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This is to certify that the
dissertation entitled

Experiences of Abuse and Stress: A Path Model
of their Joint Effects on Women's
Psychological and Physical Health

presented by

Kimberly Kay Eby

has been accepted towards fulfillment
of the requirements for

Ph.D Psychology

 

'degree in

 

my/
Major professor

William S. Davidson

Date 3&4 éé

MS U is an Affirmative Action/Equal Opportunity Institution 0-12771

 

 

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ABSTRACT
EXPERIENCES OF ABUSE AND STRESS:
A PATH MODEL OF THEIR JOINT EFFECTS ON
WOMEN’S PSYCHOLOGICAL AND PHYSICAL HEALTH
By

Kimberly Kay Eby

While past research has conceptualized experiences Of abuse as stressful for
women, no research has explicitly examined the hypothesis that experiences of abuse
lead to increased long-term stress among women. This is conceptually important
because women’s experiences of abuse may lead to a constellation of additional
Stressors and result in potential detrimental health outcomes for women. Further,
poverty has been a significant confound in interpreting results Of much Of the past
research examining the health effects Of abuse. The present study tested a path model
that examined the joint effects Of experiences Of abuse and level Of stress on women’s
psychological and physical health, for 107 women living in poverty. Women were
interviewed after being recruited from various social services agencies that serve
indigent women. This model was evaluated using Lisrel VIII. Results indicated that
experiences Of abuse did not have direct effects on women’s psychological health,
physical health symptoms, gynecological symptoms, or use of alcohol or drugs.
However, experiences Of abuse had significant indirect effects on women’s
psychological health, physical health symptoms, and gynecological symptoms mediated
by level of stress. Experiences of abuse were not found to effect women’s use of

alcohol or drugs, either directly or indirectly. Data supported the hypothesis that

 

 

levels of stress had direct significant effects on women’s psychological health and
experiences of physical health and gynecological symptoms. Hypotheses that social
support and coping would moderate the relationships between experiences of abuse and
psychological health and level of stress and psychological health were not supported.
However, social support and the use of maladaptive coping strategies did have
significant direct effects on women’s psychological health. Finally, women’s use of
maladaptive coping strategies had a significant direct effect on alcohol and drug use.
This was one of the first studies to conceptually integrate the literature into a
comprehensive model and provide a test of that model. Implications of the findings

for future research, intervention, and policy are discussed.

 

 

ACKNOWLEDGEMENTS

This project required the help of many individuals. Fortunately for me, I
received immeasurable support and assistance throughout the project. There were
times when I questionned whether or not it would all fall into place. In the end, it
did.

I feel that I first need to thank Mobley for our endless hours of studying
together for comps and hashing out our research ideas with each other over and over
and over again ...... two separate times (sometimes you just get lucky). It was these
brainstorming sessions that helped me figure out how I wanted and needed to structure
this project. Of course, that was just the beginning, and I would be remiss not to
thank you for innumerable things you’ve done for me since that time. I believe it to
be a rare occurrence when a close personal friendship and a professional relationship
are so complementary.

I also need to thank Jose at this juncture, for his ongoing support and faith in
my work, as well as for his patience. Two specific things deserve special
acknowledgement. First, for helping me with my data analyses and showing me how
to nm Lisrel. Second, for moving across the country so that I was free to work

zillions of hours per week. Though it wasn’t easy being apart for that year, it was, at

iv

 

 

least in my mind, infinitely easier than you having to put up with my long hours,
frustration, and distraction.

Thanks to Burker, Burker, Burker, Burker, one of my only close friends who
remained in the Lansing area while I was conducting this project. (Geez, what does
this tell me?) Thank you for a million things (i.e. support, encouragement, wine,
dinners, etc.), but most specifically for always being able to make me laugh, no matter
how crazy things became.

An enormous thanks to Molly and Courtney, who were as responsible,
diligent, motivated, creative, insightful, and enjoyable to work with as any two people
I can imagine. Without question, this project would not have been able to be
completed without their many hours of hard work. Thanks also to Kelly, for giving
me feedback on all of my crackpot ideas and for the brainstorming sessions. Also, to
Ginny for your input and suggestions during the initial stages of this project.

