Search

A Protocol Assessment Tool (PAT) was developed to assess emergency departments's (EDs's) protocols regarding treatment of patients sustaining partner violence. Using this tool, project staff members evaluated the content of written protocols submitted by ED nurse managers in California and in a national sample in 1992-1993 and in 1996-1997. The number of protocols and their overall content improved significantly in California between 1992-1993 and 1996-1997, and there was a suggestion of improvement in the national sample. Advocacy efforts influenced Joint Commission on Accreditation of Healthcare Organizations guidelines and California laws, which in turn may have stimulated increases in the quantity and quality of protocols. The PAT permits readers to evaluate their local facility's protocols.

This study describes the type and extent of intimate partner stalking and threatening behaviors that occurred within 12 months prior to a major assault or attempted or actual partner femicide and specifies which behaviors were associated with an increased risk of potential or actual lethality. The design was a ten-city case-control study of 821 women: 384 abuse victims and 437 attempted or actual femicide informants. Data were derived using a 16-item inventory. Logistic regressions, with adjustments for demographic variables, were used to identify the significant perpetrator behaviors associated with attempted/actual femicide. Women who reported the perpetrator followed or spied on them were more than twice as likely t o become attempted/actual femicide victims. Threats by the perpetrator to harm the children if the woman left or did not return to the relationship place the woman at a ninefold increase in the risk of attempted/actual femicide. Conclusions are that certain stalking and threatening behaviors are strong risk factors for lethality, and women must be so advised.

OBJECTIVES/SPECIFIC AIMS: Aim 1—estimate prevalence and associated characteristics of nonfatal, non-self-inflicted strangulation among women ages 18 and older who presented to a US emergency department between 2006 and 2013. Aim 2—explore care-seeking behaviors, the context of the care seeking, treatment expectations and perceived diagnosis in a sample of women ages 18 and older who present to a US emergency department and report being strangled by an intimate partner. Aim 3—merge and synthesize findings from both the quantitative and qualitative strands to provide a more complete understanding of post-strangulation emergency care of women. METHODS/STUDY POPULATION: This mixed-methods study will use a convergent parallel design, with a single phase of concurrent and independent data collection. Analysis of quantitative and qualitative data will be performed separately then compared, with main findings integrated during the interpretation phase and presented in a merged data analysis display. IRB review and approval will be obtained before initiating this study. Aim 1 will include a cross-sectional analysis of 2006–2013 Nationwide Emergency Department Sample (NEDS) data, from the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project (HCUP). NEDS is the US’s largest all-payer emergency department (ED) database, providing national estimates of hospital-based ED visits from ~120 to 135 million ED visits/year (weighted). For this study, we will examine data from patients meeting inclusion criteria with an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM; Medicode, 1996) code of strangulation. For this strand, females aged 18 years or older who presented to a US emergency department between 2006 and 2013 will be included. The outcome variable will be non-fatal, non-self-inflicted strangulation, defined using at least one of the ICD-9-CM codes for strangulation. These codes are: 994.7 (“asphyxiation and strangulation”), E963 (“assault by hanging and strangulation”), E983.8 (“strangulation or suffocation by other specified means undetermined whether accidentally or purposely inflicted”), and E983.9 (“strangulation or suffocation by unspecified means undetermined whether accidentally or purposely inflicted”). Patients with a concurrent ICD-9-CM code for suicide attempt (E953, “Suicide and self-inflicted injury by hanging, strangulation and suffocation”) will be excluded, to minimize self-inflicted assault events. Aim 2 will employ a narrative descriptive approach, with semistructured individual interviews to gather more information about women’s experiences when engaging the health care system after being strangled. Medical records related to the strangulation event will also be reviewed for diagnostic codes and other nursing and/or medical notes that may relate to diagnoses, treatment and referrals. For this strand, women aged 18 years or older who present for care to an urban, academic ED will be recruited, purposely sampling those reporting strangulation as a reason for their visit. We anticipate interviewing ~20–30 women to achieve saturation of information. RESULTS/ANTICIPATED RESULTS: Data from the NEDS from 2006 to 2013 will be analyzed for prevalence and associated characteristics of women seeking care after being strangled. Individual interviews and medical record reviews of a small sample of adult women will be conducted to explore women’s in-depth experiences within the health care system. Results from both the quantitative and qualitative analyses will then be collectively compared and interpreted to better synthesize the evidence from this work. Convergent and divergent findings will be presented in a merged data analysis display (Creswell and Plano Clark, 2011). Qualitative data will be used to fill the knowledge gap remaining from the quantitative analysis, and to explain and contextualize some of the findings. Such integration will help expand the current limited evidence on care of strangled women, and will identify additional research questions that will guide future research in this area. DISCUSSION/SIGNIFICANCE OF IMPACT: To our knowledge, this study will be the first to explore this issue using a nationally representative sample of adult women who sought emergency medical care for strangulation analyzed in conjunction with a detailed qualitative analysis of strangled women’s experiences with the health care system. The resulting knowledge will be critical to informing clinical assessment, intervention and prevention efforts for this vulnerable population, as well as public policy and future research regarding this specific violence tactic.

