Intersections Between Childhood Abuse and Adult Intimate Partner Violence Among Ecuadorian Women

Objectives Strong linkages exist between childhood abuse and adult intimate partner violence (IPV) among women in developed countries. Few studies examine this pattern in developing nations. This study explores the effect of childhood physical and/or psychological abuse on the likelihood of IPV among a national sample of Ecuadorian women of reproductive age. Methods Secondary data analysis was conducted on a subsample of 9,077 Ecuadorian women, utilizing the 2004 Encuesta Demografía y de Salud Materna e Infantil survey. Cross-tabulations and multivariate logistic regression models were utilized to assess whether women who report childhood abuse had a higher likelihood of reporting sexual, physical or psychological IPV during their lifetimes or within the past year. Results Levels of abuse were high. More than 30% of women reported childhood psychological or physical abuse, and 21% experienced both types of abuse. Forty percent of women reported sexual, physical or psychological IPV during their lifetimes, while 15% reported any form of IPV in the past year. The co-occurrence of childhood psychological and physical abuse was highly predictive of all forms of IPV, with less consistent associations for women who reported only physical or only psychological childhood abuse. Conclusions This study suggests that childhood abuse is an important risk factor for IPV victimization among Ecuadorian women. While this analysis supports findings from developed countries, more cross-cultural research about patterns of violence throughout the life course is needed to develop relevant prevention programs.     

Teachers' knowledge,attitudes and experience in sexual abuse prevention education in El Salvador

Research on how to prevent child sexual abuse (CSA) in developing nations is practically non-existent. We sought to determine Salvadoran teachers' knowledge, attitudes, experience and barriers to CSA detection and reporting to assess the need for a CSA prevention programme and to assess barriers in conducting such a programme. One hundred teachers completed a questionnaire while they visited the Tin Marin Children's Museum in San Salvador. Nineteen of these teachers also participated in a focus group. We found that 89% of teachers reported at least two signs and symptoms of child abuse. One hundred per cent of teachers agreed that it is their responsibility to teach students about sexual abuse. Unusual for a study of this kind, parental migration was mentioned as making children vulnerable to CSA, and fear of gang violence and retribution was identified as interfering with teachers' ability to protect children. We conclude that Salvadoran teachers were knowledgeable about CSA detection and reporting and would support a programme in which they are trained to speak to their students about this topic. Barriers to reporting child abuse, such as teachers' safety and fear, need to be addressed in future CSA prevention programmes.     

Social Disadvantage as a Risk for First Pregnancy Among Adolescent Females in the United States

Purpose

Differences in underlying determinants of pregnancy at different stages of adolescent development have implications for prevention strategies. We sought to determine whether social disparities in rates of adolescent pregnancy vary between early, middle, and late adolescence. We hypothesized that as age increases, racial and socioeconomic disparities in rates of teen conception decrease.

Methods

Data were obtained from the National Survey of Family Growth cycle 6. Outcome variables indicated whether respondents had a first pregnancy at ages <15 years, 15–17 years, or 18–19 years. Independent variables were race and maternal education level. Logistic regression was used to calculate the relative odds of first conception in a given age range by race and maternal education level.

Results

The disparity in odds of pregnancy between black and white teens is maximal in early adolescence (odds ratios <15 years: 3.9) and decreased by nearly 50% in late adolescence (odds ratios 18–19 years: 2.0, p < .01). After stratifying by maternal education level, the same trends are seen.

Conclusions

In accordance with our hypothesis, we found that social disparities in pregnancy rates decrease between early and late adolescence. Although pregnancy prevention efforts often target those at social risk including poor minority youth, fewer acknowledge and target the risks associated with development of sexuality in all teens. Efforts to better define the nature of healthy adolescent sexual development may lead to pregnancy prevention interventions focused on developmental risk that can apply to a wider set of adolescents.     