To Juliette and Lance, for the friendship, the support, the practical assistance,
the place to stay and transportation after I had been displaced from Michigan, the
wine, and the homemade pasta. To Stan and Jean, for the fine wine and biscotti, the
supper club, the silliness and laughter, and Winnie-the-Pooh. To the dissertation
group, for strategic problem-solving and support. To the staff at A.D.P. (Juliette,
Holly, Ray, et al.) for tolerating my absent-mindedness while I was working on my
dissertation. To numerous other individuals who were there when and if I needed
them, including Tim, Mel, Cheryl, Becki, Barb, and Bonnie. Also to the folks at The
Grill (Eric, Bryan, Aaron, etc.) for providing food, drink, and friendship for the

celebrations, the commiserations, and everything in-between.

 

 

 

Of course, I need to thank the faculty who guided me through not only
graduate school, but also this project. First and foremost, thanks to Bill, for your
enthusiasm and support toward this project from the beginning, as well as for your
attention to the practicality of it all. You are primarily responsible for my knowledge
about how to get a research project up and running in the community, and what
questions need to answered in each stage of the project. Thanks to Tom, for your
ongoing support, most particularly for helping me bring it from an abstract notion to a
concrete model in the initial stages. Thanks to Neal, for all your help with my data
analyses, particularly in the planning stages. Thanks to Bob, for your support and
encouragement throughout the process.

Thanks to my family, who have always supported and celebrated my
intellectual growth and achievements. Thanks for arriving in Lansng at a moment’s
notice when I most needed it, for providing comfort and support when I (and my
entourage) needed a weekend away, for understanding how graduate school can take
seven years to complete, for your generousity, and for wine, food, laughter, and fun.
(I won’t thank you for cigars and reminders of how many interviews I have left to
complete. "So, how many do you have now?" "I have 70 interviews done now."
"70? But that means you need to get 30 in the next 30 days!")

Finally, I need to thank the women who have generously shared their wisdom
with me. Their willingness to share the details of their personal lives, to recount
horrific acts of violence, and to pass on the lessons they’ve learned has provided me
with an education more valuable than any other. They are a constant source of

strength and inspiration.

 

 

TABLE OF CONTENTS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Page
LIST OF TABLES x
LIST OF FIGURES xiii

CHAPTER 1: INTRODUCTION 1
Incidence and Pre ‘ 1
Organization of the Review 4
Effects of Battering on Women’s Health 4
Physical Health Effects 5
Physical Health 3, r‘ 5

Alcohol and Drug Use 13

Risk for STDs or the AIDS virus 17

Mental Health Effects 19

l‘ r ' 21

Suicide 23

Effects of Poverty on Women’s Health 24

The Relationship Between Stress and Health 27

Rationale for the Present Study 33

The Present Study 36

Research Objectiv 36

I!” ‘L 38

CHAPTER 2: METHOD 42

Research Design 42

Research Pm” ', ‘ 42

Recnritment 42

Demographic CL ‘ ifii- s 52

ure 57

Interviewer Training 57

Data (‘ “ " 58

‘ ' 58

Aimee 60

Physical Health 67

Psychological Health 78

Social Snppnrt 87

gm: 39

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(‘nping 90
CHAPTER 3: RESULTS 98
Descriptive Information 98
Abuse 98
Physical Health Constructs 100
Women’s Use of Health Care Services 111
Psychological Health 114
Moderator variables: Social support, adaptive coping,
and maladaptive roping 116
Stress 1 16
Intercorrelations Among Constructs in the Path Model ............................ 126
Abuse and Major Path Constructs 129
Stress and Major Path Constructs 130
Psychological Health and Major Path Constructs .......................... 131
Physical Health and Major Path Constructs 132
Social Support, Maladaptive Coping, and Adaptive Coping ......... 132
Tests of the Moderator II,r " 134
Tests of the Moderators between Abuse and Psychological
Health 135
Tests of the Moderators between Stress and Psychological
Health 136
Test of the Path Model 138
The Effect of Abuse on Stress 138
The Effect of Abuse on Psychological Health 138
The Effect of Abuse on the Physical Health Scales ...................... 141
The Effect of Stress on Psychological Health 142
The Effect of Stress on the Physical Health Scales ...................... 143
The Effect of Social Support on Psychological Health ................. 144
The Effect of Adaptive Coping on Psychological Health ............. 145