Background Diverse economic empowerment programmes (eg, microcredit, village-led savings and loan, cash and productive asset transfers) for the poor have demonstrated mixed results as vehicles for improved economic stability, health and women9s empowerment. However, limited rigorous evaluations exist on the impact of financial and non-financial outcomes of these programmes, especially in conflict-affected areas. Methods The team evaluated the effectiveness of an innovative livestock productive asset transfer intervention—Pigs for Peace (PFP)—on economic, health and women9s empowerment outcomes with participants in households in 10 villages in Eastern Democratic Republic of Congo. Residual change analysis was used to examine the amount of change from baseline to 18 months between the intervention and delayed control groups, controlling for baseline scores. Findings The majority of the 833 household participants were women (84%), 25 years of age or older, married, had on average 3 children and had never attended school. At 18 months postbaseline, the number of participants in the PFP households having outstanding credit/loans was 24.7% lower than households in the control group (p=0.028), and they had an 8.2% greater improvement in subjective health (p=0.026), a 57.1% greater reduction in symptoms of anxiety (p=0.020) and a 5.7% greater improvement in symptoms of post-traumatic stress disorder (p Interpretation The findings support scalability of a livestock productive asset transfer programme in rural and conflict-affected settings where residents have extremely limited access to financial institutions or credit programmes, health or social services and where social norms that sustain gender inequality are strong. Trial registration number NCT02008708.

We describe a vision of screening and intervention for Intimate Partner Violence informed by deliberations during the December 2013 Intimate Partner Violence Screening and Counseling Research Symposium and the resultant manuscripts featured in this special issue of the Journal of Women's Health. Our vision includes universal screening and intervention, when indicated, which occurs routinely as part of comprehensive physical and behavioral health services that are both patient centered and trauma informed. Areas for future research needed to realize this vision are discussed.

Domestic violence homicides and suicides are significant causes of deaths among women in India. This study examined characteristics and motives of various types of domestic violence-related homicides and suicides (n = 100) in India using newspaper reports (2011-2012). The majority of victims were found to be young women, mostly killed by burning or strangulation methods. The most frequently reported motive was dowry demands followed by a history of domestic violence or harassment and family conflict. The findings highlight the need for stronger prevention/intervention programs in India to identify and intervene with women at high risk for being killed or committing suicide.

We examined associations between intimate partner forced sex (IPFS) and HIV sexual risk behaviors among physically abused Black women. Women aged 18-55 in intimate relationships were interviewed in health clinics in Baltimore, MD and St. Thomas and St. Croix, US Virgin Islands (USVI). Of 426 physically abused women, 38% experienced IPFS; (Baltimore = 44 and USVI = 116). USVI women experiencing IPFS were more likely to have 3+ past-year sex partners (AOR 2.06, 95% CI 1.03-4.14), casual sex partners (AOR 2.71, 95% CI 1.42-5.17), and concurrent sex partners (AOR 1.94, 95% CI 1.01-3.73) compared to their counterparts. Baltimore women reporting IPFS were more likely to have exchanged sex (AOR 3.57, 95% CI 1.19-10.75). Women experiencing IPFS were more likely to report their abuser having other sexual partners in Baltimore (AOR 3.30, 95% CI 1.22-8.88) and USVI (AOR 2.03, 95% CI 1.20-3.44). Clinicians should consider the influence of IPFS on individual and partnership HIV sexual risk behaviors.

This study focuses on the relationship between women’s risk of homicide as measured by the Danger Assessment and 13 protective actions. Participants (N = 432) experienced an incident of police involved intimate partner violence (IPV) and subsequently completed a structured telephone interview. Most women in this sample experienced severe violence and were classified as being at high risk for homicide. Participants engaged in an average of 3.81 (SD = 2.73) protective actions. With the exception of the use of formal domestic violence services, women in the high-risk category were significantly more likely than women in the lower risk category to have used each of the protective actions examined. Implications for research and practice are discussed.

An Internet safety decision aid was developed to help abused women understand their risk for repeat and near-lethal intimate partner violence, clarify priorities related to safety, and develop an action plan customized to these priorities.To test the effectiveness of a safety decision aid compared with usual safety planning (control) delivered through a secure website, using a multistate RCT design. The paper evaluates the effectiveness of the safety decision aid in reducing decisional conflict after a single use by abused women.RCT referred to as Internet Resource for Intervention and Safety (IRIS).Abused women who spoke English (n=708) were enrolled in a four-state RCT.The intervention was an interactive safety decision aid with personalized safety plan; the control condition was usual safety planning resources. Both were delivered to participants through the secure study website.This paper compares women's decisional conflict about safety: total decisional conflict and the four subscales of this measure (feeling: uninformed, uncertain, unsupported, and unclear about safety priorities) between intervention/control conditions. Data were collected from March 2011 to May 2013 and analyzed from January to March 2014.Immediately following the first use of the interactive safety decision aid, intervention women had significantly lower total decisional conflict than control women, controlling for baseline value of decisional conflict (p=0.002, effect size=0.12). After controlling for baseline values, the safety decision aid group had significantly greater reduction in feeling uncertain (p=0.006, effect size=0.07) and in feeling unsupported (p=0.008, effect size=0.07) about safety than the usual safety planning group.Abused women randomized to the safety decision aid reported less decisional conflict about their safety in the abusive intimate relationship after one use compared to women randomized to the usual safety planning condition.

