Factors Affecting Initial Intimate Partner Violence–Specific Health Care Seeking in the Tokyo Metropolitan Area,Japan

Abstract

This study examined the factors affecting a women’s initial intimate partner violence (IPV)-specific health care seeking event which refers to the first health care seeking as a result of IPV in a lifetime. Data were collected using the Life History Calendar method in the Tokyo metropolitan area from 101 women who had experienced IPV. Discrete-time survival analysis was used to assess the time to initial IPV-specific health care seeking. IPV-related injury was the most significant factor associated with increased likelihood of seeking IPV-specific health care seeking for the first time. In the presence of a strong effect of formal help seeking, physical and sexual IPV were no longer significantly related to initial IPV-specific health care seeking. The results suggest some victims of IPV may not seek health care unless they get injured. The timing of receiving health care would be important to ensure the health and safety of victims.

Keywords

domestic violence battered women health care seeking Japan

Introduction

Intimate partner violence (IPV) in Japan had long been considered a private matter rather than a social problem or crime (Yoshihama, 2002). The general public and policy makers in Japan did not pay attention to IPV as a social issue until the early 1990s (Kozu, 1999; Yoshihama, 1999). Since that time, there have been some social changes and improvements as a result of social transitions (Kozu, 1999) and efforts by non-governmental organizations (Yoshihama, 2005). These transitions led to further policy and legal changes to prevent IPV. The governmental report entitled the Gender Equality Plan for 2000 was issued in 1996 (Yoshihama, 2005). In 1997, the Tokyo Metropolitan Government conducted the first population-based study on IPV in Japan. Finally, the Act on the Prevention of Spousal Violence and the Protection of Victims was enacted in 2001 to provide information and assistance to victims of IPV.

A multi-national study conducted by the World Health Organization (WHO) found that the lifetime prevalence of IPV in Japan (12.9% for physical violence, 6.2% for sexual violence, and 15.4% for physical and/or sexual violence) was lower than that of other countries, which ranged from 22.8% to 48.7% for physical violence, from 6.3% to 49.7% for sexual violence, and from 23.7% to 70.9% for physical and/or sexual violence (Garcia-Moreno, Jansen, Ellsberg, Heise, & Watts, 2006).

The most recent national survey conducted by the Cabinet Office of the Japanese government found that 10.8% of the randomly sampled women had experienced physical, sexual, and/or emotional IPV multiple times in their lives (Gender Equality Bureau, 2009). Of these women, approximately a third (30%) talked about their experiences of IPV victimization with their relatives or friends, only 3% sought help from health care professionals, about 35% had been physically injured or had psychological problems, and about 53% did not seek any help.

As found in other countries (Campbell, 2002; Golding, 1999), Japanese women who had a history of IPV are more likely to have psychological distress symptoms, suicidal ideation, poorer self-rated health status, difficulty walking and performing their usual activities compared with those who do not have a history of IPV (Yoshihama, Horrocks, & Kamano, 2009). Health care may be beneficial for Japanese women who have experienced IPV. For example, Nemoto, Rodriguez, and Mkandawire-Valhmu (2008) interviewed 15 Japanese women who had a history of IPV to analyze their perspectives of the benefits of health care utilization for IPV-related health problems. The women indicated that empathy and understanding from health care professionals, professional intervention, and flexible arrangement of appointment and assistance were helpful in dealing with their partner’s violence.

Factors Affecting IPV-Specific Health Care Seeking

Health problems do not always cause health care seeking. But perceived or actual health need is one of factors that are associated with health care seeking (Andersen, 1995). Higher risks of IPV victimization are associated with poorer health status (Plichta, 2004). Injury is one of the consequences from IPV that increases the likelihood of seeking health care (Duterte et al., 2008). Duterte and colleagues (2008) examined how different types of IPV affected health care seeking and found that women who had experienced only psychological IPV were less likely to seek health care than those who had experienced sexual IPV. The severity of physical IPV was associated with health care seeking. These findings of previous studies point to the importance of examining the effect of specific types of IPV on the probability of seeking health care.

