Lifetime and Annual Incidence of Intimate Partner Violence and Resulting Injuries -- Georgia, 1995

Incidence data for intimate partner violence (IPV) at the national and state levels are limited. CDC and the Division of Public Health, Georgia Department of Human Resources (GDHR), analyzed data from the 1995 Georgia Women's Health Survey (GWHS) (1) to 1) estimate the lifetime and annual incidence of physical IPV in Georgia among women aged 15-44 years, 2) examine sociodemographic risk factors for abuse committed during the previous year, and 3) determine the likelihood of injury resulting from IPV. This report summarizes the results of this survey, which indicate that 1) 6% of reproductive-aged women in Georgia had experienced IPV during the previous year, 2) low socioeconomic status was a risk factor for IPV during the previous year, and 3) 63% of women who experienced abuse during the previous year suffered physical injuries.

GWHS was a state-based, random-digit-dialed telephone survey of noninstitutionalized women aged 15-44 years residing in households. During January-July 1995, GDHR conducted the survey on women's health that included questions about IPV. Of 4005 women contacted, 3130 (78%) agreed to participate. One eligible woman per household was selected randomly for survey participation. Data from households with more than one eligible woman or multiple residential telephone numbers were weighted to adjust for unequal probability of selection. In addition, two post-survey adjustment factors * were applied to account for bias caused by nonresponse and exclusion of households without telephones (2). Crude odds ratios were used to test for sociodemographic differences in the proportion of women who experienced IPV during the previous year compared with the proportion of women who did not.

Survey respondents were asked, "Have you ever been physically abused by a partner or ex-partner?" If the respondent answered "yes," she was asked, "In the past 12 months, did a partner or ex-partner abuse you? That is, did he push, shove, hit, slap, kick, or otherwise physically hurt you?" Women who answered "yes" to both questions were asked to report whether they had been injured and whether they had sought medical care for their injuries. Partner or ex-partner was defined as a husband, boyfriend, ex-husband, ex-boyfriend, or any other person that the respondent had dated. **

On the basis of the weighting factors, 30% (95% confidence interval {CI}=28%-31%) of women reported they had experienced IPV during their lifetimes, and 6% (95% CI=5%-7%) reported they had experienced IPV during the previous year. Most (83%) women had been physically abused during the previous year by a current partner (80% by a current partner only; 3% by both a current and a former partner); 17% had been physically abused during the previous year by a former partner only.

Compared with women with household incomes greater than or equal to $50,000, women with household incomes less than or equal to $19,999 were approximately nine times more likely and women with household incomes of $20,000-$49,999 were three times more likely to have experienced IPV during the previous year (Table_1). Other significant risk factors for IPV included being aged 15-34 years, having less than a college degree, being unemployed, having nonprivate or no health insurance, and having a current marital status/living arrangement of never married, separated, divorced, or cohabiting.

Of the women who reported IPV during the previous year, 63% (95% CI=55%-70%) suffered physical injuries; of these, 34% (95% CI=24%-43%) sought medical care. The most frequent types of injuries reported were swellings, cuts, scratches, bruises, strains, or sprains (92%), followed by black eyes (25%), broken bones (16%), knife wounds (12%), broken teeth (8%), burns or scaldings (6%), bites (5%), and broken eardrums (4%). In 1995, the rate for women aged 15-44 years who had experienced IPV-related injuries during the previous year was 38 per 1000 (Table_2).

Reported by: J Buehler, MD, B Dixon, MEd, K Toomey, MD, State Epidemiologist, Div of Public Health, Georgia Dept of Human Resources. Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion; Family and Intimate Violence Prevention Team, Div of Violence Prevention, National Center for Injury Prevention and Control; and an EIS Officer, CDC.

Editorial Note

Editorial Note: This study, the first to generate population-based estimates of IPV in Georgia, shows that in 1995, of the estimated 1,691,600 women aged 15-44 years who resided in Georgia, approximately 507,500 (30%) had experienced IPV during their lifetimes. Of these, approximately 101,500 (20%) had experienced IPV during the previous year. The findings in this report that variables indicative of low socioeconomic status are associated with IPV during the previous year are consistent with prior research (3 ). The findings that 63% of women in the Georgia survey who experienced IPV during the previous year were injured is slightly higher than the national estimate of 52% (4).

