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This study examined exposure to violence and risk for lethality in intimate partner relationships as factors related to co-occurring MH problems and use of mental health (MH) resources among women of African descent. Black women with intimate partner violence (IPV) experiences (n = 431) were recruited from primary care, prenatal or family planning clinics in the United States and the U.S. Virgin Islands. Severity of IPV was significantly associated with co-occurring MH problems, but was not associated with the use of MH resources among African-American women. Risk for lethality and co-occurring problems were also not significantly related to the use of resources. African Caribbean women with severe physical abuse experiences were significantly less likely to use resources. In contrast, severity of physical abuse was positively associated with the use of resources among Black women with mixed ethnicity. Severe IPV experiences are risk factors for co-occurring MH problems, which in turn, increases the need for MH services. However, Black women may not seek help for MH problems. Thus, social work practitioners in health care settings must thoroughly assess women for their IPV experiences and develop tailored treatment plans that address their abuse histories and MH needs.

This article explains the concept of cultural competence, adding advocacy to models of culturally competent health care already in the literature and demonstrating how it relates to domestic violence. Abuse stages according to Landenburger's model of entrapment and recovery are presented with applicable cultural differences and specificities. Cultural issues related to specific childbearing-stage abuse interventions are also discussed. The principles of cultural competence, abuse- and childbearing-stage specificity, and empowerment are used as the basis for this model of clinical intervention with abused women.

A feminist critique shows varying degrees of androcentric and ethnocentric bias in the sparse nursing literature related to single-parent families. How can a more balanced body of nursing knowledge related to single-parent families be developed?

HIV and intimate partner violence (IPV) are commonly co-occurring epidemics affecting the health of women globally and especially in sub-Saharan Africa. There is a need for interventions that address both HIV and IPV in health care settings. Our review examined recent literature for intervention studies that explored both HIV and IPV. Of the nine interventions identified, only two were set in health care settings; the remainder were community based. Large multifaceted community-based interventions showed promise in the areas of addressing social norms in order to empower women. Educational interventions have shown short-term improvements in HIV-related knowledge and behavioral intention. Further research is needed to examine brief screening, intervention, and referral for HIV and IPV services within health care settings. Health care-specific interventions such as use of preexposure and postexposure prophylaxis to prevent HIV transmission must also be studied in the context of IPV.

It has been established that battering during pregnancy is a frequently occurring and significantly deleterious phenomena. This article reviews the evidence regarding dynamics, prevalence, outcomes, and cultural and other influences on this issue. Although tested interventions for abuse during pregnancy are limited, there are clear indications from research with other battered women for directions to be taken.Battering during pregnancy is a frequently occurring and significantly deleterious phenomenon and has received increasing attention in the areas of both research and practice. This article reviews the research conducted in the US related to battering during pregnancy, along with implications for interventions. In particular, the paper outlines the results of these studies concerning the prevalence of battering, its dynamics, health-related correlates, outcomes, and cultural influences. Although tested interventions for abuse during pregnancy are limited, there are clear indications from research with other battered women for directions to be taken. Addressing abuse during pregnancy is both a significant health enhancement and an important aspect of confronting other serious threats to maternal and infant health.

The current study explored the views of women experiencing interpersonal violence (IPV) and their relationship with their mothers or other supportive adult, and determines how this relationship affected perinatal depressive symptoms. The sample consisted of 30 urban and rural pregnant women enrolled in a larger ongoing randomized controlled trial. Data from quantitative instruments that measured depressive symptoms were examined in combination with qualitative interview data collected at baseline and six months post-natal. Women describing positive relationships with their mothers or another supportive adult reported statistically significant lower depressive symptoms scores (p < .05).

Intimate partner violence (IPV) is prevalent among adolescent and adult women, with significant physical, sexual, and mental health consequences. In 2011, the Institute of Medicine's Clinical Preventive Services for Women consensus report recommended universal screening for violence as a component of women's preventive services; this policy has been adopted by the Health Resources and Services Administration (HRSA). These policy developments require that effective clinic-based interventions be identified, easily implemented, and taken to scale.To foster dialogue about implementing effective interventions, we convened a symposium entitled "Responding to Violence Against Women: Emerging Evidence, Implementation Science, and Innovative Interventions," on May 21, 2012. Drawing on multidisciplinary expertise, the agenda integrated data on the prevalence and health impact of IPV violence, with an overview of the implementation science framework, and a panel of innovative IPV screening interventions. Recommendations were generated for developing, testing, and implementing clinic-based interventions to reduce violence and mitigate its health impact.The strength of evidence supporting specific IPV screening interventions has improved, but the optimal implementation and dissemination strategies are not clear. Implementation science, which seeks to close the evidence to program gap, is a useful framework for improving screening and intervention uptake and ensuring the translation of research findings into routine practice.Findings have substantial relevance to the broader research, clinical, and practitioner community. Our conference proceedings fill a timely gap in knowledge by informing practitioners as they strive to implement universal IPV screening and guiding researchers as they evaluate the success of implementing IPV interventions to improve women's health and well-being.

