Racial Disparities in Intimate Partner Violence Examined Through the Multiple Disadvantage Model

Abstract

This research adopted the perspective of the multiple disadvantage model to explore racial disparities in intimate partner violence (IPV) against women and IPV’s links to social structural factors, social relationships, substance use, and health/mental health and access to related services. The study used data from 6,588 women who completed the National Violence Against Women Survey; linear regression was conducted separately for four ethnic groups. Results consistently showed physical assaults to increase with posttraumatic stress disorder symptoms. For African Americans, increases in assaults were linked to injury, disclosing IPV to friends/family as well as medical professionals, Medicaid use, and drug use; decreases, in turn, were linked to past assault by ex-partners. For Latinas, increases in assaults were associated with eight factors: being married, number of ex-partners, depression, disclosing IPV to friends/family and disclosing to mental-health professionals, drug use, alcohol abstinence, and partner’s frequent alcohol use. For European Americans, increases in assaults were linked to number of ex-partners, injury, low income, Medicaid use, disclosing IPV to friends/family as well as mental-health professionals, and alcohol abstinence; decreases were associated with age and with other health insurance coverages. For women of other ethnicity, increases were linked to number of ex-partners, disclosing IPV to mental-health professionals, Medicaid use, drug use, and woman’s own as well as partner’s alcohol abstinence; decreases in this ethnicity category were linked to past assault by ex-partners. Intervention and policy implications are discussed.

Keywords

alcohol and drugs battered women domestic violence mental health and violence support seeking sexual assault

Introduction

In 2010, more than 4.7 million women were physically assaulted by their intimate partners. Intimate partner violence (IPV) can include being grabbed, scratched or bitten, pushed or shoved, shaken, punched or slapped, choked, burned, and/or restrained by one’s partner (Centers for Disease Control and Prevention, 2013). Race/ethnicity is a reported factor in IPV. The proportion of African American women abused by a partner at some point is 1.3 times that of White women and 1.2 times that of Hispanic women (Black et al., 2011). The present study’s purpose was to investigate racial disparities in IPV, from the perspective of the multiple disadvantage model. The study focused on IPV committed against women by male partners—an “intimate terrorism” that violent men direct against nonviolent women with whom they have dysfunctional relationships (Johnson, 1995, 2006, 2011); these women tend to have worse physical and mental health than women not abused by partners (Coker et al., 2002; Hegarty et al., 2013). The present study measured, specifically, racial disparities marking the relationships between IPV and factors in social structural status, social relationships, health and mental health, access to health/mental health services, and substance use.

Literature Review

The present study has been derived from the multiple disadvantage model, which had recently been applied to explain racial disparities in homicide victimization (Lo, Howell, & Cheng, 2013, 2015). The model holds that, when individuals are constrained by socioeconomic disadvantages, their social and intimate relationships can manifest the distress created by those disadvantages. The multiple disadvantage model proposes, for instance, that historical and structural racism, along with social disorganization in the community, frustrates or angers members of ethnic minorities, especially African Americans, periodically generating deadly violence (homicide) prompted by those emotions (Lo et al., 2013). The present study speculated that IPV against women in dysfunctional relationships can further exemplify this type of violence. Studies have shown African American and Hispanic women, or Latinas, to be more likely to sustain physical assault by male partners than European American women (Lipsky, Cristofalo, Reed, Caetano, & Roy-Byrne, 2012; Tollestrup et al., 1999; Waller et al., 2012). The present researchers found no published findings, however, of significantly higher likelihood of IPV among Asian American or Native American women compared with European American women (Liles et al., 2012; Waller et al., 2012). Nor did they find, interestingly, any study identifying disadvantaged neighborhood as a significant factor in IPV against women (Golden, Perreira, & Durrance, 2013; Waller et al., 2012). Although prior studies (Golden et al., 2013; Graham-Bermann, Sularz, & Howell, 2011; Tollestrup et al., 1999; Yau, Stayton, & Davidson, 2013) have generally reported no significant relationships between physical IPV and women’s socioeconomic characteristics (e.g., family income, education, employment status), a few (Graham-Bermann et al., 2011; Testa et al., 2012) have indicated negative associations between IPV and both family income and education.

Married/cohabiting women have been found to be more likely than unmarried women to experience IPV (Waller et al., 2012). In addition, and not surprisingly, separated and divorced women appear more likely than married/cohabiting women to have experienced such assaults (Bernards & Graham, 2013). Those who have left physically abusive marriages or similar relationships often report believing odds are strong they will be assaulted again by the ex-partner (Connor-Smith, Henning, Moore, & Holdford, 2011). Women who have experienced one physically violent relationship appear relatively unlikely to enter subsequent violent intimate relationships (Carbone-Lopez, Rennison, & Macmillan, 2012).

For women in violent intimate relationships, social support is an important asset. Having a relatively large network for emotional and/or in-kind support (e.g., confidants, informal child care givers) reduces a woman’s likelihood of an IPV experience (Bonomi, Anderson, Rivara, & Thompson, 2007; Fortin, Guay, Lavoie, Boisvert, & Beaudry, 2012; Golden et al., 2013; Gustafsson, Cox, & Family Life Project Key Investigators, 2012; Katerndahl, Burge, Ferrer, Becho, & Wood, 2013; Shorey, Tirone, Nathanson, Handsel, & Rhatigan, 2013). Women receiving negative social responses on disclosing their IPV may tend to experience more physical assaults than women receiving positive social responses (Sullivan, Schroeder, Dudley, & Dixon, 2010), suggesting some abused women may perceive IPV as acceptable behavior (Witte & Kendra, 2010).

