Intimate Partner Violence Discussion

IPV targeted against women remains a recognized concern with far reaching consequences. Ecological frameworks identify IPV as a multifaceted phenomenon that demonstrates interplay from a range of factors. The proposed study seeks to understand the range factors through determining how they influence IPV occurrence in the USA. It intends to apply a cross-sectional approach based on NISVS data from 2010 to 2012 as published by the CDC. 4,501 interviews and 41,174 surveys were completed to collect the NISVS data. The collected data will be fitted to four multilevel logistic regression models. It is anticipated that the results will offer state and ethnic level factors as influences of IPV occurrence among women in the USA. The proposed study will be based on secondary data with the ethical concerns addressed when the primary data was first collected. Still, there is likelihood that IPV incidences were underestimated due to underreporting, acting as a limitation that affects the results’ interpretation. This is a limitation that cannot be controlled for and future research into the same topic should take this limitation into consideration.Intimate Partner Violence Discussion

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Intimate partner violence

Introduction

Globally, approximately 35% of all women in relationships experience some form of violence from their intimate partners with the violence taking the form of sexual, psychological or physical harm. These statistics are worrying, especially when it is considered that intimate partner violence (IPV) is a concern that exceeds social and health boundaries. In fact, it is perhaps the most common form of violence perpetrated by men and experienced by women. Although men can also be victims of IPV, they are rarely victims (Patra et al., 2018). The present focuses on IPV occurrence among women as they form the largest gender group for victims. The hypothesis presented for the study is that controlling community- and individual-level factors can influence IPV occurrence in the USA.

IPV among women is typically associated with indirect or direct long-term and immediate negative health outcomes for the victims. In fact, women who experience IPV report more suicidal thoughts and attempts, emotional distress and poorer health when compared to their counterparts who have not experienced IPV. In addition, 66% of IPV related homicide victims are women. Besides that, IPV limits the women’s power to make decisions concerning their reproductive health thus exposing them to unwanted pregnancies and higher risks of sexually transmitted infections. Also, IPV during pregnancy has been linked to higher risk of newborns requiring intensive care, preterm births, low-birth-weight infants, and poor attendance of prenatal and postnatal care (Rasch et al., 2018).

As earlier indicated, approximately 35% of women have been victims of IPV. Lifetime exposure to IPV stands at 5% for sexual IPV, 14% for physical IPV and 19% for emotional/psychological IPV. The prevalence for IPV ranges from 7%-31% for physical IPV, 20%-31% for sexual IPV and 31%-61% for emotional/psychological IPV (Patra et al., 2018). Different frameworks and theories have been proposed to explain and understand these statistics with the intention of guiding the design of effective intervention and prevention strategies. There is a general consensus that IPV is an expression of traditional patriarchal domination that is rooted in power and gender inequality. In this case, women are economically dependent on the men, take care of the children and are homemakers, while men are breadwinners. IPV will typically result if men feel that their authority is threatened as the women subvert the traditional order. For instance, if a woman refuses to play her traditional gender role, or challenges/disobeys her intimate partner, the man is likely to discipline her through the use of violence. In such cases, the use of IPV is intended for maintaining the man’s control and power, while putting the women in her place (Alangea et al., 2018).

