Addressing Suicide Risk Among Immigrant Women Survivors of Intimate Partner Violence

Intimate partner violence (IPV) is a significant public health problem contributing to multiple morbidities. Immigrant women who experience IPV may be disproportionately vulnerable to poor mental health outcomes, including self-harm and suicidal ideation, due to cultural experiences and contextual factors that prevent them from accessing services. While existing studies identify the risks for suicidal ideation amongst survivors of IPV, there is limited knowledge on how to tailor strategies to support immigrant women survivors of IPV who experience suicidal ideation. This study was conducted as part of the formative phase of a longitudinal research project designed to develop and evaluate a safety planning intervention for immigrant women survivors of IPV. Using qualitative in-depth interviews, we explored the perspectives of immigrant women survivors of IPV (n = 46) from various countries of origin, ages, and educational backgrounds on effective strategies for supporting immigrant women who disclose suicidal ideation. Study participants discussed various strategies for supporting survivors including building trust, providing encouragement, strengthening social support networks, and reminding survivors of parental responsibilities. Participants also pointed to the importance of the following services: domestic violence support, faith-based health resources, supportive immigration programs, mental health support, and emergency and medical treatment. These findings are informative for researchers and practitioners who work with immigrant women survivors of IPV, and they can be used to develop appropriate safety protocols and support strategies for survivors who are experiencing or have previously experienced suicidal ideation to mitigate the risk of self-harm.

Mental Telehealth Utilization Patterns Among High School Students from Racial and Ethnic Minority Backgrounds Affected by Violence and Substance Use

BACKGROUND

Recent data show high school students from racial and ethnic minority (REM) backgrounds in the United States confront a twofold challenge, marked by the highest rates of firearm-related homicides since 1994 and increased youth substance use. The pandemic increased online and telehealth usage opportunities for at-risk REM youth. Therefore, this study investigated (1) the frequency and prevalence of co-occurring youth violence and substance use among REM adolescents, (2) racial/ethnic, age, and natal sex (as gender data was not collected) differences in patterns and trends in co-occurring youth violence and substance use among REM adolescents, and (3) the relationship between these syndemic issues and REM adolescent mental telehealth use during the pandemic.

METHODS

Data was sourced from a nationally representative sample of U.S. 9th-12th students (n = 3241) who completed the CDC's 2021 Adolescent and Behavioral Experiences Survey (ABES). Using univariate (frequency distribution), bivariate (Pearson's chi-squared test), and multivariate logistic regression models, we examined seven violence victimization outcomes, four violence perpetration outcomes, two family violence outcomes, and six substance use outcomes and their associations with telehealth use for mental health (dependent variable) among REM adolescents.

RESULTS

This sample was primarily female (50.7%), Black or African American (48.3%), Hispanic or Latinx (20.6%), and identified as straight or heterosexual (69.5%). The study found significant sex-based differences in violence perpetration/victimization, substance use, and telehealth use for mental health. In general, mental telehealth use was significantly associated with substance use among REM adolescents (cigarette smoking, vaping, alcohol, marijuana, prescription meds, and illicit drug use) (p-value = .001). Mental telehealth use was also significantly associated with all peer and family violence outcomes (p < 0.001). Controlling for covariates, gun carrying was associated with 4.8 times higher odds of using mental telehealth. Students in a physical fight or carrying a weapon (gun, knife, or club) on school property had 2.45 times and 8.09 times the odds of utilizing mental telehealth. Bullied students were 2.5 times more likely to use mental telehealth (p-value < 0.05). Illicit drug use (cocaine, heroin, methamphetamines, and ecstasy) was associated with a higher likelihood of mental telehealth use (AOR = 1.3, p-value = .05).

CONCLUSION

Our results suggest crucial insights for shaping violence and substance use prevention strategies, with implications for the future of online and telehealth behavioral services. Mental telehealth help-seeking emerges as a crucial avenue for supporting adolescents affected by violence and substance use, especially when they face obstacles to accessing traditional services. It can work in tandem with in-person services to address these challenges.

The being safe, health and positively empowered pilot randomized controlled trial: A digital multicomponent intervention for immigrant women with cumulative exposures to violence

OBJECTIVES

Pre- and postmigration exposures to violence are significant social determinants of immigrant women's health, safety, and well-being, with Black immigrant women being at high risk because of many coming from conflict-zone countries. The existing literature does not report the development and testing of a multicomponent digital intervention to address safety and health issues among immigrant women with cumulative exposures to violence. This pilot randomized controlled trial evaluated preliminary efficacy of a multicomponent digital intervention (BSHAPE) to improve health and safety outcomes for immigrant women with cumulative violence exposures, posttraumatic stress disorder and/or depression symptoms, and human immune deficiency virus (HIV) risk behaviors.

METHOD

The intervention was developed based on formative qualitative work and input from women. In the randomized controlled trial, 144 Black immigrant women, average age being 33.6 years, were randomly assigned to either the BSHAPE arm (n = 72) or a control arm (n = 72). Data were collected at four time points over 12 months. A generalized estimating equation analysis was performed to examine group differences in change in outcomes over time.

RESULTS

Compared to the control arm, participants in BSHAPE showed significant improvement in multiple outcome measures (e.g., HIV/STI risk).

CONCLUSION

This pilot trial of BSHAPE showed promising results for immigrant women with lifetime exposures to violence, poor mental health, and HIV risk. The study also provided useful information to further improve BSHAPE for a full-scale efficacy trial. The digital BSHAPE can be especially advantageous for violence-affected immigrant women who face numerous barriers to accessing in-person care for their safety and health needs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploring Maternal and Child Health Among Tribal Communities in India: A Life Course Perspective

India experiences high rates of maternal and infant mortality and morbidity, with tribal communities disproportionately affected. Tribal populations frequently live in unfavorable socio-economic conditions and deficient social health indicators, culminating in adverse health consequences. Using a life course perspective, this qualitative study explored risks over the life course that contribute to maternal and child health problems among tribal populations in India. Additionally, the study examined barriers to utilization of healthcare services during the pregnancy and postpartum periods. Data collection occurred between 2017 and 2019 through participant observation, key informant interviews (n = 7) and in-depth interviews (n = 68) and a focus group (n = 7) with tribal women from the Madia-Gond tribe in the Indian state of Maharashtra. Additionally, verbal autopsies were conducted with relatives of three deceased women and five infants from the tribe. Multiple risk factors operating at different socio-ecological levels and developmental stages of life were associated with maternal and child health problems among the tribe. These included adherence to traditional harmful practices, limited access to nutritional diet, women's health neglected due to the double burden of domestic and professional labor, and a lack of accessible and well-equipped medical facilities. Inaccesibility stemmed from factors including extreme poverty, geographical isolation, and suboptimal healthcare infrastructure. There is need for provisions to promote access to care and to promote education and awareness centered on evidence-supported healthcare, particularly targeted towards expectant mothers. The implementation of nutritional support programs may help mitigate high maternal and child mortality and morbidity rates prevalent among tribal populations.