Health problems and mental problems are often related to IPV. Women experiencing IPV are more likely to have been injured in various parts of the body—including the head injury—than women not experiencing it (Yau et al., 2013). Experiences of physical abuse are adversely associated with women’s mental health (Bonomi et al., 2007; Cavanaugh et al., 2012; Hegarty et al., 2013). Studies have consistently demonstrated that women’s experience of IPV is associated significantly with depressive symptoms (Bonomi et al., 2007; Gustafsson et al., 2012; Hirth & Berenson, 2012; Mburia-Mwalili, Clements-Nolle, Lee, Shadley, & Yang, 2010; Zlotnick, Johnson, & Kohn, 2006) and symptoms of posttraumatic stress disorder (PTSD; Cavanaugh et al., 2012; Hegarty et al., 2013). Research shows African American women subjected to IPV tended to be diagnosed with concurrent PTSD and depression (Sabri et al., 2013).

The present study postulated that women who experience IPV and who also lack health insurance will be less likely to seek health or mental health services than will women who face IPV but are insured. According to the literature, women with mental health concerns who are experiencing IPV are relatively likely to seek help from mental-health professionals (Flicker et al., 2011; Hegarty et al., 2013). Some women are likely to do so following initial experience of assault. Many, however, remain uncertain about seeking help, even when further assaults follow (Cheng & Lo, 2014). African American women facing IPV are less likely than European American counterparts to seek out mental-health professionals (Flicker et al., 2011; Hutchison & Hirschel, 1998). Help seeking from mental-health or medical professionals can be related to access to affordable health insurance, and women of low socioeconomic status may lack that access. Nearly 32% of women who visit an emergency room because of IPV are uninsured (Btoush, Campbell, & Gebbie, 2009), and many low-income women facing IPV cannot afford health care (Wilson, Silberberg, Brown, & Yaggy, 2007). Compared with other women, women with IPV experience are more likely to use Medicaid or be uninsured, than to use private health insurance (Vest, Catlin, Chen, & Brownson, 2002).

Some women “self-medicate” with alcohol and/or drugs to try to cope with IPV’s trauma (El-Bassel, Gilbert, Wu, Go, & Hill, 2005; La Flair et al., 2012). But it has also been suggested that some women use substances before IPV transpires, the substances impairing the women’s cognitive ability and shaping their actions, bringing about physical assault by a partner (El-Bassel et al., 2005). Whatever the mechanism generating such violence, research links IPV alike to women’s alcohol dependence (Smith, Homish, Leonard, & Cornelius, 2012; Sullivan, Ashare, Jaquier, & Tennen, 2012), problematic drinking (La Flair et al., 2012; Tollestrup et al., 1999), and use of specified illicit drugs (Gilbert, El-Bassel, Chang, Wu, & Roy, 2012). Unsurprisingly, a male partner’s substance use is another risk associated with IPV (Connor-Smith et al., 2011; Mair, Cunradi, Gruenewald, Todd, & Remer, 2013; Stuart, Temple, & Moore, 2007). The alcohol dependence of a woman and partner who both drink problematically has been linked to her experience of IPV (Caetano, McGrath, Ramisetty-Mikler, & Field, 2005; Testa et al., 2012). In other words, a couple’s lifestyle of substance use is a risk factor in IPV, in light of, for instance, recurrent conflict about spending or about who gets what drugs (El-Bassel et al., 2005). Race may play a role in self-medication of IPV trauma. Research has shown links between IPV and African American women’s marijuana use, and between IPV and Latinas’ drug use generally; however, the literature reports no significant associations between IPV and European American women’s substance use (Nowotny & Graves, 2013).

To better understand potential racial disparities in IPV, the present researchers examined and compared patterns of IPV factors specific to four ethnic groups. It was hypothesized that (a) minority women would have more IPV experiences than European American women would; (b) IPV would be associated negatively—across ethnic groups—with social structural factors and social relationships; (c) IPV would be associated positively—again, across ethnic groups—with worsening health/mental health, with scarce access to services, and with substance use; and (d) racial differences would characterize the associations between IPV and social structural factors and between IPV and factors in social relationships, health/mental health and access to related services, and substance use.

Method

Sample

The present analysis of secondary data used a nationally representative sample of 6,588 women completing the National Violence Against Women Survey (NVAWS), a public-use data set. During 1994 to 1996, NVAWS researchers interviewed 8,000 women, gathering information about IPV experiences, mental disorders, access to health/mental health services, insurance, and substance use (Tjaden & Thoennes, 1999). The sample extracted for the present study comprised heterosexuals aged 18 to 64 and included 648 African Americans, 569 Latinas, 5,017 European Americans, and 354 women of other ethnicity.

Measures

In the present study, the outcome variable, current physical assault, was the total number (out of 12 possible) of physically violent actions perpetrated on a woman by her current partner. The 12 actions were (a) pushing/grabbing/shoving, (b) pulling hair, (c) slapping/hitting, (d) kicking/biting, (e) beating, (f) hitting with an object, (g) throwing things at the woman, (h) choking/drowning, (i) threatening with a knife, (j) threatening with a gun, (k) using a knife against the woman, and (l) using a gun against the woman. Researchers with NVAWS used 12 dichotomous (yes/no) items to ask respondents whether they had been subjected to these actions (e.g., “Did any other adult . . . grab, push, or shove you?”). Through a multiple-response item, women were also asked whether the perpetrator (or perpetrators, as one type of violence can be inflicted by multiple persons) of a violent action was the current spouse, current live-in partner, or ex-spouse/ex-partner. In the present study, the outcome variable was measured by computing the number of actions (of the 12 types) that a respondent reported experiencing at the hands of her current spouse or live-in partner. The obtained outcome measures ranged from 0 to 12; higher scores suggested worse IPV.

Explanatory variables in the present study included five sets—social structural characteristics, social relationships, health and mental health, access to health/mental health services, and substance use. The first social structural factor was ethnic group, comprising European American (the reference), African American, Latina, and Other. (As in the original data set, respondents identifying themselves as Asian/Pacific Islander, American Indian/Alaskan Native, or “Other” were combined within the latter.) Three more social structural factors were high school education (yes/no), indicating graduation from high school (at a minimum; the reference comprised those lacking a high school education); employed (yes/no), indicating whether a woman was employed; and personal income, comprising the dummy variables less than US$10,000 (constituting the reference), US$10,000 to US$20,000, and more than US$20,000.