The status of women is a complex phenomenon that varies between social locations and societies that include communities, neighborhoods, households, and families. In this case, the factors that have the capacity to enhance a woman’s status in one context can have a negative effect in another context. Gender inequality in different spheres of life and varying degrees has an effect on the phenomenon through feeding directly to the status that women are according with regards to control, choice, power, and option. Still, there is a general consensus that higher mobility/autonomy among women (control over resources and decision-making power) acts as a strong protective factor against IPV even in culturally conservative societies. Other factors that influence IPV include male right to control and discipline the behavior of women, attitudes towards IPV, educational level differences, relative employment status differences, drugs and alcohol use, family type, participation in decision making at the different social levels, prior exposure to IPV and general violence, educational attainment, employment, and age (Rasch et al., 2018). In addition to these individual-level factors, contextual factors also have an effect on IPV. They include gender-related sociocultural norms at the different community levels since these norms are the shared expectations that influence the shaping of behavior. Any deviations from these expectations can attract disapproval, sanctions, and shaming by other members of the community. It is evident that the ecological framework for IPV is a multidimensional phenomenon with entrenched levels of causality that demonstrate the interplay of factors at the larger society, community, family and individual levels. To be more precise, it becomes clear that IPV is not the result of a single factor since no single factor is necessary or sufficient for IPV to occur (Roush & Kurth, 2016). Inspired by this awareness, the proposed research study seeks to examine the effect of community- and individual-level factors on IPV occurrence in the USA. The proposed study intends to analyze IPV as consisting of emotional, sexual and physical violence, as these three forms of violence will typically overlap in IPV occurrence. The objective of the study is to assess how IPV occurrence differs across USA ethnicities and communities. Intimate Partner Violence Discussion

Methods

The proposed research intends to apply a cross-sectional approach using population-based USA victimization estimates for IPV published by the Centers for Disease Control and Prevention (CDC) in 2017 using National Intimate Partner and Sexual Violence Survey (NISVS) data from 2010 to 2012 that offers the state and national estimates (see Figure 1). The survey data is collected using stratified cluster sampling design that applies a sampling frame based on the enumeration areas identified by the census bureau. The survey results are based on interviews and surveys conducted between 2010 and 2012, with 4,501 interviews partially completed and 41,174 surveys completed. The interviews and surveys were conducted using a random-digital-dial telephone approach among US non-institutionalized Spanish and English speaking persons 18 years of age or older. It uses a dual-frame sampling strategy using both cell phones and landlines, conducted in all 50 states of the USA and the District of Columbia. Cellphones had a response rate of 56.7% while landline had a response rate of 43.3%. The cooperation rate ranged from 80.3% to 83.5% while the response rate ranged from 27.5% to 33.6%. The questions used to collect data applied behavioral-specific questions to evaluate victimization in areas of IPV across the lifetime and during the research period. The questions included assessments on physical violence, sexual violence, and psychological aggression by an intimate partner (see Figure 2). Indicators of IPV impact were evaluated to include fearfulness, concern personal safety, post-traumatic stress disorder (PTSD) symptoms, physical injury, need for medical care, need for housing services, need for legal services, contact with a crisis hotline, and missing school or work. Information on perpetrators of IPV was also collected (Smith et al., 2017).

Figure 1. IPV average annual estimates for 2010 to 2012 (source: Smith et al., 2017)

Figure 2. Lifetime and 12-month IPV prevalence (source: Smith et al., 2017)

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Results

The NISVS data for IPV from Smith et al. (2017) will be first subjected to statistical analysis to determine the proportion of women who experienced IPV with the results presented as weighted percentages and numbers. Secondly, bivariate analysis will be conducted using simple logistic regression to evaluate the link between IPV and individual women ethnicities. Owing to the NSIVS data’s hierarchical structure that has individual women nested within states and ethnicities, a multilevel logistical model was applied with two levels for the state and community levels. The multilevel logistic model will evaluate random effects (how women characterize their experiences with IPV and the extent of variation across states) and fixed effects (how state and community levels affect IPV figures (Myers, Well & Lorch Jr., 2010).

Four models will be fitted for the results. The first model is a null model that justifies the use of multilevel analysis by showing variation across communities. The second model shows fixed slopes and random intercepts through the use of individual variables. It will study the association between IPV and the women’s ethnicity. The third model is similar to the second model but shows the association between IPV and the women’s state of residence instead of ethnicity. The fourth model is a random intercept slope that will study the association between IPV and the women’s ethnicity and state of residence without controlling for the potential confounders. Any noted disparities will act as indicators of cross-level interactions. The fits for the four models will be evaluated using deviance information criterion as a measure of how well the models fit the data. A lower deviance information criterion value will act as an indicator of the model’s better fit. Stata version 16 software package will be used for the statistical analyses with the model parameters estimated using mean-variance adaptive Gauss-Hermite (Hardin & Hilbe, 2013; Tang, He & Hu, 2012).