This research used logistic regression to test components of Choice and Lamke’s (1997) two-part decision-making model and Hamby’s (2008) holistic risk assessment as predictors of the decision to separate from an abusive partner, comparing significant predictors for immigrant ( n = 497) and nonimmigrant ( n = 808) women. Findings demonstrated that immigrant women reported higher levels of perceived risks/barriers to leaving, provided some support for the use of a holistic risk assessment in understanding women’s decisions to leave, and demonstrated that immigrant and nonimmigrant women have both similarities and differences in the factors that predict leaving. Clinical and policy implications are addressed.

A person's ability to minimize HIV risk is embedded in a complex, multidimensional context. In this study, we tested a model of how relationship power impacts IPV victimization, which in turn impacts HIV risk behaviors. We analyzed data from 474 young adult women (aged 15-31) in Cebu Province, Philippines, using structural equation modeling, and demonstrated good fit for the models. High relationship power is directly associated with increased IPV victimization, and IPV victimization is positively associated with increased HIV risk. We highlight in this article the complex dynamics to consider in HIV risk prevention among these young women.

A longitudinal study of 114 women, all having serious problems in intimate relationships, recruited from the community was undertaken in order to investigate relationship and battering status over time. In the original sample (N=193), 97 women were battered and 96 were not battered, as determined by an adaptation of the Conflict Tactics Scale. Of the 114 who returned approximately 2 and 1/2 years later, only 25% of the 51 originally battered women were still in that category. Discriminant function analysis using a combination of variables from established instruments (depression, self-esteem, physical symptoms, self-care agency) and in depth interview (education, relationship control, relationship duration, childhood abuse) failed to distinguish those battered from those not abused at Time 2. Results do not support a learned helplessness model for most women experiencing abuse, and they suggest that battered women seen in the health care and/or social services systems should be supported in a process of healthy decision making about their relationship status.

Selected costs associated with intimate partner violence were estimated for a community sample of 309 Canadian women who left abusive male partners on average 20 months previously. Total annual estimated costs of selected public- and private-sector expenditures attributable to violence were $13,162.39 per woman. This translates to a national annual cost of $6.9 billion for women aged 19–65 who have left abusive partners; $3.1 billion for those experiencing violence within the past three years. Results indicate that costs continue long after leaving, and call for recognition in policy that leaving does not coincide with ending violence. Cet article rend compte d’une étude qui nous a permis d’évaluer certains coûts associés à la violence conjugale au sein d’un échantillon de 309 femmes qui avaient quitté leur conjoint abuseur depuis 20 mois en moyenne. Nous estimons ces coûts – c’est-à-dire les dépenses publiques et privées associées à la violence conjugale – à 13 162,39 $ par femme en moyenne. Si l’on considère l’ensemble des femmes canadiennes de 19 à 65 ans ayant un conjoint abuseur, les coûts associés à la violence conjugale se chiffrent donc à 6,9 milliards de dollars, et à 3,1 milliards si l’on considère les femmes victimes de violence conjugale au cours des trois dernières années. Ces résultats indiquent que la violence conjugale implique des coûts qui persistent longtemps après la séparation des conjoints. Il est donc important, en matière de politiques de lutte contre la violence conjugale, que les décideurs tiennent compte du fait que la séparation ne met pas un terme à cette violence.

The International Council on Women's Health Issues (ICOWHI) is an international nonprofit association dedicated to the goal of promoting health, health care, and well-being of women and girls throughout the world through participation, empowerment, advocacy, education, and research. We are a multidisciplinary network of women's health providers, planners, and advocates from all over the globe. We constitute an international professional and lay network of those committed to improving women and girl's health and quality of life. This document provides a description of our organization mission, vision, and commitment to improving the health and well-being of women and girls globally.

The prevalence and correlates of suicidal threats and attempts among 662 racially and ethnically diverse adult female victims of intimate partner violence (IPV) were studied. One in five women had threatened or attempted suicide during her lifetime. They observed that multiple logistic regression results indicated that women at greater risk of severe or potentially lethal assaults as measured by the Danger Assessment and those who reported having a chronic or disabling illness were more likely to have threatened or attempted suicide. A linear association was found between age and suicide threats/attempts, with younger women having increased odds. Finally, African American IPV victims were less likely to have threatened or attempted suicide as compared to Latina victims. Study implications are discussed.

The prevalence of intimate partner violence (IPV) is striking, as are its consequences to the lives of women. The IPV often includes physical assault, which can include injuries to the head and attempted strangulation injuries. Both types of injuries can result in traumatic brain injury (TBI). The TBI sustained during IPV often occurs over time, which can increase the risk for health declines and postconcussive syndrome (PCS). Current studies have identified sequelae of cognitive dysfunction, posttraumatic stress disorder, and depression in women experiencing IPV, yet, most fail to determine the role of TBI in the onset and propagation of these disorders. Although imaging studies indicate functional differences in neuronal activation in IPV, they also have not considered the possibility of TBI contributing to these outcomes. This review highlights the significant gaps in current findings related to neuropsychological complications and medical and psychosocial symptoms that likely result in greater morbidity, as well as the societal costs of failing to acknowledge the association of IPV and TBI in women.