Social relationships were measured using several variables. Married (yes/no) denoted if a woman was married or living with a male partner; single/divorced/separated/widowed women constituted the reference. Number of ex-partners was the total number of a woman’s past spouses and/or live-in partners. NVAWS researchers had asked the women two discrete questions covering how many ex-husbands/ex-common law partners they had and how many ex-live-in partners they had; we summed the answers to measure each respondent’s number of ex-partners. Former-partner physical assault gave the total number of the 12 actions (those defining our outcome variable) that a woman had experienced at the hands of ex-spouses and ex-partners, rather than her current spouse/partner. Told friends/family about physical IPV (yes/no) indicated whether a woman had ever disclosed to friends or family members her IPV experience, or alternatively whether these persons had ever reported suspected IPV to police on her behalf. The present research allowed either kind of disclosure to indicate a woman’s receipt of social support.

Several variables represented health and mental health. The dichotomous good health represented self-reported health described as good, very good, or excellent; its reference group was fair or poor health. Injury indicated whether a woman had a disabling injury and/or had been otherwise injured by IPV. Depression gave the total score from a depression scale that consisted of eight 4-point items and had a Cronbach’s alpha of .78 (Tjaden & Thoennes, 1999). (NVAWS researchers derived this scale from the SF-36 Health Survey.) Example items are “How often in the past week have you felt so down . . . that nothing could cheer you up?”; “How often in the past week have you been very nervous?”; and “How often in the past week did you feel worn out?” Scores for the variable could range from 8 to 32, with higher ones implying severe depression. PTSD reflected a woman’s reported experience of any of 21 PTSD symptoms, each symptom measured on a 4-point scale. The Cronbach’s alpha for this measure was .95. PTSD scores could range from 21 to 84, with higher ones implying serious PTSD. Other chronic mental health conditions (yes/no) indicated whether a woman reported having a mental problem other than depression or PTSD.

Several of the present explanatory variables represented access to health and mental health services. Medicaid/free-clinic coverage (yes/no) indicated whether a woman was insured through Medicaid or used free/subsidized clinics. Private health insurance coverage (yes/no) indicated whether a woman held private health insurance. Finally, other health coverage (yes/no) indicated whether military/veterans insurance, workman’s compensation, or disability insurance was used by a respondent. Uninsured provided the reference for these three variables.

In addition, disclosed IPV to medical professionals indicated whether a woman had told a medical professional about her IPV experience, and disclosed IPV to mental-health professionals indicated whether she had told a mental-health professional (for instance, a psychiatrist, psychologist, counselor, therapist, or support group) about her IPV experience.

Several variables also represented substance use. Illicit drug use (yes/no) noted whether a woman reported using (in the past month) marijuana, cocaine, heroin, angel dust, and so on. Stimulant use (yes/no) described a woman’s reported consumption (in the past month) of uppers, speed, or amphetamines. Alcohol use denoted the frequency (over the past 12 months) of a woman’s consumption of beer, light beer, wine coolers, and/or liquor. The measure comprised four dummy variables: never (the reference), 2 days a week or less, 3 to 4 days a week, and 5 to 7 days a week. The dummy variables were also used to describe partner’s alcohol use, that is, the frequency (over the past 12 months) of a spouse/partner’s consumption of the four beverage types. Finally, two demographic characteristics were included as controls: age (in years) and number of dependent children.

Limitations

An important limitation on the present study was the public-use data set’s lack of any community- or neighborhood-level information. Without such data, this study could not explore a possible relationship between IPV and social disorganization. In addition, in creating ethnicity subsamples, NVAWS researchers grouped Asian Americans and Pacific Islanders together with American Indians and Alaskan Natives, leaving the present research no alternative other than to consider respondents of all these ethnicities as one single ethnic group. Caution should thus be taken in generalizing any of this study’s results involving data from respondents whose ethnicity has been classified as “other.”

Data Analysis

This study used STATA multiple regression modeling for multivariate analysis, to evaluate separately by ethnic group the associations between the outcome and explanatory variables. Preliminary analysis of the groups’ results—via correlation coefficients (−.46 ≤ r ≤ .43) and tolerance statistics (≥.49)—suggested no multicollinearity problems.

Results

Descriptive Statistics

African American

On average, the 648 African Americans in the subsample had experienced 0.34 current physical assault behaviors (range = 0-10); the average among those reporting current physical assault was 3.4. The women’s average age was 37.7 years (range = 18-64) and average number of children was 1.3 (range = 0-10). The majority (68.5%) were employed, 87.5% had at least graduated from high school, and 39.2% had personal income below US$10,000, with 25.9% reporting US$10,000 to US$20,000, and 34.9% reporting more than US$20,000. More than 45% of the women were married. On average, they had 0.6 ex-partners (range = 0-4) and had experienced 0.56 former-partner physical assault behaviors (range = 0-11); only 20.1% said they had told friends or relatives about their IPV. Among those reporting former-partner IPV, on average 4.2 physical assault behaviors had been experienced. Good health was reported by 84% of the African American women; 22.8% of them had sustained injury through IPV. For this subsample, the average depression score was 16.2 (range = 8-32) and average PTSD score was 22.4 (range = 21-62); only 0.8% had some other chronic mental problem. More than 64% of the women had private insurance, with 10.3% using Medicaid or free clinics and 8.2% using other types of insurance. Only 3.9% had disclosed their IPV to medical professionals, whereas 4.8% had disclosed it to mental-health professionals. Almost 3% used illicit drugs; 0.2% used stimulants. More than 53% of women in this subsample never consumed alcohol; 42% consumed it on 2 or fewer days a week, 2.6% on 3 to 4 days a week, and 1.1% on 5 to 7 days a week. Among the women’s spouses/partners, 18.8% never consumed alcohol, whereas 74.1% consumed it on 2 or fewer days a week, 4.5% consumed it on 3 to 4 days a week, and 2.6% consumed it on 5 to 7 days a week.

