No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Intimate Partner Violence and Housing Instability
Abstract
The mental and physical health consequences of intimate partner violence (IPV) have been well established, yet little is known about the impact of violence on a woman's ability to obtain and maintain housing. This cross-sectional study examines the relationship between recent IPV and housing instability among a representative sample of California women. It is expected that women who have experienced IPV will be at increased risk for housing instability as evidenced by: (1) late rent or mortgage, (2) frequent moves because of difficulty obtaining affordable housing, and/or (3) without their own housing.
Data were taken from the 2003 California Women's Health Survey, a population-based, random-digit-dial, annual probability survey of adult California women (N=3619). Logistic regressions were used to predict housing instability in the past 12 months, adjusting for the following covariates; age, race/ethnicity, education, poverty status, marital status, children in the household, and past year IPV.
In the multivariate model, age, race/ethnicity, marital status, poverty, and IPV were significant predictors of housing instability. After adjusting for all covariates, women who experienced IPV in the last year had almost four times the odds of reporting housing instability than women who did not experience IPV (adjusted odds ratio=3.98, 95% confidence interval: 2.94-5.39).
This study found that IPV was associated with housing instability among California women. Future prospective studies are needed to learn more about the nature and direction of the relationship between IPV and housing instability and the possible associated negative health consequences.
... Some studies conducted prior to the pandemic have found associations between IPV victimization and increased food insecurity, housing instability, and other financial hardships (Adams et al., 2021;Montgomery et al., 2015;Pavao et al., 2007). As such, individuals who have histories of IPV prior to the COVID-19 pandemic may also be at risk for increased economic insecurity during the economic crisis stemming from the pandemic. ...
... Although limited, some research carried out in years prior to the pandemic establishes associations between IPV and specific forms of economic insecurity (Montgomery et al., 2015;Pavao et al., 2007). Food insecurity, defined as having not enough food for oneself and one's family, financially struggling to access food and nutritious meals, or being unable to obtain food in socially acceptable ways (Anderson, 1990), has been previously linked to recent IPV victimization among women. ...
... Housing insecurity (also sometimes referred to as housing instability) occurs when someone has a place to live but has difficulty paying rent or mortgage payments on time, which can lead to threats of eviction (Rollins et al., 2012). In a random sample of 4,000 women from California, Pavao et al. (2007) found that women with past-year IPV had nearly four times the odds of experiencing recent housing instability, after accounting for poverty and demographic factors. Risks for housing insecurity associated with IPV victimization may also vary across demographic characteristics. ...
Objective: This study investigated the relationship between intimate partner violence (IPV) experienced both before and during the COVID-19 pandemic and increased economic insecurity in food, phone/internet
services, health care, and housing. We also assessed sociodemographic differences associated with increased economic insecurity among women and transgender/nonbinary adults since the start of the
COVID-19 pandemic. Method: An online, cross-sectional survey was administered to a general population sample of women and transgender individuals in one Midwestern state (N = 1,169). Results: IPV
victimization during stay-at-home orders was associated with approximately three times higher odds of housing insecurity (adjusted odds ratio [AOR] = 3.06, p < .001) and increased health care insecurity
(AOR = 2.95, p < .001) than those without victimization during stay-at-home orders, even after adjusting for IPV immediately prior to the pandemic. Multiracial, pregnant, and sexual minority (defined as lesbian,
gay, bisexual, queer, or other sexual orientation [LGBQ+]) women and transgender/nonbinary individuals were at elevated risk for specific forms of increased insecurity. Conclusions: Findings highlight the need for continued COVID-19 legislation that enhances housing and rental support for populations most in need of safe and stable housing, particularly survivors of IPV. Reduced access to health care limits IPV
opportunities for intervention and treatment. Expanding accessible and affordable health care options during the COVID-19 pandemic can enhance the safety and well-being of survivors and increase
opportunities for providers to screen for IPV.
... This may be due in part to social housing sector allocations prioritising women if they have children (Malos and Hague 1997). However, intimate partner violence amongst women is a key factor that contributes to housing insecurity and homelessness for survivors and their dependents (Fraga Rizo et al. 2022;Pavao et al. 2007). Statistics reveal that there is an increased incidence of intimate partner violence among women with a substance use disorder (El-Bassel et al. 2011;Engstrom et al. 2012) and women also report more family violence upon entry to recovery than men (Mcquaid et al. 2017). ...
... Homelessness rarely occurred amongst the females in the sample because they were unable to maintain their home, pay bills, nor did they face eviction due to their drug-related issues. In line with previous studies, the main cause of homelessness amongst the women was due to having to escape negative, substance using, and/or violent relationships with male partners (Fraga Rizo et al. 2022;Pavao et al. 2007). Fleeing their home to escape a partner led to a series of ongoing temporary housing transitions. ...
Gendered understandings of housing transitions amongst women and especially amongst those in substance use disorder recovery are under-researched. To address this gap, this study explores the multifaceted challenges and pathways to housing stability amongst women in substance use disorder recovery in the UK. Through qualitative analysis of life course interviews with 15 women in recovery, it becomes evident that housing insecurity, instability, and frequent transitions are common experiences. The women in the sample faced housing instability, ranging from temporary supported accommodations to homelessness. Notably, escaping negative relationships with male partners emerged as a primary cause of homelessness among these women. What this article highlights, which has not been found elsewhere to date, is that housing transitions are essentially a social process for women in recovery. This study highlights the social dimension of housing transitions. The potency of social capital and social networks in determining housing stability and security amongst women is emphasised as they exchange negative forms of social capital for positive forms of social capital. Recommendations stemming from this study include the need for drug recovery and housing policies to integrate gender-specific strategies to adequately support women in recovery. Further, they need to adopt a broader perspective, emphasizing the importance of fostering positive social connections and networks when considering housing options for individuals in recovery. For women who have spent a long time in supported residential and therapeutic environments, there is a need to develop a scaffolded support system to help women transition to independent living. The utilisation of recovery capital (and CHIME) as frameworks may provide a basis upon which to map out holistic and sustainable pathways to housing stability and security for women in recovery due to their acknowledgement of interconnected and related life domains that produce change and transformation.
... In Tanzania, a study found that women who use heroin doubled up with friends, lived in shared spaces or in houses for shorter durations of time (Williams et al., 2006). Studies have also shown a significant relationship between housing instability and physical and sexual violence against women (Baker, Cook, & Norris, 2003;Pavao et al., 2007;Montgomery et al., 2018), including female sex workers and WWID (Kennedy et al., 2017;Reed et al., 2011). WWUD who experience housing instability face significantly higher odds of experiencing physical and sexual violence than those with stable housing (Silberg et al., 2022). ...
... Women who are economically insecure, discriminated against by housing providers or are unable to afford housing are more likely to depend on intimate partners for housing security and may give up personal safety for housing stability achieved through sexual partnerships (Baker, Cook and Norris, 2003;Kennedy et al., 2017Meyer, 2015Pavao et al., 2007). Socioeconomically disadvantaged women often face periods of housing insecurity after leaving abusive relationships and may return back to partners to secure stable housing despite the risk of violence (Baker, Cook, and Norris, 2003;Anderson and Saunders, 2003). ...
An emerging body of research has shown that women who live in highly coercive settings characterised by poverty and housing instability face a heightened risk of intimate partner violence. We seek to contribute to this literature by exploring how multiple, overlapping social and structural factors shape intimate partner violence (IPV) risk among women who use drugs (WWUD). Analysis of 16 in-depth interviews with WWUD in Uyo, Nigeria, framed by intersectionality, reveals that intimate partnerships of WWUD were contextualised by socio-economic disadvantages, housing instability, and dependent substance use. Intimate partnerships motivated by women’s concerns to meet survival needs manifested as unequal exchanges that locked them in abusive relationships. Socio-economic deprivations, housing instability and dependent substance use operated at a more distal level to shape unequal relationships characterised by dependence and subordination of WWUD, the later factors constituting the proximal axis of IPV risk. WWUD sought to negotiate IPV risk through deference and acquiescence to male partners. Interventions aiming to reduce IPV risk within intimate partnerships of WWUD should seek to expand the space women have to negotiate risks within these partnerships in the short term. In the long term, they should focus on ensuring access to safe housing, economic support and drug treatment services.
... Even with IPV decreasing, participants who experienced very unstable or unstable housing tended to also report more and various forms of IPV. This is confirmed by previous research that also determined that IPV is higher among individuals with more unstable housing [55][56][57]. IPV may be higher among individuals reporting more housing instability because it increases stress, and increases in stress coincide with increased IPV [58,59]. Another possibility is the bidirectional relationship between IPV and insecure housing. ...
... Women who experience IPV may depend economically on their partners, which greatly limits housing options after separation. On the other hand, women who experience housing instability due to economic constraints may choose to return to their partner [56,60]. Interestingly, participants tended to only speak about housing in conjunction with IPV when they discussed leaving a partner who perpetrated physical IPV and often went to a domestic violence shelter or that they financially could not afford housing without their partner. ...
Austin, Texas emerged as one of the fastest-growing cities in the U.S. over the past decade. Urban transformation has exacerbated inequities and reduced ethnic/racial diversity among communities. This qualitative study focused on housing insecurity and other syndemic factors among Black and Latina cisgender women (BLCW). Data collection from 18 BLCW using in-depth interviews guided by syndemic theory was conducted three times over three months between 2018 and 2019. Four housing insecurity categories emerged: (a) very unstable, (b) unstable, (c) stable substandard, and (d) stable costly. Participants who experienced more stable housing, particularly more stable housing across interviews, reported fewer instances of intimate partner violence (IPV), less substance use, and a reduced risk of acquiring HIV. Results identified the importance of exploring housing insecurity with other syndemic factors among BLCW along with determining structural- and multi-level interventions to improve housing circumstances and other syndemic factors. Future research should explore these factors in other geographic locations, among other intersectional communities, and among larger sample sizes and consider using a mixed methods approach.
... Women's experiences of trauma and homelessness are closely interconnected (Milaney et al., 2020). Previous studies have found that women who are homeless are a highly traumatized group and have more significant histories of traumatic stress and interpersonal violence than women who are housed (McHugo et al., 2005;Pavao et al., 2007;Wenzel et al., 2000). Trauma experiences such as intimate partner violence are often pathways to forced displacement and homelessness (Pavao et al., 2007;U.S. Conference of Mayors, 2016). ...
... Previous studies have found that women who are homeless are a highly traumatized group and have more significant histories of traumatic stress and interpersonal violence than women who are housed (McHugo et al., 2005;Pavao et al., 2007;Wenzel et al., 2000). Trauma experiences such as intimate partner violence are often pathways to forced displacement and homelessness (Pavao et al., 2007;U.S. Conference of Mayors, 2016). Additionally, while homeless, women are at higher risk for further trauma as they are particularly vulnerable to victimization such as sexual and/or physical assault and witness to violence towards others (Sikich et al., 2008;Wenzel et al., 2000). ...
Women with substance use disorders (SUDs) who are homeless or near homeless have high rates of mental health, behavioral health, and SUD treatment needs. To effectively respond to these needs, it is critical to understand the population-specific trauma experiences of these women. This descriptive study examined the extent and nature of trauma experience among women who have an SUD and are homeless or near homeless. Results (n = 851 women) indicated high rates of trauma experience. All participants (100%) reported at least one type of trauma experience in their lifetime, with the majority (75.3%) having experienced five to seven of the seven types of trauma experiences assessed. Participants reported high levels of emotional severity related to the majority of traumatic events experienced. The pervasiveness of the trauma experiences and the related emotional impact among women with SUDs who are homeless or near homeless reinforce the necessity for trauma-informed care in treatment settings.
... IPV is likewise a key driver of housing insecurity for women (Chan et al., 2021;Dillon et al., 2016;Pavao et al., 2003), with adverse consequences for health and well-being (Rollins et al., 2012). Lack of stable housing options can keep survivors in violent relationships, particularly when the relationship involves economic abuse or coercion that would burden survivors with outstanding rent arrears or eviction histories if they left (Diemer et al., 2017;Griffing et al., 2002;Wilcox, 2000). ...
... More recently, over one in four (28%) heads of homeless households reported prior experiences of domestic violence in the U.S. Department of Housing and Urban Development (HUD)'s annual homeless count (Henry et al., 2020). A large populationbased study conducted in California (N = 3,619) found that women who had experienced IPV victimization faced a four-fold increase in risk for housing insecurity, defined as having fallen behind on rent, experienced homelessness, or had difficulty finding a place to live (Pavao et al., 2003). Investigation of a large sample of socioeconomically disadvantaged mothers (N = 2,425) found that IPV was associated with increased housing insecurity more broadly, measured using a range of indicators including inability to afford rent or mortgage, eviction, doubling up (sharing accommodations due to cost), and homelessness (Marçal, 2021a). ...
Purpose
Intimate partner violence (IPV) can have devastating socioeconomic costs for survivors. Several policies exist to support survivors’ socioeconomic stability, but little research examines their impacts. The present study investigates whether three state-level workplace protections for IPV survivors – (1) right to reasonable accommodations; (2) confidentiality; and (3) protection from discharge for abuse-related work disruptions – are associated with increased employment and housing stability in a sample of mothers who have experienced IPV.
