Intimate Partner Violence, Economic Insecurity, and Health Outcomes Among American Indian and Alaska Native Men and Women: Findings From a National Sample.

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.

The impact of support programmes for survivors of sexual violence: micro-level evidence from eastern Democratic Republic of the Congo.

In the eastern Democratic Republic of the Congo there are several support programmes for sexual violence survivors, but their impacts are rarely systematically assessed. We investigated the effects for women from two support programmes that include both survivors of sexual and gender-based violence (SGBV) and others. Specifically, we estimated (1) the effect of SGBV on social exclusion and economic well-being, and (2) the effects of support programmes on social exclusion and economic well-being, as well as differential effects for SGBV survivors and others. Based on an original survey of 1,203 women, we found that survivors felt less included across various social settings, but their economic well-being was no different than that of other women. We also found that support programmes significantly improve both perceived social inclusion and economic well-being for survivors and non-survivors. The effects on economic well-being were larger for survivors. In conclusion, these support programmes brought important benefits to survivors and non-survivors alike, although there is potential for improvement, particularly on social inclusion for SGBV survivors.

[An assessment of the direct costs of healthcare for victims of sexual assaults in hospital emergency units]. / Évaluation des coûts directs de la prise en charge en urgence d'une victime de violences sexuelles.

BACKGROUND: The Forensic medicine reform in 2011 enabled the development of forensic units specialized in multidisciplinary care of victims of criminal offences. Thanks to an annual budgetary allocation, the Ministry of Justice handles the financing of judicial acts, while the health care facilities assume the medical, psychological and social aspects. The objective of this study was to determine the direct costs of medical care provided to rape victims (such as defined in the article 222-23 of the Penal Code) in order to see how its funding could be reconsidered to prevent any additional cost that could be caused by non-sufficient medical, psychological and social care. Furthermore, this first assessment may serve as a basis for further reflection on creating other medical judicial units but also for reviewing existing structures. METHODS: The direct costs for medical care of a recent rape victim (<48hours) was quantified by including staff and consumables costs, treatments, biological tests and other expenses. RESULTS: The overall time for the entire medical care procedure was approximately three hours, for an overall cost of 673.92€, of which 41.5 % (279.90€) was paid by the Ministry of Justice. The medical, psychological and social aspects stood for the major expenditure items (394.02€), attributable mainly to the biological screening tests for sexually transmissible infections (STIs). CONCLUSION: These frequent situations require the convergence of human and material needs with a financial burden shared between the Ministry of Justice and health establishments. Authors suggest that in the annual hospital budgetary allocation allotted by the Ministry of Justice, the care of victims of sexual assault be based on the rate of day hospitalization "Medicine, medical specialties part time day or night common regime", allowing to provide optimal multidisciplinary care, which lessens the risks of complications and reduces the global cost created by these situations.

Rape Messaging.

When feminists began advocating for rape reform in the 1970s, the rape message was clear: rape was not a crime to be taken seriously because women lie. After decades of criminal law reform, the legal requirement that a woman vigorously resist a man's sexual advances to prove that she was raped has largely disappeared from the statute books, and, in theory, rape shield laws make a woman's prior sexual history irrelevant. Yet, despite what the law dictates, rape law reforms have not had a "trickle-down" effect, where changes in law lead to changes in attitude. Women are still believed to be vindictive shrews so police continue to code rape allegations as "unfounded," and prosecutors continue to elect not to prosecute many rape cases. To many, "no" can sometimes still mean "yes." In short, criminal law reforms have only marginally succeeded at deterring rape and increasing conviction rates for rape. At the same time, criminal law reforms have entrenched gender norms and endorsed the message that acquaintance rapes are less worthy of harsh punishment. This Article argues against further ex post criminal law reforms and posits that efforts should shift to ex ante public health interventions. This Article draws from recent successful experiences with public health interventions in destigmatizing AIDS and denormalizing tobacco and advocates for a robust public health campaign to denormalize rape. It presents a detailed proposal for changing rape messaging, denormalizing rape, and ensuring better outcomes for victims.

