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The Epidemiology of Domestic Violence. Thomas Songer, PhD Cristie Glasheen, MPH University of Pittsburgh. Key Points. What is being measured? What is NOT being measured? How does this affect the results?. Definition of Violence. …...To understand violence, you need to define violence.

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The Epidemiology of Domestic Violence

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The epidemiology of domestic violence l.jpg

The Epidemiology of Domestic Violence

Thomas Songer, PhD

Cristie Glasheen, MPH

University of Pittsburgh


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Key Points

What is being measured?

What is NOT being measured?

How does this affect the results?


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Definition of Violence

…...To understand violence, you

need to define violence

How would you define

domestic violence?


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Defining Domestic Violence

domestic violencenoun: violence committed by one member of a family or household against another

The National Research Council defines violence as:

- behaviour by individuals that intentionally threaten, attempt, or inflict physical harm on others


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Who is Affected by Domestic Violence?

Children

Intimate Partners (IP)

Elders


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Data Sources

You are planning to do a study of domestic violence using pre-existing data.

Where would you look?

Medical sources

State sources

Government surveys


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Which surveillance system is likely to provide the best estimates for domestic violence?


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Surveillance in Domestic Violence

  • Hospital Admissions

  • Trauma Center Admissions

  • Emergency Department Admissions

  • State-based Reporting Systems

  • Government Surveys

    • National Criminal Victimization Survey

    • National Incidence Survey

    • Behavioral Risk Factor Survey

    • National Violence Against Women Survey


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Medical Sources

Hospital Records

Trauma Center Records

Emergency Department

Recommended: Rudman WJ. Coding and Documentation of Domestic Violence.

December, 2000. Available at: http://endabuse.org/programs/healthcare/files/codingpaper.pdf


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Definition of Health Care Events Related to Domestic Violence

  • Based on N-codes and E-codes

    • 995.80 to 995.85 adult physical abuse

    • 995.50 child abuse

    • E coding to distinguish domestic violence is relatively poor

    • E967.x


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State Based Reporting

  • State-based Reporting

    • Child Protective Services

    • Uniform Crime Reports

    • National Incident-Based Reporting System (NIBRS)

    • Supplementary Homicide Report (SHR)


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State-based Programs Related to Domestic Violence

  • Based on reporting to state agencies

    • most frequently for child maltreatment

    • definition of violence is not standard across the states

    • reporting is subject to knowledge of the issues to medical, educational, and legal personnel


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Government Surveys

  • Government Surveys

    • National Crime Victimization Survey (NCVS)

    • National Violence Against Women Survey (NVAW)


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Surveys Related to Domestic Violence

  • Self-report of violence based upon interviews

    • Aside from the NCVS, these surveys are not regularly collected

    • Definition of violence in surveys is not standard

    • There may be extensive under-reporting of violence


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What do we know aboutChild Maltreatment?


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Epidemiology of Child Abuse

  • Maltreatment

    • “behavior towards another person, which a) is outside the norms of conduct, and b) entails a substantial risk of causing physical or emotional harm”

      • Physical Abuse

      • Sexual Abuse

      • Emotional & Psychological Abuse

      • Neglect


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Types of Maltreatment

  • Physical abuse: physical acts by a parent, guardian or caretaker that caused physical injury to the child.

  • Neglect (including medical neglect): the failure by the caretaker to provide needed, age-appropriate care (or provide for the health care) of the child.

  • Sexual abuse: the involvement of a child in incest, or sexual assault by a relative or caretaker, includes fondling and exposure to indecent acts.


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Substantiated Cases of Child Maltreatment,

Pennsylvania, 1976-1994


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The Pyramid of Child Maltreatment in Pennsylvania, 1994

53 deaths

33 head injuries

56 trauma center admissions

177 hospital admissions

2115 ED visits

7,038 substantiated cases

64,560 maltreatment events


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What do we know about Violence Against Women?


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Terminology of IPV

Intimate Partner Violence (IPV) – relatively new term

Also called: domestic violence, domestic abuse, spousal abuse, battery, violence against women


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Who is an intimate?


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Estimates of the Frequency of Domestic Violence

Against Women seen in Medical Settings

Sample

Trauma

One year

Lifetime

Study

Definition and Method

Size

from Abuse

Prevalence

Prevalence

Physical and sexual abuse reported

McCauley

1952

5.5%

33%

in physician practices

Physical and sexual abuse and

Gin

453

threats by current partner reported

14%

28%

in internal medicine clinics

Physical abuse reported in an urban

Goldberg

492

22%

emergency department

Physical or sexual abuse reported in

Dearwater

3455

2.2%

14.4%

36.9%

community hospital emergency

departments

Physical abuse identified in trauma

McLeer

412

patients in urban emergency

30%

department

Physical abuse or threats reported in

Abbott

648

2.7%

15.3%

54.2%

urban, acute care emergency

departments and clinics

Physical trauma identified in ten

Muelleman

9057

3.1%

emergency departments


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IPV

Source: American Journal of Preventive MedicineVolume 34, Issue 2, February 2008, Pages 112-118


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WHO Multi-country Study on Women’s Health and Domestic Violence against Women


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The Pyramid of Violence Against Women, U. S.

1418 murders

7% treated in emergency department

10% sought medical care

32% not treated for injury

51% had physical injuries

50% reported to police

1992-96 NCVS

960,000 women victimized


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Trends in the rates of violent victimizations by intimates*, United States, 1992 - 1996


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Possible Risk Factors

Intimate Partner Violence

  • Gender

  • Ethnicity

  • Socio-Economic Status

  • Age ?

  • Alcohol ?

  • Pregnancy ?

  • Psychiatric problems ?


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What do we know about Elder Abuse?


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Research Methods

You have decided that existing data sources are not adequate to answer your research question.

You want to design a new study.

What do you need to consider?


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Who

Who are you going to measure?

Victims?

Perpetrators?


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What is Your Outcome?

Physical Injury?

Psychological Injury?


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Physical Injury

Easiest to identify

Severity of injury

What are you missing?

Exposed with no injury


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Psychological Injury

What is the threshold?

When is it a psychological “bruise” and when is it a “trauma”?

What does this mean for prevention

Primary

Secondary

Tertiary


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What is your exposure?

Experienced or potential for abuse?

Officially reported, unreported, or both

Suspected or confirmed

Attempts or completions

Type of exposure

Physical and/or Neglect

Sexual

Emotional


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How are You Going to Measure It?

Domestic Violence is wrought with ethical considerations unique to this field of research


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Key Lecture Points

  • Surveillance for the frequency of domestic violence is not at the same level of development as for other unintentional injuries and for criminal violence

  • Several limitations, including differing definitions, poor coding, and under-reporting influence our knowledge of the frequency of domestic violence

  • Risk factor analysis in this area is just starting


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