Addictive Behaviors 33 (2008) 12441248

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Addictive Behaviors

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The longitudinal association between alcohol use and intimate partner violence among ethnically diverse community women
Jeff R. Temple a,, Rebecca Weston b,1, Gregory L. Stuart c,2, Linda L. Marshall d,3
a b c d

University of Texas Medical Branch, Department of Obstetrics & Gynecology, 301 University Blvd., Galveston, TX 77555-0587, United States Southern Illinois University, Department of Psychology, Mailcode 6502, Carbondale, IL 62901, United States University of Tennessee, Knoxville, Department of Psychology, Austin Peay Building, University of Tennessee, Knoxville, TN 37996, United States University of North Texas, Department of Psychology, P.O. Box 311280, Denton, TX 76203-1280, United States

a r t i c l e

i n f o

a b s t r a c t
Research has consistently demonstrated a strong link between substance misuse and the perpetration of intimate partner violence (IPV). However, studies examining whether substance misuse is associated with IPV victimization have been mixed. Using data collected from 835 low-income ethnically diverse community women, this study extends previous research by utilizing a longitudinal design, considering men's and women's alcohol use, and examining multiple forms of abuse. Despite overall decreases in drinking and abuse, the frequency of male partners' drinking continued to be associated with their perpetration of threats, violence, and sexual aggression. Women's alcohol use frequency was associated with sustaining physical violence, but not threats of violence or sexual aggression. 2008 Elsevier Ltd. All rights reserved.

Keywords: Intimate partner violence Alcohol use Longitudinal design

Over the past three decades and across a variety of samples, research has documented a strong relationship between the use and abuse of alcohol and the occurrence, frequency, and severity of intimate partner violence (IPV). For example, in samples of men mandated to receive partner violence treatment, approximately 40% met diagnostic criteria for alcohol abuse or dependence (FalsStewart, 2003; Stuart, Moore, Kahler, & Ramsey, 2003), which represents over four times the rate found in the general population (Grant et al., 2004). Although not as well understood as and less pronounced than the link between alcohol use and IPV perpetration, research also indicates a possible relationship between alcohol use and IPV victimization. For example, in a large household community survey, Caetano, Cunradi, Clark, and Schafer (2000) found that women who self-reported as heavy drinkers were more likely to be victims of IPV than were their less heavy-drinking counterparts, particularly when the women were of African American or Hispanic descent. Chase, O'Farrell, Murphy, Fals-Stewart, and Murphy (2003) found that 64% of female alcohol patients reported experiencing IPV victimization. In fact, 22% of their sample reported experiencing severe violence, which is over 5 times the rate found in the general population (Straus & Gelles, 1990). The current study extends previous research by examining the relationship between partners' use of threats, violence, and sexual aggression and men's and women's use of alcohol. Additionally, the use of a longitudinal design allows us to better determine the course of the association between IPV and alcohol.

Corresponding author. Tel.: +1 409 747 8560; fax: +1 409 747 5129. E-mail addresses: jetemple@utmb.edu (J.R. Temple), Weston@siu.edu (R. Weston), Gregory_Stuart@Brown.edu (G.L. Stuart), psychair@unt.edu (L.L. Marshall). 1 Tel.: +1 681 453 3535; fax: +1 618 453 3563. 2 Tel.: +1 401 455 6313; fax: +1 401 455 6546. 3 Tel.: +1 940 565 4329; fax: +1 940 565 4682. 0306-4603/$ see front matter 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2008.05.005