Seeking formal and informal help may be a factor that can impact IPV-specific health care seeking. Higher levels of informal social support may reduce the impact of IPV on health problems (Coker, Watkins, Smith, & Brandt, 2003). While social support may improve health, it may also increase the probability of health care seeking because informal and formal social support can assist women’s taking action, such as seeking help from formal sources (Liang, Goodman, Tummala-Narra, &Weintraub, 2005).

Financial situation and employment status can also affect health care seeking. Even though Japan has universal health insurance, health care is not free: Individuals need to pay a yearly premium and a co-pay at each health care visit (Ikegami et al., 2011). As a result, low-income or unemployment can be barriers to health care in Japan. In addition, employment is helpful for women who may experience IPV because it improves finances, self-esteem, and social connections (Rothman, Hathaway, Stidsen, & de Vries, 2007) and may encourage women to seek help including health care services.

Living away from an abusive partner does not necessarily improve the mental or physical health of women who have experienced IPV (Alsaker, Moen, & Kristoffersen, 2008; Sawada, Maruyama, Yoshino, Konno, & Katakura, 2007). Separation, however, can create physical distance between a woman and her abusive partner. Since an abusive intimate partner will often attack and undermine a woman’s sense of control or confidence (Umberson, Anderson, Glick, & Shapiro, 1998), the physical distance from their abusive partner may help in regaining confidence, and as a result increase the probability of health care seeking.

Childbirth may affect IPV and IPV-specific health care seeking. For example, higher prevalence of IPV was found among women with children compared with those without (e.g., Bair-Merritt, Holmes, Holmes, Feinstein, & Feudtner, 2008). In addition, women have frequent contact with the health care system around childbirth. Childbirth is an important factors to be considered in the relation between IPV and health care seeking.

Age and education level affects IPV and health care seeking. Younger women are more susceptible to IPV (Breiding, Black, & Ryan, 2008a; Romans, Forte, Cohen, Du Mont, & Hyman, 2007; Thompson et al., 2006; Vest, Catlin, Chen, & Brownson, 2002), and may be more likely to seek health care related to IPV compared with older women. Some studies found a higher rate of IPV among women who have less education (Breiding, Black, & Ryan, 2008b; Thompson et al., 2006), while victims of IPV who are educated are likely to seek help (Coker, Derrick, Lumpkin, Aldrich, & Oldendick, 2000; Kaukinen, Meyer, & Akers, 2013).

Present Research

The purpose of this study was to examine the factors affecting the initial IPV-specific health care seeking, which refers to the first time that a woman sough IPV-specific health care that resulted from IPV in a women’s lifetime based on their self-report. The initial IPV-specific health care seeking event can provide an important chance to help women who experience IPV to reduce future risks of health problems as well as recurrence of IPV. Women who experience IPV do not always utilize health care services immediately after an IPV incident but most of them have been found to seek care later in their life (Rivara et al., 2007). If women who experience IPV have a significant delay in seeking health care for the first time, their health problems may become very serious later in life. This study intends to contribute to exploring and providing a better understanding of the factors that lead to health care seeking in Japanese women who have experienced IPV. The initial IPV-specific health care seeking experience can provide an important chance to help women who experience IPV to reduce future risks of health problems as well as recurrence of IPV.

We focused on the initial time that a women sough health care that resulted from IPV in a woman’s lifetime based on their self-report. Factors that were examined in our study included types of IPV, injury due to IPV, formal help seeking (other than health care), informal help seeking, financial situation, employment status, living with an abusive partner, childbirth, age, and educational level. These factors were drawn from a literature review focusing on health, help-seeking, or health care seeking as a result of IPV in general. We included any type of health care, both urgent and primary care.

Method

Data Collection

Prior to the data collection, the Institutional Review Board of the Principal Investigator affiliated university approved this study for human subjects. The data were collected based on the Life History Calendar (LHC) method. The LHC method is a reliable method for collecting data on incidents of IPV, and other life experiences or activities over time (Freedman, Thornton, Camburn, Alwin, & Young-demarco, 1988; Yoshihama, Gillespie, Hammock, Belli, & Tolman, 2005). Collecting reliable retrospective data is challenging due to the threat of recall bias. Through the interview structure and use of visual and contextual cues, a LHC reflects the structure of autobiographical memory and optimizes the reliability and validity of retrospective data (Belli, 1998). Identifying IPV relies heavily on the victims’ self-report and thus is often open to recall bias (Yoshihama & Gillespie, 2002). Using the LHC method increased the accuracy of the recall of IPV incidents and has reduced recall bias (Yoshihama et al., 2005; Yoshihama, Clum, Crampton, & Gillespie, 2002). In the LHC method, major life events, such as college graduation or marriage, are used as initial memory cues. In this study, life events including employment, intimate relationships, and childbirth served as memory cues for recalling IPV and IPV-specific health care seeking. In addition, “help seeking” was inadvertently included as an example of memory cues, which are usually major life events on the LHC.