In a study to evaluate a collaborative police and social service intervention, researchers asked police officers to recruit intimate partner violence victims at the scene of domestic violence incidents. This article reviews the process of building successful partnerships with police departments as well as the strategies developed with collaborating police departments to create successful recruitment methods and enhance officer and department engagement with recruitment procedures. Over a period of 298 days, 800 victims were referred to the research study. Of these referrals, we were unable to contact 41.3%; of those contacted ( n = 471), we conducted interv iews with 67.73%.

OBJECTIVE:: Nurses face one of the highest rates of reported workplace violence (WPV). This research examined the prevalence of WPV and demographic, work-related, and adult and childhood abuse histories as risk factors for WPV among 2166 nurses/nursing personnel across four health care institutions in one US metropolitan area. METHODS:: Using data from an online cross-sectional survey, multivariate logistic regression was utilized to determine risk factors for physical and psychological WPV. RESULTS:: Almost one-third (30%) of nurses/nursing personnel experienced WPV (19.4% physical, 19.9% psychological). Risk factors included being a nurse, white, male, working in the emergency department, older age, longer employment, childhood abuse, and intimate partner violence. CONCLUSIONS:: Adult and childhood abuse histories have not been considered in previous large-scale investigations, but were significant risk factors along with other previously identified risk factors for WPV. Language: en

To examine the roles of lifetime abuse-related injury, posttraumatic stress disorder (PTSD) symptom severity, and depressive symptom severity in mediating the effects of severity of assaultive intimate partner violence (IPV), psychological IPV, and child abuse on chronic pain severity in women survivors of IPV.Structural equation modeling of data from a community sample of 309 women survivors of IPV was used to test partial and full theoretical models of the relationships among the variables of interest.The full model had good fit and accounted for 40.2% of the variance in chronic pain severity. Abuse-related injury, PTSD symptom severity, and depressive symptom severity significantly mediated the relationship between child abuse severity and chronic pain severity, but only abuse-related injury significantly mediated the relationship between assaultive IPV severity and chronic pain severity. Psychological IPV severity was the only abuse variable with significant direct effects on chronic pain severity but had no significant indirect effects.These findings can inform clinical care of women with chronic pain in all areas of healthcare delivery by reinforcing the importance of assessing for a history of child abuse and IPV. Moreover, they highlight the relevance of routinely assessing for abuse-related injury and PTSD and depressive symptom severity when working with women who report chronic pain.

On 30 August 1904, in the town of Scranton, Pennsylvania, what was described as a ‘large and enthusiastic number of … representative colored citizens' gathered at the Howard Place African Methodist...

The purpose of this study was to describe the perceptions of women who sought court protection orders for domestic violence (PODV) about actions to implement laws intended to disarm their abusers.We identified female victims of intimate partner violence (IPV) in New York and Los Angeles primarily through family courts and records of police calls for domestic violence. Of these, 782 were surveyed and asked about their experiences seeking PODV from courts, judges ordering the removal of firearms from defendants, and if firearms were actually surrendered or confiscated.Of the 542 victims who had obtained a PODV and knew whether their abuser owned a firearm, 82 (15%) reported that their abuser owned a firearm. Although state law either allowed or mandated judges issuing PODVs to require abusers to surrender their firearms, 21 victims (26%) reported that judges used this authority. Ten victims (12% of victims with armed abusers) reported that their abuser had either surrendered all of his firearms or had the firearms seized. When victims reported that the judge ordered their abuser to surrender his firearms, victims were more likely to report that all firearms were either surrendered by the abuser or confiscated by law enforcement.Based on the perceptions of the IPV victims in this study, laws designed to disarm domestic violence offenders were either poorly implemented or failed to inform victims when their abuser's firearms were surrendered or confiscated.

OBJECTIVES: Women assaulted by intimate partners are frequently patients in emergency departments (EDs). Many victims and health care providers fail to take into account the potential risks of repeat partner violence. The objective of this study was to use data from a larger study of domestic violence risk assessment methods to develop a brief assessment for acute care settings to identify victims at highest risk for suffering severe injury or potentially lethal assault by an intimate partner or former partner. METHODS: Victims of intimate partner violence (IPV) were interviewed twice between 2002 and 2004. The baseline interview included the 20 items of Campbell's Danger Assessment (DA; predictor). The follow-up interview, conducted 9 months later on average, assessed abuse inflicted since the baseline interview (outcome). Multiple logistic regression was used to identify questions on the DA most predictive of severe abuse and potentially lethal assaults. Female IPV victims were recruited from New York City family courts, Los Angeles County Sheriff's Department 9-1-1 calls, New York City and Los Angeles shelters, and New York City hospitals; 666 women responded to the DA at baseline, and 60% participated in follow-up interviews. RESULTS: Severe injuries or potentially lethal assaults were experienced by 14.9% of retained study participants between the baseline and follow-up interviews. The best brief prediction instrument has five questions. A positive answer to any three questions has a sensitivity of 83% (95% confidence interval = 70.6% to 91.4%). CONCLUSIONS: This instrument can help predict which victims may be at increased risk for severe injury or potentially lethal assault and can aid clinicians in differentiating which patients require comprehensive safety interventions. Language: en