The findings in this report are subject to at least three limitations. First, women who were contacted but did not participate in the survey may differ significantly on key variables from those who did participate. For example, nonparticipants may be more likely to have been abused than participants. Second, because only women residing in households with telephones were included, the incidence of IPV among noninstitutionalized women in Georgia was probably underestimated. IPV is associated with low socioeconomic status, which may be related to having no telephone. Third, because this survey focused only on physical violence, IPV incidence is underestimated because IPV can include sexual violence or emotional abuse.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the American Medical Association (AMA) have recommended that health-care providers routinely screen patients to identify women experiencing IPV (5,6). The identification and referral for services will reduce the frequency and severity of IPV before injuries and other negative consequences (e.g., homicide, suicide attempts, and depression) occur (7). The lifetime incidence of IPV found in this study suggests that if the recommendations by JCAHO and AMA were implemented, more women experiencing IPV would be identified and receive appropriate health-care services and other services. Because 34% of women injured during IPV during the previous year sought medical care for their injuries, medical settings may represent promising sites for IPV screening and early interventions. Women experiencing IPV have numerous contacts with health-care providers, regardless of the immediate reason for their visit (7).

On the basis of the results from the GWHS, Georgia's Council on Maternal and Infant Health recommends that all women be screened for IPV and that health-care and social-service providers be trained to conduct IPV screenings (8). The Georgia Commission on Family Violence has developed the "Model Medical Protocol for Domestic Violence Incidents." This protocol, which has been distributed to family violence task forces, shelters, and physician organizations throughout the state, provides information about IPV to sensitize health-care providers regarding the needs of IPV victims and includes a screening tool to help identify them.

Many protocols have been developed to train health-care providers (9) in Georgia and across the country in screening and documenting IPV and IPV-related injuries and appropriately referring women who need follow-up services (e.g., shelters and legal aid). CDC is developing a manual to assist in evaluating programs designed to improve health-care providers' response to women experiencing IPV.

References

1. Serbanescu F, Rochat R. Georgia Women's Health Survey, 1995: preliminary report. Atlanta, Georgia: Georgia Department of Human Resources, Division of Public Health, Epidemiology and Prevention Branch, Office of Perinatal Epidemiology, 1996.

2. CDC. Knowledge about folic acid and use of multivitamins containing folic acid among reproductive-aged women--Georgia, 1995. MMWR 1996;45:793-5.

3. Straus M, Gelles R. Physical violence in American families: risk factors and adaptation to violence in 8,145 families. New Brunswick, New Jersey: Transaction, 1990.

4. Bachman R, Saltzman LE. Violence against women: estimates from the redesigned survey, Bureau of Justice Statistics Special Report. Washington, DC: US Department of Justice, August 1995.

5. Joint Commission on Accreditation of Healthcare Organizations. 1995 Comprehensive accreditation manual for hospitals Vol 1. Oakbrook Terrace, Illinois: Joint Commission on Accreditation of Healthcare Organizations, 1994.

6. American Medical Association. Diagnostic and treatment guidelines on domestic violence. Chicago, Illinois: American Medical Association, 1992.

7. Saltzman LE, Salmi LR, Branche CM, Bolen JC. Public health screening for intimate violence. Violence Against Women 1997;3:319-31.

8. Council on Maternal and Child Health. Domestic violence and pregnancy. Georgia Epidemiology Report 1996;12:3.

9. Osattin A, Short LM. Intimate partner violence and sexual assault: a guide to training materials and programs for health care providers. Atlanta, Georgia: US Department of Health and Human Services, CDC, National Center for Injury Prevention and Control, 1998.

* These adjustment factors were calculated by comparing the GWHS sample distribution to the 1990 census distribution of reproductive-aged women with and without residential telephone numbers listed by race, 5-year age groups, and education (subclasses). For each adjustment subclass, the post-survey nonresponse adjustment factor was the ratio of known state value for each subclass among women residing in households with telephones to the sample estimate of that value. The subclass adjustment factor for nontelephone coverage was the ratio of census counts of all women in each adjustment subclass over women residing in households with telephones for the same subclass.