Study participants were recruited by flyers, newspaper advertisements, and referrals from community-based organizations. Inclusion criteria included women who were 18 years or older and had experienced IPV in their lifetime. One hundred and one women participated in a semi-structured, face-to-face interview in the Tokyo Metropolitan Area from 2005 to 2006. Written consent was obtained from each participant before the interview was conducted. After the interview, participants were given a list of relevant local resources in case they needed assistance. In addition, the Principal Investigator, who is a licensed clinical social worker with extensive experience in assisting abused women, was available during the study period to provide necessary intervention. During the face-to-face interview, an interviewer collected information about the respondents’ life experiences and filled out the LHC. An interviewer asked whether a respondent experienced life events including IPV, employment, an intimate relationship, help seeking, and childbirth in each year from age 15 to the age at the time of the interview. The unit of time on the LHC was 1 year (age). To assess IPV, respondents were shown a list of behaviorally specific IPV items, and asked if they experienced each type of IPV for each relationship. If yes, the year at which they experience that type of IPV was assessed, followed by asking participants whether they experienced that type of IPV in which subsequent years. These combinations of questions resulted in assessing whether the respondent experienced each type of IPV for each year.

Because the timing of the initial IPV-specific health care seeking was the main focus, we analyzed the data for only years from age 15 to the age at the first IPV-related health care seeking and excluded years after the respondent first sought IPV-specific health care (i.e., years in which the respondent was no longer “at risk” for initial health care seeking).

Variables and Measures

Dependent variable

The outcome variable was initial IPV-specific health care seeking measured by whether a respondent sought any health care services which resulted from IPV in a given year (1 = sought health care; 0 = did not seek health care). The respondents were asked only about health care seeking specific to health problems related to IPV or to help-seeking for IPV.

Independent variables

The predictors were classified into the two categories: (1) the respondents’ experiences of specific types of IPV and IPV-related injury, and (2) experiences of various life events that are likely to be associated with IPV-specific health care seeking. Predictors in both of these categories were time-varying variables; respondents were asked whether they experienced each of the specific types of events in a given year. The information about health insurance that normally affects health care seeking was not included because Japan has a universal health insurance system.

1. Whether the respondents experienced a certain type of IPV in a given year

Independent variables included experience of each of the following types of IPV—physical IPV, sexual IPV, emotional IPV, financial IPV, threats—and injury due to IPV. Each type of IPV and injury due to IPV were measured whether a participant experienced it in a given year (1 = yes, 0 = no). Participants were asked about IPV experience for each year from any abusive intimate partner, taking into account that a respondent may have experienced abuse from multiple partners in a given year. We asked each type of IPV separately; for example, kicking was asked separately from beating up. Respondents were shown a list of behaviorally specific IPV items, and asked if they experienced each type of IPV for each relationship. If yes, the year at which they experience that type of IPV was assessed, followed by asking participants whether they experienced that type of IPV in which subsequent years. These combinations of questions resulted in assessing whether the respondent experienced each type of IPV for each year. The items to measure IPV were adopted from several widely used measures of IPV, including the Conflict Tactics Scale (Straus, Hamby, Boney-McCoy, & Sugarman, 1996).

The incidents of physical IPV included pushing, grabbing, twisting arms, pulling, hitting, punching, kicking, dragging around, and beating up. The incidents of sexual IPV included forced sex, unwanted sex, or the abusive partner’s refusal to use contraception. Emotional IPV included restriction of contact with family or friends, name calling, and claiming that the respondent is worthless. Financial IPV referred to controlling a partner by restricting access to financial and other tangible household resources. Financial IPV may be related to access to money and other tangible items as well as other barriers to health care.