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1. Methods 1.1. Procedures and participants The data are from Waves 1, 2, 3, 5, and 6 of Project HOW: Health Outcomes of Women (Temple, Weston, & Marshall, 2005). The initial sample consisted of 835 women who self-identied as African American (n = 302), Euro-American (n = 273), or Mexican American (n = 260). On average, women were 33.3 years old and in relationships for 7.7 years at Wave 1. More than half of the original sample (N = 509, 61.0%) completed all ve interviews. Time between interviews averaged approximately one year (M = 11.26 months). Although a long-term relationship was a requirement for Wave 1 participation, over half of the nal sample (n = 287, 56.4%) were no longer with their Wave 1 partner by Wave 6. 1.2. Measures The Severity of Violence Against Women Scale (SVAWS; Marshall, 1992) measured partners' threats of violence (20 items), physical violence (20 items), and sexual aggression (6 items). Women also reported on the frequency of their own and their partners' alcohol consumption on a 12-point scale ranging from never to almost daily. Because the continuous data were not normally distributed, four groups were created to reect the frequency of women's (and partners') alcohol use. Women drank negligibly (never drinking at Wave 1, but drinking at least once at some point thereafter, n = 236, 46.4%), rarely (drinking less than monthly at Wave 1, n = 159, 31.2%), occasionally (drinking at least monthly at Wave 1 but not more than once per week, n = 79, 15.5%), and often (drinking more than once per week at Wave 1, n = 35, 6.9%). Partners drank negligibly (n = 140, 27.6%), rarely (n = 140, 27.6%), occasionally (n = 104, 20.5%), and often (n = 115, 22.6%). Although women's and partners' drinking decreased for all groups over time, groups maintained their rank order (e.g., the group that drank often at Wave 1 drank more than the other groups across all waves). Therefore, groups for women and partners were created using Wave 1 data. With data on relationship termination at each wave, we were able to control for changes in relationship status that would be associated with partners' drinking. 2. Results As shown in Table 1, men generally drank more frequently than women. Consistent with previous research on this sample (e.g., Temple et al., 2005), all forms of partners' IPV decreased over time for all alcohol use groups. It is possible that by repeatedly asking about IPV, the interviews functioned as an intervention, making women more aware of this aspect of their relationships. Research questions were tested by conducting 4 (women's or partners' Wave 1 alcohol use frequency) by 2 (relationship status) repeated measures MANOVAs in which all dependent variables (partners' threats, physical violence, and sexual aggression) for each wave were included. Separate models were conducted for women's and partners' alcohol use. 2.1. Women's alcohol use As demonstrated in Table 2, the model for women's alcohol use showed multivariate main effects for group and relationship status, but no interaction between the two variables. No interaction between time and group occurred, but an interaction did occur between time and relationship status. Univariate interactions of time and relationship status occurred

Table 1 Alcohol use groups for women and partners at all waves Negligibly n Wave 1 Women Partners Wave 2 Women Partners Wave 3 Women Partners Wave 5 Women Partners Wave 6 Women Partners 390 233 289 157 273 181 322 222 288 187 % 46.7 27.9 44.3 24.0 41.9 27.8 50.1 34.6 47.3 30.7 Rarely n 264 232 181 125 207 173 188 156 180 145 % 31.6 27.8 27.8 19.1 31.8 26.6 29.2 24.3 21.6 23.8 Occasionally n 128 176 127 151 110 123 83 101 97 110 % 15.3 21.1 19.5 23.1 16.9 18.9 12.9 15.8 15.9 18.1 Often n 53 193 55 220 61 174 50 162 44 167 % 6.3 23.1 8.4 33.7 9.4 26.7 7.8 25.3 7.2 27.4

Note: The variables of interest were not measured at Wave 4.

1246 Table 2 Women's alcohol use Test Group Relationship status Time Group Time Relationship status Partners' threats Partners' physical violence Partners' sexual aggression Group Partners' threats Partners' physical violence Partners' sexual aggression Relationship status Partners' threats Partners' physical violence Partners' sexual aggression

J.R. Temple et al. / Addictive Behaviors 33 (2008) 12441248

F 1.52 1.12 a 2.68 a 4.53 4.28 3.34 2.49 a 2.66 4.66 1.34 7.93 a 12.41 18.86 17.03
a

df (9, 1503) (36, 6012) (12, 6012) (4, 2004) (4, 2004) (4, 2004) (9, 1503) (3, 501) (3, 501) (3, 501) (3, 499) (1, 501) (1, 501) (1, 501)

p ns ns b .01 b .01 b .01 b .02 b .01 ns (=.05) b .02 ns b .01 b .001 b .001 b .001

Partial 2 .01 .01 .01 .01 .01 .01 .02 .02 .03 .01 .05 .02 .04 .03

Note. Multivariate tests are reported for each interaction and main effect. When multivariate tests are signicant (e.g., time relationship status), follow-up univariate tests are reported by dependent variable. a Pillai's trace F is reported.

for partners' threats, partners' physical violence, and sexual assault. In general, IPV means for women who remained with Wave 1 partners were initially lower than for women no longer with Wave 1 partners at Wave 6. By Wave 3, means for both groups differed by only about .09 and slight increases were evident at Waves 5 and 6 for women with new partners, while means for women still with Wave 1 partners remained lower. Univariate results for alcohol use group showed the effect on partners' physical violence, but not on partners' threats or sexual aggression. Women who used alcohol often sustained signicantly more physical violence (M = 0.50) than women who used alcohol negligibly, rarely, or occasionally (M = 0.24, 0.22, and 0.25, respectively). 2.2. Partners' alcohol use In the model for partners' alcohol use, a multivariate interaction of time and group modied a main effect of group (see Table 3). Univariate results revealed interactions of time and group for partners' threats and sexual aggression, but not physical violence. As shown in Fig. 1, different patterns in partners' threats of violence existed for women whose partners drank often compared to the other groups. Specically, threats from the most frequent drinkers were relatively high initially but then rapidly decreased from Wave 1 to Wave 2. As shown in Fig. 2, different patterns were also evident in partners' sexual aggression when women were with men who drank occasionally or often versus women with men who drank negligibly or rarely; these differences were most pronounced in Waves 1 and 2. A univariate main effect of group on partners' threats and