Cumulative violence exposures among men who have sex with men living with HIV in India: Psychosocial correlates of HIV care continuum outcomes

Lifetime exposures to violence among men who have sex with men (MSM) are associated with multiple psychosocial health risks and can affect engagement and outcomes of HIV treatment. This study a) explored relationships between levels of exposures to violence and HIV care continuum outcomes among MSM living with HIV in India, and b) identified psychosocial correlates of HIV care continuum outcomes among MSM living with HIV and those with lifetime cumulative exposures to violence (CVE). CVE referred to exposures to violence in both childhood and adulthood. This cross-sectional analysis used survey data collected between August 2016 and May 2017 from 1763 men who have sex with men living with HIV across 10 cities in India, using respondent-driven sampling. We found that higher levels of violence exposure were significantly associated with lower awareness of HIV positive status, and lower likelihood of initiating antiretroviral therapy. Compared with MSM living with HIV that had no CVE, those with CVE were more likely to report perpetration of interpersonal violence, alcohol misuse, depressive symptoms, and HIV transmission risk behaviors and to have two to four co-occurring psychosocial problems. In multivariable analysis with the subset of MSM with CVE, psychosocial correlates significantly associated with at least one HIV care continuum outcome were HIV transmission risk behaviors, perpetration of interpersonal violence, depression, and alcohol misuse. The findings highlight the need for integrating care for lifetime violence exposures and associated behavioral problems in HIV care settings for men who have sex with men living with HIV in India.

Gender-Based Violence Interventions in Low- and Middle-Income Countries: A Systematic Review of Interventions at Structural, Community, Interpersonal, Individual, and Multiple Levels

Gender-based violence (GBV) disproportionately impacts women and girls in low- and middle-income countries (LMIC). This review described the characteristics of structural, community, interpersonal, individual, and multilevel GBV interventions in LMIC and examined components of interventions implemented at different socio-ecological levels. We conducted a systematic search of peer-reviewed literature on GBV intervention evaluation studies in LMIC using the following databases: PubMed, CINAHL, Embase, Cochrane, Academic Search Ultimate, PsycInfo, and Web of Science. The search resulted in 3,256 articles, with 60 articles meeting the eligibility criteria. Thirty-eight articles reported positive GBV outcomes with significant differences between intervention and control arms on at least one GBV outcome. Very few interventions were found to be stand-alone GBV interventions. The key components of interventions effective in addressing victimization and perpetration across levels were education or psychoeducation, psychotherapy, skills development, gender transformative activities, community engagement, focus on men and/or partners, and health promotion activities such as HIV or STI prevention. Most interventions were multilevel, with positive outcomes for victimization. Fewer evidence-based interventions existed for addressing perpetration. There is need for additional research using rigorous methods to establish an evidence base for effective interventions in under-researched regions in LMIC as well as for interventions that address perpetration of GBV.

Firearm-Related Risks and Consequences for Immigrant Women in Abusive Relationships: Barriers to Reporting Threats to Safety and Recommendations for Safety Planning

Firearms are the leading cause of intimate partner violence-related murders of women in the US. This study aimed to understand differing consequences of partners' firearm possession on abused women and barriers women face in reporting threats to safety due to the partners' possession of a firearm.. Additionally, the study explored participants' perceptions of effective approaches to risk assessments and safety planning with women who are at-risk for being harmed by their partners' possession of a firearm. Qualitative semi-structured interviews with seventeen service providers and 45 immigrant women survivors of intimate partner violence were conducted. Data were analyzed using content analysis procedure. Participants shared that the partners' possession of a firearm can increase risk for firearm-related injury or fatality in situations of escalation of violence. Abused women living with a partner with firearm possession live in constant fear or threat. The presence of a firearm can also be a trigger of unwanted memories of the past and can have legal and other consequences for survivors. Impediments to reporting threats to safety were barriers such as lack of knowledge of firearm-related risks and gender and social norms. The findings can be informative for safety planning with survivors of IPV whose partners own or have access to a firearm. Comprehensive assessment of risks and barriers can be used to develop individualized and tailored safety plans for survivors with a partner who possesses a firearm.

Prevalence and severity of Molar-Incisor Hypomineralisation in children in Fujairah, United Arab Emirates

AIM

This study aims to find the prevalence of MIH in children in the city of Fujairah, United Arab Emirates, utilising the current standardised guidelines for diagnosis and calibration.

BACKGROUND

Molar-Incisor Hypomineralization (MIH) prevalence in paediatric patients has been widely studied. However, most of the available studies have utilised criteria that did not offer consistent diagnostic and calibration tools, which resulted in incomparable results.

METHODS

Cross-sectional study. One hundred sixty-two school children aged 7-9 years in the city of Fujairah, UAE have been randomly selected and orally examined for the presence of MIH lesions. This was conducted following Ghanim et al. [2015] guidelines and after calibrating examiners following Ghanim et al. [2017] training manual.

CONCLUSION

MIH prevalence was high in the city of Fujairah, UAE. More studies utilising the standardised criteria are required for valid comparisons. Further research on the aetiology of MIH is also needed.

Safety Planning With Marginalized Survivors of Intimate Partner Violence: Challenges of Conducting Safety Planning Intervention Research With Marginalized Women

Intimate partner violence (IPV) disproportionately affects marginalized women in the United States. This calls for effective safety planning strategies to reduce the risk for future revictimization and address safety needs of survivors from marginalized groups. This review identified types of interventions that incorporated safety planning and were successful in reducing the risk for future revictimization among IPV survivors from diverse groups, examined elements of safety planning in effective interventions, and described challenges or limitations in safety planning intervention research with marginalized women. A systematic search of five databases was performed. The search resulted in inclusion of 17 studies for synthesis. The included studies were quantitative, U.S.-based, evaluated interventions with a safety planning component, and had an outcome of change in IPV. Effective interventions that incorporated safety planning were empowerment and advocacy focused. Elements included were comprehensive assessments of survivors' unique needs and situations, educating them about IPV, helping them identify threats to safety, developing a concrete safety plan, facilitating linkage with resources, providing advocacy services as needed, and conducting periodic safety check-ins. For survivors with mental and behavioral health issues, effective interventions included psychotherapeutic approaches along with safety planning to address survivors' co-occurring health care needs. Although most studies reported positive findings, there were limitations related to designs, methods, adequate inclusion, and representation of marginalized women and cultural considerations. This calls for additional research using rigorous and culturally informed approaches to establish an evidence base for effective interventions that specifically address the safety planning needs of marginalized survivors of IPV.

