Correlates of intimate partner violence among men and women in an inner city emergency department

Identifying best practices for substance-related intimate partner violence screening and referral: a narrative review

Introduction

Substance use is strongly associated with intimate partner violence (IPV) and is a modifiable risk factor for IPV. However, lack of comprehensive screening and referral for co-occurring IPV and substance use, along with their psychiatric sequalae, limits the identification and implementation of effective interventions for substance-related IPV. This narrative review (1) investigates the literature on screening and referral practices for IPV, and if these include screening for substance use or other psychiatric comorbidities, (2) provides recommendations for current best practices, and (3) suggests future directions for research and practice aimed at identifying and reducing substance-related IPV.

Methods

A narrative literature review examined studies investigating IPV screening and referral programs in clinics. Selected studies were reviewed for: (1) effectiveness, (2) barriers to implementation and sustainability, and (3) responsivity to psychiatric comorbidity, including substance use and substance use disorders (SUD).

Results

Findings suggest that effective IPV screening and referral programs have been developed, but disparities in IPV screening exist and many programs only screen for IPV victimization. Barriers to the implementation and sustainability of IPV screening programs include lack of ongoing provider training, funding or institutional support, and direct connection to referral services. Further, many IPV screening programs lack assessment of and referral for comorbid psychiatric conditions, including substance use, and tend not to be routinely implemented in SUD clinics.

Discussion

Additional systematic work is needed to develop universal and comprehensive screening and referral programs for substance-related IPV and address issues of long-term sustainability, particularly within SUD treatment settings.

Gender moderates the association between posttraumatic stress disorder and mutual intimate partner violence in an emergency department sample

INTRODUCTION

Patients in emergency departments (EDs) constitute a diverse population with multiple health-related risk factors, many of which are associated with intimate partner violence (IPV). This paper examines the interaction effect of depression, posttraumatic stress disorder (PTSD), impulsivity, drug use, adverse childhood experiences (ACEs), at-risk drinking, and having a hazardous drinker partner with gender on mutual physical IPV in an urban ED sample.

METHODS

Research assistants surveyed 1037 married, cohabiting, or partnered patients in face-to-face interviews (87% response rate) regarding IPV exposure, alcohol and drug use, psychological distress, ACEs, and other sociodemographic features. IPV was measured with the Revised Conflict Tactics Scale. Interaction effects were examined in multinomial and logistic models.

RESULTS

Results showed a significant interaction of gender and PTSD (odds ratio [OR] 3.06, 95% CI 1.21-7.23, p < 0.05) for mutual IPV. Regarding main effects, there were also statistically significant positive associations between mutual physical IPV and at-risk drinking (OR 1.73, 95% CI 1.07-2.77, p < 0.05), having a hazardous drinker partner (OR 2.19, 95% CI 1.35-3.55, p < 0.01), illicit drug use (OR 2.09, 95% CI 1.18-3.71, p < 0.01), ACEs (OR 1.23, 95% CI 1.06-1.42, p < 0.01), days of cannabis use past in the 12 months (OR 1.003, 95% CI 1.002-1.005, p < 0.001), and impulsivity (OR 2.04, 95% CI 1.29-3.22, p < 0.01).

CONCLUSIONS

IPV risk assessment in EDs will be more effective if implemented with attention to patients' gender and the presence of various and diverse other risk factors, especially PTSD.

Association of Cannabis Use and At-Risk Alcohol Use With Intimate Partner Violence in an Urban ED Sample

INTRODUCTION

Urban ED patients have elevated rates of substance use and intimate partner violence. The purpose of this study is to describe the risk profiles for intimate partner violence among urban ED patients who report at-risk alcohol use only, cannabis use only, or both types of substance use.

METHODS

Cross-sectional survey data were collected from study participants (N = 1037; 53% female; ages 18-50) following informed consent. We measured participants' past-year at-risk drinking (women/men who had 4+/5+ drinks in a day), cannabis use, psychosocial and demographic characteristics, and past-year physical intimate partner violence (assessed with the Revised Conflict Tactics Scale). We used bivariate analysis to assess whether rates of intimate partner violence perpetration and victimization differed by type of substance use behavior. Multivariate logistic regression models were estimated for each intimate partner violence outcome. All analyses were stratified by gender.

