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Physical Violence and Injuries in Intimate Relationships -- New York, Behavioral Risk Factor Surveillance System, 1994

Women are more likely than men to sustain injuries and to require medical attention as a result of physical violence in an intimate relationship (1). To determine the prevalence of physically violent acts by intimate partners, injuries, and the use of medical services for injuries sustained from intimate partner physical violence, the New York State Department of Health (NYSDH) analyzed data from the 1994 Behavioral Risk Factor Surveillance System (BRFSS). This report summarizes the analysis of these findings, which indicate that women are more likely to be injured than men and that their injuries are underreported.

The BRFSS is a population-based, random-digit-dialed telephone survey of the noninstitutionalized U.S. population aged greater than or equal to 18 years. In 1994, seven additional questions about intimate-partner violence (i.e., spouse, partner, or ex-partner) were added to New York's BRFSS survey. Data were weighted to reflect the 1994 New York population, and 95% confidence intervals (CIs) were calculated using SUDAAN.

Overall, 692 women and 546 men aged 18-44 years were interviewed. Among women, 43 (5.6% {95% CI=3.8%-7.4%}) reported being the victim of a physically violent act by an intimate partner during the preceding year. Of women reporting such violence, 26 (57.7% {95% CI=41.0%-74.4%}) reported being shoved, grabbed, or slapped; 17 (42.3% {95% CI=25.6%-59.0%}) reported being kicked, bitten, punched, or beaten or threatened/assaulted with a knife, gun, or other object. In comparison, 29 (6.9% {95% CI=4.0%-9.8%}) men reported physical violence by an intimate partner, of whom 13 (47.7% {95% CI=25.8%-69.6%}) reported more severe forms of violence.

Injuries as a result of the most recent violent act by an intimate partner were more prevalent among women than men. Among women reporting physical violence by an intimate partner, 23 (53.6% {95% CI=36.9%-70.3%}) reported injuries to their head or face or injuries causing pain on other parts of the body lasting longer than 1 hour; four (12.4% {95% CI=0-26.0%}) men who experienced physical violence reported being injured. During the 12 months preceding the survey, medical attention to treat injuries sustained from such violence was sought by seven (19.6% {95% CI=5.4%-33.8%}) women and two (7.6% {95% CI=0-19.1%}) men. Among women reporting less severe violent acts by an intimate partner, two (8.9% {95% CI=0-21.9%}) reported seeking medical care for violence-related injuries; among women reporting more severe violence, five (34.1% {95% CI=7.8%-60.4%}) reported seeking medical attention for injuries.

Among both sexes, the prevalence of reported physical violence was higher among younger persons. Among women aged 18-30 years, 6.7% (95% CI=3.7%-9.7%) reported being victims of physical violence by an intimate partner, compared with 4.6% (95% CI=2.4%-6.8%) of women aged 31-44 years. Among men aged 18-30 years, 10.2% (95% CI=5.0%-15.4%) reported physical violence by an intimate partner compared with 3.5% (95% CI=1.4%-5.6%) of men aged 31-44 years.

Violence by intimate partners was reported by persons of all income levels, educational backgrounds, and marital statuses. Among women, being a victim of physical violence was more common for those who reported annual household incomes less than $15,000 (9.6% {95% CI=4.5%-14.7%}) than among those with incomes $15,000-$35,000 (6.6% {95% CI=2.5%-10.7%}) and incomes greater than or equal to $35,000 (4.4% {95% CI=1.8%-7.0%}). The association between income level and physical violence was similar for men.

Among women, 4.6% (95% CI=2.1%-7.1%) with a high school education or less reported physical violence, compared with 6.4% (95% CI=3.8%-9.0%) reporting at least some college or technical school education. Men with a high school education or less reported intimate partner physical violence more frequently (8.7% {95% CI=4.0%-13.4%}) than men with at least some college or technical school education (5.3% {95% CI=1.9%-8.7%}).

Married women were least likely to report violence by an intimate partner (2.7% {95% CI=0.7%-4.7%}), followed by single/widowed women (6.9% {95% CI=3.9%-9.9%}), divorced women (9.7% {95% CI=0.1%-19.3%}), and separated women (17.1% {95% CI=3.7%-30.5%}). The association between marital status and physical violence was similar for men.