Threats can be physical or sexual. For example, threats are often considered as psychological IPV, even if it is a physical threat (e.g., Zink, Fisher, Regan, & Pabst, 2005), or is part of physical or sexual IPV (e.g., Burge, 1997). Similar to other studies (e.g., Ahmad, Hogg-Johnson, Stewart, & Levinson, 2007), we examined threats separately from other forms of IPV to investigate whether the specific form of physical or psychological IPV or threats has impact on health care seeking.

2. Other time-varying predictors

Other factors we examined that could affect IPV-specific health care seeking included formal help seeking (other than health care), informal help seeking, living with an abusive partner, full-time employment status, receipt of welfare assistance, and childbirth. Formal help involved help from non-health care professionals such as family court, police, restraining order, welfare department, shelter, and counselor. Informal help means help from family or friends. The receipt of welfare assistance was used to measure financial situation. All were measured dichotomously (1 = yes, 0 = no) for each year of the LHC.

Control variables

Age at the time of the interview and education (whether the respondent graduated from college or not: 1 = yes, 0 = no) were included as time-invariant predictors. We chose to treat education variables as time-invariant because it is not common for people in Japan to obtain college degrees past the age of 24, which is the minimum age of the respondents.

Analysis

Time to initial health care seeking for IPV was analyzed using discrete-time survival analysis. Discrete-time survival analysis, which is also known as conditional logistic regression, was used to analyze the extent to which different types of IPV and other life events are associated with increase or decrease in the odds of the initial IPV-specific health care seeking. The discrete-time model examines the experience of events at each discrete-time interval for continuous-time data (Singer & Willett, 2003).

In the LHC data, IPV incidents and life events were measured for each year of a woman’s life beginning at age 15. The first incident of IPV (physical IPV, sexual IPV, emotional IPV, financial IPV, or threats) or IPV-specific injury is the start of the measurement because IPV-specific health care seeking did not occur before the first incident. Using the time when risk of the target event starts is a very common way to set the beginning for discrete-time data (Singer & Willett, 1991).

All statistical analyses were performed by using statistical software SAS and SPSS. Two nested models were developed. Model 1 included various types of IPV experience, IPV-specific injury, and control variables, age and education. Model 1 examined baseline effect of IPV on IPV-specific health care seeking. To examine the effect of other factors on IPV-specific health care seeking, we added in Model 2 other time-varying variables. Having the two models, not just one model, allows examining the influence of these factors more in detail, such as how other factors may change the effect of IPV on IPV-specific health care seeking.

Results

Women’s mean age at the time of the interview was 48 years (range = 24-80; SD = 12.45). The 101 respondents reported their experiences of IPV starting at age 15 yielding data of about 3,403 person-years. Because we are estimating the probability of initial IPV-specific health care seeking, we included in the analyses only those years in which respondents were at risk, meaning there is a possibility for them to seek health care specific to IPV for the first time. The respondents were not at risk prior to their first experience of IPV (522 person-years) and after their initial IPV-specific health care seeking (1,428 person-years). In addition to subtracting these not-at-risk years, we also excluded 26 years for which several respondents declined to disclose their relationship status, resulting in 1,427 person-years for analyses.

Respondent Characteristics

All participants were Japanese. Ninety respondents (89%) had a high school diploma. Thirty respondents (29.7%) had graduated from college. The number of intimate partners throughout the life course ranged from one to nine. IPV cases by an ex-partner was found only in 11 person-years (0.4%), suggesting that for the respondents in this study, most IPV were committed by the respondents’ current partners in a given year.

Experience of IPV and IPV-Specific Health Care Seeking

Table 1 presents the descriptive statistics. Seventy-three participants sought health care services for IPV at least once. Most respondents experienced physical and emotional IPV. The minimum age when the respondents experienced each type of IPV for the first time was similar: 15 to 17 years old. The age at which the respondents had the initial IPV-specific health care seeking ranged widely from 17 to 69 years old (SD = 8.97). Injury from physical IPV had the shortest time to initial IPV-specific health care seeking (mean 3.38; range 0-22; SD = 4.88) while emotional IPV had the longest time (mean 8.64; range 0-34; SD = 7.81). With respect to the frequency and percentage of the person-years in which the respondent experienced that life event, emotional IPV was experienced in the highest percentage of person-years (73%) while threats were experienced in the lowest percentage (28%). The number of person-years in which respondents were injured because of IPV was 163 person-years (11%).