Using Mindfulness to Improve Mental Health Outcomes of Immigrant Women with Experiences of Intimate Partner Violence

Immigrant women are disproportionately affected by intimate partner violence (IPV), which poses risk for mental health problems, such as PTSD and depression. Post-migration barriers limit immigrant women's access to supportive services, which can further debilitate their mental health symptoms and their safety. The Being safe, Healthy, and Positively Empowered (BSHAPE) digital intervention was designed to address physical safety and healthcare needs of immigrant women through a multi-component approach that integrated mindfulness-based stress reduction (MBSR) practices. This paper reports qualitative feedback findings from eighteen Black immigrant women with recent IPV exposure and co-occurring mental health symptoms, who participated in the mindfulness sessions of BSHAPE. We identified elements of mindfulness that women perceived as beneficial in their healing. Women's feedback indicated healing and empowerment through positive appraisals and coping strategies. The benefits were noted for mindfulness elements promoting self-compassion, self-actualization, intentionality of moving forward in life, and developing positivity or a sense of optimism. Other helpful elements were relaxation, self-care and reflection, self-awareness, self-control and focused thinking. Our findings show that incorporating mindfulness practices in interventions can be beneficial for promoting the healing and empowerment of immigrant women in abusive relationships.

Conducting Intervention Research With Immigrant Survivors of Intimate Partner Violence: Barriers and Facilitators of Recruitment and Retention

Research is needed to support culturally informed interventions for diverse groups of survivors of intimate partner violence (IPV), such as immigrant women. Researchers, however, often face numerous barriers in recruiting and retaining immigrant survivors of IPV in intervention research. This qualitative study explored strategies to enhance recruitment and retention of immigrant survivors of IPV in intervention research from the perspective of immigrant survivors of IPV and providers serving immigrant women. Forty-six in-depth interviews were conducted with diverse groups of immigrant women (Africans, Asians, and Latinas) and 17 key informant interviews were conducted with providers serving immigrant women. The interviews focused on perceived facilitators and barriers to recruitment and retention including strategies to form partnerships with domestic violence organizations. Data were analyzed using systematic inductive thematic analysis. Participants identified barriers to recruitment such as fear of being judged, lack of familiarity with the recruiter, normalcy of abuse in some cultures, undocumented status, and fear related to legal implications of reporting IPV. Barriers to study retention included lack of motivation, time burden related to study participation, and emotional strain with recounting abuse experience. Participants also shared strategies to facilitate recruitment and retention such as engaging with the community, forming partnerships with domestic violence organizations, using recruiters with similar background and experiences as potential participants, using snowball sampling strategies, recruiting in locations frequently visited by immigrant survivors, providing adequate incentives, ensuring confidentiality, educating survivors about IPV, and conducting periodic check-ins throughout the study period. Findings can be useful for researchers conducting intervention studies with immigrant survivors of IPV.

Violence Against Women in India: An Analysis of Correlates of Domestic Violence and Barriers and Facilitators of Access to Resources for Support

Purpose

Domestic violence (DV) is a significant public health problem in India, with women disproportionately impacted. This study a) identified risk and protective correlates of DV and, b) barriers and facilitators for seeking and receiving help for DV among women in India.

Methods

A systematic search of 5 databases was performed to identify correlates of DV in the quantitative literature. The search resulted in inclusion of 68 studies for synthesis. For qualitative exploration, data were collected from 27 women in India.

Results

While factors such as social norms and attitudes supportive of DV were both risk correlates and barriers to addressing DV, omen's empowerment, financial independence and informal sources of support were both protective correlates of DV as well as facilitators in addressing DV.

Conclusions

Strong efforts in India are needed to reduce DV-related risk factors and strengthen protective factors and enhance access to care for women in abusive relationships.

Conducting Digital Intervention Research among Immigrant Survivors of Intimate Partner Violence: Methodological, Safety and Ethnical Considerations

Intimate partner violence, described as a global pandemic by the United Nations, has been found to disproportionately affect immigrant women. Many immigrant survivors of IPV are unable or unwilling to attend in-person services due to barriers related to immigration status, transportation, and social isolation. By providing remote support to women in abusive relationships, digital interventions can help address these barriers and ensure their health and safety. Research on safe and ethical approaches to digital service delivery for immigrant IPV survivors is a necessary first step to meeting these women's needs for remote support. The purpose of this qualitative study was to explore considerations and challenges of conducting digital intervention research (online, phone and text) with diverse groups of immigrant women. Data was collected via 5 focus groups and 46 in-depth interviews with immigrant survivors of IPV from different countries of origin. In addition, data was collected via key informant interviews with 17 service providers. Participants shared safety, ethical and methodological challenges to accessing interventions, such as their abusive partner being at home or lack of safe access to technology. Further, participants shared strategies for safe data collection, such as scheduling a contact time when participants are afforded privacy and deleting evidence of the intervention to retain personal safety. The findings will be informative for researchers conducting digital intervention studies or practitioners engaging in remote intervention approaches with marginalized populations such as immigrant women at high risk of violence.

Impact of Sources of Strengths on Coping and Safety of Immigrant Survivors of Intimate Partner Violence

Intimate partner violence (IPV) is a national and international public health and human rights concern. Immigrant women are disproportionately affected by IPV that includes homicides. This study explored the perspectives of survivors of IPV, who are immigrants to the United States, regarding their sources of strength that enhance their safety and promote coping in abusive relationships. Data for this qualitative study were collected from ethnically diverse immigrant women residing in Massachusetts, Arizona, Virginia, Washington, D.C., New York, Minnesota, and California, using purposive and snowball sampling techniques. Eighty-three in-depth interviews were conducted with adult immigrant survivors of IPV who self-identified as Asian (n = 30), Latina (n = 30), and African (n = 23). Data were analyzed using thematic analysis. Women identified both external (e.g., community support, support from social service agencies) and internal (e.g., optimism, faith, beliefs) sources of strength. The study highlights how these sources can adequately address needs of survivors and offers areas for improvement in services for survivors. The findings are informative for practitioners serving immigrant survivors of IPV in legal, social service, and physical and mental health settings.

