Physician beliefs about victims of spouse abuse and about the physician role

Our purpose was to measure the beliefs of physicians about victims of spouse abuse and to examine factors related to holding positive (e.g., supportive) and negative beliefs about providing services to victims of domestic violence. This was a total site sample of 150 physicians (76 responded; RR 51%), surveyed at one time, practicing in a large general hospital and the surrounding urban/periurban area. Four specialities are represented: emergency medicine, family practice, obstetrics-gynecology, and psychiatry. Three aspects of beliefs are measured: beliefs toward physician role in assisting victims of spouse abuse, beliefs about victims of spouse abuse, and beliefs about resources available to physicians to assist victims of spouse abuse. Almost all (97%) physicians believe it is part of their role to assist victims of domestic violence. Almost one third (30%) hold victim-blaming attitudes toward victims of spouse abuse, and the majority (70%) do not believe that they have the resources available to them to assist victims of domestic violence. Being female, younger, practicing obstetrics-gynecology, and having fewer years in practice are all significantly related to holding supportive (positive) beliefs. The majority of negative beliefs held are about resource availability. Hence, training programs may need to be developed locally for physicians and tailored to individual community characteristics. Training programs should also emphasize the importance of understanding the victims of spouse abuse and of not blaming the victims for the violence.     

The relative contribution of metacognitive beliefs and expectancies to drinking behaviour

AIM: Alcohol expectancies refer to the effects of alcohol use anticipated by an individual. Metacognitive beliefs about alcohol use are a specific form of alcohol expectancy relating to the beliefs individuals hold about the effects of alcohol on cognition and emotion. METHOD: A community sample of 355 individuals completed measures of alcohol expectancies, metacognitive beliefs about alcohol use, and drinking behaviour. RESULTS: Correlation analyses indicated that alcohol expectancies and metacognitive beliefs about alcohol use were positively correlated with drinking behaviour. Structural regression modelling revealed that three of the four facets of metacognitive beliefs about alcohol use were independent contributors to drinking behaviour, and that, when controlling for such beliefs, only negative social performance alcohol expectancies explained additional variance in drinking behaviour. CONCLUSIONS: These results add to the argument that there is a value in differentiating between metacognitive beliefs about alcohol use and alcohol expectancies in predicting drinking behaviour.     

Community influences on adolescents' use of home-brewed alcohol in rural South Africa

ABSTRACT: BACKGROUND: Alcohol represents a major public health challenge in South Africa, however little is known about the correlates of alcohol use among rural adolescents. This article examines community influences on adolescents' use of home-brewed alcohol in a rural region of South Africa. METHOD: A total of 1600 high school adolescents between 11 and 16 years of age participated in this study. Seven hundred and forty (46.3 %) were female and 795 (49.7 %) were male. Data on gender were missing for 65 students (4.0 % of the sample). The age range was 11--29 years (mean age 16.4 years; Standard deviation = 2.79).A survey questionnaire on adolescent risk behavior that examined adolescents' use of alcohol and various potential community influences on alcohol use was administered. Factor analysis was used to group community-level variables into factors. Multiple logistic regression techniques were then used to examine associations between these community factors and adolescents' use of home-brewed alcohol. RESULTS: The factor analysis yielded five community-level factors that accounted for almost two-thirds of the variance in home-brewed alcohol use. These factors related to subjective adult norms around substance use in the community, negative opinions about one's neighborhood, perceived levels of adult antisocial behavior in the community, community affirmations of adolescents, and perceived levels of crime and violence in the community (derelict neighborhood). In the logistic regression model, community affirmation was negatively associated with the use of home-brew, whereas higher scores on "derelict neighborhood" and "adult antisocial behavior" were associated with greater odds of drinking home-brew. CONCLUSION: Findings highlight community influences on alcohol use among rural adolescents in South Africa. Feeling affirmed and valued by the broader community appears to protect adolescents against early alcohol use. In contrast, perceptions of high levels of adult anti-social behavior and crime and violence in the community are significant risks for early alcohol initiation. Implications of these findings for the prevention of alcohol use among adolescents in rural communities are discussed.     

