Leonor Rivera-Rivera

Prevalence and determinants of male partner violence against Mexican women: a population-based study

OBJECTIVE To determine the prevalence of and risk factors for violence against women, inflicted by their male partners, in a representative sample of women residing in the metropolitan area of Cuernavaca Morelos, Mexico. MATERIAL AND METHODS A population-based study was conducted from June to September 1998, among 1,535 women aged 15 to 49 years. Principal components analysis was used to determine the domains of violence that served as the dependent variable. Polynomial logistic regression models were used to estimate odds ratios (OR), with 95% confidence intervals (CI). RESULTS Prevalence of low-moderate level violence was 35.8%, while prevalence of severe violence was 9.5%. The lifetime prevalence of reported rape was 5.9%. The main factors associated with violence were socio-economic status (OR=0.57; 95% CI=0.34-0.95); education level, both of the women studied (test for trend p=0.01) and of the male partner (test for trend p=0.002); number of years living with partner (OR=2.63; 95% CI=1.55-4.45), alcohol use (OR=2.56; 95% CI=2.02-3.25), illegal drug use by partner (OR=6.17; 95% CI=2.37-16.03); violence during childhood (OR=3.40; 95% CI=2.23-5.18), and a history of rape (OR=5.89; 95% CI=2.78-12.5). CONCLUSIONS Study findings confirm that violence against women is a prevalent phenomenon in Mexico. Awareness-raising campaigns about male partner violence should bring this important issue to the front of public discussion. Such efforts will help assure that future generations do not experience partner violence to the extent that contemporary Mexican women do.

Violencia contra la mujer: conocimiento y actitud del personal médico del Instituto Mexicano del Seguro Social, Morelos, México.

Objective. To asses the affective, cognitive, and behavioral attitudes of healthcare providers at the Mexican Institute of Social Security (MISS) in Morelos, Mexico; to identify the institutional and medical practice barriers that hinder screening and reference of battered women. Material and Methods. A cross-sectional study was conducted between September and December 1999. A self-administered questionnaire was applied to 269 general practitioners, specialists, and pre- and postdoctoral students working in 30 primary and secondary level of healthcare units in Morelos State. The data collection instrument was designed to assess healthcare providers’ knowledge of and attitudes towards domestic violence during medical office visits. A knowledge index was constructed and analyzed using multivariate regression methods. Results. Ninety percent of healthcare providers had never received training on violence against women. Healthcare providers’ affective and cognitive attitudes after receiving training on the subject matter were more favorable compared to those with no training. Favorable attitudes were directly related to the number of Mendez-Hernandez P, Valdez-Santiago R, Viniegra-Velazquez L, Rivera-Rivera l, Salmeron-Castro J. Violencia contra la mujer: conocimiento y actitud del personal medico del Instituto Mexicano del Seguro Social, Morelos, Mexico. Salud Publica Mex 2003;45;472-482. El texto completo en ingles de este articulo esta disponible en: http://www.insp.mx/salud/index.html

Escala de violencia e índice de severidad: una propuesta metodológica para medir la violencia de pareja en mujeres mexicanas

