The Impact of Temporary Assistance for Needy Families Benefit Requirements and Sanctions on Maternal Material Hardship, Mental Health, and Parental Aggravation.

INTRODUCTION: Temporary Assistance for Needy Families requirements can be stress-inducing, difficult for families to complete, and may be detrimental during early life. We assessed the impact of TANF requirements on primary caregiving mothers' experiences of material hardship, anxiety, depression, and parental aggravation in the first year of a child's life. METHODS: Survey responses were selected from mothers in the Future of Families and Childhood Wellbeing Study, who received TANF in the first year of their child's life (N = 1085). RESULTS: Survey-weighted regression models showed associations between: presence of any requirements and increased material hardship, work requirements and increased material hardship, requirement to name the father of their child and increased depression, benefit cuts and increased parental aggravation, and benefit cuts and increased material hardship. DISCUSSION: Federal and state policies should revise requirement programs to increase program accessibility and support the mental health and financial stability of mothers applying for TANF to facilitate sustainable movement into employment.

Evaluating a multicomponent social behaviour change communication strategy to reduce intimate partner violence among married couples: study protocol for a cluster randomized trial in Nepal.

BACKGROUND: Intimate partner violence (IPV) is a significant public health issue that affects 1 in 3 women globally and a similarly large number of women in Nepal. Over the past decade, important policy and programmatic steps have been taken to address violence against women in Nepal. There remains a dearth of evidence on the effectiveness of primary violence prevention strategies. The Change Starts at Home study begins to fill this gap by utilizing a multi-component social behaviour change communication (SBCC) strategy involving a radio drama and community mobilization to shift attitudes, norms and behaviours that underpin IPV perpetration in Nepal. METHODS/DESIGN: The study uses a concurrent mixed-methods design. The quantitative aspect of the evaluation is a pair-matched, repeated cross-sectional 2-armed, single-blinded cluster trial (RCT: N = 36 clusters, 1440 individuals), comparing a social behaviour change communication (SBCC) strategy to radio programming alone for its impact on physical and / or sexual IPV at the end of programming (12 months' post-baseline) and 6-months post the cessation of project activities (18-months post baseline). The qualitative aspects of the design include several longitudinal approaches to understand the impact of the intervention and to examine mechanisms of change including in-depth interviews with participants (N = 18 couples), and focus group discussions with community leaders (N = 3 groups), and family members of participants (N = 12 groups). Treatment effects will be estimated with generalized logistic mixed models specified to compare differences in primary outcome from baseline to 12-month follow-up, and baseline to 18-months follow-up in accordance with intention-to-treat principles. DISCUSSION: The study rigorously evaluates the effectiveness of a promising strategy to prevent IPV. The results of the trial will be immediately useful for governmental, nongovernmental, and donor funded programs targeting partner violence or social norms that underpin it. Findings of the study will also contribute to global knowledge on the effectiveness of media and community engagement as a primary prevention strategy for IPV. TRIAL REGISTRATION: Trial was registered in clinicaltrials.gov, NCT02942433 , 10/13/2016, retrospectively registered.

Intimate partner violence in late adolescence and young adulthood and subsequent cardiovascular risk in adulthood.

BACKGROUND: Childhood maltreatment has been linked to adulthood cardiovascular disease (CVD). Little is known about the relationship between intimate partner violence (IPV) in late adolescence and young adulthood and CVD risk later in adulthood. PURPOSE: To examine whether IPV perpetration and victimization experienced in late adolescence and young adulthood are associated with CVD risk among adults in the United States and whether this relationship differs by sex. METHODS: Data include 9976 participants (50% female) in the National Longitudinal Study of Adolescent to Adult Health. Physical and sexual IPV were measured at wave 3 (2001/02) with items from the revised Conflict Tactics Scales. Participants'30-year risk of CVD was calculated at wave 4 (2008/09) using a Framingham prediction model. Linear regression models adjusted for confounders and IPV by sex interaction terms were tested to examine the relationship. RESULTS: The mean CVD risk score was 13.18% (95% CI: 12.71, 13.64). Aone-standard deviation increase in the victimization score was associated with a 0.28% (95% CI: 0.03, 0.54) increase in CVD risk. Perpetration was similarly positively associated with CVD risk (beta: 0.33, 95% CI: 0.03, 0.62). When measured as a composite, all violence types were associated with increased CVD risk but only prior exposure to both victimization and perpetration reached statistical significance (0.62%, 95% CI: 0.01, 1.22). No differences by sex were detected. CONCLUSIONS: Effect sizes are not large, but early detection of increased CVD risk in this relatively young population is notable and worthy of further study to inform the clinical response.