Recent evidence suggests that it is important to consider behavioral specific sexual violence measures in assessing women's risk behaviors. This study investigated associations of history and types of sexual coercion on HIV risk behaviors in a nationally representative sample of heterosexually active American women.Analyses were based on 5857 women aged 18-44 participating in the 2002 National Survey of Family Growth. Types of lifetime sexual coercion included: victim given alcohol or drugs, verbally pressured, threatened with physical injury, and physically injured. Associations with HIV risk behaviors were assessed using logistic regression.Of 5857 heterosexually active women, 16.4% reported multiple sex partners and 15.3% reported substance abuse. A coerced first sexual intercourse experience and coerced sex after sexual debut were independently associated with multiple sex partners and substance abuse; the highest risk was observed for women reporting a coerced first sexual intercourse experience. Among types of sexual coercion, alcohol or drug use at coerced sex was independently associated with multiple sex partners and substance abuse.Our findings suggest that public health strategies are needed to address the violent components of heterosexual relationships. Future research should utilize longitudinal and qualitative research to characterize the relationship between continuums of sexual coercion and HIV risk.

The purpose of this study was to examine relational aggression and its relationship with adverse psychosocial and physical health symptoms among urban, African American youth.Quantitative, cross-sectional survey design. The sample consisted of 185 predominantly African American (95.1%) seventh-grade students (mean age: 13.0; female: 58%) attending 4 urban middle schools.The Children's Social Behavior Scale and Social Experience Questionnaire were used to measure relational aggression and relational victimization. The Pediatric Symptom Checklist was used to assess psychosocial difficulties, including internalizing behaviors, externalizing behaviors, and attention problems. Physical health symptoms were measured with questions about colds/flu, headaches, and stomach aches.2-way multivariate analysis of variance revealed significant differences in externalizing behavior, with perpetrators reporting higher levels than nonperpetrators. Victims reported more internalizing behavior than nonvictims; however, this was only significant for males. For females, significant negative effects on health outcomes were found, resulting from the interaction of perpetration and victimization.Findings suggest that relational aggression is a common occurrence among urban, minority adolescents and may result in adverse health outcomes. These results provide several avenues for future research and implications for healthcare practice. Intervention strategies are needed to prevent relational aggression and continual or subsequent adverse health symptoms.

One approach to address asthma disparities has been to create evidence-based guidelines to standardize asthma care and education. However, the adoption of these recommendations has been suboptimal among many providers. As a result, low-income minority patients may not be receiving adequate instruction in asthma self-management. In addition, these patients may fail to follow guideline-based recommendations. We conducted 25 interviews to identify the extent to which urban low-income adults have received training in, and implement, self-management protocols for acute asthma. Twenty-five adults (92% female; 76% African American; mean age 39) were enrolled. Only one subject had received asthma self-management training and only 10 (40%) used short-acting beta-(2) agonist-based (SABA) self-management protocols for the early treatment of acute asthma. No subject used a peak flow meter or an asthma action plan. Most (52%) chose to initially treat acute asthma with complementary and alternative medicine (CAM) despite the availability of SABAs. Importantly, 21 (84%) preferred an integrated approach using both conventional and CAM treatments. Four themes associated with acute asthma self-management emerged from the qualitative analysis. The first theme safety reflected subjects' perception that CAM was safer than SABA. Severity addressed the calculation that subjects made in determining if SABA or CAM was indicated based on the degree of symptoms they were experiencing. The third theme speed and strength of the combination described subjects' belief in the superiority of integrating CAM and SABA for acute asthma self-management. The final themesense of identity spoke to the ability of CAM to provide a customized self-management strategy that subjects desired. It is unclear if subjects' greater use of CAM or delays in using SABA-based self-management protocols were functions of inadequate instruction or personal preference. Regardless, delays in, or under use of, conventional self-management protocols may increase the risk for an untoward outcome. To that end, all patents' acute asthma self-management strategies should be evaluated for their timeliness and appropriateness. This would be of particular importance for vulnerable populations who bear a disproportionate burden of the disease and who have the fewest resources.

Whether intimate partner violence (IPV) screening reduces violence or improves health outcomes for women is unknown.To determine the effectiveness of IPV screening and communication of positive results to clinicians.Randomized controlled trial conducted in 11 emergency departments, 12 family practices, and 3 obstetrics/gynecology clinics in Ontario, Canada, among 6743 English-speaking female patients aged 18 to 64 years who presented between July 2005 and December 2006, could be seen individually, and were well enough to participate.Women in the screened group (n=3271) self-completed the Woman Abuse Screening Tool (WAST); if a woman screened positive, this information was given to her clinician before the health care visit. Subsequent discussions and/or referrals were at the discretion of the treating clinician. The nonscreened group (n=3472) self-completed the WAST and other measures after their visit.Women disclosing past-year IPV were interviewed at baseline and every 6 months until 18 months regarding IPV reexposure and quality of life (primary outcomes), as well as several health outcomes and potential harms of screening.Participant loss to follow-up was high: 43% (148/347) of screened women and 41% (148/360) of nonscreened women. At 18 months (n = 411), observed recurrence of IPV among screened vs nonscreened women was 46% vs 53% (modeled odds ratio, 0.82; 95% confidence interval, 0.32-2.12). Screened vs nonscreened women exhibited about a 0.2-SD greater improvement in quality-of-life scores (modeled score difference at 18 months, 3.74; 95% confidence interval, 0.47-7.00). When multiple imputation was used to account for sample loss, differences between groups were reduced and quality-of-life differences were no longer significant. Screened women reported no harms of screening.Although sample attrition urges cautious interpretation, the results of this trial do not provide sufficient evidence to support IPV screening in health care settings. Evaluation of services for women after identification of IPV remains a priority.clinicaltrials.gov Identifier: NCT00182468.

