Barriers to Screening for Intimate Partner Violence

Background: Health care providers play a vital role in the detection of intimate partner violence among their patients. Despite the recommendations for routine intimate partner violence screening in various medical settings, health care providers do not routinely screen for intimate partner violence. The authors wanted to identify barriers to intimate partner violence screening and improve the understanding of intimate partner violence screening barriers among different health care providers. Methods: The authors conducted a systematic review to examine health care providers' perceived barriers to screening for intimate partner violence. By grouping the studies into two time periods, based on date of publication, they examined differences in the reported barriers to intimate partner violence screening over time. Results: The authors included a total of 22 studies in this review from all examined sources. Five categories of intimate partner violence screening barriers were identified: personal barriers, resource barriers, perceptions and attitudes, fears, and patient-related barriers. The most frequently reported barriers included personal discomfort with the issue, lack of knowledge, and time constraints. Provider-related barriers were reported more often than patient-related barriers. Conclusions: Barriers to screening for intimate partner violence are numerous among health care providers of various medical specialties. Increased education and training regarding intimate partner violence is necessary to address perceptions and attitudes to remove barriers that hinder intimate partner violence screening by health care providers.     

Associations Between Perceptions and Involvement in Neighborhood Violence and Intimate Partner Violence Perpetration Among Urban,African American Men

Violence disproportionately affects African American men and their communities. Research is needed to inform programming efforts to reduce racial/ethnic disparities in violence exposure, involvement, and victimization. The current study examined involvement in and perceptions of neighborhood violence and relation to perpetration of intimate partner violence (IPV) among a sample of urban, African American men. Participants of this cross-sectional study were sexually active African American men (n = 703) between the ages of 18 and 65 years, recruited from urban community health centers. Age-adjusted logistic regression models were used to assess associations between neighborhood violence variables and perpetration of IPV. In age-adjusted logistic regression models, involvement with street violence in the previous 6 months (Odds Ratio (OR) = 3.0; 95% Confidence Interval (CI): 1.9–4.6), ever being involved with gangs (OR = 2.0; 95% CI: 1.3–3.2), and perceptions/beliefs that violence occurs in one’s neighborhood (ORs = 2.0–3.1) were found to be significantly associated with IPV perpetration. Findings demonstrate that involvement in neighborhood violence as well as perceptions/beliefs that violence occurs in one’s neighborhood are associated with increased likelihood of IPV perpetration among urban, African American men. While socioeconomics and substance use contribute to high rates of these forms of violence, the relation between these forms of violence and perpetration of IPV was significant beyond the influences of these factors. Findings suggest that future violence prevention and treatment efforts will be most successful by addressing multiple forms of violence.     

Intimate Partner Violence in Interracial and Monoracial Couples

This study, using a nationally representative sample, investigated intimate partner violence (IPV) in interracial and monoracial relationships. Regression analyses indicated that interracial couples demonstrated a higher level of mutual IPV than monoracial White couples but a level similar to monoracial Black couples. There were significant gender differences in IPV, with women reporting lower levels of victimization than men. Regarding relationship status, cohabiting couples demonstrated the highest levels of IPV, and dating couples reported the lowest levels. Regarding interactions among couple racial composition, relationship status, and respondents' gender, an interaction between racial composition and relationship status was found. Implications for practitioners and directions for future research are discussed.     

Urban Young Women’s Experiences of Discrimination and Community Violence and Intimate Partner Violence

This paper examines the interrelationships between urban young adult women’s experiences of discrimination and community violence and their reports of involvement in intimate partner violence (IPV). We explore whether such experiences are independent risk factors for IPV victimization and perpetration, even when accounting for aggressive behaviors and related risk taking, including drinking and sexual initiation, during early adolescence. We use data from the Reach for Health study, in which a sample of 550 urban African American and Latina women was followed from recruitment in economically distressed middle schools into young adulthood, over approximately 7 years. At the last wave, respondents were 19–20 years old; 28% were raising children. More than 40% reported experiencing at least one form of racial/ethnic discrimination sometimes or often over the past year. About 75% heard guns being shot, saw someone being arrested, or witnessed drug deals within this time period; 66% had seen someone beaten up, 26% had seen someone get killed, and 40% knew someone who was killed. Concurrent reports of lifetime IPV were also high: about a third reported being a victim of physical violence; a similar proportion reported perpetration. Results of multivariate regression analyses indicate that discrimination is significantly associated with physical and emotional IPV victimization and perpetration, controlling for socio-demographic characteristics, including ethnic identity formation, and early adolescent risk behaviors. Community violence is correlated with victimization, but the relationship remains significant only for emotional IPV victimization once early behaviors are controlled. Implications for violence prevention are discussed, including the importance of addressing community health, as well as individual patterns of behavior, associated with multiple forms of violence victimization and perpetration. Stueve is with the Health and Human Development Center, 96 Morton Street, 7th Floor, New York, 10014, New York NY, USA. O`Donnell is with the Health and Human Development, Education Development Center, Newton, MA, USA.     

