- Email: [email protected]
Population surveillance for physical violence among adult men and women, Montana 1998
Population Surveillance for Physical Violence Among Adult Men and Women, Montana 1998 Todd S. Harwell, MPH, Michael R. Spence, MD, MPH Background: Few epidemiologic studies of physical violence or intimate partner violence provide population-based surveillance data. Objectives:
To estimate the prevalence and describe the characteristics associated with physical violence among adult men and women in the past year.
Methods:
A random sample of Montana households was contacted via the Behavioral Risk Factor Surveillance System telephone survey in 1998 (N⫽1804).
Results:
Five percent of men (39/787) and 3% of women (33/1017) reported experiencing physical violence in the past year. Among respondents reporting physical violence in the past year, women were more likely than men to report that the perpetrator was a current/former partner (58% vs 10%, pⱕ0.05). Women were also more likely to report that the most recent incident occurred in their homes (58%) as compared to men (13%, pⱖ0.05). Men who reported experiencing physical violence in the past year were more likely to be younger and not to be living with a current partner. Women who reported experiencing physical violence in the past year were more likely to be younger, not currently living with a partner, have no health insurance, and have more days with mental health problems in the past month.
Conclusions: Recent physical violence is common for both men and women; however, the perpetrators, locations, and demographic characteristics differ. Further study is needed to better understand the factors associated with physical violence among men and women in the context of designing and implementing appropriate interventions to reduce violence. Medical Subject Headings: adult, domestic violence, population surveillance, risk factors, violence (Am J Prev Med 2000;19(4):321–324) © 2000 American Journal of Preventive Medicine
Introduction
P
hysical violence is a major public health concern in the United States. Population-based prevalence estimates of physical violence in the past year among adults have ranged from 6% to 8%.1–3 Recent population-based studies regarding intimate partner violence (IPV) toward women4 –7 in the past year provide estimates of 0.3% to 6%. Surveillance for physical violence and IPV is important to assess the extent of these issues and trends. However, relatively few epidemiologic studies (cited above) of physical violence or IPV provide population-based surveillance data in the United States (state or national).1–7 In addition, few studies have described the characteristics
From the Montana Department of Public Health and Human Services, Helena, Montana Address correspondence and reprint requests to: T.S. Harwell, MPH, Montana Department of Public Health and Human Services, Cogswell Bldg., C317, P.O. Box 202951, Helena MT 59620-2951. E-mail: [email protected].
of men and women who report experiencing recent physical violence.1–3 In 1998, the Montana Department of Public Health and Human Services (DPHHS) initiated surveillance for physical violence among adult men and women utilizing the Behavioral Risk Factor Surveillance System survey (BRFSS). The objectives of this effort were to estimate the prevalence and describe the characteristics of adult men and women who reported experiencing physical violence in the past year.
Methods The Montana DPHHS conducted the BRFSS telephone survey of Montanans in 1998. The methodology used in the BRFSS surveys has been described previously.8 Briefly, trained interviewers made telephone calls to a random sample of households within Montana. Persons aged ⱖ18 years were eligible to participate in the survey and a total of 1804 surveys were completed. The nonresponse rate (refusal, eligible respondent not available, unable to communicate because of
Am J Prev Med 2000;19(4) 0749-3797/00/$–see front matter © 2000 American Journal of Preventive Medicine • Published by Elsevier Science Inc. PII S0749-3797(00)00240-3
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a physical/mental impairment or language barrier) for the survey was 10%. The BRFSS survey included questions regarding demographics, health status, and physical violence. The demographic questions included age, gender, household income, employment, health insurance status, living status, and years of education. Respondents who reported being married or part of an unmarried couple were categorized as currently living with a partner, and those reporting that they were divorced, widowed, separated, or never married were categorized as not currently living with a partner. The health status questions included the following: “Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?” and “Now thinking about your mental health, which includes stress depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?” Respondents were asked a series of questions regarding physical violence. These questions and response categories included the following: “Within the past year, have you been hit, slapped, kicked, raped, or otherwise physically hurt by someone?” (yes, no, don’t know/not sure, refuse to answer); “On the most recent occasion, who was the person who did this to you?” (current or former spouse; current or former boyfriend/girlfriend or date; son or daughter; another relative; a friend or acquaintance; someone you work with; a stranger; someone else; don’t know/not sure; refuse); “On the most recent occasion, where did the violence take place?” (your home; someone else’s home; restaurant, bar, or tavern; at work; at school; outside on the street; some other place; don’t know/not sure; refuse); and “On the most recent occasion, did you receive injuries that had to be treated by a doctor, nurse, chiropractor, dentist, or other health care provider?” (yes; no; don’t know/not sure; refuse). Data analyses were completed using SPSS v8.0 software (Chicago, IL). Crude unweighted prevalence estimates for physical violence in the past year (outcome variable) were calculated. Pearson chi-square and Fisher exact tests were used to compare the characteristics of men and women who reported experiencing physical violence in the past year. Bivariate analyses and logistic regression analyses were conducted separately for men and women to identify variables associated with physical violence in the past year.
