African-American women experience significantly more domestic violence than White women in the age group of 20-24. Generally, Black women experience similar levels of intimate partner victimization in all other age categories as compared to White women, but experience slightly more domestic violence. Approximately 40% of Black women report coercive contact of a sexual nature by age 18 The number one killer of African-American women ages 15 to 34 is homicide at the hands of a current or former intimate partner.
36% of all Hispanic report being severely abused in their lifetime. •2 out of every 5 Hispanic females (39%) reported experience severe abuse. •1 out of every 5 Hispanic females (18%) reported being forced to have sex against their will. •40% reported experiencing at least one form of domestic violence took no action. •82% believe that it is never appropriate to stay in an abusive relationship, yet 46% acknowledge that leaving an abusive relationship can be more dangerous than staying. •83% agree that a husband who abuses his wife is more likely to also abuse his children; yet only 47% indicate a belief that domestic violence passes from generation to generation.
Research would also seem to indicate that victims of domestic violence have a higher incidence of alcohol or drug abuse (this might be prescription drugs rather than street drugs) than non-victims. According to Stark & Flitcraft (2006) women who experience domestic violence are 15 times more likely to have alcohol dependency and 9 times more likely to have a drug problem than women not experiencing domestic violence. Rates of misuse of both increase after the first violent episode. Another of the abuse victim characteristics is suffering from what is called traumatic bonding, where, to put it very briefly, a very strong emotional bond is built up with increases the more trauma is experiences. This is why so many abuse victims feel that they really love their abuser - they are mistaking traumatic bonding with love.
“Because, as an educated or professional person, the victim will say, ‘These things shouldn’t be happening to me.’ And so they have a greater interest in protecting the secret because they’re embarrassed. “There’s less sympathy from others and more judgment involved. People will wonder how someone like you got into that situation. They think: ‘So if you’re not poor, or on drugs, or come from a bad family, then it’s just your tough luck.’ ”
Immediate injuries from the assault, battered women may suffer from chronic pain, gastrointestinal disorders, psychosomatic symptoms, and eating problems. Although psychological abuse is often considered less severe than physical violence, health care providers and advocates around the world are increasingly recognizing devastating mental health effects of domestic violence, including anxiety, post-traumatic stress disorder, and depression. Women who are abused suffer an increased risk of unplanned or early pregnancies and sexually transmitted diseases, including HIV/AIDS. As trauma victims, they are also at an increased risk of substance abuse. Women are particularly vulnerable to attacks when pregnant, and thus may more often experience medical difficulties in their pregnancies.
According to the National Center for Injury Prevention and Control in the United States, the estimated annual direct medical cost of caring for battered women in the United States is $1.8 billion dollars.
Domestic violence can be fatal; women are both intentionally murdered by their partners and lose their life as a result of injuries inflicted by them. In particular, recent studies in the United States have focused on choking or strangulation, a tactic often used by batterers. Because choking or strangulation rarely leaves vivid external physical marks, police may not recognize the victim’s need for medical assistance or the seriousness of the violence. Injuries resulting from choking or strangulation can often be lethal; such injuries “may appear mild initially but they can kill the victim within 36 hours.” From When Abusers Choke Their Victims, Violence Against Women 22-5 (Joan Zorza ed., 2002).
The secondary effects of domestic violence involve the victim’s ability to function in daily life. Victims of domestic violence often take more absences from work to visit the doctor. Battering may lead to feelings of shame, embarrassment and humiliation, particularly when beatings leave marks, which in turn may lead to further isolation from friends and family and to absences from work. Because of increased absences and substance abuse, battered women may find it difficult to maintain steady employment.
Primary – Primary prevention is any action, strategy or policy that prevents intimate partner violence (IPV) from initially occurring. Primary prevention seeks to reduce the overall likelihood that anyone will become a victim or a perpetrator by creating conditions that make violence less likely to occur. Prevention of IPV focuses on preventing first-time perpetration and first time victimization.
Secondary – to target services to select (at-risk) individuals, in an effort to decrease the incidence of a problem by reducing known or suspected risk factors
Tertiary – to minimize the course of a problem once it is already clearly evident and causing harm, control of the behavior and its effect, punishment and/or treatment for the perpetrators, and support for the victims. Because tertiary efforts are intended more as intervention aimed at current needs as well as prevention of future harm, this document reviews only primary and secondary prevention strategies and their current research status.