Objective. To examine the role of abuse-related injury and posttraumatic stress disorder (PTSD) symptom severity in mediating the effects of assaultive intimate partner violence (IPV) severity, psychological IPV severity, and child abuse severity on chronic pain severity in women survivors of IPV. Methods. Using data collected from a community sample of 309 women survivors of IPV, structural equation modeling was used to test a theoretical model of the relationships among the key variables. Results. The theoretical model accounted for almost 38% of the variance in chronic pain severity. PTSD symptom severity was a significant mediator of the relationships of both child abuse severity (beta = 0.13) and assaultive IPV severity (beta = 0.06) with chronic pain severity. Lifetime abuse-related injury was also a significant mediator of the relationships between both child abuse severity (beta = 0.05) and assaultive IPV severity (beta = 0.06) and chronic pain severity. Child abuse severity made the largest significant contribution to the model (beta = 0.35). Assaultive IPV severity had a significant indirect effect (beta = 0.12) on chronic pain severity while psychological IPV severity had a significant direct effect (beta = 0.20). Conclusions. Management of chronic pain in IPV survivors requires attention to symptoms of PTSD, abuse-related injury, and lifetime experiences of violence. Ensuring that acute pain from injury is adequately treated and followed over time may reduce the extent of chronic pain in abused women. The results also support the importance of routine assessment for IPV and child abuse. Language: en

Understanding that informed consent forms are provided to be read and comprehended, this study compares the research assistant's perception of comprehension with the actual time potential participants spend reading their consent form. After providing information verbally to two samples of women, research assistants observed as the women reviewed and signed the consent form recording the time spent reading and the assistant's impression of reading behavior. Over half of the women “read” their consent forms in thirty seconds or less before signing. Despite the brief time participants actually read, research assistants reported that 38%–74% (depending on the sample) appeared to have completely read the forms. Research to determine if timing aids will improve research assistants' assessment of participant reading behaviors should be considered.

Nurse scientists have explored a variety of research methods and a number of philosophic approaches to expand the discipline's ability to describe and investigate nursing's phenomena of interest. This article discusses the similarities and differences in world views, epistemologies, methodologies, and methods of two of these paradigms: critical theory and feminist theory. Attributes of these two stances are contrasted, and the relationship between the methods of analysis and the philosophic point of view are explored. An example of nursing research is given, with discussion of how the approach would differ if the nurse scientist were using critical versus feminist theory as a frame of reference.

Violence disproportionately affects low- and middle-income countries. Deeper understanding is needed in areas where little research has occurred. The objectives of the study were to: (a) ascertain rate of homicide death; (b) describe the victims and circumstances surrounding their deaths in Dar es Salaam, Tanzania in 2005. This study was developed by adapting the WHO/CDC Injury Surveillance Guidelines (Holder et al., 2001). Data on 12 variables were collected on all homicide deaths. Descriptive statistics and hypothesis tests were done when appropriate. Age standardised, age-specific and cause-specific mortality rates are presented. The overall homicide rate was 12.57 (males and females respectively: 22.26 and 2.64). Homicide deaths were 93.4% male, mostly unemployed, with a mean age of 28.2 years. Most deaths occurred in urban areas. Mob violence was the cause of 57% of deaths. The risk of homicide death for males was greater than the world average, but for females it was less. Most homicides were committed by community members policing against thieves.

Homicide is predicted to increase globally. The foundation for explanatory models of violence in low-income countries is rudimentary. The objective of this article is to describe peer-reviewed literature about homicide in sub-Saharan African (SSA) from 1970-2004. Searches in PubMed, OVID, and African Journals on-Line (AJOL) using the key words / phrases "homicide"', "injury death", and "Africa", identified 37 articles. Articles were excluded if it was impossible to distinguish homicide from suicide or unintentional injury death. Of the 37 articles, 30 contained information about homicide. According to the reviewed literature, throughout Africa, males are 4-10 times more likely to die of homicide than females. While children seem to be protected, adults (20-29 years) are at highest risk. The most common mechanism of homicide appears to be sharp instruments. The estimations depicting Africa as the world's second most violent continent were made from scanty data. Regional variations exist but the lack of data also makes it impossible to answer basic questions related to proportionate mortality, occupation of the deceased, ethnic or national variations, precipitating factors, or victim-perpetrator relationships. Temporal trends cannot be ascertained. In an attempt to bridge the gaps in existing knowledge about homicide, the World Health Organization (WHO) is coordinating and supporting efforts by countries to set up injury mortality surveillance systems, as a first step towards monitoring the incidence and prevalence of violence.