RESULTS

Rates of intimate partner violence differed significantly by type of substance use behavior and were highest among those who reported both at-risk drinking and cannabis use. Multivariate analysis showed that women who reported at-risk drinking only, cannabis use only, or both types of substance use had increased odds for intimate partner violence perpetration and victimization compared with women who reported neither type of substance use. Men's at-risk drinking and cannabis use were not associated with elevated odds of intimate partner violence perpetration or victimization.

DISCUSSION

Brief screening of patients' at-risk drinking and cannabis use behaviors may help identify those at greater risk for intimate partner violence and those in need of referral to treatment.

Upper extremity fractures due to intimate partner violence versus accidental causes

Purpose

The purpose of this study is to evaluate the prevalence of intimate partner violence (IPV)-related upper extremity fractures (UEF) in women presenting to US emergency departments (ED) and compare their anatomic location to those due to accidental falls or strikes.

Methods

An Institutional Review Board exempt, retrospective review of prospectively collected data was performed using the National Electronic Injury Surveillance System’s All Injury Program data from 2005 through 2015 for all UEF sustained in women 15 to 54 years old. Injuries based on reported IPV versus accidental falls or strikes were analyzed accounting for the weighted, stratified nature of the data.

Results

IPV-related UEF represented 1.7% of all UEF and 27.2% of all IPV fractures. The finger was the most common fracture site in IPV (34.3%) and accidental striking (53.3%) but accounted for only 10% of fall-related UEF. There was a higher proportion of shoulder fractures in IPV (9.2%) compared to accidental falls (7.4%) or strikes (2.9%). The odds of a finger fracture were 4.32 times greater in IPV than falling and of a shoulder fracture were 3.65 greater in IPV than accidental striking (p < 0.0001).

Conclusions

While the finger is the most common site for IPV UEF, it is also the most common location for accidental striking. A lower proportion of finger fractures in fall and of shoulder/forearm fractures in accidental striking should prompt the radiologist to discuss the possibility of IPV with the ED physician in any woman presenting with a finger fracture due to fall and a shoulder/forearm fracture with a vague history of accidental striking.

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.

Drinking Context-Specific Dose-Response Models of Intimate Partner Violence Among an Urban Emergency Department Sample

OBJECTIVE

This cross-sectional study evaluates the association between physical intimate partner violence (IPV) and frequencies of drinking and volume consumed in six different contexts among a sample of urban emergency department (ED) patients.

METHOD

We obtained survey data from 1,037 married, cohabiting, or partnered patients (53% female; 50% Hispanic; 29% African American) at a Northern California safety-net hospital. Past-year physical IPV was measured with the Revised Conflict Tactics Scale. We asked patients about frequency of drinking and usual number of drinks consumed at bars, restaurants, homes of friends or relatives, own home, public places such as street corners or parking lots, and community centers or large events. Gender-stratified dose-response models were estimated for frequencies of IPV perpetration and victimization, with adjustment for sociodemographic and psychosocial factors, marijuana use, and spouse/partner problem drinking.

RESULTS

None of the women's context-based frequency and volume measures were associated with frequency of IPV victimization. Women's volume of alcohol consumed at home was associated positively with frequency of their IPV perpetration (β = .008, SE = .003, p < .01), and volume consumed in public places was associated negatively with this outcome (β = -.023, SE = .010, p < .05). Among men, none of the context-based frequency and volume measures were associated with frequency of either IPV outcome. Spouse/partner's problem drinking was associated with each gender's IPV victimization, and with IPV perpetration by men.

CONCLUSIONS

Frequency of drinking and volume consumed in specific contexts do not substantively contribute to frequency of IPV perpetration or victimization in this sample of urban ED patients.

