Help-seeking rates for intimate partner violence (IPV) among Canadian immigrant women

We examined rates of help seeking for intimate partner violence (IPV) among recent (0-9 years in Canada) and non-recent (10+ years in Canada) immigrant women. Data from a national, cross-sectional, telephone survey were used. Help-seeking variables included disclosure of IPV, reporting IPV to police, use of social services subsequent to IPV, and barriers to social service use. Recent immigrant women, compared with non-recent immigrant women, were significantly more likely to report IPV to police and less likely to use social services. Findings have important implications for prevention and detection of IPV in immigrant communities and in future research.     

The association between length of stay in Canada and intimate partner violence among immigrant women

OBJECTIVE: We examined the prevalence of intimate partner violence (IPV) among recent (0-9 years) and nonrecent (>/= 10 years) immigrant women in Canada to determine whether differences in IPV were associated with length of stay in Canada. METHODS: We analyzed data from the 1999 General Social Survey, a national cross-sectional telephone survey. We used weighted logistic regression analysis to examine the effect of length of stay in Canada on IPV and controlled for socio-cultural and other factors associated with IPV. RESULTS: The crude prevalence of IPV was similar among recent and nonrecent immigrant women. However, after adjustment, the risk for IPV was significantly lower among recent immigrant women compared with nonrecent immigrant women. Country of origin, age, marital status, and having an activity limitation (physical/mental disability or health problem) also were associated with a higher risk for IPV. CONCLUSIONS: Our findings have important implications for both prevention and detection of IPV among immigrant women.     

Factors associated with intimate partner violence by a former partner by immigration status and length of residence in Canada

PurposeWe examined intimate partner violence (IPV) by a former partner among Canadian-born and immigrant women by length of residence in Canada.MethodsData from a 2009 national, population-based, telephone survey were used to determine the prevalence of and factors associated with any type of IPV (emotional, financial, physical, and/or sexual) by a former partner with whom there had been contact in the previous 5 years among immigrant women 0 to 19 years in Canada, 20 or more years or longer in Canada, and Canadian-born women (n = 1681).ResultsOf immigrant women in Canada for 0 to 19 years, 41.6% had experienced IPV by a former partner; for immigrant women in Canada for 20 or more years or longer, 60.6%, and Canadian-born women, 61.5% (P = .0423). In a logistic regression model adjusted for age and other sociodemographic characteristics, immigrant women in Canada for 0 to 19 years were less likely than Canadian-born women to experience any IPV (odds ratio, 0.266; 95% confidence interval, 0.130–0.544). There was no difference in the occurrence of any IPV between immigrant women in Canada 20 or more years or longer and Canadian-born women.ConclusionsHigh rates of any IPV by a former partner were found for both Canadian-born and immigrant women. Within immigrant communities, specific prevention campaigns should address the high risk of experiencing IPV at later stages of resettlement.     

Discursos profesionales sobre la violencia del compañero íntimo: implicación en la atención de las mujeres inmigrantes en España

Objective1) to examine the discourses of professionals involved in the care of female victims of intimate partner violence (IPV), with emphasis on how they describe the immigrant women, the perpetrators and their own responsibility of care; and 2) to compare these discourses with the other professions involved in caring for these women (social services, associations and police and justice).MethodsQualitative study based on semi-structured interviews with 43 professionals from social services, associations and the police and judicial systems. A discourse analysis was carried out to identify interpretive repertoires about IPV, immigrant women and their aggressors, their culture and professional practices.ResultsFour interpretive repertoires emerged from professional discourses: “Cultural prototypes of women affected by IPV”, “Perpetrators are similar regardless of their culture of origin”, “Are victims credible and the perpetrators responsible?” and “Lack of cultural sensitivity of professionals in helping immigrant women in abusive situations”. These repertoires correspond to preconceptions that professionals construct about affected women and their perpetrators, the credibility and responsibility they attribute to them and the interpretation of their professional roles.ConclusionsThe employment of IPV-trained cultural mediators in the services responsible for caring for the female victims, together with cultural training for the professionals, will facilitate the provision of culturally sensitive care to immigrant female victims of intimate partner violence.     