Building Nehemiah's Wall: The North Minneapolis Faith Community's Role in the Prevention of Intimate Partner Violence.

African American women who are victims of intimate partner violence (IPV) often rely on faith when exposed to IPV; however, the role of the faith community in the lives of IPV victims is less clear. This study uses a community-based approach to examine the role of the faith community in addressing IPV in heterosexual relationships in North Minneapolis where rates of poverty and IPV among African Americans are disproportionately high compared to other cities in Minnesota. Five focus group discussions (FGDs) were held with 34 lay and secular leaders of mixed genders in the North Minneapolis community. FGDs were evaluated using a grounded theory method of analysis. Discussions revealed that some faith leaders effectively identified IPV as a community issue and intervened but that many remained silent or were not well trained to address the issue safely. Faith-based solutions were identified to address IPV in the African American community and included the faith community speaking openly about IPV, developing programs for unmarried and adolescent couples, and coordinating services with secular IPV support organizations.

Disparities in long-term cardiovascular disease risk by sexual identity: The National Longitudinal Study of Adolescent to Adult Health.

OBJECTIVE: To examine long-term cardiovascular disease (CVD) risk disparities by sexual identity using a nationally representative sample of young adults in the United States. METHODS: Data include participants in wave 4 (2008/09; ages 24-34years) of the National Longitudinal Study of Adolescent to Adult Health (7087 females; 6340 males). Sexual identity was self-reported (heterosexual, mostly heterosexual, bisexual, mostly homosexual, homosexual) and a Framingham-based prediction model was used to estimate participants' risk of a CVD event over 30years. Differences in CVD risk by sexual identity, relative to heterosexuals, were calculated with linear regression models adjusted for age, race/ethnicity, education, and financial distress. RESULTS: Average 30-year CVD risk was 17.2% (95% CI: 16.7, 17.7) in males and 9.0% (95% CI: 8.6, 9.3) in females. Compared to heterosexual females, mostly heterosexual (0.8%; 95% CI: 0.2, 1.4) and mostly homosexual females (2.8%; 95% CI: 0.8, 4.9) had higher CVD risk. Bisexual and homosexual females had higher but not statistically significant CVD risk compared to heterosexuals. Among males, differences in CVD risk by sexual identity were not statistically significant. CONCLUSION: Sexual identity was associated with CVD risk in sexual minority subgroups. Population- and clinic-based prevention strategies are needed to minimize disparities in subsequent disease.

Predicted long-term cardiovascular risk among young adults in the national longitudinal study of adolescent health.

OBJECTIVES: We estimated the distribution of predicted long-term cardiovascular disease (CVD) risk among young adults in the United States. METHODS: Our data were derived from National Longitudinal Study of Adolescent Health participants (n = 14 333; average age: 28.9 years). We used a Framingham-derived risk prediction function to calculate 30-year risks of "hard" and "general" CVD by gender and race/ethnicity. RESULTS: Average 30-year risks for hard and general CVD were 10.4% (95% confidence interval [CI] = 10.1%, 10.7%) and 17.3% (95% CI = 17.0%, 17.7%) among men and 4.4% (95% CI = 4.3%, 4.6%) and 9.2% (95% CI = 8.9%, 9.5%) among women. Average age-adjusted risks of hard and general CVD were higher among Blacks and American Indians than among Whites and lower among Asian/Pacific Islander women than White women. American Indian men continued to have a higher risk of general CVD after adjustment for socioeconomic status. Four percent of women (95% CI = 3.6%, 5.0%) and 26.2% of men (95% CI = 24.7%, 27.8%) had a 20% or higher risk of general CVD. Racial differences were detected but were not significant after adjustment for socioeconomic status. CONCLUSIONS: Average CVD risk among young adults is high. Population-based prevention strategies and improved detection and treatment of high-risk individuals are needed to reduce the future burden of CVD.

Women's help seeking for intimate partner violence in Jordan.