Results Of the 1804 respondents, 56% were women (n⫽1017) and 44% men (n⫽787). The mean ages of women and men were 48.8 years (SD⫽18.6) and 46.8 years (SD⫽17.4), respectively. The majority of respondents were Caucasian (96%), currently employed (62%), had ⬎12 years of education (90%), had health insurance (84%), and were living with a partner (57%). Twentyone percent of respondents had a household income of ⬍$20,000. The majority of respondents reported no days with physical (70%) or mental health problems (72%) in the past month. Table 1 displays the characteristics of respondents by gender. Men were significantly more likely to be cur322
Table 1. Characteristics of respondents by gender, Montana, 1998 (N⫽1804)
Age (years) 18–34 ⱖ35 Employed* Yes No Household income* ⬍$20,000 ⱖ$20,000 Don’t know/refused Health insurance Yes No Living status Do not live with partner Live with partner Years of education ⬍12 ⱖ12 Days where physical health was not good (past month) ⱖ1 0 Days where mental health was not gooda (past month) ⱖ1 0
Men (nⴝ787)
Women (nⴝ1017)
#
#
(%)
(%)
204 (26) 582 (74)
255 (25) 760 (75)
542 (69) 245 (31)
570 (56) 447 (44)
137 (17) 477 (61) 173 (22)
234 (23) 517 (51) 266 (26)
647 (82) 140 (!8)
864 (85) 153 (15)
317 (40) 468 (60)
451 (44) 566 (56)
84 (11) 703 (89)
95 (9) 921 (91)
219 (28) 561 (72)
318 (32) 674 (68)
160 (21) 612 (79)
336 (34) 649 (66)
*pⱕ0.05.
rently employed, have a household income of over $20,000, and to report no days with mental health problems in the past month. Overall, 4% (95% confidence interval [CI] 3–5) of respondents reported experiencing physical violence in the past year (72/1804). Five percent of men (39/787; 95% CI 3–7) and three percent of women (33/1017; 95% CI 1–5) reported physical violence in the past year (p⫽0.07). Among respondents reporting physical violence in the past year, women were more likely than men to report that the perpetrator was a current or former spouse, boyfriend, girlfriend or date (58% vs 10%) as compared to some other person (42% vs 90%, p⬍0.05). Women were also more likely to report that the most recent incident occurred in the home (58%) compared to men (13%, p⬍0.05). Women reporting physical violence in the past year were more likely to receive treatment for their injuries from the most recent incident as compared to men (15% vs 8%); however, the difference was not statistically significant (p⬎0.05) (data not shown). Men and women who reported experiencing physical violence in the past year were more likely to be younger, have a lower household income, have no health insurance, not be currently married or living with a partner, have ⬍12 years of education, and had more days with mental
American Journal of Preventive Medicine, Volume 19, Number 4
Table 2. Characteristics of respondents reporting physical violence in the past year by gender, Montana, 1998 (N⫽1804)
Age (years) 18–34 ⱖ35 Employed No Yes Household income ⬍$20,000 ⱖ$20,000 Don’t know/Refused Health insurance No Yes Living status Do not live with partner Live with partner Years of education ⬍12 ⱖ12 Days where physical health was not good (past month) ⱖ1 0 Days where mental health was not good (past month) ⱖ1 0
Men (nⴝ787) Physical violence in past year Yes No # (%) # (%)
OR (95% CI)
Women (nⴝ1017) Physical violence in past year Yes No # (%) # (%)
OR (95% CI)
27 (69) 12 (23)
177 (24) 570 (76)
7.25 (3.60 – 14.60) —
20 (61) 13 (39)
235 (24) 747 (76)
4.89 (2.40 ⫾ 9.98) —
14 (36) 25 (64)
231 (31) 517 (69)
1.25 (0.64 – 2.55) —
12 (36) 21 (64)
435 (44) 549 (56)
0.72 (0.35 – 1.48) —
12 (31) 17 (44) 10 (26)
125 (17) 460 (62) 163 (22)
2.60 (1.13 – 5.91) — 1.66 (0.69 – 3.92)
14 (42) 12 (36) 7 (21)
220 (22) 505 (51) 259 (26)
2.68 (1.15 – 6.29) — 1.14 (0.40 – 3.15)
14 (36) 25 (64)
126 (17) 622 (83)
2.76 (1.32 – 5.72) —
14 (42) 19 (58)
139 (91) 845 (86)
4.48 (2.07 – 9.62) —
32 (82) 7 (18)
285 (38) 461 (62)
7.39 (3.22 – 16.98) —
26 (78) 7 (21)
425 (14) 559 (57)
4.89 (2.10 – 11.36) —
9 (23) 30 (77)
75 (10) 673 (90)
2.69 (1.23 – 5.89) —
7 (21) 26 (79)
88 (9) 895 (91)
2.74 (1.16 – 6.49) —
16 (41) 23 (59)
203 (27) 538 (73)
1.84 (0.96 – 3.56) —
13 (39) 20 (61)
305 (32) 654 (68)
1.39 (0.68 – 2.83) —
16 (42) 22 (58)
144 (20) 590 (80)
2.98 (1.53 – 5.82) —
21 (64) 12 (36)
315 (22) 637 (67)
3.54 (1.72 – 7.29) —