Table 1.

Descriptive Statistics.

Variable	Number of Participants Who Reported at Least Once in Life	Average Age at the 1st IPV Experience (SD)	Mean Number of Years to Initial IPV Specific Health Care Seeking (SD)^a,b	Total Number of Person-Years^c,d
Initial health care seeking	73	34.8 (8.97)
Physical IPV	97	28.6 (7.21)	7.3 (7.77)	612 (42.9%)
Sexual IPV	78	27.1 (6.95)	8.1 (7.49)	445 (31.2%)
Emotional IPV	97	28.2 (8.14)	8.6 (7.81)	1,035 (72.5%)
Financial IPV	81	31.0 (9.30)	6.6 (7.45)	616 (43.2%)
Threats	76	33.0 (10.44)	4.9 (5.78)	392 (27.5%)
Injury	72		3.4 (4.88)	163 (11.4%)
Welfare status	32			50 (3.5%)
Full-time employment	96			519 (36.4%)
Informal help seeking	93			471 (33.0%)
Formal help seeking	92			151 (10.6%)
Living with an abusive partner	100			1,092 (76.5%)
Childbirth	93			129 (9.0%)

Note. IPV = intimate partner violence.

N = 101 participants.

In year: Only if that IPV occurred before or in the same year of the initial IPV–specific health care seeking.

N = 1,427 person years.

The total number of person–years for each item and percentages of years in which events occurred during years at risk for initial IPV–specific health care seeking percentages are in parentheses. The total number of person-years refers to the total number of years between 15 years of age and age at the time of the interview for all participants.

Factors Affecting the Initial IPV-Specific Health Care Seeking

The results of the discrete-time models are presented in Table 2. Overall, Model 2 (Likelihood Ratio Chi-Square = 186.26; df = 15) had a better fit and parsimony than Model 1 (Likelihood Ratio Chi-Square = 147.51; df = 9). The Akaike information criterion (AIC) was also smaller for Model 2 (662.88), indicating better fit compared to Model 1.

Table 2.

Discrete-Time Survival Analysis Predicting Initial IPV-Specific Health Care Seeking.^a

	Model 1		Model 2
Variables	Parameter Estimate (SD)	OR	Parameter Estimate (SD)	OR
Age	−0.17** (0.03)	0.93	−0.11** (0.03)	0.90
Physical IPV	0.38* (0.38)	2.24	0.64 (0.38)	1.91
Sexual IPV	0.55* (0.27)	1.73	0.50 (0.28)	1.64
Emotional IPV	−0.32 (0.43)	0.73	−0.35 (0.47)	0.71
Financial IPV	0.17 (0.26)	1.19	−0.08 (0.27)	0.93
Threats	0.53* (0.28)	1.70	0.47 (0.28)	1.61
Injury	1.11** (0.30)	3.04	1.05** (0.30)	2.85
Welfare			0.61(0.50)	1.84
Employment			0.03 (0.28)	1.03
Formal help seeking			1.51** (0.29)	4.52
Informal help seeking			0.48 (0.30)	1.61
Living with abusive partner			−0.13 (0.37)	0.88
Childbirth			0.32 (0.37)	1.38
Education	0.33 (0.26)	1.39	0.34 (0.28)	1.40
Age at interview	−0.04** (0.01)	0.96	−0.02 (0.02)	0.99
Model fit statistics
AIC	819.14		662.88
Likelihood Ratio χ²	147.51**		186.26**

Note. IPV = intimate partner violence; OR = odds ratio; AIC = Akaike information criterion.

Parameter estimates. Total person years = 1,427. Total number of respondents = 101.

p < .05. **p < .01.

Model 1, which contains IPV and injuries, age at interview, and education, examined variability in health care seeking related to specific aspects of the IPV that women experienced. This model serves as a baseline model to allow examination of the influence of IPV on health care seeking. In Model 1, injury (coefficient = 1.11; odds ratio (OR) = 3.04; p < .01), physical IPV (coefficient = 0.38; OR = 2. 24; p < .05), and sexual IPV (coefficient = 0.55; OR = 1.73; p < .05) significantly associated with shorter time to the initial IPV-specific health care seeking. Age at interview also had a significant impact on the time to the initial IPV-specific health care seeking (coefficient = −0.04; OR = 0.96; p < .01). Older age was associated with longer time to the initial IPV-specific health care seeking.

