25 Jun The World Health Organization published a fact
Question
The World Health Organization published a fact sheet in 2002 citing a growing public health concern- intimate partner violence (IPV). According to that fact sheet, IPV was one of the most common forms of violence against women; and although they did note that intimate partner violence was not always against women, the “overwhelming health burden of partner violence is borne by women at the hands of men” (“Intimate Partner Violence”, 2002). Today, in 2013, the Centers for Disease Control (CDC) lists IPV as a “serious, preventable public health problem that affects millions of Americans”(“Intimate Partner Violence | Violence Prevention | Injury | CDC”, 2013). But even though IPV is still a major public health concern, the Healthy People 2010 database shows a decrease in the prevalence of intimate partner violence in the United States from 1998 through 2010. Statistical data compiled from the National Crime Victimization Survey (NCVS), the Department of Justice (DOJ), and the Bureau of Justice Statistics (BJS) shows a decline in overall prevalence (all races and ethnicities) which was 3.6 (per 1,000 population = 12 years of age), to 2.3 (per 1,000 population = 12 years of age) in 2009. This exceeded the Healthy People 2010 target of 2.7 (per 1,000 population = 12 years of age). .apus.edu/access/content/user/4366145/IPV.gif”> In looking for trends by race or education level, I found that there was a lot of data missing- either it was not collected or did not meet the criteria for statistical reliability and therefore was not included. This was the case for a number of races/ethnicities, and the education portion of the table in its entirety. However, there were some complete data as illustrated in the graph below:
.apus.edu/access/content/user/4366145/IPV%20by%20race%20ethnicity.gif”> For both Whites and Hispanic/Latinos, the prevalence of IPV declined, falling beneath the Healthy People 2010 goal of 2.7(per 1,000 population = 12 years of age), whereas Blacks/African Americans began with an initial decline from their baseline of 3.9(per 1,000 population = 12 years of age), but ultimately failed to meet the Healthy People 2010 goal of 2.7 (per 1,000 population = 12 years of age) with a marked increase to 5.7 (per 1,000 population = 12 years of age). There are multiple factors- individual, relational, community, and societal, associated with intimate partner violence, which have been associated with an increased of either becoming a perpetrator of IPV, or the victim of it. Many of these overlap, or perpetuate a cycle for each other (i.e. unemployment may lead to depression or low self-esteem, which in turn may make it difficult to find employment, which maintains negative feelings, etc.). Some examples of individual risk factors include low socioeconomic status (SES) (i.e. low income, low education/academic achievement, being unemployed and/or underemployed), drug or alcohol abuse, depression, low self-esteem, insecurity, anger/aggression issues. Some relational factors may include marital conflict and/or instability, and economic stress. Community factors may include poverty, low social capital and the unwillingness of community members to get involved/intervene when they see violence occurring. Finally, a societal factor that may contribute to IPV is the strict adherence “traditional gender norms” where men are the breadwinners and decision-makers and women are submissive, (i.e. housewives, caregivers) (“Intimate Partner Violence | Violence Prevention | Injury | CDC”, 2013). The key to understanding the correlation between these different risk factors and intimate partner violence is to understand how these factors are interrelated- how they impact and influence one another such that measures aimed at prevention or early intervention can be designed and implemented effectively. One way to do this would be to assess at risk populations, determine what makes them vulnerable, and then introduce measures to mitigate that vulnerability. For example, many of the individual risk factors for intimate partner violence are what may be considered moderating/intervening variables, that is, those which “are intermediate in the causal process between an independent variable (risk or exposure) and outcome” (Friis, & Sellers, 2009, p. 578). Young age is considered to be an individual risk factor for IPV, as are low self-esteem, insecurity, depression, antisocial and/or borderline personality traits. Not all individual with these risk factors will go on to perpetuate or become the victim of intimate partner violence, but the risk increases when certain factors are introduced. Factors such as life events and environment (living, social, school, etc.) – are what may be considered to be independent/risk/exposure variables. These variables are independent of the individual, that is, they exert influence, but are not themselves influenced. These factors may impact different individuals in different ways. For example, a stressful life event in the life of someone who is already considered at risk for IPV may be more likely to perpetrate intimate partner violence or to become a victim of it than someone who does not have those initial risk factors. How these independent variables impact the individual – their mental health, their attitude, how they feel about their life – are all what may be considered to be dependent variables. That is, these are outcomes that are subject to change depending on what outside (independent) variable is introduced. Intimate partner violence, just as many other public health concerns, is not associated with just one risk factor, but rather is the result of a combination of risk factors, some of which are dependent on others. I like to think of the different variables involved as a recipe, of sorts. A cake is going to taste quite different if instead of using a cup of sugar, you add a cup of salt by mistake. Both the sugar and salt would be the independent variables, they do the influencing. The batter it’s been added to is the mediating variable- the way the batter accepts what is added to it may be different, depending on what its base composition is. And, finally, the finished product, or the outcome, is the dependent on both the batter itself, and what has been added to it. In order to mitigate the effects of a cup of salt, public health practitioners need to anticipate the possible addition of that salt, and to be prepared to offer a way to lessen the taste of it such that the outcome isn’t affected as drastically. This antidote, so to speak, may take the shape of community interventions such as intimate partner violence awareness education for aggressors, victims, and by-standers; offering job or career counseling for people who are unemployed or underemployed, offering free or low cost mental health clinics, drug or alcohol abuse rehabilitation programs, etc. in areas where people are considered to be high risk. Interventions aimed at combating intimate partner violence must take into account of all of these different types of risk factors and the dynamics of their complex inter-relationships in order to be as successful as they can be. References
CDC Wonder Data 2010. (n.d.). Retrieved June 24, 2013, from http://wonder.cdc.gov/scripts/broker.exeIntimate Partner Violence. (2002). Retrieved June 24, 2013, from http://www.who.int/violence_injury_prevention/violence/world_report/factsheets/en/ipvfacts.pdf Friis, R. H., & Sellers, T. A. (2009). Psychologic, Behavioral, and Social Epidemiology. InEpidemiology for public health practice (4th ed., pp. 575-612). Sudbury, Mass: Jones and Bartlett Publishers.
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