OR, odds ratio; CI, confidence interval
health problems in the past month compared to men and women not experiencing physical violence (Table 2). Logistic regression analyses were used to identify factors independently associated with physical violence in the past year among men and women. Two factors were associated with physical violence among men in the past year: age 18 to 34 (odds ratio [OR] 4.88, 95% CI 2,20 –10.81) and not currently living with a partner (OR 3.72, 95% CI 1.52–9.1 1). Among women, four factors were independently associated with physical violence in the past year: age 18 to 34 (OR 3.22, 95% CI 1.53– 6.78), not having health insurance (OR 2.04, 95% CI 1.39 – 6.68), not currently living with a partner (OR 3.50, 95% CI 1.36 – 8.99), and more than 1 day in the past month where they felt that their mental health status was not good (OR 2.54, 95% CI 1.19 –5.42).
Discussion The objectives of this study were to estimate the prevalence and describe the characteristics of adult men and women reporting physical violence in the past year. The prevalence of self-reported physical violence in the past year was similar for men and women. However, the
perpetrators, locations, and demographic characteristics of respondents who reported experiencing physical violence differed by gender. The limitations of this study and the implications of these findings are discussed below. Our findings suggest that physical violence is common among adult Montanans. Our prevalence estimate is comparable to the other population-based studies assessing physical violence in the past year among men and women.1–3 Based on our prevalence estimates, approximately 23,000 adult Montanans (based on the 1990 adult census population of 576,065) experienced some form of physical violence in the past year, and over 2300 sought medical attention for their injuries.9 We found that the perpetrators of physical violence toward women were more likely to be current or former partners, while the perpetrators among men were other persons, which concurs with previous studies.1–3 Other studies that support our findings have found that persons reporting physical violence in the past year were more likely to be younger and not be currently living with a partner.1–3,6 Women reporting physical violence were more likely to report recently having more days with mental health problems, while this was not found among men. This result concurs with previAm J Prev Med 2000;19(4)
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ous studies of women who were victims of IPV.10,11 In addition, a larger proportion of women than men reporting recent physical violence sought medical attention for injuries received as a result of this violence. This finding has been reported previously.1,3 Our findings support previous studies showing that women are more likely to be victims of IPV. Further study is needed to describe the characteristics and potential differences (e.g., frequency of events and situations where events occur) between men and women who have experienced recent physical violence. There are a number of limitations to these analyses. First, the survey was conducted by telephone and does not reflect the experience of individuals in Montana homes without telephones. Therefore the prevalence of physical violence may be underestimated since households without telephones were excluded. Our sample of respondents, however, was representative of the overall Montana adult population (1990 Census) by age (aged 18 –34, 25% vs 24%) and Caucasian race (96% vs 93%), respectively.9 A larger proportion of the telephone respondents compared to the 1990 census population had a household income of ⬍$20,000 (21 % vs 17%) and were women (56% vs 50%), respectively. Second, adults who declined to participate in the survey may be more likely to be victims of physical abuse. However, our nonresponse rate for the survey was relatively low (10%). Respondents may not have reported experiencing events that were extremely physically or psychologically traumatic. Alternatively, we may have overestimated the extent of injury if respondents with more than one event were more likely to recall events that were more serious. Third, self-reported physical violence was used in these