The Effect of Maladaptive Coping on Psychological Health ........ 145
The Effect of Maladaptive Coping on Alcohol and Drug Use 145

 

 

 

 

 

 

 

Indirect Effects of Abuse within the Path Model .......................... 146

Path Model Fit Indices 148

CHAPTER 4: DISCUSSION 152

' “ ‘ " 152

Discussion of Major Descriptive Findings 153
Summary of Intercorrelations for Constructs not Tested

in the Path Model 159

Discussion of Path Model 162

Methodological I ' " " 170

Implications for Future Research, Intervention, and Policy ...................... 173

 

APPENDICES
Appendix A: Eligibility Screening Tnnl

 

Appendix B: Income Eligibility Chart

 

 

Appendix C: Administrative 1“, ‘
Appendix D: Initial Recruitment Flyer

 

Appendix E: Revised Recruitment Flyer

 

Appendix F: PSY 490 Syllabus and Course Curriculum

 

 

Appendix G: Interviewer’s Training Manual
Appendix H: Consent Form

 

Appendix 1: Interview

 

 

LIST OF REFERENCES

179
185
186
191
192
193
206
217
218

256

 

Table 1:
Table 2:
Table 3:
Table 4:

Table 5:

Table 6:

Table 7:
Table 8:

Table 9:

Table 10:
Table 11:
Table 12:

Table 13:

Table 14:
Table 15:
Table 16:

Table 17:

LIST OF TABLES

Summary of Recruitment Process for Research Sites ...................
Demographics of Research Par" 'r ‘
Psychometric Properties of the Psychological Abuse Scale ..........
Psychometric Properties of the Overall Abuse Scale ....................

Psychometric Properties of the Physical Health Symptoms

Scale

Psychometric Properties of the Gynecological Symptoms

Scale
Psychometric Properties of the Alcohol and Drug Use Scale .......
Factor Loadings for the Physical Health Symptom Scale .............

Psychometric Properties of the Suicide Scale

 

Psychometric Properties of the Depression Scale .........................
Psychometric Properties of the Quality of Life Scale ...................
Psychometric Properties of the Psychological Health Scale ..........

Correlations between Psychological Health Items and
Major Scales in the Path Model

 

Psychometric Properties of the Social Support Scale ....................
Psychometric Properties of the Adaptive Coping Scale ................
Psychometric Properties of the Maladaptive Coping Scale ...........

Measurement Model

Page
50
53
62

65

69

7O

73

79
81
83

85

86
88
92
93

95

 

Table 18:

Table 19:

Table 20:

Table 21:

Table 22:

Table 23:

Table 24:

Table 25:

Table 26:

Table 27:

Table 28:

Table 29:

Table 30:

Percentages of Women Who Experienced Physical and
Sexual Violence

Percentages of Women Who Experienced Injuries as a
Result of Abuse

Percentages of Women Who Experienced Psychological
Al'mse

Percentages of Women Who Experienced Physical
Health Symptoms and the Percentages of Women Who
Rated Them as Due to Abuse

Percentages of Women Who Experienced Gynecological
Symptoms and the Percentages of Women Who
Rated Them as Due to Abuse

 

Percentages of Women Who Used Alcohol and Drugs .................

Percentages of Women Engaging in Behaviors that
Increase HIV/STD Risk

Summary of Women’s Use of Various Health Care Services .......
Descriptive Statistics for the Psychological Health Constructs:

Scale Summaries for Depression and Quality of Life
and Item Statistics for Suicide

 

Descriptive Statistics for the Moderator Variables:
Scale Summaries for Social Support, Adaptive,

and Maladaptive Coping and Percentages of Women
Using Maladaptive Coping ‘” ‘ 0'

 

Descriptive Statistics for the Scales in the Stress Construct:
the Difficult Life Circumstances Scale and the
Life Event Checklist

 

A Comparison of the Percentages of Abused and
Non-Abused Women Who Experienced Difficult
Life C' ‘

 

