Premigration exposure to political violence and perpetration of intimate partner violence among immigrant men in Boston

Armed conflicts and experience of intimate partner violence among women in Afghanistan: analysis of the 2015 Afghanistan DHS data

OBJECTIVE

Armed conflicts and intimate partner violence (IPV) impose a burden on individual and societal well-being. Given the history of armed conflict in Afghanistan and the high prevalence of IPV, this study aims to examine the influence of armed conflicts on IPV among Afghan women.

METHODS

Multilevel logistic regression models were applied to the 2015 Afghanistan Demographic and Health Survey (N=10 414 women aged 15-49). Armed conflict severity was measured using the conflict index issued by the Office for the Coordination of Humanitarian Affairs, IPV was measured by three types of violence, including emotional, physical and sexual violence. All analyses were conducted by using STATA V.15.1.

RESULTS

Over 52% of women experienced at least one type of IPV, with 33.01%, 49.07%, and 8.99% experiencing emotional, physical, and sexual violence, respectively. The regression results show that armed conflicts were significantly and positively associated with the experience of all types of IPV. In addition, the association between armed conflicts and the experience of emotional IPV was positively moderated by women's attitudes towards IPV.

CONCLUSION

Our findings suggest that women living in high-conflict regions were more prone to experience IPV, particularly women with positive attitudes towards IPV. Promoting progressive gender roles, women's empowerment, awareness of IPV and inclusion of women in conflict resolution will help deal with the issue of IPV.

Violence and trauma encountered by Rohingya women fleeing to Malaysia: a qualitative study

Rohingya women are doubly marginalized owing to their ethnicity and gender. Therefore, this study aims to describe the unique experiences of violence faced by Rohingya women who fled Myanmar and Bangladesh to seek asylum in Malaysia before, during, and after their transit. Primary data were collected from 33 participants comprising Rohingya women refugees and asylum seekers, medical social workers, medical officials, volunteer workers/activists, refugee organization officers, and a mental health care provider. Thematic analysis was used to identify the patterns in and relationships between the concepts in the collected data. Rohingya women were exposed to various forms of violence and trauma by various groups of men, including those from their own community, throughout their journey to and in Malaysia. The lack of recognition of refugees and asylum seekers in Malaysia prevents them from having mainstream or legal access to jobs, education, and healthcare, and this predicament compounds their suffering from violence, especially for women and girls. Rohingya women and girls in Malaysia need better access to healthcare, resources, and support to identify and address violence, which has a significant impact on their health.

Factors Associated with Intimate Partner Violence Perpetration Among Migrant Men: A Systematic Review

Intimate partner violence (IPV) is the most widespread form of violence against women and the most common perpetrators are male partners. Immigration can involve stressors and barriers that are linked to male IPV perpetration. The objective of this systematic review was to identify the factors associated with IPV perpetration among migrant men. Four electronic databases, MEDLINE Complete, Embase, PsycInfo, and SocINDEX with full text, were searched up to August 2021. Studies were selected that examined factors associated with IPV perpetration among first-generation migrants who identified as men/males and were aged 18 years or older. In all, 18 articles met the eligibility criteria for the review, representing a total of 12,321 male participants, including 4,389 migrant men. A wide range of factors associated with IPV perpetration were found at the individual, relationship, community, and societal levels. Unique risk factors for migrant men's IPV perpetration were exposure to political violence, deportation experiences, and minimal legal sanctions for perpetration in some countries of origin. Societal factors explored among Latino immigrants were traditional gender roles such as machismo and norms of violence. All identified factors should be considered in the cultural contexts of the relevant samples and should not be generalized to all migrant men. The findings of modifiable and culture-specific factors have important implications for strategies aimed at reducing IPV perpetration. Future research should explore factors associated with IPV perpetration within specific cultures rather than across broad cultural groupings.

Co-Occurring Intimate Partner Violence and Child Abuse in Eastern Democratic Republic of Congo: The Influence of Early Life Experiences of Abuse

Little is known about co-occurring intimate partner violence (IPV) against women and child abuse within families in humanitarian settings. Baseline data from 203 couples in eastern Democratic Republic of Congo were analyzed to assess associations between childhood experiences of abuse with present co-occurring violence. Over half of women (56.1%) and men (50.5%) reported co-occurring violence. Adjusted models demonstrate experiencing physical abuse as a child was associated with greatest odds of recent co-occurring violence while witnessing parental IPV had mixed influence. Programmatic approaches focused on reducing early childhood violence may be promising to prevent both IPV and child abuse.

Parenting in a post-conflict region: Associations between observed maternal parenting practices and maternal, child, and contextual factors in northern Uganda

Studies show that war leads to an increase in harsh parenting and a decrease in parental warmth, which in turn has a devastating impact on children's development. However, there is insufficient research on the factors that affect parenting in post-conflict regions. In addition, most previous studies on the role of parenting in the context of war rely on self-reports, which are subject to a number of limitations. To complement existing research, the present cross-sectional study used behavioral observations of 101 mothers and their 6-12 year old children to assess parenting in post-conflict northern Uganda. The aim of the current study was to explore associations between observed maternal warmth and coercion and self-reported socioeconomic status (e.g., mother's educational level) as well as maternal (e.g., posttraumatic stress disorder), child (e.g., externalizing problems), and social contextual factors (e.g., family violence). Results show a link between observed parenting, child characteristics, and family violence. Higher levels of children's externalizing problems were associated with more severe maternal coercion. In addition, a negative association was found between family violence and maternal warmth. Findings are discussed in terms of their implications for prevention and intervention programs and the use of behavioral observations in post-conflict environments.

Intimate Partner Violence and Immigration in the United States: A Systematic Review

This systematic review sought to describe the prevalence of intimate partner violence (IPV) victimization among immigrants in the United States (U.S.) and the prevalence of IPV perpetration among immigrants in the U.S. PsycInfo, PubMed, Global Health and Scopus databases were searched for peer-reviewed literature that quantitatively examined IPV in relation to immigration. Twenty-four articles were included in the final review. Past-year IPV victimization rates among immigrants ranged from 3.8% to 46.9% and lifetime IPV victimization rates ranged from 13.9% to 93%; past-year IPV perpetration rates ranged from 3.0% to 24.8% and the one lifetime IPV perpetration rate was 12.8%. Estimates varied widely by country of origin, type of violence measured, and measure used to quantify IPV. Reliance on small convenience samples is problematic when trying to determine the true prevalence of IPV among immigrants. Epidemiological research is needed to improve the accuracy and representativeness of findings.