Is economic dependence on the husband a risk factor for intimate partner violence against female factory workers in Nepal?

BACKGROUND: Violence related injury is a serious public health issue all over the world. This study aims to assess the association between several socio-economic factors and intimate partner violence (IPV) in Nepal. METHODS: A cross-sectional study was conducted among 236 women working in carpet and garment factories in Kathmandu, Nepal. Interviews were conducted to collect quantitative data on three forms of IPV, namely physical violence, psychological violence and sexual violence, as well as on a number of potentially associated factors. RESULTS: Twenty-two percent of women experienced sexual IPV, 28% physical IPV and 35% psychological IPV at least once in the last 12 months. The variables independently associated with at least one form of IPV were: age of the woman >29 years [OR = 4.23, p = 0.025 for physical IPV; OR = 6.94, p = 0.008 for sexual IPV; OR = 3.42, p = 0.043 for psychological IPV], alcohol consumption of the husband [OR = 9.97, p < 0.001 for physical IPV; OR = 3.76, p = 0.004 for sexual IPV; OR = 4.85, p < 0.001 for psychological IPV], education of the husband above primary level [OR = 0.43, p = 0.013 for physical IPV; OR = 0.51, p = 0.033 for psychological IPV], and economic dependency of the woman on the husband [OR = 3.04, p = 0.021 for physical IPV; OR = 2.97, p = 0.008 for psychological IPV]. CONCLUSIONS: This study identified various factors associated with IPV and showed that economic dependence of wives on their husband was among the most important ones. Thus, for the prevention of IPV against women, long term strategies aiming at livelihood and economic empowerment as well as independence of women would be suggested.

Economic Insecurity and Intimate Partner and Sexual Violence Victimization.

INTRODUCTION: Previous research has consistently found that low SES is associated with higher levels of both intimate partner violence (IPV) and sexual violence (SV) victimization. Though associated with poverty, two indicators of economic insecurity, food and housing insecurity, have been identified as conceptually distinct social determinants of health. This study examined the relationship between food and housing insecurity experienced in the preceding 12 months and IPV and SV victimization experienced in the preceding 12 months, after controlling for SES and other demographic variables. METHODS: Data were from the 2010 National Intimate Partner and Sexual Violence Survey, a nationally representative telephone survey of U.S. adults. In 2016, multivariate logistic regression modeling was used to examine the association between food and housing insecurity and multiple forms of IPV and SV victimization. RESULTS: Robust associations were found between food and housing insecurity experienced in the preceding 12 months and IPV and SV experienced in the preceding 12 months, for women and men, even after controlling for age, family income, race/ethnicity, education, and marital status. CONCLUSIONS: Food and housing insecurity may be important considerations for the prevention of SV and IPV or the reductions of their consequences, although future research is needed to disentangle the direction of the association. Strategies aimed at buffering economic insecurity may reduce vulnerability to IPV and SV victimization.

[Risk and Protective Factors Among Sexual Offenders: Relapse Prediction and Changes During Treatment]. / Risiko- und Schutzfaktoren bei sexualdelinquent gewordenen Menschen: Vorhersage erneuter Straftaten und Veränderungen im Behandlungsverlauf.

OBJECTIVE: Investigation of two questions: first, whether sexual/forensic therapists are able to make valid assessments for future criminal behavior and second, whether their treatment changes factors relevant for new offences. METHODS: First, the predictive validity for recidivism of HCR-20 and SAPROF were tested. Second, the dynamic scales of both instruments were analyzed concerning changes during treatment process. RESULTS: Both instruments showed good predictive validity. The dynamic scales scores of HCR-20 did not change, whereas the I- and M-scale scores of SAPROF increased statistically significant. CONCLUSION: The therapists were able to identify high-risk clients and seemed to mainly focus their interventions towards factors associated with new offences.

Economic impact of multisystemic therapy with juvenile sexual offenders.

