Intimate partner violence, sexual violence, and child maltreatment have a significant effect on public health. Victims of violence can experience physical injury; adverse mental health consequences such as depression, anxiety, and low self-esteem; and harmful physical health consequences such as suicide attempts, cardiovascular disease, and substance abuse. Any of these consequences can lead to hospitalization, disability, or death.

Intimate partner violence is actual or threatened physical, sexual, psychological, or emotional abuse by a current or former spouse (including common-law spouse), dating partner, or boyfriend or girlfriend. Intimate partners can be of the same or opposite sex. Nearly 25% of women have been raped and/or physically assaulted by an intimate partner and more than 40% of the women who experience partner rapes and physical assault sustain a physical injury. Women experience more chronic and injurious assaults from intimate partner violence than men.

Sexual violence is committed by an intimate or non-intimate perpetrator such as a spouse, family member, person in position of power or trust, friend, acquaintance, or stranger. Although there is some overlap between intimate partner violence and sexual violence, sexual violence is committed by a wider range of perpetrators. Sexual violence includes completed or attempted sex acts against the victim’s will or involving a victim who is unable to consent; abusive sexual contact; and non-contact sexual abuse, including sexual harassment. Women are the primary victims of sexual violence. Approximately 15% to 25% of women experience an attempted or completed rape at some time in their lives. More than half of the women reporting rape are sexually assaulted before age 18.

Child maltreatment is any recent act or failure to act resulting in imminent risk of death, serious physical or emotional harm, sexual abuse, or exploitation of a child by a parent or caretaker who is responsible for the child’s welfare. Much of the child maltreatment field divides child maltreatment into four categories: physical abuse, child neglect, sexual abuse, and emotional abuse (e.g., psychological or verbal abuse; mental injury). In the United States, child protective services identify more than 825,000 children annually as victims of maltreatment. Childhood exposure to maltreatment, parental violence, and other adverse experiences is associated with risky behaviors, such as smoking, overeating, suicidal behavior, and perpetrating youth and intimate partner violence, and with negative health outcomes such as heart disease and cancer.

These three types of violence are interrelated. They share common risk and protective factors and often co-occur within the same households.

Elder abuse is an emerging problem that may usefully be studied alongside intimate partner violence, sexual violence, and child maltreatment. Although data are poor, the best national estimate is that nearly 450,000 people ages 60 and older experienced abuse and/or neglect in domestic settings in 1996. Of these cases of abuse, only 16% (nearly 71,000) were reported to and substantiated by Adult Protective Service (APS) agencies; the remaining 379,000 were either not reported to APS or not substantiated.

The Injury Center’s Niche in Preventing Intimate Partner Violence, Sexual Violence, and Child Maltreatment

Many agencies and organizations have developed programs to prevent violence against women and children. As noted in the Institute of Medicine report Reducing the Burden of Injury, however, very few of these programs have been evaluated rigorously to assess their effectiveness and to determine which among them merit widespread adoption. CDC’s Injury Center provides leadership in developing and assessing the effectiveness of violence prevention programs and policies.

Numerous federal agencies conduct research about many aspects of intimate partner violence, sexual violence, and child maltreatment. In its work, the Injury Center emphasizes research with direct implications for prevention. This research perspective complements the work of other federal agencies. For example, the Injury Center’s focus on identifying ways to prevent the development of perpetration of intimate partner violence, sexual violence, and child maltreatment complements the U.S. Department of Justice’s focus on persons already charged with violent offenses associated with these behaviors. The Injury Center’s focus on applied dimensions of prevention in these areas complements the National Institutes of Health’s focus on basic scientific questions.

Currently, efforts to prevent or intervene in intimate partner violence, sexual violence, and child maltreatment focus on reducing victims’ risks for future violence and on mitigating the consequences of exposures to such violence. The field is dominated, therefore, by an emphasis on secondary and tertiary prevention strategies tailored to victims. Many leaders in the field are calling for greater attention to primary prevention of intimate partner violence, sexual violence, and child maltreatment. To prevent these types of violence from occurring in the first place, researchers and practitioners must place greater emphasis on approaches directed at perpetrators and potential perpetrators. Many questions, especially about young perpetrators, remain unanswered, seriously hindering the development and identification of effective violence prevention strategies. Thus, even though research on perpetration is still in the foundational stage, it is essential that the Injury Center focus on perpetration research to support future development of effective prevention programs. Parallel efforts must continue to prevent re-victimization.

The Injury Center’s Research Priorities in Preventing Intimate Partner Violence, Sexual Violence, and Child Maltreatment

Every research priority in this agenda is important. After considering input from experts in the field, Injury Center staff identified the seven most important priorities, those that warrant the greatest attention and intramural and extramural resources from the Injury Center over the next three to five years. They are designated with asterisks.