Exploring Couples’ Processes of Change in the Context of SASA!, a Violence Against Women and HIV Prevention Intervention in Uganda

There is now a growing body of research indicating that prevention interventions can reduce intimate partner violence (IPV); much less is known, however, about how couples exposed to these interventions experience the change process, particularly in low-income countries. Understanding the dynamic process that brings about the cessation of IPV is essential for understanding how interventions work (or don’t) to reduce IPV. This study aimed to provide a better understanding of how couples’ involvement with SASA!—a violence against women and HIV-related community mobilisation intervention developed by Raising Voices in Uganda—influenced processes of change in relationships. Qualitative data were collected from each partner in separate in-depth interviews following the intervention. Dyadic analysis was conducted using framework analysis methods. Study findings suggest that engagement with SASA! contributed to varied experiences and degrees of change at the individual and relationship levels. Reflection around healthy relationships and communication skills learned through SASA! activities or community activists led to more positive interaction among many couples, which reduced conflict and IPV. This nurtured a growing trust and respect between many partners, facilitating change in longstanding conflicts and generating greater intimacy and love as well as increased partnership among couples to manage economic challenges. This study draws attention to the value of researching and working with both women, men and couples to prevent IPV and suggests IPV prevention interventions may benefit from the inclusion of relationship skills building and support within the context of community mobilisation interventions.     

Human rights,transitional justice,public health and social reconstruction

Mass violence, armed conflict, genocide, and complex humanitarian emergencies continue to create major social and public health disasters at the dawn of the 21st Century. Transitional justice, a set of policies designed to address the effects of war on traumatized communities and bring justice, lies at the nexus of public health, conflict, and social reconstruction. Despite the paucity of empirical evidence, advocates of transitional justice have claimed that it can alleviate the effects of trauma, deter future violence, and bring about social reconstruction in war-affected communities. Empirical evidence – including new data and analyses presented in this article – suggests a link between trauma, mental health and attitudes towards and responses to transitional justice programs, but there has been little theoretical discussion about the intersection between public health and transitional justice, and even less empirical research to generate discussion between these two fields. Yet, public health professionals have an important role to play in assessing the impact of transitional justice on communities affected by mass violence. In this paper, we offer a conceptual model for future research that seeks to examine the relationship between transitional justice programs and their potential value to the fields of medicine and public health and discuss the methodological issues and challenges to a comprehensive evaluation of this relationship. To illustrate the discussion, we examine new data and analyses from two cases of contemporary conflicts, eastern Democratic Republic of Congo (DRC) and northern Uganda.     

Community Norms,Enforcement of Minimum Legal Drinking Age Laws,Personal Beliefs and Underage Drinking: An Explanatory Model

Strategies to enforce underage drinking laws are aimed at reducing youth access to alcohol from commercial and social sources and deterring its possession and use. However, little is known about the processes through which enforcement strategies may affect underage drinking. The purpose of the current study is to present and test a conceptual model that specifies possible direct and indirect relationships among adolescents’ perception of community alcohol norms, enforcement of underage drinking laws, personal beliefs (perceived parental disapproval of alcohol use, perceived alcohol availability, perceived drinking by peers, perceived harm and personal disapproval of alcohol use), and their past-30-day alcohol use. This study used data from 17,830 middle and high school students who participated in the 2007 Oregon Health Teens Survey. Structural equations modeling indicated that perceived community disapproval of adolescents’ alcohol use was directly and positively related to perceived local police enforcement of underage drinking laws. In addition, adolescents’ personal beliefs appeared to mediate the relationship between perceived enforcement of underage drinking laws and past-30-day alcohol use. Enforcement of underage drinking laws appeared to partially mediate the relationship between perceived community disapproval and personal beliefs related to alcohol use. Results of this study suggests that environmental prevention efforts to reduce underage drinking should target adults’ attitudes and community norms about underage drinking as well as the beliefs of youth themselves.     

