Research articleChildhood family violence history and women’s risk for intimate partner violence and poor health
Introduction
T he role of family violence as an important factor in women’s health is becoming increasingly well recognized. Both a history of childhood abuse1, 2 and adult intimate partner violence (IPV)3, 4 have been linked with poor physical and mental health. Dose–response relationships have also been identified between the number of adverse childhood experiences and the presence of a number of adult diseases.5
A history of childhood abuse or of witnessing IPV may also increase risk for adult IPV, although not all studies find these associations. Hotaling and Sugarman6 identified four reviews of a possible association between women experiencing violence from parents during childhood and husband-to-wife violence in adulthood. Two of these reviews found such an association and two did not. Hotaling and Sugarman6 also reported that they found no such association in a national survey, after controlling for other risk factors including the woman’s self-esteem and marital conflict. However, if childhood abuse is associated with IPV because of its effects on factors such as self-esteem or later marital conflict, statistically controlling for these factors may obscure a real association. More recently, in a study of over 1200 women, those who reported receiving repeated severe beatings as children had more than three times the risk of being the victim of domestic violence as adults compared to non-abused women.7
Childhood experiences of witnessing interparental violence may also be associated with adult victimization. A well-controlled study of the association between childhood witnessing of abuse and adult IPV among 1443 women seeking medical care showed a four-fold increase in risk of partner physical and sexual abuse, and a three-fold risk of physical abuse only, among those women who reported that their fathers were physically abusive to their mothers.8 However, childhood abuse was not measured, and the high rates of violence in this sample may not be typical of the general population. Over one third (37.6%) of the sample reported ever experiencing physical IPV, compared to 22.1% in the National Violence Against Women Survey.9
These studies provide growing evidence for interlocking patterns of associations between the various types of family violence, and between family violence (both in childhood and adulthood) and women’s health. However, most studies focus on some subset of family violence (child abuse, witnessing IPV as a child, and/or adult IPV), and few examine possible differences associated with the nature of abusive experiences, such as physical versus sexual abuse. The nature of abuse experiences may be important; for example, a history of early and chronic sexual abuse was associated with more than a seven-fold increase in women’s HIV-risk behaviors, while physical abuse was not significantly associated with these risk behaviors.10 Also, the majority of the studies have been based on samples drawn from healthcare facilities, which may not be generalizable to the general population.
This study used a general population survey to examine the associations between women’s childhood experiences of physical and sexual abuse and witnessing interparental violence, on the one hand, and adult intimate partner physical violence and emotional abuse, physical health, and emotional distress, on the other hand, after controlling for age and income. The focus was on women because IPV is more injurious to women than men.11
Section snippets
Methods
The Behavioral Risk Factor Surveillance System (BRFSS), sponsored by the Centers for Disease Control and Prevention, is a continuous, state-based system that collects information about modifiable risk factors for chronic diseases and other leading causes of morbidity and mortality. Interviewers collect BRFSS data using a random-digit-dial telephone survey of noninstitutionalized, English-speaking Washington State civilians aged ≥18 years. The BRFSS sample includes unlisted and listed telephone
Sample characteristics
The response rate (based on the number of completed interviews divided by the total of completed interviews, refusals, and terminations during the interview) was 61% in 1999 and 54% in 2001, averaging 57%. Sample characteristics are presented in Table 1. A total of 4456 women completed the BRFSS survey in 1999 and 2001. Of these, 929 were omitted from all analyses because of missing data on childhood abuse/witnessing history (72); recent IPV or abuse (275); age (29); income (609); health status
Discussion
Both experiencing and witnessing physical violence in childhood were strongly associated with women’s reports of physical violence by an intimate partner. After controlling for age and family income, each of these childhood experiences was associated with more than a four-fold increase in risk for reporting violence in the past year. Intimate partner physical violence was usually accompanied by emotional abuse, although the converse was not true.
Women who have witnessed interparental violence
Acknowledgements
We would like to acknowledge JoElla M. Weybright, Laurie Burke, and staff at Gilmore Research Group, Seattle, Washington, for their assistance in conducting interviews. This research was supported by the Washington State Department of Health and by the Centers for Disease Control and Prevention via Cooperative Agreements U58/CCU002118-13 and -15 (1999 and 2001).
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