Method
Data on survivors came from the Fragile Families and Child Wellbeing Study; the analytic sample was limited to mothers who had experienced IPV. State policy protections were compiled and merged with Fragile Families data in order to indicate which mothers lived in states with certain protections. Three hierarchal logistic models that nested women (N = 1,296) within states (N = 37) tested associations of living in a state with each of the protective policies with employment status and housing hardship.
Results
All three policies were associated with increased likelihood of employment, but none related with reduced risk for housing hardship.
Conclusions
Reasonable accommodations, privacy protection, and protection from discharge help survivors keep their jobs. State efforts to implement widespread protections for IPV survivors offer promise for promoting socioeconomic stability, but additional policies are needed to promote stable housing.
... This study also addresses the clear need for validated measures across multiple languages. Although some previous studies of housing instability have included Spanish-speaking immigrant Latinx samples, they have not utilized a validated measure in Spanish (Adams et al., 2021;Pavao et al., 2007). As such, there is a possibility that housing instability was not measured the same way across languages, presenting a methodological issue with important policy and practice implications. ...
... While this is an appropriate population to validate the scale on, given the link between domestic violence and housing instability (e.g. O'Campo et al., 2015;Pavao et al., 2007), additional validation measures should be undertaken with other populations and across other languages. ...
Despite increasing attention to the importance of examining factors that impact housing instability and homelessness, the field lacks a validated scale of housing instability. The current study examined the reliability and validity of a seven-item scale that measures housing instability. Data were taken from a larger study which implemented the Domestic Violence Housing First model across five domestic violence agencies in the Pacific Northwest. A total of 406 participants were interviewed every six months over a period of two years. A Spanish version of the scale was administered to Spanish-speaking participants. Results provide an overview of the psychometric functioning of the scale and support its utility in assessing housing instability and homelessness. Specifically, the scale demonstrated concurrent and predictive validity, and showed evidence of scalar equivalence over time and across both language and locality. The current scale is therefore a succinct and psychometrically sound measure of housing instability which can be used moving forward to track housing instability in English and Spanish speakers, as well as in urban and rural settings. ARTICLE HISTORY
... Comprehensive IPV programs have long provided safe housing spanning the spectrum of emergency crisis to shortand medium-term supports in response to survivors' needs for safe housing. Yet, the efficacy of TH and RRH specifically in preventing IPV revictimization and reducing housing instability among individuals made homeless because of IPV is underdeveloped 3 relative to the public health burden of IPV 4,5 and its mutually reinforcing, escalating dynamics with homelessness.6 Lack of safe, affordable housing is a barrier to leaving an abusive relationship, and IPV is a leading risk factor for homelessness and housing instability among women.6 ...
... Yet, the efficacy of TH and RRH specifically in preventing IPV revictimization and reducing housing instability among individuals made homeless because of IPV is underdeveloped 3 relative to the public health burden of IPV 4,5 and its mutually reinforcing, escalating dynamics with homelessness.6 Lack of safe, affordable housing is a barrier to leaving an abusive relationship, and IPV is a leading risk factor for homelessness and housing instability among women.6 Housing instability can prompt a hazardous cycle of revictimization and increasing IPV severity, creating opportunities for abusive partners to re-engage. ...
House of Ruth Maryland is a comprehensive intimate partner violence (IPV) service provider. Our academic‒practitioner partnership conducted a prospective, quasi-experimental evaluation (n = 70) of on-site transitional housing and community-based rapid rehousing to meet the safety and stability needs of individuals made homeless because of IPV. By 6-month follow-up, both IPV revictimization and housing instability significantly improved (P < .001). Housing supports through an IPV service provider advanced the dual goals of safety and housing stability for IPV survivors. Safe, affordable housing is an IPV prevention strategy. (Am J Public Health. Published online ahead of print April 14, 2022: e1–e6. https://doi.org/10.2105/AJPH.2022.306728 )
... 10,11 Beyond the need for clinical treatment, TBI is associated with numerous chronic morbidities, including neurological disorders (stroke, epilepsy, and neurodegenerative diseases), 12 mood disorders, 13 and impaired quality of life; the latter 2 converge with IPV/DV to worsen outcomes. 14 Furthermore, victims of IPV/DV-associated TBI (IPV/DV-TBI) incur risks of unemployment, 15,16 housing instability, 17 and poverty. 15 Although IPV/DV-TBI carries substantial medico-socio-legal consequences, understanding of its incidence, risk factors of injury acquisition, and clinical outcomes remains lacking. ...
BACKGROUND AND OBJECTIVES
Despite profound medico-socio-legal consequences of traumatic brain injury (TBI) from intimate partner violence and domestic violence (IPV/DV), the incidence and acute outcomes of concurrent IPV/DV-TBI are not well understood. We examined US IPV/DV patients with/without TBI (IPV/DV-TBI; non-TBI) using the National Trauma Data Bank. We hypothesized IPV/DV-TBI would be associated with elevated morbidity.
METHODS
National Trauma Data Bank Trauma Quality Programs Participant Use Files years 2018 to 2021 were queried for patients aged ≥18 years with IPV/DV using International Classification of Diseases, Tenth Revision external cause codes. TBI/non-TBI was defined using International Classification of Diseases, Tenth Revision diagnosis codes. TBI severity was defined by the Glasgow Coma Scale (severe = 3-8, moderate = 9-12, and mild = 13-15). Outcomes were intensive care unit (ICU) admission, in-hospital mortality, length of stay (LOS), and discharge home. Multivariable regressions examined associations between TBI and outcomes, controlling for sociodemographic and injury severity variables.
RESULTS
Of 3891 IPV/DV-related cases, 31.1% were IPV/DV-TBI. Cranial injuries included skull fracture (30.2%), subdural (19.8%), subarachnoid (13.4%), and epidural (1.1%) hemorrhage, contusion (8.1%), and cerebral edema (3.3%). In IPV/DV-TBI, mild/moderate/severe TBI proportions were 87.4%/4.3%/8.3%, with mean LOS 11.5 ± 10.9/14.4 ± 27.3/5.0 ± 7.7-days and mortality 0.9%/22.5%/28.6%, respectively. Compared with non-TBI, IPV/DV-TBI had more female (77.2%/64.6%, P < .001) and fewer Black patients (28.9%/36.6%, P < .001), more ICU admissions (20.9%/7.5%, P < .001) and mortality (4.1%/1.8%, P < .001), longer LOS (5.3 ± 9.5/4.5 ± 6.4-days, P = .008), and decreased discharge home (79.8%/83.8%, P = .005). Multivariable regressions confirmed the associations between TBI and ICU admission (adjusted odds ratio [aOR] = 4.29, 95% CI [3.46-5.33]), mortality (aOR = 3.20 [1.99-5.15]), LOS (adjusted mean difference = +1.22 [0.68-1.76]), and inability to discharge home (aOR = 0.57 [0.46-0.71]).
CONCLUSION
One-third of US IPV/DV-related trauma cases have TBI, comprising predominantly female patients. Black patients with IPV/DV-related trauma were overrepresented compared with US census estimates. IPV/DV-TBI had increased ICU admissions, LOS, in-hospital mortality, and inability to discharge home compared with non-TBI. Investigating morbidity risk factors and providing sociomedical resources during acute care are critically needed in this vulnerable population.
... This phenomenon cannot be explained exclusively by idiosyncratic or individual characteristics, it is a global-scale phenomenon associated with gender, sexual identity, talents and capacities, socioeconomic status, health conditions, and many other determinants related to human diversity (Esposito et al., 2019). The challenges faced by women survivors when social responses are insufficient may result in severe additional consequences such as housing instability or even homelessness or related to the disclosure of information associated with children (e.g., age or gender not accepted in existing resources), mental health, other health challenges, substance abuse, or sexual identity (Pavao et al., 2007;Flynn et al., 2023). ...
Violence against women persists and prevails worldwide. Women who survive are isolated in service-providing systems, with case management professionals who support navigating within the judicial, welfare, and health systems. The present study results from a PAR project “PEER NETWORK: Gender Violence and Empowerment” aimed at potentiating partnerships with women who are survivors of gender violence establishing a nationwide network of women representatives for advocacy and violence prevention. This qualitative study analyses 18 focus-group meetings transcribed verbatim (2021-2022) through thematic analysis with MAXQDA, focused on four domains: a) co-construction of guidelines for Peer Networks; b) notions of leadership and advocacy; c) facilitation and meeting management; d) roles for professionals and e) sustainability challenges. Results indicate that to build and sustain a survivor’s network and support peer advocacy efforts, the survivors require systematized knowledge of key documents and information on gender-based violence to integrate and validate their personal experiences, require a framework of systems articulated to increase effectiveness, anticipate critical incidents/crisis, and advocate a culture of prevention of abusive interpersonal relations. The resulting co-constructed PAR model reflects the multidimensional nature of gender-based violence and the relevance of extended community-based networks for gendered-based violence prevention.
... Any discrepancy in initial coding was discussed among team members until a consensus was reached. The codebook contained deductive codes based on prior literature on IPV and housing [15,16,23,24] Inductive codes were also identified. The codebook was used by the five coder team to line-by-line code the remaining interviews. ...
Background
Housing instability is highly prevalent among intimate partner violence (IPV) survivors, and the coupling consequences of structural racism, sexism, classism, and the COVID-19 pandemic, may create more barriers to safe and adequate housing, specifically for Black women IPV survivors. In particular, the consequences of the COVID-19 pandemic had the potential to amplify disadvantages for Black women IPV survivors, yet very little research has acknowledged it. Therefore, the current study sought to assess the experiences of housing insecurity among Black women experiencing intimate partner violence (IPV) while navigating racism, sexism, and classism during the COVID-19 pandemic.
Methods
From January to April 2021, we conducted in-depth interviews with 50 Black women experiencing IPV in the United States. Guided by intersectionality, a hybrid thematic and interpretive phenomenological analytic approach was used to identify sociostructural factors shaping housing insecurity.
Results
Our findings demonstrate the various ways in which the COVID-19 pandemic shaped Black women IPV survivors’ ability to obtain and sustain safe housing. We derived five themes to capture factors contributing to housing experiences: challenges with separate and unequal neighborhoods; pandemic-related economic inequalities; economic abuse limitations; and strategies to maintain housing.
Conclusions
Obtaining and maintaining safe housing during the COVID-19 pandemic was difficult for Black women IPV survivors who were also navigating racism, sexism, and socioeconomic position. Interventions are needed to reduce the impact of these intersecting systems of oppression and power to facilitate the resources necessary for Black women IPV survivors to identify safe housing.
... People who are doubled-up (ie, staying with others due to housing instability and financial insecurity, sometimes called "couch surfing") may be classified as "not homeless" according to the HUD definition of homelessness but classified as "homeless" by the DOE when it applies to young people. People experiencing housing instability who are technically housed according to the HUD definition may experience disproportionate health impacts compared with their stably housed counterparts, including food insecurity, 18,19 higher rates of domestic or sexual violence, 20 and increased disease transmission risk. 21 Consequently, not including people who may be unstably housed in data collection could generate an incomplete picture of disease risk. ...
... Research has demonstrated that, following separation from a violent partner, women and their children almost inevitably experience income loss, financial distress and housing insecurity. In the US, Pavao et al's (2007) analysis of the California Women's Health Survey found that women who experienced intimate partner violence (IPV) were four times more likely to report housing instability than other women. More recently, a nationwide Australian survey that examined the compounding effects of IPV on women's housing, employment, mental health and participation in activities of civil society, found that almost half of the women lived in temporary dwellings such as staying with friends, women's shelters, cars, or parks after they left their abusive home (Zufferey et al., 2016). ...
Domestic violence is a pervasive global social problem, as is the challenge of family homelessness. While there is compelling evidence that large numbers of women and families who experience homelessness report experiences of abuse and violence, understanding of the relationship between domestic violence and family homelessness remains weak.
Conducted in Ireland, the research aimed to examine the intersection of domestic violence and family homelessness by triangulating the views of stakeholders with the lived experience of parents who left their homes because of domestic abuse. Drawing on data garnered from the conduct of in-depth interviews with 17 parents, this paper examines their accommodation trajectories post-leaving home, underpinned by the broader aim of exploring the dynamics of domestic violence and family homelessness.
Parents reported numerous moves subsequent to leaving their homes and their accommodation paths, which spanned many months or a number of years in some cases, were unpredictable. Thematic analysis uncovered key three drivers of their accommodation trajectories: 1) the hiddenness of families subsequent to leaving an abusive home; 2) service system blockages and; 3) housing market conditions and the search for housing security. The dominant experience for families can be characterized as complicated, uncertain and daunting owing to the absence of a path through which they could transition from crisis or intermediate accommodation to secure housing.
The paper concludes by considering the implications of the findings for policy and service responses to families who leave their homes because of domestic violence.
... Moreover, based on research, mental illness and addiction have been identified as risk factors for homelessness (Gaetz, Dej, Richter & Redman, 2016). Thus, we can ascertain that personal struggles affect interpersonal relationships with family, friends and romantic partners which, in turn, could damage relationships and potential housing support (Dawson, Jackson & Cleary, 2013;Pavao, Alvarez, Baumrind, Induni, & Kimerling, 2007). ...