A Comparison of the Percentages of Abused and
Non-Abused Women Who Experienced Life Events
They Rated as m f '

99

101

102

105

107

108

112

113

115

117

119

120

123

 

  
 
   
 
  
  
  
  
   
  

_ Intercorrelations Among Constructs
MM] 127

 

MumminthePathModel:
4mm: " 128

Mary ofthe Direct arid Indirect Effects for the Path Model.. 149

 

V Proposed l’n‘l Mr J. r.
M Model «iv?! I i.. x.‘ \ .r; l
.. Revised m.» ’

Path Mirgicl .
Uncorrected I

M Mrkltl . ' _
Correlation». r, _-.~.. ,

   

 

Figure 1:
Figure 2:
Figure 3:

Figure 4:

Figure 5:

LIST OF FIGURES

 

Proposed Path Model

Path Model after Measurement Rev' '

 

Revised Path Model afier Testing Moderator Hypotheses ............

Path Model of the Presence vs. Absence of Abuse using
Uncorrected (‘u- ‘ "

Path Model of the Presence vs. Absence of Abuse using
Correlations Corrected for I“ "

 

Page
4 l
97

137

139

140

 

CHAPTER 1

INTRODUCTION

Incidence and Prevalence

Contrary to popular beliefs, women’s greatest risk for assault comes from their
intimate partners. Women who are battered by their male partners are more likely to
be repeatedly attacked, raped, injured, or killed than are women assaulted by other
types of assailants (Browne, 1993; Browne & Williams, 1989, 1993; Finkelhor & Yllo,
1985; Okun, 1986; Russell, 1982). It is estimated that at least 2 to 3 million women
are assaulted by male partners each year in the United States alone (Browne, 1993;
Straus & Gelles, 1988; Straus, Gelles, & Steinmetz, 1980). It is further estimated that
between 21 percent and 34 percent of all women will be physically assaulted by one of
the men they are involved with during adulthood (Browne, 1993; Frieze, Knoble,
Washburn, & Zomnir, 1980; Koss, 1990; Stark & Flitcraft, 1988). While these
esfimates are striking, it is thought that they are underestimates of the actual
Prevalence of battering given the likelihood of underreporting acts of violence and the
POtential exclusion of poor, homeless, institutionalized, and non-English speaking
Mple from many surveys.

While the term battering is broadly conceptualized to include psychological,

PhYSical, and sexual abuse, the vast majority of the research literature has only

 

 

 

 

 

2
examined the effects of physical and sexual abuse on women’s physical and mental
health, albeit in the presence of ongoing psychological abuse. The current state of the
literature, unfortunately, has not isolated the effects of psychological abuse on
women’s health. For this reason this discussion has been limited to the examination of
the consequences of physical and sexual abuse on women’s physical and mental health.
To their credit, researchers in the field of woman battering have paid increased
attention to the issue of sexual violence within ongoing, intimate relationships, as
oppomd to focusing solely on physical abuse. There is considerable overlap between
the act of rape and nonsexual domestic violence. Although sexual abuse is not
necessarily always a part of a battering relationship, it is certainly one of several
pOtential forms of woman battering. It has been estimated that sexual abuse occurs in
at least 40 percent of all cases of battering (Campbell, 1989a; Finkelhor & Yllo, 1985;
Hanneke, Shields, & McCall, 1986).

Research investigating the incidence of sexual violence within intimate
relationships include Russell’s 1982 study that found sexual assaults by husbands were
Ileported more than twice as frequently as sexual assaults by a stranger. Finkelhor and
Y110 (1985) reported that ten percent of the women in their study had been sexually
assanlted by their husbands, whereas only 3 percent had been similarly assaulted by a
stranger. Yet another study by Flitcraft (1978) stated that women with abusive
Partners experience rape eight times as ofien as women who are not abused. Hanneke
et al. (1986) fmmd that in their sample 41 percent of the women reported experiences
of rape as well as alternate forms of violence, while 48 percent reported experiences of

I‘Onsexual violence only. It was concluded that sexual violence in a relationship is

   

51

ii

 

 

 

3

rarer an isolated incident, and that the severity of a woman’s reaction to the marital
rape was directly related to the number of incidents of marital rape. In addition,
marital rape seemed to co-occur with other severe forms of nonsexual violence. These
results are harmonious with the findings of Stark and Flitcraft (1982) that showed that
more than one-third of the reported rapes in their study occurred in the context of
ongoing abuse. Clearly, a substantial proportion of victims of woman abuse are

victims of rape as well. It is therefore necessary to explore the impact of sexual
violence from an intimate partner, as well as nonsexual violence from a partner, on
women’s physical and mental health.