Background : Women of African descent are disproportionately affected by intimate partner abuse; yet, limited data exist on whether the prevalence varies for women of African descent in the United States and those in the US territories. Objective : In this multisite study, we estimated lifetime and 2-year prevalence of physical, sexual, and psychological intimate partner abuse (IPA) among 1,545 women of African descent in the United States and US Virgin Islands (USVI). We also examined how cultural tolerance of physical and/or sexual intimate partner violence (IPV) influences abuse. Design : Between 2009 and 2011, we recruited African American and African Caribbean women aged 18–55 from health clinics in Baltimore, MD, and St. Thomas and St. Croix, USVI, into a comparative case-control study. Screened and enrolled women completed an audio computer-assisted self-interview. Screening-based prevalence of IPA and IPV were stratified by study site and associations between tolerance of IPV and abuse experiences were examined by multivariate logistic regression analysis. Results : Most of the 1,545 screened women were young, of low-income, and in a current intimate relationship. Lifetime prevalence of IPA was 45% in St. Thomas, 38% in St. Croix, and 37% in Baltimore. Lifetime prevalence of IPV was 38% in St. Thomas, 28% in St. Croix, and 30% in Baltimore. Past 2-year prevalence of IPV was 32% in St. Thomas, 22% in St. Croix, and 26% in Baltimore. Risk and protective factors for IPV varied by site. Community and personal acceptance of IPV were independently associated with lifetime IPA in Baltimore and St. Thomas. Conclusions : Variance across sites for risk and protective factors emphasizes cultural considerations in sub-populations of women of African descent when addressing IPA and IPV in given settings. Individual-based interventions should be coupled with community/societal interventions to shape attitudes about use of violence in relationships and to promote healthy relationships. Keywords : intimate partner violence; intimate partner abuse; cultural attitudes; African American; African Caribbean; women (Published: 12 September 2014) Citation : Glob Health Action 2014, 7 : 24772 - http://dx.doi.org/10.3402/gha.v7.24772 SPECIAL ISSUE : This paper is part of the Special Issue: Intimate Partner Violence and Mental Health . More papers from this issue can be found at http://www.globalhealthaction.net

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.

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.

Objective The main aim of this study was to assess whether a history of abuse, reported during pregnancy, was associated with an operative delivery. Secondly, we assessed if the association varied according to the type of abuse and if the reported abuse had been experienced as a child or an adult. Design The Bidens study, a cohort study in six European countries (Belgium, Iceland, Denmark, Estonia, Norway, and Sweden) recruited 6724 pregnant women attending routine antenatal care. History of abuse was assessed through questionnaire and linked to obstetric information from hospital records. The main outcome measure was operative delivery as a dichotomous variable, and categorized as an elective caesarean section (CS), or an operative vaginal birth, or an emergency CS. Non-obstetrically indicated were CSs performed on request or for psychological reasons without another medical reason. Binary and multinomial regression analysis were used to assess the associations. Results Among 3308 primiparous women, sexual abuse as an adult (≥18 years) increased the risk of an elective CS, Adjusted Odds Ratio 2.12 (1.28–3.49), and the likelihood for a non-obstetrically indicated CS, OR 3.74 (1.24–11.24). Women expressing current suffering from the reported adult sexual abuse had the highest risk for an elective CS, AOR 4.07 (1.46–11.3). Neither physical abuse (in adulthood or childhood

Chinese people make up one fifth of the world's total population, yet little is known regarding the prevalence, risk factors, and health outcomes of intimate partner violence (IPV) among this population. There is a lack of public awareness as well as research about IPV in Chinese populations. Studies of IPV prevalence in the Chinese-American population are also limited. Thus, studies of IPV in Chinese populations are needed to increase the Chinese public's recognition of this social problem and its impact on women's rights and health. In order to help identify areas of needed focus for future research, this review centers on the strengths and weaknesses of existing literature on IPV in China and compares the findings with other populations. Also, knowledge about Chinese women's position in society and family, risk factors for IPV, social barriers preventing victims from receiving help, and mental and physical outcomes of IPV are reviewed.

This analysis of data from a 10-city control study of 821 women describes the frequency and types of justice services used during the 12 months prior to an attempted or completed femicide perpetrated by an intimate partner (EP). A total of 437 victims of attempted or completed femicide were identified from police and medical examiner records. Interviews with attempted femicide victims and with proxies for the victims of completed femicides were compared with data from abused control subjects (n = 384) who were identified via random digit dialing in the same 10 cities. Reported levels of violence and demographic characteristics of users and nonusers of justice services were compared. Twenty-two percent of the abused control subjects, 55 percent of the attempted femicide victims, and 48 percent of the proxy respondents for the completed femicide victims reported use of the justice system during the 12 months period to the attempted or completed femicide or, for the control subjects, prior to the worst abuse incident. The most frequent use of justice services among attempted or completed femicide victims was to report perpetrator or stalking. Among abused control subjects the most frequent use of justice services was to report IP assault to the police. African-American victims of attempted or completed femicide were the highest users of justice services, followed by white women and Hispanics. Women who made use of the justice system reported significantly higher levels of violence (p < .05). It would appear that more than half of abused women seek justice services prior to an attempted or completed femicide. Justice services thus provide a unique window of opportunity to connect abused women in serious danger with essential community resources that can potentially interrupt violence and prevent attempted or completed femicide.

Summary This chapter outlines a process of individualized safety planning with the partners of batterers in intervention programs that is based on the principles of empowerment and autonomy, and takes into account the context of the woman's situation. Assessing context is operationalized as considering the potential lethality of the situation from her partner, her relationship and emotional status, available resources, and her children. The safety planning process is described as an opportunity for the abused woman to gain information in order to strategize her responses. It is also a way for the program staff to gain more accurate information about the batterer's level of violence and dan-gerousness, and to work with women to enhance retention of abusers in the program.