Intimate partner violence (IPV) screening remains controversial. Major medical organizations mandate screening, whereas the U.S. Preventive Services Task Force (USPSTF) cautions that there is insufficient evidence to recommend for or against screening. An effective IPV screening program must include a screening tool with sound psychometric properties. A systematic review was conducted to summarize IPV screening tools tested in healthcare settings, providing a discussion of existing psychometric data and an assessment of study quality.From the end of 2007 through 2008, three published literature databases were searched from their start through December 2007; this search was augmented with a bibliography search and expert consultation. Eligible studies included English-language publications describing the psychometric testing of an IPV screening tool in a healthcare setting. Study quality was judged using USPSTF criteria for diagnostic studies.Of 210 potentially eligible studies, 33 met inclusion criteria. The most studied tools were the Hurt, Insult, Threaten, and Scream (HITS, sensitivity 30%-100%, specificity 86%-99%); the Woman Abuse Screening Tool (WAST, sensitivity 47%, specificity 96%); the Partner Violence Screen (PVS, sensitivity 35%-71%, specificity 80%-94%); and the Abuse Assessment Screen (AAS, sensitivity 93%-94%, specificity 55%-99%). Internal reliability (HITS, WAST); test-retest reliability (AAS); concurrent validity (HITS, WAST); discriminant validity (WAST); and predictive validity (PVS) were also assessed. Overall study quality was fair to good.No single IPV screening tool had well-established psychometric properties. Even the most common tools were evaluated in only a small number of studies. Sensitivities and specificities varied widely within and between screening tools. Further testing and validation are critically needed.

Despite high rates of intimate partner violence in South Africa, there have been no national studies of men's perpetration of violence against female partners.We analyzed data from the South Africa Stress and Health Study, a cross-sectional, nationally representative study, specifically examining data for men who had ever been married or had ever cohabited with a female partner. We calculated the prevalence of physical violence against intimate female partners and used logistic regression to examine associations with physical abuse during childhood and exposure to parental and community violence.A total of 834 male participants in the South Africa Stress and Health Study met the study criteria. Of these, 27.5% reported using physical violence against their current or most recent female partner during their current or most recent marriage or cohabiting relationship. Crude odds ratios (ORs) and 95% confidence intervals (CIs) indicated significant associations between perpetration of violence against an intimate partner and witnessing parental violence (OR 3.91, 95% CI 2.66-5.73) or experiencing physical abuse during childhood (OR 3.24, 95% CI 2.27-4.63), but not exposure to community violence (OR 1.29, 95% CI 0.88-1.88). The 2 significant associations persisted in adjusted analyses: OR 3.22 (95% CI 1.94-5.33) for witnessing parental violence and OR 1.73 (95% CI 1.07-2.79) for experiencing physical abuse during childhood.We found a high prevalence of physical violence perpetrated by men against their intimate partners. Men who experienced physical abuse during childhood or were exposed to parental violence were at the greatest risk.

Objective To describe current evidence on home visiting interventions for pregnant or postpartum women with specific intimate partner violence assessment and content. Data Sources Online bibliographic databases including PubMed, CINAHL Plus, and Web of Science and a hand search of bibliographies of relevant articles. Study Selection Original research and intervention studies were included that contained (a) a well-described prenatal and/or postpartum home visitation; (b) an assessment of perinatal intimate partner violence; and (c) quantitative data describing health outcomes for the women and their infants. Data Extraction The search yielded 128 articles, and 8 relevant articles met all of the inclusion criteria. Nonresearch, nonintervention, and international articles were excluded. Data Synthesis No perinatal home visiting interventions were designed to address intimate partner violence. Programs that screened for intimate partner violence found high rates, and the presence of intimate partner violence limited the ability of the intervention to improve maternal and child outcomes. Conclusions Perinatal home visitation programs likely improve pregnancy and infant outcomes. Home visiting interventions addressing intimate partner violence in nonperinatal population groups have been effective in minimizing intimate partner violence and improving outcomes. This suggests that perinatal home visiting programs adding specific intimate partner violence interventions may reduce intimate partner violence and improve maternal and infant health. Continued rigorous research is needed.

The Danger Assessment (DA) is an instrument designed to assess the likelihood of lethality or near lethality occurring in a case of intimate partner violence. This article describes the development, psychometric validation, and suggestions for use of the DA. An 11-city study of intimate partner femicide used multivariate analysis to test the predictive validity of the risk factors on the DA from intimate partner femicide cases ( N = 310) compared with 324 abused women in the same cities (controls). The results were used to revise the DA (four items added; one “double-barreled” item divided into two), and the calculated weights (adjusted odds ratios) used to develop a scoring algorithm with levels of risk. These levels of risk were then tested with an independent sample of attempted femicides ( N = 194) with a final outcome of .90 of the cases included in the area under the receiver operating characteristic (ROC) curve.

Intimate partner violence (IPV) research has expanded dramatically in the past 2 decades. However, updated ethical guidelines to protect the safety and autonomy of research participants, study data, and the research team are still lacking in this evolving area of research. This article presents general concepts in research ethics and the specific challenges and strategies for IPV research related to recruitment and retention, maintenance of women's safety, privacy, and confidentiality, and their voluntary participation as well as assessment of benefits and risks, strategies to minimize risk, the Certificates of Confidentiality, and training of the research team. This area of nursing research is critical for developing practice guidelines and improving the health and quality of life of abused women.