Relationships have been established between physical, sexual, and psychological

abuse and health in samples of poor women who have recently experienced abuse. A
detailed literature review follows. However, the vast majority of the research
iIIVestigating the relationship between health and abuse has been conducted on women
liVing with restricted incomes. Non-abused poor women have also been found to have
GXtensive health problems. Unfortunately, previous research has done little to control
for this potential confound, and the observed relationships may confound the effects of
abuse and poverty. While it is essential to continue research with respect to abused
P00!“ women (because these women often have the greatest need for resources),
rescatch that controls for the potential effects of poverty is needed to determine the
etiOlogy of physical and mental health problems for women with restricted incomes.
Fm“flier, not all women who experience abuse experience the same level of health
“Yulptoms and problems. Research has not yet investigated the environmental or

in‘fliVidualdifferences among women who have experienced abuse that may contribute

 

 

 

4

to increased resilience among some women, while contributing to decreased resilience
among others. For example, it may be that the level of stress women experience,
including but not limited to their experiences of abuse, affects women’s psychological
and physical health. Women’s level of social support and use of coping strategies may

additionally affect women’s health status. It is necessary to start formulating a more

complete picture of what predicts health problems among women living with restricted

incomes, both abused and non-abused.

Organization of the Review
This literature review examined previous research regarding the effects of
battering on women’s physical and mental health, including physical health
s.‘lmptomatology, alcohol and drug use, risk for sexually transmitted diseases (STD’s)
01' the AIDS virus, suicidal thoughts and attempts, depression, and perceived quality of
life. It additionally provides a critical examination of the methods used in previous
research, and identifies gaps in our knowledge due to these methodological issues.
This research study viewed experiences of abuse as one of many potential stressors in
Women’s lives, and a cursory review of the effects of stress on women’s physical and
PSYchological well-being is therefore provided. Further, the constructs social support
and coping are reviewed due to the likelihood that they are potential factors that
inibact women’s physical and psychological health. Finally, the rationale for the
"M study is discussed.
Effects of Battering on Women’s Health
Battering is the single most common source of serious injury to women,

ac°0unfing for more injury than auto accidents, muggings, and rapes combined (Stark

 

"’32).

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5
& Flitcrafi, 1988). To demonstrate just how lethal this violence can be, it is estimated
that more than half of all women (52%) murdered in the United States during the first

half of the 19808 were victims of partner homicide (Browne & Williams, 1989).

 

Campbell and Humphreys (1987) reported that women with abusive partners
experienced more health symptoms than other groups, due to the injuries incurred from
the physical battering g! the manifestations of the stress from the battering.

Physical Health Effects

Physical Health Symptoms

Battering can result in acute medical conditions and has been associated with
negative self-reported health status, increased physical symptomatology, increased
injurious health behaviors, and greater utilization of medical services in women who
have experienced abuse (Campbell, 1992; Goodman, Koss, & Russo, 1993a; Koss &
Heslet, 1992). Physical symptoms frequently reported by women with abusive
Winners include: headaches, back pain, and stomach pain (Follingstad, Brennan, Hause,
Polak, & Rutledge, 1991); headaches, choking sensations, hyperventilation, asthma,
Chem pain, gastrointestinal symptoms, pelvic pain, back pain, allergic phenomena,
inability to relax or sleep, and nightmares (Hilberman & Munson, 1977—78); soreness
fi'Om bruises, cuts, and bone fractures, insomnia, fatigue, anemia, allergies, arthritis,
and physical sensations (Kerouac, Taggart, Lescop, & Fortin, 1986); high blood
pressure, ulcers, chronic back pain, miscarriages, and menstruation problems
(Rodriguez 1989); tension headaches, flank pain, general pain and dizziness,
abdominal and chest pains, heart pounding, and somatic problems (Stark & Flitcrafl,

1982); and finally, headaches, cold sweats, and feelings of intense stress or

 

A;

 

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6
nervousness (Straus & Gelles, 1987). Clearly, these findings indicate that women who
have experienced abuse similarly experience a myriad of negative health symptoms as
well.