Intimate Partner Violence Against Women in the Arab Countries: A Systematic Review of Risk Factors

Intimate partner violence (IPV) profoundly damages physical, sexual, reproductive, and psychological health, as well as social well-being of individuals and families. We sought in this systematic review to examine the risk factors according to the integrative ecological theoretical framework for IPV for women living in the Arab countries. We searched Embase, PubMed, PsycINFO, and SCOPUS, supplemented by hand searching of reference lists. A research strategy was developed and observational studies were included if they considered female participants (age ≥13) in heterosexual relationships, estimates of potential risk factors of IPV, and IPV as a primary outcome. We conducted a narrative synthesis of the risk factors data from 30 cross-sectional studies. Factors associated with increased IPV against women were extracted and categorized into four levels according to the updated integrative ecological model. At the individual level, risk factors were either related to victims or perpetrators of IPV. Factors relating to marriage, conflict within the family, etc., were explored and included within the family level, whereas factors relating to the extended family and the nature of marriage were included in the community level. Finally, risk factors relating to the cultural context that are influenced by the political and religious backgrounds were included in the societal level. The complex structure of violence against women in the Arab world calls for socioculturally sensitive interventions, which should be accompanied by systematic and structured work aimed at improving Arab women's status at all levels.

Attitudes towards gender roles and prevalence of intimate partner violence perpetrated against pregnant and postnatal women: Differences between women immigrants from conflict-affected countries and women born in Australia

BACKGROUND

The aim was to compare, for the first time in a large systematic study, women born in conflict-affected countries who immigrated to Australia with women born in Australia for attitudes towards gender roles and men's use of IPV and the actual prevalence of IPV. The study also examined if any associations remained across the two timepoints of pregnancy and postpartum.

METHODS

Women were interviewed during their first visit to one of three Australian public hospital antenatal clinics and re-interviewed at home six months after giving birth. A total of 1111 women completed both interviews, 583 were born in conflict-affected countries and 528 born in Australia. Associations between attitudes towards gender roles and men's use of IPV, socio-demographic characteristics and reported actual experiences of IPV were examined using bivariate and multiple logistic regression analyses.

RESULTS

Attitudes toward inequitable gender roles including those that condone men's use of IPV, and prevalence of IPV, were significantly higher (p<0.001) among women born in conflict-affected countries compared to Australia-born women. Women born in conflict-affected countries with the strongest held attitudes towards gender roles and men's use of IPV had an adjusted odds ratio (aOR) of 3.18 for IPV at baseline (95% CI 1.85-5.47) and an aOR of 1.83 for IPV at follow-up (95% CI 1.11-3.01). Women born in Australia with the strongest held attitudes towards gender roles and IPV had an aOR of 7.12 for IPV at baseline (95% CI 2.12-23.92) and an aOR of 10.59 for IPV at follow-up (95% CI 2.21-50.75).

CONCLUSIONS

Our results underscore the need for IPV prevention strategies sensitively targeted to communities from conflict-affected countries, and for awareness among clinicians of gender role attitudes that may condone men's use of IPV, and the associated risk of IPV. The study supports the need for culturally informed national strategies to promote gender equality and to challenge practices and attitudes that condone men's violence in spousal relationships.

Physical and Sexual Violence Experienced by Male War-Affected Youth: Implications for Post-Conflict Functioning and Intimate Relationships

This study explored the association between war violence exposure during armed conflict and intimate partner violence (IPV) victimization, and the impact of positive community and family reintegration on IPV among a sample (N = 92) of war-affected male youth, post-conflict Sierra Leone. Trained Sierra Leonean researchers conducted face-to-face interviews with youth and their caregivers. Results indicate that exposure to violence during armed conflict as well as community and family reintegration were negatively associated with psychological IPV perpetration. Community reintegration was negatively associated with physical IPV. Sexual victimization was negatively associated with sexual IPV perpetration, whereas physical victimization had positive association. More research needs to be done on male war-affected youth as victims of physical, psychological, and sexual violence during conflict and the impact this has on the quality of their intimate relationships, occurrence of IPV in those relationships (as victims in addition to being perpetrators), and their community reintegration.

Latina and Caribbean Immigrant Women's Experiences With Intimate Partner Violence: A Story of Ambivalent Sexism

Despite extensive descriptive work on intimate partner violence (IPV) among Latina and Caribbean immigrant women (LCIW), culturally appropriate interventions for primary and secondary prevention of IPV for this population remain lacking. Developing culturally appropriate and effective prevention interventions for abused LCIW requires a more nuanced understanding regarding the dynamics of cultural values, immigration status, and manifestations of IPV. The purposes of this study were to examine LCIW's experiences of domestic violence, using a gender stereotype framework, and to describe how ascribing to gender stereotypes perpetuates and normalizes experiences of abuse. Thirty semistructured individual interviews were conducted with LCIW (a) who were at least 18 years old and (b) who had experienced abuse from an intimate partner within the last 2 years. Overall, women described themselves as communal-being caretakers, submissive, and dependent on men. From their perspective, they described their male abusers as being controlling, angry, and violent. The risk for experiencing violence increased when women defied their prescriptive gender roles by seeking employment and by developing their social networks and activities. Substance abuse and alcohol misuse also compounded their partners' abusive behaviors. Despite some women experiencing more abuse after migration to the United States, coming to the United States exposed them to other opportunities and ways of being a woman, which facilitated an awareness about their abuse and was a motivator for help-seeking and ending abuse. Our findings highlight the importance of addressing traditional gender stereotypes for secondary prevention of IPV.

A Qualitative Study of Women's Lived Experiences of Conflict and Domestic Violence in Afghanistan

This article empirically explores women’s lived experiences of domestic violence and conflict in Afghanistan. A thematic analysis of 20 semistructured interviews with women living in safe houses produced three main themes about the relationship between conflict and domestic violence: (a) violence from loss of patriarchal support, (b) violence from the drug trade as an economic driver, and (c) violence from conflict-related poverty. We discuss the bidirectional nature of this relationship: Not only does conflict contribute to domestic violence, but domestic violence contributes to conflict through justifying armed intervention, separating women from economic and public life, and perpetuating patriarchy.

