Patrice A. C. Vaeth

Intimate Partner Violence Victim and Perpetrator Characteristics Among Couples in the United States

This paper describes the characteristics (sociodemographic, drinking and selected psychological attributes) of victims, perpetrators and those who engage in mutual intimate partner violence (IPV) among couples in the U.S. Subjects constitute a multistage area probability sample representative of married and cohabiting couples from the 48 contiguous United States. Results indicate that age is the only variable that appears to have a consistent effect for men and women and across violence-related statuses: Older individuals are less likely to be victims, perpetrators and less likely to be involved in mutually violent relationships. Other variables such as ethnicity, marital status, drinking, impulsivity, depression and powerlessness are either gender or status-specific in their ability to predict victimization, perpetration or victimization/perpetration. Overall, those involved in violent relationships do not appear to be very different from those not involved in violent relationships. The most likely reason for lack of this difference is the nature of IPV in general population samples, which is in most cases moderate.

Lay beliefs about high blood pressure in a low- to middle-income urban African-American community: an opportunity for improving hypertension control

PURPOSE Lay beliefs about illness are a potential barrier to improving the control of hypertension. We investigated the extent to which lay beliefs about hypertension diverge from current medical understanding. METHODS We conducted street intercept interviews and focus group discussions in six predominantly African-American census tracts in the southern sector of Dallas County, Texas. Sixty subjects, aged 18 to 67 years, were stopped along popular thoroughfares and administered a brief survey. Additionally, 107 participants were interviewed in 12 homogeneous focus groups, balanced by sex and age (18 to 74 years). Participants were asked about the meaning, causes, consequences, and treatment of high blood pressure. RESULTS The street intercept data indicated that 35% (n = 21) of respondents related high blood pressure to eating pork or other foods that makes the blood travel too fast to the head, and only 15% (n = 9) related hypertension to an elevated pressure in blood vessels. The focus group data indicated that hypertension was causally linked to eating pork in 8 of the 12 groups; was perceived as a symptomatic illness in all 12 groups; and was considered treatable with vitamins, garlic, and other herbs in 11 groups, with prescription medications in 10 groups and with lifestyle modifications such as weight loss in 8 groups. Hypertension was mentioned as a leading cause of death among African Americans in none of the 4 focus groups of 18-year-old to 29-year-old participants, in 2 of the 4 focus groups of 30-year-old to 49-year-old participants, and in 3 of the 4 focus groups of 50-year-old to 74-year-old participants. CONCLUSIONS In a low- to middle-income urban African-American community, the predominant beliefs about hypertension diverged sharply from current medical understanding. Lack of appreciation of these lay beliefs by providers may contribute to noncompliance and poor rates of hypertension control.

Factors Associated With Hypertension Awareness, Treatment, and Control in Dallas County, Texas

BACKGROUND Hypertension (HTN) control rates in the United States remain lower in black than white persons, particularly before 65 years of age. Potential sociocultural factors have not been sufficiently addressed. METHODS We analyzed data from structured interviews and blood pressure measurements in a population-based sample of 1514 hypertensive (1194 non-Hispanic black and 320 non-Hispanic white) subjects aged 18 to 64 years in Dallas County, Texas, from 2000 to 2002 to identify sociocultural factors associated with low rates of HTN control. We calculated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) using multivariate logistic regression. RESULTS Awareness, treatment, and control of HTN were negatively associated with a common perception of good health, with aORs (95% CIs) of 0.37 (0.27-0.50) for awareness, 0.47 (0.36-0.62) for treatment, and 0.66 (0.51-0.86) for control. They were positively associated with having a regular physician, with aORs (95% CIs) of 3.81 (2.86-5.07) for awareness, 8.36 (5.95-11.74) for treatment, and 5.23 (3.30-8.29) for control. Among untreated hypertensive subjects, lack of perceived need for a regular physician was associated with perceived good health (aOR [95% CI], 2.2 [1.2-4.0]), male gender (aOR [95% CI], 2.4 [1.4-4.1]), and black race/ethnicity (aOR [95% CI], 2.1 [1.0-4.4]). The HTN outcomes were unrelated to perceived racism or lay beliefs about the causes, consequences, and treatment of HTN. CONCLUSIONS Among young to middle-aged hypertensive subjects, a perception of good health and the lack of perceived need for a regular physician remain major factors associated with untreated and uncontrolled HTN at the community level-particularly among black men. These factors merit greater emphasis in professional education and public health programs on HTN.