analyses, which raises concerns about reliability and validity. Little is know, regarding the reliability and validity of selfreported physical violence and further study is warranted. In addition, our question assessing physical violence included multiple types of violent events, thereby limiting our ability to assess different forms of physical violence. Finally, our ability to detect differences between male and female respondents reporting physical violence in the past year was limited by our overall sample size. Establishing local, state, and national surveillance for physical violence is important to describe the extent of this problem, monitor future trends, and begin to develop interventions and services to address it. We found that it is feasible to integrate questions assessing recent physical violence within the BRFSS survey. A strength of this study was that we included survey items to assess the perpetrators, location, and severity of injury among both men and women reporting recent physical violence. However, our questions differ some-
324
what from the violence-related questions developed for the BRFSS survey by the Centers for Disease Control and Prevention. Consequently, comparisons of our estimates to those of other states are problematic. This highlights the need to develop a consensus on standard definitions of physical violence for surveillance purposes. Our findings indicate that men and women experience physical violence differently. Women were more likely to be victims of physical violence perpetrated by an intimate partner, while the perpetrators for men were more likely to be some other person. Potentially different interventions and services may be needed for men and women who experience physical violence. However, two variables—younger age and not currently living with a partner—were associated with recent physical violence for both men and women, suggesting that not all interventions need to be gender-specific. Further study is needed to better understand the factors associated with physical violence among men and women in the context of designing and implementing appropriate interventions to reduce violence. We would like to thank Linda Priest and the staff members at Northwest Resource Consultants for their expertise and work on the telephone survey.
References 1. Potter LB, Sacks JJ, Kresnow MJ, Mercy J. Nonfatal physical violence, United States, 1994. Public Health Rep 1999;114(4):343–52. 2. Forjuoh SN, Kinnane JM, Coben JH, Dearwater SR, Songer TJ. Victimization from physical violence in Pennsylvania: prevalence and health care use. Acad Emerg Med 1997;4(11):1052– 8. 3. National Institute of Justice and the Centers for Disease Control and Prevention. Prevalence, incidence and consequences of violence against women: findings from the National Violence Against Women Survey. Washington, DC: U.S. Department of Justice, Office of Justice Programs, National Institute of Justice, Nov 1998. 4. Centers for Disease Control and Prevention. Physical violence in intimate partner relationships—New York, Behavioral Risk Factor Surveillance System, 1994. MMWR Morb Mort Wkly Rep 1996;45(35):765– 67. 5. Wilt S, Olson S. Prevalence of domestic violence in the United States. J Am Med Wom Assoc 1996;51(3):77– 82. 6. Schafer J, Caetano R, Clark CL. Rates of intimate partner violence in the United States. Am J Public Health 1998;88(11):1702– 4. 7. Centers for Disease Control and Prevention. Lifetime and annual incidence of intimate partner violence and resulting injuries—Georgia, 1995. MMWR Morb Mort Wkly Rep 1998;47(40):849 –53. 8. Remington PL, Smith MY, Williamson DF, Anda RF, Gentry EM, Hogelin GC. Design, characteristics, and usefulness of state-based behavioral risk factor surveillance: 1981–1987. Public Health Rep 1988;103:366 –75. 9. U.S. Department of Commerce. 1990 population and housing, summary tape file 3A. Washington, DC: U.S. Department of Commerce, Economic and Statistics Administration, Bureau of the Census, 1990. 10. Campbell J, Kub JE, Roso L. Depression in battered women. J Am Med Wom Assoc 1996;51:106 –10. 11. Drossman DA, Talley NJ, Leserrnan J, Olden KW, Barreiro MA. Sexual and physical abuse and gastrointestinal illness: review and recommendations. Ann Intern Med 1995;123(10):782–94.