PURPOSE: This article describes the health status of and care provided to patients in visits coded to intimate partner violence (IPV) victims in a national survey of emergency departments (EDs). Visits coded for IPV were defined by International Classification of Diseases, 8th edition-Clinical Modification (ICD-9-CM) codes. METHODS: Data from the National Hospital Ambulatory Medical Care Survey for 1997-2001 were analyzed. The sample consisted of 111 ED visits with ICD codes for IPV (or 12 IPV visits per 10,000 ED visits, and 21 female IPV visits per 10,000 female ED visits). FINDINGS: The majority of visits coded to IPV were for patients who presented with mild to moderate pain (86%), physical or sexual violence (50%), and injuries to the body (38%). The majority of patients in visits coded to IPV received radiologic testing, wound care, and pain medications (odds ratios [ORs], 1.6, 3.3, and 2.3 respectively). Disposition was mostly referral to another physician or clinic (42%) or return to the ED when needed (20%), but much less to nonphysician services such as social services, support services, and shelters (14%). Uninsured IPV patients were more likely to receive radiologic testing and pain medications (ORs 5.1 and 3, respectively). Patients seen by nurses were 9 times more likely to receive wound care. CONCLUSION: Caution should be exercised when interpreting the study results because they reflect only coded IPV visits in the ED and these might be the most obvious IPV cases. The results signal the need for further studies to evaluate access to and the quality of care for IPV patients and to improve screening, documentation, coding, and management practices. Language: en

BACKGROUND: Although youth are exposed to many forms of violence, most studies have been concentrated on only one type of violence exposure and focused on older adolescents or very young children. Little is known about direct and indirect effects of violent stressors on the health of African American adolescents in urban middle schools or the cumulative effect of multiple forms of exposures. OBJECTIVE: To test theoretically derived relationships between the types and levels of violence exposure and experiences; coping; and physical, behavioral, and mental health outcomes. METHODS: A structural equation modeling approach was used in this cross-sectional predictive correlational model testing design. Youth's experiences with exposure to and witnessing of violence were examined on three levels-community, family, and peer-in relation to physical, behavioral, and mental health outcomes. The sample (n = 309) consisted almost entirely of African American seventh graders from four urban middle schools. Forty-two percent of students were boys. More than 80% said that they had been in a boyfriend or girlfriend relationship, and 55% were currently in such a relationship. RESULTS: Eight of the 15 paths tested in the hypothesized model were found to be statistically significant, indicating an average fit (chi = 133.06, df = 40, ratio of 3.3, p

Objectives. We revised the Danger Assessment to predict reassault in abusive female same-sex relationships. Methods. We used focus groups and interviews to evaluate the assessment tool and identify new risk factors and telephone interviews at baseline and at 1-month follow-up to evaluate the revised assessment. Results. The new assessment tool comprised 8 original and 10 new items. Predictors included increase in physical violence (relative risk ratio [RRR]=1.95; 95% confidence interval [CI]=0.84, 4.54), constant jealousy or possessiveness of abuser (RRR = 4.07; 95% CI = 0.61, 27.00), cohabitation (RRR = 1.96; 95% CI = 0.54, 7.12), threats or use of gun by abuser (RRR=1.93; 95% CI=0.79, 4.75), alcoholism or problem drinking of abuser (RRR=1.47; 95% CI=0.79, 2.71), illegal drug use or abuse of prescription medications by abuser (RRR = 1.33; 95% CI = 0.72, 2.46), stalking by abuser (RRR=1.39; 95% CI=0.70, 2.76), failure of individuals to take victim seriously when she sought help (RRR=1.66; 95% CI=0.90, 3.05), victim’s fear of reinforcing negative stereotypes (RRR=1.42; 95% CI=0.73, 2.77), and secrecy of abuse (RRR=1.72; 95% CI=0.74, 3.99). Both unweighted (P < .005) and weighted (P < .004) versions of the revised assessment were significant predictors of reassault. Conclusions. The revised Danger Assessment accurately assesses risk of re-assault in abusive female relationships.

Feminists have often criticized nursing for lack of commitment to women's movements. This article addresses the contradictions and conflicts in the relationship of feminism and nursing from a historical perspective. Different feminist epistemologies, those of enlightened liberal, cultural, and radical feminism, are examined historically and their relevance to nursing is discussed. A reflexive theory, proposed by Harding, is used to conceptualize the differing responses, feminist and nonfeminist, of women and nurses, as alternative reactions to the many types of patriarchy they have encountered.