Reported by: G Hale-Carlsson, MPH, Office of Health Systems Management; B Hutton, MPH, J Fuhrman, Bur of Injury Prevention; D Morse, MD, State Epidemiologist, New York State Dept of Health; L McNutt, PhD, School of Public Health, State Univ of New York at Albany; A Clifford, New York State Office for the Prevention of Domestic Violence, Albany, New York. Family and Intimate Violence Prevention Team, Div of Violence Prevention, National Center for Injury Prevention and Control, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that although reported violent acts appeared similar for women and men, women reported substantially more injuries than men as a result of intimate-partner physical violence. In addition, this report underscores that injuries to women from intimate-partner physical violence are underestimated when based on reports from emergency departments and physicians' offices. Estimates from a recent emergency department survey indicate that 23% of women who had been physically assaulted or emotionally abused by a boyfriend or husband sought medical care because of trauma, and only 13% had told staff or were asked by staff about domestic violence (2). Because women presenting for health care may be hesitant to admit they are victims of intimate-partner violence, broadening of inquiries about violence to all female patients has been advocated by professional organizations (3).

The findings in the report are subject to at least five limitations. First, questions about injuries were limited to the most recent violent incident, thus potentially underestimating the total number of injuries a person received. Second, injury questions focused on head and face injuries, which are the more common sites of injury (4). Third, assessment of the severity of injuries was not conducted. As a result, the survey could not determine whether multiple injuries were sustained during a single event, whether outpatient or inpatient care was needed, and whether medical care was needed but not sought. Fourth, the circumstances under which intimate physical violence occurred were not assessed. For example, the survey could not determine the extent to which 1) violence perpetrated against male partners by women was in self defense or in direct response to violence initiated by the male partner and 2) whether the violent incident reported was isolated or part of a repeated cycle of physical violence (5,6). Finally, data were based on self-report of physical violence occurring in the context of fights or arguments only and are not necessarily representative of ongoing patterns of control and abuse. To better characterize violence among intimate partners, additional studies should focus not only on the number and types of violent acts but also on violence-related injuries, symptoms of psychological stress, and other acute and chronic sequelae that may result from such violence (7).

NYSDH is funding several programs to address intimate-partner violence, including four demonstration projects to model effective methods for reducing violence and training for physicians and clinicians in identifying and helping victims of abuse. In addition, because primary-care and emergency-department clinicians are likely to see victims of physical violence through visits related to the violence or for routine care (7,8), the New York State Department of Health, in collaboration with the New York State Office for the Prevention of Domestic Violence and the Medical Society of the State of New York, developed a physician's reference card (based on American Medical Association guidelines) to assist physicians in recognizing and treating victims of domestic violence. Copies of the physician's reference card are available from the Bureau of Injury Prevention, New York State Department of Health, telephone (518) 473-1143.

References

  1. Cascardi M, Langhinrichsen J, Vivian D. Marital aggression: impact, injury, and health correlates for husbands and wives. Arch Intern Med 1992;152:1178-84.

  2. Abbott J, Johnson R, Koziol-McLain J, Lowenstein SR. Domestic violence against women: incidence and prevalence in an emergency department population. JAMA 1995;273:1763-7.

  3. Council on Scientific Affairs, American Medical Association. Violence against women: relevance for medical practitioners. JAMA 1992;267:3184-9.

  4. Stark E, Flitcraft A, Zuckerman D, Grey A, Robison J, Frazier W. Wife abuse in the medical setting: an introduction for health personnel. Rockville, Maryland: National Clearinghouse on Domestic Violence, 1981. (Monograph no. 7).

  5. Strauss MA, Gelles RJ. How violent are American families? In: Strauss MA, Gelles RJ, eds. Physical violence in American families: risk factors and adaptations to violence in 8,145 families. New Brunswick, New Jersey: Transaction Publishers, 1990:95-112.

  6. Stark E, Flitcraft A. Violence among intimates: an epidemiologic review. In: Van Hasselt, ed. Handbook of family violence. New York: Plenum Press, 1988:293-317.

  7. McCauley J, Kern DE, Kolodner K, et al. The "battering syndrome:" prevalence and clinical characteristics of domestic violence in primary care internal medicine practices. Ann Intern Med 1995;123:737-46.

  8. Drossman DA, Leserman J, Nachman G, et al. Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med 1990;113:828-33.

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