Trauma, Post-Migration Stress, and Mental Health: A Comparative Analysis of Refugees and Immigrants in the United States

Numerous studies describe mental health effects of pre-migration trauma and post-resettlement stress among refugees, yet less research examines these associations with non-refugee immigrants. Additionally, few studies assess the prevalence and impact of traumatic experiences after settlement in a new country. Using a U.S.-based representative sample of Asian (n = 1637) and Latino (n = 1620) refugees and immigrants, we investigated how traumatic events prior to and after migration, and post-migration stressors, are associated with mental illness and distress. Pre-migration trauma posed risk across a broad range of psychological outcomes for Asian refugees and Latino immigrants. Deleterious effects of post-migration trauma were notable for both groups of refugees and immigrants. Discrimination, acculturative stress, and family conflict increased risk for disorder and distress across groups in complex ways. Findings highlight the importance of examining trauma and stress at pre- and post-migration phases across migrant populations, including those not labeled as refugees.

Violence Against Displaced Syrian Women in Lebanon

This study used focus group discussions to explore 29 Syrian women's experiences of being displaced refugees in Lebanon. Women reported intimate partner violence (IPV), harassment, and community violence. They experienced difficult living conditions characterized by crowding and lack of privacy, adult unemployment, and overall feelings of helplessness. Most frequently, they used negative coping strategies, including justification and acceptance of IPV and often physically harmed their own children due to heightened stress. Some sought support from other Syrian refugee women. Although the study did not address the root causes of IPV, the results shed light on women's experiences and indicate that training them in positive coping strategies and establishing support groups would help them face IPV that occurs in refugee settings.

Factor Structure for Chronic Stress Before and During Pregnancy by Racial/Ethnic Group

This study aimed to explore race/ethnicity-specific dimensionalities of chronic stress before and during pregnancy for non-Hispanic (N-H) White, N-H Black, Hispanic, and Asian women in the United States. This study analyzed the data among 6,850 women from the New York City and Washington State Pregnancy Risk Assessment Monitoring System (2004-2007) linked with birth certificates. Separate exploratory factor analysis was conducted by race/ethnicity using a maximum-likelihood extraction method with 26 chronic stress items before and during pregnancy. Correlations and internal consistency reliabilities among items and latent factors determined race/ethnicity-specific factor structures of chronic stress. Chronic stress was race/ethnicity-distinctive and multidimensional with low correlations among the factors ( r = .07-.28, p < .05). Despite financial hardship, perceived isolation, and physical violence underlying chronic stress among the racial/ethnic groups, intergroup variations existed under each group's cultural or sociopolitical contexts. This study could help develop targeted strategies to intervene with women's chronic stressors before childbirth.

How Do Risk Environment Factors Influence Perpetration of Partner Violence among Male Migrant and Non-migrant Market Workers in Central Asia?

Intimate partner violence (IPV) has emerged as a serious public health issue in migrant communities in Central Asia and globally. To date, however, research on risk factors associated with male perpetration of IPV among migrants remains scant. This study aims to examine risk environment theory-driven factors associated with male perpetration of IPV in the prior 6 months. We recruited, enrolled, and surveyed a respondent-driven sample of 1342 male market workers in Almaty, Kazakhstan, that included 562 (42%) non-migrants defined as Kazakhstan citizens who reside in Almaty; 502 (37%) external migrants from Kyrgyzstan, Tajikistan, or Uzbekistan; and 278 (21%) internal migrants from other areas of Kazakhstan. We conducted multivariate logistic regressions to estimate the effects of physical, economic, and political risk environment factors on IPV perpetration by migration status after controlling for potentially confounding socio-demographic and psychosocial variables. A total of 170 participants (12.7%) reported ever perpetrating physical or sexual IPV and 6.7% perpetrated such IPV in the prior 6 months. Multiple logistic regression results suggest that the risk environment factors of poor living conditions, exposure to political violence, and deportation experiences are associated with IPV perpetration among external and internal migrants, but not among non-migrants. Food insecurity is associated with IPV perpetration among external migrants and non-migrants, but not among internal migrants. Homelessness and arrests by police are associated with IPV perpetration among internal migrants, but not among external migrants or non-migrants. These findings underscore the need to consider the unique combination of risk environment factors that contribute to male IPV perpetration in the design of programs and policies to address IPV perpetration among external and internal migrant and non-migrant men in Central Asia.

From the battlefield to the bedroom: a multilevel analysis of the links between political conflict and intimate partner violence in Liberia

Objectives

Assess the link between levels of armed conflict and postconflict intimate partner violence (IPV) experienced by women in Liberia.

Methods

Armed Conflict Location and Event Data Project data were used to measure conflict-related fatalities in districts in Liberia during the country’s civil war from 1999 to 2003. These data were linked to individual-level data from the 2007 Demographic and Health Survey, including past-year IPV. Multilevel logistic models accounting for the clustering of women within districts evaluated the relationship of conflict fatalities with postconflict past-year IPV. Additional conflict measures, including conflict events and cumulative years of conflict, were assessed.

Results

After adjusting for individual-level characteristics correlated with IPV, residence in a conflict fatality-affected district was associated with a 50% increase in risk of IPV (adjusted OR (aOR): 1.55, 95% CI 1.26 to 1.92). Women living in a district that experienced 4–5 cumulative years of conflict were also more likely to experience IPV (aOR 1.88, 95% CI 1.29 to 2.75).

Conclusion

Residing in a conflict-affected district even 5 years after conflict was associated with postconflict IPV.

Policy implications

Recognising and preventing postconflict IPV violence is important to support long-term recovery in postconflict settings.

The Co-Occurrence and Unique Mental Health Effects of Political Violence and Intimate Partner Violence

The global mental health ramifications of political violence and intimate partner violence (IPV) are well established. There also exists a growing body of evidence about the increased risks for IPV within situations of political violence. Yet, except for a few studies, there is little literature that simultaneously examines how political violence and IPV might result in unique risks for particular types of mental health sequela. Delineating possible divergent patterns between specific mental health conditions resulting from political violence and IPV takes on an increased urgency given that, although they are related, the two most commonly reported outcomes of these two types of violence-post-traumatic stress disorder (PTSD) and depression-not only require different types of treatment, but may in fact be generated or maintained by disparate paths. Using survey data from adult women in Palestine ( n = 122), this study explores the relationships between IPV and political violence (both lifetime and past-month exposure) and tests their independent relationships to PTSD and depressive symptomology. After controlling for the other form of violence exposure, political violence was correlated with PTSD and not with depressive symptomology, while IPV was correlated with depressive symptomology and not with PTSD. Findings demonstrate that distinct forms of violence exposure might indeed be associated with specific mental health outcomes. Results illustrate the need to assess for both political violence and IPV when researching and designing interventions related to violence.