Co-Occurrence of Multiple Risk Factors and Intimate Partner Violence in an Urban Emergency Department

INTRODUCTION

Urban emergency departments (ED) provide care to populations with multiple health-related and overlapping risk factors, many of which are associated with intimate partner violence (IPV). We examine the 12-month rate of physical IPV and its association with multiple joint risk factors in an urban ED.

METHODS

Research assistants surveyed patients regarding IPV exposure, associated risk factors, and other sociodemographic features. The joint occurrence of seven risk factors was measured by a variable scored 0-7 with the following risk factors: depression; adverse childhood experiences; drug use; impulsivity; post-traumatic stress disorder; at-risk drinking; and partner's score on the Alcohol Use Disorders Identification Test. The survey (N = 1037) achieved an 87.5% participation rate.

RESULTS

About 23% of the sample reported an IPV event in the prior 12 months. Logistic regression showed that IPV risk increased in a stepwise fashion with the number of present risk factors, as follows: one risk factor (adjusted odds ratio [AOR] [3.09]; 95% confidence interval [CI], 1.47-6.50; p<.01); two risk factors (AOR [6.26]; 95% CI, 3.04-12.87; p<.01); three risk factors (AOR = 9.44; 95% CI, 4.44-20.08; p<.001); four to seven risk factors (AOR [18.62]; 95% CI, 9.00-38.52; p<001). Ordered logistic regression showed that IPV severity increased in a similar way, as follows: one risk factor (AOR [3.17]; 95% CI, 1.39-7.20; p<.01); two risk factors (AOR [6.73]; 95% CI, 3.04-14.90; p<.001); three risk factors (AOR [10.36]; 95%CI, 4.52-23.76; p<.001); four to seven risk factors (AOR [20.61]; 95% CI, 9.11-46.64; p<001).

CONCLUSION

Among patients in an urban ED, IPV likelihood and IPV severity increase with the number of reported risk factors. The best approach to identify IPV and avoid false negatives is, therefore, multi-risk assessment.

Problem Drinking and Marijuana Use as Risks for Unidirectional and Bidirectional Partner Violence

Despite evidence that most who perpetrate intimate partner violence (IPV) also report victimization, little is known about bidirectional IPV among Emergency Department (ED) patients and its association with problem drinking and marijuana use. We conducted an observational, cross-sectional survey among low- and moderate-acuity patients at a Northern California safety-net ED. Physical IPV was measured with the Revised Conflict Tactics Scale (CTS2). We recorded patient's frequency of intoxication and marijuana use. Spouse/partner's problem drinking and marijuana use were measured dichotomously. Odds Ratios [ORs] and 95% confidence intervals [CIs] were estimated using multinomial logistic regression models of unidirectional and bidirectional IPV. Among 1,037 patients (53% female), perpetration only, victimization only, and bidirectional IPV were reported by 3.8%, 6.2%, and 13.3% of the sample, respectively. Frequency of intoxication was associated with perpetration (OR 1.50; 95% CI 1.18 to 1.92) and bidirectional IPV (OR=1.34; 95% CI 1.13 to 1.58). Days of marijuana use were associated with bidirectional IPV (OR=1.15; 95% CI 1.03 to 1.28). Patients whose partners were problem drinkers were at risk for victimization (OR=2.56; 95% CI=1.38, 4.76) and bidirectional IPV (OR=1.97; 95% CI 1.18, 3.27). Among patients who reported any past-year IPV, most experienced bidirectional aggression. ED staff should consider asking patients who are married, cohabiting, or in a dating relationship about their experience with past-year IPV and inquire about their substance use patterns and those of their romantic partner, to share information about potential linkages. Medical and recreational marijuana legalization trends underscore the importance of further research on IPV and marijuana.