Little is known about Jordanian women's help seeking for intimate partner violence (IPV), despite local and international investment in victim services. Using a clinic based survey (n = 517; response rate 70%) and focus group discussions (FGDs, n = 17) we explored Jordanian women's nonfamily help seeking for physical or sexual IPV. We evaluated survey data using bivariate and multivariate regression and examined FGD transcripts using open coding methodology. Nonfamily help seeking was uncommon, an option only in serious circumstances after familial help was ineffective, and correlated with violence severity and relative violence. Nonfamily resources are underutilized but critical for vulnerable Jordanian women.

The Impact of Increased Minimum Wage on Child Neglect Varies by Developmental Age of Child.

Children in poverty are at significantly greater risk of experiencing child maltreatment. Family economic security policies, such as minimum wage laws, offer a promising prevention strategy to support low-income families. This study utilized data from the Fragile Families and Child Wellbeing Study, a longitudinal birth cohort study, to examine the effect of changes in state-specific minimum wage laws on maternal self-reported child maltreatment and material hardship as it varies by developmental age of the child. A series of fixed effects models with an interaction between the minimum wage and the age of the focal child were used to estimate if there was variation by developmental period of the impact of minimum wage laws on the following outcome variables: all domains of child maltreatment, maternal work-related stress, reported material hardship, aggravation in parenting, and maternal depression. Results revealed significant effects of increased minimum wage on maternal self-reported child neglect and material hardship when children are 3 years of age, and this relationship became non-significant as children aged. No effect was observed by age for other forms of child maltreatment nor any other outcome variables. Study findings suggest minimum wage laws may have differential effects on child neglect depending on the developmental period in which they are received.

Women's Lived Experiences with Temporary Assistance for Needy Families (TANF): How TANF Can Better Support Women's Wellbeing and Reduce Intimate Partner Violence.

Women experiencing poverty are more likely to face intimate partner violence (IPV), poor health, and stigma. IPV survivors are overrepresented among those who receive Temporary Assistance for Needy Families (TANF), a conditional cash program serving families experiencing poverty. More generous TANF policies may be protective against IPV, but a greater insight into TANF's effect could be gleaned through a contemporaneous study that examines intersecting determinants of wellbeing and engages community interpretation of findings. Using an adapted Family Stress Model framework and analyzing data through an intersectional and community-based lens, we explore the impact of TANF on women's wellbeing through in-depth, semi-structured interviews during the COVID-19 pandemic with 13 women who had TANF experience in three U.S. states. Data were analyzed using thematic analysis in MAXQDA and researchers facilitated three member-checking events to enhance validity of result interpretation. Four themes emerged: (1) Low cash and conditional benefits provided limited short-term "relief" but contributed to poverty and hard choices; (2) TANF benefit levels and conditions increased women's dependence on others, straining relationships; (3) Women undertook extraordinary measures to access TANF, largely to fulfill their roles as mothers; and (4) TANF stigma creates psychological stress, differentially experienced by African Americans. Increasing TANF cash benefits and other cash transfers for those experiencing poverty, adopting solely state funded TANF programs, increasing funding for TANF administration, addressing TANF stigma and racialized narratives, and allowing optional child support participation or a larger "pass-through" of child support are important steps toward making TANF more protective against IPV.

"There Is Always an Excuse to Blame the Girl": Perspectives on Sexual Harassment at a Jordanian University.

Sexual harassment (SH), defined as unwelcome conduct of a sexual nature, presents a global public health issue and a barrier to empowerment for women and girls. To understand the perceived causes of SH in the Jordanian university context, we conducted focus groups (n = 6) and participatory data collection with students (n = 317) and interviews with staff and administrators (n = 5) at a public university. These data identified norms governing men's and women's behavior, institutional climate and policies, tribal conservatism and protection of perpetrators, and early socialization as underlying SH. Campus-based interventions should adopt approaches aimed at multiple levels of the social ecology.

Adapting and Validating the Sexual Experiences Questionnaire to Study Sexual Harassment Among University Women in Jordan.