I commend Swartout and colleagues on their study (1) in this issue of JAMA Pediatrics for their secondary data analysis of the 2 largest longitudinal data sets of men in college that operationalize sexual assault with a well-validated measure. The results shed additional needed light on the nature of campus sexual assault. By combining 2 data sets, albeit 15 years apart, they maximize our ability to detect the nature of sexual assault on campus. This information will inform better strategies for best identifying, adjudicating, and treating sexually assaultive men. As they point out, one of the major findings is that most men in college do not rape women. In the combined data set, 5.6% of 1645 men committed a sexual assault that met the FBI definition of rape during college. In current conversations about campus sexual assault, many college-aged men believe they are being demonized—if they are not rapists, then they are likely to rape as soon as exposed to a university atmosphere that condones rape. Clearly this is not true, and although all universities need to improve the response to those who are raped and improve accountability for those who do rape, we should avoid any rhetoric that suggests that men at universities are likely to rape and that young women in college should be frightened of the men on their campus in general.... Although the study by Swartout et al in this issue is informative, it also highlights the dearth of high-quality research in the field. Although we have an excellent national survey of sexual assault as part of the National Intimate Partner and Sexual Violence Survey that includes women of college age, there is not sufficient representation of college students in that sample to identify the complex patterns needed to inform campus policy and prevention strategies. The results of the last well-measured population-based multi-university study of perpetration of sexual assault were published in 1987. Another important limitation of this study is that the samples are from only 2 universities in the southeastern United States and are limited in terms of diversity. One was 25.7% black and 5.8% other; the second was only 7.3% black and 3.3% other. Thus, the findings of this important study inform current policy discussions of college sexual assault by highlighting the need for a multifaceted approach to high school and college rape response and prevention. However, the most important finding is that there is insufficient current national research in this field to support the kind of evidence-based policy and programming in campus sexual assault prevention called for by the White House Council on Women and Girls. Although the Campus Climate Surveys will be informative for surveillance, without validated measures, sufficient response rates, and the ability to answer complex research questions about perpetrators, trajectories, and the interplay of risk and protective factors, they will not provide the kind of findings needed. 1 Swartout KM, Koss MP, White JW, Thompson MP, Abbey A, Bellis AL. Trajectory analysis of the campus serial rapist assumption [published online July 13, 2014]. JAMA Pediatr. doi:10.1001/jamapediatrics.2015.0707. Language: en

Statement of purpose To identify, evaluate, and implement evidence-based and promising strategies to prevent severe and fatal intimate partner violence. Methods/Approach The OK Injury Program partnered with OU College of Nursing, Arizona State University, and Johns Hopkins University on a National Institute of Justice grant to evaluate the lethality assessment protocol (LAP) in OK. Police conducted a brief 11-item lethality screen at the domestic violence (DV) scene to identify victims at high risk for homicide and attempted to connect them with DV services and safety planning. A quasi-experimental design was used to collect data from high-risk victims referred by police during comparison and intervention phases. Baseline and follow-up telephone interviews were conducted to assess victims’ violence exposure and protective actions. Results The study was conducted from 2009–2013. Seven police and local collaborating DV services agencies were recruited to participate. A total of 689 (342 comparison and 347 intervention) high risk women completed a baseline interview at 4–7 days following the incident; 414 (212 comparison and 202 intervention) completed a follow-up interview approximately 6 months later. Nearly 90% of these women reported severe or near lethal violence. Upon follow-up, women in the intervention group reported less frequency and severity of violence and more protective actions than women in the comparison group. Conclusions While results of the study are not generalizable, the LAP was found to be an effective police strategy to reduce intimate partner violence in OK. The data supports the LAP as a promising practice to decrease violent victimisation and increase protective actions among women who experience severe or near lethal violence. Significance and contribution to the field In 2014, HB 2526 was passed by the OK legislature directing all Oklahoma police officers to ask the 11 questions from the LAP screen. Statewide training on the LAP is now coordinated by the OK Office of the Attorney General. An indirect result of the study, this legislation translates research to practice in the community.

The body of knowledge on abuse during pregnancy is particularly broad because of its contributions from a variety of disciplines its origins in clinical and/or advocacy concerns and its inclusion of qualitative as well as quantitative research. Despite progress made in the first decade of research initiatives in public health policy programs and research are sorely needed. This article provides a review of past achievements and an outline for future directions of research in this field. Overall a linkage of abuse and unintended pregnancy has been established through studies and it has shown that abuse can be assessed through planned parenthood settings. In view of this international and local prevention programs have begun to include domestic violence considerations. However it is noted that not enough is being done. There are still many fields of inquiry that could well include abuse during pregnancy systematically in research clinical and policy initiatives. These include: population control international womens health postpartum assessment and intervention postpartum depression HIV/AIDS and other sexually transmitted diseases breast-feeding child abuse adolescent pregnancy substance abuse and cultural influences.

Intimate partner violence is a significant women's health issue. Since the news media can play a role in policy development, it is important to understand how newspapers have portrayed training and screening. The purpose of this study was to describe the frequency and nature of print news coverage of health issues related to partner violence, specifically, provider training and screening by health providers. We conducted a content analysis on articles obtained from major city and state capital daily newspapers from 20 states. News articles and editorials mentioning intimate partner violence and provider training and screening were examined for the years 1994 through 2001 (N = 188). Results showed that print news coverage was limited and received low levels of attention, indicating little potential to influence either policy or individual behavior. However, when the issue was covered, little debate or controversy was present, and a broad discussion of the issue was generally provided. News coverage of training and screening could be improved by increasing dissemination of research results, illustrating the policy implications of these issues, and offering resource information to women experiencing violence.