Family violence and its psychological management at the Emergency Department: A review

An Emergency Department provides emergency diagnosis and interventions, first clinical instrumental and laboratory examinations, actions needed to stabilize the patient. The purpose of this review was to evaluate the state-of-the-science focused on intimate partner violence. The review search period was from 2000 to 2019. The search was not restricted by language or geographical region, and was carried out by combining an exhaustive list of terms denoting intimate partner violence, domestic violence, emergency department care of women, women victims of violence, identifying abuse among women. Databases searched included MEDLINE, PsycINFO, Web of Science, Scopus, and Cochrane Library.

Drinking and Intimate Partner Violence Severity Levels Among U.S. Ethnic Groups in an Urban Emergency Department

BACKGROUND

Emergency departments (EDs) provide care to ethnically diverse populations with multiple health-related risk factors, many of which are associated with intimate partner violence (IPV). This paper examines ethnic-specific 12-month rates of physical IPV by severity and their association with drinking and other sociodemographic and personality correlates in an urban ED sample.

METHODS

Research assistants surveyed patients at an urban ED regarding IPV exposure as well as patterns of alcohol and drug use, psychological distress, adverse childhood experiences (ACEs), and other sociodemographic features.

RESULTS

The survey (N = 1,037) achieved an 87.5% participation rate. About 23% of the sample reported an IPV event in the past 12 months. Rates were higher (p < 0.001) among blacks (34%), whites (31%), and multiethnic (46%) respondents than those among Asians (13%) and Hispanics (15%). Modeled results showed that black respondents were more likely than Hispanics (reference) to report IPV (adjusted odds ratio [AOR] = 1.69, 95% confidence interval [CI] = 1.98-2.66, p < 0.05) and that respondents' partner drinking was associated with IPV (AOR = 1.85, 95% CI = 1.25-2.73, p < 0.01) but respondents' drinking was not. Use of illicit drugs, younger age, impulsivity, depression, partner problem drinking, ACEs, and food insufficiency were all positively associated with IPV.

CONCLUSIONS

There was considerable variation in IPV rates across ethnic groups in the sample. The null results for the association between respondents' drinking and IPV was surprising and may stem from the relatively moderate levels of drinking in the sample. Results for ethnicity, showing blacks as more likely than Hispanics to report IPV, support prior literature.

Association Between Substance Use and the Perpetration of Family Violence in Industrialized Countries: A Systematic Review

This review examines the association between alcohol and illicit drug use and the perpetration of intimate partner violence (IPV) and child maltreatment (CM). In clinical populations, alcohol use is related to IPV, although other variables are also known to influence this relationship. Studies in specialized social/health care and in the community have also demonstrated the association between alcohol use and IPV. Although data on the association between illicit drug use and IPV are less clear, in most studies perpetration seems related to the use of cannabis and cocaine. The occurrence of CM is related to alcohol use in specialized social/health care and community populations but has not been extensively investigated in clinical samples. These findings also apply to studies on the association between illicit drug use and CM. Moreover, many studies on CM fail to distinguish between the effects of alcohol and those of illicit drugs. This review concludes with recommendations for future research about substance use and family violence and discusses implications for prevention and treatment.

The interplay of race, socioeconomic status and neighborhood residence upon birth outcomes in a high black infant mortality community

This study examined the interrelationship of race and socioeconomic status (SES) upon infant birthweight at the individual and neighborhood levels within a Midwestern US county marked by high Black infant mortality. The study conducted a multi-level analysis utilizing individual birth records and census tract datasets from 2010, linked through a spatial join with ArcGIS 10.0. The maternal population of 2861 Black and White women delivering infants in 2010, residing in 57 census tracts within the county, constituted the study samples. The main outcome was infant birthweight. The predictors, race and SES were dichotomized into Black and White, low-SES and higher-SES, at both the individual and census tract levels. A two-part Bayesian model demonstrated that individual-level race and SES were more influential birthweight predictors than community-level factors. Specifically, Black women had 1.6 higher odds of delivering a low birthweight (LBW) infant than White women, and low-SES women had 1.7 higher odds of delivering a LBW infant than higher-SES women. Moderate support was found for a three-way interaction between individual-level race, SES and community-level race, such that Black women achieved equity with White women (4.0% Black LBW and 4.1% White LBW) when they each had higher-SES and lived in a racially congruous neighborhood (e.g., Black women lived in disproportionately Black neighborhood and White women lived in disproportionately White neighborhood). In sharp contrast, Black women with higher-SES who lived in a racially incongruous neighborhood (e.g., disproportionately White) had the worst outcomes (14.5% LBW). Demonstrating the layered influence of personal and community circumstances upon health, in a community with substantial racial disparities, personal race and SES independently contribute to birth outcomes, while environmental context, specifically neighborhood racial congruity, is associated with mitigated health risk.