Primary: Community Forums (Domestic Violence The Role of the Health Care Professional, n.d.) Education about Domestic Violence through community forums, offices, and schools Community forums: Increase awareness in the general public Offices: Posters and Resource cards School: Provides the healthcare provider an opportunity to teach adolescents about the risk of dating violence and provide an understanding between an honest relationship and a power-controlled relationship
Secondary: Routine Screening of Women for Domestic Violence (Domestic Violence The Role of the Health Care Professional, n.d.) Assessment of violence should be constant, especially during prenatal and and healthcare visits Open-ended questions should be asked to give the patient an opportunity to feel comfortable speaking with a healthcare professional Example: "Sometimes when I see injuries like yours, the person has been hurt by someone close. Is that happening to you?”
Tertiary: (Domestic Violence The Role of the Health Care Professional, n.d.) The choice of leaving a violent relationship is the victim’s As a PH nurse, the intervention is to accept the women’s decision for action or for lack of action. If she remains to stay with the abuser, the HCP should remain supportive of the family and pursue alternative methods to solve the problem.
Assessment: (Domestic Violence Assessment, n.d.) Assess the immediate safety needs of the victim: Asking questions if the victim is in immediate danger, whereabouts of the abuser, and if police assistance is needed are important questions to ask. Assess the pattern and history of abuse: Physical, sexual, psychological and economical assessment Assess the connections between the domestic violence and the patient’s health issue: How is the domestic violence emotionally and psychologically affecting the overall wellbeing of the victim? How is the physical abuse impacting her physiologically (broken bones, bruises, cuts, etc.)?
Policy: Domestic Violence Prevention Act (Family Law Domestic Violence, n.d.) Family Code section 6320 Request for temporary restraining order. Emergency/Protective Order Court has the right to deny request for restraining order if the court lacks subject matter jurisdiction in the case
Penal Code (CA codes, n.d.) A battery is any willful and unlawful use of force or violence upon the person of another. An assault is punishable by a fine not exceeding one thousand dollars ($1,000), or by imprisonment in the county jail not exceeding six months, or by both the fine and imprisonment.
Evaluation: (Domestic Violence Assessment, n.d.)
Listen and respond to safety issues: Provide brochures about safe planning and escapes Review how to keep information obtained away from the abuser Provide the number to a 24 hour emergency domestic violence hotline (local, state, national) Tell the patient that if he or she plans of leaving the relationship, it is best to do so without informing the abuser
Make referrals to local resources Refer patient advocacy and support services within the community including legal options, advocacy services, etc.
Orange county Domestic Violence Assistance Programs (Domestic Violence, n.d.) Victims may file for a petition to requesting orders for restraining the abuser, directing the abuser to leave the household, restraining the abuser from interfering with minor children in custody of the victim, and preventing the attacker from entering the residence. No fees are charged for a temporary Restraining Order under the Domestic Violence Prevention Act.
2. Women’s Transitional Living Center (WTLC, n.d.) WTLC helps women build their self-esteem and continue their lives into a more independent living Programs and Services include transitional housing program, community outreach, emergency shelter, immigration services, legal advocacy, 40-hour domestic violence training, Operation Facelift, and Residential Children’s Program. To be entered into a WTLC, the victim must complete a 45/90 day emergency program. Once admitted to the Transitional Housing Program clients are provided with a furnished one –bedroom apartment. Strict safety and confidentiality policies are maintained.
3. Laura’s House (Programs and Services, n.d.) Laura’s House provides a 30-bed shelter for battered women and their children. Food, clothing, toiletries are provided to victims as well as regular and individual counseling Case managers assist with legal and financial situations.
“We define domestic violence as a pattern of abusive
behavior in any relationship that is used by one
partner to gain or maintain power and control over
another intimate partner. Domestic violence can be
physical, sexual, emotional, economic, or
psychological actions or threats of actions that
influence another person. This includes any
behaviors that intimidate, manipulate, humiliate,
isolate, frighten, terrorize, coerce, threaten,
blame, hurt, injure, or wound someone” (USDOJ:
Domestic Violence, 2013).
▪ 40% of Domestic Violence
victims are men
▪ Our focus is on the 60% of
▪ According to “the United
States Department of
Justice estimates that 4.5
million women are
violently victimized in
the United States every
year” (Santana, 2004).
“Domestic violence can happen to anyone regardless of race, age,
sexual orientation, religion, or gender. Domestic violence affects
people of all socioeconomic backgrounds and education levels.
