, and underscore the pressing need for prompt action to mitigate economic hardship and to address racism and discrimination.

A global collaboration to study intimate partner violence-related head trauma: The ENIGMA consortium IPV working group

Intimate partner violence includes psychological aggression, physical violence, sexual violence, and stalking from a current or former intimate partner. Past research suggests that exposure to intimate partner violence can impact cognitive and psychological functioning, as well as neurological outcomes. These seem to be compounded in those who suffer a brain injury as a result of trauma to the head, neck or body due to physical and/or sexual violence. However, our understanding of the neurobehavioral and neurobiological effects of head trauma in this population is limited due to factors including difficulty in accessing/recruiting participants, heterogeneity of samples, and premorbid and comorbid factors that impact outcomes. Thus, the goal of the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Consortium Intimate Partner Violence Working Group is to develop a global collaboration that includes researchers, clinicians, and other key community stakeholders. Participation in the working group can include collecting harmonized data, providing data for meta- and mega-analysis across sites, or stakeholder insight on key clinical research questions, promoting safety, participant recruitment and referral to support services. Further, to facilitate the mega-analysis of data across sites within the working group, we provide suggestions for behavioral surveys, cognitive tests, neuroimaging parameters, and genetics that could be used by investigators in the early stages of study design. We anticipate that the harmonization of measures across sites within the working group prior to data collection could increase the statistical power in characterizing how intimate partner violence-related head trauma impacts long-term physical, cognitive, and psychological health.

Food Insecurity and Intimate Partner Violence Among HIV-Positive Individuals in Rural Kenya

INTRODUCTION

Intimate partner violence and food insecurity are both structural drivers of HIV acquisition, care, and treatment, but little is known about how the 2 conditions intersect in the lives of those already living with HIV.

METHODS

This study examined cross-sectional baseline data (collected in January 2016-December 2017) from an ongoing trial in southwestern Kenya. Trained interviewers asked enrolled participants living with HIV aged 18-60 years about household food insecurity (using the Household Food Insecurity Access Scale), intimate partner violence (using an adapted WHO multicountry study instrument), and sociodemographics. Negative binomial regression was used to examine the association between food insecurity and partner violence victimization (among women) or perpetration (among men). Secondary data were analyzed in August 2019-March 2020.

RESULTS

Of 720 participants, more than half of women reported experiencing intimate partner violence (57.6%) and most men reported perpetrating it (58.4%). Participants reporting any partner violence had higher Household Food Insecurity Access Scale scores (21.8) compared with those reporting no violence (21.3, p=0.02). Each categorical change in food insecurity (mild, moderate, severe) was associated with a 41% increased risk of an additional partner violence episode. In models controlling for relationship status, wealth, season of interview (lean versus not lean), and baseline physical health, each 1-point increase in food insecurity was associated with a 6% higher risk of violence victimization among women and 4% greater risk of men perpetrating partner violence.

CONCLUSIONS

This study highlights the interconnected nature of intimate partner violence and food insecurity among women and men living with HIV. This relationship suggests that enhancing food security may be a useful intervention strategy to prevent intimate partner violence and improve HIV-related health outcomes.

Household food insecurity and its association with self-reported male perpetration of intimate partner violence: a survey of two districts in central and western Uganda

OBJECTIVES

This study aimed to determine the lifetime prevalence of male-perpetrated intimate partner violence (IPV), and to assess the association with food insecurity, sociodemographic factors and health risk behaviours in Uganda in the year preceding COVID-19-associated lockdowns.

DESIGN

Population-based, cross-sectional household survey.

SETTING

Urban, semiurban and rural communities of the Wakiso and Hoima districts in Uganda.

PARTICIPANTS

A total of N=2014 males aged 13-80 years participated in the survey. The current study included males who reported having ever been in a sexual union and responded to the IPV questions (N=1314).