Studies on former prisoners who end up homeless are relatively new in Malaysia, although the phenomenon itself has been around since the advent of prison institutions. Most former prisoners live in the city and rely mostly on individual or community sympathy to survive. Former prisoners are the most marginalised group in the stratification of marginalised communities in Malaysia. This theoretical paper was written solely using data gathered via library research methods, conducted by examining the documents and web pages to support the discussion throughout this study. The issue of homeless former prisoners is not widely discussed. As a result, no specific research has focused on the problem of homelessness among former prisoners. It is hoped that this theoretical paper will serve as a guide to improve some existing policies to provide more appropriate social interventions to help this group. This model can be a guideline in drafting a better policy in making sure the welfare of this marginalised community. Like all citizens, former prisoners who are homeless also deserve to have their basic rights acknowledged and protected. It is the researcher's hope that through this paper, the 'justice and welfare' of this group is upheld.
... 3,8,11,12 Abuse-related chronic stress may increase the risk of severe maternal morbidity and mortality through the combined effects of the physiological impacts of stress, financial insecurity, increased risk of housing instability and being unhoused, emotional abuse and being controlled or stalked, and increased reliance on addictive coping behaviors, such as smoking and substance use. 2,[13][14][15][16][17][18] Risk of IPV during pregnancy differs by race, with Black and Indigenous/American Indian/Alaska Native people experiencing the highest rates in the United States (US). 19,20 Rural and urban US residents may experience different rates of IPV and consequences from IPV, and the likelihood of IPV being identified through screenings may differ between rural and urban residents as well. ...
Objective
To describe rates and predictors of perinatal intimate partner violence (IPV) and rates and predictors of not being screened for abuse among rural and urban IPV victims who gave birth.
Data Sources and Study Setting
This analysis utilized 2016–2020 Pregnancy Risk Assessment Monitoring System (PRAMS) data from 45 states and three jurisdictions.
Study Design
This is a retrospective, cross‐sectional study using multistate survey data.
Data Collection/Extraction Methods
This analysis included 201,413 survey respondents who gave birth in 2016–2020 ( n = 42,193 rural and 159,220 urban respondents). We used survey‐weighted multivariable logistic regression models, stratified by rural/urban residence, to estimate adjusted predicted probabilities and 95% confidence intervals (CIs) for two outcomes: (1) self‐reported experiences of IPV (physical violence by a current or former intimate partner) and (2) not receiving abuse screening at health care visits before, during, or after pregnancy.
Principal Findings
Rural residents had a higher prevalence of perinatal IPV (4.6%) than urban residents (3.2%). Rural respondents who were Medicaid beneficiaries, 18–35 years old, non‐Hispanic white, Hispanic (English‐speaking), or American Indian/Alaska Native had significantly higher predicted probabilities of experiencing perinatal IPV compared with their urban counterparts.
Among respondents who experienced perinatal IPV, predicted probabilities of not receiving abuse screening were 21.3% for rural and 16.5% for urban residents. Predicted probabilities of not being screened for abuse were elevated for rural IPV victims who were Medicaid beneficiaries, 18–24 years old, or unmarried, compared to urban IPV victims with those same characteristics.
Conclusions
IPV is more common among rural birthing people, and rural IPV victims are at higher risk of not being screened for abuse compared with their urban peers. IPV prevention and support interventions are needed in rural communities and should focus on universal abuse screening during health care visits and targeted support for those at greatest risk of perinatal IPV.
... For example, programs and policies providing services to strengthen economic supports and household financial security are critical to preventing IPV as well as providing survivors and their children with resources needed to safely leave abusive relationships (Matjasko et al., 2013;Niolon et al., 2017). However, the effects of economic instability can be compounding: IPV is a significant contributor to housing instability and homelessness among survivors and children (Pavao et al., 2007;O'Campo et al., 2016), which can have serious implications for children's sense of safety and stability. Thus, evidencebased strategies that are survivor-and family-centered and that support economic stability to prevent and mitigate the harms of IPV are critical. ...
Purpose
Intimate partner violence (IPV) exposure in childhood is common, with impacts on lifespan well-being. However, there are knowledge gaps about needs and barriers to services for IPV survivors with children.
Method
We analyzed data from adults aged ≥ 19 years who resided in the U.S., were experiencing IPV, and who contacted the National Domestic Violence Hotline from 1/1/ 2017–12/31/2021 (N = 599,207). Adjusted prevalence ratios (aPRs) and 95% CIs were calculated to compare differences in IPV exposure, service requests, and service access barriers for IPV survivors with and without children at home, adjusting for age, gender, and race/ethnicity. We examined time trends (2017–2021), with comparisons before and during the COVID-19 pandemic.
Results
Many adult IPV survivors (42.6%) reported having a child at home; survivors with children reported greater polyvictimization (mean IPV types: 2.27, SD: 1.03) than those without children (M: 2.06, SD: 1.04). A small proportion of those with children requested support identifying child-focused services (4.1%); a greater proportion of those with children (30.8%) requested economic stability services compared to those without children (25.2%) (aPR: 1.16, 95% CI: 1.15–1.17). Additionally, 33.1% of survivors with children at home reported having any service access barrier; this was 16% higher than adult IPV survivors without children (28.7%) (aPR: 1.16, 95% CI: 1.15–1.17). There were changes over time, including during the COVID-19 pandemic.
Conclusions
IPV survivors with children need additional supports; organizations serving IPV survivors with children may consider the unique needs and victimization profile of this population when designing interventions and services.
... 6 Intimate partner violence is also a leading cause of homelessness and housing instability. [7][8][9] Given the link between IPV and housing instability, as well as the lack of affordable housing in the US, 10 domestic violence (DV) agencies are increasingly focusing on helping IPV survivors achieve stable housing along with long-term safety and well-being. 11,12 One intervention that is increasingly being implemented by DV agencies is the Domestic Violence Housing First (DVHF) model. ...
Importance:
Intimate partner violence (IPV) is a leading cause of homelessness and a serious threat to public health and well-being.
Objective:
To determine whether the Domestic Violence Housing First (DVHF) model improves safety, housing stability, and mental health over 2 years.
Design, setting, and participants:
This longitudinal comparative effectiveness study interviewed IPV survivors and reviewed their agency records. All unstably housed or homeless IPV survivors entering domestic violence (DV) services were eligible to participate in the study, ensuring capture of typical variability in service delivery (eg, some survivors would enter services when agencies had the capacity to provide DVHF and others would receive services as usual [SAU]). Clients from 5 DV agencies (3 rural and 2 urban) referred by agency staff in a Pacific Northwest state of the United States were assessed between July 17, 2017, and July 16, 2021. Interviews were conducted in English or Spanish at entry into services (baseline) and at 6-, 12-, 18-, and 24-month follow-up visits. The DVHF model was compared with SAU. The baseline sample included 406 survivors (92.7% of 438 eligible). Of the 375 participants retained at the 6-month follow-up (92.4% retention), 344 had received services and had complete data across all outcomes. Three hundred sixty-three participants (89.4%) were retained at the 24-month follow-up.
Intervention:
The DVHF model has 2 components: housing-inclusive advocacy and flexible funding.
Main outcomes and measures:
Main outcomes included housing stability, safety, and mental health, which were assessed using standardized measures.
Results:
Of the 344 participants (mean [SD] age, 34.6 [9.0] years) included in the analyses, 219 (63.7%) received DVHF and 125 (36.3%) received SAU. Most participants identified as female (334 [97.1%]) and heterosexual (299 [86.9%]). Two hundred twenty-one participants (64.2%) were from a racial and ethnic minority group. Longitudinal linear mixed-effects models showed that receiving SAU was associated with greater housing instability (mean difference, 0.78 [95% CI, 0.42-1.14]), DV exposure (mean difference, 0.15 [95% CI, 0.05-0.26]), depression (mean difference, 1.35 [95% CI, 0.27-2.43]), anxiety (mean difference, 1.15 [95% CI, 0.11-2.19]), and posttraumatic stress disorder (mean difference, 0.54 [95% CI, 0.04-1.04]) compared with receiving the DVHF model.
Conclusions and relevance:
Evidence in this comparative effectiveness study suggests that the DVHF model was more effective than SAU in improving the housing stability, safety, and mental health of survivors of IPV. The DVHF's amelioration of all of these interconnected public health issues-relatively quickly and with long-term continuance-will be of substantial interest to DV agencies and others working to support unstably housed IPV survivors.
... Previous research has found that IPV can erode such citizenship domains, during and after the relationship. IPV has been established as a primary reason for women's homelessness, and the negative impacts on housing circumstances are compounded for women who are, or have been, dependent upon their partner's financial support Niolon et al., 2009;Pavao et al., 2007). Further, women's access to and availability for employment, which are impacted by IPV, also limit housing access and standards of living (Abraham, 2010;Staggs et al., 2007). ...
Ongoing health issues influence the postseparation lives of survivors of intimate partner violence (IPV). This study identified associations between health following IPV and demographic, housing, employment, and social participation factors. Survivors of IPV in Australia were surveyed. Logistic regression assessed factors of interest with physical and mental health conditions. Six hundred and fifty-eight women participated. Physical health issues were associated with reduced skills and confidence in employment. A mental health diagnosis was associated with women not working as desired and lower incomes. Screening for health impacts and longer-term responses to women could reduce the long shadow of IPV impacts.
... In part because it disrupts family units, violence among intimate partners is indeed directly associated with housing instability among women (Baker et al., 2003;Pavao et al., 2007). In cases of intimate partner abuse, the very nature of obtaining refuge through domestic violence or battered women's shelters necessitates the vulnerable or victimized party's displacement. ...
In T. K. Shackelford (Ed.), Encyclopedia of Domestic Violence. Springer Nature.
... The goal of these agencies is to provide the individualized services needed to ensure that all survivors are safer, more stable, and experiencing greater well-being after receipt of services (Cattaneo et al., 2021;Davies & Lyon, 2013;Sullivan, 2018). Avoiding homelessness and attaining affordable, safe housing is a tremendous hurdle for many IPV survivors exiting an abusive relationship Pavao et al., 2007). With affordable housing becoming less available across the United States, agencies have accelerated their focus on helping unstably housed survivors obtain safe and stable housing. ...
Intimate partner violence remains a significant public health issue and survivors often need various forms of support to achieve safety. The increased likelihood of experiencing housing instability and homelessness among survivors has led to an uptake in domestic violence agencies implementing housing-based interventions, such as Domestic Violence Housing First (DVHF), to address survivors’ needs. The present study expands on prior research supporting the effectiveness of DVHF to examine situational factors that moderate the outcomes associated with this model among 406 survivors seeking services from domestic violence agencies located in the Pacific Northwestern region of the United States. Using latent profile analysis, participants were grouped into three latent classes: (a) “high abuse/instability,” (b) “still affected,” and (c) “doing better.” Latent transition analysis was used to estimate the probability that participants would transition into a different latent class over time with social support (SS), material hardship, and receipt of DVHF services included as model predictors. Receipt of DVHF predicted improvements in survivors’ safety, housing stability, mental health, and well-being, such that receiving DVHF was associated with higher odds of survivors transitioning into the “doing better” class. Social support and material hardship also emerged as significant factors predicting class membership, such that higher levels of social support and financial stability predicted membership in the “doing better” class. Additionally, social support and financial stability appeared to augment receipt of DVHF services, with DVHF being more strongly associated with positive outcomes among participants who also had high levels of social support and lower levels of material hardship.
... Over 90% of women who become homeless have significant histories of childhood trauma, as well as episodes of domestic violence and victimization that recur throughout their adult years (Baker et al., 2003;Guarino et al., 2007;Menard, 2001;Pardeck, 2005;Rollins et al., 2012). This trauma often goes unreported and untreated, contributing to adverse health outcomes such as poor mental health (Chambers et al., 2014;Duke & Searby, 2019;Feltey & Nichols, 2008;Roze et al., 2018), low levels of perceived control and social support (Finfgeld-Connett, 2010), decreased well-being and life satisfaction (Douglas et al., 2008), lower-than-average self-rated health scores (Burgard et al., 2012), and other health issues (Bassuk et al., 2006;Burlington et al., 2010;Hudson et al., 2010;Karim et al., 2006;Pavao et al., 2007;Sulgia et al., 2011). ...
Mothers experiencing homelessness are seldom asked about past trauma that may be causal to housing instability and poor health. There are also few validated trauma-focused interventions in family shelters. To address this gap, we tested the feasibility and acceptability of the trauma-focused clinical ethnographic narrative intervention (CENI-TF) in increasing mothers' trauma disclosure, appraisal of its meaning in their lives, and help-seeking behaviors. We also present the qualitative findings to contextualize the intervention. Findings are organized under three major domains and nine subthemes that capture participants' voices and experiences. The CENI-TF has the potential to promote help-seeking behaviors and interrupt recurring cycles of trauma and housing instability in this at-risk population.
... Food and housing insecurity, both indicators of economic instability, are associated with higher vulnerability for IPV victimization (Baker et al., 2003;Breiding et al., 2017;Ricks et al., 2016). Previous research shows that women who reported housing instability were almost four times as likely to report experiencing IPV as well (Pavao et al., 2007). Indeed, housing and economic support are among the most requested IPV-related services. ...