American Journal of Preventive Medicine, Volume 19, Number 4
To estimate the prevalence and describe the characteristics associated with physical violence among adult men and women in the past year.
Methods:
A random sample of Montana households was contacted via the Behavioral Risk Factor Surveillance System telephone survey in 1998 (N⫽1804).
Results:
Five percent of men (39/787) and 3% of women (33/1017) reported experiencing physical violence in the past year. Among respondents reporting physical violence in the past year, women were more likely than men to report that the perpetrator was a current/former partner (58% vs 10%, pⱕ0.05). Women were also more likely to report that the most recent incident occurred in their homes (58%) as compared to men (13%, pⱖ0.05). Men who reported experiencing physical violence in the past year were more likely to be younger and not to be living with a current partner. Women who reported experiencing physical violence in the past year were more likely to be younger, not currently living with a partner, have no health insurance, and have more days with mental health problems in the past month.
Conclusions: Recent physical violence is common for both men and women; however, the perpetrators, locations, and demographic characteristics differ. Further study is needed to better understand the factors associated with physical violence among men and women in the context of designing and implementing appropriate interventions to reduce violence. Medical Subject Headings: adult, domestic violence, population surveillance, risk factors, violence (Am J Prev Med 2000;19(4):321–324) © 2000 American Journal of Preventive Medicine
Introduction
P
hysical violence is a major public health concern in the United States. Population-based prevalence estimates of physical violence in the past year among adults have ranged from 6% to 8%.1–3 Recent population-based studies regarding intimate partner violence (IPV) toward women4 –7 in the past year provide estimates of 0.3% to 6%. Surveillance for physical violence and IPV is important to assess the extent of these issues and trends. However, relatively few epidemiologic studies (cited above) of physical violence or IPV provide population-based surveillance data in the United States (state or national).1–7 In addition, few studies have described the characteristics
From the Montana Department of Public Health and Human Services, Helena, Montana Address correspondence and reprint requests to: T.S. Harwell, MPH, Montana Department of Public Health and Human Services, Cogswell Bldg., C317, P.O. Box 202951, Helena MT 59620-2951. E-mail: [email protected].
of men and women who report experiencing recent physical violence.1–3 In 1998, the Montana Department of Public Health and Human Services (DPHHS) initiated surveillance for physical violence among adult men and women utilizing the Behavioral Risk Factor Surveillance System survey (BRFSS). The objectives of this effort were to estimate the prevalence and describe the characteristics of adult men and women who reported experiencing physical violence in the past year.
Methods The Montana DPHHS conducted the BRFSS telephone survey of Montanans in 1998. The methodology used in the BRFSS surveys has been described previously.8 Briefly, trained interviewers made telephone calls to a random sample of households within Montana. Persons aged ⱖ18 years were eligible to participate in the survey and a total of 1804 surveys were completed. The nonresponse rate (refusal, eligible respondent not available, unable to communicate because of
Am J Prev Med 2000;19(4) 0749-3797/00/$–see front matter © 2000 American Journal of Preventive Medicine • Published by Elsevier Science Inc. PII S0749-3797(00)00240-3
321
a physical/mental impairment or language barrier) for the survey was 10%. The BRFSS survey included questions regarding demographics, health status, and physical violence. The demographic questions included age, gender, household income, employment, health insurance status, living status, and years of education. Respondents who reported being married or part of an unmarried couple were categorized as currently living with a partner, and those reporting that they were divorced, widowed, separated, or never married were categorized as not currently living with a partner. The health status questions included the following: “Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?” and “Now thinking about your mental health, which includes stress depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?” Respondents were asked a series of questions regarding physical violence. These questions and response categories included the following: “Within the past year, have you been hit, slapped, kicked, raped, or otherwise physically hurt by someone?” (yes, no, don’t know/not sure, refuse to answer); “On the most recent occasion, who was the person who did this to you?” (current or former spouse; current or former boyfriend/girlfriend or date; son or daughter; another relative; a friend or acquaintance; someone you work with; a stranger; someone else; don’t know/not sure; refuse); “On the most recent occasion, where did the violence take place?” (your home; someone else’s home; restaurant, bar, or tavern; at work; at school; outside on the street; some other place; don’t know/not sure; refuse); and “On the most recent occasion, did you receive injuries that had to be treated by a doctor, nurse, chiropractor, dentist, or other health care provider?” (yes; no; don’t know/not sure; refuse). Data analyses were completed using SPSS v8.0 software (Chicago, IL). Crude unweighted prevalence estimates for physical violence in the past year (outcome variable) were calculated. Pearson chi-square and Fisher exact tests were used to compare the characteristics of men and women who reported experiencing physical violence in the past year. Bivariate analyses and logistic regression analyses were conducted separately for men and women to identify variables associated with physical violence in the past year.
