Melissa E. Dichter

Disparities in Adverse Childhood Experiences Among Individuals With a History of Military Service

IMPORTANCE Adverse childhood experiences (ACEs) are associated with several adulthood health problems, such as self-directed violence. For some individuals, enlistment in the military may be an instrumental act to escape adverse household environments; however, to our knowledge prevalence of ACEs among persons with a history of military service has not been documented in the United States using population-based data. OBJECTIVE To compare the prevalence of ACEs among individuals with and without a history of military service. DESIGN, SETTING, AND PARTICIPANTS Data are from the 2010 Behavioral Risk Factor Surveillance System. Computer-assisted telephone interviews were conducted with population-based samples of noninstitutionalized US adults from January 1 through December 31, 2010. Analyses were limited to respondents who received the ACE module (n = 60,598). Participants were categorized by history of military service and whether a respondent was 18 years of age in 1973. MAIN OUTCOMES AND MEASURES History of military service was defined by active duty service, veteran status, or training for the Reserves or National Guard. The ACE inventory assessed 11 negative experiences before the age of 18 years. Weighted χ2 tests and multiple logistic regression analyses were used to examine differences in ACEs by history of military service, era of service, and sex. RESULTS Those with military experience had greater odds of any difference in prevalence of ACEs. In the all-volunteer era, men with military service had a higher prevalence of ACEs in all 11 categories than men without military service. Notably, in the all-volunteer era, men with military service had twice the odds of reporting forced sex before the age of 18 years (odds ratio, 2.19; 95% CI, 1.34-3.57) compared with men without military service. In the draft era, the only difference among men was household drug use, in which men with a history of military service had a significantly lower prevalence than men without a history of military service (2.1% vs. 3.3%; P = .003). Fewer differences were observed among women in the all-volunteer and draft eras. CONCLUSIONS AND RELEVANCE Differences in ACEs by era and sex lend preliminary support that enlistment may serve as an escape from adversity for some individuals, at least among men. Further research is needed to understand how best to support service members and veterans who may have experienced ACEs.

Intimate Partner Violence Victimization Among Women Veterans and Associated Heart Health Risks

PURPOSE Cardiovascular disease (CVD) is the leading cause of death for women in the United States. CVD risk factors, including depression, smoking, heavy drinking, being overweight, and physical inactivity, are associated with stress and may be linked to womens experiences of intimate partner violence (IPV) victimization. We know little about IPV and CVD risk factors among veteran women. The purpose of this study was to identify the association between lifetime IPV victimization and CVD risk factors among women, accounting for veteran status. METHODS We used data from the Centers for Disease Control and Preventions Behavioral Risk Factor Surveillance System for 2006 for the eight states that included the IPV module. We explored the associations between veteran status and lifetime IPV victimization and between IPV exposure and CVD risk factors, for veteran and non-veteran women. FINDINGS Veteran women were more likely than non-veteran women to report lifetime IPV victimization (33.0% vs. 23.8%). IPV exposure was associated with depression, smoking, and heavy drinking. We did not find evidence for an association between IPV exposure and lack of exercise or being overweight or obese, when controlling for demographic characteristics and veteran status. CONCLUSION Women veterans have particularly high rates of lifetime IPV victimization. In addition, IPV victimization is associated with an increased risk of heart health risk factors. The findings suggest that we should attend to IPV exposure among veteran women and further investigate the link between IPV and military service, and the associated health impacts.

“I Didn’t Want To Put Them Through That”: The Influence Of Children on Victim Decision-making in Intimate Partner Violence Cases

For mothers, intimate partner violence (IPV) presents a concern not only for their own well-being but also for that of their children who are exposed to the violence and its aftermath. In focus groups with adult women (N = 39) across three jurisdictions who had experienced legal system intervention for IPV victimization, mothers raised unsolicited concerns about the negative effects of IPV exposure on their children. These comments were not prompted by the facilitator but were raised by women in all seven of the focus groups during discussions about motivations and barriers to participation in prosecution of their abusive partners. The overall message was that victims with children felt very conflicted. Children both facilitate and inhibit leaving the abusive relationship. Mothers wanted to spare their children from harmful effects of violence but also wanted to keep their families together and protect their children from potential agitation and instability caused by legal system involvement. Participants described how fears and threats of involvement from child protective services inhibited help-seeking while simultaneously voicing a desire for services that would help their children. More research is needed to help service providers understand the quagmire mothers who are victims of IPV encounter regarding their children’s wellbeing.

Recent and Past Intimate Partner Abuse and HIV Risk Among Young Women

OBJECTIVE To examine the associations between past intimate partner abuse experienced during adolescence (verbal and physical), recent intimate partner abuse (verbal, physical, and sexual), and HIV risk (as indicated by lack of condom use) for sexually active young adult women in relationships with male partners. DESIGN Secondary data analysis of waves II and III of the National Longitudinal Study of Adolescent Health (Add Health). SETTING The Add Health Study is a longitudinal, in-home survey of a nationally representative sample of adolescents. SAMPLE Analyses involved 2,058 sexually active young adult women. MAIN OUTCOME MEASURES HIV risk was measured by consistent condom use over the past 12 months. RESULTS Physical and verbal abuse experienced in adolescence were associated with physical/verbal abuse experienced in young adulthood. Young, sexually active women experiencing no abuse in their relationships were more likely to consistently use condoms in the past 12 months than were their abused counterparts. CONCLUSION A causal pathway may exist between prior abuse, current abuse, and HIV risk.