Risk Factors for Intimate Partner Violence and Associated Injury Among Urban Women

The objective of this study was to identify risk factors for abuse and IPV related injury among an urban population. This study reports an additional analysis of a case-control study conducted from 1994 to 2000 in 11 USA metropolitan cities where of 4746 women, 3637 (76.6%) agreed to participate. Control group women (N = 845) were identified through random digit dialing. Significant risk factors for abuse included women’s young age (adjusted odds ratio (AOR) 2.05 p = .011), being in fair or poor mental health (AOR 2.65 p < .001), and former partner (AOR 3.33 p < .001). Risk factors for partners perpetrating IPV included not being a high school graduate (AOR 2.06 p = .014), being in fair or poor mental health (AOR 6.61 p < .001), having a problem with drug (AOR 1.94 p = .020) or alcohol use (AOR 2.77 p = .001), or pet abuse (AOR 7.59 p = .011). College completion was observed to be protective (AOR 0.60, p < .001). Significant risk factors for injury included partner’s fair or poor mental health (AOR 2.13, p = .008), suicidality (AOR 2.11, p = .020), controlling behavior (AOR 4.31, p < .001), prior domestic violence arrest (AOR 2.66, p = .004), and relationship with victim of more than 1 year (AOR 2.30, p = .026). Through integration of partner related risk factors into routine and/or targeted screening protocols, we may identify more abused women and those at greater risk of abuse and injury.     

Intimate Partner Violence of Rural Aging Women*

Abstract: Although reports of intimate partner violence (IPV) decrease with age, a significant number of aging women experience IPV in their relationships. The structure and culture of rural environments may inadvertently conceal violence against aging women and inhibit prevention and treatment efforts. Guided by an ecological community framework, 3 focus groups involving 24 professionals working with victims of IPV in rural Kentucky and in‐depth interviews with 10 aging rural women who had experienced IPV were conducted to examine the trajectory of, and community responses to, violence in late life. Findings revealed multiple interacting influences on IPV of aging women in rural areas including the women’s families and resources, culture and locality, religion, community support, and government entities.     

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.     

Neighborhood Influences and Intimate Partner Violence: Does Geographic Setting Matter?

Intimate partner violence is one health-related outcome that has received growing attention from those interested in the role of neighborhood context. A limitation of existing contextual health research is its' failure to look beyond urban settings. Because suburban and rural areas have received so little attention, it is not clear whether data generated from urban samples can be generalized to non-urban geographic settings. We began to explore this issue using concept mapping, a participatory, mixed method approach. Data from 37 urban and 24 suburban women are used to explore and compare perceptions of neighborhood characteristics related to intimate partner violence. While several similarities exist between the perceptions of participants residing in urban and suburban areas, some differences were uncovered. These results provide valuable information regarding the perceived relationship between neighborhood context and intimate partner violence and suggest future avenues for research interested in examining the role of geographic setting.     

Validity of the Brief Inpatient Screen for Intimate Partner Violence Among Adult Women

Background: Identifying intimate partner violence in healthcare settings is becoming the standard of care. The Brief Inpatient Screen was designed to assess recent emotional, physical, and sexual abuse in a general inpatient medical-surgical setting and compared to the Composite Abuse Scale. Methods: Researchers matched “cases” (inpatients screening Brief Inpatient Screen-positive) to up to four “controls” (inpatients screening Brief Inpatient Screen-negative). Forty-six female hospital inpatients ages 18–64 years completed a self-administered survey. The sensitivity and specificity of the Brief Inpatient Screen and its subscales were compared to the Composite Abuse Scale. Researchers examined the performance of the Brief Inpatient Screen when used as a verbal screen versus an anonymous written screen. Results: Twelve of 46 participants (26%) had a positive screen. Compared to the Composite Abuse Scale, the overall sensitivity and specificity of the verbal Brief Inpatient Screen were 52.6% (95% CI 28.9–75.6) and 92.6% (95% CI 75.7–99.1), respectively. The written Brief Inpatient Screen showed improved sensitivity overall (68.4%, 95% CI 43.5–87.4) for the most severe intimate partner violence. Subscale analysis revealed greater sensitivity for emotional and severe combined intimate partner violence. Conclusions: The verbal Brief Inpatient Screen, when compared to the Composite Abuse Scale, was limited in its ability to identify intimate partner violence. An anonymous written format improved sensitivity. Future research should optimize intimate partner violence screening among inpatients.     

