Highlight 10/04 Intimate Partner Violence

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Highlights in Minority Health
October, 2004

Domestic Violence Awareness Month, October 2004

WHAT IS THE BURDEN OF INTIMATE PARTNER VIOLENCE IN THE UNITED STATES?

Intimate partner violence (IPV), also called domestic violence¹ refers to any behavior purposely inflicted by one person against another within an intimate relationship that causes physical, psychological or sexual harm. Such behavior includes acts of physical aggression, psychological or emotional abuse, as well as forced intercourse and other forms of sexual coercion.² Most often, the violent person is a husband, former husband, boyfriend, or ex-boyfriend, but sometimes the abuser is female.¹

Accurate information on the extent of intimate partner violence is difficult to obtain because of extensive under-reporting.³ Approximately 1.5 million women and 834,700 men are raped and/or physically assaulted by an intimate partner each year.⁴ About 588,490, or 85% of victimizations by intimate partners in 2001 were against women. IPV made up 20% of all nonfatal violent crime experienced by women and 3% of the nonfatal violence against men. 1,247 women and 440 men were killed by an intimate partner in 2000.⁵

The consequences of abuse are profound, extending beyond the health and happiness of individuals to affect the well-being of entire communities. Violence has been linked to a host of different health outcomes, both immediate and long term, including physical, sexual, reproductive, psychological and behavioral, and fatal health consequences (see table 1).² This violence also takes a devastating toll on children who are exposed to its cruelty. Approximately 826,000 children are abused by their parents each year. Children whose mothers are victims of wife abuse are twice as likely to be abused themselves as those children whose mothers are not victims of abuse. When children witness violence in the home, they have been found to suffer many of the symptoms that are experienced by children who are directly abused.³

Table 1: Health Consequences of Intimate Partner Violence

Physical

Psychological and behavioral

Abdominal / thoracic injuries Bruises and welts Alcohol and drug abuse Depression and anxiety

Chronic pain syndromes Disability Eating and sleep disorders Feelings of shame and guilt

Fibromyalgia Fractures Phobias and panic disorder Physical inactivity

Gastrointestinal disorders Irritable bowel syndrome Poor self-esteem Post-traumatic stress disorder

Lacerations and abrasions Ocular damage Psychosomatic disorders Smoking

Reduced physical functioning Suicidal behavior and self-harm Unsafe sexual behavior

Sexual and Reproductive

Fatal Health consequences

Gynecological disorders Infertility AIDS-related mortality Maternal mortality

Pelvic inflammatory disease Pregnancy complication / miscarriage Homicide Suicide

Sexual dysfunction Unwanted pregnancy

Unsafe abortion Sexually transmitted diseases, including HIV/AIDS

Source: World Health Organization (WHO), �World Report on Violence and Health,� 2002, p. 101

EXAMPLES OF HEALTH DISPARITIES RELATED TO DOMESTIC VIOLENCE

The prevalence of intimate partner violence varies among women of diverse racial backgrounds. When data on African-American, Asian American and Pacific Islander (AAPI), American Indian/Alaska Native (AI/AN), and mixed-race respondents are combined, nonwhite women and men report significantly more intimate partner violence than do their white counterparts (Females: 24.8% white; 28.6% non-white. Males: 7.5% white; 10.0% non-white). These findings suggest that all racial minorities experience more intimate partner violence than do whites. More research is needed to determine how much of the difference in intimate partner prevalence among women and men of different racial and ethnic backgrounds can be explained by the respondent's willingness to disclose intimate partner violence and how much by social, demographic, and environmental factors.⁶

Table 2: Persons victimized by an intimate partner in a lifetime, by victim gender, type of victimization, and victim race

Victim Gender/ Type of Victimization

Persons Victimized in Lifetime (%)

White African American Asian/Pacific Islander (API) American Indian / Alaska Native (AI/AN) Mixed Race

Women n=6,452 n=780 n=133 n=88 n=397

    Rape 7.7 7.4 3.8 ^b 15.9 8.1

    Physical
    Assault 21.3 26.3 12.8 30.7 27.0

    Stalking 4.7 4.2 -- ^e 10.2 ^b 6.3

    Total
    Victimized 24.8 29.1 15.0 37.5 30.2

Men n=6,424 n=659 n=165 n=105 n=406

    Rape 0.2 0.9^b -- ^e -- ^e -- ^e

    Physical
    Assault 7.2 10.8 -- ^e 11.4 8.6

    Stalking 0.6 1.1 ^b -- ^e -- ^e 1.2 ^b

    Total
    Victimized 7.5 12.0 3.0 ^b 12.4 9.1

^a Estimates for American Indian/Alaska Native women are significantly higher than those for white and African-American women: Tukey�s B, p< 0.05.

^b Relative standard error exceeds 30 percent; estimates not included in statistical testing.

^c Estimates for Asian/Pacific Islander women are significantly lower than those for African-American, American Indian/Alaska Native, and mixed-race women: Tukey�s B, p< 0.05.

^d Estimates for African-American women are significantly higher than those for white women: Tukey�s B, p< 0.05.

^e Estimates not calculated on fewer than five victims.