Objective: To extend our understanding of intimate partner violence (IPV) during the COVID-19 pandemic, we examined socioecological correlates of IPV, as well as rates of victimization. We assessed physical IPV, sexual IPV, psychological IPV, reproductive coercion, coercive labor, and coercive control. Method: A total of 374 recent survivors of IPV were recruited in partnership with IPV and social service agencies in Southeast Texas. Participants were asked about their experiences with IPV, COVID-19, and economic situation during the first year of the pandemic (March 2020–December 2020). Data were collected in December 2020. The sample was racially and ethnically diverse and primarily female-identified (77%). Statistical analyses included descriptive, analysis of variance, t tests, and chi-square test. Results: Among participants, rates of past-year IPV were high, with 77.3% reporting physical victimization and 94.7% reporting psychological abuse victimization. A majority (55.5%) of participants, self-reported violence increases since the pandemic began. Older (46+) and Black participants reported higher rates of IPV, including coercive control. Reported IPV increases since COVID was significantly associated with homelessness during COVID-19, lower income, and physical IPV, psychological IPV, economic IPV, along with coercive control and coerced labor by a partner. Conclusions: We found that COVID-19-related IPV increases were associated with IPV victimization types and economic factors, including low income and homelessness. Results also confirm a “dual pandemic” perspective, underscoring the heightened risk for IPV for Black, middle age, and older survivors. These findings highlight the need for a strong and sustained community response to address potential outcomes.
... IPV affects all racial and ethnic minority groups, but access to legal and medical resources can be more difficult for low-income victims and cultural factors can affect likelihood to report (Kasturirangan et al., 2004). IPV is also linked to uncertain economic circumstances and insecure housing (Pavao et al., 2007). Further, members of communities marginalized because of their gender identity or sexual orientation are sometimes more likely to be victims of IPV (Barrett & St. Pierre, 2013) while at the same time some LGBTQ communities may have less readiness to address the occurrence of IPV (Turell et al., 2012). ...
Purpose
To evaluate the language used in screening instruments employed by physicians and other health care providers to determine whether a patient is a victim of IPV.
Method
We employed Critical Discourse Analysis, including a three-step iterative coding process, to analyze the language used in 40 text- and computer-based screening tools.
Results
We found many screening tools contain language that may reinforce the power imbalance inherent in the physician–patient relationship through discourse that denies patient agency, echoes violent imagery with terms that are inherently violent themselves, and reduces the patient to a depersonalized object of a care provider’s actions.
Conclusions
The choice of language used in screening instruments that guide physicians’ interactions with patients is crucial, particularly in evaluating patients for intimate partner violence. Violence between intimate partners can be exacerbated by an imbalance in power in a personal relationship. When language mimics that power imbalance in the exam room—a place where patients may already feel diminished agency—the potential arises that a patient will be reluctant to disclose IPV.
... Adults experiencing homelessness are more likely to be treated in trauma centers with intentional violent injuries compared with housed adults [28], and almost three-quarters of YYEH report lifetime intimate partner violence [29]. Intimate partner violence is a predictor of housing instability [30], so experiencing violent injury may have even been a reason for becoming homeless for these youth. Additional research is needed to understand the extent of brain injury, including the types of injury involved, and the role of brain injury in experiences related to homelessness for young people. ...
70%+ of youth and young adults experiencing homelessness (YYEH; 14–24 years old) smoke combustible tobacco. Little is known about the prevalence of acquired brain injury (ABI) among youth and young adult smokers experiencing homelessness (YYSEH) and its impact on tobacco use progression—the aim of our study. Through an interviewer-administered survey, YYSEH were asked about timing of tobacco use; exposure to causes of ABI; including brain oxygen deprivation (BOD; strangulation; accidental; choking games) and blunt force head trauma (BFHT; intentional; shaken violently; accidental); and perpetrators of intentional assault. Participants (n = 96) were on average 22 years old and from populations who experience structural disparities; including those minoritized by race (84.4%) and gender/sexual orientation (26.0%). In total, 87% of participants reported at least one exposure to BFHT and 65% to BOD. Intentional injury was more common than accidental. Furthermore, 60.4% of participants (n = 59) were classified as having ABI using the Brain Injury Severity Assessment. A significant proportion of YYSEH living with ABI were exposed to both BFHT and BOD prior to trying (68.5%, p = 0.002) and to first regular use (82.8%, p < 0.001) of tobacco. Among YYSEH with ABI; injury exposure occurred a median of 1 and 5 years before age of first regular tobacco use, dependent on injury mechanism. ABI from intentional violence is prevalent and precedes tobacco use among YYSEH.
... The codebook contained deductive codes based on prior literature on IPV and housing. 14,15,20,21 Inductive codes were also identi ed. Weekly meetings were held to discuss inconsistencies in code application and discuss prior assumptions that shaped interpretation. ...
Background. To investigate housing experiences during the COVID-19 pandemic among Black women experiencing intimate partner violence (IPV) who are also navigating racism, sexism, and classism.
Methods. From January to April 2021, we conducted in-depth interviews with 50 Black women experiencing IPV in the United States. Guided by intersectionality, a hybrid thematic and interpretive phenomenological analytic approach was used to identify sociostructural factors shaping housing insecurity.
Results. Our findings demonstrate the various ways in which the COVID-19 pandemic shaped Black women IPV survivors’ ability to obtain and sustain safe housing. Five themes were derived to capture factors contributing to housing experiences: challenges with separate and unequal neighborhoods; pandemic-related economic inequalities; economic abuse limitations; mental toll of eviction; and strategies to maintain housing.
Conclusions. Obtaining and maintaining safe housing during the COVID-19 pandemic was difficult for Black women IPV survivors who were also navigating racism, sexism, and socioeconomic position. Structural-level interventions are needed to reduce the impact of these intersecting systems of oppression and power in order to facilitate the resources necessary for Black women IPV survivors to identify safe housing.
... Others conceptualize stability based on type of housing, such that living in shelters or foster care describes higher risk of instability, whereas living in one's own apartment conveys stability [27,28]. Further singledimension metrics of stability focused on timeline of relocation [29], relocation frequency [30], and eviction frequency [31]. Other work has proposed a model of housing stability that focuses on processes within service systems, such as active information sharing, partnership, and accountability [32]. ...
Many cities across the United States are experiencing homelessness at crisis levels, including rises in the number of unhoused emerging adults (18–25). Emerging adults experiencing homelessness may be at higher risk of experiencing negative outcomes, given that being unhoused increases risk for a variety of behaviors. To better understand the current living circumstances of emerging adults with a history of homelessness, as well as their perceptions about associations between housing stability and quality of life (QOL), we conducted 30 semistructured in-depth interviews with individuals recruited from drop-in centers for youth experiencing homelessness. At the time of recruitment, n = 19 were stably housed and n = 11 were unstably housed. Two coders analyzed these data inductively and deductively, using preidentified domains and open coding. Coding reliability was assessed. Three main themes emerged, each with subthemes: (1) housing quality (neighborhood safety, convenience, and housing unit characteristics); (2) QOL before stable housing (physical and mental wellbeing, social wellbeing, and other determinants of QOL, such as encounters with law enforcement); and (3) changes in QOL after stable housing (same subthemes as for prehousing stability QOL). Findings indicated a pattern of perceived relationships between housing stability, housing quality, built and social environments, and QOL in the context of emerging adults who experienced or continued to experience homelessness. However, results were mixed with regard to the perceived effects of housing stability on alcohol and other drug use. Taken together, results indicate several areas of challenge but also highlight opportunities to facilitate improvements in QOL among vulnerable emerging adults who experience homelessness.
... More specifically, perpetrators will find ways to control and exploit survivors' economic and financial resources and sabotage their ability to find and maintain employment . As a result, IPV is associated with a range of economic hardships, including work-related challenges (Roschelle, 2008;Tolman & Rosen, 2001), homelessness and housing instability (Jasinski et al., 2005;Pavao et al., 2007), and financial insecurity (Johnson, 2021;O'Connor & Nepomnyaschy, 2020;Tolman & Rosen, 2001). Financial well-being is also critical to survivor safety, as poverty and financial dependence on a perpetrator can act as primary barriers to leaving an abusive relationship (Adams, Greeson et al., 2013;Slabbert, 2017). ...
The purpose of this study was to explore financial strategies that intimate partner violence (IPV) survivors undertake when engaging in safety planning and to examine the relationship between these strategies and various survivor characteristics. As part of the cross-sectional study, a total of 425 female survivors of IPV were surveyed. To examine the relationship between financial safety planning strategies and participants’ demographic characteristics, abuse experiences, and financial knowledge, binomial logistic regression analyses were conducted. Factors associated with financial safety planning varied by strategy; ethnicity and nativity were often significantly associated. Implications for practice and areas for future research are discussed.
... It is also hypothesised that, like poverty, low food security can promote stress, placing individuals at an increased risk for IPV (Conroy et al., 2019). Finally, given that IPV is the leading cause of homelessness (Pavao et al., 2007), and those who are homeless experience lower rates of food security (Gundersen et al., 2003), IPV has direct implications for food security for women and children. ...
Intimate partner violence (IPV) and food security are two leading public health issues that disproportionately impact women in the United States. Despite this connection, the relationship between IPV and food security has been relatively unexplored. While food security is a known factor in increased well- being, it is not often explicitly included in care for survivors. As part of a larger study on survivors of domestic violence who are receiving services from a domestic violence and sexual assault agency in the Southern United States, we analysed participant responses (n= 26) to various scales (i.e. depression, anxiety, PTSD, disability, well- being, hope, food security) to determine the relationships between mental health and food- related variables. Importantly, findings from our study show that survivors experience low food security at higher rates (53.8%) than the U.S. national average (11.5%). Additionally, the proportion of survivors in our sample who are receiving some form of food aid and remain food insecure is high (26.9%), leading to questions about the adequacy of food aid. Finally, our results underpin the relationship between food security and mental health for survivors, as low food security is positively correlated with depression, PTSD, disability, trouble concentrating, lack of hope and decreased well- being. These findings have implications for how we evaluate food security and the role it plays in well- being for survivors.
... Relatedly, in a sample of women who reported experiencing IPV, 38% also reported homelessness and 33% reported reducing food intake in order to pay rent (Baker et al., 2003). Another study of nearly 4,000 California women found that those with histories of IPV were almost four times as likely as those without to report recent housing instability (Pavao et al., 2007). And in a nationally representative sample of U.S. adults, both women and men who reported food and/ or housing insecurity were significantly more likely than those who did not report intimate partner and/or SV victimization (Breiding et al., 2017). ...
Limited data are available on experiences of intimate partner violence (IPV) and sexual violence (SV) and health outcomes among American Indian and Alaska Native (AIAN) populations. This study explores the relationship between IPV and SV, food insecurity, housing insecurity, healthcare access, and self-reported physical and mental health status in a nationally representative sample of AIAN adults ( N = 3,634). IPV and SV were associated with poorer physical and mental health at the bivariate level, but not in multivariate analyses. Economic inequalities are a salient predictor of health and may be compounded by demographic and geographic contexts.
... Housing insecurity, such as frequent moves, homelessness, and unaffordable housing, is linked to negative health outcomes for children (Leventhal & Newman, 2010;Sandel et al., 2018). Furthermore, parents without stable housing may experience stress, depression, and family conflict (Jocson & McLoyd, 2015;Pavao et al., 2007), which may increase the risk for CAN (Centers for Disease Control and Prevention, 2019). For instance, parental stress associated with unstable housing may increase the likelihood of harsh and punitive parenting behaviors (Leventhal & Newman, 2010). ...
This study aimed to understand the relationship between home eviction and child welfare system involvement at the county level. Using administrative data, we examined associations of home eviction and eviction filing rates with child abuse and neglect (CAN) reports and foster care entries. We found one additional eviction per 100 renter-occupied homes in a county was associated with a 1.3% increase in the rate of CAN reports and a 1.6% increase in foster care entries. The association between eviction and foster care entries was strongest among Hispanic children with an 8.1% increase. Assisting parents in providing stable housing may reduce the risk of child welfare system involvement, including out-of-home child placement. Primary and secondary prevention strategies could include housing assistance, increasing access to affordable and safe housing, as well as providing economic support for families (e.g., tax credits, childcare subsidies) that reduce parental financial burden to access stable housing.
... Survivors are also at increased risk of long-term injuries and other physical health problems (Pritchard et al., 2017;Valera, 2018). Only in recent years has IPV victimization been established as a major contributor to housing instability and homelessness (Broll & Huey, 2020;Chan et al., 2021;Dillon et al., 2016;Pavao et al., 2007). In response, domestic violence (DV) victim service agencies have amplified their efforts in helping survivors attain safe and stable housing. ...
Intimate partner violence (IPV) is a widespread and devastating phenomenon resulting in a myriad of long-term consequences for survivors and their children. IPV victimization not only has negative health and economic consequences, it has also been linked to homelessness and housing instability. In response, the Domestic Violence Housing First (DVHF) model is being used in some domestic violence (DV) agencies to help survivors attain safe and stable housing. The model includes using individualized advocacy and/or flexible funding to help survivors meet these goals. Using a longitudinal, quasi-experimental design, the current study involved conducting interviews with survivors and examining agency records to investigate the effectiveness of this model. We hypothesized that survivors who received DVHF would experience less re-abuse and greater housing stability over 12 months compared to those who received services as usual (SAU). The sample included 345 IPV survivors who had been homeless or unstably housed when they approached one of five DV programs for help. Interviews were spaced 6 months apart (when survivors first sought services as well as 6 months and 12 months later). Longitudinal analyses showed that survivors who received the DVHF model reported greater improvements in housing stability at both the 6-month and 12-month time points compared to those receiving SAU. At the 12-month time point, survivors who had received DVHF reported decreased physical, psychological, and economic abuse, as well as the use of their children against them as a form of abuse. This study adds to a growing body of evidence supporting this model’s effectiveness and adds to our understanding of factors impacting the long-term housing stability and safety for IPV survivors.