The Anatomy of a Community Health Center System-Level Intervention for Intimate Partner Violence

The US Preventive Services Task Force (USPSTF) now recommends screening for intimate partner violence (IPV) as part of routine preventive services for women. However, there is a lack of clarity as to the most effective methods of screening and referral. We conducted a 3-year community-based mixed-method participatory research project involving four community health centers that serve as safety net medical providers for a predominately indigent urban population. The project involved preparatory work, a multifaceted systems-level demonstration project, and a sustainability period with provider/staff debriefing. The goal was to determine if a low-tech system-level intervention would result in an increase in IPV detection and response in an urban community health center. Results highlight the challenges, but also the opportunities, for implementing the new USPSTF guidelines to screen all women of childbearing years for intimate partner violence in resource-limited primary care settings.     

Perceptions of Prominent Neighborhood Individuals Regarding Neighborhood Factors and Intimate Partner Violence

Research addressing the impact of neighborhood factors on intimate partner violence (IPV) often lacks discussion of how and why such factors impact IPV. In order to address this gap, 16 prominent neighborhood individuals (PNI) from 4 low-income urban neighborhoods were asked to share through in-depth interviews their insights and perceptions of IPV as an issue in their neighborhoods, and the relationship between social and structural neighborhood-level factors and IPV. PNIs most often associated IPV with only physical violence. Several did not feel IPV was a significant issue in their neighborhood, confirming a lack of awareness and underreporting of IPV. However, other PNIs were able to speak of the relationship between IPV and neighborhood factors, including lack of opportunities for employment, vacant housing, trash management, lack of community awareness, and social capacity to act to address IPV. Results provide unique insights regarding the mechanisms linking neighborhood factors to IPV outcomes. These results contribute to a deeper understanding of contextual influences upon IPV, the development of tailored quantitative research and to the design of local multi-level public health IPV intervention and prevention efforts.     

An Exploration of Maternal Intimate Partner Violence Experiences and Infant General Health and Temperament

Objectives While the women’s health consequences of intimate partner violence have received much research attention, less is known about how maternal abuse experiences affect infant health and well-being. Existing studies have also been unable to examine specific types of intimate partner violence such as psychological aggression, physical abuse, and sexual coercion. This secondary data analysis explored the prevalence, patterns, and types of intimate partner violence within a large cohort of mothers and explored the relationship between maternal intimate partner violence experiences and infant’s general health and temperament at 1 year of age. Methods Existing data were drawn from the Fragile Families and Child Wellbeing study which collected data through surveys conducted shortly after the infant’s birth (baseline) and at 1 year of age (follow-up). Records from 4,141 mothers recruited from 75 hospitals, in 20 cities, in the US were used. Bivariate and multivariate regression analyses were conducted. Results Results show high rates of intimate partner violence. Maternal reports of any intimate partner violence at baseline or follow-up were both significantly associated with increased odds of less than excellent infant general health and difficult temperament. Independent examination of psychological, physical, and sexual abuse revealed differential relationships between the types of intimate partner violence and infant health outcomes. Conclusions Results from this study contribute to our understanding of the infant health threats associated with maternal intimate partner violence experiences. Additional research addressing the complex relationship between maternal abuse experiences and infant health and specific intervention implications is warranted.     

Health Care Utilization and Costs Associated with Physical and Nonphysical-Only Intimate Partner Violence

Objective. To estimate health care utilization and costs associated with the type of intimate partner violence (IPV) women experience by the timing of their abuse.
Methods. A total of 3,333 women (ages 18–64) were randomly sampled from the membership files of a large health plan located in a metropolitan area and participated in a telephone survey to assess IPV history, including the type of IPV (physical IPV or nonphysical abuse only) and the timing of the abuse (ongoing; recent, not ongoing but occurring in the past 5 years; remote, ending at least 5 years prior). Automated annual health care utilization and costs were assembled over 7.4 years for women with physical IPV and nonphysical abuse only by the time period during which their abuse occurred (ongoing, recent, remote), and compared with those of never-abused women (reference group).
Results. Mental health utilization was significantly higher for women with physical or nonphysical abuse only compared with never-abused women—with the highest use among women with ongoing abuse (relative risk for those with ongoing abuse: physical, 2.61; nonphysical, 2.18). Physically abused women also used more emergency department, hospital outpatient, primary care, pharmacy, and specialty services; for emergency department, pharmacy, and specialty care, utilization was the highest for women with ongoing abuse. Total annual health care costs were higher for physically abused women, with the highest costs for ongoing abuse (42 percent higher compared with nonabused women), followed by recent (24 percent higher) and remote abuse (19 percent higher). Women with recent nonphysical abuse only had annual costs that were 33 percent higher than nonabused women.
Conclusion. Physical and nonphysical abuse contributed to higher health care utilization, particularly mental health services utilization.     

