A Fundamental Cause Approach to Intimate Partner Violence in Marginalized Populations

Intimate Partner Violence (IPV) is a serious public health concern that transcends partnership types and societies, affecting approximately one-third of women worldwide. Men in same-sex relationships likely experience violence at similar rates. This dissertation takes a fundamental cause approach to social-ecological and minority stress theories, arguing that structural forces are the root causes of violence in two target populations: women residing in low- and middle-income countries (LMIC) and Indigenous men who have sex with men (MSM) in the United States. Consisting of eight chapters, four of which are empirical studies, this body of work creates new knowledge surrounding how social scripts, environments of stigma, and contexts of inequality shape the risk for IPV in marginalized populations. Chapter 4 uses the Demographic and Health Surveys (DHS) fieldworker dataset to test for interviewer bias in the DHS Domestic Violence Module. Multilevel modeling was used to test associations between three types of IPV and socio-demographic interviewer characteristics. Previous experience as a DHS interviewer was associated with significantly lower odds (aOR: 0.67) of reporting physical IPV. In addition to highlighting a potential source of bias, this paper argues for the expanded use of the fieldworker survey to control for potential interviewer bias in the DHS. Chapter 5 studies how individual deviation from community norms shapes the risk for sexual IPV in 32 low- and middle-income countries (LMIC). Using a positive deviance approach, this analysis seeks to better understand how transcending community norms alters the risk for violence, and how this relationship changes across six structural contexts fundamental to IPV. Positive deviance is associated with both increased and decreased odds of reporting sexual IPV and the nature of these relationships vary by structural environment. Lessons from this paper may highlight pathways for future interventions to change restrictive social scripts and increase women’s social capital while avoiding an unintended increase in violence. Chapter 6 represents the first nationwide study of IPV in Indigenous MSM, a population experiencing multiple structural vulnerabilities. A 30-minute online survey consisting of instruments previously validated in LGBT or Indigenous communities was targeted to Indigenous MSM using social media algorithms. Logistic regression models were fit to calculate adjusted associations between race- and sexuality-based structural stressors, theory-derived points of resiliency, and lifetime experience of physical, sexual, and emotional IPV. Results suggest that Indigenous MSM experience high levels of IPV, and that structural stressors play a significant role as antecedents of violence Chapter 7 uses a birth cohort analysis of 25 Demographic and Health Surveys (DHS) to examine whether the socio-political environments in which a woman forms her attitudes around IPV influences its reporting, and whether this cohort effect varies by rate of decline in gender inequality. Results suggest a birth cohort effect is present in physical IPV, sexual IPV, and the justification of IPV across the 25 countries, with women reporting less IPV with each successive cohort. This effect wanes as the rate of gender inequality decline slows. Chapter 8 provides summary, conclusions, and recommendations for future work to mitigate and prevent IPV in LMIC women and Indigenous MSM.PHDNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/149983/1/metheny_1.pd

Brief intervention to prevent sexually transmitted infections and unintended pregnancies : protocol of a mixed methods feasibility study

Background: Sexual well-being is fundamental to physical and emotional health, and the ability to achieve it depends on access to comprehensive sexuality information and high-quality sexual health care from evidence-informed, nonjudgmental providers. Adequate and timely delivery of these components to individuals who are at high risk for sexually transmitted infections (STIs), including HIV, and unintended pregnancies promotes sexual health and mitigates consequences arising from risky sexual behavior. Brief interventions that allow health care providers to improve the information available to clients and motivate and help them to develop risk-reduction skills are seen as efficient ways to improve knowledge, change client behavior, and reduce provider stigma regarding sexual health. Objective: The aim of the study is to evaluate five aspects of feasibility (acceptability, willingness, safety, satisfaction, and process) of a brief sexuality-related communication (BSC) intervention based on motivational interviewing and behavior change techniques in primary health care settings in low- and middle-income countries (LMICs). Methods: This protocol outlines a multisite, multiphase study of feasibility of a BSC intervention in primary health care settings in LMICs that will be examined across four phases of the study. Phases I through III involve the collection of formative, qualitative data to examine provider and client perceptions of the feasibility of the intervention, adaptation of the intervention guide, and training providers on how to implement the final version of the BSC intervention. During phase IV, the feasibility of the intervention will be tested in a nonrandomized pre-post test trial where providers and clients will be followed for 6 months and participate in multiphase data collection. Results: Phase I is currently underway in Moldova, and phases I and II were completed in Peru in late 2019. Results are expected for the feasibility study in 2021. Conclusions: This feasibility study will determine whether the implementation of brief intervention programs aimed at improving sexual health outcomes is possible in the constraints of LMIC health systems and will add to our understanding of factors shaping clinical practice among primary care providers