... IPV has economic impacts across the lifespan, resulting in lost earnings, career disruptions, and economic and housing instability (Chan et al., 2021). Economic consequences of IPV include housing disruptions, such as late mortgage and/or rent payments, multiple moves, and loss of housing (Pavao et al., 2007;Rollins et al., 2012). IPV is the main contributor to family homelessness, with 25% to 40% of women and families homeless as a result (Stringer, 2019). ...
Accessing stable housing is a basic need for intimate partner violence (IPV) survivors, and rapid rehousing programs are a critical way to address homelessness. However, little is known about survivor experiences, needs, and outcomes in rapid rehousing services within IPV agencies. This study uses an exploratory approach to understand the needs and experiences of 31 survivors using vouchers facilitated by an IPV program in the U.S. Southwest. Thematic analysis of structured interviews resulted in four summary themes: getting to housing, managing multiple needs, accessing support, and facing barriers. Practice and evaluation implications are discussed.
... Domestic and family violence is a known risk factor for homelessness in women (Australian Institute of Health and Welfare, 2018; Murray, 2011;Pavao et al., 2007), as finding alternative accommodation can be extremely difficult, leaving many women little other option. ...
Aims
To investigate the scope of practice of nurse‐led services for people experiencing homelessness, and the influence on access to healthcare.
Design
A scoping review.
Data Sources
On 20 November 2020, the following databases were searched: CINAHL, Embase, MEDLINE, PubMed and Scopus.
Review Methods
Included studies focused on people experiencing homelessness aged 18 years and over, nurse‐led services in any setting and described the nursing scope of practice. Studies were peer‐reviewed primary research, published in English from the year 2000. Three authors performed quality appraisals using the mixed methods assessment tool. Results were synthesized and discussed narratively and reported according to the PRISMA‐ScR 2020 Statement.
Results
Nineteen studies were included from the United States (n = 9), Australia (n = 4), United Kingdom (n = 4) and Canada (n = 2). The total participant sample size was n = 6303. Studies focused on registered nurses (n = 10), nurse practitioners (n = 5) or both (n = 4), in outpatient or community settings. The nursing scope of practice was broad and covered a range of skills, knowledge and attributes. Key skills identified include assessment and procedural skills, client support and health education. Key attributes were a trauma‐informed approach and building trust through communication. Important knowledge included understanding the impact of homelessness, knowledge of available services and the capacity to undertake holistic assessments. Findings suggest that nurse‐led care facilitated access to healthcare through building trust and supporting clients to access services.
Conclusion
Optimized nursing scope of practice can facilitate access to healthcare for people experiencing homelessness. Key factors in enabling this include autonomy in nursing practice, organizational support and education.
Impact
The broad range of skills, knowledge and attributes reported provide a foundation from which to design an educational framework to optimize the nursing scope of practice, thereby increasing access to healthcare for people experiencing homelessness.
... With respect to IV exposure, no significant differences were observed between Black and White veterans, yet a sizable proportion of the sample (11.0%) endorsed being exposed to past-year IV. Research has demonstrated a link between different forms of IV, such as intimate partner violence, and housing instability among the general population (e.g., Pavao et al., 2007) and veteran populations (e.g., Yu et al., 2020). Given the results of the current investigation and the broader literature on MST exposure and socioecological vulnerabilities among veterans, providers are encouraged to attend to patients' reports of housing stability and perceived safety within their interpersonal contexts and consider appropriate referrals to additional services, such as VHA Homeless Program and Intimate Partner Violence Assistance Program coordinators, to facilitate effective coping and recovery from MST at multiple levels of socioecological functioning. ...
Veterans who have experienced military sexual trauma (MST) are at increased risk for a host of negative outcomes, including posttraumatic stress disorder, depressive disorders, and substance use disorders. Previous studies have shown racial differences in MST exposure, namely that Black veterans experience MST more frequently than White veterans. One way to help clinicians and researchers understand the impact of these ethnoracial differences in MST exposure is through an applied theory of ecological resources, which has demonstrated ecological factors (e.g., aspects of identity, beliefs, and environmental stressors) contribute to veteran well‐being in the aftermath of MST. The present study aimed to examine ethnoracial differences in ecological resources (i.e., available social support, spiritual coping, past‐year interpersonal violence, financial sufficiency, and stable living environment). Participants (N = 505) were U.S. veterans who sought care at a Veterans Healthcare Administration clinic in the midwestern United States for mental health issues related to MST. Results demonstrated Black veterans were more likely than White veterans to report being financially insecure, U = 18,091.50, z = –2.04, p = .042, r = .10. Black veterans were also more likely to report spiritual beliefs that assisted with coping, Cramer's V = .19, but less likely to report having a social support system, Cramer's V = .16. These findings highlight the importance of assessing and addressing disparities illuminated by ethnoracial differences in ecological resources and barriers in veterans seeking care for MST.
... Housing instability, and conversely housing stability, is an important environmental determinant of violence and other adverse health outcomes. As shown in crosssectional research from high-resource settings, there is a significant association between housing instability and physical and sexual violence among women who have experienced IPV [22][23][24]. Similarly, this association has been established among female sex workers in India and in communities of people who use or inject heroin in Canada [25,26]. ...
Background
Women who use heroin and other drugs (WWUD) are a key population with elevated risk of physical and sexual violence perpetrated by intimate partners and non-partners. While housing instability has been shown to be associated with violence in high-income settings, this is an underexplored topic in sub-Saharan Africa. In this research, we aimed to assess the relationship between housing instability and various forms of violence within a sample of WWUD in Dar es Salaam.
Methods
This analysis uses data from a parent study from 2018. A total of 200 WWUD were recruited through respondent-driven sampling methods and administered a survey. Two multivariable logistic regression models were built to assess the relationship between housing instability and physical violence (Model 1) and housing instability and sexual violence (Model 2) while controlling for a number of sociodemographic characteristics.
Results
Approximately 35% of participants were classified as housing unstable. More than half of participants (62%) reported experiencing physical violence in the past 12 months, and more than a third (36%) reported sexual violence in the same time period. Housing instability was found to be independently associated with both physical and sexual violence victimization in the past year when adjusting for covariates (Model 1 adjusted odds ratio [AOR]: 2.40, 95% CI 1.22–4.46; Model 2 AOR: 1.93. 95% CI 1.02–3.67).
Conclusion
To our knowledge, this is the first study to document a significant association between housing instability and violence among WWUD communities in sub-Saharan Africa. This analysis adds to the growing body of literature on the relationship between stable housing and livelihood and health outcomes across differing populations. The cyclical nature of housing instability and violence may be disrupted through housing programming that provides safety, security, and stability for WWUD.
... Research has demonstrated significant associations between IPV, housing instability, and homelessness (Salomon et al., 2002;Slesnick et al., 2010;Bassuk et al., 2006), however, few studies have explored the impact of IPV and SV on housing apart from experiences of homelessness, which obscures additional forms of housing issues that may inform rates of violence (Baker et al., 2003;Rollins et al., 2012). A study of nearly 4000 women in California found that women with histories of IPV had almost four times the odds of recent housing instability than those without violence histories (Pavao et al., 2007), suggesting that survivors face other economic challenges related to their housing situations. Housing insecurity-also described in the literature as housing instability-occurs when someone may have a place to live but has difficulties with maintaining their residence (Rollins et al., 2012). ...
The costs and consequences of intimate partner violence (IPV) and sexual violence (SV) are well-documented; however, little is known about how experiences of violence are connected to specific economic insecurities including food, healthcare, and housing insecurity among both men and women. This study investigates (1) the prevalence of food, healthcare, and housing insecurity across gender and racial groups exposed to IPV and SV and (2) associations between exposure to past-year IPV and SV and past-year food, healthcare, and housing insecurity controlling for confounding factors. A cross-sectional survey design was used in this study. Data from 2010 National Intimate Partner and Sexual Violence Survey (NISVS) were analyzed in a nationally representative sample of men ( N = 8079) and women ( N = 9970). Logistic regressions were used to model associations between past-year intimate partner and sexual violence and dependent variables of food, healthcare, and housing insecurity. Analyses were stratified by gender and included control variables of age, income, education, and race/ethnicity. Higher rates of food, housing, and healthcare insecurity were found among men and women of color exposed to violence, particularly among respondents who identified as Black/African American, Latinx, American Indian/Alaska Native, and other racial/ethnic minority groups. For men, IPV and SV was associated with higher odds for experiencing food ( AOR = 2.40, p <.001), housing ( AOR = 2.06, p <.001), and healthcare insecurity ( AOR = 2.39, p <.001). For women, IPV and SV was also associated with higher odds for experiencing food ( AOR = 2.16, p <.001), housing ( AOR = 1.94, p <.001), and healthcare insecurity ( AOR = 2.38, p <.001). Findings identify specific economic needs among survivors and suggest that the burdens of IPV and SV are not equitably shared across racial/ethnic populations. Findings can inform policy that aims to reduce inequalities in food, housing, and healthcare associated with IPV and SV.
Introduction:
Hospitals and community-based organizations (CBOs) provide the service-base for survivors of intimate partner violence (IPV), particularly those in acute crisis. Both settings face discrete challenges in meeting survivors' needs. In hospitals these challenges include the pressures of a fast-paced work setting, and a lack of trauma-informed and survivor-centered care. Connections to community care are often unmeasured, with relatively little known about best practices. Often IPV survivors who receive hospital care fail to connect with community-based services after discharge. Despite the critical role of CBOs in supporting IPV survivors, there is limited research examining the perspectives and insights of CBO staff on the challenges and opportunities for improving care coordination with hospitals. The purpose of this study was to address this knowledge gap by characterizing CBO staff perceptions of IPV care coordination between hospital and community-based organizations in Metropolitan Atlanta.
Methods:
We used a qualitative study design to conduct a cross-sectional examination of the perceptions and experiences of staff working at CBOs serving IPV survivors in Metropolitan Atlanta, Georgia. The adapted in-depth interview (IDI) guide was used to explore: (1) IPV survivor experiences; (2) Survivors' needs when transitioning from hospital to community-based care; (3) Barriers and facilitators to IPV care coordination; and (4) Ideas on how to improve care coordination. Data analysis consisted of a thematic analysis using MAXQDA Analytics Pro 2022.
Results:
Participants (N = 14) included 13 women and one man who were staff of CBOs serving IPV survivors in Metropolitan Atlanta. CBO staff perceived that: (1) IPV survivors face individual-, organizational-, and systems-level barriers during help seeking and service provision; (2) Care coordination between hospitals and CBOs is limited due to siloed care provision; and (3) Care coordination can be improved through increased bidirectional efforts.
Conclusion:
Our findings highlight the multi-level barriers IPV survivors face in accessing community-based care following medical care, the limitations of existing hospital-CBO coordination, and opportunities for improvement from the perspectives of CBO staff. Participants identified silos and inconsistent communication/relationships between hospital and CBOs as major barriers to care connections. They also suggested warm handoffs and a Family Justice Center to support care connection.
Purpose
This study aims to explore the gendered nature of housing insecurity by investigating how gender affects women’s experience moving from transitional to market housing. By describing women’s pathways out of supportive or transitional housing support, the authors show how patriarchal forces in housing policies and practices affect women’s efforts to find secure housing. The authors argue that gender-neutral approaches to housing will fail to meet women’s needs.
Design/methodology/approach
This study explores the narratives from women accessing support services in Halifax, Canada. The first author conducted deep narrative interviews with women seeking to move from transition to market housing.
Findings
This research sheds light on the effects of gendered barriers to safe, suitable and affordable housing; how women’s experiences and expectations are shaped by these barriers; and, how housing-based supports must address the uniquely gendered experiences women face as they access market housing. In addition, this research reveals the importance of gender-responsive services that empower women facing a sexist housing market.
Originality/value
Little research has explored questions related to gender and housing among those seeking to move from transitional to marker housing, and existing research focuses on women’s housing insecurity as it relates to domestic violence. The sample of women included those having housing insecurity for a variety of reasons, including substance use and young motherhood.
COVID‐19 lockdowns have resulted in significant societal disruptions, intensifying family stress and escalating instances of intimate partner violence (IPV). Lockdowns necessitated prolonged proximity to abusers, magnifying home's significance as a space of victimization. The current study conducted in Korea ( n = 813) examined the impact of housing density and room count on COVID‐19‐related IPV. Analyzing data from Seongnam City, Korea, the study examined a couple of pre‐/postpandemic, factors covariates like gender, age, employment, education, and income. Using STATA 13.0, the study conducted multiple logistic regression to examine the association between housing conditions and IPV during and prior to COVID‐19, with all covariates included. Housing density was associated with emotional IPV victimization before COVID‐19, while the number of rooms was associated with physical and sexual IPV victimization before COVID‐19 and sexual IPV victimization after COVID‐19. Time spent with partners was significantly associated with emotional IPV victimization, and the association between the number of rooms and sexual IPV victimization remained significant after adjusting for COVID‐19‐related variables. Practical implications and recommendations are discussed to address this issue and protect vulnerable populations from harm. Although poor housing conditions have been linked to increased stress levels and comprised mental health, scant attention has been paid to those relationships.