The results will be presented as characteristics of the study sample by IPV, the prevalence of IPV, and multilevel analyses. The results will be expressed as odds ratios (OR) with 95% confidence interval. The significance level is set at p-value < 0.05.

Discussion

It is anticipated that the results will offer state and ethnic level factors as influences of IPV occurrence among women in the USA. These results will underscore the importance of state legislative influences, existing interventions, and socio-cultural norms. In addition, they will support calls for adopting intervention strategies at both the ethnic and state levels. Using these results, policy makers are expected to design intervention strategies that keep in mind the complex dynamics between factors affecting IPV occurrence among women in the USA.

There are no ethical concerns with the present study since it is based on secondary data and ethical approval was already received when NISVS data was first collected from 2010 to 2012. The primary study design (NISVS) adhered to WHO ethical guidelines for interviewing respondents about violence to maximize their safety. In addition, care was taken to ensure that individual identifiers were not included to protect the participants and make it difficult to track any of the participants. Besides that, the respondents were assured that they did not have to answer any questions that they were uncomfortable answering. Permission for using NISVS data will be obtained from CDC before the present study commences (Smith et al., 2017).

NISVS data is nationally representative and uses a large sample size (4,501 interviews and 41,174 surveys) thus improving the proposed study’s generalizability and external validity. Still, the proposed study has a limitation that affects the results’ interpretation. NISVS approaches are designed to ensure safety and privacy, with the surveys and interviews designed to enhance disclosure. However, there is likelihood that IPV incidences were underestimated due to underreporting. This is a limitation that cannot be controlled for and future research into the same topic should take this limitation into consideration. Future research studies can advance the proposed research interest through exploring how individual factors particular to the women (such as male right to control and discipline the behavior of women, attitudes towards IPV, educational level differences, relative employment status differences, drugs and alcohol use, family type, participation on decision making at the different social levels, prior exposure to IPV and general violence, educational attainment, employment, and age) influence IPV incidence among women in the USA. Intimate Partner Violence Discussion

References

Alangea, D., Addo-Lartey, A., Sikweyiya, Y., Chirwa, E., Coker-Appiah, D. … & Adanu, R. (2018). Prevalence and risk factors of intimate partner violence among women in four districts of the central region of Ghana: Baseline findings from a cluster randomised controlled trial. PLoS ONE, 13(7), e0200874. DOI: 10.1371/journal.pone.0200874. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200874

Hardin, J. & Hilbe, J. (2013). Generalized estimating equations (2^nd ed.). Boca Raton, FL: CRC Press/Taylor & Francis Group.

Myers, J., Well, A. & Lorch Jr., R. (2010). Research design and statistical analysis (3^rd ed.). New York, NY: Routledge.

Patra, P., Prakash, J., Patra, B. (2018). Intimate partner violence: wounds are deeper. Indian Journal of Psychiatry, 60(4), 494-498. DOI: 10.4103/psychiatry.IndianJPsychiatry_74_17

Rasch, V., Van, T., Nguyen, H., Manongi, R., Mushi, D., … & Wu, C. (2018) Intimate partner violence (IPV): The validity of an IPV screening instrument utilized among pregnant women in Tanzania and Vietnam. PLoS ONE, 13(2), e0190856. DOI: 10.1371/journal.pone.0190856. Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190856

Roush, K. & Kurth, A. (2016). Intimate partner violence: the knowledge, attitudes, beliefs, and behaviors of rural health care providers. The American Journal of Nursing, 116(6), 24-34. DOI: 10.1097/01.NAJ.0000484221.99681.85

Smith, S. G., Chen, J., Basile, K. C., Gilbert, L. K., Merrick, M. T., Patel, N., Walling, M. & Jain, A. (2017). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010-2012 State Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/violenceprevention/pdf/NISVS-StateReportBook.pdf

Tang, W., He, H. & Hu, X. (2012). Applied categorical and count data analysis. Boca Raton, FL: CRC Press/Taylor & Francis Group.

Intimate Partner Violence Discussion