Association between sociodemographic characteristics and anxiety levels of violence-exposed patients admitted to emergency clinic

BACKGROUND

Here we aimed to investigate sociodemographic characteristics, psychiatric history, and association between sociodemographic characteristics and anxiety levels of violence-exposed patients admitted to emergency clinic.

METHODS

This study consists of 73 violence-exposed patients admitted to emergency clinic who were literate and agreed to participate in the study. A sociodemographic data form created by us to investigate alcohol-substance abuse, suicide attempt, previous history of trauma, self and family history of psychiatric disorders and Beck Anxiety Inventory was given to the patients.

RESULTS

Of the patients exposed to violence 63% (n=46) were female and 27% (n=27) were male. Of these patients, 68.5% (n=50) were married, 43.8% (n=25) were workers, 34.2% were housewives, 11% were unemployed, and 11% were civil servants. Of the violence-exposed patients, 56.2% (n=41) were primary school, 21.9% (n=16) were high school, and 21.9% (n=16) were university graduates. Smoking and alcohol use rates were 54.8% (n=40) and 17.8% (n=13), respectively. The most common trauma type was assault using physical force with a ratio of 78.1% (n=57). In addition, anxiety scores were high in 42.5% (n=31) and moderate in 9.6% (n=7) of the patients. Mentioned psychiatric disorder was present in 17.8% (n=13) of the patients and 19.2% (n=14) of the patients' relatives. The correlation between sociodemographic characteristics and anxiety scores revealed that married patients had higher anxiety scores (P<0.01) and patients assaulted by their parents had lower anxiety scores (P<0.00).

CONCLUSION

A total of 63% of the violence-exposed patients admitted to emergency room were females, 56.2% were primary school graduates, and 43.8% were factory workers; this result shows that low socioeconomical status and education level affect exposure to trauma especially in females. In addition, ~20% of the patients and patients' relatives had a psychiatric disorder and 53.4% of perpetrators were parents, spouses, and children; this result shows that psychiatric history and family relations are one of the issues that should be taken into account and treated.

Does Marijuana Use Contribute to Intimate Partner Aggression? A Brief Review and Directions for Future Research

Marijuana users are more likely to perpetrate intimate partner aggression (IPA) than non-users, yet the mechanism responsible for this association is unknown. Recent studies considering the association between episodes of marijuana use and episodes of IPA have failed to find evidence consistent with an acute effect of marijuana. Research gaps are highlighted and a heuristic model of marijuana's potential effects on IPA is presented. Research priorities include consideration of mediating mechanisms, moderating variables at the individual and couple level, and examination of acute effects of marijuana using daily report and EMA designs.

Substance abuse treatment response in a Latino sample: the influence of family conflict

Latino Americans report underutilization of treatment and poor treatment response for substance use and abuse compared to other racial/ethnic groups; thus, it is important to assess factors that contribute to these disparities. The current study objective was to assess the influence of family conflict on substance abuse treatment response in a sample of Latino Americans using two different yet complementary analyses. First, ordinary least squares regression was used to assess the association between overall family conflict and pre- and post-treatment substance use. Second, repeated measures latent class analysis was used to identify groups based on family member conflict and timing of conflict during treatment. Findings indicated that family conflict contributed unique variance to concurrent substance use; however pre-treatment family conflict was not related to post-treatment outcomes. Results also identified three distinct family conflict groups: no/low conflict, pre-treatment conflict, and post-treatment conflict who differed in pre- and post-treatment substance use. Post hoc investigation revealed that those who experienced pre-treatment conflict but low post-treatment conflict showed the greatest decrease in substance use. Findings highlight the importance of considering family conflict during all stages of treatment for Latino American substance users.