'And when a certain health issue happen, they try to cover it': Stakeholder perspectives on the health of temporary foreign workers and their families

This study examines stakeholders' perspectives on the health and well-being of temporary foreign workers (TFWs) and their families in Alberta, Canada. We used a critically informed qualitative methodology. We interviewed 13 stakeholders, including service providers and policy makers. Stakeholders involved in providing services to TFWs perceived that the workers experience (1) barriers in accessing mental health services, (2) mental health challenges, (3) family health challenges, (4) occupational health challenges, and (5) income and social status as a social determinant of health. Immigration and class status intersect to influence the health of this vulnerable population in Canada.

Risk of perpetrating intimate partner violence amongst men exposed to torture in conflict-affected Timor-Leste

BACKGROUND

A key issue in need of empirical exploration in the post-conflict and refugee mental health field is whether exposure to torture plays a role in generating risk of intimate partner violence (IPV), and whether this pathway is mediated by the mental health effects of torture-related trauma. In examining this question, it is important to assess the impact of socio-economic hardship which may be greater amongst survivors of torture in low-income countries.

METHODS

The study data were obtained from a cohort of 870 women (recruited from antenatal clinics) and their male partners in Dili district, Timor-Leste. We conducted bivariate and path analysis to test for associations of men's age, socioeconomic status, torture exposure, and mental disturbance, with IPV (the latter reported by women).

RESULTS

The path analysis indicated positive paths from a younger age, torture exposure, and lower socio-economic status amongst men leading to mental disturbance. Mental disturbance, in turn, led to IPV. In addition, younger age, lower socio-economic status, torture exposure, and mental disturbance were directly associated with IPV.

CONCLUSIONS

Our data provide the first systematic evidence of an association between torture and IPV in a low-income, post-conflict country, confirming that low socio-economic status, partly related to being a torture survivor, adds to the risk. The high prevalence of IPV in this context suggests that other structural factors, such as persisting patriarchal attitudes, contribute to the risk of IPV. Early detection and prevention programs may assist in reducing the risk of IPV in families in which men have experienced torture.

Drivers of Intimate Partner Violence Against Women in Three Refugee Camps

This qualitative study examined the “drivers” of intimate partner violence (IPV) against women in displacement to identify protective factors and patterns of risk. Qualitative data were collected in three refugee camps in South Sudan, Kenya, and Iraq ( N = 284). Findings revealed interrelated factors that triggered and perpetuated IPV: gendered social norms and roles, destabilization of gender norms and roles, men’s substance use, women’s separation from family, and rapid remarriages and forced marriages. These factors paint a picture of individual, family, community and societal processes that exacerbate women’s risk of IPV in extreme conditions created by displacement. Implications for policy and practice are indicated.

The impact of humanitarian emergencies on the prevalence of violence against children: an evidence-based ecological framework

Little is known about the patterns and mechanisms by which humanitarian emergencies may exacerbate violence against children. In this article, we propose using the ecological framework to examine the impact of humanitarian emergencies on interpersonal violence against children. We consider the literature that supports this framework and suggest future directions for research to fill identified gaps in the framework. The relationship between humanitarian emergencies and violence against children depends on risk factors at multiple levels, including a breakdown of child protection systems, displacement, threats to livelihoods, changing gender roles, changing household composition, overcrowded living conditions, early marriage, exposure to conflict or other emergency events, and alcohol abuse. The empirical evidence supporting the proposed emergency/violence framework is limited by cross-sectional study designs and a propensity to predominantly examine individual-level determinants of violence, especially exposure to conflict or emergency events. Thus, there is a pressing need to contextualize the relationship between conflict or emergency events and violence against children within the wider ecological and household dynamics that occur during humanitarian emergencies. Ultimately, this will require longitudinal observations of children, families and communities from before the emergency through recovery and improvements to ongoing global surveillance systems. More complete data will enable the humanitarian community to design effective, appropriate and well-targeted interventions.

Perceptions and Experiences of Intimate Partner Violence in Abidjan, Côte d'Ivoire

Background

Men and women’s perceptions of intimate partner violence (IPV) within crisis-affected populations are not well understood. This mixed-methods study examined the frequency of IPV against women in urban Cote d’Ivoire, and qualitatively explored how men and women perceive the impact of various forms of IPV on health, everyday activities, and feelings of shame.

Methods

A survey was administered to Ivorian women (N = 80) to measure the frequency of IPV, and ten focus group discussions were conducted with women (n = 46) and men (n = 45) to explore perceptions of different forms of IPV, including its impacts on disruptions to health, everyday activities, and experiences of shame.

Results

Half of all surveyed women (53.6%) reported past year exposure to physical, sexual, or emotional IPV. Of the multiple types of violence, emotional IPV was most common (46.4%), followed by sexual IPV (21.7%) and physical IPV (17.4%). Focus group participants identified additional forms of violence including economic IPV and community discrimination. Lack of financial resources and unemployment were common problems among crisis-affected women and were described as an underlying source of IPV. Both women and men reported that shame and stigma play a large role in how women experience the repercussions of IPV, regardless of the form of violence, with public episodes of IPV almost always seen as more detrimental than private episodes of IPV.

Conclusions

These results underscore the need for increased social support mechanisms for women to reduce the shame, stigma, and isolation associated with their experiences. The creation of safe and supportive spaces for women to talk about and challenge social norms may be an important first step in reducing community shaming and the secrecy that often surrounds IPV. Safe spaces along with broader societal outreach, including challenging men’s social positions and creating opportunities for increasing economic resources can, in turn potentially decrease the frequency of IPV and its deleterious impacts on a woman’s well-being

What Factors Contribute to Intimate Partner Violence Against Women in Urban, Conflict-Affected Settings? Qualitative Findings from Abidjan, Côte d'Ivoire

Rapid urbanization is a key driver of the unique set of health risks facing urban populations. One of the most critical health hazards facing urban women is intimate partner violence (IPV). In post-conflict urban areas, women may face an even greater risk of IPV. Yet, few studies have examined the IPV experiences of urban-dwelling, conflict-affected women, including those who have been internally displaced. This study qualitatively examined the social and structural characteristics of the urban environment that contributed to the IPV experiences of women residing in post-conflict Abidjan, Côte d'Ivoire. Ten focus groups were conducted with men and women, both internally displaced (IDPs) and non-displaced. Lack of support networks, changing gender roles, and tensions between traditional gender norms and those of the "modern" city were reported as key contributors to IPV. Urban poverty and with it unemployment, food insecurity, and housing instability also played a role. Finally, IDPs faced heightened vulnerability to IPV as a result of displacement and discrimination. The relationship between economic strains and IPV are similar to other conflict-affected settings, but Abidjan's urban environment presented other unique characteristics contributing to IPV. Understanding these factors is crucial to designing appropriate services for women and for implementing IPV reduction interventions in urban areas. Strengthening formal and informal mechanisms for help-seeking, utilizing multi-modal interventions that address economic stress and challenge inequitable gender norms, as well as tailoring programs specifically for IDPs, are some considerations for IPV program planning focused on conflict-affected women in urban areas.