Despite the adverse effects of sexual harassment, measurement gaps persist. Using a sequential, mixed-methods approach, we adapted and validated the Sexual Experiences Questionnaire (SEQ) to measure sexual harassment victimization among college-going women in Jordan. From a 213-item pool and qualitative data from students at the study site, we removed 50 items and collapsed or rephrased 163 items into selected 27 items for examination. After expert reviewers and study-site staff assessed content validity, we replaced three items. Items were tested using cognitive interviews (n = 7) and then administered in a survey to 567 women students. We sequentially performed exploratory factor analysis (EFA) with a random split-half sample (N1 = 283), confirmatory factor analysis (CFA) with the second sample (N2 = 284), and confirmatory bifactor analysis. Five items with cross-factor loadings were dropped. Model fit for the final four-factor EFA and CFA was adequate (EFA: RMSEA: 0.013, CFI: 0.996, TLI: 0.994; CFA: RMSEA 0.020, CFI: 0.988, TLI: 0.986). Three factors were similar to those identified in the SEQ-gender harassment, sexual coercion, and unwanted sexual attention-but we also identified a fourth factor-physical-contact sexual harassment. The bifactor analysis suggested that the scale was unidimensional (general factor ECV=.701 and PUC =.727). The unidimensional scale was positively associated with depressive symptoms. Using an adapted SEQ, sexual harassment is a measurable construct in the Jordanian university context. Further validation of this tool and efforts to capture each dimension of sexual harassment in the Arab region is needed.

The effect of increased minimum wage on child externalizing behaviors.

The Family Stress Model (FSM) has been used to show the relationship between socioeconomic disadvantage and child externalizing behaviors and suggests that interventions promoting economic security may be a promising approach to reduce child externalizing behavior. Using longitudinal data from the Fragile Families and Child Wellbeing study from 2002 to 2010 we examined the effect of minimum wage laws on child externalizing behaviors through a difference in difference in differences (DDD) study design. Externalizing behavior was assessed with the Child Behavior Checklist (CBCL) using the rule breaking, attention problems, and violence subscales. DDD analyses suggest a $1 increase in the minimum wage was associated with a 2% reduction in violent behaviors (ß = -1.90, 95%CI[-3.12, -0.68], p = 0.003) for the most vulnerable families headed by a primary caregiver with less than a high school education. The study results suggest that increases in the minimum wage are associated with reductions in the most severe and costly externalizing behaviors among children. Study results contribute to a growing body of literature showing that increased family incomes have positive impacts on child development, and that minimum wage policy is potentially an effective mechanism for the primary prevention of violence.

Implications of Severe Polyvictimization for Cardiovascular Disease Risk Among Female Survivors of Violence.

In this study, we examined the impact of severe polyvictimization on 30-year cardiovascular disease (CVD) risk among female survivors of intimate partner violence (IPV). Data were collected from 34 participants in the "Leave it on the Mat" pilot study. The study was conducted in an urban city in a Midwestern state from August 2012 to April 2014. Severe polyvictimization was considered present if participants reported a history of three or more forms of victimization (childhood exposure to domestic violence, being psychologically or physically abused in childhood, and lifetime sexual assault) in addition to IPV. CVD risk factors included smoking, body mass index (BMI), and systolic blood pressure (SBP). A Framingham-based prediction model was used to estimate 30-year CVD risk. A linear regression model, adjusted for age, education, race/ethnicity, and family history of CVD, was calculated. Fifty percent (n = 17) of the study participants reported severe polyvictimization and the average 30-year risk of CVD in the full sample was 22.3. Participants who experienced severe polyvictimization had higher 30-year CVD risk scores when compared to participants who experienced two or fewer forms of victimization. The findings revealed that severe polyvictimization was prevalent among survivors of IPV and was associated with increased scores on the 30-year CVD risk model. Screening for abuse history could aid identification of individuals at high CVD risk.

Association between Temporary Assistance for Needy Families (TANF) and child maltreatment among a cohort of fragile families.