Model 2 added recipients of welfare assistance, full-time employment status, formal help seeking, informal help seeking, childbirth, and living with an abusive partner to Model 1 to estimate the impact of time-varying factors other than IPV on initial IPV-specific health care seeking. Of these social factors, only formal help seeking had significant impact on the first IPV- specific health care seeking (coefficient = 1.51; OR = 4.52; p < .01). Formal help seeking was associated with shorter time to the initial IPV-specific health care seeking. Like Model 1, IPV-related injury significantly shortened the time to initial IPV-specific health care seeking (coefficient = 1.05; OR = 2.85; p < .01). But the impact of physical and sexual IPV and age at interview were no longer significant in the presence of time-varying factors other than IPV in the model.

Discussion

Injury, physical and sexual IPV, and formal help seeking had significant impact on the timing of initial IPV-specific health care seeking while emotional IPV did not. Injury was the strongest predictor of shorter time to initial health care seeking. The finding that experiencing an injury had a significant impact on health care seeking is consistent with previous studies (e.g., Duterte et al., 2008). Physical and sexual IPV was also associated with a shorter time to initial IPV-specific health care seeking, although the magnitude of the effect of these variables was reduced and the significance was eliminated by the inclusion of time-varying variables. The results of this study suggest the association between emotional IPV and immediate health care seeking is not evident. Future research is warranted to examine whether emotional IPV may affect longer-term health problems and have an indirect effect on health care seeking.

The result, formal help seeking was significantly associated with initial IPV-specific health care seeking, follows the framework developed by Liang et al. (2005) that shows how social factors affect decisions to seek help. Participants who have utilized formal help resources might have fewer barriers to seeking help from a health care facility as positive experience with other formal sources of help would increase desire to seek help from other sources (Liang et al., 2005). Health care is one form of formal help seeking. Women who seek any kind of formal help seeking may also be more willing to seek health care. Because we used 1 year as the time unit, it is not possible which help-seeking preceded the other. Further research is needed to understand the nature of the interrelationship between health care seeking and other formal help seeking.

This study has limitations. The first is the number of respondents. Recruiting women who experience IPV can be very challenging. Major barriers to recruitment in Japan include the sense of privacy, shame/embarrassment, or time constraints and scheduling conflicts. Second, the data were collected in the Tokyo Metropolitan area. While the demographic characteristics of the respondents are similar to the women living in the catchment area, they do not necessarily represent all Japanese women who have a history of IPV. Also respondents are more likely to remain anonymous if data are collected in large urban settings that are important for the respondents’ safety. In addition, focusing on a specific locality helped reduce the variability of available assistance programs and other resources, which can affect the respondent’s help-seeking behavior. While the LHC method is shown to provide reliable retrospective data, it is possible that recall bias still occurred. Finally, it is not possible to be certain of the temporal order in all relationships between variables because multiple incidents may have occurred in one year. Despite these limitations, this study provides information on initial health care seeking for IPV among Japanese women that is not otherwise available, and contributes to providing knowledge to better understand IPV and health care seeking.

Footnotes

Acknowledgements

We acknowledge helpful comments from Drs. Richard Hirth, Jersey Liang, Richard Tolman, and Lenora Olson.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project was funded by Japan Society for the Promotion of Science and the University of Michigan, School of Social Work, to Mieko Yoshihama, Principal Investigator.

Author Biographies

Akiko Kamimura, PhD, MSW, MA, is an assistant professor in the Department of Sociology at the University of Utah. Her primary areas of interest include health care management and policy, social determinants of health, health disparities, minority and immigrant health, survey research methods, global health (Asia), women’s health, and community-based participatory research.

Deborah Bybee, PhD, is a professor of Ecological/Community Psychology at Michigan State University. She specializes in research design and statistical methodology. Her work focuses on the application of multivariate techniques to understand complex, real-world phenomena, especially those that involve change over time. Her substantive interests include violence against women, trauma, and mental health.