Characteristics and treatment interests among individuals with substance use disorders and a history of past six-month violence: findings from an emergency department study

The study examined clinical characteristics and treatment interests of individuals identified to have substance use disorders (SUDs) in an urban emergency department (ED) who reported past six-month history of violence or victimization. Specifically, participants were 1441 ED patients enrolled in a randomized controlled trial of interventions designed to link those with SUDs to treatment. To examine factors related to violence type, four groups based on participants' reports of violence toward others were created: no violence (46.8%), partner violence only (17.3%), non-partner violence only (20.2%), and both partner and non-partner violence (15.7%). Four groups based on participants' reports of victimization were also created: no violence (42.1%), victimization from partner only (18.7%), victimization from non-partner only (20.2%), and both partner and non-partner victimization (17.7%). Separate multinomial logistic regression analyses were conducted to examine which variables distinguished the violence and victimization groups from those reporting no violence or victimization. For violence toward others, demographic variables, alcohol and cocaine disorders, and rating treatment for psychological problems were higher for violence groups, with some differences depending on the type of violence. For victimization, demographic variables, having an alcohol disorder, and rating treatment for family/social problems were higher for violence groups, also with some differences depending on the type of violence. Findings from the present study could be useful for designing effective brief interventions and services for ED settings.

Intimate partner violence and musculoskeletal injury: bridging the knowledge gap in orthopaedic fracture clinics

Intimate partner violence (IPV) is a serious health issue. There have been widespread research efforts in the area of IPV over the past several decades, primarily focusing on obstetrics, emergency medicine, and primary care settings. Until recently there has been a paucity of research focusing on IPV in surgery, and thus a resultant knowledge gap. Renewed interest in the underlying risk of IPV among women with musculoskeletal injuries has fueled several important studies to determine the nature and scope of this issue in orthopaedic surgery. Our review summarizes the evidence from surgical research in the field of IPV and provides recommendations for developing and evaluating an IPV identification and support program and opportunities for future research.

Gender, violence and brief interventions for alcohol in the emergency department

BACKGROUND

The impact of gender and violence on brief interventions (BIs) for alcohol use in the emergency department (ED) has not been studied. Our objective was to examine the effectiveness of alcohol BIs in an ED population stratified by gender and violence.

METHODS

This was a secondary analysis of datasets pooled from three ED-based randomized controlled studies of alcohol BIs. AUDIT-C was the primary outcome measure; secondary outcomes were binge drinking and achievement of NIAAA safe drinking levels. We conducted univariate comparisons and developed generalized linear models (GLM) for the primary outcome and generalized estimating equation (GEE) models for secondary outcomes to examine the intervention effect on the whole study group, gender-stratified subgroups, and gender- and violence-stratified subgroups.

RESULTS

Of 1219 participants enrolled, 30% were female; 31% of women and 42% of men reported violence involvement at baseline. In univariate analysis, no differences in outcomes were found between intervention and control groups for any subgroup. However, in multivariable models, men demonstrated an intervention effect for likelihood of safe drinking limits. Stratifying further by violence, only men without violence involvement demonstrated a positive intervention effect for safe drinking limits. There was no evidence of an intervention effect on women.

CONCLUSIONS

Analyzing the overall effect of ED-based BI may mask its ability to improve alcohol-related outcomes in a subset of the population. Alternatively, interventions may need to be significantly improved in subsets of the ED population, e.g., in women and in men with involvement in violence.