The role of alcohol outlet visits derived from mobile phone location data in enhancing domestic violence prediction at the neighborhood level

Domestic violence (DV) is a serious public health issue, with 1 in 3 women and 1 in 4 men experiencing some form of partner-related violence every year. Existing research has shown a strong association between alcohol use and DV at the individual level. Accordingly, alcohol use could also be a predictor for DV at the neighborhood level, helping identify the neighborhoods where DV is more likely to happen. However, it is difficult and costly to collect data that can represent neighborhood-level alcohol use especially for a large geographic area. In this study, we propose to derive information about the alcohol outlet visits of the residents of different neighborhoods from anonymized mobile phone location data, and investigate whether the derived visits can help better predict DV at the neighborhood level. We use mobile phone data from the company SafeGraph, which is freely available to researchers and which contains information about how people visit various points-of-interest including alcohol outlets. In such data, a visit to an alcohol outlet is identified based on the GPS point location of the mobile phone and the building footprint (a polygon) of the alcohol outlet. We present our method for deriving neighborhood-level alcohol outlet visits, and experiment with four different statistical and machine learning models to investigate the role of the derived visits in enhancing DV prediction based on an empirical dataset about DV in Chicago. Our results reveal the effectiveness of the derived alcohol outlets visits in helping identify neighborhoods that are more likely to suffer from DV, and can inform policies related to DV intervention and alcohol outlet licensing.     

Armed conflict,alcohol misuse,decision-making,and intimate partner violence among women in Northeastern Uganda: a population level study

Background

Relations among and interactions between exposure to armed conflict, alcohol misuse, low socioeconomic status, gender (in)equitable decision-making, and intimate partner violence (IPV) represent serious global health concerns. Our objective was to determine extent of exposure to these variables and test pathways between these indicators of interest.

Methods

We surveyed 605 women aged 13 to 49 who were randomly selected via multistage sampling across three districts in Northeastern Uganda in 2016. We used Mplus 7.4 to estimate a moderated structural equation model of indirect pathways between armed conflict and intimate partner violence for currently partnered women (n?=?558) to evaluate the strength of the relationships between the latent factors and determine the goodness-of-fit of the proposed model with the population data.

Results

Most respondents (88.8%) experienced conflict-related violence. The lifetime/ past 12 month prevalence of experiencing intimate partner violence was 65.3%/ 50.9% (psychological) and 59.9%/ 43.8% (physical). One-third (30.7%) of women’s partners reportedly consumed alcohol daily. The relative fit of the structural model was superior (CFI?=?0.989; TLI?=?0.989). The absolute fit (RMSEA?=?0.029) closely matched the population data. The partner and joint decision-making groups significantly differed on the indirect effect through partner alcohol use (a₁b₁?=?0.209 [0.017: 0.467]).

Conclusions

This study demonstrates that male partner alcohol misuse is associated with exposure to armed conflict and intimate partner violence—a relationship moderated by healthcare decision-making. These findings encourage the extension of integrated alcohol misuse and intimate partner violence policy and emergency humanitarian programming to include exposure to armed conflict and gendered decision-making practices.

     

Perceptions of illness causation among new referrals to a community mental health team: "explanatory model" or "exploratory map"?

The health beliefs of people suffering from mental health problems are important. Such beliefs have been identified as key factors in models of health and illness behaviour, and may therefore indirectly influence clinical outcome. In addition, the increasing move towards patient-centred health care suggests that such beliefs need to be identified if a patient's perspective of his or her illness is to be addressed in the care process. Past research on health beliefs surrounding depression have concentrated on identifying "explanatory models" among the general community or among people who already have an established diagnosis of depression. This paper describes the content and status of health beliefs among people who are in the process of receiving a diagnosis. In-depth interviews were carried out with new referrals to a community mental health team (CMHT). Individuals expressed a variety of perceived causes throughout the interview. Beliefs were therefore characterised as changeable. It is argued that the concept of an "explanatory model" is too fixed to fully convey the fluid status of beliefs among this patient group. The concept of an "exploratory map" is suggested as a replacement. Such maps outline the avenues of thought which individuals explored when attempting to understand why they were currently experiencing particular psychological problems. The strength and persistence of beliefs is discussed in relation to both theoretical and clinical implications.     