Mieko Yoshihama, PhD, LMSW, is a professor of Social Work at the University of Michigan. Her research interests are violence against women, immigrants, mental health, and community organizing. Combining research and social action at local, state, national, and international levels over the last 25 years, she focuses on the prevention of gender-based violence and promotion of the safety and well-being of marginalized populations and communities.

References

Ahmad

Hogg-Johnson

Stewart

D. E.

Levinson

(2007). Violence involving intimate partners: Prevalence in Canadian family practice. Canadian Family Physician, 53, 461-468.

Alsaker

Moen

B. E.

Kristoffersen

(2008). Health-related quality of life among abused women one year after leaving a violent partner. Social Indicators Research, 86, 497-509.

Andersen

R. M.

(1995). Revisiting the behavioral model and access to medical care: Does it matter. Journal of Health and Social Behavior, 36, 1-10.

Bair-Merritt

M. H.

Holmes

W. C.

Holmes

J. H.

Feinstein

Feudtner

(2008). Does intimate partner violence epidemiology differ between homes with and without children? A population-based study of annual prevalence and associated risk factors. Journal of Family Violence, 23, 325-332.

Belli

R. F.

(1998). The structure of autobiographical memory and the event history calendar: Potential improvements in the quality of retrospective reports in surveys. Memory, 6, 383-406.

Breiding

M. J.

Black

M. C.

Ryan

G. W.

(2008a). Chronic disease and health risk behaviors associated with intimate partner violence—18 US states/territories, 2005. Annals of Epidemiology, 18, 538-544.

Breiding

M. J.

Black

M. C.

Ryan

G. W.

(2008b). Prevalence and risk factors of intimate partner violence in eighteen US states/territories, 2005. American Journal of Preventive Medicine, 34, 112-118.

Burge

S. K.

(1997). Violence against women. Primary Care, 24, 67-81.

Campbell

J. C.

(2002). Health consequences of intimate partner violence. Lancet, 359, 1331-1336.

10.

Coker

A. L.

Derrick

Lumpkin

J. L.

Aldrich

T. E.

Oldendick

(2000). Help-seeking for intimate partner violence and forced sex in South Carolina. American Journal of Preventive Medicine, 19, 316-320.

11.

Coker

A. L.

Watkins

K. W.

Smith

P. H.

Brandt

H. M.

(2003). Social support reduces the impact of partner violence on health: Application of structural equation models. Preventive Medicine, 37, 259-267.

12.

Duterte

E. E.

Bonomi

A. E.

Kernic

M. A.

Schiff

M. A.

Thompson

R. S.

Rivara

F. P.

(2008). Correlates of medical and legal help seeking among women reporting intimate partner violence. Journal of Women’s Health, 17, 85-95.

13.

Freedman

Thornton

Camburn

Alwin

Young-demarco

(1988). The life history calendar: A technique for collecting retrospective data. Sociological Methodology, 18, 37-68.

14.

Garcia-Moreno

Jansen

Ellsberg

Heise

Watts

C. H.

(2006). Prevalence of intimate partner violence: Findings from the WHO multi-country study on women’s health and domestic violence. Lancet, 368, 1260-1269.

15.

Gender Equality Bureau. (2009). Data on spousal violence. Tokyo, Japan: Gender Equality Bureau, Cabinet Office.

16.

Golding

J. M.

(1999). Intimate partner violence as a risk factor for mental disorders: A meta-analysis. Journal of Family Violence, 14, 99-132.

17.

Ikegami

Yoo

B. K.

Hashimoto

Matsumoto

Ogata

Babazono

. . .Kobayashi

(2011). Japan: Universal Health Care at 50 Years 2 Japanese universal health coverage: Evolution, achievements, and challenges. Lancet, 378, 1106-1115.

18.

Kaukinen

C. E.

Meyer

Akers

(2013). Status compatibility and help-seeking behaviors among female intimate partner violence victims. Journal of Interpersonal Violence, 28, 577-601.

19.

Kozu

(1999). Domestic violence in Japan. Paper presented at the 104th Annual Convention of the American-Psychological-Association, Toronto, Canada.

20.

Liang

Goodman

Tummala-Narra

Weintraub

(2005). A theoretical framework for understanding help-seeking processes among survivors of intimate partner violence. American Journal of Community Psychology, 36, 71-84.