A technology-based intervention to improve safety, mental health and empowerment outcomes for immigrant women with intimate partner violence experiences: it's weWomen plus sequential multiple assignment randomized trial (SMART) protocol

BACKGROUND

Intimate partner violence (IPV) disproportionately affects immigrant women, an understudied and underserved population in need for evidence-based rigorously evaluated culturally competent interventions that can effectively address their health and safety needs.

METHODS

This study uses a sequential, multiple assignment, randomized trial (SMART) design to rigorously evaluate an adaptive, trauma-informed, culturally tailored technology-delivered intervention tailored to the needs of immigrant women who have experienced IPV. In the first stage randomization, participants are randomly assigned to an online safety decision and planning or a usual care control arm and safety, mental health and empowerment outcomes are assessed at 3-, 6- and 12-months post-baseline. For the second stage randomization, women who do not report significant improvements in safety (i.e., reduction in IPV) and empowerment from baseline to 3 months follow up (i.e., non-responders) are re- randomized to safety and empowerment strategies delivered via text only or a combination of text and phone calls with trained advocates. Data on outcomes (safety, mental health, and empowerment) for early non-responders is assessed at 6 and 12 months post re-randomization.

DISCUSSION

The study's SMART design provides an opportunity to implement and evaluate an individualized intervention protocol for immigrant women based on their response to type or intensity of intervention. The findings will be useful for identifying what works for whom and characteristics of participants needing a particular type or intensity level of intervention for improved outcomes. If found to be effective, the study will result in an evidence-based trauma-informed culturally tailored technology-based safety decision and planning intervention for immigrant survivors of IPV that can be implemented by practitioners serving immigrant women in diverse settings.

TRIAL REGISTRATION

This trial was registered with ClinicalTrials.gov as NCT04098276 on September 13, 2019.

Methodological and Ethical Considerations in Research With Immigrant and Refugee Survivors of Intimate Partner Violence

To promote safe and positive health outcomes by utilizing culturally relevant evidence-based interventions for immigrant and refugee women survivors of intimate partner violence, their active participation in research is critical. With 43.6 million immigrants and refugees living in the United States, there is a need for research studies to eliminate health disparities in these populations. However, barriers to recruiting and retaining these populations in research prevent the provision of quality and culturally informed services to meet their needs. The aim of this article is to discuss the recruitment and retention strategies employed and analyze the methodological and ethical challenges in the context of the weWomen Study. The use of a multifaceted approach informed by best practices maximized recruitment efforts and active participation that generated high numbers of immigrant and refugee women participants. The study also substantiated the need for more community-based participatory approaches to engage community members in the development of culturally appropriate approaches that instill a sense of ownership over the research process. Active research participation of immigrant and refugee survivors will help investigators understand their unique needs and facilitate the implementation of targeted evidence-based interventions.

Advance Directives for Adolescents and Young Adults Living With Neuromuscular Disease: An Integrative Review of the Literature

The use of advance directives is an important component in helping individuals living with chronic and/or life-threatening illnesses establish goals of care and make decisions regarding care at the end of life. Advance care planning may help achieve enhanced health outcomes, yet it is not routinely offered to adolescents/young adults living with neuromuscular disease. An integrative review of the literature was conducted to examine the evidence related to the use of advance directives with adolescents/young adults living with neuromuscular disease and to identify reasons why they are not being used and how this can be improved. Three-hundred-seven studies were retrieved from PubMed, CINAHL, and EMBASE. Five studies met the final inclusion search criteria and were included in the analysis. Four themes emerged from the literature: conversations about advance directives with adolescents/young adults with neuromuscular disease are not being conducted, only a small number of patients have documented advance directives, patients want to have conversations about goals of care and want to have them sooner, and there is a lack of evidence in this area. These findings may influence neuromuscular clinicians' practice surrounding the use of advance directives and increase their knowledge regarding the need for discussions regarding goals of care.

Exploring multilevel determinants of co-occurring violence, HIV, mental health and substance use problems

Multiple factors contribute to co-occurring issues such as violence, HIV, and mental disorders among people who inject drugs (PWID), particularly those residing in limited resource settings. Using an ecological framework, this study explored multilevel determinants of co-occurring violence, HIV, mental health, and substance use issues among PWID. Data were collected via semi-structured in-depth interviews with 31 men and women PWID in India. Findings revealed factors at the community (e.g., stigma), interpersonal (e.g., abusive partners), and individual (e.g., financial stress) levels. Findings highlight the need for prevention and intervention programs addressing factors at multiple ecological levels to reduce comorbidity among PWID.

Contextual factors associated with gender-based violence and related homicides perpetrated by partners and in-laws: A study of women survivors in India

Gender based violence (GBV) is a significant public health concern for women globally, including countries such as India. The researchers investigated factors related to GBV and GBV-related homicides perpetrated by both husbands and in-laws using a qualitative approach. Data were collected from 27 women in India. Analysis revealed factors at the societal/cultural (e.g. dowry), community (e.g. inadequate resources), relationship (e.g. in-laws abuse) and individual (e.g. internalized powerlessness) levels. Findings highlight the need for culturally appropriate risk assessment and safety planning procedures, as well as policies and programs across different ecological levels to reduce risk for GBV and GBV-related homicides.

Intimate Partner Homicides in the United States, 2003-2013: A Comparison of Immigrants and Nonimmigrant Victims

Intimate partner homicide (IPH) is a significant public health issue that has negative consequences for families and communities. Evidence is needed to support heterogeneity among groups affected by IPHs. This study examined differences in characteristics of male-perpetrated and female-perpetrated killings of native-born and foreign-born residents in the United States. We analyzed 2003-2013 IPH homicide data collected in 19 U.S. states by the National Violence Death Reporting System, Center for Disease Control and Prevention, comparing IPH cases where the victim was U.S.-born versus foreign-born. We examined characteristics associated with male-perpetrated female killings and female-perpetrated male killings. Among the total homicides (n = 147,092), foreign-born victims were more likely than U.S.-born victims to be associated with intimate-partner-violence-related deaths. Women were the victims in 77.4% of IPHs, with a greater proportion of women victims of IPHs being foreign-born than U.S.-born. Foreign-born women killed by their partners were more likely than U.S.-born women to be young, married, and killed by a young partner who stabbed, strangled, or suffocated them. IPHs policies, prevention, and intervention efforts need collaborative efforts between victim services, mental health, and the legal system to identify and intervene with populations at risk. Culturally specific prevention and intervention strategies are needed to address risks of IPHs among diverse groups based on nativity and race/ethnicity.