A paucity of research has examined the prevalence of domestic and intimate partner violence (DV/IPV) victimization among persons experiencing eviction. The current study uses administrative records for a random sample of evicted adults in Omaha, Nebraska from 2017 to 2019 ( n = 306) to assess the prevalence of DV/IPV victimization among evicted persons and differences among the DV/IPV and no DV/IPV groups. Findings indicated over 20% of evicted persons experienced DV/IPV victimization, and DV/IPV often preceded the first eviction. DV/IPV disproportionately impacted Black women. Implications regarding the compounding consequences of eviction and DV/IPV victimization and recommendations for future research are discussed.
Although family and migration scholars recognize that intimate partner violence (IPV) can motivate women’s movement between countries, little research considers IPV or other gendered family violence further back in women migrants’ life histories or explores the legacy of gendered family violence in cases where such violence is not the primary push factor. Here, we analyze in-depth interviews conducted among thirty-four Latin American women seeking asylum or international protection from a diversity of threats to comprehensively understand their experiences with childhood and adult family violence prior to migration. Our analysis reveals three key takeaways. First, IPV, incest, abandonment, and other forms of gendered family violence can characterize women’s family dynamics across the life course even when these experiences do not directly prompt migration. Second, amidst pervasive patriarchal norms, family violence has the power to destabilize women’s social circumstances and fracture their ties to family members in ways that indirectly encourage migration. Third, owing to these same gender norms, even when gendered family violence directly prompts migration, women may conceptualize their primary motive as protecting their children rather than themselves. These findings move beyond common conceptualizations of the family violence–migration nexus and highlight the breadth and implications of gendered family violence among migrants seeking protection from a broad spectrum of intra- and extra-familial threats.
Background:
Hardships such as custody issues and financial stress may increase suicide risk for individuals experiencing intimate partner problems, particularly intimate partner violence (IPV). The objective of this study was to examine associations among custody issues, financial strain, and IPV among female suicide decedents with known intimate partner problems using data from the National Violent Death Reporting System (NVDRS).
Methods:
NVDRS data from 2018, which comes from 41 U.S. states, was used to examine the nature and frequency of custody and financial strain and IPV among a sample of 1,567 female suicide decedents with known intimate partner problems (e.g., divorce, breakup, argument). Case narratives were used to extract detailed information about these situations.
Results:
IPV was documented in 22.14% of cases. Compared with those without documented IPV, cases with documented IPV were more likely to include custody issues (3.44% vs. 6.34%). Controlling for demographic characteristics and mental health, documented child custody issues were associated with greater odds of IPV (odds ratio = 1.80; 95% confidence interval = 1.03-3.16). Financial strain was not statistically significantly associated with child custody issues or IPV among this sample.
Conclusions:
Child custody issues can contribute to suicide among women with known intimate partner problems and is positively associated with IPV. Suicide prevention and intervention efforts should recognize child custody issues as a risk factor, particularly when coupled with IPV. There is also a need to promote policies and services that improve the financial and civil legal circumstances of IPV survivors.
Objectives. To model the relationship of unstable housing and evictions with physical and sexual violence perpetrated against women sex workers in intimate and workplace settings.
Methods. We used bivariate and multivariable logistic regression with generalized estimating equations to model the association of unstable housing exposure and evictions with intimate partner violence (IPV) and workplace violence among a community-based longitudinal cohort of cisgender and transgender women sex workers in Vancouver, Canada, from 2010 through 2019.
Results. Of 946 women, 85.9% experienced unstable housing, 11.1% eviction, 26.2% IPV, and 31.8% workplace violence. In multivariable generalized estimating equation models, recent exposure to unstable housing (adjusted odds ratio [AOR] = 2.04; 95% confidence interval [CI] = 1.45, 2.87) and evictions (AOR = 2.45; 95% CI = 0.99, 6.07) were associated with IPV, and exposure to unstable housing was associated with workplace violence (AOR = 1.46; 95% CI = 1.06, 2.00).
Conclusions. Women sex workers face a high burden of unstable housing and evictions, which are linked to increased odds of intimate partner and workplace violence. Increased access to safe, women-centered, and nondiscriminatory housing is urgently needed. (Am J Public Health. 2023;113(4):442–452. https://doi.org/10.2105/AJPH.2022.307207 )
While there has been a growth in studies examining sexual violence among sexual minority men, little research attention has been paid to the experience of sexual violence among young sexual minority men (YSMM). In this article we analyze secondary data from the baseline of a pilot randomized control trial with 318 YSMM aged 15 to 24 years in the United States who were in relationships with other males to examine the associations between sexual minority-specific stigma and sociodemographic and relationship characteristics and experiences of intimate partner violence (IPV) and sexual IPV in their relationships. Approximately one-in-five participants reported experiencing any form of IPV and 6% reported sexual IPV in their current relationship. Participants who reported sexual minority-specific familial rejection (Adjusted Odds Rato (aOR) = 2.33, 95% confidence interval [CI] [1.03, 5.26], p < .05), internalized heterosexism (aOR = 3.17, 95% CI [1.45, 6.95], p < .01), and housing insecurity (aOR = 7.22, 95% CI [1.66, 31.34], p < .01) reported higher odds of sexual IPV in their relationship. Study findings point to the role of multiple sexual minority-specific forms of stigma in creating vulnerabilities for the experience of sexual IPV among YSMM, and highlight the need for continued research and interventions that address sexual minority-specific stigma and structural vulnerabilities to guide violence prevention efforts with YSMM.
Experiences of material hardship vary across poor families, but little is understood about this variability. The present study aimed to distinguish subtypes of material hardship as well as which characteristics predict subtypes. Latent class analysis with data from a large, longitudinal study of families with youth children investigated subtypes of material hardship as well as predictors of subtypes. Multinomial logistic regression then predicted class membership used on known housing risk factors maternal IPV victimization, depression, and substance use. Analyses identified three distinct subtypes of material hardship: “Housing Insecure,” “Food Insecure,” and “Cost‐Burdened but Managing.” Maternal IPV victimization and depression reduced likelihood of membership in the “Managing” class, but no predictors distinguished families who become food versus housing insecure. Findings suggest widespread financial stress and complex tradeoffs for low‐income families, who struggle to afford basic needs. Maternal safety and mental health prove crucial to families' coping abilities. Increased systemic supports targeting specific circumstances may promote stability and prevent more severe hardship.
Violence experienced by cisgender (cis) and gender minority women living with HIV is known to be high. More work is needed to better understand how to support women living with HIV who have experienced violence. The objectives of this study are therefore to identify the prevalence and correlates of violence by any perpetrator among women living with HIV in a Canadian setting. Data were drawn from 9 years (January, 2010 to February, 2019) of a longitudinal community-based open cohort study of 350+ cis and trans women living with HIV who were living and/or accessed care in Metro Vancouver, Canada (Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment "SHAWNA"). Participants completed baseline and biannual follow-up interviews. Bivariate and multivariable logistic regression with generalized estimating equations (GEE) were performed to identify correlates of recent (last 6 months) violence (physical and/or sexual) by any perpetrator. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CIs) are presented. At baseline, prevalence of violence was high: 95.5% (recent = 19.4%) of participants reported lifetime physical and/or sexual violence, 94.8% (recent = 17.9%) reported lifetime physical violence, and 84.5% (recent = 5.7%) reported lifetime sexual violence. In multivariable logistic regression with GEE, the following variables were associated with higher odds of recent physical/sexual violence: youth (<30 years) (AOR: 1.60, 95% CI [1.15, 2.22]), recent unstable housing/homelessness (AOR: 1.96, 95% CI [1.30, 2.97]), recent food insecurity (AOR: 1.57, 95% CI [1.13, 2.17]), recent incarceration (AOR: 1.85, 95% CI [1.18, 2.91]), recent opioid use (AOR: 1.38, 95% CI [1.04, 1.82]), recent stimulant use (AOR: 2.48, 95% CI [1.72, 3.56]), and lifetime HIV status disclosure without consent (AOR: 1.59, 95% CI [1.13, 2.24]). Trauma- and violence-informed (TVI) policies that include a focus on confidentiality and safe disclosure practices should be integrated into existing housing, incarceration, and harm reduction programs, and HIV care and practice for women living with HIV. Programs and policies that address high levels of violence remain critical.
The violence - without the apparent “Gender Peace”, if data and households are examined - occurs against adult and older women, is beginning to become apparent, but there is only information from recent years. The objective is demonstrate that social isolation can be a key factor in gender peace in the case of adult and older women, even more so in the case of disability or dependency situation. This work focuses on what we call older women gender peace based on qualitative techniques. Moreover, women in this vital stage continue to be vulnerable, defenseless, have more fear and risk, despite their plausible gender peace – expression that we contribute - which connects with the current post-health crisis scenario, armed violence and wars. This chapter also contributes to the consideration of technologies addressed to adults and older women to increase gender peace.
Prospective data from a nationally representative sample of women were used to examine 4 objective indexes of social adjustment following direct, interpersonal crime. Household income, marital status, employment, and education level were evaluated as risk factors for and outcomes of victimization. Data were collected in 3 waves at 1-year intervals, and 2,863 women completed all 3 waves. Results indicate that women experience increased risk for victimization when income is below poverty level and when newly divorced. Further, victimization appears to increase women’s risk for unemployment, reduced income, and divorce. The cyclical nature of victimization is discussed.
Empirical research addressing the decision to leave an abusive relationship is reviewed, methodological limitations in that research are outlined, and theoretical models potentially useful for explaining this decision process are discussed. The review of past research suggests that a variety of factors influence the decision to leave an abusive relationship, including employment outside the home, length of relationship, presence of child abuse, and number of previous separations. Many of these studies, however, are limited by nonrandom samples, retrospective designs, and overreliance on self-report measures. Four interrelated models show promise for aiding in the understanding of this complex decision situation: psychological entrapment, learned helplessness, cost/benefit analysis, and reasoned action.
The present study examines self-identified reasons for returning to abusive relationships. Ninety female residents of an urban domestic violence shelter completed structured interviews that included questions about their previous attempts to separate from the batterer and their perceived likelihood of returning in the future. The results indicated that participants appeared to underestimate their likelihood of returning to the relationship. A particularly intriguing pattern of findings emerged with respect to emotional attachment. Compared to those leaving for the first time, participants with a history of past separations were significantly more likely to indicate that they might return to the batterer because of their continued attachment. Emotional attachment also had a high rate of repeat endorsement, indicating that those who considered returning because of their attachment to the batterer were significantly more likely to have done so for this reason in the past. Clinical implications of the findings will be discussed.
This article describes a revised Conflict Tactics Scales (the CTS2) to measure psychological and physical attacks on a partner in a marital, cohabiting, or dating relationship; and also use of negotiation. The CTS2 has (a) additional items to enhance content validity and reliability; (b) revised wording to increase clarity and specificity; (c) better differentiation between minor and severe levels of each scale; (d) new scales to measure sexual coercion and physical injury; and (e) a new format to simplify administration and reduce response sets. Reliability ranges from .79 to .95. There is preliminary evidence of construct validity.
The current study presents the results of a needs assessment of 141 women exiting an emergency shelter for women with abusive partners. Extensive in-person interviews were conducted. Results indicate that battered women need numerous community resources upon their shelter exit, including legal assistance, employment, and housing. Race, age, and whether a woman was returning to her assailant influenced which resources she reported needing at shelter exit. Most of the women had experienced severe abuse and injuries, and required physical protection. Implications of these findings as they relate to program development and integration of social services are discussed.
This article describes recent research on the prevalence of alcohol, drug, and mental (ADM) disorders and the characteristics of homeless substance abusers and persons with mental illness. Methodological problems in homelessness research are reviewed, particularly in relation to definitions of homelessness and sampling- and case-ascertainment methods. Prevalence rates of ADM disorders are much higher in homeless groups than in the general population. As is true of homeless people in general, homeless substance abusers and mentally ill persons are characterized by extreme poverty; underutilization of public entitlements; isolation from family, friends, and other support networks; frequent contact with correctional agencies; and poor general health. Knowledge of these disadvantages should be used to advocate for better services to prevent homelessness and support homeless people.
We studied 196 homeless and 194 housed poor families in Los Angeles, California to gain an understanding of events that precipitate family homelessness. Both homeless and housed poor mothers averaged 29 years old and were accompanied by two or three children. Three-fourths of both the homeless and housed families had income below the poverty level, and both groups expended almost two-thirds of their income on housing. Mothers in homeless families more commonly reported spousal abuse (35 vs 16 percent), child abuse (28 vs 10 percent), drug use (43 vs. 30 percent), or mental health problems (14 vs 6 percent) and weaker support networks. Homeless mothers more commonly came from homes where their parents abused drugs or alcohol (49 vs 34 percent) or more commonly lived outside the home or in foster care (35 vs 25 percent). Homelessness was reported as due primarily to economic pressures of housing costs, but personal and family problems frequently played a contributing role, especially for single parent families. Burdens of increasing housing costs and family dysfunction among housed poor families place many at risk for homelessness.
In an exploration of residential instability and recidivism in chronic mental patients, 215 psychiatric admissions were followed for a year after the initial episode. In addition to an unusually high incidence of residential mobility, a relationship between mobility and number of hospitalizations was evident, as were isolation, disruptive family situations, and homelessness. The needed response of the mental health system is discussed.
