18.

Violence and Minority Women

Violence against women affects all racial, cultural, and economic backgrounds. It is a leading cause of injury for American women between the ages of 15 and 54, but it can happen at any age. Acts of violence have terrible and costly results for everyone involved, including families, communities, and society. Violence can take several forms including domestic or intimate partner violence, sexual assault and abuse, dating violence, and elder abuse.

• Intimate partner violence, or domestic violence, is when one person purposely
causes either physical or psychological harm to another, including physical abuse,
psychological/emotional abuse, sexual assault, isolation, or economic abuse.

• Sexual assault is any type of sexual activity you do not agree to, including
   inappropriate touching, vaginal penetration, sexual intercourse, rape, attempted
   rape, and child molestation. Sexual assault and abuse can also be verbal, visual,
   or any other form which forces a person to participate in unwanted sexual contact
   or attention.

• Dating violence is when one person purposely causes physical or psychological harm
to another person they are dating, including sexual assault, physical abuse, and
psychological/emotional abuse.

• Elder abuse is when older persons are abused, neglected, and exploited by family
   members and others. The National Institute of Justice and Centers for Disease Control
   and Prevention (CDC) sponsored the National Violence Against Women Survey. The
   report had the following conclusions:

• American Indian/Alaska Native women were more likely than white women or African
American women to report they were raped or stalked.

• American Indian/Alaska Natives are at a greater risk of being victims of violence than
other Americans.

• Only a small number of Asian American women report rape and stalking. It has been
suggested that traditional Asian values may discourage Asian women from reporting
violence, especially by intimate partners.

• Hispanic women are less likely to report being raped.

If you’re a victim of violence at the hands of someone you know or love, or you are recovering from an assault by a stranger, you are not alone. To get immediate help and support, call the National Domestic Violence Hotline at 800-799-SAFE (7233) or 800-787-3224 (TTY).

v Screening for Abuse in Spanish-Speaking Women

By Colleen T. Fogarty, MD, Judity Beele Brown, PhD

Intimate partner violence has been determined to be a major public health concern, contributing to poor physical and mental health in affected persons, primarily women. Because of documented poor detection rates of domestic violence by physicians, the medical community has focused increasing attention on recognizing and providing treatment for victims in various contexts, including emergency department and outpatient practice settings. Several instruments have been developed to increase physicians' ability to detect violence. Four of these instruments have been validated in English.

Studies suggest that partner violence occurs in women of all socioeconomic and educational attainment, in all types of communities, and among different ethnic groups and nations. Despite the knowledge that violence occurs in all communities, there is relatively little published research about domestic violence among diverse ethnic groups and among economically disadvantaged communities.

Some research is available on Hispanic women's experience of domestic violence. Torres' shelter-based study of Mexican-American women^[31] found no difference in the types of abuse experienced compared with Anglo-American women, but Mexican-American women viewed certain types of emotional abuse as less abusive than did Anglo-American women. In addition, this study found that the Mexican-American women stayed in abusive relationships longer. Another study showed a trend toward abused Hispanic women reporting abuse less frequently to law enforcement agencies or seeking medical attention less often compared with abused Anglo-American women. In several studies of rural Spanish-speaking women, no statistically significant difference in types of abuse was found between Anglo-American and Hispanic respondents, although there was a slight trend toward more physical abuse among the Hispanic women.

Some authors have addressed cultural factors that might contribute to violence, but few articles have addressed the unique problems of exposing violence among non-English speakers. Recent research conducted from the patient perspective has described factors making an abused woman more or less likely to disclose abuse to a health care professional. Patients in these studies stated they would be more able to disclose abuse if asked directly and in a manner that communicated respect, compassion, and belief. A qualitative study including abused Latino and Asian immigrant women reflected similar findings.

The barriers experienced by both physicians and patients in addressing domestic violence are considerable, and questionnaires that can be used by health care providers for routine screening could help clinicians inquire more routinely about violence in their patients’ lives. To date, efforts have focused on developing tools for English-speaking patients; to our knowledge, no one has validated instruments in languages other than English. Below is a translated version of the screening tool developed for and studied with English-speaking women that will be useful for screening women from non-English-speaking or ethnic minority groups.

Women Abuse Screening Tool

Pruebas De La Violencia Contra La Mujer

1. In general, how would you describe your releationship?

En general, como describiria usted su relación con su pareja?

o A lot of tension o Some Tension o No tension

o Mucho tensión o Alguna tensión o Sin tensión

2. Do you and your partner work out arguments with:

Usted y su pareja resuelven sus discusiones (argumentos) con:

o Great Difficulty o Some difficulty o No difficulty

o Mucha dificultad o Alguna dificultad o Sin dificultad

3. Do arguments ever result in you feeling down or bad about yourself?

Al terminar las discusiones usted se siente decalda o mal con usted misma?

o Often o Sometimes o Never