This study investigated the economics of multisystemic therapy for problem sexual behaviors (MST-PSB), a family-based treatment that has shown promise with juvenile sexual offenders. We evaluated the cost and benefits of MST-PSB versus usual community services using arrest data obtained in an 8.9-year follow-up from a randomized clinical trial with 48 juvenile sexual offenders, who averaged 22.9 years of age at follow-up (Borduin, Schaeffer, & Heiblum, 2009). The net benefit of MST-PSB over usual community services was calculated in terms of (a) the value to taxpayers, which was based on measures of criminal justice system expenses (e.g., police and sheriff's offices, court processing, community supervision); and (b) the value to crime victims, which was based on measures of both tangible (e.g., property damage and loss, health care, lost productivity) and intangible (e.g., pain, suffering, reduced quality of life) losses. Lower rates of posttreatment arrests in the MST-PSB versus usual community services conditions were associated with lasting reductions in expenses for both taxpayers and crime victims, with an estimated total benefit of $343,455 per MST-PSB participant. Stated differently, every dollar spent on MST-PSB recovered $48.81 in savings to taxpayers and crime victims over the 8.9-year follow-up. These findings demonstrate that a family-based treatment such as MST-PSB can produce lasting economic benefits with juvenile sexual offenders. Policymakers and public service agencies should consider these findings when making decisions about interventions for this challenging clinical population.

Reducing sexual violence by increasing the supply of toilets in Khayelitsha, South Africa: a mathematical model.

BACKGROUND: Sexual violence is a major public health issue, affecting 35% of women worldwide. Major risk factors for sexual assault include inadequate indoor sanitation and the need to travel to outdoor toilet facilities. We estimated how increasing the number of toilets in an urban township (Khayelitsha, South Africa) might reduce both economic costs and the incidence and social burden of sexual assault. METHODS: We developed a mathematical model that links risk of sexual assault to the number of sanitation facilities and the time a woman must spend walking to a toilet. We defined a composite societal cost function, comprising both the burden of sexual assault and the costs of installing and maintaining public chemical toilets. By expressing total social costs as a function of the number of available toilets, we were able to identify an optimal (i.e., cost-minimizing) social investment in toilet facilities. FINDINGS: There are currently an estimated 5600 toilets in Khayelitsha. This results in 635 sexual assaults and US$40 million in combined social costs each year. Increasing the number of toilets to 11300 would minimize total costs ($35 million) and reduce sexual assaults to 446. Higher toilet installation and maintenance costs would be more than offset by lower sexual assault costs. Probabilistic sensitivity analysis shows that the optimal number of toilets exceeds the original allocation of toilets in the township in over 80% of the 5000 iterations of the model. INTERPRETATION: Improving access to sanitation facilities in urban settlements will simultaneously reduce the incidence of sexual assaults and overall cost to society. Since our analysis ignores the many additional health benefits of improving sanitation in resource-constrained urban areas (e.g., potential reductions in waterborne infectious diseases), the optimal number of toilets identified here should be interpreted as conservative.

Addressing intimate partner violence and sexual violence among adolescents: emerging evidence of effectiveness.

Intimate partner violence (IPV) and sexual violence (SV) are widespread among adolescents and place them on a lifelong trajectory of violence, either as victims or perpetrators. The aim of this review was to identify effective approaches to prevent adolescent IPV and SV and to identify critical knowledge gaps. The interventions reviewed in this article reflect the global focus on interventions addressing violence perpetrated by men against women in the context of heterosexual relationships. Interventions for girls and boys (10-19 years) were identified through electronic searches for peer-reviewed and gray literature such as reports and research briefs. Studies were excluded if they were published before 1990 or did not disaggregate participants and results by age. Programs were classified as "effective," "emerging," "ineffective," or "unclear" based on the strength of evidence, generalizability of results to developing country settings, and replication beyond the initial pilot. Programs were considered "effective" if they were evaluated with well-designed studies, which controlled for threats to validity through randomization of participants. A review of 142 articles and documents yielded 61 interventions, which aimed to prevent IPV and SV among adolescents. These were categorized as "parenting" (n = 8), "targeted interventions for children and adolescents subjected to maltreatment" (n = 3), "school based" (n = 31; including 10 interventions to prevent sexual assault among university students), "community based" (n = 16), and "economic empowerment" (n = 2). The rigor of the evaluations varies greatly. A good number have relatively weak research designs, short follow-up periods, and low or unreported retention rates. Overall, there is a lack of robust standardized measures for behavioral outcomes. Three promising approaches emerge. First, school-based dating violence interventions show considerable success. However, they have only been implemented in high-income countries and should be adapted and evaluated in other settings. Second, community-based interventions to form gender equitable attitudes among boys and girls have successfully prevented IPV or SV. Third, evidence suggests that parenting interventions and interventions with children and adolescents subjected to maltreatment hold promise in preventing IPV or SV by addressing child maltreatment, which is a risk factor for later perpetration or experience of IPV or SV. Results suggest that programs with longer term investments and repeated exposure to ideas delivered in different settings over time have better results than single awareness-raising or discussion sessions. However, lack of rigorous evidence limits conclusions regarding the effectiveness of adolescent IPV and SV prevention programs and indicates a need for more robust evaluation.