21.

Nemoto

Rodriguez

Mkandawire-Valhmu

(2008). Battered Japanese women’s perceptions and experiences of beneficial health care. Japan Journal of Nursing Science, 5, 41-49.

22.

Plichta

S. B.

(2004). Intimate partner violence and physical health consequences - Policy and practice implications. Journal of Interpersonal Violence, 19, 1296-1323.

23.

Rivara

F. P.

Anderson

M. L.

Fishman

Bonomi

A. E.

Reid

R. J.

Carrell

Thompson

R. S.

(2007). Healthcare utilization and costs for women with a history of intimate partner violence. American Journal of Preventive Medicine, 32, 89-96.

24.

Romans

Forte

Cohen

M. M.

Du Mont

Hyman

(2007). Who is most at risk for intimate partner violence? A Canadian population-based study. Journal of Interpersonal Violence, 22, 1495-1514.

25.

Rothman

E. F.

Hathaway

Stidsen

de Vries

H. F.

(2007). How employment helps female victims of intimate partner violence: A qualitative study. Journal of Occupational Health Psychology, 12, 136-143.

26.

Sawada

Maruyama

Yoshino

Konno

Katakura

(2007, May 13-16). The health status of Japanese women who separated because of intimate partner violence. Paper presented at the 15th International Congress of the International-Society-of-Psychosomatic-Obstetrics-and-Gynecology, Kyoto, Japan.

27.

Singer

J. D.

Willett

J. B.

(1991). Modeling the days of our lives—Using survival analysis when designing and analyzing longitudinal studies of duration and the timimg of events. Psychological Bulletin, 110, 268-290.

28.

Singer

J. D.

Willett

J. B.

(2003). Applied longitudinal data analysis: Modeling change and event occurrence. New York, NY: Oxford University Press.

29.

Straus

M. A.

Hamby

S. L.

Boney-McCoy

Sugarman

D. B.

(1996). The Revised Conflict Tactics Scales (CTS2): Development and preliminary psychometric data. Journal of Family Issues, 17, 283-316.

30.

Thompson

R. S.

Bonomi

A. E.

Anderson

Reid

R. J.

Dimer

J. A.

Carrell

Rivara

F. P.

(2006). Intimate partner violence - Prevalence, types, and chronicity in adult women. American Journal of Preventive Medicine, 30, 447-457.

31.

Umberson

Anderson

Glick

Shapiro

(1998). Domestic violence, personal control, and gender. Journal of Marriage and the Family, 60, 442-452.

32.

Vest

J. R.

Catlin

T. K.

Chen

J. J.

Brownson

R. C.

(2002). Multistate analysis of factors associated with intimate partner violence. American Journal of Preventive Medicine, 22, 156-164.

33.

Yoshihama

(1999). Domestic violence: Japan’s “hidden crime.” Japan Quarterly, 46(3), 76-82.

34.

Yoshihama

(2002). Policies and services addressing domestic violence in Japan: From non-interference to incremental changes. Womens Studies International Forum, 25, 541-553.

35.

Yoshihama

(2005). A web in the patriarchal clan system—Tactics of intimate partners in the Japanese sociocultural context. Violence Against Women, 11, 1236-1262.

36.

Yoshihama

Clum

Crampton

Gillespie

(2002). Measuring the lifetime experience of domestic violence: Application of the life history calendar method. Violence and Victims, 17, 297-317.

37.

Yoshihama

Gillespie

(2002). Age adjustment and recall bias in the analysis of domestic violence data: Methodological improvement through the application of survival analysis methods. Journal of Family Violence, 17, 199-221.

38.

Yoshihama

Gillespie

Hammock

A. C.

Belli

R. E.

Tolman

R. M.

(2005). Does the Life History Calendar method facilitate the recall of intimate partner violence? Comparison of two methods of data collection. Social Work Research, 29, 151-163.

39.

Yoshihama

Horrocks

Kamano

(2009). The role of emotional abuse in intimate partner violence and health among women in Yokohama, Japan. American Journal of Public Health, 99, 647-653.

40.

Zink

Fisher

B. S.

Regan

Pabst

(2005). The prevalence and incidence of intimate partner violence in older women in primary care practices. Journal of General Internal Medicine, 20, 884-888.