Physical and mental health effects of intimate partner violence for men and women

BACKGROUND: Few population-based studies have assessed the physical and mental health consequences of both psychological and physical intimate partner violence (IPV) among women or men victims. This study estimated IPV prevalence by type (physical, sexual, and psychological) and associated physical and mental health consequences among women and men. METHODS: The study analyzed data from the National Violence Against Women Survey (NVAWS) of women and men aged 18 to 65. This random-digit-dial telephone survey included questions about violent victimization and health status indicators. RESULTS: A total of 28.9% of 6790 women and 22.9% of 7122 men had experienced physical, sexual, or psychological IPV during their lifetime. Women were significantly more likely than men to experience physical or sexual IPV (relative risk [RR]=2.2, 95% confidence interval [CI]=2.1, 2.4) and abuse of power and control (RR=1.1, 95% CI=1.0, 1.2), but less likely than men to report verbal abuse alone (RR=0.8, 95% CI=0.7, 0.9). For both men and women, physical IPV victimization was associated with increased risk of current poor health; depressive symptoms; substance use; and developing a chronic disease, chronic mental illness, and injury. In general, abuse of power and control was more strongly associated with these health outcomes than was verbal abuse. When physical and psychological IPV scores were both included in logistic regression models, higher psychological IPV scores were more strongly associated with these health outcomes than were physical IPV scores. CONCLUSIONS: Both physical and psychological IPV are associated with significant physical and mental health consequences for both male and female victims.     

湖南省孕产妇亲密伴侣暴力发生及影响因素研究

目的 了解孕产妇在孕前和妊娠期亲密伴侣暴力(intimate partner violence,IPV)的发生情况,探索和识别影响亲密伴侣暴力发生的因素。 方法 通过湖南省某妇幼保健院产科门诊招募孕妇进行问卷调查,内容包括一般人口学特征,家庭条件,妊娠经历,社会支持和亲密伴侣暴力经历。 结果 本次回收有效问卷510份,共113例(22.2%)孕产妇有遭受亲密伴侣暴力的经历,其中68例(13.3%)是在孕前发生的亲密伴侣暴力,45例(8.8%)是在妊娠期发生亲密伴侣暴力;就暴力类型而言,精神暴力发生率最高,有97例(19.0%),其次为躯体暴力有21例(4.1%),性暴力最少,有6例(1.2%)。多因素logistic回归分析显示有不良妊娠史是孕前亲密伴侣暴力发生的危险因素(OR=2.941,95%CI:1.574~5.494),而社会支持中主观支持是妊娠期亲密伴侣暴力发生的保护因素(OR=0.803,95%CI:0.722~0.893)。 结论 孕产妇遭遇孕前和妊娠期亲密伴侣暴力将影响孕产妇及婴幼儿身心健康,在母婴保健工作中应增加对妇女精神暴力伤害及孕产妇亲密伴侣暴力发生的关注,并及早识别受害者的暴力经历,从而采取早期干预措施。     

Childhood family violence history and women's risk for intimate partner violence and poor health

BACKGROUND: There is growing evidence for associations between generations in family violence and between family violence in both childhood and adulthood and women's health. Most studies focus on a subset of family violence (child abuse, witnessing intimate partner violence [IPV] as a child, and/or adult IPV), and few examine possible differences associated with the nature of abusive experiences, such as physical versus sexual abuse. METHODS: A population-based telephone survey, the 1999 and 2001 Washington State Behavioral Risk Factor Surveillance System, asked a representative sample of 3527 English-speaking, non-institutionalized adult women whether they had been physically or sexually assaulted or witnessed interparental violence in childhood, and whether they had experienced physical assault or emotional abuse from an intimate partner in the past year. The survey also asked about current general health and mental distress in the past month. RESULTS: The risks associated with childhood family violence experiences varied depending on the nature of those experiences. Women reporting childhood physical abuse or witnessing interparental violence were at a four- to six-fold increase in risk of physical IPV, and women reporting any of the experiences measured were at three- to four-fold increase in risk of partner emotional abuse. In contrast, women reporting childhood sexual abuse only were not at increased risk of physical IPV. Women reporting childhood physical abuse were at increased risk of poor physical health, and women reporting any type of childhood family violence were at increased risk of frequent mental distress. Approximately one third of women reporting poor general health and half of women reporting frequent mental distress also reported at least one of the childhood experiences measured. CONCLUSIONS: These findings underscore the role of childhood experiences of abuse and of witnessing family violence in women's current risk for IPV, poor physical health, and frequent mental distress.     