Domestic violence occurs in both opposite-sex and same-sex
relationships and can happen to intimate partners who are married,
living together, or dating” (USDOJ: Domestic Violence, 2013).
Background: Types of Abuse
Effect on Public Health
▪ Clinical data indicate that 22-37% of emergency room
visits made by women are for injuries sustained from
relationship violence and 75% of those women will be
re-victimized (Santana, 2004).
▪ Increased health problems such as injury, chronic pain,
gastrointestinal, STDs, depression, and post-traumatic
stress disorder are well documented by controlled
research in abused women in various settings (Lancet,
▪ In addition to the human costs, research also shows
that violence has huge economic costs, including the
direct costs to health, legal, police and other
services (WHO, 2011).
▪ More common in low socioeconomic families
▪ WHO would like to have a primary, secondary and tertiary level of
prevention: including both services that respond to the needs of women
living with or who have experienced violence and interventions to
▪ Limited research is available
▪ This is an area of health where further research is needed to address
the most effective approach.
▪ Immigrants – fear of being deported if they report incident
▪ California law enforcement received 176,299 domestic violence-related
calls in 2006.
– Notes: 80,946 of the calls involved weapons, including firearms and knives.
▪ 43,911 people were arrested for domestic violence offenses in 2006.
– Note: Of the 43,911 offenders, 80% were men and 20% were women.
▪ 134 homicides resulted from intimate partner violence in 2006. 110 of
the victims were women and 24 were men.
▪ 9,213 forcible rapes were reported in California in 2006.
▪ In California, one forcible rape occurs every 56 minutes.
According to the Attorney General’s report, the California criminal
justice system is failing to enforce the state’s domestic violence
laws. These failures include the following:
•Courts failing to issue restraining orders
•Restraining orders being issued, but not served
•Prosecuting officers not fully utilizing community-based victims advocates
•Batterers failing to attend court-ordered programs without repercussions
•Lack of coordination of criminal justice agencies
•The cost of intimate partner violence exceeds $5.8 billion each year
• $4.1 billion of which is for direct medical and mental health services
Native Americans are victims of rape
or sexual assault at more than
double the rate of other racial
For Native American victims of
violence, the offender was slightly
more likely to be a stranger than an
intimate partner, family member or
Native Americans described the
offender as an acquaintance in 34%
of rapes/sexual assaults, and as an
intimate partner or family member in
25% of sexual assaults.
Cultural Background Cont...
African Americans, especially women, suffer deadly violence from
family members at rates higher than other racial groups in the US.
Black females experienced intimate partner violence at a rate 35%
higher than that of white females, and about 22 times the rate of
women of other races.
Cultural Background Cont...
The rate of intimate partner violence
for Hispanic women, like women of
other races, peaked at ages 20-24.
The victimization rates of Hispanic
women peaked at lower levels than
non-Hispanic women in every age
group, but spread over a wider range
36% of all Hispanic report being
severely abused in their lifetime.
Cultural Background Cont...
Japanese study of a random sample of 211 Japanese immigrant
women and Japanese American women in Los Angeles County
conducted in 2005:
61% reported some form of physical, emotional, or sexual partner
violence that they considered abusive - including culturally
demeaning practices such as overturning a dining table, or
throwing liquid at a woman.
52% reported having experienced physical violence during their
lifetime. When the probability that some women who have not been
victimized at the time of the interview, but may be abused at a
later date is calculated, 57% of women are estimated to
experience a partner's physical violence by age 49.
Cultural Background Cont...
Asian & Pacific Islanders
•12.8% of Asian and Pacific Islander
women reported experiencing physical
assault by an intimate partner at least
once during their lifetime.
•The rate of physical assault was lower
than those reported by Whites (21.3%),
African-Americans (26.3%), Hispanic, of
any race, (21.2%); mixed race (27.0%),
American Indians and Alaskan Natives
The low rate for Asian and Pacific
Islander women may be attributed to
• Low self esteem
• Emotional and economic dependency
• Continued faith and hope abuser will "stop"
• Depression and Stress disorders and/or psychosomatic
• Accepts blame and guilt for violence
• Socially isolated
• Believes social myths about battering, believes in
stereotypical sex roles
• Has poor self-image
• Contemplates or attempts suicide or self-harms
• Participation in pecking-order battering
• Appears nervous or anxious
• May defend any criticism of abuser. May have repeatedly
left or considered leaving the relationship.
“It’s important to note that domestic violence crosses
all socioeconomic classes, professions, education
levels, religious and ethnic groups. It’s not just the
poor and uneducated.”