Exploring African Immigrant Women's Pre- and Post-Migration Exposures to Stress and Violence, Sources of Resilience, and Psychosocial Outcomes

This qualitative study seeks to identify pre- and post-migration stressors experienced by African women who had immigrated to the United States along with the vulnerability and resilience factors that exacerbate or mitigate the negative health effects of these experiences. Seventeen interviews and six focus groups were conducted with 39 African immigrant women. Participants reported encountering experiences of political instability and armed conflict pre-migration and intimate partner violence pre- and post-migration. Religious faith was an important source of resilience for women. Findings support the design of culturally appropriate interventions to improve the mental health of vulnerable African immigrant women.

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.

Characteristics, incidence, and trends of intimate partner homicides in Massachusetts: Patterns by birthplace, race, and ethnicity

This study compared the incidence rates of intimate partner homicide (IPH) in Massachusetts by place of birth and race/ethnicity. The analysis involved 340 IPH victim cases between 1994 and 2014. Victims were just under 40 years of age, on average, and most were female (85%), White (67%), and killed by stabbing (34.4%) or firearms (33%). The incidence of IPH victims ranged from 1.3 to 5.6 cases per million people per year between 1994 and 2014 (M = 2.4 per million). Foreign-born individuals had 1.9-fold higher IPH incidence rates of victims relative to U.S.-born individuals. The incidence of IPH-suicide victims was also significantly higher among foreign-born (M = 1.2 per million) relative to U.S.-born individuals (M = 0.4 per million). Furthermore, minority racial/ethnic groups had significantly high incidence rates of victims, with highest incidence of IPH among Blacks. In the full sample there was a 1.9% decline in the incidence of IPH victims per year, which was not statistically significant. The findings highlight the need for culturally specific prevention and intervention strategies to address risks of IPHs and IPH-suicides among diverse groups, particularly among groups most at-risk in Massachusetts such as foreign-born born individuals and racial and ethnic minorities.

Unwanted Sexual Acts Among University Students: Correlates of Victimization and Perpetration

Unwanted sexual experiences are common among university students in the United States and pose a substantial public health concern. Campus policies and programs to prevent unwanted sexual incidents in university settings require research on prevalence and risk correlates of both victimization and perpetration. This study determined the prevalence of unwanted sexual victimization and perpetration experiences among students, both before and after joining the university, and examined risk correlates for both unwanted sexual victimization and perpetration experiences. Data were collected from 3,977 full-time graduate and undergraduate students using an online survey in a large private university. The findings revealed nearly one in eight students surveyed were victimized by unwanted sexual incidents at the university. Risk correlates of victimization by unwanted sexual incidents included female gender, undergraduate student status, and victimization experiences prior to joining the university. Most (95.5%) sexual violence incidents occurred when the victim was incapacitated due to alcohol, substance, or asleep. An acquaintance, peer, or colleague was the most frequently reported perpetrator. Risk correlates of perpetration included male gender, undergraduate student status, and perpetration of unwanted sexual activities before joining the university. Perpetrators most frequently reported perpetration of unwanted sexual behaviors against a current or former intimate partner or a stranger. The findings highlight the importance of enhanced efforts to reduce prevalence of unwanted sexual incidents, particularly among students most at risk for victimization and perpetration.

Effect of COVID-19 pandemic on women's health and safety: A study of immigrant survivors of intimate partner violence

Intimate partner violence (IPV) is a significant national and global public health concern, with COVID-19 pandemic increasing IPV and associated health issues. Immigrant women may be disproportionately vulnerable to IPV-related health risks during the pandemic. Using qualitative in-depth interviews, we explored the perspectives of service providers (n  = 17) and immigrant survivors of IPV(n  = 45) on the impact of COVID-19 on immigrant women, existing services for survivors and strategies needed needed to enhance women's health and safety. Participants reported issues such as increased IPV and suggested strategies (e.g. strengthening virtual platforms). The findings could be informative for providers in national and international settings.

Understanding Intimate Partner Violence among Immigrant and Refugee Women: A Grounded Theory Analysis

Immigrant and refugee women may experience considerable multifaceted and interrelated barriers that place them at heightened risk for intimate partner violence (IPV). The objective of this analysis was to increase our understanding of immigrant and refugee women's responses to abuse. We conducted in-depth interviews with 84 women who immigrated from Africa, Asia, and Latin America. Engendering Resilience to Survive emerged as the core category explaining women's strength to stay safe and survive IPV experiences. In the face of the violence they experienced, women in this sample demonstrated remarkable resilience and the ability to harness their strength to survive. Resilience as a process and outcome could facilitate empowerment, and self-directedness to access health services and resources to stay safe. The developed Engendering Resilience to Survive Model can be utilized as a framework to inform research, policy, and practice to support abused women.

Human trafficking among nationals, refugees and migrants in Tunisia

Human trafficking is a worldwide phenomenon organized by national and international gangs and generating important financial resources. Refugees and migrants constitute the main victims of such organized crimes. At national level, human trafficking is facilitated by poverty, social exclusion and all forms of vulnerability. School dropout at young age is among determinants of Child labor, organized begging, drug trafficking and involvement in criminal gangs. Economic and political migrants are easy targets to national and international traffickers.

The 2018 report shows that documented cases have increased from 28 in 2015 to 780 in 2018. Women and children represent the high majority respectively 75 % and 50 %. Criminal activities include forced employment (55 %), economic exploitation of children (33 %), sexual exploitation (10 %) and slavery like practice (2 %). Victims of human trafficking are from Tunisia (55 %), Ivory coast (40 %) and Caucasian countries (5 %).

The reported cases are provided social and health services by government and national and international civil society organizations active in Tunisia. Victims suffer stigmatization particularly for HIV carriers and also depression and psychological disorders. Civil society organizations in addition to service delivery, facilitate case notifications and encourage victims for self-reporting which remains low (10 %).

The objectives of the paper are to: Shed light on human trafficking in Tunisia particularly among refugees and migrantsAddress ways and means of preventing such criminal phenomenonInclude care of victims of human trafficking in the social and health package for refugees and migrants.