Intimate partner violence and housing instability

BACKGROUND: The mental and physical health consequences of intimate partner violence (IPV) have been well established, yet little is known about the impact of violence on a woman's ability to obtain and maintain housing. This cross-sectional study examines the relationship between recent IPV and housing instability among a representative sample of California women. It is expected that women who have experienced IPV will be at increased risk for housing instability as evidenced by: (1) late rent or mortgage, (2) frequent moves because of difficulty obtaining affordable housing, and/or (3) without their own housing. METHODS: Data were taken from the 2003 California Women's Health Survey, a population-based, random-digit-dial, annual probability survey of adult California women (N=3619). Logistic regressions were used to predict housing instability in the past 12 months, adjusting for the following covariates; age, race/ethnicity, education, poverty status, marital status, children in the household, and past year IPV. RESULTS: In the multivariate model, age, race/ethnicity, marital status, poverty, and IPV were significant predictors of housing instability. After adjusting for all covariates, women who experienced IPV in the last year had almost four times the odds of reporting housing instability than women who did not experience IPV (adjusted odds ratio=3.98, 95% confidence interval: 2.94-5.39). CONCLUSIONS: This study found that IPV was associated with housing instability among California women. Future prospective studies are needed to learn more about the nature and direction of the relationship between IPV and housing instability and the possible associated negative health consequences.     

Health, Access to Health Care, and Health Care use Among Homeless Women with a History of Intimate Partner Violence

Among a sample of sheltered homeless women, we examined health, access to health care, and health care use overall and among the subgroup of participants with and without intimate partner violence (IPV). We recruited homeless women from a random sampling of shelters in New York City, and queried them on health, access to health care and health care use. Using multivariable logistic regression, we determined whether IPV was associated with past-year use of emergency, primary care and outpatient mental health services. Of the 329 participants, 31.6% reported one or more cardiovascular risk factors, 32.2% one or more sexually transmitted infections, and 32.2% any psychiatric condition. Three-fourths (73.5%) had health insurance. Health care use varied: 55.4% used emergency, 48.9% primary care, and 75.9% outpatient mental health services in the past year. Across all participants, 44.7% reported IPV. Participants with IPV compared to those without were more likely to report medical and psychiatric conditions, and be insured. Participants with IPV reported using emergency (64.4%) more than primary care (55.5%) services. History of IPV was independently associated with use of emergency (Adjusted odds ratio (AOR) 1.7, 95% CI 1.0-2.7), but not primary care (AOR 1.5, 95% CI 0.9-2.6) or outpatient mental health services (AOR 1.9, 95% CI 0.9-4.1). Across the whole sample and among the subgroup with IPV, participants used emergency more than primary care services despite being relatively highly insured. Identifying and eliminating non-financial barriers to primary care may increase reliance on primary care among this high-risk group.     