Research has shown that parenting interventions can reduce and prevent child maltreatment. For these interventions to reach the broadest audience possible, more applied research about their dissemination and implementation is necessary. For example, a program’s effectiveness may vary depending on the setting in which it is delivered; research should examine the impact of delivering parenting programs in a variety of specific settings, such as the work place and primary care settings, and through the media. Research to guide the adaptation of interventions to specific communities, subcultures, and populations will further enhance their effectiveness.

Victims of child maltreatment are at risk for other types of violence later in life, including youth violence, suicide, and intimate partner violence. Therefore, it is plausible that parenting interventions may also reduce the likelihood of experiencing these other types of violence.

The key to preventing intimate partner violence, sexual violence, and child maltreatment is to intervene with individuals, families, and communities in ways that stop the perpetration of violent behaviors. Programs and policies that provide counseling for batterers, improve parenting skills, or prevent dating violence, for example, intervene with perpetrators and potential perpetrators before the violence occurs or recurs. Research should focus on evaluating these programs and policies with a particular emphasis on those that attempt to address two or more types of perpetration simultaneously. Identifying programs and policies that can effectively address multiple types of perpetration will facilitate a more efficient allocation of prevention resources. Further, large public demand exists for effective programs and policies in this area.

C.* Identify social norms that support intimate partner violence, sexual violence, and child maltreatment and evaluate strategies to change them.

Research has demonstrated the importance of changing social norms to reduce major public health problems such as smoking and HIV. In some social contexts, intimate partner violence, sexual violence, and child maltreatment are considered normative behavior. To design effective interventions, researchers must first identify the particular social norms and beliefs that support these types of violence and then find ways to alter or replace them with ones that prevent violence. Even when such violent behaviors are not considered "acceptable," cultural attitudes and beliefs may exacerbate these problems by blaming victims or by supporting attitudes and behaviors that create social atmospheres conducive to, or tolerant of, such violence. Given CDC’s role in addressing the contribution of social norms to other public health problems, the Injury Center—as part of CDC—is well-positioned to address this research opportunity. Research about social norms related to intimate partner violence, sexual violence, and child maltreatment will also apply to other forms of violence.

D.* Evaluate training programs about intimate partner violence, sexual violence, child maltreatment, and elder abuse for health professionals.

According to the Institute of Medicine, programs to train health professionals about intimate partner violence, sexual violence, child maltreatment, and elder abuse have received insufficient attention and evaluation. Few studies investigate whether curricula have the desired impact on delivery of health care to victims. Evaluation research is needed to determine the impact of training programs on the practices of health professionals as well as their effects on victims. Factors that affect the development, implementation, and maintenance of such programs include the nature of accreditation, licensure, and certification; characteristics of health professional organizations; views of the stakeholder groups; attitudes of health professionals; and the existence of mandatory laws and education requirements. It is also important to consider whether a health professional’s own experience with violence may influence his or her response to victims and to identify training strategies that account for that influence.

E.* Evaluate the health consequences of intimate partner violence, sexual violence, and child maltreatment victimization across the life span.

Research has linked intimate partner violence, sexual violence, and child maltreatment to a wide range of negative health outcomes and risk behaviors. However, little information exists about the mechanisms that may be responsible for these negative outcomes or the factors that may diminish them. Further understanding of the relationship between victimization and various health outcomes is important to guide interventions. Research in this area will guide development of interventions tailored to victims’ needs.

Ultimately, the cause of and responsibility for intimate partner violence, sexual violence, and child maltreatment lie with the perpetrators. Programs and policies that address the needs of victims (including same-sex victims), while critically important, fail to address the root causes for the behaviors that lead to the violence. However, important knowledge about these root causes is lacking. To understand how the propensity to behave violently toward partners and children develops, researchers must follow study populations for extended periods. A better understanding of the developmental pathways and social circumstances that contribute to perpetration will greatly enhance the development of effective primary prevention programs and guide refinement of existing prevention programs. Research about the development of perpetration may also apply more broadly to areas of youth violence and suicide prevention because of their association with intimate partner violence, sexual violence, and child maltreatment.

Few data are available to monitor intimate partner violence, sexual violence, and child maltreatment, and those that exist are of questionable validity and reliability; better tracking and monitoring methods are necessary to support prevention efforts. To develop better surveillance systems, research should determine the sensitivity and specificity of alternative definitions, the utility of alternative surveillance methodologies, and the validity and reliability of the specific measures. Biomechanics research may be useful in diagnosing intimate partner violence and child maltreatment, identifying specific injuries that are highly predictive of these types of violence and establishing appropriate case definitions. Data sources for information about intimate partner violence, sexual violence, and child maltreatment differ to some extent, so evaluation of the methods for each must frequently be done independently. Improved surveillance methods will render better information to guide program development and evaluation. Because states and localities often lack adequate monitoring systems, research findings will be particularly valuable to them as they expand their efforts to address violence as a public health issue.