A Systematic Review of Interventions for Preventing Adolescent Intimate Partner Violence

PurposeIntimate partner violence (IPV) is a pervasive global health issue affecting adolescents. We reviewed randomized controlled trials of interventions to reduce physical, sexual, and psychological violence perpetration and victimization among adolescents.MethodsPUBMED, CINAHL, Science Direct, EMbase, PsychLIT, ISI Web of Science, Scopus, and the Cochrane database were searched for English language papers published up to the end of February 2013.ResultsEight articles reporting on six randomized controlled trials were retrieved. Four interventions contained both school and community components. We found positive intervention effects on IPV perpetration (three studies) and IPV victimization (one study). Compared with the studies with no effects on IPV, the effective interventions were of longer duration, and were implemented in more than one setting. There were quality issues in all six trials.ConclusionInterventions targeting perpetration and victimization of IPV among adolescents can be effective. Those interventions are more likely to be based in multiple settings, and focus on key people in the adolescents' environment. Future trials should assess perpetration and victimization of IPV among male and female adolescents with and without prior experiences with IPV, taking gender differences into account.     

Stress in the City: Influence of Urban Social Stress and Violence on Pregnancy and Postpartum Quality of Life among Adolescent and Young Mothers

Adolescent and young mothers transitioning from pregnancy to postpartum need to maintain an optimal quality of life. Stress and exposure to violence (e.g., intimate partner violence (IPV), nonpartner violence) are predictors of poor quality of life for adult women; however, these associations remain understudied among adolescent and young mothers in urban areas. Guided by the social ecological model, the current study created a latent variable, urban social stress, to examine the impact of the urban social environment (i.e., stressful life events, discrimination, family stress, and neighborhood problems) on the quality of life of adolescent and young mothers during both pregnancy and postpartum. The current study is a secondary data analysis of a prospective cohort study of 296 expectant young mothers recruited at obstetrics and gynecology clinics. Results from structural equation and multigroup models found that higher urban social stress predicted lower mental and physical quality of life during pregnancy, but these associations were significantly stronger for IPV-exposed and nonpartner violence-exposed mothers. In the postpartum period, higher urban social stress predicted lower mental and physical quality of life, but these associations were significantly stronger for IPV-unexposed and nonpartner violence-exposed mothers. Stress reduction programs need to help adolescent and young mothers in urban areas develop stress management skills specific to urban social stress. Pregnancy and parenting programs need to be tailored to the specific needs of young mothers in urban areas by becoming sensitive to the role of IPV and nonpartner violence in these young women’s lives.     

Resources and obstacles to developing and implementing a structural intervention to prevent HIV in San Salvador,El Salvador

HIV prevention researchers have increasingly advocated structural interventions that address factors in the social, political and economic context to reduce disparities of HIV/AIDS among disadvantaged populations. This paper draws on data collected in three different types of low-income communities (n = 6) in the San Salvador metropolitan area in El Salvador. Nine focus group discussions were conducted between January 2006 and July 2007, 6 with community leaders, and 3 with crack cocaine users, as well as in-depth interviews with 20 crack users and crack dealers. We explore opportunities and barriers to the implementation of a community-level, structural intervention. We first analyze the different forms of leadership, and other community resources including existing HIV prevention activities that could potentially be used to address the related problems of crack use and HIV in the communities, and the structural factors that may act as barriers to capitalizing on communities' strengths in interventions. Each of the communities studied demonstrated different resources that stem from each community's unique history and geographic location. HIV testing and prevention resources varied widely among the communities, with resources concentrated in one Older Central community despite a strong need in all communities. In many communities, fear of gang violence and non-responsiveness by government agencies to communities' needs have discouraged community organizing. In the discussion, we offer concrete suggestions for developing and implementing structural interventions to reduce HIV risks that use communities' different but complementary resources.     

Implementation of maternal influenza immunization in El Salvador: Experiences and lessons learned from a mixed-methods study

IntroductionThe World Health Organization (WHO) recommends that countries prioritize pregnant women for influenza vaccination, yet few low- or middle-income countries (LMICs) have implemented maternal influenza immunization programs. To inform vaccine decision-making and operational planning in LMICs, there is a need to document and share experiences from countries that provide seasonal influenza vaccine to pregnant women, particularly those with high coverage, like El Salvador.MethodsIn 2015 and 2016, PATH and country researchers conducted a mixed-methods study to document the experience and lessons learned from maternal influenza immunization delivery and acceptance in El Salvador as part of a collaborative effort between WHO and PATH. Researchers conducted focus group discussions, semi-structured interviews, antenatal clinic exit interviews, and key informant interviews with 326 participants from two municipalities in each of the country’s three regions. Respondents included pregnant and recently pregnant women, family members, community leaders, health personnel, public health managers and partners, and policymakers.ResultsFactors perceived as positively influencing maternal influenza immunization delivery and acceptance in El Salvador include the use of multiple vaccine delivery strategies, targeted education and community engagement efforts, and a high degree of trust between the community and health care providers. Influenza vaccine acceptance by pregnant women is high and has improved over time, largely attributed to education targeting health care advisors. Perceived challenges to pregnant women receiving health care and vaccination include the need for permission to attend services and limited access to health services in insecure areas related to the presence of criminal gang activity.ConclusionsWe identified approaches and barriers perceived to affect maternal influenza vaccine delivery in El Salvador. This information will be useful to public health decision-makers and implementers in El Salvador and other countries considering introduction of new maternal vaccines or striving to increase coverage of vaccines currently provided.     