The role of intimate partner violence, race, and ethnicity in help-seeking behaviors

Objective . Women experiencing intimate partner violence (IPV) have multiple health and social service needs but many, especially Hispanic, women may not access these resources. This research sought to examine the relationship between IPV and health and social services utilization (help-seeking behaviors), with a focus on racial and ethnic disparities.

Design . Case-control study from an urban US emergency department population in which cases (women with IPV) and controls (women without IPV) were frequency matched by age group and race/ethnicity. Logistic regression analyses were performed to examine the relationship between IPV and help-seeking behaviors and between help-seeking behaviors and race/ethnicity among abused women. In addition, a stratified analysis was conducted to examine the relationship between acculturation and help-seeking behaviors among Hispanic women.

Results . The sample included 182 cases and 147 controls. Among the health services, alcohol program, emergency department, and hospital utilization were significantly increased among IPV victims compared to non-victims after taking demographic and substance use factors into account. Similarly, IPV victims were more likely to access social/case worker services and housing assistance compared to non-victims. Specific help-seeking behaviors were significantly associated with race and ethnicity among IPV victims, with non-Hispanic white and black women more likely to use housing assistance and emergency department services and black women more likely to use police assistance compared to Hispanic women. Among all Hispanic women, low acculturation was associated with decreased utilization of social services overall and with any healthcare utilization, particularly among abused women.

Conclusions . Social service and healthcare workers should be alerted to and screen for IPV among all clients. The need for increased outreach and accessibility of services for abused women in Hispanic communities in the USA should be addressed, with cultural and language relevance a key component of these efforts.     

Associations of intimate partner violence with unintended pregnancy and pre-pregnancy contraceptive use in South Asia

ObjectiveTo assess associations of intimate partner violence (IPV) with pregnancy intendedness and pre-pregnancy contraceptive use among pregnant women in South Asia.Study designCross-sectional analyses were conducted using the most recent Demographic and Health Surveys from Bangladesh, India and Nepal for married, pregnant women aged 15–49 years who responded to IPV assessments specific to current marriage (N= 4738). Adjusted logistic and multinomial regression analyses were conducted with pooled data to assess associations of IPV ever (sexual only, physical only, sexual plus physical or none) with the outcomes of pregnancy intendedness (wanted, mistimed or unwanted) and pre-pregnancy contraceptive use (no, traditional or modern) for the current pregnancy.ResultsIPV was not associated with a mistimed or unwanted pregnancy. Sexual IPV was associated with pre-pregnancy modern contraceptive use (aOR=2.32, 95% CI=1.24, 4.36); sexual plus physical IPV was associated with pre-pregnancy traditional contraceptive use (aOR=1.85, 95% CI=1.12, 3.07). Post hoc analysis of reasons for pre-pregnancy contraceptive discontinuation revealed that women with a history of IPV, particularly sexual IPV, had higher prevalence of contraceptive failure (sexual only, 37.3%; sexual plus physical, 30.9%; physical only, 22.6%; no IPV, 13.6%).ConclusionPregnant women who experienced sexual IPV from husbands were more likely to use contraceptives pre-pregnancy but had no reduced risk unintended pregnancy, possibly due to higher rates of pre-pregnancy contraceptive failure among those with this history. These findings suggest that victims of sexual IPV are able to acquire and use family planning services but require more support to sustain effective contraceptive use.ImplicationsFamily planning services are reaching women affected by sexual IPV, and programs should be sensitive to this concern and the heightened vulnerability to contraceptive failure these women face. Long-acting reversible contraception could be beneficial by allowing women to have greater reproductive control in situations of compromised sexual autonomy.     