Intimate partner violence and women's physical, mental, and social functioning

OBJECTIVE: To describe the relationship between women's health and the timing, type, and duration of intimate partner violence (IPV) exposure. METHODS: A telephone interview was completed by 3429 women aged 18 to 64 randomly selected from a large health plan, to assess IPV exposure and heath status (response rate 56.4%). Questions from the Behavioral Risk Factor Surveillance System and the Women's Experience with Battering scale were used to construct IPV exposures: (1) recent (past 5 years) and remote (before past 5 years only) IPV exposure of any type (physical, sexual, or non-physical); (2) recent (past 5 years) IPV exposure to physical and/or sexual or non-physical only; and (3) IPV duration (0 to 2 years, 3 to 10 years, and >10 years). Health outcomes were measured using the Short Form-36 survey (SF-36), the Center for Epidemiologic Studies Depression scale, and the National Institute of Mental Health Presence of Symptoms survey. RESULTS: In adjusted models, compared to women with no IPV in their adult lifetime, more-pronounced adverse health effects were observed for women with recent (vs remote) IPV; for physical and/or sexual (vs non-physical) IPV; and for longer IPV exposure. Compared to women who never experienced IPV, women with any recent IPV (physical, sexual, or non-physical) had higher rates of severe (prevalence ratio [PR]=2.6; 95% confidence interval [CI]=1.9-3.6) and minor depressive symptoms (PR=2.3; 95% CI=1.9-2.8); higher number of physical symptoms (mean, 1.0; 95% CI=0.7-1.2); and lower SF-36 mental and social functioning scores (range, 4.3-5.5 points lower across subscales). Women with recent physical and/or sexual IPV were 2.8 times as likely to report fair/poor health, and had SF-36 scores that ranged from 5.3 to 7.8 points lower, increased risk of depressive symptoms (PR=2.6) and severe depressive symptoms (PR=4.0), and more than one additional symptom. Longer duration of IPV was associated with incrementally worse health. CONCLUSIONS: Women's health was adversely affected by the proximity, type, and duration of IPV exposure.     

Exploring risk factors for suicidal ideation in a population‐based sample of New Zealand women who have experienced intimate partner violence

Objective : To explore factors associated with suicidal thoughts among women who had experienced intimate partner violence (IPV), using data from the New Zealand replication of the WHO Multi‐country Violence Against Women study. Method : Face‐to‐face interviews were conducted. A population‐based cluster sampling scheme with a fixed number of dwellings per cluster was employed. Logistic regression was conducted to identify those variables independently associated with suicidal ideation. Results : Women who had experienced IPV were more likely to report they had thought about taking their own life if they: reported that their partner's behaviour had impacted on their mental health (OR = 4.81, 95% CI 3.30–7.01); were current or former users of recreational drugs (OR=1.94, 95% CI 1.43–2.64); had experienced a stillbirth/abortion/miscarriage (OR=1.93, 95% CI 1.44–2.58); and had experienced emotional abuse in the previous 12 months (OR=1.40, 95% CI 1.00–1.96). Conclusion and Implications : This study corroborates international findings that women's experience of IPV is associated with increased risk of suicidal thoughts. While the results point to the need for all health care providers to routinely enquire about intimate partner violence among their patients, they also argue for the need for health care providers to be aware of, and equipped to respond to, the mental health needs of their clients. The results also indicate that there is a need for mental health services to assess for, and respond to intimate partner violence among women presenting with suicidal ideation.     

Detecting intimate partner violence during pregnancy: awareness-raising indicators for use by primary healthcare professionals

BACKGROUND: Given the deleterious consequences of intimate partner violence (IPV) for gestation, it is important to promote a more effective and amicable approach that engenders greater receptiveness, stimulates more open communication and, ultimately, facilitates addressing the problem. In this regard, active primary care professionals need to be educated about the different profiles of violence found in domestic environments. The aim of this study is to make the identification of those subgroups of pregnant women most likely to be living in IPV situations both practical and simple. Its ultimate goal is to give healthcare professionals who work directly with the public the tools to anticipate such events. To this end, this study presents a profile of IPV during pregnancy according to different characteristics observed among primary health service users. METHODS: Five hundred and twenty-seven women who carried children to term in Rio de Janeiro were interviewed. A Portuguese version of the Revised Conflict Tactics Scale (CTS2) was used to detect IPV. Several sociodemographic factors, life habits and reproductive health characteristics of pregnant women and their partners were scrutinized. Prevalence projections by subgroup were obtained using a multinomial logit model. RESULTS: The projected prevalences for negotiation, psychological violence, minor physical violence and severe physical violence were, respectively, 0.1% [95% confidence interval (CI) 0.0-0.6], 2.6% (95%CI 0.7-6.9), 7.0% (95%CI 1.7-18.5) and 90.3% (95%CI 77.2-96.8) for the extreme scenario, i.e. women <20 years of age, non-White, living in house with inadequate garbage disposal, previous history of abortion, reporting fear of someone, reporting lack of affective social support, and reporting drug use by woman or spouse. In the absence of these characteristics, the projected prevalences were 51.3% (95%CI 38.5-64.6), 40.0% (95%CI 28.5-51.9), 7.6% (95%CI 4.2-12.7) and 1.1% (95%CI 0.3-2.4), respectively. CONCLUSION: This study found that knowledge of certain characteristics of pregnant women who attend health services can alert professionals to the high probability of IPV, facilitating early identification of the problem and subsequent implementation of proactive measures.     