Distressed communities as a breeding ground for noncommunicable conditions.

Recent research has driven home the close relationship between place and health. Geography is often a greater driver of adolescent morbidity and mortality than behavior. To elucidate these relationships, the Well-Being of Adolescents in Vulnerable Environments study has collected and analyzed data on the health and well-being of adolescents' lowest income communities of five cities: Baltimore, United States; Ibadan, Nigeria; Johannesburg, South Africa; New Delhi, India; and Shanghai, China.

Prevalence and Health Impact of Intimate Partner Violence and Non-partner Sexual Violence Among Female Adolescents Aged 15-19 Years in Vulnerable Urban Environments: A Multi-Country Study.

PURPOSE: Globally, adolescent women are at risk for gender-based violence (GBV) including sexual violence and intimate partner violence (IPV). Those in economically distressed settings are considered uniquely vulnerable. METHODS: Female adolescents aged 15-19 from Baltimore, Maryland, USA; New Delhi, India; Ibadan, Nigeria; Johannesburg, South Africa; and Shanghai, China (n = 1,112) were recruited via respondent-driven sampling to participate in a cross-sectional survey. We describe the prevalence of past-year physical and sexual IPV, and lifetime and past-year non-partner sexual violence. Logistic regression models evaluated associations of GBV with substance use, sexual and reproductive health, mental health, and self-rated health. RESULTS: Among ever-partnered women, past-year IPV prevalence ranged from 10.2% in Shanghai to 36.6% in Johannesburg. Lifetime non-partner sexual violence ranged from 1.2% in Shanghai to 12.6% in Johannesburg. Where sufficient cases allowed additional analyses (Baltimore and Johannesburg), both IPV and non-partner sexual violence were associated with poor health across domains of substance use, sexual and reproductive health, mental health, and self-rated health; associations varied across study sites. CONCLUSIONS: Significant heterogeneity was observed in the prevalence of IPV and non-partner sexual violence among adolescent women in economically distressed urban settings, with upwards of 25% of ever-partnered women experiencing past-year IPV in Baltimore, Ibadan, and Johannesburg, and more than 10% of adolescent women in Baltimore and Johannesburg reporting non-partner sexual violence. Findings affirm the negative health influence of GBV even in disadvantaged urban settings that present a range of competing health threats. A multisectoral response is needed to prevent GBV against young women, mitigate its health impact, and hold perpetrators accountable.

The role of sexual violence in creating and maintaining economic insecurity among asset-poor women of color.

This article argues that economic instability and sexual violence reinforce each other in two ways. First, the devastating psychological consequences of sexual assault can diminish work performance and disrupt income, creating economic instability, particularly for the asset-poor. Latina and African American women face particular risk due to barriers to appropriate post-assault resources and low rates of asset ownership. Second, income- and asset poverty increase women's risk for sexual violence and complicate recovery. Women with financial and social resources can leverage these assets to both avoid and recover from sexual assault, whereas women without such resources lack these options. Policy solutions are proposed.

Incidence and cost of sexual violence in Iowa.