Presents findings on the prevalence, severity, and patterns of intimate violence across the lifespan in an ethnically diverse sample of homeless and poor housed women. Analyses are based on baseline data gathered in an ongoing longitudinal case-comparison study of homeless and low-income housed female heads of households (E. L. Bassuk et al, 1996). Of 220 homeless (mean age 26.2 yrs) and 216 poor housed mothers (mean age 28.5 yrs), nearly two-thirds reported severe physical violence by a childhood caretaker, 42% reported childhood sexual molestation, and 61% reported severe violence by a male partner. Comparisons of homeless and housed women are presented, and implications for prevention and intervention are discussed in light of recent welfare reform legislation.
This study examined predictors of entry into shelter and subsequent housing stability for a cohort of families receiving public assistance in New York City.
Interviews were conducted with 266 families as they requested shelter and with a comparison sample of 298 families selected at random from the welfare caseload. Respondents were reinterviewed 5 years later. Families with prior history of shelter use were excluded from the follow-up study.
Demographic characteristics and housing conditions were the most important risk factors for shelter entry; enduring poverty and disruptive social experiences also contributed. Five years later, four fifths of sheltered families had their own apartment. Receipt of subsidized housing was the primary predictor of housing stability among formerly homeless families (odds ratio [OR] = 20.6, 95% confidence interval [CI] = 9.9, 42.9).
Housing subsidies are critical to ending homelessness among families.
Past studies that have addressed the health effects of intimate partner violence (IPV) have defined IPV as violence based on physical blows that frequently cause injuries. To our knowledge, no epidemiologic research has assessed the physical health consequences of psychological forms of IPV.
To estimate IPV prevalence by type and associated physical health consequences among women seeking primary health care.
Cross-sectional survey.
A total of 1152 women, aged 18 to 65 years, recruited from family practice clinics from February 1997 through January 1999 and screened for IPV during a brief in-clinic interview; health history and current status were assessed in a follow-up interview.
Of 1152 women surveyed, 53.6% ever experienced any type of partner violence; 13.6% experienced psychological IPV without physical IPV. Women experiencing psychological IPV were significantly more likely to report poor physical and mental health (adjusted relative risk [RR], 1.69 for physical health and 1.74 for mental health). Psychological IPV was associated with a number of adverse health outcomes, including a disability preventing work (adjusted RR, 1.49), arthritis (adjusted RR, 1.67), chronic pain (adjusted RR, 1.91), migraine (adjusted RR, 1.54) and other frequent headaches (adjusted RR, 1.41), stammering (adjusted RR, 2.31), sexually transmitted infections (adjusted RR, 1.82), chronic pelvic pain (adjusted RR, 1.62), stomach ulcers (adjusted RR, 1.72), spastic colon (adjusted RR, 3.62), and frequent indigestion, diarrhea, or constipation (adjusted RR, 1.30). Psychological IPV was as strongly associated with the majority of adverse health outcomes as was physical IPV.
Psychological IPV has significant physical health consequences. To reduce the range of health consequences associated with IPV, clinicians should screen for psychological forms of IPV as well as physical and sexual IPV.
Homelessness affects tens of thousands of canadians and has important health implications. Homeless people are at increased risk of dying prematurely and suffer from a wide range of health problems, including seizures, chronic obstructive pulmonary disease, musculoskeletal disorders, tuberculosis, and skin and foot problems. Homeless people also face significant barriers that impair their access to health care. More research is needed to identify better ways to deliver care to this population.
Domestic violence results in long-term and immediate health problems. This study compared selected physical health problems of abused and never abused women with similar access to health care.
A case-control study of enrollees in a multisite metropolitan health maintenance organization sampled 2535 women enrollees aged 21 to 55 years who responded to an invitation to participate; 447 (18%) could not be contacted, 7 (0.3%) were ineligible, and 76 (3%) refused, yielding a sample of 2005. The Abuse Assessment Screen identified women physically and/or sexually abused between January 1, 1989, and December 31, 1997, resulting in 201 cases. The 240 controls were a random sample of never abused women. The general health perceptions subscale of the Medical Outcomes Study 36-Item Short-Form Health Survey measured general health. The Miller Abuse Physical Symptom and Injury Scale measured abuse-specific health problems.
Cases and controls differed in ethnicity, marital status, educational level, and income. Direct weights were used to standardize for comparisons. Significance was tested using logistic and negative binomial regressions. Abused women had more (P<.05) headaches, back pain, sexually transmitted diseases, vaginal bleeding, vaginal infections, pelvic pain, painful intercourse, urinary tract infections, appetite loss, abdominal pain, and digestive problems. Abused women also had more (P< or =.001) gynecological, chronic stress-related, central nervous system, and total health problems.
Abused women have a 50% to 70% increase in gynecological, central nervous system, and stress-related problems, with women sexually and physically abused most likely to report problems. Routine universal screening and sensitive in-depth assessment of women presenting with frequent gynecological, chronic stress-related, or central nervous system complaints are needed to support disclosure of domestic violence.
Few population-based studies have assessed the physical and mental health consequences of both psychological and physical intimate partner violence (IPV) among women or men victims. This study estimated IPV prevalence by type (physical, sexual, and psychological) and associated physical and mental health consequences among women and men.
The study analyzed data from the National Violence Against Women Survey (NVAWS) of women and men aged 18 to 65. This random-digit-dial telephone survey included questions about violent victimization and health status indicators.
A total of 28.9% of 6790 women and 22.9% of 7122 men had experienced physical, sexual, or psychological IPV during their lifetime. Women were significantly more likely than men to experience physical or sexual IPV (relative risk [RR]=2.2, 95% confidence interval [CI]=2.1, 2.4) and abuse of power and control (RR=1.1, 95% CI=1.0, 1.2), but less likely than men to report verbal abuse alone (RR=0.8, 95% CI=0.7, 0.9). For both men and women, physical IPV victimization was associated with increased risk of current poor health; depressive symptoms; substance use; and developing a chronic disease, chronic mental illness, and injury. In general, abuse of power and control was more strongly associated with these health outcomes than was verbal abuse. When physical and psychological IPV scores were both included in logistic regression models, higher psychological IPV scores were more strongly associated with these health outcomes than were physical IPV scores.
Both physical and psychological IPV are associated with significant physical and mental health consequences for both male and female victims.
Homeless people are at high risk for illness and have higher death rates than the general population. Patterns of mortality among homeless men have been investigated, but less attention has been given to mortality rates among homeless women. We report mortality rates and causes of death in a cohort of women who used homeless shelters in Toronto. We also compare our results with those of other published studies of homeless women and with data for women in the general population.
A cohort of 1981 women not accompanied by dependent children who used homeless shelters in Toronto in 1995 was observed for death over a mean of 2.6 years. In addition, we analyzed data from published studies of mortality rates among homeless women in 6 other cities (Montreal, Copenhagen, Boston, New York, Philadelphia and Brighton, UK).
In Toronto, mortality rates were 515 per 100,000 person-years among homeless women 18-44 years of age and 438 per 100,000 person-years among those 45-64 years of age. Homeless women 18-44 years of age were 10 times more likely to die than women in the general population of Toronto. In studies from a total of 7 cities, the risk of death among homeless women was greater than that among women in the general population by a factor of 4.6 to 31.2 in the younger age group and 1.0 to 2.0 in the older age group. In 6 of the 7 cities, the mortality rates among younger homeless women and younger homeless men were not significantly different. In contrast, in 4 of the 6 cities, the mortality rates were significantly lower among older homeless women than among older homeless men.
Excess mortality is far greater among homeless women under age 45 years than among older homeless women. Mortality rates among younger homeless women often approach or equal those of younger homeless men. Efforts to reduce deaths of homeless women should focus on those under age 45.
The Anderson behavioral model was used to investigate racial and ethnic disparities in access to specialty mental health services among women in California as well as factors that might account for such disparities.
The study was a cross-sectional examination of a probability sample of 3,750 California women. The main indicators of access to services were perceived need, service seeking, and service use. Multivariate models were constructed that accounted for need and enabling and demographic variables.
Significant racial and ethnic variations in access to specialty mental health services were observed. African-American, Hispanic, and Asian women were significantly less likely to use specialty mental health services than white women. Multivariate analyses showed that Hispanic and Asian women were less likely than white women to report perceived need, even after frequent mental distress had been taken into account. Among women with perceived need, African-American and Asian women were less likely than white women to seek mental health services after differences in insurance status had been taken into account. Among women who sought services, Hispanic women were less likely than white women to obtain services after adjustment for the effects of poverty. Need and enabling factors did not entirely account for the observed disparities in access to services.
Additional research is needed to identify gender- and culture-specific models for access to mental health services in order to decrease disparities in access. Factors such as perceived need and decisions to seek services are important factors that should be emphasized in future studies.
Objective.
—To compare characteristics of homeless and low-income housed mothers across economic, psychosocial, and physical health domains.Design.
—Case-control study.Setting.
—Community of Worcester, Mass.Participants.
—A cross-sectional sample of 220 sheltered homeless mothers and 216 low-income housed (never homeless) mothers receiving welfare.Main Outcome Measures.
—Income, housing, life events, social support, history of abuse and assault, and mental and physical health.Results.
—Comparison of homeless and housed mothers revealed some important similarities and differences. The proportion of homeless mothers with annual incomes of less than $7000 was 46% vs 17% for housed mothers (P<.01). Homeless mothers experienced more residential instability than the housed mothers (3.8 moves vs 1.8 moves; P<.001) and had smaller support networks (P<.001). More homeless mothers reported severe physical and sexual assault over the lifespan than housed mothers (91.6% vs 81.1%; P<.003). No significant differences were found between the groups in mental and physical health. However, the lifetime prevalence of major depressive disorder, posttraumatic stress disorder, and substance use disorders was overrepresented compared to the general female population. Both groups had lower physical functioning compared to the general population and a higher prevalence of chronic health conditions.Conclusion.
—Sheltered homeless mothers had fewer economic resources and social supports and higher cumulative rates of violent abuse and assault over their lifespans than their housed counterparts. However, both groups faced extreme adversity that compromised family well-being. Practitioners and social policymakers need to be cognizant of the multiple economic, psychosocial, and physical health needs of these mothers in providing treatment and developing program interventions.
Using data from a random sample of women from the welfare caseload in an urban Michi- gan county, the authors investigate the prevalence of domestic violence and its associa- tion with mental health, health, and economic well-being. Nearly a quarter of the women experienced physical partner violence in the past 12 months, and almost two thirds in their lifetimes. Recent victims had significantly higher rates of five psychiatric disorders (depression, generalized anxiety disorder, post-traumatic stress disorder, drug depend- ence, and alcohol dependence) and health problems than women who never experienced domestic violence. Recent partner violence was also associated with greater material hardship. Analyses did not indicate any significant association between domestic vio- lence, past or present, and employment.
This study examined housing problems and homelessness after separation in a sample of 110 women who had experienced domestic violence. Of the sample, 38% reported home- lessness. Similar percentages reported housing problems (e.g., late paying rent, skipping meals, threatened with eviction). Predictors of more housing problems included experi- encing a greater severity of violence, contacting fewer formal systems, having less infor- mational support, and receiving a negative response from welfare. Women's odds of reporting homelessness were reduced by 30% if police officers responded positively. These findings highlight the importance of changing system responses in an effort to reduce women's housing problems and risks for homelessness after separation.
Objective.
—To determine the prevalence and risk factors for human immunodeficiency virus (HIV) and tuberculosis (TB) infection and investigate the relationship between these two infections in homeless adults.Design.
—Cross-sectional study.Setting.
—Inner-city shelters and free meal programs.Participants.
—A representative sample of 1226 adults (≥18 years) were enrolled from community sites.Main Outcome Measures.
—Serum HIV-1 antibody status and tuberculin skin test reactivity.Results.
—Human immunodeficiency virus seroprevalence was 8.5% (95% confidence interval [CI], 7.0% to 10.1%) and the prevalence of TB infection was 32% (95% CI, 30% to 37%). Nineteen percent of the HIV-seropositive subjects had positive tuberculin skin tests. Independent risk factors for HIV infection included younger age, black race, male homosexual contact, injection drug use, use of injection drugs in shooting galleries, and selling sex. Tuberculosis infection was associated with the duration of homelessness and living in crowded shelters or single-room-occupancy hotels. Injection drug use, a risk factor for HIV, was also a risk factor for TB, with a particularly strong association in women. No evidence of an association between TB and HIV infection was found, even after accounting for anergy.Conclusions.
—The homeless population in the United States should be considered a group at high risk for HIV infection and TB. Given the constellation of risk factors present, the high prevalence of infection, and lack of access to medical services, we anticipate that these communicable diseases in this population will represent a growing public health problem.(JAMA. 1994;272:455-461)
The purpose of this study was to examine the psychosocial, behavioral, and environmental profiles of homeless women, both those with and without a history of victimization, and their intimate partners. Five hundred seven homeless women and their intimate partners participated in the study. Thirty-nine percent of the women reported being physically and/or sexually assaulted as adults. Controlling for potential confounders, victimized women were more likely than others to have a history of childhood sexual and physical abuse, lifetime substance use, greater mental health symptomatology, and current risky sexual activity. Thus, homeless women with mental health and substance abuse problems ought to be screened for violent experiences and encouraged to obtain treatment appropriate to their problems to reduce their ongoing risk of victimization. © 2001 John Wiley & Sons, Inc. Res Nurs Health 24:324–335, 2001
This article reviews literature on the prevalence of mental health problems among women with a history of intimate partner violence. The weighted mean prevalence of mental health problems among battered women was 47.6% in 18 studies of depression, 17.9% in 13 studies of suicidality, 63.8% in 11 studies of posttraumatic stress disorder (PTSD), 18.5% in 10 studies of alcohol abuse, and 8.9% in four studies of drug abuse. These were typically inconsistent across studies. Weighted mean odds ratios representing associations of these problems with violence ranged from 3.55 to 5.62, and were typically consistent across studies. Variability was accounted for by differences in sampling frames. Dose-response relationships of violence to depression and PTSD were observed. Although research has not addressed many criteria for causal inferences, the existing research is consistent with the hypothesis that intimate partner violence increases risk for mental health problems. The appropriate way to conceptualize these problems deserves careful attention.
