The Epidemiology of Domestic ViolenceKey PointsDefinition of ViolenceDefining Domestic ViolenceWho is Affected by Domestic Violence?Data SourcesWhich surveillance system is likely to provide the best estimates for domestic violence?Surveillance in Domestic ViolenceMedical SourcesDefinition of Health Care Events Related to Domestic ViolenceState Based ReportingState-based Programs Related to Domestic ViolenceGovernment SurveysSurveys Related to Domestic ViolenceWhat do we know about Child Maltreatment?Epidemiology of Child AbuseTypes of MaltreatmentSlide 18The Pyramid of Child Maltreatment in Pennsylvania, 1994What do we know about Violence Against Women?Terminology of IPVWho is an intimate?Slide 23IPVWHO Multi-country Study on Women’s Health and Domestic Violence against WomenSlide 26Trends in the rates of violent victimizations by intimates*, United States, 1992 - 1996Possible Risk FactorsWhat do we know about Elder Abuse?Research MethodsWhoWhat is Your Outcome?Physical InjuryPsychological InjuryWhat is your exposure?How are You Going to Measure It?Key Lecture PointsThe Epidemiology of Domestic ViolenceThomas Songer, PhDCristie Glasheen, MPHUniversity of PittsburghKey Points1. What is being measured?2. What is NOT being measured?3. How does this affect the results?Definition of ViolenceHow would you define domestic violence?…...To understand violence, you need to define violenceDefining Domestic ViolenceDefining Domestic Violence•domestic violencedomestic violencenoun:noun: violence committed by one member violence committed by one member of a family or household against anotherof a family or household against another•The National Research Council defines The National Research Council defines violence as:violence as:- behaviour by individuals that intentionally - behaviour by individuals that intentionally threaten, attempt, or inflict physical harm threaten, attempt, or inflict physical harm on others on othersWho is Affected by Domestic Violence?Who is Affected by Domestic Violence?•ChildrenChildren•Intimate Partners (IP)Intimate Partners (IP)•EldersEldersData SourcesData Sources You are planning to do a study of domestic violence You are planning to do a study of domestic violence using pre-existing data.using pre-existing data.Where would you look?Where would you look?•Medical sourcesMedical sources•State sources State sources •Government surveysGovernment surveysWhich surveillance system is likely to provide the best estimates for domestic violence?Surveillance in Domestic Violence•Hospital Admissions•Trauma Center Admissions•Emergency Department Admissions•State-based Reporting Systems•Government Surveys–National Criminal Victimization Survey–National Incidence Survey–Behavioral Risk Factor Survey–National Violence Against Women SurveyMedical SourcesMedical Sources•Hospital RecordsHospital Records•Trauma Center Trauma Center RecordsRecords•Emergency Emergency DepartmentDepartmentRecommended: Rudman WJ. Coding and Documentation of Domestic Violence.December, 2000. Available at: http://endabuse.org/programs/healthcare/files/codingpaper.pdfDefinition of Health Care Events Related to Domestic Violence•Based on N-codes and E-codes–995.80 to 995.85 adult physical abuse–995.50 child abuse–E coding to distinguish domestic violence is relatively poor–E967.xState Based ReportingState Based Reporting•State-based ReportingState-based Reporting–Child Protective ServicesChild Protective Services–Uniform Crime ReportsUniform Crime Reports–National Incident-Based Reporting System National Incident-Based Reporting System (NIBRS)(NIBRS)–Supplementary Homicide Report (SHR)Supplementary Homicide Report (SHR)State-based Programs Related to Domestic Violence•Based on reporting to state agencies–most frequently for child maltreatment–definition of violence is not standard across the states–reporting is subject to knowledge of the issues to medical, educational, and legal personnelGovernment SurveysGovernment Surveys•Government SurveysGovernment Surveys–National Crime Victimization Survey (NCVS)National Crime Victimization Survey (NCVS)–National Violence Against Women Survey (NVAW)National Violence Against Women Survey (NVAW)Surveys Related to Domestic Violence•Self-report of violence based upon interviews–Aside from the NCVS, these surveys are not regularly collected–Definition of violence in surveys is not standard–There may be extensive under-reporting of violenceWhat do we know aboutChild Maltreatment?Epidemiology of Child AbuseEpidemiology of Child Abuse•Maltreatment Maltreatment –““behavior towards another person, which a) is outside behavior towards another person, which a) is outside the norms of conduct, and b) entails a substantial risk the norms of conduct, and b) entails a substantial risk of causing physical or emotional harm” of causing physical or emotional harm” »Physical AbusePhysical Abuse»Sexual AbuseSexual Abuse»Emotional & Psychological AbuseEmotional & Psychological Abuse»NeglectNeglectTypes of Maltreatment•Physical abuse: physical acts by a parent, guardian or caretaker that caused physical injury to the child.•Neglect (including medical neglect): the failure by the caretaker to provide needed, age-appropriate care (or provide for the health care) of the child.•Sexual abuse: the involvement of a child in incest, or sexual assault by a relative or caretaker, includes fondling and exposure to indecent acts.010002000300040005000600070008000900076 78 80 82 84 86 88 90 92 94Substantiated Cases of Child Maltreatment,Pennsylvania, 1976-1994The Pyramid of Child Maltreatment in Pennsylvania, 199453 deaths33 head injuries56 trauma center admissions177 hospital admissions2115 ED visits7,038 substantiated cases64,560 maltreatment eventsWhat do we know about Violence Against Women?Terminology of IPVTerminology of IPV•Intimate Partner Violence (IPV) – relatively new term•Also called: domestic violence, domestic abuse, spousal abuse, battery, violence against womenWho is an intimate?NCVS SHR NVAWSSpouse Husband/wife SpouseEx-spouse Ex-husband/ex-wife Ex-spouseCommon-law husband or wifeCohabitating partnerBoyfriend/girlfriend Boyfriend/girlfriend Boyfriend/girlfriendEx-boyfriend/ex-girlfriendSame sex relationship Same sex relationship DateStudySampleSizeDefinition and MethodTraumafrom AbuseOne yearPrevalenceLifetimePrevalenceMcCauley 1952Physical and sexual abuse