The Impact of Intimate Partner Violence on the Mental Health of Pregnant Women Residing in Slum Areas: A Cross-Sectional Study

Background

Intimate partner violence is one of the most common types of violence, and the association between intimate partner violence and mental health has serious implications for public health. This article aimed at investigating the impact of IPV on the mental health of pregnant women who reside in slum areas.

Methods

A group of 456 women living in slum areas was investigated. The Conflict Tactics Scale was used to measure the respondent’s experience of different types of IPV during the past year. General Health Questionnaire-28 was used to measure the likelihood that an individual had a psychiatric disorder.

Results

A total of 456 pregnant women aged ≥ 20 years were interviewed using a shortened version of the Conflict Tactics Scale and the General Health Questionnaire. All types of intimate partner violence were found to be associated with various mental health problems (p < 0.05). Overall, physical (AOR: 3.61; 95% CI 2.11–6.17) and sexual (AOR: 1.72; 95% CI 1.01–2.94) violence increased the odds of probable psychiatric disorders in victims compared with their counterparts who had not experienced such types of violence.

Conclusions

Further research is needed on the relationship between intimate partner violence and other mental health problems, protocols to screen for intimate partner violence in healthcare settings, and supportive services.

     

Physical partner violence and medicaid utilization and expenditures

OBJECTIVES: Little research has addressed differences in health care expenditures among women who are currently experiencing intimate partner violence (IPV) compared with those who are not. The purpose of this work is to provide estimates of direct medical expenditure for physician, drug, and hospital utilization among Medicaid-eligible women who screened as currently experiencing IPV compared with those who are not currently experiencing IPV. METHODS: In this family practice-based cross-sectional study, women were screened for current IPV using a 15-item Index of Spouse Abuse-Physical (ISA-P) between 1997 and 1998. Consents were obtained from study subjects to review Medicaid expenditure and utilization data for the same time period. RESULTS: Mean physician, hospital, and total expenditures were higher for those women with higher IPV scores compared with those who scored as not currently experiencing IPV, after adjusting for confounders. Higher IPV scores were associated with a three-fold increased risk of having a total expenditure over $5,000 (95% confidence interval [CI] 1.3, 8.4). The mean total expenditure difference between the high IPV and no IPV groups was $1,064 (95% CI $623, $1506). The adjusted risk ratio for high IPV score and the log of total Medicaid expenditures was 2.3 (95% CI 1.2, 4.4). CONCLUSIONS: Women screened as experiencing higher IPV scores had higher Medicaid expenditures compared with women not currently experiencing IPV. Early IPV assessment partnered with effective clinic or community-based interventions may help to identify IPV earlier and reduce the health impact and cost of IPV.     

Police-Reported Intimate Partner Violence During Pregnancy and the Risk of Antenatal Hospitalization

OBJECTIVES: Intimate partner violence (IPV) is a significant public health problem and the abuse of women during pregnancy is of particular concern. Few studies have addressed the relationship between IPV and antenatal hospitalization. This study utilized a novel approach to examine the impact of IPV during pregnancy on antenatal hospitalization not associated with delivery. METHODS: This retrospective cohort study included Seattle women residents 16-49 years of age. Exposed subjects were women with a police-reported IPV incident during pregnancy in the years 1995 through 1998 and who subsequently had a singleton live birth or fetal death. The unexposed group was composed of randomly selected residents with a singleton birth or fetal death and without a police-reported IPV incident during the study period. Linked hospital discharge files and birth records were utilized to determine study outcomes. Logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI). RESULTS: Women reporting any IPV during pregnancy were twice as likely as unexposed women to experience an antenatal hospitalization not associated with delivery (aAOR 2.39, CI 1.77, 3.24). Women with IPV were more likely to have been hospitalized with a substance abuse-related diagnosis (aOR 2.70, CI 1.52, 4.78) or a mental health-related diagnosis (aOR 1.93, CI 0.96, 3.91). Physical IPV was more strongly associated with antenatal hospitalization than nonphysical IPV or IPV overall. CONCLUSION: This study suggests that women hospitalized during pregnancy, particularly those with substance abuse and mental health-related conditions, may be at high risk for concurrent IPV.     