** A partner could be of the opposite or same sex. However, information about the sex of a partner was not collected.

TABLE 1. Number and percentage of women aged 15-44 years who reported
experiencing intimate partner violence (IPV) during the previous year and crude odds
ratios (COR), by age group, education, insurance type, location of residence, income
level, employment status, and marital status/living arrangement -- Georgia, Georgia
Women's Health Survey, 1995*
====================================================================================
                                        IPV+
                             ---------------------------
                                 Yes            No.
                             -----------   -------------
Category                     No.     (%)    No.     (%)    COR      (95% CI&)
-------------------------------------------------------------------------------
Age group (yrs)
 15-24                        59    ( 7)    731    ( 93)   2.6     (1.7- 4.0@)
 25-34                        71    ( 6)   1119    ( 94)   2.1     (1.4- 3.1@)
 35-44                        34    ( 3)   1097    ( 97)   1.0
Education
 Less than high school        54    (11)    454    ( 89)   4.6     (2.7- 7.8@)
 High school graduate         49    ( 5)    866    ( 95)   2.2     (1.3- 3.7@)
 Some college                 42    ( 4)    898    ( 96)   1.8     (1.0- 3.1@)
 College graduate/            19    ( 2)    726    ( 98)   1.0
 Postgraduate
Type of insurance
 None                         58    (10)    500    ( 90)   3.8     (2.6- 5.5@)
 Medicaid                     37    (16)    188    ( 84)   6.4     (4.2- 9.9@)
 Private                      69    ( 3)   2259    ( 97)   1.0
Location of residence
 Atlanta MSA**                66    ( 4)   1442    ( 96)   0.6     (0.5- 1.1 )
 Other MSA                    45    ( 7)    642    ( 93)   1.1     (0.8- 1.7 )
 Rural (non-MSA)              53    ( 6)    863    ( 94)   1.0
Income level
 <=19,999                     67    (12)    472    ( 88)   8.7     (5.0-15.2@)
 20,000-49,999                81    ( 5)   1496    ( 95)   3.3     (1.9- 5.7@)
       >=50,000               16    ( 2)    979    ( 98)   1.0
Employed
 No                           69    ( 7)    868    ( 93)   1.7     (1.3- 2.4@)
 Yes                          95    ( 4)   2079    ( 96)   1.0
Marital status/
Living arrangement++
 Married                      50    ( 3)   1727    ( 97)   1.0
 Separated                    18    (21)     66    ( 79)   9.4    (5.2- 17.0)@
 Divorced                     28    (12)    212    ( 88)   4.6    (2.8-  7.4)@
 Widowed                       0    ( 0)     17    (100)   0.0     (0.0-999.0)
 Cohabiting                   16    ( 9)    167    ( 91)   3.3    (1.8-  5.9)@
 Never married                51    ( 6)    750    ( 94)   2.4    (1.6-  3.5)@

Total&&                      164    ( 6)   2966    ( 94)
-------------------------------------------------------------------------------
*   n=3130.
+   Unweighted data.
&   Confidence interval.
@   p<0.05.
**  Metropolitan statistical area.
++  Categories for marital status/living arrangement variables are mutually exclusive. Women
    who lived with a partner but were not married were categorized as "cohabiting."
    Current marital status or living arrangement takes precedence over former marital status or
    living arrangement (e.g., women who were remarried were categorized as "married;" women who
    were widowed or separated but were currently cohabiting were categorized as
    "cohabiting").
&&  Does not equal the total for each category because of nonresponse to some questions.
===============================================================================================

TABLE 2. Population estimates* and rates+ of women aged 15-44 years who reported
experiencing intimate partner violence (IPV)-related physical injuries during the
previous year, by type of injury -- Georgia, Georgia Women's Health Survey, 1995
=================================================================================
Type of injury                           Population estimate    Rate
-----------------------------------------------------------------------
Swellings, cuts, scratches, bruises,
 strains, or sprains                                  58,800      35
Black eyes                                            16,000       9
Broken bones                                          10,200       6
Knife wounds                                           7,700       5
Broken teeth                                           5,100       3
Burns or scalds                                        3,800       2
Bites                                                  3,200       2
Broken eardrums                                        2,600       2

All women reporting                                   63,900      38
-----------------------------------------------------------------------
* Estimates are rounded to the nearest hundred.
+ Per 1000 women.
=================================================================================

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