Dissemination of research findings is especially important to guide prevention and intervention activities, but little research to assess alternative dissemination strategies has been done in the violence prevention field. Moreover, information dissemination activities present many opportunities for collaboration with agencies and organizations working to prevent intimate partner violence, sexual violence, and child maltreatment. It is important to identify and evaluate methods to facilitate collaboration across advocacy, consumer, research, and practice settings in conducting dissemination. Encouraging collaboration among these groups is necessary to maintain the public’s interest and meet policy makers’ need for information to guide development of appropriate policies, legislation, and litigation procedures.

The prominence of the Rape Prevention and Education Grant Program (RPE), administered by the Injury Center, presents a unique opportunity to test models of dissemination through the sexual violence service infrastructure. The RPE distributes funds to states to support sexual violence prevention services and programs. It is crucial that state programs have access to and distribute the most up-to-date information. Research should identify the most effective strategies for translating and disseminating knowledge about sexual violence victimization and perpetration.

Federal, state, and local government agencies and private organizations currently invest many resources in services for battered and sexually assaulted women and maltreated children. It is critically important to determine the effectiveness of these programs and policies in preventing victimization and its consequences. This type of research can help agencies and organizations that provide victim services determine whether their investments actually reduce violence and maltreatment.

Intimate partner violence, sexual violence, and child maltreatment often overlap in families, so evaluating the effectiveness of programs and policies that address two or more of these behaviors simultaneously is of high priority. Identifying programs that can effectively address multiple types of victimization (including same-sex violence) at once will facilitate a more efficient allocation of prevention resources. One area requiring particular attention is the evaluation of screening instruments for intimate partner violence, sexual violence, and child maltreatment used in health care and social service settings to identify victims needing additional services.

Collaboration among various members of a community and various groups working in intimate partner violence, sexual violence, and child maltreatment prevention is essential to preventing such violence. Expanding prevention research to include the development of integrated community responses to these public health problems will significantly advance prevention and intervention research. Further development of integrated community responses depends largely on advances in effectiveness research about specific prevention policies and interventions.

The Injury Center’s mission of violence prevention emphasizes primary prevention of intimate partner violence, sexual violence, and child maltreatment. Currently, many research efforts focus on secondary or tertiary prevention, that is, preventing revictimization. Research is needed to identify the different risk and protective factors related to victimization in order to prevent first-time victimization. In addition, research should explore the commonalities and differences among risk factors for victimizations involving these kinds of violence.

To understand the characteristics that place people at risk of victimization, researchers must follow study populations for extended periods. Longitudinal research helps researchers specify optimal times and methods for intervention and prevention. For example, research indicates that early exposure to violence in the home can lead to future risk of victimization. Identifying potential moderators will aid in designing prevention programs. Longitudinal research can also identify patterns of coping and resilience across the life span for victims of intimate partner violence, sexual violence, and child maltreatment; this information can enhance prevention and intervention activities. As with preventing perpetration, a better understanding of the risk factors associated with victimization would greatly enhance the development of effective primary prevention programs.

Elder abuse is an emerging area of public health concern. As the population ages, this form of abuse may become a much greater problem. Little research about risk and protective factors for elder abuse victimization and perpetration currently exists. Risk factors appear to differ according to the type of elder abuse; physical and psychological abuse, for example, share risk factors that are distinct from those for neglect and financial abuse. Absent important foundational research, program development is difficult. Similarly, little information is available about the effectiveness of existing interventions to prevent elder abuse and mitigate its consequences. Given the limited body of scientific knowledge about elder abuse, this is an important priority for the future.

Researchers do not clearly understand the roles of substance use and abuse as precursors to and consequences of victimization and perpetration across intimate partner violence, sexual violence, and child maltreatment. Studies investigating substance use and its co-occurrence with perpetration of and victimization by these types of violence should identify key components for prevention and intervention programs. Other federal agencies such as the National Institute of Drug Abuse and the Substance Abuse and Mental Health Services Administration support research and programs in this area. Injury Center research activities should complement the efforts of these agencies whenever possible.

Natural and man-made disasters such as floods and terrorism may exacerbate intimate partner violence, sexual violence, and child maltreatment in affected communities. Research should assess the impact of community and environmental stressors on these three types of violence. Findings from this research can aid service agencies as they develop appropriate responses during periods of extreme stress. Injury Center research on this issue would complement other CDC work related to disaster response and terrorism.

Better information about service delivery use, impact, and costs of interventions for intimate partner violence, sexual violence, and child maltreatment is needed to support research about the cost effectiveness of interventions and policies designed to prevent these problems and their consequences. This research will become more important as more information about the efficacy and effectiveness of prevention programs and policies becomes available.

This page last reviewed September 07, 2006.

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