In fact, experts say, when domestic violence happens to
people of a higher income and educational level the
stakes can be much higher and the shame much greater.
▪ Chronic pain, gastrointestinal
disorders, psychosomatic symptoms,
▪ Mental health problems (anxiety,
post-traumatic stress disorder,
▪ Increased risk of unplanned or
early pregnancies and sexually
▪ Increased risk of substance abuses
Prevention and Control
▪ Primary – educational outreach to community groups, churches, schools.
▪ Secondary – routine assessments for domestic violence at standard
medical visits (in pregnancy, especially).
▪ Tertiary – increase levels of services required by battered women
(shelters, legal protection, emergency hotlines, etc)
Role of the PH Nurse
▪ Primary: Education about Domestic
▪ Secondary: Routine screening of women
for domestic violence
▪ Tertiary: Accept women’s decision for
action or for lack of action.
– Remain supportive of the family, and
pursue alternative methods to solve
– Assess the immediate safety needs of the victim
– Assess the pattern and history of abuse
– Assess the connections between the domestic
violence and the patient’s health issues
– Domestic Violence Prevention Act
– Penal Code
– Listen and respond to safety issues
the victim may have
– Make referrals to local resources
1. Orange County Domestic Violence Assistance Programs
2. Women’s Transitional Living Center
3. Laura’s House
The Advocates for Human Rights. (2013, August). Health Effects of Domestic Violence. Retrieved from
ChildWelfare Information Gateway (June 2014).
DomesticViolence. (n.d.). Orange County Sheriff's Department. Retrieved July 27, 2014, from
DomesticViolenceAssessment and Intervention provided by the FamilyViolence Prevention Fund. (n.d.).
Domestic Violence Assessment and Intervention provided by the Family Violence Prevention Fund. Retrieved July
27, 2014, from http://socialworkers.org/pressroom/events
DomesticViolence:The Role of the Health Care Professional. (n.d.). Domestic Violence:The Role of the Health
Care Professional. Retrieved July 27, 2014, from http://quod.lib.umich.edu/m/mfr/4919087.0002.105/--
Family Law: DomesticViolence Prevention Act forms. (n.d.). courts.ca.gov. Retrieved July 27, 2014, from
Hagion, C. (2001). Preventing Domestic Violence. Retrieved from http://www.the-ripple-
CA Codes (pen:). (n.d.). CA Codes (pen:). Retrieved July 27, 2014, from http://www.leginfo.ca.gov/cgi-
NCADV (n.d.). . Retrieved July 28, 2014, from
Programs & Services. (n.d.). Laura's House. Retrieved July 27, 2014, from
Santana, I. DomesticViolence In Hispanics InThe Southeastern United States: A Survey And Needs
Analysis. Journal of FamilyViolence, 107-115.
Violence against women: an urgent public health priority. (n.d.).WHO. Retrieved July 28, 2014, from
WTLC 24-Hour Hotline 877-531-5522. (n.d.). Transitional Living Program. Retrieved July 27, 2014, from
Physical Abuse: Hitting, slapping, shoving, grabbing,
pinching, biting, hair pulling, etc. This type of abuse also
includes denying a partner medical care or forcing alcohol /
Sexual Abuse: Coercing or attempting to coerce any sexual contact
or behavior without consent. Sexual abuse includes, but is certainly
not limited to, marital rape, attacks on sexual parts of the body,
forcing sex after physical violence has occurred, or treating one in a
sexually demeaning manner.
Spiritual Abuse: using religious or spiritual beliefs to
manipulate someone, preventing the partner from practicing
their religious or spiritual beliefs, ridiculing the other person’s
religious or spiritual beliefs, forcing the children to be reared in
a faith that the partner has not agreed to.
Stalking: calling, following, harassing, spying on, leaving
messages, unwanted e-mails and phone calls.
Emotional Abuse: Undermining an individual's sense of self-
worth or self-esteem. This may include, but is not limited to
constant criticism, diminishing one's abilities, name-calling, or
damaging one's relationship with his or her children.
Economic Abuse: Is defined as making or attempting to make
an individual financially dependent by maintaining total
control over financial resources, withholding one's access to
money, or forbidding one's attendance at school or
Psychological Abuse: Elements of psychological abuse include
- but are not limited to - causing fear by intimidation;
threatening physical harm to self, partner, children, or
partner's family or friends; destruction of pets and property;
and forcing isolation from family, friends, or school and/or