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Susan A. Murty, PhD, Corinne Peek-Asa, PhD, Craig Zwerling, MD, PhD, MPH, Ann M. Stromquist, PhD, Leon F. Burmeister, PhD and James A. Merchant, MD, DrPH

Susan A. Murty is with the University of Iowa School of Social Work, Iowa City. Susan A. Murty, Corinne Peek-Asa, Craig Zwerling, Ann M. Stromquist, Leon F. Burmeister, and James A. Merchant are with the University of Iowa Injury Prevention Research Center, Department of Occupational and Environmental Health, Iowa City.

Correspondence: Requests for reprints should be sent to Susan A. Murty, PhD, School of Social Work, 308 North Hall, University of Iowa, Iowa City, IA 52242 (e-mail: susan-murty{at}uiowa.edu).

	INTRODUCTION

TOP INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION References

 
Intimate partner violence exacts an enormous toll each year in the United States, affecting 3% to 5% of adult intimate relationships.^1–3 Compared with urban settings, much less is known about the prevalence and correlates of partner violence in rural areas.^4–6 Rural women are more isolated, have access to fewer services, and face different attitudes and norms than urban women.^5–7

This study examined the prevalence of severe physical abuse, measured by the Conflict Tactics Scale,⁸ and controlling emotional abuse, measured by Yllo’s Controlling Behavior Questions,⁹ as reported by a cohort of cohabiting couples in a rural Iowa county. The objectives were to estimate the prevalence of abuse victimization reported by men and women on each scale and to identify factors associated with violence against men and women.

	MATERIALS AND METHODS

TOP INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION References

 
The study population included members of a prospective cohort study in a rural county. The county, cohort, and overall methods are described elsewhere.¹⁰ Respondents aged 18 and older were asked whether they were currently living with a spouse or partner and, if so, were asked to respond to questions about partner violence. Participants were interviewed in person and without their partner being present. Of the 1633 adult cohort members, 1310 (80.2 %) lived with their partners.

We used 5 items from the Conflict Tactics Scale⁸ to measure severe physically abusive acts perpetrated by the respondent’s partner during the last 12 months. As recommended by Straus,¹¹ these severe abuse items are kicking, hitting with a fist, hitting with some other object, threatening with a knife or gun, and using a knife or gun to harm.

We used Yllo’s Controlling Behavior Questions to assess controlling emotional abuse in the previous 12 months. We used the following items:

1. You felt intimidated and frightened (e.g., by your husband’s/wife’s/partner’s shouting, looks, smashing things).
   
2. You felt isolated by your husband/wife/partner controlling whom you could see or call or where you could go.
   
3. You felt you were treated like a subordinate, like a servant by your husband/wife/partner, making you wait on him or her or making important decisions alone.
   
4. You felt you were made to do sexual things against your will.
   

The Conflict Tactics Scale and the Controlling Behavior Questions were independently coded into dichotomous variables, so that a positive response to any one item indicated the presence of that type of abuse.

Prevalence of abuse measured by each scale was compared by gender, and ² tests of independence were used to determine whether reported abuse varied by age, marital status, education, residence, and farm work. Multivariate logistic regression analysis was conducted to identify factors associated with abuse as measured on each scale independently and to determine whether these differed among men and women. The odds ratios (ORs) should not be interpreted as risk ratios on the Controlling Behavior Questions because emotional abuse was not a rare outcome.

	RESULTS

TOP INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION References

 
Based on the Conflict Tactics Scale, 2.9% of the women and 4.7% of the men reported at least 1 incidence of severe physical violence directed at them by their partners (Table 1) (P = .11). On the Yllo Controlling Behavior Questions, however, 46.7% of the women and 30.2% of the men reported experiencing emotional abuse perpetrated by their partners (P < .001).

For the overall sample, women reported experiencing more controlling emotional abuse from their partners (OR = 1.84; 95% confidence interval [CI] = 1.30, 2.61) (Table 2). Increasing age and being married were protective against both types of victimization for both men and women. Education was unrelated to prevalence of any type of abuse.

	DISCUSSION

TOP INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION References

 
Partner violence is an important public health problem in rural and urban areas. Indicators of abuse in rural populations differ from those in urban areas. Gender appears to be a strong effect modifier for both severe physical and emotional abuse. Women who live outside of towns but not on farms reported more physical abuse than other women. Increased isolation might explain this finding. Women living on farms may have more interaction with others (e.g., farm workers) than women who do not live on farms. In addition, some individuals might choose rural nonfarm areas because of the isolation, and one reason to prefer isolation is to hide abusive behavior.