Family and community driven response to intimate partner violence in post-conflict settings

This study explores risk factors, individual and family consequences and community-driven responses to intimate partner violence (IPV) in post-conflict eastern Democratic Republic of Congo (DRC). This qualitative study was conducted in 3 rural villages in South Kivu Province of DRC, an area that has experienced prolonged conflict. Participants included 13 female survivors and 5 male perpetrators of IPV as reported during baseline data collection for the parent study, an impact evaluation of the Congolese-led livestock microfinance program, Pigs for Peace. Participants described social and behavioral circumstances that increase risk for IPV; social, health and economic consequences on women and their families; and resources to protect women and their families. Social and behavioral factors reported by survivors and perpetrators indicate that IPV was linked to husband's alcohol consumption, household economic instability, male desire to maintain his position as head of family and perceived disrespect of husband by wife. In addition to well-known health consequences of IPV, women reported negative social consequences, such as stigma, resulting in barriers for the well-being of the family. Survivors and perpetrators described the impact of IPV on their children, specifically the lack of proper parental guidance and lack of safety and stability that could result in the child(ren) misbehaving and using violence in their relationships resulting in further stigma towards the child and family. Strategies employed by survivors to protect themselves and family, include placating male behaviors (e.g., not responding to insults, trying to meet household demands). Perpetrators that tried to reduce the impact of IPV reported a preference for social and financial control of their partner rather than physical violence, believing this to be less severe. Participants described community and family based social support systems including couple's mediation, responsible partner and fatherhood programs and economic activities that can influence behavior, maintain confidentiality, address social stigma and other multi-level outcomes.

The association between immigrant generational status, child maltreatment history and intimate partner violence (IPV): evidence from a nationally representative survey

PURPOSE

The extent to which immigrant-specific factors influence the intergenerational transmission of family violence is unknown. The objectives of this paper are to examine the associations between immigrant generational status (IGS), child maltreatment (CM), intimate partner violence (IPV) and acculturation (i.e., the extent to which an individual adopts the values, language and attitudes of a new culture).

METHODS

The sample was drawn from wave two of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n = 34,653), a nationally representative survey of United States (US) residents aged 20 years and older. Logistic regression was used to estimate the associations between IGS, CM history, IPV, and acculturation.

RESULTS

Compared to 3rd generation (or later) respondents, 1st generation immigrants were less likely to report a history of sexual (AOR = 0.74, CI0.95 = 0.62, 0.90) and emotional abuse (AOR = 0.69, CI0.95 = 0.55, 0.87), but were more likely to report physical neglect (AOR = 1.30, CI0.95 = 1.11, 1.52). After adjusting for covariates, IGS was not associated with IPV among respondents with or without a CM history. Among those without a CM history, highly acculturated 1st generation immigrants (AOR = 1.07, CI0.95 = 1.01, 1.13) were more likely to report perpetrating IPV, with highly acculturated 3rd generation respondents having lower odds of reporting IPV perpetration (AOR = 0.93, CI0.95 = 0.88-1.00).

CONCLUSION

IGS and acculturation are important factors in CM and IPV. Longitudinal studies are needed to clarify the influence of IGS, recency of immigration, acculturation and acculturative stress on the experiences and relationship between CM and IPV.

Being a bridge: Swedish antenatal care midwives' encounters with Somali-born women and questions of violence; a qualitative study

BACKGROUND

Violence against women is associated with serious health problems, including adverse maternal and child health. Antenatal care (ANC) midwives are increasingly expected to implement the routine of identifying exposure to violence. An increase of Somali born refugee women in Sweden, their reported adverse childbearing health and possible links to violence pose a challenge to the Swedish maternity health care system. Thus, the aim was to explore ways ANC midwives in Sweden work with Somali born women and the questions of exposure to violence.

METHODS

Qualitative individual interviews with 17 midwives working with Somali-born women in nine ANC clinics in Sweden were analyzed using thematic analysis.

RESULTS

The midwives strived to focus on the individual woman beyond ethnicity and cultural differences. In relation to the Somali born women, they navigated between different definitions of violence, ways of handling adversities in life and social contexts, guided by experience based knowledge and collegial support. Seldom was ongoing violence encountered. The Somali-born women's' strengths and contentment were highlighted, however, language skills were considered central for a Somali-born woman's access to rights and support in the Swedish society. Shared language, trustful relationships, patience, and networking were important aspects in the work with violence among Somali-born women.

CONCLUSION

Focus on the individual woman and skills in inter-cultural communication increases possibilities of overcoming social distances. This enhances midwives' ability to identify Somali born woman's resources and needs regarding violence disclosure and support. Although routine use of professional interpretation is implemented, it might not fully provide nuances and social safety needed for violence disclosure. Thus, patience and trusting relationships are fundamental in work with violence among Somali born women. In collaboration with social networks and other health care and social work professions, the midwife can be a bridge and contribute to increased awareness of rights and support for Somali-born women in a new society.

Gender norms, poverty and armed conflict in Côte D'Ivoire: engaging men in women's social and economic empowerment programming

Engaging men is a critical component in efforts to reduce intimate partner violence (IPV). Little is known regarding men's perspectives of approaches that challenge inequitable gender norms, particularly in settings impacted by armed conflict. This article describes men's experiences with a women's empowerment program and highlights men's perceptions of gender norms, poverty and armed conflict, as they relate to achieving programmatic goals. Data are from 32 Ivorian men who participated in indepth interviews in 2012. Interviews were undertaken as part of an intervention that combined gender dialogue groups for both women and their male partners with women's only village savings and loans programs to reduce IPV against women. Findings suggested that in the context of armed conflict, traditional gender norms and economic stressors experienced by men challenged fulfillment of gender roles and threatened men's sense of masculinity. Men who participated in gender dialogue groups discussed their acceptance of programming and identified improvements in their relationships with their female partners. These men further discussed increased financial planning along with their partners, and attributed such increases to the intervention. Addressing men's perceptions of masculinity, poverty and armed conflict may be key components to reduce men's violence against women in conflict-affected settings.

