To assess the association between IPV and the outcomes of perceived emotional support, life satisfaction, and health status among women aged 18 years and over in the U.S., data from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey were analyzed. BRFSS is a state-based, cross-sectional survey designed to measure behavioral risk factors within the adult population of those ages 18 years and older(24). BRFSS data are collected via telephone in 50 states. Though 13 years have passed since the data was collected, this survey in 2007 contains the most recent module on IPV that covered across states in the United States.
Participants are asked a series of questions from the core component of the questionnaire, and some from the optional modules(24). BRFSS selects individuals randomly by dialing household telephone numbers and interviews only one participant per household(24). To evaluate the primary independent variable, for the current study, the Intimate Partner Violence Module was used. The optional module has been applied to the states of Hawaii, Virginia, and West Virginia, and that the analysis depicted only three states where the IPV module was included.
All measures were based on self-reported data obtained from the 2007 BRFSS, which is the latest BRFSS study that included an IPV module. IPV is measured by the following questions:
Intimate partner violence (IPV)
“Has an intimate partner ever threatened you with physical violence? This includes threatening to hit, slap, push, kick, or hurt you in any way.”
“Has an intimate partner ever attempted physical violence against you? This includes times when they tried to hit, slap, push, kick, or otherwise hurt you, but they were not able to.”
“Has an intimate partner ever hit, slapped, pushed, kicked, or hurt you in any way?”
“In the past 12 months, have you experienced any physical violence or had unwanted sex with an intimate partner?”
The first three questions do not have a specific timeframe for the IPV experience, while the last question about unwanted sex is constrained with any experiences that occurred in the past 12 months. The following variables were used to correlate the association with IPV.
Emotional support is measured with the following question ‘How often do you get the social and emotional support you need?’ and participants responded with an ordinal level of measurement, ranging from “always”, “usually”, “sometimes”, “rarely”, “never”, “don’t know”, “not sure”, and “refused”. We collapsed the responses from five to three levels, using only “always”, “sometimes” and “rarely” for a better fit with our analysis.
Life satisfaction is measured with the following question ‘In general, how satisfied are you with your life?’ Participants responded from “very satisfied”, “satisfied”, “dissatisfied”, “very dissatisfied”, “don’t know”, “not sure”, and “refused”. We collapsed the responses from four to two levels, as “satisfied” and “dissatisfied” as a dichotomous variable.
Perceived general health status is measured with the following question ‘Would you say that in general, your health status is?’ The response options were “excellent”, “very good”, “good”, “fair” and “poor”
Perceived physical health, mental health, and poor health are measured by the following questions with the response options “__number of days”, “none”, “don’t know/not sure”, or “refused”. The items measured in days were classified as “none”, “1-5 days” or “6 days or more” in a month.
‘Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?
‘Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?’
‘During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?’ Additional covariates considered were race, education, employment, income, and age.
Univariate analyses were used to describe the frequency and proportion of selected characteristics (i.e. demographics variables). Bivariate analyses were conducted with chi-square tests for nominal data to assess the association between perceived emotional support, life satisfaction, unhealthy days, sociodemographic factors, and IPV. Multivariable logistic regression analyses were used to estimate adjusted odds ratios (ORs) and 95% confidence interval (CIs) for factors associated with IPV. Ordinal logistic regression analysis was initially used to examine the relationship of IPV variables to each of the ordinally scaled variables. Since the proportional odds assumption is not satisfied, the continuation ratio approach was used to obtain the ORs and CIs for each transition of the choices in the variable. Bivariate and multivariable analyses excluded persons with responses that were missing or recorded as “don’t know/not sure” or “refused”. With the large sample size in the dataset, and the IPV module is not compulsory for participants, it is anticipated that the missing data are at random. We used hot deck imputation to address the missing variables, which calculated the average score on an identified outcome variable by matching the score of other variables in the sample (i.e., donor variables). We used participants’ gender, education level, and race as the donor variables. Hot deck imputation provides less bias compared to mean imputation and is deemed as a better overall solution than the listwise deletion(25). A 2-sided p-value of <.05 was considered to indicate statistical significance. Race, education, and employment were used as covariates for all dependent variables, while income and age were added exclusively for perceived health outcomes including physical, mental, and poor health. Analyses were conducted using SPSS version 25.
Demographics showed a sample size of n=19,102 with the mean age of 48.32 for those with IPV experience, while 53.87 is the mean age for those without any IPV experience. 3,240 (16.9%) participants indicated with an IPV experience in their lifetime. Women (n=11665; 61%) comprised the majority of the sample. The sample included white (n=13,490; 78.6%) and non-white persons (n=3,681; 21.4%). Majority of the participants graduated from high school or had some high school education (n= 7,650; 41.1%), followed by college or more (n=6,339; 33.2%), and college 1-3 years (n=5,089; 26.7%) as shown in Table 1.