Latina

On average, the 569 Latinas in the sample had experienced 0.4 current physical assault behaviors (range = 0-12); the average among those reporting current physical assault was 3.6. For the subsample of Latinas, average age was 34.4 years (range = 18-64) and average number of children was 1.5 (range = 0-6). More than 72% had at least graduated from high school; 52.2% had personal income below US$10,000, with 22.1% reporting US$10,000 to US$20,000, and 25.7% reporting more than US$20,000. More than half of the Latinas (54%) were employed, fewer—38.9%—were married. On average, they had 0.5 ex-partners (range = 0-10) and had experienced 0.6 former-partner physical assault behaviors (range = 0-12); 16.3% had told friends or family about their IPV. Among Latinas experiencing former-partner IPV, the average number of physical assault behaviors experienced was 5.7. The majority (83.3%) of women in the Latina subsample reported good health; 17.4% reported having an IPV injury. Average depression score among Latinas was 16.1 (range = 8-32); average PTSD score was 22.6 (range = 21-71). In addition, less than 1% reported some other chronic mental problem. More than half of the Latinas had private health insurance; 12.5% used Medicaid/free clinics and 7% used other types of insurance. Almost 2% had disclosed their IPV to medical professionals, whereas 5.3% had disclosed it to mental-health professionals. Illicit drug use was reported by 2.8% of this subsample, stimulant use by 1.1%. More than 52% of Latinas never consumed alcohol; 44.6% consumed it on 2 or fewer days a week, 1.8% on 3 to 4 days a week, and 0.9% on 5 to 7 days a week. Among their spouses/partners, 24.3% never consumed alcohol, whereas 69.2% consumed it on 2 or fewer days a week, 2.3% consumed it on 3 to 4 days a week, and 4.2% consumed it on 5 to 7 days a week.

European American

On average, the 5,017 European American women in this study had experienced 0.3 physical assault behaviors (range = 0-12); the average among those reporting current physical assault was 3.9. For the European American women, average age was 40.4 years (range = 18-64) and average number of children was 1 (range = 0-10). The majority (68.7%) were employed, 93.9% had at least graduated from high school, and 42.2% had personal income below US$20,000, with 19.6% reporting US$10,000 to US$20,000, and 37.1% reporting more than US$20,000. More than 77% of women in this subsample were married. On average, women in the subsample had 0.5 ex-partners (range = 0-11) and had experienced 0.7 former-partner physical assault behaviors (range = 0-12). Relatively many (17.6%) in the subsample had told friends/family about their IPV. Those experiencing former-partner IPV reported 4.7 physical assault behaviors on average. More than 90% of the subsample reported good health, with 16.5% reporting an IPV injury. The women’s average depression score was 15.6 (range = 8-32) and average PTSD score was 22.0 (range = 21-84); just 0.4% reported some other chronic mental problem. Almost 80% of the subsample used private health insurance, whereas 2.9% used Medicaid/free-clinic coverage and 3.8% used another type of coverage. Finally, 2.5% of the European American women had disclosed their IPV to medical professionals, with 7.5% disclosing it to mental-health professionals. Illicit drug use was reported by 1.7% of this subsample, stimulant use by 0.3%. Of the European American women, 34.7% reported they never consumed alcohol; 58.2% consumed it on 2 or fewer days a week, 3.8% on 3 to 4 days a week, and 3.3% on 5 to 7 days a week. Among their spouses/partners, just under 23% never consumed alcohol, whereas 62.9% consumed it on 2 or fewer days a week, 6.5% consumed it on 3 to 4 days a week, and 7.7% consumed it on 5 to 7 days a week.

Other

On average for all 354 women whose ethnicity fell under Other, 0.4 current physical assault behaviors had been experienced (range = 0-12); the average among those experiencing physical assault was 4.3. This subsample’s average age was 37.7 years (range = 18-64) and average number of children was 1 (range = 0-7). More than 89% of these women at least graduated from high school, 61.3% were employed, and 48.3% had personal income below US$10,000, with 18.1% reporting US$10,000 to US$20,000, and 33.6% reporting more than US$20,000. In addition, almost 68.4% were married. On average, the women in this subsample had 0.6 ex-partners (range = 0-5) and had experienced 0.9 former-partner assault behaviors (range = 0-12); 20.9% had told friends/family about their IPV. Those experiencing former-partner IPV reported five physical assault behaviors on average. Although 82.5% of the respondents in this subsample reported good health, 22.3% reported having an IPV injury. The subsample’s average depression score was 16.5 (range = 8-31) and average PTSD score was 22.4 (range = 21-77); only 0.6% of these women reported some other chronic mental problem. The majority (65%) used private health insurance, with 7.1% using Medicaid/free clinics and 8.2% using some other type of insurance. Just 2.5% had disclosed their IPV to medical professionals, whereas 8.5% had disclosed it to mental-health professionals. Just 2.3% of these women said they used illicit drugs; 0.6% of the subsample reported they used stimulants. Half (50.9%) of women in the subsample never consumed alcohol; 44.9% consumed it on 2 or fewer days a week, 1.4% on 3 to 4 days a week, and 2.8% on 5 to 7 days a week. Among their spouses/partners, 19.5% never consumed alcohol, whereas 69.2% consumed it on 2 or fewer days a week, 3.7% consumed it on 3 to 4 days a week, and 4.8% consumed it on 5 to 7 days a week.

Across the four ethnic subsamples, the two most common physical assault behaviors reported to have been perpetrated by a current spouse or live-in partner or by an ex-spouse were pushing/grabbing/shoving and slapping/hitting.