BACKGROUND: Sexual violence is a serious and costly public health problem. Current research that systematically documents the broad range of economic costs of sexual violence is lacking. PURPOSE: To estimate the incidence and costs of sexual violence in Iowa in 2009. METHODS: Using data obtained from population surveys, six Iowa government agencies, and other sources, we estimated sexual violence incidence, costs per incident, and total costs in 2009 dollars, by age and sexual violence category, and for various cost elements. We calculated direct costs of medical care, mental health care, property damage, victim services, investigation, adjudication, and sanctioning, as well as indirect costs for lost work and quality of life. We collected data in 2010-2011 and completed analysis in 2013. RESULTS: In 2009, an estimated 55,340 individuals experienced sexual violence in Iowa, including 49,510 adults and 5,930 children. Nearly three of every four victims were women. The estimated total cost of sexual violence in 2009 was $4.7 billion, equating to $1,580 per resident. This estimate included $4.44 billion in indirect costs and $265 million in direct costs. In the same year, the government spent an estimated $100.6 million as a result of sexual violence in Iowa, more than half of which ($55.3 million) was spent on perpetrators and little ($0.9 million) on prevention. CONCLUSIONS: The economic costs of sexual violence are high for individuals and society. Cost information can help identify the burden of sexual violence relative to other social problems in Iowa and prioritize funding for prevention and intervention.

A U.K. cost-benefit analysis of circles of support and accountability interventions.

Circles of Support and Accountability (CoSA) aim to augment sex offender risk management at the point of community reentry by facilitating "Circles" of volunteers who provide support, guidance, and advice, while ensuring that the offender remains accountable for their actions. In this study, the authors provide (a) a rapid evidence assessment of the effectiveness of CoSA in reducing reoffending, and (b) a U.K. cost-benefit analysis for CoSA when compared to the criminal justice costs of reoffending. From the study analysis, the average cost of a "Circle" was estimated to be £11,303 per annum and appears to produce a 50% reduction in reoffending (sexual and nonsexual), as the estimated cost of reoffending was estimated to be £147,161 per offender, per annum. Based on a hypothetical cohort of 100 offenders--50 of whom receive CoSA and 50 of whom do not--investment in CoSA appears to provide a cost saving of £23,494 and a benefit-cost ratio of 1.04. Accounting for estimates that the full extent of the cost to society may be 5 to 10 times the tangible costs substantially increases estimated cost savings related to CoSA.

Mental health and poverty in the inner city.

Rapid urbanization globally threatens to increase the risk to mental health and requires a rethinking of the relationship between urban poverty and mental health. The aim of this article is to reveal the cyclic nature of this relationship: Concentrated urban poverty cultivates mental illness, while the resulting mental illness reinforces poverty. The authors used theories about social disorganization and crime to explore the mechanisms through which the urban environment can contribute to mental health problems. They present some data on crime, substance abuse, and social control to support their claim that mental illness reinforces poverty. The authors argue that, to interrupt this cycle and improve outcomes, social workers and policymakers must work together to implement a comprehensive mental health care system that emphasizes prevention, reaches young people, crosses traditional health care provision boundaries, and involves the entire community to break this cycle and improve the outcomes of those living in urban poverty.

Cost per incident of alcohol-related crime in New South Wales.

INTRODUCTION AND AIMS: The purpose of this paper is to provide a per incident of crime cost measure for New South Wales that is suitable for the use within cost-effectiveness studies of interventions aimed at reducing the burden of alcohol. This paper seeks to quantify the individual cost of an assault, property damage, sexual offence and disorderly conduct in New South Wales. DESIGN AND METHODS: Costs regarding the criminal act, police involvement, prosecution in criminal courts and incarceration are estimated and then using a four-stage probability analysis, the expected cost per incident is calculated. RESULTS: It is found that expected cost per incident for assault, sexual offence, property damage and disorderly conduct (in 2006 dollar values) is $3982, $5976, $1166 and $501 respectively. DISCUSSION AND CONCLUSIONS: A large total cost figure is a powerful policy motivator; however, for the purpose of economic analysis it is often more useful to estimate the per incident cost. This research furthers the existing research on cost of crime estimates and facilitates future cost-effectiveness and other economic analysis of interventions that reduce alcohol-related crime.