Prevalence of intimate partner violence and related factors in a local city in Japan

OBJECTIVES: This study sought to assess the prevalence of intimate partner violence in a local city of Fukui Prefecture, and whether the subjects' and their partners' demographic characteristics, alcohol use, and violence experienced in the families in which they were raised might be related risk factors. METHODS: We conducted a mail survey of 1,000 subjects aged 20-69 in the city randomly sampled from the population of 45,220 that were stratified by 10 years of age and sex and pulled 100 from each group. Data from two 248 respondents were eligible for analysis. The self-administered questionnaire included items on; 1) whether they were the victims of physical, sexual, social-economic and psychological violence from their intimate partners, and whether they perpetrated violence or not on their partners; 2) demographic characteristics of the subjects and their partners with information on gender, age, occupation, educational background, annual income, the cohabitants, and their alcohol use; 3) the subjects' experience of violence in the family in which they had grown up; exposure to violence between their parents, and being abused by them. RESULTS: Out of 248 subjects, men accounted for 41.5%. The prevalence rate of any violence experienced from intimate partners was 46.4%, and that of having perpetrated any violence on the partner was 43.1%. Women reported experiencing more "sexual violence" from their partners than did men. In addition, men admitted to more "physical, sexual, and psychological violence" on their partners than women. Those who had themselves been exposed to violence between parents or were victimized by their parents significantly had more experience of violence from their partners and perpetration than those who did not. CONCLUSION: The results suggest that questioning about the experience of violence in the family is useful for the early detection of intimate partner violence.     

Sexual violence against intimate partners in Cape Town: prevalence and risk factors reported by men

OBJECTIVE: To describe the prevalence of and risk factors for the perpetration of sexual violence by men against female intimate partners. METHODS: A cross-sectional study was conducted on 1368 randomly selected men working in three Cape Town municipalities. The men were interviewed with the aid of a questionnaire on current sexual partners in the preceding 10 years, personal and relationship characteristics and the use of violence against their partners. RESULTS: The perpetration of sexual violence against intimate partners in the past 10 years was reported by 15.3% of the men. After adjustment for sociodemographic circumstances, the factors associated with such violence were involvement in physical conflict outside the home, problematic alcohol use, having more than one current partner and abusing partners verbally. While having frequent conflict with partners was important for the risk of sexual violence, only two types of conflict sources were significantly associated with this risk, namely conflict over sexual refusal and conflict when men perceived their authority to be undermined. CONCLUSION: Sexual violence in intimate relations was common. The risk of being sexually violent was associated with the use of violence to solve problems in other settings, having more than one current partner, alcohol abuse and verbally abusing a partner. It was also associated with particular types of conflict stemming from ideas of male sexual entitlement and dominance. Prevention programmes that focus on gender relations and non-violent conflict resolution for men and youths may be useful in combating such sexual violence.     

Identifying individual‐ and population‐level characteristics that influence rates of risky alcohol consumption in regional communities

Objective: To examine the extent to which individual‐ and community‐ level characteristics account for differences in risky alcohol consumption. Method: A cross‐sectional postal survey of 2,977 randomly selected individuals from 20 regional communities in NSW, Australia. Individuals drinking at harmful levels on the AUDIT and for risk of harm in the short term and long‐term were identified. Multi‐level modelling of the correlates of risky alcohol consumption at the individual and community level was conducted. Results: There were differences between communities in alcohol consumption patterns. Being male, unmarried and reporting worse health were significant individual‐level correlates for drinking at levels for risk of harm in the long term. The number of GPs (+) and police (‐) were significant community characteristics. Being younger (≤25), unmarried, Australian born and with a larger income was associated with drinking at levels for risk of harm in the short term and harmful drinking on the AUDIT. The number of hotels and clubs was positively associated with drinking at levels for risk of harm in the short term. Conclusions: Rates of risky drinking vary significantly between communities and both individual and community characteristics are significantly associated with risky alcohol consumption. Implications: A combination of individual‐ and population‐level interventions, tailored to the risk profile of individual communities, is most likely to be optimally effective.     

Community perceptions of risk factors for interpersonal violence in townships in Cape Town,South Africa: A focus group study

Interpersonal violence is a major contributor to the burden of disease globally, and in South Africa, it is the leading cause of injury. There is an emerging consensus that the development of actionable policy and effective prevention strategies for interpersonal violence requires an understanding of the contextual matters that elevate risk for interpersonal violence. The objective of this study was to explore community perceptions of risks for interpersonal violence in five townships in Cape Town, South Africa, with high rates of violence. Focus group discussions were conducted with community members to identify key factors in that contributed to being either a perpetrator or victim of interpersonal violence. The ecological framework was used to classify the risk factors as occurring at individual, relationship, community or society levels. Some of the risk factors identified included alcohol abuse, poverty, informality of settlements and cultural norms. Differences in how each of these risk factors are expressed and experienced in the five communities are also elucidated. This approach enabled the collection of contextual community-based data that can complement conventional surveillance data in the development of relevant community-level strategies for interpersonal violence prevention.     