Intimate Partner Abuse among Gay and Bisexual Men: Risk Correlates and Health Outcomes

Little is known about the patterns and types of intimate partner abuse in same-sex male couples, and few studies have examined the psychosocial characteristics and health problems of gay and bisexual men who experience such abuse. Using a cross-sectional survey sample of 817 men who have sex with men (MSM) in the Chicago area, this study tested the effect of psychological and demographic factors generally associated with intimate partner abuse and examined their relationship to various health problems. Overall, 32.4% (n = 265) of participants reported any form of relationship abuse in a past or current relationship; 20.6% (n = 168) reported a history of verbal abuse (“threatened physically or sexually, publicly humiliated, or controlled”), 19.2% (n = 157) reported physical violence (“hit, kicked, shoved, burned, cut, or otherwise physically hurt”), and 18.5% (n = 151) reported unwanted sexual activity. Fifty-four percent (n = 144) of men reporting any history of abuse reported more than one form. Age and ethnic group were unrelated to reports of abuse. Depression and substance abuse were among the strongest correlates of intimate partner abuse. Men reporting recent unprotected anal sex were more likely to also report abuse, Wald (1, n = 773) = 9.02, p < .05, Odds Ratio (OR) = 1.61, Confidence Interval (CI) = 1.18–2.21. We discuss psychosocial issues faced by gay and bisexual men who experience intimate partner abuse as they may pertain to interventions among this group.     

Disability,Gender and Intimate Partner Violence: Relationships from the Behavioral Risk Factor Surveillance System

Research on women with disabilities has found that the most common perpetrators of violence were current or former intimate partners (Young et al. Arch. Phys. Med. Rehabil. 78, S34–S38, 1997; Riddington, Beating the “odds”: Violence and Women with Disabilities (Position Paper 2). 1989). This article examines intimate partner sexual and physical abuse experienced by women with disabilities compared to women without disabilities and men with and without disabilities through chi square analysis and regression analysis using data from the 2005 Behavioral Risk Factor Surveillance System (BRFSS). Results show that women with disabilities experienced almost twice the rate of all forms of abuse compared to the other populations. Variables increasing the likelihood of abuse include being female, disabled, not employed, uncoupled and younger age. Implications for future research, screening and intervention for rehabilitation professionals are discussed.     

Social Norms and Beliefs Regarding Sexual Risk and Pregnancy Involvement among Adolescent Males Treated for Dating Violence Perpetration

The present study explored perceived sexual norms and behaviors related to sexual risk and pregnancy involvement among adolescent males (ages 13 to 20) participating in programs for perpetrators of dating violence. The purpose of this study was to generate hypotheses regarding the contexts and mechanisms underlying the intersection of adolescent dating violence, sexual risk and pregnancy. Six focus groups were conducted (N = 34 participants). A number of major themes emerged: 1) male norm of multiple partnering, 2) perceived gain of male social status from claims of sexual activity, 3) perception that rape is uncommon combined with belief that girls claiming to be raped are liars, 4) perception that men rationalize rapes to avoid responsibility, 5) condom non-use in the context of rape and sex involving substance use, 6) beliefs that girls lie and manipulate boys in order to become pregnant and trap them into relationships, and 7) male avoidance of responsibility and negative responses to pregnancy. The combination of peer-supported norms of male multiple partnering and adversarial sexual beliefs appear to support increased male sexual risk, lack of accountability for sexual risk, and rationalization of rape and negative responses to pregnancy. Further research focused on the context of male sexual risk and abusive relationship behaviors is needed to inform intervention with young men to promote sexual health and prevent rape, dating violence, and adolescent pregnancy.Silverman, Decker, Reed, and Hathaway are with the Harvard School of Public Health, Department of Society, Human Development and Health, Boston, MA, USA; Rothman and Raj are with the Department of Social and Behavioral Sciences, Boston, MA, USA; Miller is with the Harvard Medical School, Department of Adolescent Medicne, Boston, MA, USA.     