Significant proportions of women in all health care settings have been “battered” which can be defined as physical and/or sexual assault by a current or former intimate partner. There is mounting evidence that intimate partner violence (IPV) has long-term negative health consequences for survivors even after the abuse has ended. Lower health status lower quality of life and higher utilization of health services by battered women have all been documented. In response to this growing body of evidence official health care professional organizations have increasingly recognized IPV as a health care problem and have called for clinical interventions and institutional changes to provide better care for abused women. This paper addresses two of the issues that continue to engender debate among health care professionals routine screening and mandatory reporting using data from three major studies that have been recently completed. (excerpt)

Objective: To provide clinical practice recommendations for screening and interventions for intimate partner violence (IPV) in ED settings. Setting: Eleven mid-sized community-level hospital emergency departments (20,000 to 40,000 admissions annually) in Pennsylvania and California. Participants: All women (4641) aged 18 years or older who came to the emergency department during 309 selected shifts. Methods: An anonymous survey inquiring about physical, sexual, and emotional IPV was conducted from 1995 through 1997. In addition, medical records were abstracted for every woman (18 years and older) seen in the 11 participating emergency departments during the study period. Results: The vast majority of both abused and nonabused women supported routine screening for IPV; however, fewer than 25% of women said they were asked about IPV by ED staff. ED screening rates for IPV were higher among women who came to the emergency department because of acute trauma from abuse (39%) than for women who reported that they had been abused within the past year (13%). The prevalence of past year and lifetime IPV was significantly higher when the questionnaire was self-administered than when it was administered by a nurse. More than a third of women who had recently been abused and 76% of women who acknowledged experiencing physical or sexual IPV within the past year reported that they did not come to the emergency department for treatment of an injury. Although the majority of women (76% to 90%) agreed with the concept of health care providers reporting IPV to the police, women abused recently were significantly less likely to support this practice. Conclusion: The study provides evidence supporting standard protocols for routine screening for IPV among women who come to emergency departments and chart prompts for both screening and interventions. These actions are acceptable to the majority of both abused and nonabused women seen in the emergency department and should be considered in systematic repeated training of health care professionals in emergency departments. This information is important for health care providers who are seeking to improve their identification of and care for abused women.

Background Nurses are the health professionals most frequently involved in the diagnosis and treatment of victims of family violence (FV). Understanding their personal experience with victimization is the key to shaping an appropriate role as advocates for medical recognition of FV and as integral members of the screening teams. We sought to determine the lifetime prevalence of intimate partner abuse among them and identify its risk factors. Methods In our cross-sectional study, 1,150 registered nurses and nurses' aides at 11 urban hospitals in Mexico City self-administered an anonymous survey. We calculated descriptive statistics, Fisher exact tests, and multivariate logistic regression models to analyze physical, sexual, and emotional abuse during adulthood. Results Physical/sexual abuse during adulthood was 13% for nurses' aides and 18% for nurses. Similar proportions (13% of nurses' aides and 14% of nurses) also reported childhood physical/sexual abuse. Additional respondents (39% nurses' aides, 42% nurses) reported emotional abuse during adulthood. Detecting no significant differences in abuse patterns between the two groups, we combined occupations for all subsequent analyses. Results Being separated or divorced (vs. married) (Apr = 3.41, 95% confidence interval (CI): 1.81–6.44) and having suffered physical/sexual abuse during childhood (Apr = 3.39, 95% CI: 2.26–5.08) were associated with physical/sexual abuse in adulthood. The same variables were associated with adult emotional abuse (separated/divorced: Apr = 5.33, 95% CI: 2.61–10.85, and childhood physical/sexual abuse: Apr = 2.58, 95% CI: 1.79–3.75). Younger women (between the ages of 23 and 28 years) reported more emotional abuse (Apr = 2.10, 95% CI: 1.48–2.98). Conclusions Counseling for abused nursing staff may help break the cycle. Physical/sexual partner abuse among nurses appears lower than among the general Mexican population, but remains worrisome. Battling childhood abuse might prevent intimate partner violence.

Intimate partner violence is widespread and results in significant negative mental and physical health outcomes for women. This article is a review of nursing research on intimate partner violence and women’s reproductive health and focuses on studies published since 1995, building on prior reviews. We begin with research on forced sex and the resulting physical and emotional trauma as well as implications for contraception, STD/HIV prevention, and condom use negotiation. We then discuss several approaches to the study of abuse during pregnancy, including several studies of nursing interventions. We conclude with the clinical implications of these studies.

Surveillance in the field of violence against women holds great promise as a tool to establish and track prevalence over time, identify risk groups and factors, and evaluate interventions. Appropriate surveillance systems are population based and can be used as the basis for informed public policy formation and evaluation, and public attitude assessment and analysis. They can also decrease research costs and can be established in all of the systems (legal, health, and social services) that interact with victims. Yet surveillance is not a perfect system. This article examines the issues with surveillance in this field, including its assumptions, prevalence variations, sensitivity and specificity issues, and safety concerns. The conclusion offers some creative approaches to address these problems.

The purpose of this grounded theory study was to devise a theoretical framework that describes the problem of sexual violence by male intimates from the point of view of 23 women who have experienced such violence at some time in their adult lives. The core variable, forging ahead in a dangerous world, reflects the women’s descriptions of life after violence as a struggle to get on with their lives in a social world they know through firsthand experience to be unsafe. The theoretical framework includes three variations of forging ahead (getting back on track, starting over again, and surviving the long, hard road) described by three subgroups of women who experienced different types of sexual violence. The framework also outlines three common processes used to forge ahead: telling others, making sense of the violence, and creating a safer life. The nature and meaning of these processes differ according to group.

Domestic violence is a pervasive problem for women, and depression is the most prevalent negative mental health consequence of domestic violence. This study investigates the extent to which domestic violence is part of the history of women diagnosed with depression. Eighty two women with a diagnosis of depression were surveyed. A 61.0% lifetime prevalence of domestic violence was found. Lifetime prevalence for forced sex was 29.3%. Demographics of abused and nonabused women were not significantly different. Abused women were found to be less healthy. Prevalence of headaches, chronic pain, rape or marital rape, and sleep problems or nightmares were significantly higher. Severity of abuse was significantly correlated (p < .01) to severity of depression. Implications for mental health practice and training of peer support group leaders for women with depression are described, as well as directions for future research.