Reproductive coercion and intimate partner violence among rural women in Côte d'Ivoire: a cross-sectional study

A growing body of U.S.-based research demonstrates that reproductive coercion is an important consideration regarding the negative health impacts of intimate partner violence (IPV). However, less work on IPV and reproductive coercion has been done in West African settings. Cross-sectional data of 981 women who participated in the baseline survey of a randomized-controlled trial in rural, Côte d'Ivoire in October 2010 were analyzed for specific reports of reproductive coercion. Half (49.8%) of all women reported lifetime physical or sexual IPV, and nearly 1 in 5 (18.6%) reported experiencing reproductive coercion. In the final adjusted analyses, lifetime IPV was associated with a 3.7 increase in odds of reporting reproductive coercion (95% CI: 2.4-5.8) compared to women who did not report such victimization. Study findings underscore the importance of reducing IPV in order to improve reproductive health among women in rural Côte d'Ivoire.

Violence and reproductive health preceding flight from war: accounts from Somali born women in Sweden

Background

Political violence and war are push factors for migration and social determinants of health among migrants. Somali migration to Sweden has increased threefold since 2004, and now comprises refugees with more than 20 years of war experiences. Health is influenced by earlier life experiences with adverse sexual and reproductive health, violence, and mental distress being linked. Adverse pregnancy outcomes are reported among Somali born refugees in high-income countries. The aim of this study was to explore experiences and perceptions on war, violence, and reproductive health before migration among Somali born women in Sweden.

Method

Qualitative semi-structured individual interviews were conducted with 17 Somali born refugee women of fertile age living in Sweden. Thematic analysis was applied.

Results

Before migration, widespread war-related violence in the community had created fear, separation, and interruption in daily life in Somalia, and power based restrictions limited access to reproductive health services. The lack of justice and support for women exposed to non-partner sexual violence or intimate partner violence reinforced the risk of shame, stigmatization, and silence. Social networks, stoicism, and faith constituted survival strategies in the context of war.

Conclusions

Several factors reinforced non-disclosure of violence exposure among the Somali born women before migration. Therefore, violence-related illness might be overlooked in the health care system. Survival strategies shaped by war contain resources for resilience and enhancement of well-being and sexual and reproductive health and rights in receiving countries after migration.

Women's perceptions of effects of war on intimate partner violence and gender roles in two post-conflict West African Countries: consequences and unexpected opportunities

Background

The aim of this paper is to explore women’s perceptions of the causes of intimate partner violence (IPV) in West Africa, and the ways in which they understand these causes to interact with the experiences of war.

Methods

The study was conducted in two locations in Sierra Leone and two in Liberia, using focus group discussions (N groups =14) and individual interviews (N = 20).

Results

Women perceive the causes of IPV to be linked with other difficulties faced by women in these settings, including their financial dependence on men, traditional gender expectations and social changes that took place during and after the wars in those countries. According to respondents, the wars increased the use of violence by some men, as violence became for them a normal way of responding to frustrations and challenges. However, the war also resulted in women becoming economically active, which was said by some to have decreased IPV, as the pressure on men to provide for their families reduced. Economic independence, together with services provided by NGOs, also gave women the option of leaving a violent relationship.

Conclusions

IPV was found to be a significant problem for women in Sierra Leone and Liberia.

The interactions between war experiences and financial and cultural issues are multi-faceted and not uniformly positive or negative.

Recent abuse from in-laws and associations with adverse experiences during the crisis among rural Ivorian women: extended families as part of the ecological model

Violence against women in the aftermath of conflict represents a growing area of concern. However, little is known about violence perpetrated by a woman's in-laws and how these experiences may be related to adverse experiences during a crisis. Therefore, guided by the ecological model, the objectives of the following analysis were to (1) document adverse experiences during the crisis among rural Ivorian women and (2) investigate the association between such experiences and abuse perpetrated by partners' extended families, among a sample of women residing in rural Côte d'Ivoire. Utilising data from a baseline survey conducted in 2010, we generated descriptive statistics and used generalised estimating equations to assess the relationships of interest. Women whose family was victimised during the crisis had 1.7 times the odds of reporting past-year in-law abuse compared to those women whose families did not experience such adversity (95% CI: 1.1-2.4), and women who experienced a personal form of adversity had twice the odds of reporting past-year in-law abuse compared to women who did not report victimisation (95% CI: 1.2-3.2). Being forced to flee was not statistically associated with in-law abuse. Findings underscore the importance of addressing in-law abuse in order to promote women's health in post-conflict settings.

Substance use, generation and time in the United States: the modifying role of gender for immigrant urban adolescents

Although immigrant youth have lower rates of substance use than US born youth, whether substance use varies by generation and time in the US is unclear. This study examines adolescent alcohol, tobacco and marijuana use by generation/time in US (i.e., first generation, in US ≤4 years; first generation, in US >4 years; second generation; and third generation or higher). Data come from a 2008 survey of Boston, Massachusetts public high school students (n = 1485). Multivariable logistic regression models were used to examine the association between generation/time in the US and risk of past 30-day substance use, adjusting for age and race/ethnicity. To determine whether the associations differed by gender, we fit gender stratified regression models. The prevalence of substance use was lowest among immigrants who had been in the US ≤4 years. Among girls, generation/time in US was not related to alcohol use or to tobacco use. For boys, being an immigrant regardless of number of years in the US, as well as second generation was associated with a significantly lower risk of tobacco use, compared to third generation youth. Additionally, immigrant boys who had been in the US ≤4 years had a significantly lower risk of alcohol use. Among both boys and girls, all first and second generation youth were significantly less likely to report marijuana use compared to third generation youth. Immigrant youth have a lower risk of alcohol, tobacco and marijuana use relative to US born youth; however the protective effect of foreign nativity on alcohol was eroded much more quickly than for tobacco or marijuana. The effects of generation and time in US on substance use differ by gender and the particular substance.