Mortality due to intimate partner violence in foreign women living in Spain (1999-2006)

OBJECTIVES: To describe the distribution of mortality due to intimate partner violence (IPV) in foreign women living in Spain and to explore the potentially greater risk of dying from IPV in this group. METHODS: We performed a retrospective ecological study of deaths from IPV registered by the Women's Institute of Spain (1999-2006). Mortality rates and Poisson models for relative risk and 95% confidence intervals were calculated. RESULTS: The average risk of dying from IPV in foreign women was 5.3 times greater than that in Spanish women. In the years studied, the increased risk in foreign women was 2 to 8 times greater than that in Spanish women. CONCLUSION: Foreign women living in Spain are especially vulnerable to death from IPV. Further research on the causes of this phenomena and strategies involving health services are needed.     

Work-related violence and incident use of psychotropics

Although the mental health consequences of domestic violence are well documented, empirical evidence is scarce regarding the mental health effects of violence in the workplace. Most studies have used data from small occupation-specific samples, limiting their generalizability. This article examines whether direct exposure to work-related violence is associated with clinically pertinent mental health problems, measured by purchases of psychotropics (antidepressants, anxiolytics, hypnotics), in a cross-occupational sample of 15,246 Danish employees free from using psychotropics at baseline. Self-reported data on work-related violence were merged with other data on purchases of medications through a national registry to estimate cause-specific hazard ratios during 3.6 years (1,325 days) of follow-up in the years 1996-2008. Outcomes were examined as competing risks, and analyses were adjusted for gender, age, cohabitation, education, income, social support from colleagues, social support from supervisor, and influence and quantitative demands at work. Work-related violence was associated with purchasing antidepressants alone (hazard ratio = 1.38, 95% confidence interval: 1.09, 1.75) or in combination with anxiolytics (hazard ratio = 1.74, 95% confidence interval: 1.13, 2.70) but not with purchasing anxiolytics or hypnotics only. The frequency of violent episodes and risk of caseness were unrelated. Work-related violence is associated with increased risk of clinically pertinent mental health problems. Reducing levels of work-related violence may help to prevent mental disorders in the working population.     

Intimate partner violence and cervical neoplasia

Intimate partner violence (IPV) is associated with a range of adverse physical health outcomes, including chronic and infectious diseases. An emerging literature suggests that partner violence and specifically sexual violence may be associated with an increased risk of cervical neoplasia. To assess the risk of preinvasive and invasive cervical cancer in a cross-sectional study of women screened for IPV by type, frequency and duration, 1152 women ages 18-65 were recruited from family practice clinics in 1997-1998. They were screened for IPV during a brief in-clinic interview, and health history and current status were assessed in a follow-up interview. Of 1152 women surveyed, 14 (1.2%) reported cervical cancer, and 20. 3% (n = 234) reported treatment for cervical neoplasia. Ever experiencing IPV was associated with an increased risk of invasive cervical cancer (adjusted relative risk [aRR] = 4.28; 95% CI 1.94, 18.39) and with preinvasive cervical neoplasia (aRR = 1.47; 95% CI 1. 16, 1.82). This association was stronger for women experiencing physical or sexual IPV than for women experiencing psychological IPV. Women with cervical cancer reported being in violent relationships longer and experiencing more frequent physical and sexual assaults and more IPV-associated injuries than did controls. This exploratory study suggests that IPV may increase a woman's risk of cervical neoplasia. The mechanism by which IPV effects cervical neoplasia may be indirect through psychosocial stress or negative coping behaviors or direct through sexual assaults and transmission of human papillomavirus (HPV).     