Results Of the 1804 respondents, 56% were women (n⫽1017) and 44% men (n⫽787). The mean ages of women and men were 48.8 years (SD⫽18.6) and 46.8 years (SD⫽17.4), respectively. The majority of respondents were Caucasian (96%), currently employed (62%), had ⬎12 years of education (90%), had health insurance (84%), and were living with a partner (57%). Twentyone percent of respondents had a household income of ⬍$20,000. The majority of respondents reported no days with physical (70%) or mental health problems (72%) in the past month. Table 1 displays the characteristics of respondents by gender. Men were significantly more likely to be cur322
Table 1. Characteristics of respondents by gender, Montana, 1998 (N⫽1804)
Age (years) 18–34 ⱖ35 Employed* Yes No Household income* ⬍$20,000 ⱖ$20,000 Don’t know/refused Health insurance Yes No Living status Do not live with partner Live with partner Years of education ⬍12 ⱖ12 Days where physical health was not good (past month) ⱖ1 0 Days where mental health was not gooda (past month) ⱖ1 0
Men (nⴝ787)
Women (nⴝ1017)
#
#
(%)
(%)
204 (26) 582 (74)
255 (25) 760 (75)
542 (69) 245 (31)
570 (56) 447 (44)
137 (17) 477 (61) 173 (22)
234 (23) 517 (51) 266 (26)
647 (82) 140 (!8)
864 (85) 153 (15)
317 (40) 468 (60)
451 (44) 566 (56)
84 (11) 703 (89)
95 (9) 921 (91)
219 (28) 561 (72)
318 (32) 674 (68)
160 (21) 612 (79)
336 (34) 649 (66)
*pⱕ0.05.
rently employed, have a household income of over $20,000, and to report no days with mental health problems in the past month. Overall, 4% (95% confidence interval [CI] 3–5) of respondents reported experiencing physical violence in the past year (72/1804). Five percent of men (39/787; 95% CI 3–7) and three percent of women (33/1017; 95% CI 1–5) reported physical violence in the past year (p⫽0.07). Among respondents reporting physical violence in the past year, women were more likely than men to report that the perpetrator was a current or former spouse, boyfriend, girlfriend or date (58% vs 10%) as compared to some other person (42% vs 90%, p⬍0.05). Women were also more likely to report that the most recent incident occurred in the home (58%) compared to men (13%, p⬍0.05). Women reporting physical violence in the past year were more likely to receive treatment for their injuries from the most recent incident as compared to men (15% vs 8%); however, the difference was not statistically significant (p⬎0.05) (data not shown). Men and women who reported experiencing physical violence in the past year were more likely to be younger, have a lower household income, have no health insurance, not be currently married or living with a partner, have ⬍12 years of education, and had more days with mental
American Journal of Preventive Medicine, Volume 19, Number 4
Table 2. Characteristics of respondents reporting physical violence in the past year by gender, Montana, 1998 (N⫽1804)
Age (years) 18–34 ⱖ35 Employed No Yes Household income ⬍$20,000 ⱖ$20,000 Don’t know/Refused Health insurance No Yes Living status Do not live with partner Live with partner Years of education ⬍12 ⱖ12 Days where physical health was not good (past month) ⱖ1 0 Days where mental health was not good (past month) ⱖ1 0
Men (nⴝ787) Physical violence in past year Yes No # (%) # (%)
OR (95% CI)
Women (nⴝ1017) Physical violence in past year Yes No # (%) # (%)
OR (95% CI)
27 (69) 12 (23)
177 (24) 570 (76)
7.25 (3.60 – 14.60) —
20 (61) 13 (39)
235 (24) 747 (76)
4.89 (2.40 ⫾ 9.98) —
14 (36) 25 (64)
231 (31) 517 (69)
1.25 (0.64 – 2.55) —
12 (36) 21 (64)
435 (44) 549 (56)
0.72 (0.35 – 1.48) —
12 (31) 17 (44) 10 (26)
125 (17) 460 (62) 163 (22)
2.60 (1.13 – 5.91) — 1.66 (0.69 – 3.92)
14 (42) 12 (36) 7 (21)
220 (22) 505 (51) 259 (26)
2.68 (1.15 – 6.29) — 1.14 (0.40 – 3.15)
14 (36) 25 (64)
126 (17) 622 (83)
2.76 (1.32 – 5.72) —
14 (42) 19 (58)
139 (91) 845 (86)
4.48 (2.07 – 9.62) —
32 (82) 7 (18)
285 (38) 461 (62)
7.39 (3.22 – 16.98) —
26 (78) 7 (21)
425 (14) 559 (57)
4.89 (2.10 – 11.36) —
9 (23) 30 (77)
75 (10) 673 (90)
2.69 (1.23 – 5.89) —
7 (21) 26 (79)
88 (9) 895 (91)
2.74 (1.16 – 6.49) —
16 (41) 23 (59)
203 (27) 538 (73)
1.84 (0.96 – 3.56) —
13 (39) 20 (61)
305 (32) 654 (68)
1.39 (0.68 – 2.83) —
16 (42) 22 (58)
144 (20) 590 (80)
2.98 (1.53 – 5.82) —
21 (64) 12 (36)
315 (22) 637 (67)
3.54 (1.72 – 7.29) —
OR, odds ratio; CI, confidence interval
