Alcohol, Job Woes Cited in Domestic Violence
Men’s alcohol abuse and shaky employment status rank among the most important precipitating factors in domestic violence against women, while ethnicity plays virtually no role, according to one of the most comprehensive studies to date of assailants and their victims.
The nationwide research, led by UCLA and USC physicians and published today in the New England Journal of Medicine, also confirmed that women are at greatest risk of being assaulted by former partners, underscoring women’s vulnerability after breakups.
The study is one of two in the journal to show that violence stems primarily from the characteristics of the mostly male assailants rather than those of the female victims. In the past, researchers often have focused on the victim’s background, such as whether she had been raped as a child or was herself a substance abuser.
“I think we have to continue to support women who are battered, but we also have to shift our focus to the batterers,” said Dr. Jeane Ann Grisso of the University of Pennsylvania, lead author of one of the studies that looked at women in a low-income community in Philadelphia.
In terms of social programs, “the men have been ignored,” Grisso said.
Like the UCLA-USC group, the Philadelphia team found that substance abuse--in this instance, cocaine abuse--and pervasive economic insecurity were important contributors to assaults on women. Both sets of researchers said that economic class, rather than ethnicity, was a key element.
“I don’t think that violence is race- or ethnicity-motivated. It has to do with socioeconomic status,” said Dr. Demetrios N. Kyriacou, lead author of the UCLA-USC study. “Black women sustain much more violence because they are much poorer in general.”
In particular, the risk factors for male abusers include intermittent employment or unemployment as well as having less than a high school education, the UCLA-USC team found. Lower education levels, which are linked with lower economic status, may render men less able to communicate their frustrations verbally, other researchers have suggested.
Violence against women can be so prevalent that it becomes an ugly part of the landscape. The Philadelphia study showed that low-income women who seek care for their injuries in emergency rooms are more likely to have been assaulted in their neighborhoods by friends and acquaintances than by intimate partners--often outdoors and overwhelmingly as witnesses look on.
“It becomes the norm, the way to resolve conflicts,” said Jacquelyn Campbell, a violence researcher and nurse at Johns Hopkins University in Baltimore.
But the Philadelphia findings--which Campbell found striking--suggest that violence is not an individual failing merely requiring one-on-one attention. Instead, she said, it is a community problem crying out for community attention and intervention. That might include everything from improving economic and housing conditions to developing a more protective police force alert to violence against women and creating long-term screening programs in hospital emergency rooms.
“It’s not easy,” she said. “And it’s not free.”
An editorial in the Journal takes a similar stand. “Perhaps nothing would constrain violence against women more than crystal-clear public and cultural messages that such behavior will not be tolerated,” writes Martha Minow, a faculty member of Harvard Law School.
She offers a concrete recommendation: The U.S. Supreme Court should not tamper with the federal Violence Against Women Act of 1994, which is up for review. The act provides grants to states to assist victims of domestic violence, promotes research and permits victims to bring federal lawsuits against perpetrators. The court is examining whether that last provision goes beyond the federal government’s power by bringing matters that traditionally have been handled in state courts under federal jurisdiction.
The two studies in the journal compared abused women being treated in emergency rooms for their injuries with female patients being treated for other medical complaints. The UCLA-USC team looked at 256 abused adults and 659 non-abused peers; the Philadelphia team compared 405 abused adolescent girls and women with 520 peers.
The most dramatic finding in the UCLA-USC study was that alcohol abuse by male partners in general increased the risk of domestic violence by more than three times and that the more men drank, the greater their likelihood of their being physically abusive. That does not mean all abusers drink excessively or that all heavy drinkers abuse women.
Both research teams cautioned that their findings might not apply to domestic violence victims as a whole, because the teams focused on women who acknowledged their domestic violence injuries and sought medical care for them in emergency rooms. Women who denied being abused or who did not seek medical care were not represented.
Even so, studies suggest that violence against women is pervasive. The Philadelphia researchers found that even among low-income women who were not in the emergency room for a recent assault, more than half reported they had in the past been raped, assaulted by a partner while pregnant or sexually abused as a child.
Citing previous research, the UCLA-USC team noted that more than one in five women are at risk for injury from domestic violence during their lives, and nearly one in 10 risk severe injury. One-third of the murders of women in the United States are committed by a spouse or a partner.
While outside experts said they were not surprised to see that substance abuse and economic status are linked with violence against women, many said they were pleased to see these associations highlighted, measured and dissected by members of the medical community.
“What’s significant is the use of very sophisticated and very powerful public health techniques to examine risk factors the same way [doctors] have used them to look for cardiac disease and other medical conditions,” said Dr. Art Kellermann, an emergency room physician and violence expert at Emory University in Atlanta.
“[The findings] are clearly major advances in the science of studying domestic violence, but they are also of practical use in understanding the steps we can take to prevent it and assess the level of danger.”