The Men's Group at St. Pius V: A Case Study of a Parish-Based Voluntary Partner Abuse Intervention Program

Literature on Latino men and intervention for intimate partner violence/abuse (IPV/A) is slim. Over 100 men have voluntarily sought help for IPV/A perpetration from “The Men’s Group” (TMG) at St. Pius V parish in Chicago, IL (US) and remained engaged for extended periods. Given the rarity of prolonged non-court mandated engagement in batterer intervention programs (BIPs), a case study was conducted to explore how TMG functions. Drawing on multiple data sources, this study examined development and implementation of TMG, while also investigating contextual factors, motivators and facilitators of participants’ involvement. Data revealed that TMG functions within a supportive community context by using a mixture of traditional techniques and innovative practices, creating a unique treatment modality. The program was found to be culturally-sensitive and spirituality-based. Reasons for initial attendance varied but included: (1) fear of losing or actual loss of their partner/family; (2) acknowledging a problem and desiring to change for self or others; and (3) a desire to reach inner peace. Three themes shed light on why men remain engaged in TMG, including: (1) being met with respect by facilitators; (2) experiencing TMG as “family”; and (3) gaining benefits. Reliance upon the criminal justice system is not enough to address IPV/A perpetration. This program shows promise as an alternative or supplement to traditional BIPs, which typically rely on clients being court-mandated to attend treatment. Given the widespread nature of IPV/A, understanding the operation of potential community-based alternatives or supplements to BIPs is critical in widening access to treatment.

Patterns of abuse among South Asian women experiencing domestic violence in the United States

This qualitative study was conducted with a convenience sample of 20 South Asian women experiencing domestic violence in the United States. The results explore the patterns of abuse and factors and circumstances (i.e. turning points) that motivated South Asian women to change in the context of the stage that they were in as per the Landenburger's model (binding, enduring, disengaging, and recovery). The four themes that emerged from the interviews and analysis are (1) 'Timing and Frequency of abuse', (2) 'Methods of control - financial, isolation and suspicion', (3) 'Cycle of Abuse', and (4)' Turning Points - motivation to change'. Implications for practice and policy-level changes for abused South Asian women in the United States are discussed.

Integrated Multicomponent Interventions for Safety and Health Risks Among Black Female Survivors of Violence: A Systematic Review

The epidemic of violence disproportionately affects women, including Black women. Black women survivors of violence have been found to face multiple safety and health issues such as depression, post-traumatic stress disorder, HIV, and poor reproductive health. Many health issues co-occur, and this co-occurrence can be associated with additional safety and health-related challenges for survivors. Consequently, there is a need for multicomponent interventions that are designed to concurrently address multiple health issues commonly faced by Black survivors of violence. This systematic review of literature determines the efficacy of various strategies used in the existing evidence-based multicomponent interventions on violence reduction, promotion of reproductive health, reduction in risk for HIV, reduction in levels of stress, and improvement in mental health. Sixteen intervention studies were identified. Examples of components found to be efficacious in the studies were safety planning for violence, skill building in self-care for mental health, education and self-regulatory skills for HIV, mindfulness-based stress reduction for reducing stress, and individual counseling for reproductive health. Although some strategies were found to be efficacious in improving outcomes for survivors, the limitations in designs and methods, and exclusive focus on intimate partner violence calls for more rigorous research for this population, particularly for Black survivors of all forms of violence. There is also need for culturally responsive multicomponent interventions that account for diversity among Black survivors.

A systematic review of comprehensive interventions for substance abuse: Focus on victimization

Violence victimization is common among men and women who use substances and is associated with co-occurring health issues such as PTSD, depression and HIV. Substance use interventions, therefore, should include integrated components that are designed to address co-occurring health issues among victimized substance-using individuals. This systematic review synthesized the evidence on efficacy of comprehensive, integrated, multicomponent interventions for victimized substance-using individuals. The efficacy of integrated multicomponent intervention strategies was assessed for the following syndemic conditions: mental health, substance misuse, violence, and HIV risk. Seventeen studies were identified. Examples of effective components were empowerment strategies for violence, mindfulness-based stress reduction for mental health, social cognitive skill building for addressing HIV risk and psychoeducation for substance misuse. Although in this review, some components were found to be effective, we identified methodological limitations of included studies which calls for more rigorous research in this area. Further, there is lack of evidence base for multicomponent interventions for victimized substance-using individuals in developing countries. Additional studies are needed to establish rigorous evidence base for multicomponent interventions for victimized substance using individuals that help them cope effectively with their trauma of violence and address their needs.

The weWomen and ourCircle randomized controlled trial protocol: A web-based intervention for immigrant, refugee and indigenous women with intimate partner violence experiences

Intimate partner violence (IPV), including homicides is a widespread and significant public health problem, disproportionately affecting immigrant, refugee and indigenous women in the United States (US). This paper describes the protocol of a randomized control trial testing the utility of administering culturally tailored versions of the danger assessment (DA, measure to assess risk of homicide, near lethality and potentially lethal injury by an intimate partner) along with culturally adapted versions of the safety planning (myPlan) intervention: a) weWomen (designed for immigrant and refugee women) and b) ourCircle (designed for indigenous women). Safety planning is tailored to women's priorities, culture and levels of danger. Many abused women from immigrant, refugee and indigenous groups never access services [WHY?] and research is needed to support interventions that are most effective and suited to the needs of abused women from these populations in the US. In this two-arm trial, 1250 women are being recruited and randomized to either the web-based weWomen or ourCircle intervention or a usual safety planning control website. Data on outcomes (i.e., safety, mental health and empowerment) are collected at baseline and at 3, 6, and 12 months post- baseline. It is anticipated that the findings will result in an evidence-based culturally tailored intervention for use by healthcare and domestic violence providers serving immigrant, refugee and indigenous survivors of IPV. The intervention may not only reduce risk for violence victimization, but also empower abused women and improve their mental health outcomes.

Health and Academic Consequences of Sexual Victimization Experiences among Students in a University Setting

The current study examines the association between multiple interpersonal violence victimization types experienced in a university setting and the consequences for each type. Students at a mid-Atlantic university (n = 3977) completed a survey in 2015 assessing attitudes, experiences, consequences of (physical, behavioural, academic, mental), and university resources and reporting procedures for sexual assault, harassment, and intimate partner violence. Effect on mental health was the most cited consequence for all victimization types. Sexual harassment was reported by the largest number of students but with smaller percentages of students reporting consequences, while the opposite was true for sexual assault and multiple forms of abuse (smaller numbers experiencing; larger percentages reporting consequences). In the adjusted models, being in an abusive/controlling relationship and sexual harassment were significantly associated with physical health consequences (ps < .001). Sexual harassment was the only predictor of substance use (p < .001). Being an undergraduate and experiencing an abusive/controlling relationship, sexual harassment, or assault were associated with sexual risk behaviour (all ps < .05). These findings point to a need for holistic approaches to helping students heal from interpersonal victimization-approaches that include mental health services, attention to increased substance use and sexual risk, and monitoring academic performance.