Tobacco use among immigrant and nonimmigrant adolescents: individual and family level influences

PurposeTo identify individual and family level characteristics that might explain differences in rates of tobacco use among immigrant and nonimmigrant adolescents.MethodsData for analysis come from a probability sample of 5401 adolescents aged 12–18 years participating in the Ontario Health Survey (OHS). Three groups were compared: (a) adolescents born in Canada to Canadian-born parents (n = 3886), (b) adolescents born in Canada to immigrant parents (n = 1233), and (c) adolescents born outside of Canada (n = 282). Discrete, multilevel logistic regression was used in the analysis.ResultsAdolescents born outside of Canada report the lowest rates of tobacco use, despite greater economic hardship. A negative association emerges between family socioeconomic status and tobacco use among adolescents born in Canada but not among adolescents born outside of Canada. Immigrant youth are less likely to affiliate with peers who smoke and are more likely to come from families where parents do not smoke: these differences partially explain the decreased rates of tobacco use among immigrant adolescents.ConclusionsAlthough subject to greater economic hardship, immigrant youth are less likely to engage in tobacco use. Protective factors associated with immigrant family life, such as lower rates of parental tobacco use and less exposure among immigrant adolescents to peers who smoke, may counteract some of the negative effects of poverty and social hardship. Future research should begin to address the processes that lead to adaptive outcomes among adolescents from immigrant families, despite greater exposure to social disadvantage.     

Prospective Association of Intimate Partner Violence with Receipt of Clinical Preventive Services in Women of Reproductive Age

BackgroundWomen who experience intimate partner violence (IPV) have a greater risk for adverse health outcomes, suggesting the importance of preventive services in this group. Little prior research has explored how IPV exposure impacts receipt of relevant preventive services. We assess the prospective association of IPV exposure with receiving specific preventive services.MethodsWomen in the Central Pennsylvania Women's Health Study's longitudinal cohort study (conducted 2004–2007; n = 1,420) identified past-year exposure to IPV at baseline and receipt of IPV-relevant preventive services (counseling for safety and violence concerns, tests for sexually transmitted infections [STIs], counseling for STIs, Pap testing, counseling for smoking/tobacco use, alcohol/drug use, and birth control) at 2-year follow-up. Multiple logistic regression analysis assessed the impact of IPV on service receipt, controlling for relevant covariates.FindingsWomen exposed to IPV had greater odds of receiving safety and violence counseling (adjusted odds ratio [AOR], 2.40; 95% confidence interval [CI], 1.25–4.61), and tests for STIs (AOR, 2.46; 95% CI, 1.41–4.28) compared with women who had not been exposed to IPV. Independent of other predictors, including IPV, women who saw an obstetrician-gynecologist were more likely to receive Pap tests, STI/HIV testing and counseling, and birth control counseling, compared with women who had not seen an obstetrician-gynecologist.ConclusionOverall rates of preventive service receipt for all women in the sample were low. Women exposed to IPV were more likely to receive safety and violence counseling and STI testing, and seeing an obstetrician-gynecologist increased the odds of receiving several preventive services.     

Health Indicators,Social Support,and Intimate Partner Violence Among Women Utilizing Services at a Community Organization

PurposeIntimate partner violence (IPV) against women is a significant public health concern. This study examines the physical and mental health status and relationship to social support for women seeking services to end IPV at a walk-in community organization that serves the community at large, including a shelter for abused women.MethodsOne hundred seventeen (117) English-speaking women between the ages of 18 and 61 years participated in a self-administered survey. Physical, mental, and oral health, social support, and IPV homicide lethality were measured using standardized instruments.ResultsSocial support was the most important factor related to better health. The participants who had more social support reported better physical (p < .05), mental (p < .01), and oral health (p < .05), and a lower level of psychological distress (p < .01) and depression (p < .01) compared with participants who reported less social support. The participants living in the shelter reported worse physical health (p < .05) but better mental health (p < .05) than the participants not living in a shelter. Older age and low income were related to oral health problems, whereas older age, low education level, and unemployment were related to poor mental health.ConclusionThe present study adds to the evidence that social support contributes to improving physical and mental health for women who experience IPV. The findings also suggest the importance of providing or referring women to mental health services.     