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

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

Screening for Intimate Partner Violence in Reproductive Health Centers: An Evaluation Study

This study compared rates of intimate partner violence reports on a new, empirically-developed screening tool completed by 385 women in 2007 to those from an older tool completed by 420 women in 2006. Data were obtained from randomly selected medical charts across three health center locations, which were part of the same reproductive health care organization. Chi-square analyses were conducted to test associations between demographic characteristics and partner violence reports. Multiple regression analyses were used to compare odds ratios of disclosure by type of screening tool, adjusting for associated demographic factors associated with partner violence reports. Women completing the old and new tools were similar across all demographic characteristics. After adjusting for age and center location, women completing the new screening form were more than 2.5 times as likely to report any partner violence. When analyzed by mutually exclusive violence history categories, women completing the new screening form were over 2.5 times as likely to report past or current violence and over 4 times as likely to report experiencing both past and current violence. Findings suggest that implementing empirically developed brief screening tools for partner violence in reproductive health settings may elicit more disclosures from patients than more traditional tools.     

Linkages Between Gender Equity and Intimate Partner Violence Among Urban Brazilian Youth

Purpose

Gender inequity is a risk factor for intimate partner violence (IPV), although there is little research on this relationship that focuses on youth or males. Using survey data collected from 240 male and 198 female youth aged 15–24 in Rio de Janeiro, Brazil, we explore the association between individual-level support for gender equity and IPV experiences in the past 6 months and describe responses to and motivations for IPV.

Methods

Factor analysis was used to construct gender equity scales for males and females. Logistic and multinomial logistic regression models were used to examine the relationship between gender equity and IPV.

Results

About half of female youth reported some form of recent IPV, including any victimization (32%), any perpetration (40%), and both victimization and perpetration (22%). A total of 18% of male youth reported recently perpetrating IPV. In logistic regression models, support for gender equity had a protective effect against any female IPV victimization and any male IPV perpetration and was not associated with female IPV perpetration. Female victims reported leaving the abusive partner, but later returning to him as the most frequent response to IPV. Male perpetrators said the most common response of their victims was to retaliate with violence. Jealousy was the most frequently reported motivation of females perpetrating IPV.

Conclusion

Gender equity is an important predictor of IPV among youth. Examining the gendered context of IPV will be useful in the development of targeted interventions to promote gender equity and healthy relationships and to help reduce IPV among youth.     

Interpersonal- and Community-Level Predictors of Intimate Partner Violence Perpetration among African American Men

Intimate partner violence (IPV) has been associated with adverse physical, psychoemotional, and sexual health, and African American women are at higher risk for experiencing IPV. Considering African American women predominantly have African American male partners, it is essential to identify factors associated with IPV perpetration among African American men. The present study examined attitudes toward IPV, ineffective couple conflict resolution, exposure to neighborhood violence, and the interplay of these factors as predictors of IPV perpetration. A community sample of 80 single, heterosexual, African American men between 18 and 29 years completed measures assessing sociodemographics, attitudes towards IPV, perceived ineffective couple conflict resolution, exposure to neighborhood violence, and IPV perpetration during the past 3 months. Hierarchical multiple linear regression analyses, with age, education, and public assistance as covariates, were conducted on 65 men who reported being in a main relationship. Couple conflict resolution and exposure to neighborhood violence moderated the relation between attitudes supporting IPV and IPV perpetration. Among men who reported high ineffective couple conflict resolution and high exposure to neighborhood violence, IPV perpetration increased as attitudes supporting IPV increased. The findings indicated that interpersonal- and community-level factors interact with individual level factors to increase the risk of recent IPV perpetration among African American men. While IPV prevention should include individual-level interventions that focus on skills building, these findings also highlight the importance of couple-, community-, and structural-level interventions.     

Intimate Partner Violence,Maternal Gatekeeping,and Child Conduct Problems

We examined the mediating role of parenting behavior on the relationship between intimate partner violence and child conduct problems, as well as the moderating role of maternal gatekeeping to these associations. The sample (N = 395) is from a longitudinal study of rural poverty in the eastern United States exploring the ways in which child, family, and contextual factors shape child development over time. Study findings indicate that a father's harsh–intrusive parenting behavior may be a key mediating pathway linking intimate partner violence and child conduct problems. Study findings further provide evidence for problematic outcomes for children when mothers encourage fathers with high levels of harsh–intrusive parenting to interact with their children.     

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.