OBJECTIVE To construct and validate a scale to assess violence by the male partner against women. An index of severity of the emotional and physical damage was also designed to assess the intensity of the violent actions against women. MATERIAL AND METHODS The sample consisted of a total of 26 042 women who participated as respondents in the National Survey on Violence against Women (ENVIM per its abbreviation in Spanish) conducted in Mexico during 2003. Respondents were all users of health services provided by the Mexican government. The questionnaire was organized into 17 sections, one of which was a 27-item scale to assess partner violence. The purpose of this scale was to measure the type (physical, emotional, sexual and financial) and degree of violence based on severity. A severity index was constructed based on two procedures: 1) the validity, reliability, and factor analyses of the scale and 2) the assessment of severity by expert judges who assigned a value to each item of the scale. RESULTS The validity and reliability results indicated this scale has adequate internal validity (Cronbachs Alpha = 0.99). The factor analysis with Varimax rotation yielded a four-factor solution. The factors were: 1) Psychological violence; 2) Physical violence; 3) Severe physical violence; and 4) Sexual violence. The combination of the four factors accounted for 62.2% of the variance in the scale. Using the ratings from the judges a table of values for each of the violent actions described was obtained. The scores assigned by the judges ranged from 0 to 354. Results revealed a prevalence of 21% partner violence in the last twelve months. The prevalence of psychological violence was 18.5%; of physical violence 10.1%; severe physical violence 6.7% and sexual violence 7.0%. CONCLUSION The scale of violence described in this article is a very useful and reliable instrument to assess marital violence against women. It is suggested that this instrument be used in other settings to compare results with different samples.Objective. To construct and validate a scale to assess violence by the male partner against women. An index of severity of the emotional and physical damage was also designed to assess the intensity of the violent actions against women. Material and Methods. The sample consisted of a total of 26 042 women who participated as respondents in the National Survey on Violence against Women (ENVIM per its abbreviation in Spanish) conducted in Mexico during 2003. Respondents were all users of health services provided by the Mexican government. The questionnaire was organized into 17 sections, one of which was a 27-item scale to assess partner violence. The purpose of this scale was to measure the type (physical, emotional, sexual and financial) and degree of violence based on severity. A severity index was constructed based on two procedures: 1) the validity, reliability, and factor analyses of the scale and 2) the assessment of severity by expert judges who assigned a value to each item of the scale. Results. The validity and reliability results indicated this scale has adequate internal validity (Cronbach’s Alpha=0.99). The factor analysis with Varimax rotation yielded a four-factor solution. The factors were: 1) Psychological violence; 2) Physical violence; 3) Severe physical violence; and 4) Sexual violence. The combination of the four factors accounted for 62.2% of the variance in the scale. Using the ratings from the judges a table of values for each of the violent actions described was obtained. The scores assigned by the judges ranged from 0 to 354. Results reValdez-Santiago R, Hijar-Medina MC, Salgado de Snyder VN, Rivera-Rivera L, Avila-Burgos L, Rojas R. Escala de violencia e indice de severidad: una propuesta metodologica para medir la violencia de pareja en mujeres mexicanas. Salud Publica Mex 2006;48 supl 2:S221-S231.

Violencia durante el noviazgo, depresión y conductas de riesgo en estudiantes femeninas (12-24 años)

Objective. Determine the prevalence of dating violence and its association with depression and various risk behaviors in a sample of female students from the state of Morelos. Material and Methods. This is a baseline cohort study of a sample of 13 293 students from 12 to 24 years of age who attended public schools in the state of Morelos during the 1998-1999 school year. The participants were selected from a random sample of 260 junior high schools, 92 high schools and one university. For the purpose of this analysis, a total of 4 587 female students who had a previous dating relationship were selected. To control for possible confounding variables, multiple logistic regression analysis was used. Results. The total prevalence of dating violence in females who attended public schools in Morelos was 28%. The following variables were associated with dating violence: depression (OR= 1.92; 95%CI 1.61-2.28); tobacco smoking (OR= 1.31; 95%CI 1.06-1.60); alcohol abuse (OR= 1.30, 95%CI 1.12-1.51); poor academic performance (low grades) (OR= 1.25; 95%CI 1.03-1.52); a history of sexual relations (OR= 1.52; 95%CI 1.26-1.82).Conclusions. The results of this study clearly indicate that women experience partner violence beginning with dating during adolescence. Health and education professionals need to establish intervention strategies to prevent or treat dating violence among female students. Such strategies should take into account the association betweenOBJECTIVE Determine the prevalence of dating violence and its association with depression and various risk behaviors in a sample of female students from the state of Morelos. MATERIAL AND METHODS This is a baseline cohort study of a sample of 13 293 students from 12 to 24 years of age who attended public schools in the state of Morelos during the 1998-1999 school year. The participants were selected from a random sample of 260 junior high schools, 92 high schools and one university. For the purpose of this analysis, a total of 4 587 female students who had a previous dating relationship were selected. To control for possible confounding variables, multiple logistic regression analysis was used. RESULTS The total prevalence of dating violence in females who attended public schools in Morelos was 28%. The following variables were associated with dating violence: depression (OR = 1.92; 95% CI 1.61-2.28); tobacco smoking (OR = 1.31; 95% CI 1.06-1.60); alcohol abuse (OR = 1.30, 95% CI 1.12-1.51); poor academic performance (low grades) (OR = 1.25; 95% CI 1.03-1.52); a history of sexual relations (OR = 1.52; 95% CI 1.26-1.82). CONCLUSIONS The results of this study clearly indicate that women experience partner violence beginning with dating during adolescence. Health and education professionals need to establish intervention strategies to prevent or treat dating violence among female students. Such strategies should take into account the association between depression and violence, as well as other related risk behaviors.