Violent behavior in Chinese adolescents with an economic disadvantage. Psychological,family and interpersonal correlates

Two studies investigating the psychological, family and interpersonal correlates of adolescent violent behavior are reported in this paper. In Study 1, secondary school students (N = 1,519) responded to established scales assessing their psychological attributes, family functioning, parenting qualities and psychosocial support and conflict. Results of Study 1 showed that: a) adolescents who showed higher levels of perceived stress and psychological symptoms displayed more signs of adolescent violence; b) adolescents who had a higher sense of mastery and existential mental health displayed less signs of violence; c) adolescents' attitudes towards poverty and traditional Chinese beliefs about adversity were significantly related to adolescent violence; d) higher levels of family functioning, positive parenting styles as well as interpersonal support and lower levels of interpersonal conflicts were associated with a lower level of adolescent violence. Results further showed that some of the above factors were more strongly related to adolescent violence in adolescents experiencing economic disadvantage than in adolescents who did not experience economic disadvantage. Some of the findings of Study 1 were replicated in Study 2, where adolescents from 229 families (either families on welfare or low income families) were recruited. These studies suggested that several psychological, family and interpersonal factors are related to adolescent violent behavior, particularly in adolescents with economic disadvantage.     

Functional beliefs and risk minimizing beliefs among Thai healthcare workers in Maharaj Nakorn Chiang Mai hospital: its association with intention to quit tobacco and alcohol

Background

Individual health beliefs are likely to play a key role in how people respond to knowledge and information about the potential harm from smoking and alcohol abuse. The objectives of the study were to 1) explore whether functional beliefs and risk minimizing beliefs were associated with intention to quit smoking and confidence to quit smoking and 2) explore whether functional beliefs and risk minimizing beliefs were associated with intention to quit alcohol drinking and confidence to quit alcohol drinking.

Methods

A cross-sectional survey was conducted in 2013 among health care workers working in Thailand. Using predicted factor scores from factor analysis, the relationship between factor scores for each of the two beliefs and intention to quit and confidence to quit were tested using ANOVA and further adjusted for age and sex using linear regression.

Results

Functional beliefs were inversely associated with the intention to quit and confidence to quit smoking. Both functional beliefs and risk minimizing beliefs were each inversely associated with the intention to quit and confidence to quit alcohol drinking.

Conclusion

Our study enhances the understanding of the complexities of health beliefs regarding these two commonly abused substances. As functional beliefs were associated with smoking and alcohol use, interventions to counter the cultural values and individual beliefs about the benefits of smoking and alcohol use are needed. Tackling risk minimizing beliefs by providing individualized feedback regarding harm may also be useful in alcohol drinkers.

     

Interrupting Violence: How the CeaseFire Program Prevents Imminent Gun Violence through Conflict Mediation

Cities are increasingly adopting CeaseFire, an evidence-based public health program that uses specialized outreach workers, called violence interrupters (VIs), to mediate potentially violent conflicts before they lead to a shooting. Prior research has linked conflict mediation with program-related reductions in homicides, but the specific conflict mediation practices used by effective programs to prevent imminent gun violence have not been identified. We conducted case studies of CeaseFire programs in two inner cities using qualitative data from focus groups with 24 VIs and interviews with eight program managers. Study sites were purposively sampled to represent programs with more than 1 year of implementation and evidence of program effectiveness. Staff with more than 6 months of job experience were recruited for participation. Successful mediation efforts were built on trust and respect between VIs and the community, especially high-risk individuals. In conflict mediation, immediate priorities included separating the potential shooter from the intended victim and from peers who may encourage violence, followed by persuading the parties to resolve the conflict peacefully. Tactics for brokering peace included arranging the return of stolen property and emphasizing negative consequences of violence such as jail, death, or increased police attention. Utilizing these approaches, VIs are capable of preventing gun violence and interrupting cycles of retaliation.     