Substance use as a longitudinal predictor of the perpetration of teen dating violence

The prevention of teen dating violence is a major public health priority. However, the dearth of longitudinal studies makes it difficult to develop programs that effectively target salient risk factors. Using a school-based sample of ethnically diverse adolescents, this longitudinal study examined whether substance use (alcohol, marijuana, and hard drugs) and exposure to parental violence predicted the perpetration of physical dating violence over time. 1,042 9th and 10th grade high schools students were recruited and assessed in the spring of 2010, and 93 % of the original sample completed the 1-year follow-up in the spring of 2011. Participants who had begun dating at the initial assessment and who self-identified as African American (n = 263; 32 %), Caucasian (n = 272; 33 %), or Hispanic (n = 293; 35 %) were included in the current analyses (n = 828; 55 % female). Slightly more than half of the adolescents who perpetrated dating violence at baseline reported past year dating violence at follow-up, relative to only 11 % of adolescents who did not report perpetrating dating violence at baseline. Structural equation modeling revealed that the use of alcohol and hard drugs at baseline predicted the future perpetration of physical dating violence, even after accounting for the effects of baseline dating violence and exposure to interparental violence. Despite differences in the prevalence of key variables between males and females, the longitudinal associations did not vary by gender. With respect to race, exposure to mother-to-father violence predicted the perpetration of dating violence among Caucasian adolescents. Findings from the current study indicate that targeting substance use, and potentially youth from violent households, may be viable approaches to preventing the perpetration of teen dating violence.

Intimate partner violence among HIV-infected crack cocaine users

HIV-infected crack cocaine users are at high risk for HIV transmission and disease progression because they encounter difficulty practicing safe sex, entering and remaining in HIV care, and taking antiretroviral therapy (ART). We hypothesized intimate partner violence (IPV) occurs frequently in this population and contributes to these shortcomings. From December 2006 to April 2010 inpatient HIV-infected crack users were recruited from Grady Memorial (Atlanta, GA) and Jackson Memorial Hospitals (Miami, FL). Participants were screened for IPV using a 5-item tool that was adapted from a previously validated instrument, the STaT. IPV survivors were questioned about support service utilization. Multivariable analysis was conducted to evaluate the association between IPV and unprotected sexual intercourse and sexually transmitted infection (STI) diagnosis in the prior 6 months, use of outpatient HIV care in the past year, and current ART use. We enrolled 343 participants, the majority African Americans of low socioeconomic status. The estimated IPV prevalence was 56%, highest in women (68%) and gay, bisexual, and transgendered men (71%). In multivariable analysis, IPV was associated with diminished ART use (adjusted prevalence ratios [adjPRs] 0.57; 95% confidence interval [CI] 0.41-0.80), unprotected sexual intercourse (adjPR 1.34; 95% CI 1.08-1.68) and STI diagnosis in the prior 6 months (adjPR 3.49; 95% CI 1.60-7.62). After experiencing abuse, IPV survivors most commonly turned to emergency services; however, 38% reported not using any supportive services. This study highlights that IPV occurs frequently among HIV-infected crack users and is associated with outcomes known to facilitate HIV transmission and disease progression. Reduced utilization of outpatient HIV care, ART nonadherence, and new STI diagnoses in this population should trigger IPV screening and support services referral.

Alcohol outlet density and intimate partner violence-related emergency department visits

BACKGROUND

Previous research has identified risk factors for intimate partner violence (IPV) severity, injury, and emergency department (ED) visits. These risk factors have been shown at both the individual level (heavy drinking and other substance use on the part of 1 or both partners) and the neighborhood level (residence in an area characterized by poverty and social disadvantage). Alcohol outlet density has been linked with assaultive violence in community settings, but has not been analyzed in relation to IPV-related ED visits. This study examined the effects of outlet densities on IPV-related ED visits throughout California between July 2005 and December 2008.