Track D Social Science, Human Rights and Political Science

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138414/1/jia218442.pd

Protocol for a Systematic Review of Intimate Partner Violence Prevalence among Gay and Bisexual Men who have Sex with Men

This update review spans the years 2012-2021 and seeks to understand the state of the science regarding the prevalence and measurement of IPV among sexual minority men globall

6 Applying a positive deviance framework to the prevention of sexual intimate partner violence in 30 low- and middle-income countries

Statement of purposeThis study examines whether positive deviance to specific community norms is associated with experiences of sexual intimate partner violence (IPV) among women in 30 low- and middle-income countries.Methods/approachPositive deviants are individuals who transcend community norms and obtain better health outcomes than their peers with similar resources. In the first-ever application of positive deviance to IPV, this analysis used 30 nationally-representative Demographic and Health Surveys (DHS) completed in 2010 or later and containing a domestic violence module. Currently-married women ages 15–49 interviewed as part of the domestic violence module (n=350,794) were included. Respondents indicated their husbands ever committed sexual IPV, creating a binary outcome. Twelve theory-derived variables were created and aggregated to the Primary Sampling Unit (PSU) to create community-level norms. Multilevel modelling was used to examine the association between positive departure from community-level norms and individual experiences of sexual IPV. Subsequent analyses stratified countries by IPV prevalence and score on the Gender Inequality Index (GII).ResultsResults show positive deviance from at least one community-level norm was significantly associated with not reporting IPV in all 30 countries. These effects vary considerably by country, country-level IPV prevalence, and GII score.ConclusionsPositive deviance to certain community norms is associated with not experiencing sexual IPV among women across low- and middle-income countries. The increased normativity of abuse in countries with higher scores on the GII and higher rates of IPV may explain the stronger association between positive deviance and sexual IPV in these contexts.Significance/Contribution to Injury and Violence Prevention ScienceThis study is the first to apply positive deviance to the study of IPV and identifies factors that may be used for the primary prevention of IPV. The social proof that these are already adopted by some members of a community indicate scale-up may be possible

Family support modifies the effect of changes to same-sex marriage legislation on LGB mental health: evidence from a UK cohort study

Many lesbian, gay and bisexual (LGB) individuals continue to experience unique challenges, such as the lack of family support and access to same-sex marriage. This study examines the effect of the introduction of same-sex marriage in the UK (2013-14) on mental health functioning among sexual minorities, and investigates whether low family support may hamper the positive effects of marriage equality legislation among LGB individuals. This analysis included LGB participants (n = 2172) from the UK household longitudinal study waves 3-7, comprising two waves before and two waves after marriage equality legislation passed in England, Wales and Scotland. Individual-level mental health functioning was measured using the mental component score (MCS-12) of the Short Form-12 survey. Fixed-effect panel linear models examined the effect of marriage equality on MCS-12 across varying family support levels. Analyses included adjustment for covariates and survey weights. Legalization of same-sex marriage was independently associated with an increase of 1.17 [95% confidence interval (CI): 0.28-2.05] MCS-12 in men and 1.13 (95% CI: 0.47-2.27) MCS-12 in women. For men, each additional standard deviation of family support modified the effect of legalization on mental health functioning by +0.70 (95% CI: 0.22-1.18) MCS-12 score. No interaction was found in women. Our findings provide evidence that same-sex marriage will likely improve LGB mental health functioning, and these effects may be generalizable to other European countries. Since male sexual minorities with low family support benefited the least, additional interventions aimed at improving family support and acceptance of this group is required to help reduce mental health disparities