Despite the recognition that violence may be associated with serious consequences for women's reproductive health, the understanding of the relationship between the two remains limited, as does our understanding of the most effective role for reproductive health care providers and services. This paper briefly summarizes the history of the nexus of public health, health care, and violence against women in the United States. In addition, we present some considerations for future directions for research, health care practice, and policy that will advance the understanding of the complex relationship between violence and reproductive health.

An 18-item stalking inventory and personal interviews with knowledgeable proxy informants and victims of attempted femicide were used to describe the frequency and type of intimate partner stalking that occurred within 12 months of attempted and actual partner femicide. One hundred forty-one femicide and 65 attempted femicide incidents were evaluated. The prevalence of stalking was 76% for femicide victims and 85% for attempted femicide victims. Incidence of intimate partner assault was 67% for femicide victims and 71% for attempted femicide victims. A statistically significant association existed between intimate partner physical assault and stalking for femicide victims as well as attempted femicide victims. Stalking is revealed to be a correlate of lethal and near lethal violence against women and, coupled with physical assault, is significantly associated with murder and attempted murder. Stalking must be considered a risk factor for both femicide and attempted femicide, and abused women should be so advised.

Self-reported data from a survey of roughly 1,100 female health maintenance organization enrollees in the Washington, DC, metropolitan area are used to investigate the lifetime and annual prevalence of emotional, physical, and sexual abuse by intimate partners. The sample consists of a racially balanced and, for the most part, well-educated group of working women. Three dimensions of abuse based on responses to questions from a modified version of the Abuse Assessment Screen are employed. In addition to simple descriptive analyses, logistic regression was performed. The estimated annual prevalence is lower than estimates reported in other studies. However, lifetime prevalence is very similar to estimates found in primary care clinical samples and somewhat higher than those derived from population-based surveys. More highly educated women report the lowest lifetime prevalence of intimate partner abuse. The finding that this sample of well-educated, middle-class working women has lifetime prevalence rates similar to those of women who are not as well off demonstrates that intimate partner abuse is not limited to disadvantaged women from vulnerable population subgroups.

This study sought to determine the risk of low birth weight from intimate partner abuse. The case-control design was used in a purposively ethnically stratified multisite sample of 1,004 women interviewed during the 72 hours after delivery between 1991 and 1996. Abuse was determined by the Index of Spouse Abuse and a modification of the Abuse Assessment Screen. Separate analyses were conducted for 252 full term and 326 preterm infants. The final multiple logistic regression models were constructed to determine relative risk for low birth weight after controlling for other complications of pregnancy. Physical and nonphysical abuse as determined by the Index of Spouse Abuse were both significant risk factors for low birth weight for the full term infants but not the preterm infants on a bivariate level. However, the risk estimates decreased in significance in the adjusted models. Although today's short delivery stays make it difficult to assess for abuse, it is necessary to screen for domestic violence at delivery, especially for women who may not have obtained prenatal care. The unadjusted significant risk for low birth weight that became nonsignificant when adjusted suggests that other abuse-related maternal health problems (notably low weight gain and poor obstetric history) are confounders (or mediators) that help to explain the relation between abuse and low birth weight in full term infants.

This article traces and analyzes the development of a collaboration between a battered women's shelter and a university school of nursing to provide health services, nursing student education, action research, program evaluation and improvement, and data for policy change. The authors discuss the wide variety of shared activities that they undertook over time as well as competing and shared commitments to knowledge, programs, and audiences. The importance of a long-term commitment, development of trust, working through frustrations, and formulating mutual goals is stressed.

A volunteer community sample of 141 well-educated, economically heterogeneous, primarily African American (80%), urban battered women was used to test a model of women's responses to battering. The model, based on Orem's theory, was developed previously with an independent sample. The major independent variables were physical and nonphysical abuse, and self-care agency. The outcomes were physical and emotional health. Using structural equation modeling techniques, there was sufficient support for the model structure to conclude preliminary support for the overall model. There was both a direct effect of abuse on health, and an indirect effect mediated through self-care agency as a protective factor.

A community volunteer sample of 98 battered women was interviewed using a combination of established instruments and in-depth questions over three points in time during a period of 3½ years. An ANOVA change analysis approach was used, dividing the women into three approximately equal groups according to abuse status. Groups 1 and 2, women who indicated a change from abuse to nonabuse status, reported significantly better health as compared to women reporting abuse at all three times. In contrast, depression decreased for all 3 groups from Time 1 to Time 2, with a significant increase at Time 3 with no effect of abuse status. Self-esteem in non-African American women had a similar trajectory. However, for African American women, the means in both self-esteem and self-care agency increased across all three times, regardless of abuse. Depression trajectories also differed between African American and non-African American women.

Qualitative and quantitative data from a longitudinal study of 98 primarily (80%) African American women's responses to battering was used to analyze the complex relationship of substance use to intimate partner violence against women. Approximately one third of the women used alcohol and/or drugs, while almost 60% of their partners did. The partner's substance abuse was a significant predictor of the dangerousness and severity of physical abuse, while her substance abuse was inversely related to lethality risks and physical and nonphysical abuse in multi-variate analysis, controlling for demographics. Battered women perceived substance abuse as a significant problem in their relationships and said it contributed to their decisions about how to address the violence in their lives.