MEASURES

Data were collected face-to-face from May 2018 to July 2019 using an interviewer-mediated questionnaire. Lifetime IPV perpetration was measured as 'no physical and/or sexual IPV', 'physical' versus 'sexual violence only', and 'physical and sexual violence'. Past-year food insecurity was measured through the Food Insecurity Experience Scale and categorised into 'none', 'low' and 'high'. Multinomial logistic regression was used to determine the crude and adjusted relative risk ratios (aRRRs) of IPV perpetration in relation to self-reported food insecurity, adjusting for sociodemographic and health risk behaviours.

RESULTS

The prevalence of self-reported lifetime IPV perpetration was 14.6% for physical and 6.5% for sexual violence, while 5.3% reported to have perpetrated both physical and sexual IPV. Most (75.7%) males reported no food insecurity, followed by low (20.7%) and high (3.6%) food insecurity. In adjusted models, food insecurity was associated with increased risk of having perpetrated both physical and sexual violence (aRRR=2.57, 95% CI 1.52 to 4.32). IPV perpetration was also independently associated with having had more than one lifetime sexual partner and drinking alcohol, but not with education level or religion.

CONCLUSION

This study suggests that food insecurity is associated with male IPV perpetration, and more efforts are needed to prevent and mitigate the expected worsening of this situation as a result of the COVID-19 pandemic.

Persistence and transience of food insecurity and predictors among residents of two disadvantaged communities in South Carolina

BACKGROUND

Little is known about patterns of household food insecurity (HFI) across more than two time points in adults in the United States, the frequency predictors of different trajectories. The distinctions between persistent and transient food insecurity trajectories may be crucial to developing effective interventions.

OBJECTIVE

To characterize dominant trajectories of food security status over three time points between 2013 and 2016 and identify demographic, socioeconomic and health-related predictors of persistent and transient HFI.

DESIGN

Cohort study in disadvantaged communities in South Carolina.

SETTING

and subjects: 397 middle-aged participants, predominantly female, African American, living in USDA-designated food deserts.

MAIN OUTCOME MEASURE

Household food insecurity over time using the 18-item USDA's Household Food Security Survey Module.

STATISTICAL ANALYSES PERFORMED

Descriptive analyses of food security trajectories and multinomial regression analyses.

RESULTS

At baseline (2013-2014), 61% of households reported HFI during the previous 12 months, which decreased to 54% in 2015 and to 51% in 2016. Only 27% of households were persistently food secure, 36% experienced transient and 37% persistent food insecurity. Female sex (OR 2.7, 95%CI 1.2-5.9), being married or living with a partner (OR 2.4, 95CI% 1.1-5.3) and fair health status (OR 4.4, 95%CI 2.2-8.8) were associated with increased odds of persistent food insecurity. Fair health was also a significant predictor of transient food insecurity.

CONCLUSIONS

These findings suggest that future research should focus on persistent versus transient trajectories separately and that tailored interventions may be needed to make progress on alleviating food insecurity among disadvantaged communities.

New learnings on drivers of men's physical and/or sexual violence against their female partners, and women's experiences of this, and the implications for prevention interventions

Background: Understanding the drivers of intimate partner violence (IPV), perpetrated by men and experienced by women, is a critical task for developing effective prevention programmes.Objectives: To provide a comprehensive assessment of the drivers of IPV.Methods: A comprehensive review of the drivers of IPV, at the end of a six-year programme of research through the What Works to Prevent Violence Against Women and Girls Global Programme with reference to other important research in the field.Results: Broadly, we argue that IPV is driven by poverty, patriarchal privilege, and the normative use of violence in interpersonal relationships. These factors also increase childhood trauma, poor mental health and substance misuse, and poor communication and conflict in relationships, which in turn impact on IPV. Disability status, and contexts of armed conflict, or post-conflict, further reinforce and exacerbate these risks. We move beyond describing associations towards describing the causal pathways through which these factors operate to increase IPV.Conclusions: Specific recommendations about the future of further research on drivers of IPV include a greater focus on understanding the causal pathways from drivers to IPV and clearly delineating association from causality in studies, particularly for women and girls with disabilities, in armed conflicts, and adolescent girls and young women. To achieve this, we recommend extensive in-depth qualitative research, and complex quantitative modeling studies. Understanding drivers and causal pathways better will enable the identification of points of entry for the development of more effective IPV prevention interventions.