Abuse from in-laws and associations with attempts to control reproductive decisions among rural women in Côte d'Ivoire: a cross-sectional study

OBJECTIVE

To document the lifetime prevalence of abuse from in-laws (both nonphysical maltreatment and physical violence), the forms of in-law abuse and reproductive control, and the relationship between experiences of in-law abuse and reproductive control among partnered women in rural Côte d'Ivoire.

DESIGN

Cross-sectional study using baseline data (October 2010) from a randomised controlled trial examining socio-economic interventions on reduction of violence against Ivorian women.

SETTING

Rural Côte d'Ivoire.

POPULATION

A total of 981 Ivorian women aged 18 years and older who reported having a male partner and a current source of stable income.

METHODS

Bivariate and multivariable logistic regression.

MAIN OUTCOME MEASURES

Lifetime, in-law-perpetrated reproductive control.

RESULTS

More than one in four (27.0%) women reported experiencing lifetime in-law abuse. In adjusted logistic regression analysis, in-law abuse was significantly associated with in-law-perpetrated reproductive control (adjusted odds ratio 6.9; 95% confidence interval 3.9-12.2; P < 0.0001). Religion and having fewer pregnancies were also associated with reporting in-law-perpetrated reproductive control.

CONCLUSIONS

Increased efforts are needed to involve in-laws in programmes that seek to reduce gender-based violence against women and improve women's reproductive health.

Integrating social epidemiology into immigrant health research: a cross-national framework

Scholarship on immigrant health has steadily increased over the past two decades. This line of inquiry is often approached as a "specialty" topic involving a discrete de-contextualized population, rather than a topic that is central for understanding patterns of population health within and between sending and receiving countries. Frequently immigrant health research employs theoretical frameworks (e.g., acculturation) that emphasize cultural explanations, while less commonly utilized is the "social determinants of health" framework, which emphasizes social and structural explanations. Drawing upon literature in the fields of economics, sociology of immigration, and social epidemiology, we present a conceptual framework for understanding immigrant health from a cross-national perspective. We discuss the theoretical foundations of this framework; the methodological challenges for undertaking research on immigration and health using this framework; examples of emerging research in this area; and directions for future research. Progress in immigrant health research and population health improvements can be achieved through an enhanced understanding of population health patterns in sending and receiving societies. Immigrant health research needs to be better integrated into social epidemiology. Concurrently, immigrant health research offers conceptual, empirical, and analytic opportunities to advance social epidemiological research. Together, scholarship in immigrant health and social epidemiology can make significant contributions toward one of their mutual and ultimate goals: to improve knowledge about population health.

Sexual violence among host and refugee population in Djohong District, Eastern Cameroon

The following is a population-based survey of the Central African Republic (CAR) female refugee population displaced to rural Djohong District of Eastern Cameroon and associated female Cameroonian host population to characterise the prevalence and circumstances of sexual violence. A population-based, multistage, random cluster survey of 600 female heads of household was conducted during March 2010. Women heads of household were asked about demographics, household economy and assets, level of education and sexual violence experienced by the respondent only. The respondents were asked to describe the circumstances of their recent assault. The lifetime prevalence of sexual violence among Djohong district female heads of household is 35.2% (95% CI 28.7-42.2). Among heads of household who reported a lifetime incident of sexual violence, 64.0% (95% CI 54.3-72.5) suffered sexual violence perpetrated by their husband or partner. Among the host population, 3.9% (95% CI 1.4-10.5) reported sexual violence by armed groups compared to 39.0% (95% CI 25.6-54.2) of female refugee heads of household. Women who knew how to add and subtract were less likely to report sexual violence during their lifetime (OR 0.16, 95% CI 0.08-0.34). Sexual violence is common among refugees and host population in Eastern Cameroon. Most often, perpetrators are partners/husbands or armed groups.

Accidental and intentional perpetration of serious injury or death: correlates and relationship to trauma exposure

BACKGROUND

The pernicious individual and societal effects of exposure to violence highlight the importance of understanding factors related to trauma perpetration. Little research has investigated the phenomenon of accidental perpetration of serious injury and death, or considered the relationship between perpetration and trauma exposure.

METHODS

This study uses data from the National Comorbidity Survey-Replication to examine the demographic correlates and characteristics of both intentional and accidental perpetration of trauma, as well as the relationship of these types of perpetration to exposure to traumatic events. Participants were 83 individuals who had accidentally perpetrated trauma and 120 individuals who had intentionally perpetrated trauma.

RESULTS

Findings indicated that men were more likely than women to report having intentionally, compared to accidentally, perpetrated trauma. Intentional and accidental perpetration of trauma were both associated with high levels of psychologic disorders, although those who had intentionally perpetrated trauma were more likely to report symptoms of posttraumatic stress disorder compared with those who had accidentally perpetrated trauma. Intentional perpetrators were more likely to have experienced interpersonal trauma in adulthood and childhood compared to accidental perpetrators. Interpersonal and sexual trauma was likely to precede any kind of trauma perpetration.

CONCLUSIONS

Findings suggest that accidental, as well as intentional, perpetration of serious injury or death frequently occurs in the context of trauma and violence. Both types of perpetration are related to psychopathology. Potential mechanisms underlying the relationship between trauma exposure, psychopathology, and perpetration are discussed. Further research is needed to elucidate pathways from trauma exposure to perpetration and mental disorder.

Peer violence perpetration among urban adolescents: dispelling the myth of the violent immigrant

Researchers have found an inverse relationship between immigrant status and violence perpetration. Most studies have examined Mexican immigrants, and few have assessed immigration factors other than nativity. Additionally, the majority have focused on the most serious forms of violence despite the fact that moderate violence is more common. Using data from the 2008 Boston Youth Survey, we generated prevalence estimates of peer violence perpetration across immigration related factors, examined whether risk factors for peer violence differed by these variables, and explored the contribution of risk factors to peer violence perpetration. Recent immigrants had a significantly lower prevalence of peer violence compared to each other generations/time in U.S. group. Known risk factors for violence perpetration varied by generation/time in U.S.: compared to other groups, recent immigrants were less likely to have used substances, and were more likely earn A's and B's in school. Recent immigrants had a significantly lower risk of violence perpetration relative to U.S.-born (RR = 0.35, 95% CI: 0.19, 0.62). Adjusting for known risk factors did not attenuate differences in risk. While immigrant youth had a lower risk of peer violence, the protective effect was diminished among immigrants who had resided in the U.S. for >4 years. This pattern demonstrates that negative assimilation occurs within the first generation, not just across generations. Results suggest that perpetration of violence worsens with increased time in the U.S. Research is needed to identify factors that contribute to the acquisition of behaviors such as violence among recently arrived immigrant youth.