Women’s Perceptions of Safety and Risk Following Police Intervention for Intimate Partner Violence:

Police intervention is a primary response to intimate partner violence (IPV) but does not guarantee a victim’s future safety. This study sought to identify factors associated with IPV survivors’ perceptions of safety and risk of revictimization following police intervention. One hundred sixty-four women completed a questionnaire, and 11 of those women also took part in qualitative interviews. The findings revealed that feeling unsafe and perceiving oneself to be at risk of future violence is associated with experiencing particular forms of IPV, including battering, lethality threats, and sexual violence. Having support from others and distance from the partner helps women feel safe.

Women Veterans and Intimate Partner Violence: Current State of Knowledge and Future Directions

Intimate partner violence (IPV) is a serious public health concern for all; however, women who experience IPV are more likely to sustain injury and report adverse health consequences. An expanding body of research suggests that experience of IPV is common in women veterans (WV), particularly those who access Veterans Health Administration (VA) services. With unprecedented numbers of women serving in the military and subsequently becoming veterans, it is critical that clinicians and advocates caring for WV understand the impact of IPV on this population. WV have unique risk factors for experiencing IPV, including high rates of premilitary trauma, as well as military sexual trauma and posttraumatic stress disorder (PTSD). Correlates of IPV, traumatic brain injury (TBI) and homelessness, are common among this group. Although research on WV health and IPV is emergent, evidence suggests that IPV results in multiple health sequelae and increased healthcare utilization. In this context, we next discuss clinical and policy implications for VA. A number of targeted interventions and treatments are available for WV who experience IPV, including evidence-based mental health services. VA is well situated to implement screening programs for WV to facilitate referral to needed services and treatments available both within and outside its facilities. As the population of WV expands, future research will be needed to determine best practices; many avenues of inquiry exist. Finally, WV are strong and resilient; it is crucial that those who work with them recognize evidence of IPV and refer to needed services and evidence-based treatment to enable strength-based recovery.

Intimate Versus Nonintimate Partner Murder A Comparison of Offender and Situational Characteristics

To explore whether homicide of intimate partners is distinct from homicide of nonintimates, we compared sociodemographic, legal, family, clinical, and situational characteristics of men who murdered an intimate partner (n = 71) to those of men who murdered a nonintimate (n = 363). Bivariate findings suggest that intimate murder offenders are more socially bonded and conforming regarding employment and relationship patterns and use fatal violence to meet emotional rather than instrumental needs compared to nonintimate offenders. Multivariate findings indicate marital status, history of severe mental illness, and motive are important factors that differentiate men who murder intimates from those who murder nonintimates. Homicide prevention efforts must be tailored to account for factors that differentiate these two offender types.

Protection Orders Protect Against Assault and Injury A Longitudinal Study of Police-Involved Women Victims of Intimate Partner Violence

The objective of this study was to measure the efficacy of protection orders (POs) in reducing assault and injury-related outcomes using a matched comparison group and tracking outcomes over time. This study was a retrospective review of police, emergency department, family court, and prosecutor administrative records for a cohort of police-involved female IPV victims; all events over a 4-year study period were abstracted. Victims who obtained POs were compared with a propensity-score-based match group without POs over three time periods: Before, During, and After the issuance of a PO. Having a PO in place was associated with significantly more calls to police for nonassaultive incidents and more police charging requests that were of multiple-count and felony-level. Comparing outcomes, PO victims had police incident rates that were more than double the matched group prior to the PO but dropped to the level of the matched group during and after the order. ED visits dropped over time for both groups. This study confirmed the protective effect of POs, which are associated with reduced police incidents and emergency department visits both during and after the order and reduced police incidents compared with a matched comparison group.

Intimate Partner Violence Survivors’ Unmet Social Service Needs

ABSTRACT Women who have experienced intimate partner violence (IPV) victimization are at risk for physical and mental health problems, as well as social and economic challenges. In this cross-sectional study, 173 adult, English-speaking women who had experienced police response to IPV completed a self-report questionnaire about their use of, interest in, and need for various social services and whether or not each type of service helped (or would help) them to feel safer. More than three quarters of the participants reported a current need for health and economic support services. There was less interest in traditional IPV resources: law enforcement and domestic violence counseling or shelter. Expanding services to meet survivors’ needs for health care and economic independence may facilitate long-term safety. Recommendations for further research in this area are provided.

Explaining the IPV Arrest Decision: Incident, Agency, and Community Factors

Over the last half century in the United States, we have seen the criminal system become increasingly aggressive in its response to violence against intimate partners. Although policies have been implemented to encourage arrest, police continue to maintain discretion over whether or whom to arrest in cases of intimate partner violence (IPV). Using data from three national data sets, we examined the contributions of incident, agency, and community factors on the police arrest decisions, independently considering atypical cases of women arrested and dual arrest. The findings from this study reveal that incident factors account for the majority of the variance in arrest for single arrest cases, more so than factors associated with the particular police agency or the community in which the alleged crime occurred. The frequency of dual arrest is affected more by community factors. The findings from this study can be used to guide police training and local policies as well as to inform legislation designed to prevent variance in arrest based on sociodemographic and other extralegal factors.