Men, but not women, who engaged in farm work reported experiencing more abuse than did nonfarmers. This finding has not been reported previously. The strains of farm work on relationships, which include exhausting physical labor, long hours, and financial uncertainty, may lead to increased risk of abuse by women, but this finding needs to be studied further.

Measurements of abuse should include both physical and emotional components. Further study of factors associated with different types of abuse in rural environments will help direct the development and implementation of programs that offer assistance to victims and prevent violent behavior.

	Acknowledgments

 
Support for this project was provided by the Great Plains Center for Agricultural Health (Centers for Disease Control and Prevention/National Institute for Occupational Safety and Health, U07/CCU706145) and the University of Iowa Injury Prevention Research Center (Centers for Disease Control and Prevention/National Center for Injury Prevention and Control, CCR 703640), both housed in the University of Iowa Department of Occupational and Environmental Health.

Human Participant Protection

The Keokuk County Rural Health Cohort Study was approved by the University of Iowa human subjects review board.

	Footnotes

 
Contributors

S. A. Murty developed the study and wrote early drafts of the manuscript. C. Peek-Asa conducted analyses and wrote later drafts of the brief. C. Zwerling participated in the study design, contributed to the oversight of data collection, and reviewed multiple drafts of the brief. A. M. Stromquist supervised data collection, contributed to data interpretation, and reviewed multiple drafts of the brief. L. F. Burmeister contributed to planned data analysis and reviewed multiple drafts of the brief. J. A. Merchant is the Principal Investigator of the Keokuk County Rural Health Study and reviewed multiple drafts of the brief.

Peer Reviewed

Accepted for publication January 2, 2003.

	References

TOP INTRODUCTION MATERIALS AND METHODS RESULTS DISCUSSION References

 
1. Straus MA, Gelles RJ, Steinmetz SK. Behind Closed Doors: Violence in the American Family. Garden City, NJ: Anchor Books; 1980.

2. Straus MA, Gelles RJ. How violent are American families? Estimates from the National Family Violence Resurvey and other studies. In: Hotaling GT, Finkelhor D, Kirkpatrick JT, Straus MA, eds. Family Abuse and Its Consequences: New Directions in Research. Newbury Park, Calif: Sage Publications; 1988:14–36.

3. Straus MA, Smith C. Violence in Hispanic families in the United States: incidence rates and structural interpretations. In: Straus MA, Gelles RJ, eds. Physical Violence in American Families: Risk Factors and Adaptations to Violence in 8145 Families. New Brunswick, NJ: Transaction Books; 1990:341–367.

4. Johnson M, Elliott BA. Domestic violence among family practice patients in midsized and rural communities. J Fam Pract. 1997;44:391–400.[ISI][Medline]

5. Goeckermann CR, Hamberger LK, Barber K. Issues of domestic violence unique to rural areas. Wisc Med J. 1994;93:473–479.

6. Kershner M, Anderson JE. Barriers to disclosure of abuse among rural women. Minn Med. 2002;85:32–37.

7. Van Hightower NR, Gorton J. Domestic violence among patients at two rural health care clinics: prevalence and social correlates. Public Health Nurs. 1998;15:355–362.[ISI][Medline]

8. Straus MA. Measuring intrafamily conflict and violence: the Conflict Tactics (CT) Scale. J Marriage Fam.1979;41:74–85.

9. Yllo K. Political and methodological debates in wife abuse research. In: Yllo K, Bograd M, eds. Feminist Perspectives on Wife Abuse Research. Newbury Park, Calif: Sage Publications; 1990:28–50.

10. Merchant JA, Stromquist AM, Kelly KM, Zwerling C, Reynolds SJ, Burmeister LF. Chronic disease and injury in an agricultural county: the Keokuk County Rural Health Cohort Study. J Rural Health. 2002;18:521–535.[ISI][Medline]

11. Straus MA. Measuring intrafamily conflict and violence: the Conflict Tactics (CT) Scales. In: Straus MA, Gelles RJ, eds. Physical Violence in American Families: Risk Factors and Adaptations to Violence in 8145 Families. New Brunswick, NJ: Transaction Books; 1990:29–47.

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This Article Extract Full Text (PDF) Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (6) Citing Articles via Google Scholar Google Scholar Articles by Murty, S. A. Articles by Merchant, J. A. Search for Related Content PubMed PubMed Citation Articles by Murty, S. A. Articles by Merchant, J. A. Related Collections Injury/Emergency Care/Violence Rural Health