BACKGROUND: Child maltreatment disproportionately affects families experiencing poverty and structural discrimination, including African American (AA) families. The generosity of Temporary Assistance for Needy Families (TANF) may reduce child maltreatment disparities. OBJECTIVE: Our aim is to understand TANF's impact on the mother's perpetration of child maltreatment and whether the effect differs across AA and White mothers. PARTICIPANTS AND SETTING: Participants are 2457 primary caregiving mothers participating in waves 3 (2001-2003), 4 (2003-2006), and 5 (2007-2010) of the U.S.-based Fragile Families and Child Wellbeing birth cohort study. METHODS: We use a difference-in-differences study design to estimate overall and race-specific effects of TANF policies on caregivers' self-report of child neglect and physical and psychological maltreatment measured by the Child-Parent Conflict Tactics Scale. State-level TANF policy exposures include the TANF-to-Poverty Ratio (TPR), maximum cash benefits, time limits, sanctions, diversion payments, and family caps. RESULTS: A $100 increase in TANF benefits was associated with a reduction of 1.8 reported physical abuse events (Beta = -1.80, 95% CI (-3.29, -0.31)). Imposing a time limit on TANF receipt was associated with an increase of 2.3 reported physical abuse events (Beta = 2.27, 95% CI (0.04, 4.50)). No significant differences were found for AA mothers versus White mothers. CONCLUSIONS AND RELEVANCE: Increasing TANF cash benefits should be prioritized to reduce poverty-related child maltreatment disparities. TANF time limits should be reconsidered.

Diagnosing Norms Surrounding Sexual Harassment at a Jordanian University.

Sexual harassment (SH) is a form of gender-based violence (GBV) that negatively impacts women's physical, mental, social, and financial well-being. Although SH is a global phenomenon, it also is a contextualized one, with local and institutional norms influencing the ways in which harassment behavior manifests. As more women attend institutions of higher education in Jordan, these women are at increased risk of experiencing SH in university settings, with potential implications for their health and future employment. Social norms theory, which examines the informal rules governing individual behavior within groups, has been a useful framework for understanding and developing interventions against GBV globally. We sought to apply a social-norms lens to the understanding and prevention of SH at a Jordanian university. To gain a comprehensive and nuanced picture of social norms surrounding SH, we collected qualitative data using three complementary methods: focus group discussions (n = 6) with male and female students (n = 33); key informant interviews with staff and faculty (n = 5); and a public, participatory event to elicit anonymous short responses from students (n = 317). Using this data, we created a codebook incorporating social-norms components and emergent themes. As perceived by participants, SH was unacceptable yet common, characterized as a weak norm primarily because negative sanctioning of harassers was unlikely. Distal norms related to gender and tribal affiliation served to weaken further norms against SH by blaming the victim, preventing reporting, discouraging bystander intervention, and/or protecting the perpetrator. The complexity of the normative environment surrounding SH perpetration will necessitate the use of targeted, parallel approaches to change harmful norms. Strengthening weak norms against SH will require increasing the likelihood of sanctions, by revising university policies and procedures to increase accountability, increasing the acceptability of bystander intervention and reporting, and fostering tribal investment in sanctioning members who harass women. Creating dialogue that emphasizes the harmful nature of SH behaviors and safe spaces to practice positive masculinity also may be an effective strategy to change how male students interact in the presence of peers. Any social norms change intervention will need to consider the various reference groups that dictate and enforce norms surrounding SH.

The impact of temporary assistance for needy families, minimum wage, and Earned Income Tax Credit on Women's well-being and intimate partner violence victimization.

Women experiencing poverty and women of color disproportionately experience intimate partner violence (IPV) victimization. Economic policies targeting women at this intersection of poverty and IPV, including Temporary Assistance for Needy Families (TANF), Minimum Wage (MW), and Earned Income Tax Credits (EITCs), may be powerful violence prevention tools. Using data from waves 1 (1998-2000) through 4 (2007-2010) of the U.S.-based Fragile Families and Child Well-being (FFCW) birth cohort study, we apply a difference-in-difference (DD) study design to estimate both the overall and race-specific effects of state-level economic policies on non-physical IPV and several intermediate outcomes. In DD models analyzing the difference in violence outcomes by intervention group (i.e., TANF exposure based on women's educational attainment, ≤high school vs >high school) and by race (African American (AA) vs White) few state-level TANF policies were associated with IPV victimization and the MW had no differential effect, but the refundable EITC was protective against IPV. Of the few TANF policies associated with IPV - sanctions and the ratio of families receiving TANF for every 100 families in poverty (the TANF-to-Poverty Ratio (TPR)) - those linked with fewer TANF restrictions seemed to increase coercive victimization, especially among AA women. With regard to intermediate variables, we found no overall impact of economic policies on depression or economic hardship, while monetary benefits and the TPR, were associated with a decrease in employment. The effect of TANF policies by race on intermediate outcomes was complex and analyses suggest that while White women are more likely to be employed when TANF time limits are in place, they also experience larger increases in economic hardship events compared to AA women. Research into the effects of cash transfer conditionality on mediators, including economic instability, perceived stress, bargaining power, and coercive IPV to interfere with TANF compliance, is needed.