Table 3 Partners' alcohol use Test Group Relationship status Time Group Partners' threats Partners' physical violence Partners' sexual aggression Time Relationship status Partners' threats Partners' physical violence Partners' sexual aggression Group Partners' threats Partners' physical violence Partners' sexual aggression Relationship status Partners' threats Partners' physical violence Partners' sexual aggression F 0.77 1.70 a 3.59 1.40 1.79 1.98 a 3.48 3.52 3.00 3.81 a 11.51 6.45 3.93 7.21 a 13.43 15.63 16.37
a

df (9, 1500) (36, 6000) (12, 2000) (12, 2000) (12, 2000) (12, 6000) (4, 2000) (4, 2000) (4, 2000) (9, 1500) (3, 500) (3, 500) (3, 500) (3, 498) (1, 166) (1, 166) (1, 166)

p ns b .03 b .001 ns b .05 .03 b .01 b .01 b .05 b .001 b .001 b .001 b .01 b .001 b .001 b .001 b .001

Partial 2 .01 .04 .02 .01 .01 .00 .01 .01 .01 .02 .07 .04 .02 .04 .03 .03 .03

Note. Multivariate tests are reported for each interaction and main effect. When multivariate tests are signicant (e.g., time relationship status), follow-up univariate tests are reported by dependent variable. a Pillai's trace F is reported.

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Fig. 1. Partners' alcohol use by time interaction on partners' threats.

Fig. 2. Partners' alcohol use by time interaction on partners' sexual aggression.

physical violence occurred, with a linear effect apparent. Adjacent groups did not differ from each other. For example, men who drank negligibly were signicantly less violent than men who drank occasionally or often, but not signicantly less violent than men who drank rarely. 3. Discussion Alcohol use was signicantly and persistently associated with partner abuse. Specically, women who drank more and perceived their partners as more frequent drinkers were generally more likely to experience IPV than were women who drank less or had partners who drank infrequently. Indeed, although we found overall decreases in drinking and abuse, the frequency of partners' drinking continued to be associated with their perpetration of threats, violence, and sexual aggression. Although women's drinking in this sample was unrelated to sustaining threats of violence or sexual aggression, we did nd an association between women's drinking and sustaining physical violence. These results provide additional support for the association between alcohol and IPV, and further indicate that substance use treatment may be benecial for both perpetrators and victims of IPV when appropriate (Stuart, Temple, & Moore, 2007). It is important to note that while women are never to blame for their victimization, these results do imply a potential important vulnerability to victimization that is associated with drinking. It should also be noted that alcohol misuse by women experiencing IPV may be a consequence of their victimization. Specically, substance use may be employed as a coping mechanism for the physical and emotional pain of being abused (Testa & Leonard, 2001). While this study extends the literature by demonstrating a longitudinal association between IPV and men and women's alcohol use, some limitations are worth noting. First, a reliance on women's reports of their partners' drinking and aggression increased the

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potential for misreporting. It would have been preferable to have both partners reporting on their own and their partners' drinking and aggression. Second, the nature of the data prevents us from knowing the extent to which the use of alcohol directly relates to experiencing IPV or if the association is the result of an underlying third variable (e.g., antisocial behavior). Third, while this study focused on male partners' perpetration of violence, future studies would benet from examining the association between alcohol use and females' perpetration of violence. This is a particularly important avenue of study given previous ndings that women commit IPV at comparable rates to men (albeit less severe and injurious), and that a majority of violent relationships are characterized by mutual violence (Anderson, 2002; Temple et al., 2005). Acknowledgements This study was funded by grant R49/CCR610508 from the National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention with the National Institute of Justice and grant 3691 from the Hogg Foundation for Mental Health, both awarded to the fourth author. Additional funding was provided by grant 2001-WT-BX-0504 from NIJ, awarded to the second and fourth authors. The results do not necessarily represent the ofcial view of the funding agencies. Dr. Temple is supported by a research career development award (K12HD052023: Building Interdisciplinary Research Careers in Women's Health Program BIRCWH) from the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Child Health and Human Development (NICHD), and the Ofce of the Director (OD), National Institutes of Health. References
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