METHODS

Half-yearly counts of ED visits related to IPV (E-code 967.3) were computed for each zip code from patient-level public data sets. Alcohol outlet density measures, calculated separately for bars, off-premise outlets, and restaurants, were derived from California Alcohol Beverage Control records. Census-based neighborhood demographic characteristics previously shown to be related to health disparities and IPV (percent black, percent Hispanic, percentage below 150% of poverty line, percent unemployed) were included in models. This study used Bayesian space-time models that allow longitudinal analysis at the zip code level despite frequent boundary redefinitions. These spatial misalignment models control for spatial variation in geographic unit definitions over time and account for spatial autocorrelation using conditional autoregressive (CAR) priors. The model incorporated data from between 1,686 (2005) and 1,693 (2008) zip codes across California for 7 half-year time periods from 2005 through 2008 (n = 11,836).

RESULTS

Density of bars was positively associated with IPV-related ED visits. Density of off-premise outlets was negatively associated with IPV-related ED visits; this association was weaker and smaller than the bar association. There was no association between density of restaurants and IPV-related ED visits.

CONCLUSIONS

Further research is needed to understand the mechanisms by which environmental factors, such as alcohol outlet density, affect IPV behaviors resulting in ED visits.

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

Background:

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

Methods:

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

Results:

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

Conclusions:

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

Prevalence of Physical Violence in Intimate Relationships, Part 2: Rates of Male and Female Perpetration

Physical violence perpetrated by men against their female partners is widely recognized as a serious social problem. Whether women’s use of physical violence against their male partners represents a serious social problem remains a question under debate. We examined research published in the last 10 years to summarize the current state of knowledge regarding the prevalence of physical IPV perpetrated by men and women in heterosexual relationships. Our specific aims were to (a) describe the prevalence of physical IPV perpetration in industrialized, English-speaking nations, and (b) explore study and sample characteristics that affect prevalence. Literature searches undertaken in 3 databases (PubMed, PsycINFO, and Web of Science) identified 750 articles published between 2000 and 2010. We included 111 articles that reported 272 rates of physical IPV perpetration in our review: 25 articles reported 34 rates for men, 14 articles reported 24 rates for women, and 72 articles reported 214 rates for both men and women. The vast majority of studies were conducted in the United States (k = 95, 85.6%) and most (k = 81, 73.0%) measured IPV using a Conflict Tactics Scale-based approach. We calculated unweighted, pooled prevalence estimates for female and male perpetration overall and by sample type, country, measurement time frame, and measurement approach. Across studies, the overall pooled prevalence estimate was 24.8%. Consistent with prior reviews, pooled prevalence was slightly greater for female- compared to male-perpetrated physical IPV: more than 1 in 4 women (28.3%) and 1 in 5 men (21.6%) reported perpetrating physical violence in an intimate relationship. This pattern of results remained when we calculated pooled prevalence estimates by sample and study characteristics, with few exceptions. Findings underscore the need for interventions that acknowledge the use of violence by women in intimate relationships.

Intimate partner violence and specific substance use disorders: findings from the National Epidemiologic Survey on Alcohol and Related Conditions

The association between substance use and intimate partner violence (IPV) is robust. It is less clear how the use of specific substances relates to relationship violence. This study examined IPV perpetration and victimization related to the following specific substance use disorders: alcohol, cannabis, cocaine, and opioid. The poly substance use of alcohol and cocaine, as well as alcohol and marijuana, were also examined. Data were analyzed from wave two of the National Epidemiologic Survey on Alcohol and Related Conditions (2004-2005). Associations between substance use disorders and IPV were tested using logistic regression models while controlling for important covariates and accounting for the complex survey design. Alcohol use disorders and cocaine use disorders were most strongly associated with IPV perpetration, while cannabis use disorders and opioid use disorders were most strongly associated with IPV victimization. A diagnosis of both an alcohol use disorder and cannabis use disorder decreased the likelihood of IPV perpetration compared to each individual substance use disorder. A diagnosis of both an alcohol use disorder and cocaine use disorder increased likelihood of reporting IPV perpetration compared with alcohol use disorders alone but decreased likelihood of perpetration compared with a cocaine use disorder diagnosis alone. Overall, substance use disorders were consistently related to intimate partner violence after controlling for important covariates. These results provide further evidence for the important link between substance use disorders and IPV and add to our knowledge of which specific substances may be related to relationship violence.