The longitudinal and dyadic effects of mutuality on perceived stress for stroke survivors and their spousal caregivers

Objective: Functional impairment resulting from a stroke frequently requires the care of a family caregiver, often the spouse. This change in the relationship can be stressful for the couple. Thus, this study examined the longitudinal, dyadic relationship between caregivers’ and stroke survivors’ mutuality and caregivers’ and stroke survivors’ perceived stress. Method: This secondary data analysis of 159 stroke survivors and their spousal caregivers utilized a cross-lagged, mixed models analysis with the actor–partner interdependence model to examine the dyadic relationship between mutuality and perceived stress over the first year post-discharge from inpatient rehabilitation. Results: Caregivers’ mutuality showed an actor effect (β = −3.82, p < 0.0001) but not a partner effect. Thus, caregivers’ mutuality influenced ones own perceived stress but not the stroke survivors’ perceived stress. Stroke survivors’ perceived stress showed a partner effect and affected caregivers’ perceived stress (β = 0.13, p = 0.047). Caregivers’ perceived stress did not show a partner effect and did not significantly affect stroke survivors’ perceived stress. Conclusion: These findings highlight the interpersonal nature of stress in the context of caregiving for a spouse. Caregivers are especially influenced by perceived stress in the spousal relationship. Couples should be encouraged to focus on positive aspects of the caregiving relationship to mitigate stress.

Depression Among Couples in the United States in the Context of Intimate Partner Violence

This paper examines the relationship between intimate partner violence and depression. A multicluster random household sample of U.S. couples was interviewed as part of a five-year national longitudinal study (response rate = 72%). Depression was assessed with the CES-D. The multivariate analyses for men showed that the odds of depression did not vary significantly by type of male-to-female (MF) or female-to-male (FM) aggression. Men who engaged in infrequent binge drinking, compared to those who never binged, were less likely to be depressed, as were men with greater collective efficacy. For women, the multivariate analysis, showed that FM aggression (psychological: minor and severe, and physical) was associated with a greater likelihood of depression. Exposure to parental violence was also associated with depression. Women may experience depression as the result of psychological and physical aggression even if they are the perpetrators of such aggression.

The Hispanic Americans Baseline Alcohol Survey (HABLAS): Acculturation, Birthplace and Alcohol-Related Social Problems Across Hispanic National Groups.

The purpose of this study was to examine the association between acculturation, birthplace, and alcohol-related social problems across Hispanic national groups. A total of 5,224 Hispanic adults (18+ years) were interviewed using a multistage cluster sample design in Miami, New York, Philadelphia, Houston, and Los Angeles. Multivariate analysis shows no association between acculturation and problems among men or women. Birthplace is a risk factor for social problems among both genders. Among men, Mexican Americans, Puerto Ricans, and South/Central Americans are more likely to report social problems than Cuban Americans. Other risk factors for men are unemployment, a higher volume of drinking, and a higher frequency of binge drinking. Among women, Mexican American origin and binge drinking are also risk factors for reporting problems. U.S.-born Hispanics may experience stress and other detrimental effects to health because of their minority status, which may increase the likelihood of more drinking and the development of alcohol-related problems.

Alcohol-related social problems among Mexican Americans living in U.S.-Mexico border and non-border areas

This paper examines alcohol-related social problems among Mexican Americans living along the U.S.-Mexico border and in non-border areas. Interviews were conducted among Mexican Americans in the border regions of California, Arizona, New Mexico, and Texas (N=1307). Non-border respondents were interviewed primarily in Houston and Los Angeles (N=1288) as part of the Hispanic Americans Baseline Alcohol Survey (HABLAS). Both the border and HABLAS surveys employed multistage cluster sample designs (response rates were 67% and 76%, respectively). In the bivariate analysis, there were no significant differences between border and non-border areas in the proportion of those with one or more social problem. In non-border areas, the prevalence of alcohol problems did not differ significantly by age. However, along the border the prevalence of alcohol problems was significantly different across age groups, with 18 to 29year old men and women having the highest prevalence. The final models showed no residence effect on problem likelihood. Drinking was strongly associated with problems. Although young border residents had higher problem prevalence rates than older residents, the logistic regression models showed no effect of border residence on the likelihood of problems, indicating that problems are due to alcohol consumption, not the border environment. The border, however, did appear to influence more drinking among young people. Regardless of residence, alcohol treatment and preventive interventions tailored to Mexican Americans are essential and special attention should be focused on younger individuals near the border.