Source: U.S. Department of Justice, Extent, Nature, and Consequences of Intimate Partner Violence: Findings from the National Violence Against Women Survey, 2000, p. 26

African Americans

According to the National Violence Against Women Survey (NVAWS), an estimated 29.1% of African American females and 12.0% of African American males are victimized by IPV in their lifetime, defined by rape, physical assault or stalking. This rate is second only to American Indians and Alaska Natives (AI/ANs) victimized by IPV (AI/AN: 37.5% females, 12.4% males).⁶

American Indians/Alaska Natives (AI/ANs)

AI/AN women and men report higher rates of intimate partner violence than do women and men from other minority backgrounds. According to the NVAWS, 37.5% of AI/AN women and 12.4% of AI/AN men are victimized by IPV in a lifetime, defined by rape, physical assault or stalking. These are the highest rates for any racial or ethnic groups. 10.2 percent of AI/AN women are stalked in their lifetime, compared to 4.7 percent of white women, 4.2 percent of African-American women, and 6.3 percent of mixed race women.⁶ About one in six violent victimizations among American Indians involved an offender who was an intimate or family member to the victim. Intimate and family violence each account for about nine percent of all violence victimizations experienced by American Indian victims, about the same percentage as found among all victims of violence.⁹

Asians/Pacific Islanders (APIs)

AAPI women and men tend to report lower rates of intimate partner violence than do women and men from other minority backgrounds. According to the NVAWS, 15.0% of Asian Pacific Islander (API) women and 3.0% of API men report being victimized by IPV in a lifetime, defined by rape, physical assault or stalking.⁶

Because information on violence against AAPI women and men is limited, it is difficult to explain why they reported significantly less intimate partner violence than did women and men of other racial backgrounds. Research is also needed to determine how prevalence rates vary among women and men of diverse AAPI groups.⁶ It has been suggested that

Traditional Asian values emphasizing close family ties and harmony may discourage Asian women from disclosing physical and emotional abuse by intimates.

There may be significant differences in rates of intimate partner violence between AAPI women that cannot be discerned from the survey because data on these two groups are combined.

There may be significant differences between AAPI women born in this country and those who immigrated.

More research is recommended on violence committed by intimates against AAPI women.⁶

Hispanics/Latinos

According to the NVAWS, 23.4 percent of Hispanic/Latino females and 7.4 percent of Hispanic/Latino males are victimized by IPV in a lifetime, defined by rape, physical assault or stalking. This compares with 25.6 percent of non-Hispanic females, 24.8 percent of white females, 8.0 percent of non-Hispanic males, and 7.5 percent of white males.⁶

The NVAWS found little difference in Hispanic and non-Hispanic women's reports of intimate partner physical assault (Hispanic: 21.2 percent, non-Hispanic: 22.1 percent) and intimate partner stalking (4.8 percent for both groups). However, Hispanic women were significantly more likely than non-Hispanic women to report that they were raped by a current or former intimate partner at some time in their lifetime (Hispanic: 7.9 percent, non-Hispanic 5.7 percent). These findings are noteworthy because previously published NVAW Survey findings show that Hispanic women report significantly less rape victimization than do non-Hispanic women when all types of perpetrators are considered. Future research should focus on why Hispanic women are less likely to be raped by a non intimate but more likely to be raped by an intimate.⁶

PROMISING INTERVENTION STRATEGIES

Most intimate partner victimizations are not reported to the police. Only approximately one-fifth of all rapes, one-quarter of all physical assaults, and one-half of all stalkings perpetrated against female respondents by intimates were reported to the police. Even fewer rapes, physical assaults, and stalkings perpetrated against male respondents by intimates were reported. The majority of victims who did not report their victimization to the police thought the police would not or could not do anything on their behalf. These findings suggest that most victims of intimate partner violence do not consider the justice system an appropriate vehicle for resolving conflicts with intimates.⁶ Increasingly, addressing IPV in primary care settings is recognized as an important component of behavioral risk assessment. Although incorporating IPV screening and intervention into clinical settings can be challenging, these efforts can be critical in improving the lives of women who experience violence.¹⁰

If you or someone you know has been a victim of intimate partner violence, seek help from other family members and friends or community organizations. Make sure you and your children are SAFE. Reach out for support or counseling. Talk with a health care provider, especially if you have been physically hurt. Learn more about how to get help for intimate partner violence. Another important part of getting help is knowing if you are in an abusive relationship. There are clear signs to help you know if you are being abused.¹

PROGRAMS

CDC provides leadership in developing IPV prevention programs and evaluating their effectiveness. CDC�s research on preventing IPV complements the work of other federal agencies to broaden the understanding of causes of violence and ways to prevent it. CDC also funds 10 projects to prevent intimate partner violence and sexual violence among various racial and ethnic populations, including African Americans, AI/ANs, Hispanic Americans, and AAPIs. The projects were selected based on their capacity to identify and respond to the special needs of the target groups. Project staffs are developing and evaluating programs for children, victims, and perpetrators; programs to prevent dating violence among school-age youth; or programs that link victims with service providers in their communities.¹¹ CDC research is looking at how other health behaviors and violence issues, such as substance abuse and dating violence, affect risk factors for family violence.¹²

In July 1995, in response to new statistics which showed an alarming rise in sexual and intimate partner violence assaults on America's women, the U.S. Department of Health and Human Services and the U.S. Department of Justice announced the creation of the Advisory Council on Violence Against Women. Consisting of 42 experts from law enforcement, media, business, sports, health and social services, and victim advocacy, the Council was formed to bring national attention to the problem of violence against women and to increase public awareness of the need for improved strategies to curb these crimes.¹³

The Office on Violence Against Women was created in 1995 to implement the 1994 Violence Against Women Act (VAWA) and to lead the national effort to stop domestic violence, sexual assault, and stalking of women. The Office on Violence Against Women administers grants to help states, tribes, and local communities transform the way in which criminal justice systems respond to violent crimes against women.

HHS launched the National Domestic Violence Hotline in 1996, a 24-hour, toll-free service that provides crisis assistance and local shelter referrals for callers across the country. Since then, the hotline has responded to more than 500,000 calls, mostly from individuals who have never before reached out for assistance. HHS funds the hotline through a grant to the Texas Council on Family Violence. The hotline number is 1-800-799-SAFE, and the TDD line for the hearing impaired is 1-800-787-3224.¹³

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