Men's exposure to human rights violations and relations with perpetration of intimate partner violence in South Africa

BACKGROUND

Despite widespread apartheid-related human rights violations (HRV) and intimate partner violence (IPV) in South Africa, research investigating the influence of HRV on IPV perpetration is scarce.

METHODS

This study analysed data from the South Africa Stress and Health Study, a cross-sectional survey conducted from 2003 to 2004 with 4351 South Africans examining public health concerns associated with apartheid. Analyses were restricted to men who had ever been married or had ever cohabited with a female partner. Logistic regression was used to examine associations between experiences of HRV and lifetime physical IPV perpetration.

RESULTS

A total of 772 South Africa men met the study criteria (389 liberation supporters and 383 government supporters). Adjusted logistic regression analyses indicated that among liberation supporters, a significant association existed between experiencing major HRV (AOR 2.40, 95% CI 1.20 to 4.81), custody-related HRV (AOR 6.61, 95% CI 2.00 to 21.83), victimisation of close friends/family members (AOR 3.38, 95% CI 1.26 to 9.07) and physical IPV perpetration. Among government supporters, a significant association was observed between experiencing HRV (AOR 2.99, 95% CI 1.34 to 6.65) and victimisation of close friends/immediate family (AOR 5.42, 95% CI 1.44 to 19.02) and IPV perpetration.

CONCLUSION

This work indicates the importance of men's experiences with HRV with regard to IPV perpetration risk. Future work is needed to understand the mechanisms underlying the observed relationships, particularly regarding mental health and gender norms as suggested by current literature, in order to inform interventions in South Africa and other regions affected by politically motivated conflict.

Intimate male partner violence in the migration process: intersections of gender, race and class

AIM

This paper is a report of a study of Sri Lankan Tamil Canadian immigrants' perspectives on factors that contribute to intimate male partner violence in the postmigration context.

BACKGROUND

Increasing evidence illustrates the extent and nature of intimate male partner violence and its links to a range of physical and mental health problems for women around the world. However, there has been little health sciences research on intimate male partner violence in the postmigration context in Canada.

METHODS

Data were collected for this qualitative descriptive study in 2004 and 2005, through individual interviews with community leaders (n = 16), four focus groups with women and four with men from the general community (n = 41), and individual interviews with women who had experienced intimate male partner violence (n = 6). The research was informed by a postcolonial feminist perspective and an ecosystemic framework.

FINDINGS

Participants' conceptualization of the production of intimate male partner violence in the postmigration context involved (a) experiences of violence in the premigration context and during border crossing; (b) gender inequity in the marital institution; (c) changes in social networks and supports; and (d) changes in socioeconomic status and privilege.

CONCLUSION

Increasing immigration requires that nurses pay attention to and respond appropriately to women's unique needs, based on complex and interrelated factors that produce intimate male partner violence in the postmigration context.

Intimate partner violence perpetration, immigration status, and disparities in a community health center-based sample of men

OBJECTIVE

We examined disparities in male perpetration of intimate partner violence (IPV) based on immigration status.

METHODS

From 2005 to 2006, 1,668 men aged 18-35 who were recruited from community health centers anonymously completed an automated, computer-assisted self-interview. Men self-reported their immigrant status (e.g., native-born, <6 years in the U.S. [recent immigrants], or > or = 6 years in the U.S. [non-recent immigrants]) and IPV perpetration. We calculated differences in IPV perpetration based on immigrant status. Among immigrant men, we further examined differences in IPV perpetration based on English-speaking ability.

RESULTS

Recent immigrants were less likely to report IPV perpetration than native-born men in the overall sample (adjusted odds ratio [AOR] = 0.60, 95% confidence interval [CI] 0.36, 1.00). However, we observed no differences in IPV perpetration between non-recent immigrants and native-born men (AOR=0.88, 95% CI 0.63, 1.23). Among immigrant men, those who were non-recent immigrants and reported limited English-speaking ability were at the highest risk for IPV perpetration, compared with recent immigrants with high English-speaking ability (AOR=7.48, 95% CI 1.92, 29.08).

CONCLUSIONS

Although immigrant men were at a lower risk as a group for IPV perpetration as compared with non-immigrants, this lower likelihood of IPV perpetration was only evident among recent immigrants. Among immigrant men, those who arrived in the U.S. more than six years ago and reported speaking English relatively poorly appeared to be at greatest risk for using violence against partners. Future research should examine the effects of fear of legal sanctions, discrimination, and changes in gender roles to clarify the present findings.

Association between exposure to political violence and intimate-partner violence in the occupied Palestinian territory: a cross-sectional study

BACKGROUND

Intimate-partner violence might increase during and after exposure to collective violence. We assessed whether political violence was associated with male-to-female intimate-partner violence in the occupied Palestinian territory.

METHODS

A nationally representative, cross-sectional survey was done between Dec 18, 2005, and Jan 18, 2006, by the Palestinian Central Bureau of Statistics. 4156 households were randomly selected with a multistage random cluster design, from which 3815 ever-married women aged 15-64 years were identified. We restricted our analysis to presently married women (n=3510, 92% participation rate), who completed a short version of the revised conflict tactics scales and exposure to political violence inventory. Exposure to political violence was characterised as the husband's direct exposure, his indirect exposure via his family's experiences, and economic effects of exposure on the household. We used adjusted multinomial logistic regression models to estimate odds ratios (ORs) for association between political violence and intimate-partner violence.

FINDINGS

Political violence was significantly related to higher odds of intimate-partner violence. ORs were 1.89 (95% CI 1.29-2.76) for physical and 2.23 (1.49-3.35) for sexual intimate-partner violence in respondents whose husbands were directly exposed to political violence compared with those whose husbands were not directly exposed. For women whose husbands were indirectly exposed, ORs were 1.61 (1.25-2.07) for physical and 1.97 (1.49-2-60) for sexual violence, compared with those whose husbands were not indirectly exposed. Economic effects of exposure were associated with increased odds of intimate-partner violence in the Gaza Strip only.

INTERPRETATION

Because exposure to political violence is associated with increased odds of intimate-partner violence, and exposure to many traumas is associated with poor health, a range of violent exposures should be assessed when establishing the need for psychosocial interventions in conflict settings.