An ethnically and economically heterogeneous (majority well educated, African American, and poor) urban community sample of women, self-identified as having a serious problem in an intimate relationship, were interviewed three times over 2½ years. The inclusion criteria of battering was repeated physical and/or sexual assault within a context of coercive control. Feminist action research was used, combining interview and measurement instruments. Thematic analysis (coding, clustering, “subsuming particulars into the general,” confirming) was used for a random subset of 31 women's in-depth interviews. The patterns of response identified were complicated and iterative, demonstrating resistance and resourcefulness. A process of achieving nonviolence was identified for most of the participants, although relationship status did not necessarily correspond to abuse status and there was continued violence after leaving the relationship. Identifiable themes included (a) active problem solving, including conscious decisions to “make do” in a relationship and/or subordinate the self; (b) responding to identifiable pivotal events, and (c) a negotiating process first with the self and then, directly and/or indirectly, with the male partner.

The critical paradigm is increasingly being recognized as an appropriate perspective for the development of nursing knowledge. While different research approaches including feminist, neo-Marxist, and participatory research have been described, all share the goals of empowerment, emancipation, and change. As a relatively new world-view for nursing, the concept of a critical nursing science faces much the same resistance as the interpretive paradigm did a decade ago. This article reviews the aims and assumptions of the critical paradigm; discusses the merits of combining stories and numbers for the agenda of change; and, using examples from our research, describes three strategies for combining stories and numbers in the critical paradigm.

Objectives: This study examines the prevalence of violence experienced by patients enrolled in the Step by Step program, a combined prenatal care/substance abuse treatment program at the Wake County Health Department in North Carolina. In addition, potential associations between violence and sociodemographic characteristics, substance use, and mental health are investigated. Method: All prenatal care/substance abuse treatment patients who met study eligibility criteria (N = 84) were assessed by health care providers. Descriptive statistics and bivariate analyses were used to compare victims of violence and nonvictims on a wide range of variables. Multiple linear regression analysis estimated the impact of the women's experiences of violence on their levels of mental health symptoms while controlling for confounding factors. Results: Forty-two percent of patients had been victims of both sexual and physical violence, and 30% had been victims of physical violence alone. The combination of sexual and physical violence was significantly less common among African-American women compared with other women. No other significant differences were found between victims and nonvictims in terms of sociodemographics or substance use. Compared with nonvictims, victims of the combination of sexual and physical violence had significantly elevated levels of general psychological distress as well as elevated levels of hostility, depression, anxiety, interpersonal sensitivity, and somatization. However, no significant differences in levels of mental health symptoms were observed among women who had experienced physical violence in the absence of sexual violence. Conclusions: Questions concerning experiences of violence, including sexual victimization, should be incorporated into the clinical history-taking procedures of professionals working within prenatal care/substance abuse treatment programs so that effective interventions that take experiences of violence into account can be put into place for these high-risk women.

This article demonstrates how theoretical substruction with its various levels of abstraction can be used as a guide for theory testing research. The article describes a method for substructing research hypotheses as well as an entire study. Substruction and its benefits, including assuring the internal consistency of model testing, are discussed as applied to a study testing hypotheses derived from proposition two of Orem's self-care deficit theory of nursing. This approach to theory testing is congruent with the coherence theory of truth and promises to contribute to the advancement of nursing epistemology.

The sample for this study consisted of 164 women recruited from newspaper advertisements and bulletin board postings asking for volunteers with serious problems in intimate relationships with men. Women were screened for battering using the Conflict Tactics Scale (CTS). Of 164 battered women, 28% were moderately to severely depressed and 11% were severely depressed on the Beck Depression Inventory. Significant predictors of depression (accounting for 44% of variance) by multivariate analysis were childhood physical abuse, self-care agency, physical abuse by partner, and daily hassles. In addition to these analyses, the influence of self in relationship on depression was examined. The findings from this study suggest that physical abuse is an important part of the etiology of depression in battered women and that the abuse in combination with daily hassles supports a stress explanation of depression, with a woman's ability to take care of herself a protective factor.

The battering of female partners and the concomitant emotional abuse that is almost always part of the coercive control have significant mental and physical health consequences for the women who experience this type of violence. Children who live in households fraught with the conflict, violence, and unpredictable danger of domestic violence often witness the battering of their mothers and may also be victims of child abuse themselves. This article highlights current knowledge regarding the mental and physical health effects of intimate partner violence on women and their children, and discusses needed directions for screening, intervention, research, and changes in the health care system.This article reviews the literature on the effects of domestic violence on women and children. The introduction notes that domestic violence affects millions of women in the US each year, significantly increasing their health problems and their use of the health care system. The next sections review the incidence of mortality related to such abuse and women's physical health sequelae from battering. Consideration of women's mental health consequences focuses on the traumatic response framework that has been developed to conceptualize the psychological effects of domestic violence. The article then considers studies of abuse during pregnancy. Next, the article turns to the children of battered women, noting how they often fit the description of traumatized children but that there have been no studies to date of the existence among them of post-traumatic stress disorder. After looking at studies that marked children's responses to traumatic events and the effects of domestic violence on the children, the review examines work that revealed developmental differences in children from violent homes. The article then points to several limitations in prior research in the area of domestic violence and highlights the lack of experimental evaluation of treatments or interventions. Next, research into possible opportunities for routine screening and intervention is considered. The article concludes by documenting the need for a change in the health care system so that it can respond appropriately to the needs of battered women.

A combination of participant observation and in-depth interviews (10 with key informants; 21 with battered women) was used to investigate wife battering in Nicaragua and the casas de la mujer, or women's centers, that have been established to help abused women. The results are presented within the context of the historical and structural realities of women's lives in Nicaragua and the sanctions and sanctuary framework of cultural analysis of wife battering. Nicaraguan wife battering is exacerbated in the context of cultural traditions of acceptance of wife beating, machismo, and the recent history of warfare. Findings about the relationship context and intervention outcomes were similar to those found in studies of battered women and shelters in the United States. The results were generally supportive of the framework, demonstrating the importance of women's solidarity groups, community sanctions against domestic violence, and sanctuary for battered women.

