湖南省家庭暴力的流行病学调查总体报告

目的 了解湖南省家庭暴力的现状。方法 采用多级分层抽样方法，在湖南省境内的城市、农村和工业区各抽取一个样本，共计9451户家庭，32720人。以多种形式的线索调查与深入细致的入户调查相结合的方式进行家庭暴力现况调查。结果 （1）家庭暴力的发生率为16．2％，当年内的发生率为11．6％，城市、农村及工业三地区的发生率和年内发生率的差异均具有统计学意义（19〈0．01）；（2）夫妻暴力的发生率为10．2％、虐待儿童为7．8％、虐待老人为1．5％；（3）重组家庭的家庭暴力发生率最高（21．0％），夫妻独子家庭和多代大家庭次之（分别为20．1％和20.0％）；（4）夫妻暴力以重组家庭最多见（14．7％），虐待儿童与虐待老人则以多代大家庭居多（分别为12．4％和4．1％）。结论 湖南省家庭暴力的发生率以夫妻暴力多见，不同地区、不同的家庭结构其暴力发生率和暴力对象均有所不同。     

温州地区已婚妇女家庭暴力的现状及影响因素

目的  调查温州地区已婚妇女遭受家庭暴力行为的发生情况,并探讨其影响因素。 方法  2018年采用多阶段分层抽样方法抽取705名温州地区已婚妇女作为调查对象,通过自填式问卷调查收集其基本信息、近12个月内家庭暴力行为发生情况及相关因素。 结果  约40%的已婚妇女在过去的12个月遭受了至少一次暴力行为,其中心理暴力的年发生率约为33.8%,其次是身体暴力19.1%和性暴力14.9%;在遭受家庭暴力的已婚妇女中,超过半数经历了多重暴力。Logistic回归分析模型分析结果显示,来至农村、结婚时间10年以下和两地分居的已婚妇女遭受家庭暴力的风险性更高,而配偶文化水平高、初婚、婚姻满意度高、婚姻自主、夫妻角色相辅相成的已婚妇女能较好地避免家庭暴力。 结论  已婚妇女遭受暴力发生率较为普遍,应引起重视,采取针对性的综合措施防范妇女家庭暴力的发生。     

Domestic violence against women seeking induced abortion in China

A cross-sectional study was conducted to investigate the prevalence, type and severity of domestic violence (DV), and determine the factors related to DV among women seeking induced abortion in China. A total of 1215 women seeking induced abortion were interviewed. The results show that the prevalence of DV among participants was 22.6%. The violence included 18.1% sexual abuse, 7.8% physical abuse and 3.0% emotional abuse. Among abused women, 46 (16.8%) experienced violence frequently; 4.4% experienced three types of violence (sexual, physical and emotional violence). The number of times of having induced abortion in the abused group was significantly higher than that in the nonabused group (p<.001). There is statistically significant association between the occurrence of DV and relevant factors including fear of partner, quarreling with partner, partner's economic control, receiving the cold shoulder from partner (p<.001, OR 1.8-2.5).     

上海市7所接产医院孕产保健人员应对家庭暴力的现况调查

目的:了解上海市7所接产医院孕产保健人员对家庭暴力的认知、应对态度以及实际处理家庭暴力的状况和遇到的障碍。方法:对上海市7所接产医院的所有332名孕产保健人员进行问卷调查,调查工具为根据查阅文献的自编问卷。结果:实际共调查273例孕产保健人员(应答率为82.2%)。孕产保健人员对家庭暴力知识的得分中位数为18分(满分为48分),态度得分中位数为13分(满分为24分)。知识总分与态度总分呈正相关。12.8%的孕产保健人员曾怀疑过病人是家庭暴力受害者,34.4%偶尔向病人询问家庭暴力问题。"曾怀疑过病人是家庭暴力受害者"和"向病人询问过家庭暴力问题"的孕产保健人员态度总分更高。孕产保健人员认为"我国没有明确的法律指导医务人员干预家庭暴力","缺乏处理家庭暴力的相关知识和技能","对此问题感到不舒服,害怕冒犯病人"是他们不询问家庭暴力问题的主要原因。结论:孕产保健人员关于家庭暴力的认知不够,应对态度不积极,在实际处理中存在很多障碍。应通过制定相关法律,加强社会支持系统,增加对孕产保健人员的相关教育,来使孕产保健人员自觉参与到防止家庭暴力中。     