Multiple Regression Results

To carry out multiple regression modeling of the ethnic group variables only, we pooled the four ethnic groups’ data. The obtained results showed no significant association between ethnic group and current physical assault (see Table 1, column 1). In turn, modeling with all other variables also included (F = 196.64, p < .01; see Table 1, column 2) showed African American (b = −.094; p < .05) and Latina (b = −.078; p < .05) ethnicity to be associated negatively with the outcome (current physical assault). The outcome was also associated negatively with age, former-partner physical assault, private health insurance coverage, and drinking 5 to 7 days a week. It was associated positively with number of ex-partners, disclosing IPV to friends/family, disclosing IPV to mental-health professionals, injury, PTSD, Medicaid/free-clinic coverage, drug use, and partner’s alcohol consumption on 5 to 7 days weekly.

Table 1.

Multiple Regression on Current Physical Assault With All Four Ethnic Groups Pooled Together (n = 6,588).

Variables	Column 1		Column 2
Variables	B	SE	b	SE
African American (White)	.029	.056	−.094*	.042
Hispanic (White)	.081	.060	−.078*	.045
Other ethnic minority (White)	.130*	.074	−.003	.054
Age			−.004**	.001
Number of dependent children			.007	.011
High school education (no)			.002	.045
Employed (no)			.003	.029
Personal income US$10,000-US$20,000 (below US$10,000)			−.042	.033
Personal income above US$20,000 (below US$10,000)			−.000	.030
Married (no)			.001	.033
Number of ex-partners			.032	.032
Former-partner physical assault			.091**	.015
Told friends/family about physical IPV (no)			−.025**	.007
Good health (fair/poor health)			.244**	.038
Injury (no)			−.041	.041
Depression			.335**	.038
PTSD			.002	.003
Other chronic mental health conditions (no)			.184**	.003
Medicaid/free-clinic coverage (uninsured)			−.117	.175
Private health insurance coverage (uninsured)			.180**	.065
Other health coverage (uninsured)			−.068*	.035
Disclosed IPV to medical professionals (no)			−.085	.063
Disclosed IPV to mental-health professionals (no)			−.020	.081
Illicit drug use (no)			.254**	.052
Stimulant use (no)			.190*	.094
Alcohol use 2 days a week or less (never)			−.008	.029
Alcohol use 3-4 days a week (never)			−.019	.072
Alcohol use 5-7 days a week (never)			−.208**	.080
Partner’s alcohol use 2 days a week or less (never)			−.004	.035
Partner’s alcohol use 3-4 days a week (never)			−.029	.060
Partner’s alcohol use 5-7 days a week (never)			.096*	.058
Constant	.313**	.019	−3.672**	.122
	(continued)
F	1.54		196.64**
R²	.0007		.4818

Note. Reference groups/categories are in parentheses. SE = standard error; IPV = intimate partner violence; PTSD = posttraumatic stress disorder.

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

The separate multiple regression analyses confirmed that the tested models differed significantly from the null model (F = 17.24-172.62, p < .01; see Table 2). These analyses’ results, moreover, explained 47% to 61% of the variance (R² = .47-.61).

Table 2.

Separate Multiple Regressions on Current Physical Assault in Four Specific Ethnic Groups.

Variables	African American		Latina		European American		Other
Variables	b	SE	b	SE	b	SE	b	SE
Age	−0.001	.003	−0.007	.005	−0.004**	.001	−0.004	.006
Number of dependent children	−0.020	.028	−0.003	.038	0.013	.012	−0.025	.053
High school education (no)	0.147	.115	−0.089	.117	−0.016	.057	−0.039	.213
Employed (no)	0.068	.088	−0.142	.110	0.006	.032	0.014	.137
Personal income US$10,000-US$20,000 (below US$10,000)	−0.003	.093	0.127	.125	−0.073*	.038	0.046	.172
Personal income above US$20,000 (below US$10,000)	0.092	.094	−0.131	.131	0.001	.032	−0.011	.147
Married (no)	0.024	.096	0.225*	.116	0.022	.037	−0.228	.153
Number of ex-partners	0.056	.045	0.098*	.058	0.087 **	.017	0.215**	.081
Former-partner physical assault	−0.135 **	.023	−0.008	.025	−0.009	.008	−0.097 **	.032
Told friends/family about physical IPV (no)	0.369**	.101	0.415**	.146	0.205**	.043	−0.005	.191
Good health (fair/poor health)	−0.103	.106	0.138	.140	−0.031	.048	−0.149	.181
Injury (no)	0.334**	.098	0.125	.145	0.363 **	.043	0.262	.181
Depression	−0.007	.008	0.022*	.012	0.002	.003	−0.007	.015
PTSD	0.168 **	.008	0.123 **	.009	0.195 **	.003	0.231 **	.013
Other chronic mental health conditions (no)	0.105	.411	0.299	.521	−0.231	.214	−0.858	.838
Medicaid/free-clinic coverage (ui)	0.326*	.140	−0.127	.166	0.275 **	.088	0.616*	.275
Private health insurance coverage (ui)	−0.092	.103	0.063	.122	−0.073*	.041	−0.040	.164
Other health coverage (ui)	−0.073	.150	0.023	.199	−0.169*	.077	0.274	.252
Disclosed IPV to medical professionals (no)	0.570**	.206	−0.023	.359	−0.067	.091	−0.745 *	.423
Disclosed IPV to mental-health professionals (no)	−0.078	.178	1.449 **	.230	0.114 *	.057	1.010 **	.248
Illicit drug use (no)	0.511**	.215	0.837**	.304	0.016	.115	0.765*	.446
Stimulant use (no)	−0.178	.893	0.578	.473	−0.263	.218	−0.335	.832
Alcohol use 2 days a week or less (never)	0.075	.076	−0.029	.108	−0.022	.033	0.049	.133
Alcohol use 3-4 days a week (never)	0.280	.234	−0.321	.382	−0.020	.076	−1.759**	.593
Alcohol use 5-7 days a week (never)	−0.216	.345	−0.961*	.521	−0.199*	.084	−0.002	.413
Partner’s alcohol use 2 days a week or less (never)	0.014	.117	0.079	.127	0.026	.039	−0.304*	.170
Partner’s alcohol use 3-4 days a week (never)	−0.201	.195	0.094	.328	0.013	.064	−0.117	.361
Partner’s alcohol use 5-7 days a week (never)	−0.223	.238	0.771**	.257	0.096	.062	−0.274	.335
Constant	−3.501**	.344	−2.923**	.387	−3.896**	.142	−4.139**	.550

F	26.29**		17.24**		172.62**		17.61**
R²	.5432		.4721		.4921		.6027
n	648		569		5,017		354

Note. Reference groups/categories are in parentheses. SE = standard error; IPV = intimate partner violence; PTSD = posttraumatic stress disorder; ui = uninsured.