Background: Few population-based studies have assessed the physical and mental health consequences of both psychological and physical intimate partner violence (IPV) among women or men victims. This study estimated IPV prevalence by type (physical, sexual, and psychological) and associated physical and mental health. consequences among women and men. Methods: The study analyzed data from the National Violence Against Women Survey (NVAWS) of women and men aged 18 to 65. This random-digit-dial telephone survey included questions about violent victimization and health status indicators. Results: A total of 28.9% of 6790 women and 22.9% of 7122 men had experienced physical, sexual, or psychological IPV during their lifetime. Women were significantly more likely than men to experience physical or sexual IPV (relative risk [RR] =2.2, 95% confidence interval [CI] =2.1, 2.4) and abuse of power and control (RR=1.1, 95% CI=1.0, 1.2), but less likely than men to report verbal abuse alone (RR=0.8, 95% CI=0.7, 0.9). For both men and women, physical IPV victimization was associated with increased risk of current poor health; depressive symptoms; substance use; and developing a chronic disease, chronic mental illness, and injury. In general, abuse of power and control was more strongly associated with these health outcomes than was verbal abuse. When physical and psychological IPV scores were both included in logistic regression models, higher psychological IPV scores were more strongly associated with these health outcomes than were physical IPV scores. Conclusions: Both physical and psychological IPV are associated with significant physical and mental health consequences for both male and female victims.
• When seeking medical care, homeless persons often turn to health centers that were designed to treat the poor who have homes. To provide for effective medical care, personnel in such facilities need to know how the health care needs of the homeless are different from those of other clinic users. To compare the physical health of these two groups, we conducted a health survey and screening physical examination of 464 patients who attended the general adult and homeless clinic sessions of one of the main neighborhood health centers in Los Angeles County, California. As compared with the poor who have homes, homeless persons were more likely to have dermatological problems (32% vs 21%), functional limitation (median, 2 vs 0 per person), seizures (14% vs 6%), chronic obstructive pulmonary disease (21% vs 12%), social isolation, serious vision problems (22% vs 12%), foot pain, and grossly decayed teeth (median, 1 vs 0 per person). We conclude that to care more optimally for homeless adults, health centers must pay attention to their functional disabilities, substance abuse, skin abnormalities, vision impairment, dental problems, and foot problems.
(Arch Intern Med. 1990;150:2325-2330)
Empirical research addressing the decision to leave an abusive relationship is reviewed, methodological limitations in that research are outlined, and theoretical models potentially useful for explaining this decision process are discussed. The review of past research suggests that a variety of factors influence the decision to leave an abusive relationship, including employment outside the home, length of relationship, presence of child abuse, and number of previous separations. Many of these studies, however, are limited by nonrandom samples, retrospective designs, and overreliance on self-report measures. Four interrelated models show promise for aiding in the understanding of this complex decision situation: psychological entrapment, learned helplessness, cost/benefit analysis, and reasoned action. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
We compared 49 homeless female-headed families with 81 housed female-headed families in Boston. Most housed families were living in public or private subsidized housing. In both groups the mothers were poor, currently single, had little work experience, and had been on welfare for long periods. Many of their children had serious developmental and emotional problems. Homeless mothers had more frequently been abused as children and battered as adults and their support networks were fragmented; the housed mothers had female relatives and extended family living nearby whom they saw often. The frequency of drug, alcohol, and serious psychiatric problems was greater among the homeless mothers. The homeless mothers may have been more vulnerable to the current housing shortage because they lacked support in time of need. This, in turn, may have been due to their history of family violence. Psychiatric disabilities may have been another contributing factor in the minority of homeless women. The notion that a "culture of poverty" accounts for homelessness was not supported by the data since the homeless were less likely to have grown up in families on welfare. The data suggest that solutions to family homelessness in the current housing market require an increase in the supply of decent affordable housing, income maintenance, and assistance from social welfare agencies focused on rebuilding supportive relationships.
The present study explored differences between women who are currently housed but are at risk for homelessness versus homeless women in a middle-sized city in the southeast. The research focused on experiences in the women's history which might explain some differences between homeless women and women who are at risk for homelessness but are currently housed through public-assistance programs. 98 women from a community emergency shelter and public-assistance programs were either interviewed or completed questionnaires. The questionnaires assessed the women's history of mental illness, employment and housing problems, physical and sexual abuse, drug and alcohol problems, and skills for building and maintaining relationships. The women were young (18-35 years), about 80% were single mothers and about 50% had children living with them. t tests for independent samples indicated that compared to 48 at-risk housed women, the 50 homeless women reported a history of more symptoms of mental illness, more instability of employment and housing, more physical and sexual abuse, more drug and alcohol problems, and fewer skills for interacting with others. When all variables were entered simultaneously into a multiple regression equation, only skills for interacting accounted for a significant proportion of the variability between the two groups of women.
To determine the prevalence and risk factors for human immunodeficiency virus (HIV) and tuberculosis (TB) infection and investigate the relationship between these two infections in homeless adults.
Cross-sectional study.
Inner-city shelters and free meal programs.
A representative sample of 1226 adults (> or = 18 years) were enrolled from community sites.
Serum HIV-1 antibody status and tuberculin skin test reactivity.
Human immunodeficiency virus seroprevalence was 8.5% (95% confidence interval [CI], 7.0% to 10.1%) and the prevalence of TB infection was 32% (95% CI, 30% to 37%). Nineteen percent of the HIV-seropositive subjects had positive tuberculin skin tests. Independent risk factors for HIV infection included younger age, black race, male homosexual contact, injection drug use, use of injection drugs in shooting galleries, and selling sex. Tuberculosis infection was associated with the duration of homelessness and living in crowded shelters or single-room-occupancy hotels. Injection drug use, a risk factor for HIV, was also a risk factor for TB, with a particularly strong association in women. No evidence of an association between TB and HIV infection was found, even after accounting for anergy.
The homeless population in the United States should be considered a group at high risk for HIV infection and TB. Given the constellation of risk factors present, the high prevalence of infection, and lack of access to medical services, we anticipate that these communicable diseases in this population will represent a growing public health problem.
To compare characteristics of homeless and low-income housed mothers across economic, psychosocial, and physical health domains.
Case-control study.
Community of Worcester, Mass.
A cross-sectional sample of 220 sheltered homeless mothers and 216 low-income housed (never homeless) mothers receiving welfare.
Income, housing, life events, social support, history of abuse and assault, and mental and physical health.
Comparison of homeless and housed mothers revealed some important similarities and differences. The proportion of homeless mothers with annual incomes of less than $7000 was 46% vs 17% for housed mothers (P<.O1). Homeless mothers experienced more residential instability than the housed mothers (3.8 moves vs 1.8 moves; P<.001) and had smaller support networks (P<.001). More homeless mothers reported severe physical and sexual assault over the lifespan than housed mothers (91.6% vs 81.1 %; P<.003). No significant differences were found between the groups in mental and physical health. However, the lifetime prevalence of major depressive disorder, posttraumatic stress disorder, and substance use disorders was overrepresented compared to the general female population. Both groups had lower physical functioning compared to the general population and a higher prevalence of chronic health conditions.
Sheltered homeless mothers had fewer economic resources and social supports and higher cumulative rates of violent abuse and assault over their lifespans than their housed counterparts. However, both groups faced extreme adversity that compromised family well-being. Practitioners and social policymakers need to be cognizant of the multiple economic, psychosocial, and physical health needs of these mothers in providing treatment and developing program interventions.
Prospective data from a nationally representative sample of women were used to examine 4 objective indexes of social adjustment following direct, interpersonal crime. Household income, marital status, employment, and education level were evaluated as risk factors for and outcomes of victimization. Data were collected in 3 waves at 1-year intervals, and 2,863 women completed all 3 waves. Results indicate that women experience increased risk for victimization when income is below poverty level and when newly divorced. Further, victimization appears to increase women's risk for unemployment, reduced income, and divorce. The cyclical nature of victimization is discussed.
This study examines the relationship between residential instability, including mobility and previous homelessness, and the use of medical care among previously sheltered and never-sheltered mothers in New York City. The study represents one of the first efforts to follow up on families after they are no longer homeless.
Mothers from 543 welfare families in New York City were interviewed, once in 1988 (Time 1) and again beginning in 1992 (Time 2). The sample included 251 families who first entered shelters after their 1988 interview, and 292 families who spent no time in shelters before or after that point. Mothers were asked about the source and volume of medical care used in the year before follow-up.
Bivariate and multivariate analyses showed that previously sheltered mothers had a greater reliance on emergency departments (EDs) and weaker ties to private physicians or health maintenance organizations (HMOs) than did mothers who never used shelters. Mobility before the Time 1 interview was associated with greater reliance on EDs and absence of a usual source of care. More recent mobility was not associated with a usual source of care. Current residential stability reduced the likelihood of using an emergency department or having no regular source of care. None of the measures of residential instability were related to the volume of outpatient care used by mothers.
A history of residential instability, particularly previous shelter use, strongly predicts where poor mothers currently seek health care. Further research is needed to determine whether these patterns of health care use existed before mothers entered shelters. The study provides evidence that upon leaving shelters, mothers are not being well integrated into primary care services.
The impact of Connecticut's welfare reform program (Jobs First), physical and mental health status, personal resources and household violence on employment was examined 18 months after women were randomized to either the welfare reform or the older AFDC program. Multivariate analyses showed that although the Jobs First program was statistically significantly associated with women having worked sometime since assignment to the welfare reform program, the Jobs First program was not associated with women currently working or having worked at some point but no longer working. Rather, women were more likely to be working at the 18 month interview if they reported frequent help from their social networks (OR = 1.52; p = .009), they had at least a high school degree (OR = 1.65; p =.002) and they were in good physical health (OR = 3.41; p = .009). Women who had worked sometime since random assignment but were no longer working at the 18 month interview reported few social contacts (OR = 1.33; p = .042), did not pay rent or own their own homes (OR = 6.94; p = .025), reported receiving AFDC for 2 years or more prior to randomization (OR = 1.83; p = .035) and reported high levels of household violence (OR = 1.52; p = .035). The need for attention to be focused on the importance of health problems, household violence and personal resources for the successful transitioning from public income support to employment is discussed.
Homelessness and hunger are associated with poor health outcomes. Housing instability and food insecurity describe less severe problems securing housing and food.
To determine the association between housing instability and food insecurity and access to ambulatory health care and rates of acute health care utilization.
Secondary data analysis of the National Survey of American Families.
16,651 low-income adults.
Self-reported measures of past-year access: (1) not having a usual source of care, (2) postponing needed medical care, or (3) postponing medication; and past-year utilization: (1) not having an ambulatory care visit, (2) having emergency department (ED) visits, or (3) inpatient hospitalization.
23.6% of subjects had housing instability and 42.7% had food insecurity. In multivariate logistic regression models, housing instability was independently associated with not having a usual source of care (adjusted odds ratio [AOR] 1.31, 95% confidence interval [CI] 1.08 to 1.59), postponing needed medical care (AOR 1.84, 95% CI 1.46 to 2.31) and postponing medications (AOR 2.16, 95% CI 1.70 to 2.74), increased ED use (AOR: 1.43, 95% CI 1.20 to 1.70), and hospitalizations (AOR 1.30, 95% CI 1.01 to 1.67). Food insecurity was independently associated with postponing needed medical care (AOR 1.74, 95% CI 1.38 to 2.21) and postponing medications (AOR 2.15, 95% CI 1.62 to 2.85), increased ED use (AOR 1.39, 95% CI 1.17 to 1.66), and hospitalizations (AOR 1.42, 95% CI 1.09 to 1.85).
Housing instability and food insecurity are associated with poor access to ambulatory care and high rates of acute care. These competing life demands may lead to delays in seeking care and predispose to acute care.
Women with housing insecurity, California, 2003. Paper presented at the California Women's Heath Survey Symposium
- Z Weinbaum
- Roberson N S Baumrind
- L Holzman
- Induni
Weinbaum Z, Baumrind N, Roberson S, Holzman L, Induni M. Women with housing insecurity, California, 2003. Paper presented at the California Women's Heath Survey Symposium, May 20, 2004, Sacramento CA.
Impediments to employment under Welfare reform: the importance of physical health and psychosocial characteristics.
- Horowitz S.M.
- Kerker B.D.
Predictors of homelessness among families in New York City: from shelter request to housing stability.
- Shinn M.
- Weitzman B.C.
- Stojanovic D.
HIV and tuberculosis infection in San Francisco’s homeless adults.
- Zolopa A.R.
- Hahn J.A.
- Gorter R.
Predictors of homelessness among families in New York City: from shelter request to housing stability
- Shinn
HIV and tuberculosis infection in San Francisco’s homeless adults
- Zolopa