中国农村地区已婚妇女家庭暴力发生情况及其相关知识调查

目的 了解中国农村地区已婚妇女家庭暴力发生情况及相关知识。方法 2004年11月至2005年1月，在吉林、安徽省和重庆市的人口基金项目县，采用多阶段容量比例抽样方法随机抽取25个乡镇，对3998名18岁及以上的已婚妇女进行问卷调查。结果 调查地区家庭暴力发生非常普遍，一生中总暴力、心理暴力、躯体暴力和性暴力的发生比例分别为64．8％、58．1％、29．7％和16．7％；调查前12个月中总暴力、心理暴力、躯体暴力和性暴力的发生比例分别为42．6％、37．2％、14．0％和7．7％。不同种类家庭暴力常常同时存在，将近1／3的妇女同时遭受2种或3种家庭暴力的伤害。调查妇女对家庭暴力的认识较差，75．2％的调查妇女对家庭暴力不了解，很多遭受过家庭暴力伤害的妇女对家庭暴力也一无所知，尤其是对心理暴力的知晓情况更差。结论 中国农村地区家庭暴力发生非常普遍，尤其是心理暴力，但已婚妇女对家庭暴力的了解还比较欠缺，需要引起有关部门的重视。     

武汉市社区妇女家庭暴力与创伤后应激障碍的相关性研究

目的 了解武汉市社区妇女家庭暴力的流行特征,分析家庭暴力与创伤后应激障碍（PTSD）的关系,为提高女性心理健康水平提供依据。方法 采用横断面研究方法,以在武汉市某社区卫生服务中心进行妇科检查的女性作为研究对象,调查其一般特征、社会支持、伤害情况、家庭暴力及PTSD流行情况。采用 χ²检验、t检验、Cochran-Armitage趋势检验分析PTSD组与健康组间差异,logistic回归分析PTSD与家庭暴力的关系。结果 家庭暴力终身发生率为29.36%,心理暴力、身体暴力和性暴力的发生率分别为28.28%、6.60%和3.55%;PTSD的总患病率为4.73%。遭受家庭暴力的女性患PTSD的风险是未遭受暴力女性的2.11倍（OR=2.11,95%CI：1.04～4.29）;同时遭受身体与心理暴力的女性发生PTSD的风险是未受暴力女性的5.06倍（OR=5.06,95%CI：1.91～13.42）。结论 家庭暴力与PTSD存在较强的相关性,对遭受家庭暴力的妇女应进行心理疏导,降低PTSD的发生风险。     

童年期目睹家庭暴力与大学生自伤和暴力行为的关联

目的了解大学生童年期目睹家庭暴力的发生状况及其与大学生自伤和暴力行为的关系,为儿童青少年身心健康相关研究提供参考。方法于2018年10月采用自编"安徽省大学生健康相关行为问卷"对合肥市4所高校4 034名大学生进行调查,多因素Logistic回归分析用于探讨童年期目睹不同类型家庭暴力对大学生自伤和暴力行为的影响。结果大学生童年期目睹家庭情感暴力、轻度躯体暴力、重度躯体暴力的报告率分别为27. 6%,22. 4%,10. 7%。单因素分析显示,童年期有目睹家庭轻度躯体暴力、重度躯体暴力和情感暴力大学生自伤行为、躯体暴力、情感暴力和性暴力的报告率均高于童年期无目睹家庭暴力的大学生,差异均有统计学意义(P值均<0. 05)。多因素Logistic回归分析(控制混杂因素)显示,童年期目睹父母间重度躯体暴力和情感暴力是大学生自伤行为(OR=1. 53,95%CI=1. 05~2. 23;OR=2. 15,95%CI=1. 51~3. 04)和情感暴力(OR=1. 65,95%CI=1. 16~2. 35;OR=2. 57,95%CI=1. 87~3. 53)的影响因素;童年期目睹父母重度躯体暴力是大学生躯体暴力(OR=4. 99,95%CI=2. 58~9. 62)和性暴力行为(OR=8. 68,95%CI=3. 30~22. 81)的影响因素(P值均<0. 05)。结论童年期目睹父母间家庭暴力会增加大学生自伤和暴力行为的发生风险,尤其是父母间重度躯体暴力。     

广西家庭暴力干预政策制定与执行过程分析

目的：分析广西家庭暴力干预政策制定和执行过程中,以妇联为代表的社会组织的参与方式、过程以及存在的问题。方法：采用目的抽样法选择被访者,即政策过程的关键知情者,进行个人深入访谈。结果：针对妇女的家庭暴力是一个严重的社会问题,为遏制其蔓延,国家和广西地方政府都出台了相应的政策法规,并开展了一系列相应的社会行动。在家庭暴力干预政策制定和执行过程中,以妇联为代表的社会组织发挥了不可替代的作用。但是,目前在政策执行过程中仍存在政府主导不力和社会组织参与不足的问题。结论：家庭暴力干预政策的完善和执行力的提高应主要在四个方面有所改进,包括完善政策制定与执行、增强多部门的协作、进一步发挥妇联的作用以及调动全社会的广泛参与。     