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

African American

Results for the African American subsample (see Table 2, column labeled African American) showed no social structural factor to have significant association with current physical assault. Disclosing IPV to friends/family (b = .369; p < .01) was associated positively with the outcome. The outcome was associated negatively, in turn, with former-partner physical assault (b = −.135; p < .01). Injury (b = .334; p < .01) and PTSD (b = .168; p < .01) were associated positively with the outcome, but no association was observed between the outcome and the remainder of the health and mental health variables. Using Medicaid/free clinics (b = .326; p < .05) and disclosing IPV to medical professionals (b = .570; p < .01) showed positive associations with the outcome, but use of other types of insurance and disclosing to mental-health professionals showed no significant associations. Whereas drug use (b = .511; p < .01) showed a positive association with current physical assault, other substance-use variables showed no significant associations with the outcome.

Latina

Among Latinas none of the social structural factors showed significant association with the outcome (see Table 2, column labeled Latina). Three variables from other sets were associated positively with the outcome: being married (b = .225; p < .05), number of ex-partners (b = .098; p < .05), and disclosing IPV to friends/family (b = .415; p < .01). Of the health and mental health factors examined, depression (b = .022; p < .05) and PTSD (b = .123; p < .01) were significantly associated with the outcome; type of health insurance showed no significant association with the outcome. Disclosing IPV to mental-health professionals (b = 1.449; p < .01) was associated positively with the outcome. Whereas Latinas’ drug use (b = .837; p < .01) and their partners’ alcohol consumption on 5 to 7 days a week (b = .771; p < .01) were associated positively with the outcome, a negative association was found between the outcome and Latinas’ own alcohol consumption on 5 to 7 days a week (b = −.961; p < .05).

European American

In the subsample of European American women, age (b = −.004; p < .01) and US$10,000 to US$20,000 personal income (b = −.073; p < .05) were associated negatively with current physical assault; income was the sole social structural factor showing a significant association with the outcome (see Table 2, column labeled European American). Number of ex-partners (b = .087; p < .01) and disclosing IPV to friends/family (b = .205; p < .01) were each associated positively with the outcome. Of factors in the health and mental health variables set, injury (b = .363; p < .01) and PTSD (b =. 195; p < .01) were significantly associated with the outcome. In addition, using Medicaid/free clinics (b = .275; p < .01) and disclosing IPV to mental-health professionals (b = .114; p < .05) were associated positively with the outcome; private health insurance coverage (b = −.073; p < .05) and other health coverage (b = −.169; p < .05) were associated negatively with it. For the European American subsample, respondent’s alcohol consumption on 5 to 7 days weekly (b = −.199; p < .01) was the sole substance-use variable exhibiting a negative association with the outcome.

Other

For women of other ethnicity, no social structural factor showed significant association with current physical assault (see Table 2, column labeled Other). Former-partner physical assault (b = −.097; p < .01) was associated negatively with the outcome; number of ex-partners (b = .215; p < .01) was associated positively with it. For this subsample, PTSD (b = .231; p < .01) was the sole health/mental health variable to show significant association with the outcome. Using Medicaid/free clinics (b = .616; p < .01) and disclosing IPV to mental-health professionals (b = 1.010; p < .01) were associated positively with the outcome; drug use (b = .765; p < .05) was also associated positively with it, whereas respondent’s alcohol consumption on 3 to 4 days a week (b = −1.970; p < .01) was associated negatively with it.

Differences in Coefficients (b)

To explore possible racial differences in the outcome variable’s significant associations with certain explanatory variables, the present researchers coded the three minority groups as dummy variables, with European American providing the reference. The researchers selected, for this analysis, the 10 explanatory variables that showed significant association with the outcome within at least 2 ethnic groups. The 10 were number of ex-partners, former-partner physical assault, injury, PTSD, Medicaid/free-clinic coverage, disclosed IPV to medical professionals, disclosed IPV to mental-health professionals, illicit drug use, and respondent’s alcohol use 5 to 7 days a week. Three interaction terms were created for each of the 10 explanatory variables; each term included an ethnic minority dummy variable (as in “between African American and former-partner physical assault,” “between Latina and former-partner physical assault,” and “between Other and former-partner physical assault”). The researchers then produced a series of multiple regression models, each including (a) three ethnic minority dummy variables, (b) 1 of the 10 selected explanatory variables, (c) three interaction terms, and (d) all other explanatory variables. In all, 30 interaction terms were created, of which 11 exhibited significant associations with the outcome.

The 11 were the terms between African American and number of ex-partners (b = −.093; p < .05), between African American and former-partner physical assault (b = −.105; p < .01), between Other and former-partner physical assault (b = −.059; p < .01), between Other and injury (b = −.235; p < .05), between African American and PTSD (b = −.028; p < .01), between Latina and PTSD (b = −.057; p < .01), between Other and PTSD (b = .037; p < .01), between Latina and Medicaid/free-clinic coverage (b = −.568; p < .01), between Other and disclosed IPV to medical professionals (b = −.687; p < .05), between Latina and disclosed IPV to mental-health professionals (b = 1.072; p < .01), and between Other and disclosed IPV to mental-health professionals (b = .503; p < .01). Between-ethnic-group differences in coefficients for these interactions appear underlined in Table 2, though the table does not present the significant interactions themselves.