Physical health consequences of physical and psychological intimate partner violence

BACKGROUND: Past studies that have addressed the health effects of intimate partner violence (IPV) have defined IPV as violence based on physical blows that frequently cause injuries. To our knowledge, no epidemiologic research has assessed the physical health consequences of psychological forms of IPV. OBJECTIVE: To estimate IPV prevalence by type and associated physical health consequences among women seeking primary health care. DESIGN: Cross-sectional survey. SETTING AND PARTICIPANTS: A total of 1152 women, aged 18 to 65 years, recruited from family practice clinics from February 1997 through January 1999 and screened for IPV during a brief in-clinic interview; health history and current status were assessed in a follow-up interview. RESULTS: Of 1152 women surveyed, 53.6% ever experienced any type of partner violence; 13.6% experienced psychological IPV without physical IPV. Women experiencing psychological IPV were significantly more likely to report poor physical and mental health (adjusted relative risk [RR], 1.69 for physical health and 1.74 for mental health). Psychological IPV was associated with a number of adverse health outcomes, including a disability preventing work (adjusted RR, 1.49), arthritis (adjusted RR, 1.67), chronic pain (adjusted RR, 1.91), migraine (adjusted RR, 1.54) and other frequent headaches (adjusted RR, 1.41), stammering (adjusted RR, 2.31), sexually transmitted infections (adjusted RR, 1.82), chronic pelvic pain (adjusted RR, 1.62), stomach ulcers (adjusted RR, 1.72), spastic colon (adjusted RR, 3.62), and frequent indigestion, diarrhea, or constipation (adjusted RR, 1.30). Psychological IPV was as strongly associated with the majority of adverse health outcomes as was physical IPV. CONCLUSIONS: Psychological IPV has significant physical health consequences. To reduce the range of health consequences associated with IPV, clinicians should screen for psychological forms of IPV as well as physical and sexual IPV.     

Actions Taken by Women in Response to Intimate Partner Violence and Intimate Partner Violence Status at 1-Year Follow-Up

BackgroundIntimate partner violence (IPV) is a pervasive public health issue with significant physical and mental health sequelae. A longer duration and greater severity of abuse are associated with adverse health outcomes and increased risk of revictimization. Current research has identified a variety of strategies used by women in response to abuse, but has not established whether the use of these strategies is associated with decreased IPV over time. For this study, we analyzed the associations between the use of specific actions in response to abuse—placating, resistance, informal or formal network help-seeking, safety planning, and substance use—and IPV victimization at the 1-year follow-up.MethodsNinety-five women with past-year IPV at baseline participated in a 1-year follow-up survey measuring their use of specific actions in response to IPV and subsequent IPV status. IPV victimization at the 1-year follow-up was analyzed as a function of types of actions taken and sociodemographic variables.ResultsAmong women with past-year IPV at baseline (N = 95), 53% reported no further IPV victimization at the 1-year follow-up. In bivariate analysis, social support was associated with decreased risk of IPV victimization (odds ratio, 0.43; 95% confidence interval [CI], 0.18–0.99). In multivariable analyses, high use of placating (adjusted odds ratio, 9.40; 95% CI, 2.53–34.9), formal network help-seeking (adjusted odds ratio, 7.26; 95% CI, 1.97–26.74), and safety planning (adjusted odds ratio, 2.98; 95% CI, 1.02–8.69) strategies were associated with an increased risk of IPV victimization at the 1-year follow-up.ConclusionsOur data demonstrate that IPV exposure can change over time and that the use of specific actions in response to IPV can be indicators of risk of subsequent victimization. Abuse severity is an important potential confounder of action efficacy.     

Intimate Partner Violence Associated With Poor Health Outcomes in U.S. South Asian Women