Family Economic Security Policies and Child and Family Health.

In this review, we examine the effects of family economic security policies (i.e., minimum wage, earned income tax credit, unemployment insurance, Temporary Assistance to Needy Families) on child and family health outcomes, summarize policy generosity across states in the USA, and discuss directions and possibilities for future research. This manuscript is an update to a review article that was published in 2014. Millions of Americans are affected by family economic security policies each year, many of whom are the most vulnerable in society. There is increasing evidence that these policies impact health outcomes and behaviors of adults and children. Further, research indicates that, overall, policies which are more restrictive are associated with poorer health behaviors and outcomes; however, the strength of the evidence differs across each of the four policies. There is significant diversity in state-level policies, and it is plausible that these policy variations are contributing to health disparities across and within states. Despite increasing evidence of the relationship between economic policies and health, there continues to be limited attention to this issue. State policy variations offer a valuable opportunity for scientists to conduct natural experiments and contribute to evidence linking social policy effects to family and child well-being. The mounting evidence will help to guide future research and policy making for evolving toward a more nurturing society for family and child health and well-being.

The influence of family violence and child marriage on unmet need for family planning in Jordan.

BACKGROUND: Risk for unmet need for contraception is associated with men's perpetration of intimate partner violence (IPV) against women and may be influenced by violence perpetrated by other family members (family violence, FV). Women who married as minors may be most vulnerable to the potential compounding effect of IPV and FV on unmet need. AIM: Using nationally representative data from the 2012 Jordan Population and Family Health Survey we examined unmet need by exposure to IPV and FV by women's age at marriage (<18, 18+ years). DESIGN: Logistic regression was used to test whether IPV and FV were independently associated with unmet need, by age at marriage. Interaction terms (IPV×FV) were tested in both models. Stratification by FV was employed to clarify the interpretation of significant interactions. RESULTS: IPV increased the odds of unmet need by 87% [adjusted odds ratio (AOR) 1.87; 95% confidence interval (95% CI) 1.13-3.10] and 76% (AOR 1.76; 95% CI 1.30-2.38) among women who married prior to and after the age of 18 years, respectively. Women married as minors who experienced IPV and FV had a four-fold higher likelihood of having an unmet need (AOR 6.75; 95% CI 1.95-23.29) compared to those experiencing only IPV (AOR 1.49; 95% CI 0.84-2.38). No interaction between IPV and FV was detected for women married at or above majority. CONCLUSIONS: Laws that prohibit child marriage should be strengthened and health sector screening for violence experience could help identify women at risk of unmet need and improve women's reproductive agency.

Patterns of Dating Violence Perpetration and Victimization in U.S. Young Adult Males and Females.

Dating violence (DV) is frequently reported by young adults in intimate relationships in the United States, but little is known about patterns of DV perpetration and victimization. In this study, we examined sexual and physical violence perpetration and victimization reported by young adults to determine how the violence patterns differ by sex and race/ethnicity. Data from non-Hispanic White, non-Hispanic Black, and Hispanic participants in Wave 3 of the National Longitudinal Study of Adolescent to Adult Health were analyzed. DV was assessed using responses to four questions focused on perpetration and four questions focused on victimization. The information on DV was taken from the most violent relationship reported by participants prior to Wave 3. Latent class analysis was first conducted separately by sex, adjusting for age, race/ethnicity, and financial stress, then by race/ethnicity, adjusting for age and financial stress. Relative model fit was established by comparing Bayesian Information Criteria (BIC), adjusted BIC, entropy, interpretability of latent classes, and certainty of latent class assignment for covariate-adjusted models. The results indicate that patterns of violence differed by sex and for females, by race/ethnicity. A three-class model was the best fit for males. For females, separate four-class models were parsimonious for White, Black, and Hispanic females. Financial stress was a significant predictor of violence classification for males and females and age predicted membership in White and Black female models. Variations in DV patterns by sex and race/ethnicity suggest the need for a more nuanced understanding of differences in DV.