Epidemiology of drinking, alcohol use disorders, and related problems in US ethnic minority groups

This chapter reviews selected epidemiologic studies on drinking and associated problems among US ethnic minorities. Ethnic minorities and the White majority group exhibit important differences in alcohol use and related problems, including alcohol use disorders. Studies show a higher rate of binge drinking, drinking above guidelines, alcohol abuse, and dependence for major ethnic and racial groups, notably, Blacks, Hispanics, and American Indians/Alaskan Natives. Other problems with a higher prevalence in certain minority groups are, for example, cancer (Blacks), cirrhosis (Hispanics), fetal alcohol syndrome (Blacks and American Indians/Alaskan Natives), drinking and driving (Hispanics, American Indians/Alaskan Natives). There are also considerable differences in rates of drinking and problems within certain ethnic groups such as Hispanics, Asian Americans, and American Indians/Alaskan Natives. For instance, among Hispanics, Puerto Ricans and Mexican Americans drink more and have higher rates of disorders such as alcohol abuse and dependence than Cuban Americans. Disparities also affect the trajectory of heavy drinking and the course of alcohol dependence among minorities. Theoretic accounts of these disparities generally attribute them to the historic experience of discrimination and to minority socioeconomic disadvantages at individual and environmental levels.

Alcohol use among Mexican American U.S.-Mexico border residents: Differences between those who drink and who do not drink in Mexico

The predominately Hispanic U.S.-Mexico border population is at an elevated risk for drinking and associated problems due to the areas low SES, poor services infrastructure, and drug-related violence. Among Mexican American residents, recent studies suggest this risk is particularly pronounced among younger age groups, and a key characteristic of this elevated risk involves crossing the border to drink in Mexico (where the legal drinking age is 18). However, few studies have compared the drinking behavior of U.S. residents who consume alcohol on the Mexico side of the border with those who do not. We address this gap in the present study. A multistage household probability sample of 1307 Mexican American border residents was interviewed about their drinking and associated problems over the past year. The survey response rate was 67%. Among current drinkers who reported going to Mexico in the past 12 months (N=468), 36.1% reported consuming alcohol in Mexico. Those who drank in Mexico reported significantly more drinks per week (12.8 versus 8.7, p<.05), were more likely to have binged (58.3% versus 35.4%, p<.001), and were more likely to report one or more alcohol problem (35.5% versus 19.5%, p<.01) than those who did not drink in Mexico. Among those who drank in Mexico, men reported significantly more drinks per day while in Mexico than women (6.2 versus 4.0, p<.001). Male gender and lower income were significant predictors of drinking in Mexico. These findings suggest that drinking in Mexico contributes to the heightened risk for drinking and associated problems seen in previous research among Mexican Americans living on the U.S.-Mexico border.

The dimensionality of DSM5 alcohol use disorder in Puerto Rico.

AIMS TO Test the dimensionality and measurement properties of lifetime DSM-5 AUD criteria in a sample of adults from the metropolitan area of San Juan, Puerto Rico. DESIGN Cross-sectional study with survey data collected in 2013-2014. SETTING General population. PARTICIPANTS Random household sample of the adult population 18 to 64years of age in San Juan, Puerto Rico (N=1510; lifetime drinker N=1107). MEASUREMENT DSM-5 alcohol use disorder (2 or more criteria present in 12months). RESULTS Lifetime reports of AUD criteria were consistent with a one-dimensional model. Scalar measurement invariance was observed across gender, but measurement parameters for tolerance varied across age, with younger ages showing a lower threshold and steeper loading. CONCLUSIONS Results provide support for a unidimensional DSM-5 AUD construct in a sample from a Latin American country.