Objectives. The primary objective was to investigate the prevalence of a history of abuse among women attending routine antenatal care in six northern Euro- pean countries. Second, we explored current suffering from reported abuse. Design. A prospective cohort study. Setting. Routine antenatal care in Belgium, Iceland, Denmark, Estonia, Norway, and Sweden between March 2008 and August 2010. Population. A total of 7174 pregnant women. Methods. A ques- tionnaire including a validated instrument measuring emotional, physical and sexual abuse. Main outcome measure. Proportion of women reporting emo- tional, physical and sexual abuse. Severe current suffering defined as a Visual Analogue Scale score of 6. Results. An overall lifetime prevalence of any abuse was reported by 34.8% of the pregnant women. The ranges across the six countries of lifetime prevalence were 9.7–30.8% for physical abuse, 16.2–27.7% for emotional abuse, and 8.3–21.1% for sexual abuse. Few women reported current sexual abuse, 0.4% compared with 2.2% current physical abuse and 2.7% current emotional abuse. Current severe suffering was reported by 6.8% of the women who reported physical abuse, 9.8% of those who reported sexual abuse and 13.5% for emotional abuse. Conclusion. A high proportion of preg- nant women attending routine antenatal care report a history of abuse. About one in ten of them experiences severe current suffering from the reported abuse. In particular, these women might benefit from being identified in the antenatal care setting and being offered specialized care. © Wiley. This is the authors’ accepted and refereed manuscript to the article.

Intimate partner violence (IPV) is a public health issue existing in most countries, occurring across all demographic, ethnic, cultural and socio-economic lines. Women of child-bearing age are at the highest risk of IPV, and the prevalence of IPV is disproportionately high in families with children younger than five years of age. Research has documented a pervasive link between intimate partner violence and child maltreatment (CM). This chapter provides a foundation for understanding the relationship between IPV and CM. An overview of related epidemiology is presented with a discussion of the comorbidity of IPV and CM. Focus is given to the cultural considerations in researching and addressing the occurrence and co-occurrence of IPV and CM. The chapter concludes with recommendations for future research as well as policy implications.

OBJECTIVES:Intimate partner violence (IPV) during pregnancy affects 0.9% to 17% of women and affects maternal health significantly. The impact of IPV extends to the health of children, including an increased risk of complications during pregnancy and the neonatal period, mental health problems, and cognitive delays. Despite substantial sequelae, there is limited research substantiating best practices for engaging and retaining high-risk families in perinatal home visiting (HV) programs, which have been shown to improve infant development and reduce maltreatment.METHODS:The Domestic Violence Enhanced Home Visitation Program (DOVE) is a multistate longitudinal study testing the effectiveness of a structured IPV intervention integrated into health department perinatal HV programs. The DOVE intervention, based on an empowerment model, combined 2 evidence-based interventions: a 10-minute brochure-based IPV intervention and nurse home visitation.RESULTS:Across all sites, 689 referrals were received from participating health departments. A total of 339 abused pregnant women were eligible for randomization; 42 women refused, and 239 women were randomly assigned (124 DOVE; 115 usual care), resulting in a 71% recruitment rate. Retention rates from baseline included 93% at delivery, 80% at 3 months, 76% at 6 months, and 72% at 12 months.CONCLUSIONS:Challenges for HV programs include identifying and retaining abused pregnant women in their programs. DOVE strategies for engaging and retaining abused pregnant women should be integrated into HV programs’ federal government mandates for the appropriate identification and intervention of women and children exposed to IPV.

A foundational implementation of the WHO/CDC Injury Surveillance Guidelines was conducted in Dar es Salaam region of the United Republic of Tanzania in 2005. The Guidelines were adapted to gather qualitative as well as quantitative data about intentional injury mortality which were collected concurrently at the Muhimbili National Hospital Mortuary. An interview schedule of 12 quantitative variables and one open-ended question, participant observation and newspaper reports were used. Mixed methods allowed an understanding of intentional injury mortality to emerge, even for those with the least amount of data, the 22% of homicides whose bodies were never claimed. Mixed methods made it possible to quantify intentional injury mortality rates, describe subpopulations with scanty data, and learn how to embed ongoing injury mortality surveillance into daily practice.

This article examines children and adolescent exposure to violence in various contexts. A systematic review of the literature was conducted to identify the definitions and types of violence reported in studies on victimization using the ecological systems framework. Sources included research studies and/or reports from scholarly journals (n = 140), books (n = 9), conference/workshops (n = 5), and web sources, such as Uniform Crime Reports (n = 23). The findings indicated that research differed in terminologies, conceptual and operational definitions, sample sizes and age group classification for children and adolescents. Further, studies lacked focus on the co-occurrence and inter-relatedness of victimization, and how these factors might affect the outcomes. Many studies employed a cross-sectional design, which limits strong conclusions about the temporal order of victimization experiences and outcomes. Future research efforts need more consistency among researchers in conceptual and operational definitions and the use of more rigorous designs. Increased holistic assessments are critical for effective prevention and intervention strategies for at-risk children and adolescents