Discussion

This study demonstrated the applicability of the multiple disadvantage model to investigations of women’s IPV experiences. Its findings challenge our first hypothesis, that minority women would be more likely than European American women to experience physical IPV. Our study, unlike prior studies (Lipsky et al., 2012; Tollestrup et al., 1999; Waller et al., 2012), found African Americans and Latinas to experience less serious IPV than European Americans. One plausible explanation is that we used a continuous variable to represent IPV within the respondent’s current relationship. In contrast, two earlier studies allowed a dichotomous/categorical variable to represent IPV, focusing on likelihood of experiencing IPV; whereas another (Lipsky et al., 2012) simply made comparisons using percentages. Furthermore, the makeup of research samples varied widely across earlier studies. One (Lipsky et al., 2012) obtained respondents from a state’s municipal police reports of IPV, and another (Waller et al., 2012) limited itself to national data from young adult women only. Closer examination of data in the present study showed that, across ethnic groups, fairly small proportions (8.0%-10.9%) of respondents reported experiencing IPV at some point in their current relationships, results similar to those of two studies in the literature (Tollestrup et al., 1999; Waller et al., 2012).

The present findings partially support our second hypothesis, that across ethnic groups IPV would be associated negatively with social structural factors and social relationships. Across the subsamples, none of the social structural factors showed significant association with the outcome, current physical assault. Moreover, US$10,000 to US$20,000 personal income was the sole social structural factor to be associated negatively with the outcome—and then only within the European American subsample. Low income appeared to wield strong, lasting socioeconomic effects on European Americans but not on minority women.

In contrast, for three of its social relationship variables, the present study observed significant relationships to the outcome; those relationships characterized two and even three ethnic groups. At odds with the hypothesized relationship, across three ethnic subsamples the variable number of ex-partners showed a positive association with current physical assault, results suggesting that having more ex-partners increased the number of assault behaviors women in these subsamples had experienced. The findings indicate, furthermore, that for Latina, European American, and other-ethnicity respondents, having had multiple relationships may be associated with more experiences of IPV. Consistent with prior findings (Carbone-Lopez et al., 2012), among African American women and women in the other-ethnicity category, former-partner physical assault was found to reduce the number of assault behaviors experienced at the hands of a current partner. The implication is that when a prior intimate relationship has been marked by violence, women in these two groups are relatively unlikely to establish a subsequent abusive relationship, suggesting their intolerance of IPV. Interestingly, our present findings contradict some prior ones (Bonomi et al., 2007; Fortin et al., 2012; Golden et al., 2013; Gustafsson et al., 2012; Katerndahl et al., 2013; Shorey et al., 2013) in indicating that African American, Latina, and European American women tended to disclose IPV to friends/family as the number of IPV behaviors experienced went up. That is, they became more likely to seek social support when IPV became more severe.

The present findings also partially support our third hypothesis that across ethnic groups, IPV would be associated positively with worsening health/mental health, with lack of services access, and with substance use. Although our study did not observe (in any subsample) the outcome’s significant association with health, it did observe that, at least for women of particular ethnicities, current physical assault was significantly associated with injury and PTSD. The present findings for African Americans and European Americans—again consistent with the literature (Yau et al., 2013)—linked the outcome variable to injury reported by women (the link took a positive direction). Moreover, across ethnic groups, severity of PTSD was associated positively with current physical assault, again corroborating prior research (Cavanaugh et al., 2012; Hegarty et al., 2013). Traumatic injury resulting from IPV appears capable of fostering severe mental disorder in the form of PTSD.

In three of the four ethnic groups analyzed, using Medicaid/free clinics was associated significantly and positively with current physical assault, whereas use of another insurance type was significantly associated with outcome only among the European American respondents. Because low-income families are the likely recipients of Medicaid and free-clinic services, these findings suggest that current IPV is associated (within the African American, Latina, and other-ethnicity subsamples) with low income. In other words, women of lowest socioeconomic status tended to experience very serious IPV. As their IPV worsened, African Americans and women in the group designated “Other” tended to disclose their situations to medical professionals. Women not of African American ethnicity tended, when experiencing very serious IPV, to disclose it to mental-health professionals. The present findings support others (Flicker et al., 2011; Hutchison & Hirschel, 1998), in that IPV disclosure by African Americans in the present sample was not significantly associated with the outcome measures for these women.

In all our subsamples except European American, illicit drug use was observed to be significantly associated with the outcome. This result suggests that worsening IPV among ethnic minority women is strongly associated with drug use, supporting a prior finding for Latinas (Nowotny & Graves, 2013). In three of the present study’s four subsamples, relatively frequent drinking (compared with no consumption of alcohol) was associated with relatively few reported physical assault behaviors, a result that challenges prior research findings (La Flair et al., 2012; Tollestrup et al., 1999) of a link between IPV and problem drinking suggestive of self-medication. Furthermore, Latinas in the present study reported more physical assaults when partners were relatively frequent drinkers. That result seems to support earlier findings for samples undifferentiated as to ethnicity (Connor-Smith et al., 2011; Mair et al., 2013). Women of other ethnicity (neither African American, Latina, or European American), however, were found by the present study to experience relatively few physical assaults when their partners consumed alcohol relatively frequently. The finding suggests that these women suffered greater numbers of physical assaults at the hands of partners who did not drink than from partners who were drinkers.

As for the fourth hypothesis, the findings partially support it; racial differences did characterize certain associations observed between IPV and social structural factors, social relationships, health and mental health, access to services, and substance use. Most informative were the across-group, significant differences between significant coefficients (see underlined entries in Table 2). For instance, the outcome variable’s positive association with number of ex-partners was stronger among European Americans than African Americans. Such a finding implies that, given identical numbers of ex-partners for both groups, in the latter group IPV in the current relationship would be less severe. In addition, if they had experienced IPV in prior relationships, African Americans and women in our “Other” group alike tended to report current-relationship IPV at a lower level than did European Americans reporting similar numbers of prior dysfunctional relationships. This result suggests that (compared with European American women) following an experience of IPV, fewer African American women and other-ethnicity women tolerate any violence from future partners.