Estado de salud y violencia contra la mujer en la pareja

Objective

To describe the prevalence of intimate partner violence (IPV) in Spain in the last year and at some point during the lifetime, to determine health status in women according to whether they had experienced IPV or not, and to analyze the individual variables associated with IPV in Spain.

Methods

A cross-sectional study was performed of the database, Macrosurvey on Gender Violence in Spain 2011. This database includes data on 7,898 women older than 18 years old. The dependent variables were IPV-last year, IPV-ever in life. Covariates consisted of sociodemographic characteristics, socioeconomic status, maternal experience of IPV, social support, and self-care. The measure of association used was the OR with its 95% confidence interval (95% CI).

Results

A total of 3.6% of women had experienced IPV-last year and 12.2% ever in life. Female victims of IPV had poorer health than women who had not experienced IPV. Immigrant women living in Spain for 6 years or more were more likely to experience IPV-ever in life than Spanish women [OR (95% CI): 1.95 (1.50, 2.53)]. An interaction was found between nationality and the existence of children under 18 years old. Among women with children under 18 years old, immigrant women were more likely to experience IPV-last year than Spanish women [OR (95% CI): 1.99 (1.25, 3.17)]. Other variables associated with IPV were age, low socioeconomic status, low social support and having a mother who had experienced IPV.

Conclusions

In Spain, some women have a higher probability of experiencing IPV. The variables associated with greater vulnerability to IPV should be taken into account when implementing measures to prevent or alleviate IPV.     

Social Support and Employment Status Modify the Effect of Intimate Partner Violence on Depression Symptom Severity in Women: Results from the 2006 Behavioral Risk Factor Surveillance System Survey

BackgroundDepression and intimate partner violence (IPV) are significant health issues for U.S. women. Interaction effects between IPV and other psychosocial factors on the severity of depressive symptoms have not been fully explored. This study assessed effect modification, that is, how IPV interacts with sociodemographics, psychosocial factors and health risk behaviors, on the severity of depressive symptoms in women.MethodsWe utilized cross-sectional data from female respondents (n = 16,106) of the 2006 Behavioral Risk Factors Surveillance Survey. Sociodemographics, psychosocial variables, and health risk behaviors determined to be significantly associated with depression were tested for interaction effects with IPV. Weighted ordinal logistic regression and predicted probabilities illustrated the effect of IPV status on depressive symptom severity, stratified by interaction effects.ResultsRecent and lifetime IPV exposure were associated with more severe depressive symptoms compared with no IPV exposure. IPV history interacted with employment status and social support on the severity of depressive symptoms in women. Overall, any IPV exposure was associated with more severe depressive symptoms among women with low social support and unemployment, although the effect of recent (versus lifetime) IPV was most pronounced among women with high social support or employed women.ConclusionsSocial support and employment status interact with IPV on the severity of depressive symptoms in women. Therefore, social support or workplace interventions designed to improve depressive symptoms should examine IPV history.     

Pathways and trajectories linking housing instability and poor health among low-income women experiencing intimate partner violence (IPV): Toward a conceptual framework

ABSTRACT

We used grounded theory to understand pathways and trajectories to housing instability (HI) and poor health among low-income women with experiences of intimate partner violence (IPV). We conducted in-depth interviews during 2010–11 with forty-one women (ages 18–45 years) living in Ontario, Canada. All women reported depressive symptoms in combination with other health problems. In addition to the direct pathway of IPV to poor health, thematic analysis revealed an indirect multi-tiered pathway with complex trajectories among IPV, HI, and poor health. These trajectories included material HI (homelessness, high mobility, evictions, problems paying rent, hiding, and landlord discrimination), psychological HI (feeling unsafe, low self-esteem, and poor control), and social trajectories (financial problems, loss of employment, income, or social networks, and leaving school). These trajectories elevated stress and decreased self-care (unhealthy behaviors, substance abuse, and reduced medical compliance) and exacerbated poor health already compromised by IPV. Depending on her specific context, each woman experienced these pathways and trajectories differently. Moreover, the women’s experiences differed across three time periods: before, immediately after, and long after leaving an abusive relationship. Finally, we found that for these women, achieving stable housing was crucial for stabilizing their health.     