Men’s violence against women—particularly intimate partner sexual violence (IPSV)—is associated with the transmission of HIV. Men who physically abuse their female intimate partners often also sexually abuse them. Latinas are one of the fastest growing populations in the USA and at high-risk for contracting HIV, though little is known about IPSV against physically abused Latinas, including whether there is an association between nativity of the victim and the likelihood of sexual violence by intimate partners. This study examined the (1) prevalence of recent (past 6 months) IPSV against 555 physically abused, help-seeking Latinas and (2) relationship of nativity to recent IPSV. This study used data collected in 2002–2003 from participants in one major city on the East Coast and one West Coast county, who were involved in the Risk Assessment Validation (RAVE) Study. The RAVE Study assessed the accuracy of four different methods for predicting risk of future intimate partner violence. IPSV was defined as an abusive male partner physically forcing sex (rape) or making the woman have sex without a condom. Recent IPSV was reported by 38 % of the sample. Among those reporting recent IPSV, multiple assaults were common: 30 % of women were raped and 51 % were made to have unprotected sex six or more times during the past 6 months. IPSV was significantly associated with nativity. Physically abused Latinas who were foreign born had two times greater odds of reporting recent IPSV than physically abused Latinas born in the USA, after controlling for other demographic covariates. Exploratory post hoc analyses examining all pairwise comparisons of IPSV against Latinas born in the USA, Mexico, Central America, South America, and the Caribbean also revealed some significant differences that warrant further study with larger samples. HIV prevention efforts aimed at reducing IPSV in this population are needed.

Violence against women is a major public health problem associated with mental disorders. Few studies have examined the heterogeneity of interpersonal violence and abuse (IVA) among women and associated mental health problems. Latent class analysis was used to identify subpopulations of women with similar lifetime histories of IVA victimization and to examine 10 associated past-year mental disorders. Participants were 19,816 adult women who participated in Wave 2 of the National Epidemiologic Study on Alcohol and Related Conditions (NESARC). The 3-class model was best supported by the data. Class 1 (6.7%) had a high probability of witnessing domestic violence as a child. Class 2 (21.8%) had a low probability of all events except lifetime sexual assault. Class 3 (71.5%) had a low probability for all events. Mental disorders were more common among members of Classes 1 and 2 than Class 3. For example, members in Class 1 were approximately 8 and 9 times more likely than members in Class 3 to have had posttraumatic stress disorder or a drug use disorder, respectively, during the past year. Of the 10 mental disorders, 5 were more common among members of Class 1 than of Class 2. Findings suggest the mental health consequences of IVA among women are extensive and interventions should be tailored for distinct subpopulations affected by IVA.

BACKGROUND: Homicide is an important cause of premature mortality globally, but evidence for the magnitude of homicides by intimate partners is scarce and hampered by the large amount of missing information about the victim-offender relationship. The objective of the study was to estimate global and regional prevalence of intimate partner homicide. METHODS: A systematic search of five databases (Medline, Global Health, Embase, Social Policy, and Web of Science) yielded 2167 abstracts, and resulted in the inclusion of 118 full-text articles with 1122 estimates of the prevalence of intimate partner homicide after double-blind screening. All studies were included that reported the number or proportion of women or men who were murdered by an intimate partner in a country, province, or town, using an inclusive definition of an intimate partner. Additionally, a survey of official sources of 169 countries provided a further 53 estimates. We selected one estimate per country-year using a quality assessment decision algorithm. The median prevalence of intimate partner homicide was calculated by country and region overall, and for women and men separately. FINDINGS: Data were obtained for 66 countries. Overall 13·5% (IQR 9·2-18·2) of homicides were committed by an intimate partner, and this proportion was six times higher for female homicides than for male homicides (38·6%, 30·8-45·3, vs 6·3%, 3·1-6·3). Median percentages for all (male and female) and female intimate partner homicide were highest in high-income countries (all, 14·9%, 9·2-18·2; female homicide, 41·2%, 30·8-44·5) and in southeast Asia (18·8%, 11·3-18·8; 58·8%, 58·8-58·8). Adjustments to account for unknown victim-offender relationships generally increased the prevalence, suggesting that results presented are conservative. INTERPRETATION: At least one in seven homicides globally and more than a third of female homicides are perpetrated by an intimate partner. Such violence commonly represents the culmination of a long history of abuse. Strategies to reduce homicide risk include increased investment in intimate partner violence prevention, risk assessments at different points of care, support for women experiencing intimate partner violence, and control of gun ownership for people with a history of violence. Improvements in country-level data collection and monitoring systems are also essential, because data availability and quality varied strongly across regions. FUNDING: WHO, Sigrid Rausing Trust, and the UK Economic and Social Research Council.

Forensic clinicians are routinely asked to estimate the age of cutaneous bruises. Unfortunately, existing research on noninvasive methods to date bruises has been mostly limited to relatively small, homogeneous samples or cross-sectional designs. Purpose: The purpose of this prospective, foundational study was to examine change in bruise colorimetry over time and evaluate the effects of bruise size, skin color, gender, and local subcutaneous fat on that change. Method: Bruises were created by a controlled application of a paintball pellet to 103 adult, healthy volunteers. Daily colorimetry measures were obtained for four consecutive days using the Minolta Chroma-meter®. The sample was nearly equal by gender and skin color (light, medium, dark). Analysis included general linear mixed modeling (GLMM). Results: Change in bruise colorimetry over time was significant for all three color parameters (L*a*b*), the most notable changes being the decrease in red (a*) and increase in yellow (b*) starting at 24 h. Skin color was a significant predictor for all three colorimetry values but sex or subcutaneous fat levels were not. Bruise size was a significant predictor and moderator and may have accounted for the lack of effect of gender or subcutaneous fat. Conclusion: Study results demonstrated the ability to model the change in bruise colorimetry over time in a diverse sample of healthy adults. Multiple factors, including skin color and bruise size must be considered when assessing bruise color in relation to its age. This study supports the need for further research that could build the science to allow more accurate bruise age estimations.