Gender-based violence and trauma in marginalized populations of women: Role of biological embedding and toxic stress

Gender-based violence (GBV) and trauma can dysregulate and recalibrate environmentally sensitive physiological (i.e. central nervous, endocrine, and immune) systems placing survivors at risk for multiple health problems. The researchers build the case that the effects of GBV are likely to be particularly high impact and contribute to health disparities for marginalized survivors of GBV. Further, the researchers underscore a need for a multi-level bio-socio-ecological model that deciphers, characterizes, and explains individual differences in these effects and the need to establish an evidence base from which to derive interventions that address biological effects of toxic stress among marginalized survivors of GBV.

Multilevel Risk and Protective Factors for Intimate Partner Violence Among African, Asian, and Latina Immigrant and Refugee Women: Perceptions of Effective Safety Planning Interventions

Immigrant and refugee women are at high risk for intimate partner violence (IPV) and intimate partner homicide (IPH). Given the growing number of immigrants and refugees in the US and the concerns about IPV and IPH among immigrant and refugee groups, this paper aims to identify survivors and practitioners' perceptions of a) common and culturally specific risk and protective factors for IPV and IPH for immigrant and refugee women and b) areas of safety planning interventions for survivors who are at risk for severe or lethal violence by an intimate partner. Qualitative data for this multi-site study were collected from women and practitioners residing in seven geographically diverse US locations. Eighty-three in-depth interviews were conducted with adult immigrant and refugee survivors of IPV, who identified as Asian (n=30), Latina (n=30), and African (n=23). Additionally, nine focus groups and five key informant interviews were conducted with practitioners (n=62) who serve immigrant and refugee survivors of IPV. Results revealed multilevel risk and protective factors for IPV/IPH found at the societal-level (e.g., patriarchal cultural norms), relationship-level (e.g., partner abusive behaviors), and individual-level (e.g., acculturation in the US). These findings can inform the development of culturally responsive risk assessment and safety planning interventions across legal, social service, and healthcare settings.

Perspectives on Factors Related to HIV Risk and Preventative Interventions at Multiple Levels: A Study of African Immigrant Women Survivors of Cumulative Trauma

African immigrant women survivors of cumulative trauma are at high risk for HIV infection. This study aims to identify survivors' perceptions of (a) contextual (i.e., community, and relationship) and individual-level risk and protective factors for HIV among African immigrant women in the United States and (b) areas and strategies of HIV prevention intervention at contextual and individual levels. Qualitative data for this study were collected from African-born women (n = 39) in Maryland, Virginia, and Washington, DC, from February 2017 to March 2018. Seventeen in-depth interviews and five focus groups were conducted with African immigrant survivors of cumulative trauma. Results revealed HIV prevention intervention needs and risk and protective factors for HIV at the community (e.g., community education), relationship (e.g., intimate partner violence, family), and individual (e.g., women's empowerment) levels. These findings can inform the development of culturally tailored multilevel HIV prevention interventions for African immigrant women.

Risk and protective factors of intimate partner violence among South Asian immigrant women and perceived need for services

OBJECTIVES

Limited research exists on multilevel influences of intimate partner violence (IPV) among immigrant groups in the United States, particularly South Asians. Using a socioecological framework, this study examined risk and protective factors of IPV among a diverse group of South Asian immigrant survivors of IPV and identified their perceived need for services.

METHOD

Sixteen South Asian immigrant survivors were recruited from New York; Maryland; Virginia; and Washington, DC, using a snowball sampling method. Participants were 1st-generation and 2nd-generation immigrants born in India (n = 4), Bangladesh (n = 4), Pakistan (n = 5), the United States (n = 2), and Sri Lanka (n = 1). Data were collected using in-depth interviews (n = 16) and a focus group (n = 1). A thematic analysis procedure was used to analyze the data and to identify themes across different ecological levels.

RESULTS

IPV was related to factors at multiple levels, such as cultural normalization of abuse, gender role expectations, need to protect family honor, arranged marriage system, abusive partner characteristics, and women's fear of losing children and being on own. Protective factors included supportive family and friends, religion, safety strategies, education, and empowerment. Women highlighted the need for community education and empowerment efforts and culturally responsive services for addressing IPV in South Asian communities.

CONCLUSIONS

South Asian survivors of IPV have experienced, and some continue to experience, abuse due to factors operating at multiple levels of the ecological framework. Consideration of culturally specific risk and protective factors for IPV at multiple contexts in women's lives could inform culturally responsive IPV prevention and intervention strategies for South Asian communities in the United States. (PsycINFO Database Record

Unwanted Sexual Experiences in University Settings: Survivors' Perspectives on Effective Prevention and Intervention Strategies

Unwanted sexual incidents on university campuses pose significant public health and safety risks for students. This study explored survivors' perspectives on secondary prevention of campus sexual assault and effective strategies for intervention programs for unwanted sexual incidents in university settings. Twenty-seven student survivors of unwanted sexual experiences participated in semi-structured in-depth interviews. Data were analyzed using thematic analysis and a constructionist perspective. The findings were contextualized using the ecological model. Barriers to reporting included concerns about one's story not being believed, personal minimization of the incident, belief that no action will be taken after reporting, confidentiality concerns, and other perceived costs of reporting. Survivors provided valuable insight on potentially effective prevention and intervention strategies to address the problem of unwanted sexual incidents on university campuses. These findings may be useful for prevention and intervention policies and programs in university settings and for providers who assist survivors of unwanted sexual experiences.

Dangerous Abusive Relationships and Sources of Resilience for South Asian Immigrant Women Survivors of Intimate Partner Violence

This study explored South Asian immigrant women survivors' perspectives on intimate partner relationships that could lead to severe violence or a homicide and sources of resilience for South Asian immigrant survivors in the United States. The study recruited 16 South Asian immigrant survivors for in-depth interviews and focus groups. Data were analyzed using thematic analysis. Survivors shared some characteristics of dangerous partner such as controlling behavior, anger issues, infidelity, alcohol and drug problems, and history of childhood abuse. Incidents of severe physical abuse, threats to kill, possession of a weapon, and suspicious behavior led survivors to feel fearful for their lives. Sources of resilience in the community (e.g., support from formal sources of help) and at the individual level (e.g., education) were discussed. The needs for culturally informed services and to generate awareness of services among South Asian immigrants were highlighted.

Multiple Intimate Partner Violence Experiences: Knowledge, Access, Utilization and Barriers to Utilization of Resources by Women of the African Diaspora

OBJECTIVE

This study examined knowledge, access, utilization, and barriers to use of resources among Black women exposed to multiple types of intimate partner violence in Baltimore, Maryland and the U.S. Virgin Islands (USVI).

METHODS

We analyzed quantitative survey data collected by 163 women recruited from primary care, prenatal or family planning clinics in Baltimore and the USVI. In addition we analyzed qualitative data from in-depth interviews with 11 women. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using thematic analysis.