From the present findings, it also appears that the relationship between current physical assault and PTSD is strongest for women whose ethnicity we designated “Other.” The data for African American women and Latinas indicated an association between PTSD and the outcome variable that was weaker than the association measured for European American women. Such a finding suggests PTSD’s negative impact was comparatively more salient for European American women. In contrast, the association between Medicaid/free-clinic coverage and current IPV was weaker for the Latina subsample than the European American, a finding that suggests low-income European Americans would experience greater numbers of current physical assaults than low-income Latinas would. Interestingly, in the present study, the outcome was more strongly affected by disclosure of IPV to mental-health professionals when the respondent was Latina or of “Other” ethnicity versus European American. Of the three ethnic minority subsamples examined, African American women’s coefficient for drug use was lowest. What this result suggests is that African Americans would be less likely than Latinas or women in our “Other” group to self-medicate IPV trauma with illicit drugs; at the very least, compared with Latinas and women in our “Other” group, African American women’s use of drugs would lack the same tendency to instigate IPV. In addition, in this study, women in the “Other” group were much less likely than European American women to have had an IPV injury and much less likely to have disclosed IPV to medical professionals (even with IPV at levels comparable with those measured among European Americans).

Conclusion

The present study demonstrated that the multiple disadvantage model can be successfully applied to study women’s experience of physical IPV. In each of the four ethnic groups studied, our research identified distinct patterns of factors significantly associated with current physical assault. These patterns offer a unique opportunity to understand factors in IPV in given ethnic groups, as well as those factors’ implications for intervention and policy making. Furthermore, although NVAWS was conducted 20 years ago, many of the present findings are consistent with other, very recent ones, and it is clear that observations from the present study are applicable to contemporary questions concerning IPV.

The present results suggest that ending self-medication (via drugs) of IPV trauma among African American women would tend to reduce their injuries from worsening IPV. Medical professionals should recognize illegal drugs as the self-medication of choice for African American women experiencing IPV. They should also provide these women the support and patience women experiencing IPV may require to choose to discuss IPV openly before violence escalates. By building trust between African American women and mental-health professionals, help seeking can be promoted. Trust might be built by educating communities about IPV’s links to PTSD and drug use, using community-based organizations as conduits (especially in low-income neighborhoods). Most important, though, is to capitalize on African American women’s key strength where IPV is concerned: Their prompt recognition of abuse in a relationship and their rejection of it in their subsequent relationships. This strength should be shared via self-help groups and in the broader community. This sort of intervention promises to empower African American women to decide to end any abusive relationship.

In light of findings from this study, psychoeducational intervention with Latinas might most productively focus on those who are married, on those with partners who drink frequently, and on those who perhaps have experienced IPV. This group’s data showed that they tended not to disclose IPV experience to medical professionals when the IPV led to injury. To avoid language barriers to disclosure of IPV in medical settings, bilingual medical staff and social workers might be made available to assist Latinas seeking services. The present results also suggest that Latinas are relatively willing to disclose IPV; mental-health professionals should take full advantage of such willingness to, among other goals, motivate women to eschew maladaptive self-medication (illicit drug use) in favor of improved social support (expanded networks of friends and family members).

The present research speculated that, to overcome IPV experiences, European American women with low income would require extensive support. It speculated, too, that such women could usefully be guided by mental-health professionals to an understanding that the end of an abusive relationship may be the beginning of a future nonviolent relationship. As they confront their involvement with IPV, European American women should, this study suggests, continue seeking support from their social networks; family and friends may encourage them to disclose their IPV to the medical professionals treating their IPV-related injuries. Social workers can urge these women to go for medical care in the company of friends or relatives.

In addition, in keeping with our findings psychoeducational intervention among women of ethnicities other than African American, Latina, and European American should focus on IPV’s associations with drug use and PTSD symptoms. As women of other ethnicities appear reluctant to disclose IPV to medical professionals even in the presence of an IPV-related injury, mental-health professionals might try establishing support networks among them. IPV and other self-help groups might invite women of shared ethnic background to present their accounts of ending abusive intimate relationships and going on to attain new, nonviolent ones. Many women of other ethnicities may lack awareness of the power of even one single, stable relationship to deter IPV.

Many of the present results point up the possible utility of screening low-income women using Medicaid or free clinics to identify any experiencing IPV. Similarly, mental-health professionals working with women manifesting symptoms of PTSD should probe, with sensitivity appropriate to the task, the client’s history of IPV. Finally, future research might carry the investigation of IPV to the specific ethnic groups subsumed within the present variable “Other” ethnicity, treating each ethnic group separately. Groups might include Asian American women and Native American women.

Footnotes

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) received no financial support for the research, authorship, and/or publication of this article.

Author Biographies

Tyrone C. Cheng received the MSW and PhD in social work from the University of Alabama in 1993. He had taught in Southern Illinois University at Carbondale (1993-1994) and University of Alabama at Birmingham (2002-2008). Since 2008, Cheng has been an associate professor and the MSW program chair for the School of Social Work. Cheng had been a social worker, child therapist, and community organizer in Hong Kong, Chicago, Michigan, and Ohio. His research areas include welfare policies, child welfare, substance abuse, and mental health. Recent publications include articles published in Journal of Social Policy, Journal of Health Care for the Poor and Underserved, Journal of Child and Adolescent Substance Abuse, Journal of Interpersonal Violence, Aggression and Violent Behavior, Families in Society—The Journal of Contemporary Social Services, Children and Youth Services Review, Substance Use & Misuse, American Journal on Addictions, American Journal on Addictions, Journal of Psychoactive Drugs, and Journal of Mental Health.

Celia C. Lo, PhD, is a professor in the Department of Sociology and Social Work at the Texas Woman’s University. Her research interests include the sociology of drugs and alcohol, disparities in health and in health-risk behaviors, and drugs and crime.

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