health problems in the past month compared to men and women not experiencing physical violence (Table 2). Logistic regression analyses were used to identify factors independently associated with physical violence in the past year among men and women. Two factors were associated with physical violence among men in the past year: age 18 to 34 (odds ratio [OR] 4.88, 95% CI 2,20 –10.81) and not currently living with a partner (OR 3.72, 95% CI 1.52–9.1 1). Among women, four factors were independently associated with physical violence in the past year: age 18 to 34 (OR 3.22, 95% CI 1.53– 6.78), not having health insurance (OR 2.04, 95% CI 1.39 – 6.68), not currently living with a partner (OR 3.50, 95% CI 1.36 – 8.99), and more than 1 day in the past month where they felt that their mental health status was not good (OR 2.54, 95% CI 1.19 –5.42).
Discussion The objectives of this study were to estimate the prevalence and describe the characteristics of adult men and women reporting physical violence in the past year. The prevalence of self-reported physical violence in the past year was similar for men and women. However, the
perpetrators, locations, and demographic characteristics of respondents who reported experiencing physical violence differed by gender. The limitations of this study and the implications of these findings are discussed below. Our findings suggest that physical violence is common among adult Montanans. Our prevalence estimate is comparable to the other population-based studies assessing physical violence in the past year among men and women.1–3 Based on our prevalence estimates, approximately 23,000 adult Montanans (based on the 1990 adult census population of 576,065) experienced some form of physical violence in the past year, and over 2300 sought medical attention for their injuries.9 We found that the perpetrators of physical violence toward women were more likely to be current or former partners, while the perpetrators among men were other persons, which concurs with previous studies.1–3 Other studies that support our findings have found that persons reporting physical violence in the past year were more likely to be younger and not be currently living with a partner.1–3,6 Women reporting physical violence were more likely to report recently having more days with mental health problems, while this was not found among men. This result concurs with previAm J Prev Med 2000;19(4)
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ous studies of women who were victims of IPV.10,11 In addition, a larger proportion of women than men reporting recent physical violence sought medical attention for injuries received as a result of this violence. This finding has been reported previously.1,3 Our findings support previous studies showing that women are more likely to be victims of IPV. Further study is needed to describe the characteristics and potential differences (e.g., frequency of events and situations where events occur) between men and women who have experienced recent physical violence. There are a number of limitations to these analyses. First, the survey was conducted by telephone and does not reflect the experience of individuals in Montana homes without telephones. Therefore the prevalence of physical violence may be underestimated since households without telephones were excluded. Our sample of respondents, however, was representative of the overall Montana adult population (1990 Census) by age (aged 18 –34, 25% vs 24%) and Caucasian race (96% vs 93%), respectively.9 A larger proportion of the telephone respondents compared to the 1990 census population had a household income of ⬍$20,000 (21 % vs 17%) and were women (56% vs 50%), respectively. Second, adults who declined to participate in the survey may be more likely to be victims of physical abuse. However, our nonresponse rate for the survey was relatively low (10%). Respondents may not have reported experiencing events that were extremely physically or psychologically traumatic. Alternatively, we may have overestimated the extent of injury if respondents with more than one event were more likely to recall events that were more serious. Third, self-reported physical violence was used in these analyses, which raises concerns about reliability and validity. Little is