Afecto, besos y condones: el ABC de las prácticas sexuales de las trabajadoras sexuales de la Ciudad de México

Objective. To describe and explore the meanings of sexual practices among female sex workers (FSW) in Mexico City. Material and Methods. A qualitative and quantitative study was carried out. The qualitative approach was conducted in 1992 and the latter from 1991 to 1992. The study population was a representative sample of FSW (n=335) who completed a questionnaire; 52 of them also participated in six focal groups. Simple frequencies, central trend, and dispersion measures were calculated. Qualitative data were interpreted using Grounded Theory and a feminist perspective. Results. Female sex workers accepted vaginal penetration with clients and oral penetration to a lesser extent, while anal penetration and kissing were rejected. All sexual modalities were accepted with personal partners. In their practice, FSW use psychophysical dissociation as a psychological defense mechanism and to construct their identities. Services requested by their latest clients were: 98.4% vaginal, 39.1% oral, and 7.7% anal sex. Condom use was reported by 94%. With their personal partner, 72.6% of FSW never used condoms. The week before the study, FSW worked 3.7±1.5 days on average and had sexual intercourse with 8.6±8.1 clients. Conclusions. Interventions are needed to promote safe sex among FSW in their private and professional lives.

Factores del abuso sexual en la niñez y la adolescencia en estudiantes de Morelos, México

OBJECTIVE To estimate the prevalence and factors associated with sexual abuse in childhood and adolescence. METHODS Study conducted in a sample of students in the state of Morelos, Mexico, in 2004-2005. Participants (n=1730) were drawn from a cohort of 13,293 students aged 12 to 24 years. Data were collected by means of a questionnaire comprising parts of validated scales. The variables studied were: sociodemographic (gender, living area, socioeconomic status), family (parental education, parental addictions, violence between parents), individual psychological factors (self-esteem assessed using the Coopersmith Self-Esteem Inventory, depression, alcohol consumption), intrafamily violence (assessed through Strauss Scale) and sexual abuse. Multiple logistic regression assessed the risk factors associated. Odds ratios (OR) with 95% confidence intervals were estimated. RESULTS Of all students studied, 4.7% (n=80) reported attempted sexual abuse and 2.9% (n=50) were victims of consummated sexual abuse. Women had higher prevalence of attempted (6.1%) abuse; 3.6% of females and 1.9% of men were sexually abused. Main perpetrators were boyfriends in women and a stranger in men. Mean age was 12.02 years old among females and 11.71 years old among men. Factors found to be associated with abuse: high parental alcohol consumption (OR = 3.37, 95% CI 1.40;8.07), violence toward the mother (OR = 4.49, 95% CI 1.54;13.10), female gender (OR = 2.47, 95% CI 1.17;5.24), being a victim of great domestic violence (OR = 3.58, 95% CI 1.32;9.67). High self-esteem was a protective factor (OR = 0.27, 95% CI 0.09;0.75). CONCLUSIONS Overall sexual abuse occurs at the age of 12 in both males and females, and it is more frequent among females. Most victims do not report abuse.OBJETIVO: Estimar a prevalencia e fatores associados ao abuso sexual infantil e na adolescencia. METODOS: Estudo realizado em amostra de estudantes do estado de Morelos, Mexico, entre 2004 e 2005. Os participantes (n=1730) pertencem a uma coorte de 13.293 estudantes de 12 a 24 anos. Os dados foram coletados por meio de questionario formado por partes de escalas validadas. As variaveis analisadas foram: fatores sociodemograficos (sexo, zona de residencia, nivel socioeconomico); familiares (educacao dos pais, vicios dos pai, violencia entre pais); psicologicos individuais (autoestima- Inventario de Autoestima de Coopersmith, depressao, consumo de alcool); violencia intrafamiliar (Escala de Strauss); e abuso sexual. As variaveis dependentes analisadas foram a intencao e o abuso sexual consumado. Os fatores associados foram analisados por meio de regressao logistica multipla, com odds ratios e respectivos intervalos de 95% de confianca (IC 95%). RESULTADOS: Do total, 4,7% (n=80) dos alunos reportaram terem sofrido intencao de abuso e 2,9% foram vitimas de abuso sexual consumado. As mulheres relataram maior prevalencia de intencao (6,1%). Foram abusados sexualmente 3,6% das mulheres e 1,9% dos homens. O principal agressor das mulheres foi o namorado e dos homens, uma pessoa desconhecida. A idade do abuso foi de 12,02 anos para mulheres e 11,71 para os homens. Os fatores associados ao abuso foi o maior consumo de alcool pelos pais (RM = 3.37; IC 95% 1.40;8.07); violencia contra a mae (OR=4.49; IC 95%1.54;13.10); ser mulher (OR= 2.47; IC 95%1.17;5.24); ser vitima de violencia intrafamiliar alta (OR=3.58; IC 95%1.32;9.67). Autoestima alta foi um fator protetor (RM=0.27; IC 95% 0.09;0.75). CONCLUSOES: A media de idade do abuso sexual foi de 12 anos em ambos os sexos, sendo mais frequente entre as do sexo feminino. A maioria das vitimas nao denuncia o abuso.