To assess the associations between Intimate Partner Violence (IPV) victimization and health outcomes of South Asian women in Greater Boston. To explore the nature of the health experiences of victimized women in this population. Cross-sectional surveys with a community-based sample of women in relationships with males (n = 208) assessed demographics, IPV history, and health. In-depth interviews were conducted with a separate sample of women with a history of IPV (n = 23). Quantitative data were assessed by logistic regression, qualitative data by a grounded theory approach. Twenty-one percent of the quantitative sample reported IPV in the current relationship. Abused women were significantly more likely than those with no history of IPV in their current relationship to report poor physical health (95% CI = 1.3–12.0), depression (95% CI = 1.8–9.3), anxiety (95% CI = 1.3–6.4), and suicidal ideation (95% CI = 1.9–25.1). Qualitative subjects described how victimization resulted in injury and chronic health concerns and how IPV-induced depression and anxiety affected their sleep, appetite, energy, and wellbeing. Experiences of IPV are related to increased poor health among South Asian women. This elevated risk demands intervention. Healthcare providers should be trained to screen and refer South Asian patients for partner violence. This work was presented as a poster at the Third International Conference on Urban Health, Boston, MA, October 2004. It was awarded Honorable Mention in the Student Abstract Contest (Masters Level). Conflict of Interest: Anita Raj is a volunteer with and advisor to Saheli, the local South Asian CBO of volunteers providing cultural programs in the South Asian community and helping women in crisis. She has provided domestic violence advocacy and community education in the local South Asian community, and she has served as a South Asian Advisor to Asian Task Force Against Domestic Violence (ATFADV), the local Asian domestic violence program in Boston. Both Saheli and ATFADV assisted with recruitment for the current study. Saheli events that were not domestic violence-specific served as venues for recruitment for the cross-sectional study. Saheli and ATFADV cases of domestic violence were referred to the qualitative study.     

Risk factors for intimate partner violence initiation and persistence among high psychosocial risk Asian and Pacific Islander women in intact relationships

PurposeThe present study identifies risk factors for intimate partner violence (IPV) initiation and persistence over three years in a high psychosocial risk Asian American and Pacific Islander (AAPI) sample of women with children living in Hawaii.MethodsWe included 378 women in a 3-year relationship with the same partner who reported IPV experiences at baseline and 3 years later. Baseline risk factors included characteristics of each woman, her partner, and their relationship. Bivariate and multivariate regression models were conducted to assess the influence of risk factors on the likelihood of experiencing IPV initiation and persistence.FindingsOf women who experienced no physical violence at baseline, 43% reported IPV initiation. Of women who did experience physical violence at baseline, 57% reported IPV persistence. Being unemployed and reporting poor mental health at baseline are important risk factors for experiencing IPV initiation. Reporting frequent physical violence at baseline increases the likelihood of experiencing IPV persistence. Asian women were significantly less likely to report IPV persistence than other groups of women.ConclusionsOur study indicates that among a high psychosocial risk sample of AAPI women there are different risk factors for IPV initiation and persistence. Future prevention and screening efforts may need to focus on these risk factors.     

Assessing cardiovascular risk in regional areas: the healthy hearts -- beyond city limits program

ABSTRACT: BACKGROUND: Cardiovascular disease (CVD) is more prevalent in regional and remote Australia compared to metropolitan areas. The aim of Healthy Hearts was to determine age and sex specific CVD risk factor levels and the potential value of national risk clinics. METHODS: Healthy Hearts was an observational research study conducted in four purposefully selected higher risk communities in regional Victoria. The main outcome measures were the proportion of participants with CVD risk factors with group comparisons to determine the adjusted likelihood of elevated risk factor levels. Trained personnel used a standardized protocol over four weeks per community to measure CVD risk factor levels, estimate absolute CVD risk and provide feedback and advice. RESULTS: A total of 2125 self-selected participants were assessed (mean age 58 +/- 15 years, 57 % women). Overall, CVD risk factors were highly prevalent. More men than women had >= 2 modifiable CVD risk factors (76 % vs. 68 %, p < .001), pre-existing CVD (20 vs. 15 %, p < .01) and a major ECG abnormality requiring follow-up (OR 2.35, 95 % CI 1.75 to 3.16). A higher proportion of women were obese (adjusted OR 1.39, 95 % CI 1.16 to 1.65), physically inactive (adjusted OR 1.47, 95 % CI 1.20 to 1.80) and reported depressive symptoms compared to men (28 % vs. 22 %, p < .01). CONCLUSIONS: High CVD risk factor levels were confirmed for regional Victoria. Close engagement with individuals and communities provides scope for the application of regional risk management clinics to reduce the burden of CVD risk in regional Australia.