know, regarding the reliability and validity of selfreported physical violence and further study is warranted. In addition, our question assessing physical violence included multiple types of violent events, thereby limiting our ability to assess different forms of physical violence. Finally, our ability to detect differences between male and female respondents reporting physical violence in the past year was limited by our overall sample size. Establishing local, state, and national surveillance for physical violence is important to describe the extent of this problem, monitor future trends, and begin to develop interventions and services to address it. We found that it is feasible to integrate questions assessing recent physical violence within the BRFSS survey. A strength of this study was that we included survey items to assess the perpetrators, location, and severity of injury among both men and women reporting recent physical violence. However, our questions differ some-
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what from the violence-related questions developed for the BRFSS survey by the Centers for Disease Control and Prevention. Consequently, comparisons of our estimates to those of other states are problematic. This highlights the need to develop a consensus on standard definitions of physical violence for surveillance purposes. Our findings indicate that men and women experience physical violence differently. Women were more likely to be victims of physical violence perpetrated by an intimate partner, while the perpetrators for men were more likely to be some other person. Potentially different interventions and services may be needed for men and women who experience physical violence. However, two variables—younger age and not currently living with a partner—were associated with recent physical violence for both men and women, suggesting that not all interventions need to be gender-specific. Further study is needed to better understand the factors associated with physical violence among men and women in the context of designing and implementing appropriate interventions to reduce violence. We would like to thank Linda Priest and the staff members at Northwest Resource Consultants for their expertise and work on the telephone survey.
References 1. Potter LB, Sacks JJ, Kresnow MJ, Mercy J. Nonfatal physical violence, United States, 1994. Public Health Rep 1999;114(4):343–52. 2. Forjuoh SN, Kinnane JM, Coben JH, Dearwater SR, Songer TJ. Victimization from physical violence in Pennsylvania: prevalence and health care use. Acad Emerg Med 1997;4(11):1052– 8. 3. National Institute of Justice and the Centers for Disease Control and Prevention. Prevalence, incidence and consequences of violence against women: findings from the National Violence Against Women Survey. Washington, DC: U.S. Department of Justice, Office of Justice Programs, National Institute of Justice, Nov 1998. 4. Centers for Disease Control and Prevention. Physical violence in intimate partner relationships—New York, Behavioral Risk Factor Surveillance System, 1994. MMWR Morb Mort Wkly Rep 1996;45(35):765– 67. 5. Wilt S, Olson S. Prevalence of domestic violence in the United States. J Am Med Wom Assoc 1996;51(3):77– 82. 6. Schafer J, Caetano R, Clark CL. Rates of intimate partner violence in the United States. Am J Public Health 1998;88(11):1702– 4. 7. Centers for Disease Control and Prevention. Lifetime and annual incidence of intimate partner violence and resulting injuries—Georgia, 1995. MMWR Morb Mort Wkly Rep 1998;47(40):849 –53. 8. Remington PL, Smith MY, Williamson DF, Anda RF, Gentry EM, Hogelin GC. Design, characteristics, and usefulness of state-based behavioral risk factor surveillance: 1981–1987. Public Health Rep 1988;103:366 –75. 9. U.S. Department of Commerce. 1990 population and housing, summary tape file 3A. Washington, DC: U.S. Department of Commerce, Economic and Statistics Administration, Bureau of the Census, 1990. 10. Campbell J, Kub JE, Roso L. Depression in battered women. J Am Med Wom Assoc 1996;51:106 –10. 11. Drossman DA, Talley NJ, Leserrnan J, Olden KW, Barreiro MA. Sexual and physical abuse and gastrointestinal illness: review and recommendations. Ann Intern Med 1995;123(10):782–94.
American Journal of Preventive Medicine, Volume 19, Number 4