Determinantes de violencia de pareja en trabajadoras del IMSS Morelos

OBJECTIVE To study the prevalence of partner violence, and to identify the associated risk factors in a sample of female workers of IMSS (Mexican Social Security Institute), Morelos State. MATERIAL AND METHODS Cross-sectional data from 1 173 women participating in the cohort study of IMSS workers are utilized to study these associations. The study provides information on frequency of psychological, physical or sexual violence and perception of severity during the 12 months prior to the time of data collection. It was carried out in Morelos between October 1998 and March 2000. Polytomous logistic regression models were used to obtain odds ratios for different degrees of partner violence. RESULTS A high prevalence of partner violence is observed in the sample. Main factors associated with higher severity of violence are state of the relationship and alcohol intake, emotional status of the couple at home, work burden of the woman, and a history of violence in childhood. CONCLUSIONS All these factors are potentially modifiable through interventions aimed at stress reduction. These results should be considered when developing preventive programs against partner violence in Mexico.Objective. To study the prevalence of partner violence, and to identify the associated risk factors in a sample of female workers of IMSS (Mexican Social S...

Anticoncepción de emergencia en estudiantes mexicanos

Objective. To evaluate emergency contraception (EC) knowledge and use as well as identify factors associated to correct EC knowledge among public schools students in Morelos, Mexico. Material and Methods. Cross-sectional study conducted in 2003-2004 in a sample of 1 550 students (ages 14-24). Logistic regression was used to identify factors associated to EC correct knowledge. Results. Among all, 40% were men and 60% women with an average age of 19 years. Sixty percent have heard about EC, nevertheless, only 45% have correct knowledge about it; 3% of sexually active students (43%) reported its use. Factors associated to EC correct knowledge are: being a woman (OR=1.66; CI 1,33, 2,06), being sexually active (OR=1.77; CI 1,43, 2,18), middle income (OR=1.87; CI 1,04, 3,37), living in a semi-urban zone (OR=1.34; CI 1,02, 1,77), drinking alcohol (OR=1.78; CI 1,42, 2,22). Conclusions. In Morelos, adolescents’ knowledge of EC is scarce. Specific messages regarding its correct use are necessary.

Factors for sexual abuse during childhood and adolescence in students of Morelos, Mexico