家庭暴力对流动人口已婚育龄妇女健康的影响

目的 了解家庭暴力对流动人口已婚育龄妇女心理健康及一般健康状况的影响。方法 2010年4－5月在上海市某中心城区采用以社区为基础的多阶段整群抽样方法,对符合条件的流动人口已婚育龄妇女进行问卷调查,共收回有效问卷958份。采用χ2检验、 Fisher精确检验和多因素非条件logistic回归统计学分析。结果 调查对象中以往曾经遭受配偶实施家庭暴力的比例为40.0%。在评价一般健康状况不良结局的5项指标和心理健康状况不良结局的6项指标中,以往和最近一年遭受身体/性暴力与 “经常感觉身上疼痛/不适” 和 “经常感觉睡眠差” 2项一般健康状况指标以及 “经常感到害怕/紧张/担忧”、“容易发怒”、“哭的次数比以前多”、“对生活感到厌倦” 4项心理健康状况指标有关; 以往遭受控制行为与 “经常感觉身上疼痛/不适” 1项一般健康状况指标及 “容易发怒”、“经常觉得自己毫无价值”、“对生活感到厌倦” 3项心理健康状况指标有关; 最近一年遭受精神暴力与 “经常感觉身上疼痛/不适” 有关。多元logistic回归分析发现,遭受过身体暴力/性暴力、 控制行为和精神暴力的调查对象出现上述不良健康结局的危险性,分别是未遭受过任何暴力调查对象的2.25～3.70倍、 1.94～4.75倍和2.12倍。结论 家庭暴力对流动人口已婚育龄妇女的一般健康和心理健康状况均有影响,特别是身体/性暴力和控制行为。     

Unexpected heaping in reported gestational age for women undergoing medical abortion

Background

In August 2006, the Planned Parenthood Federation of America (Planned Parenthood) conducted an extensive audit of first-trimester medical abortions with oral mifepristone plus buccal misoprostol through 56 days of gestation so that patients could be given accurate information about the success rate of the new regimen.

Objectives

We sought to evaluate the effectiveness of this buccal misoprostol regimen and to examine correlates of its success during routine service delivery.

Methods

Audits in 10 large urban service points were conducted in 2006 to estimate the success rates of the buccal regimen. Success was defined as medical abortion without vacuum aspiration.

Results

We discovered unexpected heaping of reported gestational age (GA) on days divisible by 7.

Conclusion

Such heaping, which has not been reported in the literature, would make it more difficult to detect a modest trend in declining effectiveness with increasing GA, if there were one. High coefficients of variation of sac size and crown-rump length characterize the early gestational weeks. We suspect, but are unable to prove, that the source of the heaping found in our investigation is a tendency for operators of ultrasound machines at some sites to simplify reporting by rounding a portion of the results to a date corresponding to the nearest complete gestational week. We believe that immediate supervisory awareness and feedback may reduce the extent of the problem. However, the problem may persist in multiple-site studies given the underlying variability of ultrasound measurements with differently calibrated machines and different rules for recording data, some of which may permit acceptance of an estimate based on the stated date of the last menses, if it differs by no more than 2 or 3 days from the ultrasound result.     

农村地区家庭暴力发生情况及影响因素分析

目的了解我国农村地区家庭暴力发生情况及其影响因素。方法2004年11月～2005年1月．在联合国人口基金生殖健康／计划生育第五周期3个项目县，采用多阶段容量比例抽样方法，随机抽取25个乡镇．3998名18岁及以上的已婚育龄妇女进行定量问卷调查。这3个项目县分别为吉林东辽县、安徽居巢区和重庆铜梁市。结果我国部分农村地区家庭暴力发生率为65．0％．精神暴力最为常见。其次是躯体暴力，性暴力发生率相对较低，分别为58．3％．29．8％，16．9％。生活中的暴力经历与家庭暴力的发生有非常显著的关联，妇女年幼时经历过或看到、听到过家庭暴力者，其遭受家庭暴力伤害的危险明显增高．但妇女的个人特征与家庭暴力发生之间没有明显关系。结论在我国家庭暴力普遍存在，尤其是精神暴力。生活中的暴力经历对家庭暴力发生有重要影响。应该加强宣传教育．提高对家庭暴力的普遍性的认识，以减少暴力发生。     

Impacts of domestic violence on child growth and nutrition: a conceptual review of the pathways of influence

Domestic violence against women is a global problem, and young children are disproportionate witnesses. Children's exposure to domestic violence (CEDV) predicts poorer health and development, but its effects on nutrition and growth are understudied. We propose a conceptual framework for the pathways by which domestic violence against mothers may impair child growth and nutrition, prenatally and during the first 36 months of life. We synthesize literatures from multiple disciplines and critically review the evidence for each pathway. Our review exposes gaps in knowledge and opportunities for research. The framework also identifies interim strategies to mitigate the effects of CEDV on child growth and nutrition. Given the global burden of child malnutrition and its long-term effects on human-capital formation, improving child growth and nutrition may be another reason to prevent domestic violence and its cascading after-effects.     