Frequency of Intimate Partner Violence among an Urban Emergency Department Sample: A Multilevel Analysis

Intimate partner violence (IPV) is a pervasive public health problem. Within the U.S., urban emergency department (ED) patients have elevated prevalence of IPV, substance use, and other social problems compared to those in the general household population. Using a social-ecological framework, this cross-sectional study analyzes the extent to which individual, household, and neighborhood factors are associated with the frequency of IPV among a socially disadvantaged sample of urban ED patients. Confidential survey interviews were conducted with 1037 married/partnered study participants (46% male; 50% Hispanic; 29% African American) at a public safety-net hospital. Gender-stratified multilevel Tobit regression models were estimated for frequency of past-year physical IPV (perpetration and victimization) and frequency of severe IPV. Approximately 23% of participants reported IPV. Among men and women, impulsivity, adverse childhood experiences, substance use, and their spouse/partner's hazardous drinking were associated with IPV frequency. Additionally, household food insufficiency, being fired or laid off from their job, perceived neighborhood disorder, and neighborhood demographic characteristics were associated with IPV frequency among women. Similar patterns were observed in models of severe IPV frequency. IPV prevention strategies implemented in urban ED settings should address the individual, household, and neighborhood risk factors that are linked with partner aggression among socially disadvantaged couples.

Food Insecurity Predicts Urban Gun Violence

INTRODUCTION

Food insecurity (FI), defined as inadequate access to affordable and quality nutrition, has negative health consequences. FI and violence share similar root causes. The aim of this study was to determine the association of FI with gunshot injury (GSI) incidence.

METHODS

We performed a retrospective review of all patients from 2012 to 2018 who sustained a GSI. Food access data was abstracted from the US Department of Agriculture. We analyzed the impact of FI, low food access (LA), and low food access with no vehicle (LANV) on the incidence of GSI using Poisson regression. We also compared high-risk zip codes for GSI, FI, LA, and LANV using geospatial analysis.

RESULTS

There were 1700 patients in our cohort from 33 different zip codes. The median incidence of GSI per zip code was 142 (85-164); 5 zip codes comprised 50% of all GSI events. FI (incidence rate ratio [IRR] 4.05, 95% CI 3.98-4.13, P < .0001), LA (IRR 2.97, 95% CI 2.92-3.03. P < .0001), and LANV (IRR 2.58, 95% CI 2.55-2.62, P < .0001) were significant predictors of GSI incidence. The FI model was superior to the LA and LANV models. Geospatial analysis demonstrated that both FI (P < .0001) and LANV (P < .0001) were significantly associated with GSI, while LA was not (P > .05).

CONCLUSION

FI is an independent risk factor for GSI incidence. Additionally, a majority of GSI events occur in a minority of communities. These data provide a novel opportunity for social services to guide future violence prevention strategies.

Sub-optimal household water access is associated with greater risk of intimate partner violence against women: evidence from Nepal

Household water management is often women's responsibility, as related to the gendered nature of household roles. Ethnographic data suggest that household water insecurity could increase women's exposure to emotional and physical forms of intimate partner violence (IPV), as punishments for failures to complete socially expected household tasks that rely on water (like cooking and cleaning) and the generally elevated emotional state of household members dealing with resource scarcity. Here, we test the associations between sub-optimal household water access and women's exposure to IPV, using the nationally-representative data from Nepal Demographic and Health Survey, 2016. Drawing upon the intra-household bargaining model as the theoretical framework, we run instrumental variable probit regression, to test the association between household water access and prevalence of IPV against women. After controlling for other known covariates of IPV such as women's empowerment and education, the findings substantiate that worse household water access consistently elevates women's exposures to all forms of IPV. This suggests that improvements in household water access may have additional ramifications for reducing women's risk of IPV, beyond currently recognized socioeconomic benefits. While both household water access and IPV have known health consequences, linking them provides another pathway through which water could affect women's health.