家庭环境与儿童期性虐待发生的单因素分析

目的了解家庭环境与儿童期性虐待发生的关系,为儿童期性虐待的预防提供依据。方法对某学院18岁以上的701名女生进行自填式问卷调查。结果生活在重组家庭中的儿童性虐待的报告率高于核心家庭,父、母亲经常在家庭中使用暴力、有不良嗜好、体弱多病、家庭关系紧张(父母之间、父母与祖父母之间、父母与孩子之间)是性虐待发生的危险因素;女童也是性虐待发生的危险因素。结论家庭环境在儿童期性虐待发生中起重要作用。     

Domestic violence against women in India: A systematic review of a decade of quantitative studies

Domestic violence (DV) is prevalent among women in India and has been associated with poor mental and physical health. We performed a systematic review of 137 quantitative studies published in the prior decade that directly evaluated the DV experiences of Indian women to summarise the breadth of recent work and identify gaps in the literature. Among studies surveying at least two forms of abuse, a median 41% of women reported experiencing DV during their lifetime and 30% in the past year. We noted substantial inter-study variance in DV prevalence estimates, attributable in part to different study populations and settings, but also to a lack of standardisation, validation, and cultural adaptation of DV survey instruments. There was paucity of studies evaluating the DV experiences of women over age 50, residing in live-in relationships, same-sex relationships, tribal villages, and of women from the northern regions of India. Additionally, our review highlighted a gap in research evaluating the impact of DV on physical health. We conclude with a research agenda calling for additional qualitative and longitudinal quantitative studies to explore the DV correlates proposed by this quantitative literature to inform the development of a culturally tailored DV scale and prevention strategies.     

湘潭某工厂子弟中学学生受虐待的多因素分析

目的探讨儿童受虐待的危险因素，以便为保护儿童身心健康提供依据。方法抽取湘潭某工厂子弟学校初中二年级学生282名，采用一般资料问卷、儿童受虐筛查表、父母养育方式评价量表及艾森克个性问卷(儿童版)进行调查。将父母养育方式评价量表及艾森克个性问卷(儿童)共计15个因子作为自变量进行Logistic回归分析。结果近1a内遭受过虐待的儿童有86名，儿童遭受虐待行为的危险因素有父亲惩罚、严厉(B=0．073，OR=1．076，P=0．012，95％CI为1．016—1．140)，母亲拒绝、否认(B=0．115，OR=1．121，P=0．002，95％CI为1．042～1．207)，儿童性格古怪、孤僻、易找麻烦(B=-0．026，OR=0．974，P=0．099，95％CI为0．944—1．005)以及儿重个性的掩饰维度(B=-0．035，OR=0．966，P=0．041，95％CI为0．934-0．999)进入Logistie回归方程。结论父亲应减少对儿童的惩罚、严厉，母亲应减少对儿童的拒绝、否认。同时，着力塑造儿童健全的人格，有望减少儿童受虐的发生。     

某中学高中女生儿童期性虐待发生情况调查

目的 了解高中女生儿童期性虐待发生情况，为卫生及教育部门制定预防儿童期性虐待对策提供参考依据。方法 用自填式问卷，于2000年12月对某高中学校985名女生就有关儿童期受性虐待经历进行不记名的回顾性调查。结果 在被调查的985名女生中，有251人（25．5％）16岁前曾经历过非身体接触或身体接触的性虐待；其中18人经历过被试图性交，5人经历过被强行性交。儿童期性虐待首次发生年龄58％在13岁及以前。性交行为的发生率在有儿童期性虐待经历的女生中（2．6％）高于没有性虐待经历的女生（0．4％），差异有显性(x^2=6.48,P=0.011)。在不同的父母化程度间，儿童期性虐待发生率差异未发现有显性。结论 儿童期性虐待问题在我国女童中可能并非少见，有必要对这一问题开展研究，并重视在小学生中开展预防性虐待教育工作。     

Exposure to Partner,Family, and Community Violence: Gang-Affiliated Latina Women and Risk of Unintended Pregnancy