RESULTS

A substantial proportion of Black women with multiple types of violence experiences lacked knowledge of, did not have access to, and did not use resources. Barriers to resource use were identified at the individual, relationship, and community levels.

CONCLUSION

There is need for programs to develop awareness, promote access and utilization of resources, and eliminate barriers to resource use among abused Black women.

A Qualitative Study of Survival Strategies Used by Low-Income Black Women Who Experience Intimate Partner Violence

Women who experience intimate partner violence (IPV) are often portrayed as helpless victims. Yet many women who experience IPV implement strategies to help them survive the abuse. This qualitative study sought to explore the survivor strategies used by low-income black women who experience IPV. Authors used a semistructured interview guide to survey 26 survivors who reported being in an IPV relationship in the past two years. Thematic analysis revealed three types of survivor strategies used by low-income black women: (1) internal (use of religion and becoming self-reliant), (2) interpersonal (leave the abuser or fight back), and (3) external (reliance on informal, formal, or both kinds of sources of support). This article informs social work practitioners of the strategies used by low-income black women in surviving IPV so that practitioners can develop interventions that support these strategies.

Violence Against Widows in Nepal: Experiences, Coping Behaviors, and Barriers in Seeking Help

Widows are a vulnerable population in Nepal. This study examined Nepalese widows' experiences of violence, their coping strategies, and barriers faced in seeking help. Study participants were recruited from Women for Human Rights, an NGO in Nepal. A stratified purposive sampling approach was used to select 51 widows and 5 staff members for in-depth interviews. Twenty-seven women who experienced violence were included in this analysis. Data were analyzed and synthesized using a thematic analysis procedure. Widows reported a range of violent experiences perpetrated by family and community members that spanned psychological, physical, and sexual abuse. Women dealt with abusive experiences using both adaptive (e.g., attempting to move ahead, seeking social support, using verbal confrontation) and maladaptive coping strategies (e.g., suicidal thoughts or self-medication). However, they faced barriers to seeking help such as insensitivity of the police, perceived discrimination, and general lack of awareness of widows' problems and needs. Findings highlight the need for interventions across the individual, family, community, and policy levels. Avenues for intervention include creating awareness about widows' issues and addressing cultural beliefs affecting widows' lives. Furthermore, efforts should focus on empowering widows, promoting healthy coping, and addressing their individual needs.

Cumulative Violence Exposures: Black Women's Responses and Sources of Strength

Black women with cumulative violence exposures (CVE) may have unique needs for health care and safety. Qualitative data was analyzed from interviews with nine Black women with CVE to explore factors that motivated women to leave abusive relationships, women's sources of strengths, and their responses to abuse. Quantitative data (N = 163) was analyzed to examine relationships between CVEs by intimate partner and health among Black women to further characterize the challenges these women face in making changes and finding their sources of strengths. Findings highlight the need to assess for CVE and identify multiple motivators for change, sources of strengths and coping strategies that could be potential points of intervention for women with CVE.

Gender Differences in Intimate Partner Homicides Among Ethnic Sub-Groups of Asians

This study explored differences in intimate partner homicides (IPHs) among Asian Americans. Data from newspapers and femicide reports by different state coalitions on 125 intimate partner killings occurring between 2000 and 2005 were analyzed. Men were the perpetrators in nearly 9 out of 10 cases of Asian IPHs. Gender differences were found in ages of victims and perpetrators, types of relationship between partners, and methods of killing. Most homicides occurred among South-east Asians, and East Asians had the highest within-group proportion of suicides. The findings call for culturally competent risk assessment and intervention strategies to prevent IPHs among at-risk Asian Americans.

Injury outcomes in African American and African Caribbean women: the role of intimate partner violence

INTRODUCTION

Intimate partner violence has been linked to increased and repeated injuries, as well as negative long-term physical and mental health outcomes. This study examines the prevalence and correlates of injury in women of African descent who reported recent intimate partner violence and control subjects who were never abused.

METHODS

African American and African Caribbean women aged 18 to 55 years were recruited from clinics in Baltimore, MD, and the US Virgin Islands. Self-reported demographics, partner violence history, and injury outcomes were collected. Associations between violence and injury outcomes were examined with logistic regression.

RESULTS

All injury outcomes were significantly more frequently reported in women who also reported recent partner violence than in women who were never abused. Multiple injuries were nearly 3 times more likely to be reported in women who had experienced recent abuse (adjusted odds ratio 2.75; 95% confidence interval 1.98-3.81). Reported injury outcomes were similar between the sites except that women in Baltimore were 66% more likely than their US Virgin Islands counterparts to report ED use in the past year (P = .001). In combined-site multivariable models, partner violence was associated with past-year ED use, hospitalization, and multiple injuries.

DISCUSSION

Injuries related to intimate partner violence may be part of the explanation for the negative long-term health outcomes. In this study, partner violence was associated with past-year ED use, hospitalization, and multiple injuries. Emergency nurses need to assess for intimate partner violence when women report with an injury to ensure that the violence is addressed in order to prevent repeated injuries and negative long-term health outcomes.

Racial and ethnic differences in factors related to workplace violence victimization

Workplace violence (WPV) is a significant public health concern affecting all racial or ethnic groups. This study examined whether different racial/ethnic groups differed in vulnerability to WPV exposure and utilization of resources at the workplace. This cross-sectional research focused on White, Black, and Asian nursing employees (N = 2,033) employed in four health care institutions in a mid-Atlantic U.S. metropolitan area. Whereas childhood physical abuse was significantly related to risk of WPV among workers from all racial/ethnic backgrounds, intimate partner abuse was a significant factor for Asians and Whites. Blacks and Asians were found to be less likely than Whites to be knowledgeable about WPV resources or use resources to address WPV. Services to address past trauma, and education and training opportunities for new workers may reduce risk of WPV and promote resource utilization among minority workers.

Factors associated with increased risk for lethal violence in intimate partner relationships among ethnically diverse black women

The purpose of this study was to identify factors associated with increased risk for lethal violence among ethnically diverse Black women in Baltimore, Maryland (MD), and the U.S. Virgin Islands (USVI). Women with abuse experiences (N = 456) were recruited from primary care, prenatal, or family planning clinics in Baltimore, MD, and St. Thomas and St. Croix. Logistic regression was used to examine factors associated with the risk for lethal violence among abused women. Factors independently related to increased risk of lethal violence included fear of abusive partners, posttraumatic stress disorder (PTSD), symptoms, and use of legal resources. These factors must be considered in assessing safety needs of Black women in abusive relationships.