Alcohol Outlets,Neighborhood Characteristics,and Intimate Partner Violence: Ecological Analysis of a California City

Neighborhood indicators of social disadvantage, such as poverty and unemployment, are associated with intimate partner violence (IPV). Despite the well-established link between heavy drinking and IPV, few studies have analyzed the contribution of alcohol outlet density to the occurrence of IPV. Greater numbers of alcohol outlets in a community may be a sign of loosened normative constraints against violence, promote problem drinking among at-risk couples, and provide environments where groups of persons at risk for IPV may form and mutually reinforce IPV-related attitudes, norms, and problem behaviors. This study used ecological data to determine if alcohol outlet density (number of bars, restaurants serving alcohol, and off-premise outlets per unit area) is related to rates of IPV-related police calls and IPV-related crime reports in Sacramento, California. Separate analyses for IPV calls and crime reports were conducted using Bayesian space–time models adjusted for area characteristics (poverty rate, unemployment rate, racial/ethnic composition). The results showed that each additional off-premise alcohol outlet is associated with an approximate 4% increase in IPV-related police calls and an approximate 3% increase in IPV-related crime reports. Bars and restaurants were not associated with either outcome. The findings suggest that alcohol outlet density, especially off-premise outlets, appear to be related to IPV events. Further research is needed to understand the mechanisms by which neighborhood factors, such as alcohol outlet density, affect IPV behaviors. Understanding these mechanisms is of public health importance for developing environmental IPV prevention strategies, such as changes in zoning, community action, education, and enforcement activities.     

Young Australian adults' beliefs about alcohol's role in sexual aggression and victimisation

Beliefs and misconceptions about sex, gender, and rape have been explored extensively to explain attributions concerning alcohol-involved sexual violence. However, less is known about the specific beliefs that people hold about how alcohol facilitates sexual aggression and victimisation. The present study aimed to identify these alcohol-related beliefs among young Australian adults. Six men and nine women (N = 15; 18–24 years) in focus groups (n = 13) and interviews (n = 2) were asked to discuss the role of alcohol in a hypothetical alcohol-involved rape. Using a consensual qualitative research methodology, the effects of alcohol that were seen to introduce, progress, and intensify risks for rape were: increased confidence; character transformation; impaired cognition; behavioural disinhibition; altered sexual negotiation; enhanced self-centredness; impaired awareness of wrongdoing; increased/decreased sexual assertiveness; and compromised self-protection. Some of the beliefs identified in this study are not currently captured in alcohol expectancy measures which assess people's beliefs about alcohol's effects on cognition, emotion, and behaviour. This study's findings offer a conceptual basis for the development of a new alcohol expectancy measure that can be used in future rape-perception research.     

Vietnamese refugee children in camps in Hong Kong

Vietnamese refugee children staying in an open camp in Hong Kong were interviewed to find out the nature of their war experience. The effects of war and refugee experience on their fears about being hurt or killed were assessed. Most of the Vietnamese children in the present sample travelled to Hong Kong with their family and had little experience of separation, death or injury of close family members. However, about two-thirds of them had witnessed violence and one-third reported experience of being assaulted. Children exposed to unpleasant war experience were more likely to report a fear of being hurt than those not exposed to similar negative events. However, there was no consistent finding relating other types of fear to war experience. The family and the cohesiveness of the community in which they lived may have protected them against adverse psychological reactions.     

Taxing sin and saving lives: Can alcohol taxation reduce female homicides?

With costs exceeding $5.8 billion per year, violence against women has significant ramifications for victims, their families, the health care systems that treat them, and the employers who depend on their labor. Prior research has found that alcohol abuse contributes to violence against both men and women, and that stringent alcohol control policies can reduce alcohol consumption and in turn some forms of violence. In this paper, we estimate the direct relationship between an important alcohol control measure, excise taxes, and the most extreme form of violence, homicide. We use female homicide rates as our measure of severe violence, as this measure is consistently and accurately reported across multiple years. Our results provide evidence that increased alcohol taxes reduce alcohol consumption and that reductions in alcohol consumption can reduce femicide. Unfortunately, a direct test of the relationship does not have the power to determine whether alcohol taxes effectively reduce female homicide rates. We conclude that while alcohol taxes have been shown to effectively reduce other forms of violence against women, policy makers may need alternative policy levers to reduce the most severe form of violence against women.