Incidence of violence against HIV-infected and uninfected women: Findings from the HIV epidemiology research (HER) study

The effect of human immunodeficiency virus (HIV) infection on the incidence of violence against women was addressed in a prospective cohort of HIV-infected and uninfected women. Participants were enrolled between 1993 and 1995 in four US cities and followed up semiannually through 1998. Among 1,087 women with a total accrual of 2,988 person-years (PY) of follow-up, there were 185 reports of abuse (incidence rate=6.19 per 100 PY). The rate of abuse among HIV-infected women with a CD4+count less than 350 cells/μL was lower than that among HIV-infected women with more CD4+ cells/μL or among uninfected women (4.87, 6.92, and 6.44 per 100 PY, respectively). In multivariate analysis, being separated or divorced, having a history of abuse in adulthood, using marijuana, using crack, and having multiple sex partners were each significantly associated with an elevated abuse rate; being older was inversely associated with abuse. Among HIV-infected women, those with fewer CD4+ cells/μL continued to show a decreased abuse rate (bazard ratio=0.55, 95% CI=0.36, 0.82) after adjustment for these factors. It is important to complement existing and future HIV prevention and intervention strategies with efforts to reduce violence against women.     

Understanding women's desires for contraceptive counseling at the time of first-trimester surgical abortion

Objective

The objective was to investigate whether or not women presenting for a first-trimester surgical abortion want to discuss contraception on the day of their procedure.

Study Design

Between October 2012 and January 2013, an anonymous self-administered survey was distributed to women receiving first-trimester surgical abortions at four northern California family planning clinics. The survey obtained demographic information about each woman and inquired about her desire for contraceptive counseling during her appointment. Results were analyzed using both univariate and multivariable regression analyses to assess trends in responses related to desire for contraceptive counseling based on demographic and other variables.

Results

Of the 199 respondents, 64% reported that they did not want to talk to a counselor or doctor about contraception on the day of their abortion. About half of the women (52%) who did not want to discuss contraception indicated they already knew what they wanted for pregnancy prevention. Of the 25% who reported that they did want to discuss contraception, the most important topic desired from the counseling was identification of methods that were easier to use than what they used previously.

Conclusion

The majority of women seeking first-trimester surgical abortion may not desire additional information about contraception on the day of the procedure.

Implications Statement

This study demonstrates that a significant proportion of women may not want contraceptive counseling on the day of a planned surgical abortion.     

Do changes in spousal employment status lead to domestic violence? Insights from a prospective study in Bangalore,India

The prevalence of physical domestic violence – violence against women perpetrated by husbands – is staggeringly high across the Indian subcontinent. Although gender-based power dynamics are thought to underlie women's vulnerability, relatively little is known about risk and protective factors. This prospective study in southern India examined the association between key economic aspects of gender-based power, namely spousal employment status, and physical domestic violence. In 2005–2006, 744 married women, aged 16–25, residing in low-income communities in Bangalore, India were enrolled in the study. Data were collected at enrollment, 12 and 24 months. Multivariable logistic regression models were used to examine the prospective association between women's employment status, their perceptions of their husband's employment stability, and domestic violence. Women who were unemployed at one visit and began employment by the next visit had an 80% higher odds of violence, as compared to women who maintained their unemployed status. Similarly, women whose husbands had stable employment at one visit and newly had difficulty with employment had 1.7 times the odds of violence, as compared to women whose husbands maintained their stable employment. To our knowledge, this study is the first from a developing country to confirm that changes in spousal employment status are associated with subsequent changes in violence risk. It points to the complex challenges of violence prevention, including the need for interventions among men and gender-transformative approaches to promote gender-equitable attitudes, practices and norms among men and women.     

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.     

Predictors of intimate partner violence in women seeking medication abortion

Background

High rates of intimate partner violence (IPV) have been reported among women seeking surgical abortion. Women seeking medication abortion differ from surgical abortion patients on many measures. The rate of IPV among medication abortion patients is unknown.

Study Design

The Modified Abuse Assessment Questionnaire was administered to 1128 women at enrollment into a prospective, multicenter medication abortion trial.

Results

Twenty-three percent of subjects reported ever experiencing IPV. Women reporting IPV were significantly more likely to be white and less likely to be married. They were more likely to have had previous spontaneous and induced abortions, and were more likely to incorrectly estimate their gestational age (GA).

Conclusion

The rate of IPV in this study was similar to the background US rate. Few demographic variables are predictive of IPV among women seeking medication abortion. Gynecologic variables associated with IPV are consistent with less control over reproductive health.