Use of medical care, police assistance, and restraining orders by women reporting intimate partner violence--Massachusetts, 1996-1997

Approximately 1.5 million women in the United States are physically or sexually assaulted by an intimate partner (IP) each year (1). The Woman Abuse Tracking in Clinics and Hospitals (WATCH) Project at the Massachusetts Department of Public Health analyzed data from the 1996 and 1997 Behavioral Risk Factor Surveillance System (BRFSS) in Massachusetts to 1) estimate the percentage of women aged 18-59 years experiencing intimate partner violence (IPV) who used medical care, police assistance, and restraining orders during the preceding 5 years, 2) determine where women experiencing IPV went for medical care, and 3) examine the overlap in use of these three services. This report describes the results of these analyses, which indicate that a higher percentage of women aged 18-59 years use police assistance rather than obtain a restraining order or seek medical care.     

Depression and Social Support Among Women Living with the Substance Abuse,Violence, and HIV/AIDS Syndemic: A Qualitative Exploration

BackgroundIntimate partner violence (IPV), HIV/AIDS, and substance use are described as the SAVA “syndemic” among low-income urban women because of their intersecting and synergistic presence in these women's lives. Depressive symptoms are significantly associated with these SAVA factors and although social support is potentially protective for depression, little is understood about its impact on depression associated with the SAVA syndemic.MethodsThis paper investigates how women living with SAVA experience and describe depressive symptoms, and examines how the types of social support they access impact their experiences of SAVA and depressive symptoms. Qualitative, in-depth interviews were conducted with 24 HIV-positive, low-income, urban women who experienced IPV and used cocaine or heroin in their lifetime. Interviews were analyzed based on study aims, principles of thematic content analysis, and grounded theory.ResultsWomen identified multiple SAVA factors as catalysts for depression and noted their synergistic effect on depressive symptoms, which were both a trigger for and a result of drug use. Women accessed varying sources of social support to address their SAVA factors and associated symptoms of depression, relying on informal sources for instrumental support related to IPV and formal sources for support related to HIV, drug use, and depression.ConclusionsThese findings have important implications for health providers who serve SAVA-affected women, and suggest that comprehensively addressing all SAVA factors (and IPV in particular) and improving their access to quality social support at critical times is essential to improve their mental health.     

Factors That Contribute or Impede the Physical Health Recovery of Women Exposed to Intimate Partner Violence: A Longitudinal Study

BackgroundSeveral cross-sectional studies have demonstrated the negative impact that intimate partner violence (IPV) has on the physical health of women. However, longitudinal studies are needed to establish the time course of this effect. This study assessed the physical health course of female IPV victims and established the factors that enhance or impede their recovery.MethodsWomen (n = 91) who participated in a previous cross-sectional study (T-1) and were either victims of physical/psychological IPV (n = 33) or psychological IPV (n = 23) were evaluated 3 years later (T-2). A control group of women (n = 35) was included for comparison. Structured interviews provided information regarding IPV characteristics, physical health, and lifestyle.FindingsPhysical symptoms decreased over time for both groups of abused women. Factors that contributed to this improvement were perception of social support and the cessation of physical IPV. Factors that impaired recovery included cohabitation with the aggressor, victimization experiences at T-2, negative perceptions of life events, and continuing psychological IPV.ConclusionsThis study shows that physical health improvement is possible in female victims of IPV, but that continuing psychological IPV hinders recovery. Additional longitudinal studies are needed to investigate the factors that best predict health recovery in female IPV victims to design effective intervention programs.     