OBJECTIVE To estimate the prevalence and factors associated with sexual abuse in childhood and adolescence. METHODS Study conducted in a sample of students in the state of Morelos, Mexico, in 2004-2005. Participants (n=1730) were drawn from a cohort of 13,293 students aged 12 to 24 years. Data were collected by means of a questionnaire comprising parts of validated scales. The variables studied were: sociodemographic (gender, living area, socioeconomic status), family (parental education, parental addictions, violence between parents), individual psychological factors (self-esteem assessed using the Coopersmith Self-Esteem Inventory, depression, alcohol consumption), intrafamily violence (assessed through Strauss Scale) and sexual abuse. Multiple logistic regression assessed the risk factors associated. Odds ratios (OR) with 95% confidence intervals were estimated. RESULTS Of all students studied, 4.7% (n=80) reported attempted sexual abuse and 2.9% (n=50) were victims of consummated sexual abuse. Women had higher prevalence of attempted (6.1%) abuse; 3.6% of females and 1.9% of men were sexually abused. Main perpetrators were boyfriends in women and a stranger in men. Mean age was 12.02 years old among females and 11.71 years old among men. Factors found to be associated with abuse: high parental alcohol consumption (OR = 3.37, 95% CI 1.40;8.07), violence toward the mother (OR = 4.49, 95% CI 1.54;13.10), female gender (OR = 2.47, 95% CI 1.17;5.24), being a victim of great domestic violence (OR = 3.58, 95% CI 1.32;9.67). High self-esteem was a protective factor (OR = 0.27, 95% CI 0.09;0.75). CONCLUSIONS Overall sexual abuse occurs at the age of 12 in both males and females, and it is more frequent among females. Most victims do not report abuse.OBJETIVO: Estimar a prevalencia e fatores associados ao abuso sexual infantil e na adolescencia. METODOS: Estudo realizado em amostra de estudantes do estado de Morelos, Mexico, entre 2004 e 2005. Os participantes (n=1730) pertencem a uma coorte de 13.293 estudantes de 12 a 24 anos. Os dados foram coletados por meio de questionario formado por partes de escalas validadas. As variaveis analisadas foram: fatores sociodemograficos (sexo, zona de residencia, nivel socioeconomico); familiares (educacao dos pais, vicios dos pai, violencia entre pais); psicologicos individuais (autoestima- Inventario de Autoestima de Coopersmith, depressao, consumo de alcool); violencia intrafamiliar (Escala de Strauss); e abuso sexual. As variaveis dependentes analisadas foram a intencao e o abuso sexual consumado. Os fatores associados foram analisados por meio de regressao logistica multipla, com odds ratios e respectivos intervalos de 95% de confianca (IC 95%). RESULTADOS: Do total, 4,7% (n=80) dos alunos reportaram terem sofrido intencao de abuso e 2,9% foram vitimas de abuso sexual consumado. As mulheres relataram maior prevalencia de intencao (6,1%). Foram abusados sexualmente 3,6% das mulheres e 1,9% dos homens. O principal agressor das mulheres foi o namorado e dos homens, uma pessoa desconhecida. A idade do abuso foi de 12,02 anos para mulheres e 11,71 para os homens. Os fatores associados ao abuso foi o maior consumo de alcool pelos pais (RM = 3.37; IC 95% 1.40;8.07); violencia contra a mae (OR=4.49; IC 95%1.54;13.10); ser mulher (OR= 2.47; IC 95%1.17;5.24); ser vitima de violencia intrafamiliar alta (OR=3.58; IC 95%1.32;9.67). Autoestima alta foi um fator protetor (RM=0.27; IC 95% 0.09;0.75). CONCLUSOES: A media de idade do abuso sexual foi de 12 anos em ambos os sexos, sendo mais frequente entre as do sexo feminino. A maioria das vitimas nao denuncia o abuso.

Intra-familial physical violence among Mexican and Egyptian youth

OBJECTIVE To determine the prevalence of experiencing intra-familial violence among Mexican and Egyptian youth and to describe its associated risk factors. METHODS Data from questionnaires applied to 12,862 Mexican and 5,662 Egyptian youth, aged 10 to 19, who attended public schools were analyzed. Biviarate and logistic regression analysis were used to determine the relationship between socio-demographics, the experience of intra-familial violence and violence perpetration. RESULTS The prevalence of having experienced intra-familial violence was comparable across the Mexican and Egyptian populations (14% and 17%, respectively). In Mexico, young men were more likely to have experienced such violence (OR=2.36) than women, whereas in Egypt, young women were at slightly greater risk than young men (OR=1.25). Older age, male gender and urban residence were independent correlates of experiencing intra-familial violence among Mexican youth. For Egyptian adolescents, in contrast, younger age, female gender and having non-married parents were independent correlates of victimization. Intra-familial violence victims were also more likely than non-victims to perpetrate violence (Mexico: OR=13.13; Egypt: OR=6.58). CONCLUSIONS Mexican and Egyptian youth experienced intra-familial violence at a relatively low prevalence when compared with youth of other countries. A strong association was found between experiencing intra-familial violence and perpetrating violence.