While teen pregnancy rates appear to be declining in the USA overall, the rate of decline among young Latinas has been less than other ethnic groups. Among the myriad factors associated with elevated pregnancy rates, for Latina girls living in the inner city, exposure to gang and community violence may be a critical context for increased pregnancy risk. This study explores the relationship between gang involvement and reproductive health, and the pathways through which childhood, family, and relationship violence exposure may lead to unintended pregnancy. Interviews of 20 young adult Latinas with known gang involvement in Los Angeles County were audiotaped, transcribed, and coded for key themes related to violence exposure and reproductive health. Limited access to reproductive health care compounded by male partner sexual and pregnancy coercion, as well as physical and sexual violence, emerged in the interviews. Exposures to interparental domestic violence, childhood physical and sexual abuse, and gang violence were prominent and closely associated with unhealthy and abusive intimate relationships. Adverse childhood experiences and exposure to partner, family, and community violence impact the reproductive lives and choices of young Latina women in gangs. These findings may guide targeted pregnancy prevention efforts among urban gang-affiliated Latinas as well as encourage the integration of sexual violence prevention and reproductive health promotion within gang violence intervention programs.     

Adolescent Obesity as a Risk Factor for High-Level Nicotine Addiction in Young Women

Purpose

Obesity and cigarette smoking are two of the most frequent and preventable causes of disease and death in the United States; both are often established during youth. We hypothesized that obese, adolescent girls would be at higher risk for nicotine addiction in young adulthood, and that particular individual and social factors would mediate this association.

Methods

Students surveyed in the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative school-based and in-home survey conducted in three waves, comprised the sample. More than 4,000 respondents were used for the multivariate linear and logistic regression analyses used to determine the association between obesity and level of nicotine addiction. Potential mediation effects of the association were also examined.

Results

Obesity doubled the risk of the highest level of nicotine addiction after controlling for demographic factors, parent and friend smoking, and baseline smoking (OR, 2.12; 95% CI, 1.22–3.68). Family smoking was the strongest predictor of nicotine addiction (OR, 4.72; 95% CI, 2.89–7.72). Grade point average was a partial mediator of this relationship (OR, .48; 95% CI, .32–.74).

Conclusions

Obese, adolescent females are at increased risk for high-level nicotine addiction in young adulthood as compared with their nonobese peers. Grade point average partially mediates the association, and may represent a confluence of factors including increased absenteeism, social marginalization, biases, and lack of confidence in academic ability. Obese, adolescent females may require targeted interventions to address their risk of subsequent high-level nicotine addiction, especially if risk factors such as parental smoking and poor school performance are present.     

Catching-up with pentavalent vaccine: Exploring reasons behind lower rotavirus vaccine coverage in El Salvador

Rotavirus vaccine was introduced in El Salvador in 2006 and is recommended to be given concomitantly with DTP–HepB–Haemophilus influenzae type b (pentavalent) vaccine at ages 2 months (upper age limit 15 weeks) and 4 months (upper age limit 8 months) of age. However, rotavirus vaccination coverage continues to lag behind that of pentavalent vaccine, even in years when national rotavirus vaccine stock-outs have not occurred. We analyzed factors associated with receipt of oral rotavirus vaccine among children who received at least 2 doses of pentavalent vaccine in a stratified cluster survey of children aged 24–59 months conducted in El Salvador in 2011. Vaccine doses included were documented on vaccination cards (94.4%) or in health facility records (5.6%). Logistic regression and survival analysis were used to assess factors associated with vaccination status and age at vaccination. Receipt of pentavalent vaccine by age 15 weeks was associated with rotavirus vaccination (OR: 5.1; 95% CI 2.7, 9.4), and receipt of the second pentavalent dose by age 32 weeks was associated with receipt of two rotavirus vaccine doses (OR: 5.0; 95% CI 2.1–12.3). Timely coverage with the first pentavalent vaccine dose was 88.2% in the 2007 cohort and 91.1% in the 2008 cohort (p = 0.04). Children born in 2009, when a four-month national rotavirus vaccine stock-out occurred, had an older median age of receipt of rotavirus vaccine and were less likely to receive rotavirus on the same date as the same dose of pentavalent vaccine than children born in 2007 and 2008. Upper age limit recommendations for rotavirus vaccine administration contributed to suboptimal vaccination coverage. Survey data suggest that late rotavirus vaccination and co-administration with later doses of pentavalent vaccine among children born in 2009 helped increase rotavirus vaccine coverage following shortages.