Comparison of Screening and Referral Strategies for Exposure to Partner Violence

BackgroundAlthough under debate, routine screening for intimate partner violence (IPV) is recommended in health care settings. This study explored the utility of different screening and referral strategies for women exposed to IPV in primary health care.MethodsUsing a randomized controlled trial design we compared two screening strategies (health care providers [HCP] versus audio computer-assisted self-interviews [A-CASI]) and three referral strategies (HCP alone, A-CASI referral with HCP endorsement, and A-CASI alone). English-speaking women who were 18 years and older and were attending women's health clinics at a public hospital were eligible to participate. Participants were randomly assigned to one of three study groups (HCP screen and referral, A-CASI screen and referral with HCP referral endorsement, and A-CASI screen and referral). Women were reinterviewed by telephone 1 week later. The primary outcome was rate of IPV disclosure; secondary outcomes were screening mode preference, reactions to IPV screening, and use of referral resources.ResultsOf the 129 eligible women, 126 women were enrolled (98%); 102 women (81% of those enrolled) completed the follow-up telephone interview. Disclosure rates were higher for women screened with A-CASI compared with HCP-screened women (21% vs. 9%; p = .07). Screening mode preference, impact of screening (positive and negative reactions), and rates of use of referral resources were similar between study groups.ConclusionA-CASI tended to yield higher rates of IPV disclosure and similar rates of use of referral resources. A-CASI technology may be a practical way to screen for IPV.     

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.     

Every cloud has a silver lining but… “pathways to seeking formal-help and South-Asian immigrant women survivors of intimate partner violence”

Abstract

It takes an inordinate amount of resiliency for South Asian (SA) immigrant women survivors of intimate partner violence (IPV)/domestic violence (DV) to seek outside help. The purpose of authors of this study is to understand the process/pathways used by abused SA women to seek formal sources of help. A convenience sample of adult SA women (N?=?9), who were survivors of IPV was recruited from a SA women's organization located in a large Southwestern metropolitan area in the United States. In-depth interviews were conducted and analyzed resulting in five themes. Despite seeking help, participants experienced barriers in accessing formal help and leaving an abusive relationship.     

Intimate Partner Violence around the Time of Pregnancy and Postpartum Contraceptive Use

ObjectivesWe sought to examine postpartum contraceptive use among women who reported physical intimate partner violence (IPV) during or within 12 months before pregnancy compared with women who did not report physical IPV and to identify factors associated with nonuse of contraception among women who reported physical IPV.MethodsData were obtained from women with a recent live birth from 2012 to 2015 who participated in the Pregnancy Risk Assessment and Monitoring System. We described characteristics of women and postpartum contraceptive use by method effectiveness (most effective [female sterilization, male sterilization, intrauterine device, implant], moderately effective [injectable, pill, patch, ring], less effective [condoms, natural family planning, withdrawal, other]) or no method, stratified by reported physical IPV. Multivariable logistic regression was used to examine characteristics associated with nonuse of contraception among women who reported physical IPV.ResultsThe proportion of women using most or moderately effective contraception was similar for women reporting and not reporting physical IPV. Less effective contraceptive use was lower among women who reported physical IPV (13.9%) than those who did not report physical IPV (25.1%) (p < .001). Nonuse was higher among women who reported physical IPV (33%) than those who did not report physical IPV (21%) (p < .001). Having no health insurance at the time of survey and experiencing traumatic stress within 12 months before delivery were associated with nonuse of contraception among women who reported physical IPV.ConclusionsThe higher proportion of contraception nonuse among women who reported physical IPV indicates a potential unmet need for contraception among this vulnerable population. Recommended screening for IPV and counseling about the full range of contraceptive methods should begin during pregnancy and continue through the postpartum period.