Unfortunately, while the above studies provide an accurate description of the
health of some women with abusive partners, methodological and conceptual flaws
preclude our ability to make definitive statements about the relationship between
experiences of abuse and physical health symptoms. For example, Rodriguez’s (1989)
study used a shelter sample composed of primarily low SES women, did not include a
comparison group, and used descriptive analyses only to examine research findings.
These problems are likewise replicated in the study by Kerouac et a1. (1986). While
Hilberman and Munson (1977-78) did not use a shelter sample, the problems with
uSing a poor sample without a comparison group and only presenting descriptive
analyses are still present. Follingstad et al.’s (1991) work did not report participants’
SES, include a comparison group, or present anything other than descriptive analyses.
For two studies, Straus & Gelles (1987) and Stark & F litcraft (1982), the inclusion of
comparison groups and not focusing on exclusively poor samples are signficant
stl'engths when compared to other studies. Unfortunately, despite these improvements,
only descriptive analyses were reported. This means that while women with abusive
Partners did report more physical health symptoms than women without abusive
Partners, specific examinations of the relationships between physical health
s'yllllatomology and experiences of abuse are absent from the literature.

Especially relevant to the investigation of health concerns for survivors of

W0ltnan battering is the observation that many of these women have experienced

 

 

7

gynecological problems as well, possibly a result of sexual violence within their
relationships. Rodriguez (1989) found that the most frequently reported medical
conditions included miscarriages, hysterectomies, and menstruation problems.

Flitcrafi’s (1978) study of hospital records revealed that one in four battered women
had experienced at least one miscarriage, while only one in fifteen non-battered

women reported ever having had a miscarriage. It has also been noted that women
who are battered are at risk for pregnancy complications and premature labor as well
as miscarriages (Campbell & Humphreys, 1987).

Researchers have examined the impact of sexual violence on women’s health.

A 1989 study by Campbell and Alford investigated the impact of marital rape on
Women’s health among 115 women who resided in shelters for women with abusive
Partners and had disclosed they had been sexually abused. The two most frequently
l“eported health concerns for their participants were painful intercourse (72%) and
Vaginal pain (63%). Other physical health symptoms these participants attributed to
their experiences of sexual violence included bladder infections, vaginal bleeding, anal
01' Vaginal stretching, missed menstrual periods, anal bleeding, leaking of urine,
miscarriages and stillbirths, and sexually transmitted diseases. This study, however,
was entirely descriptive in nature, and methodological problems resulted in a response
rate of only 11.5 percent. While this research is valuable in terms of describing some
women’s experiences of sexual violence within intimate relationships and their health
concerns, it provides no evidence that the women who responded to the survey are

”Nutritive shelter samples or of battered women in the general population.

 

 

8
In a large group (N = 1,610) of randomly selected women, Golding (1994)
fotmd that sexually assaulted women were more likely than non-assaulted women to
report poor health perceptions, several chronic diseases, medically explained somatic
symptoms, and medically unexplained somatic symptoms. Further, her work
demonstrated that sexual assault was associated with increased risk of symptoms in a
variety of organ systems rather than solely reproductive or sexual symptoms (Golding,
1994). This means that in her sample, women who were sexually assaulted were just
as likely to exhibit more gastrointestinal symptoms, generalized pain, neurologic
symptoms, and cardiopulmonary symptoms as sexual or reproductive symptoms.
While improving on research designs of many previous studies through the use

Of a randomly selected sample and a comparison group, there are significant
methodological limitations to this study. First, the time frame for assessing history of
sexual assault and of somatic symptoms was a lifetime. For this reason it is
impossible to determine the order of onset of sexual assault and of somatic symptoms,
that is, whether or not sexual assault preceded or followed the somatic symptoms.
Second, while asking participants to accurately recall their lifetime sexual assault
hiStory may be plausible, asking participants to accurately recall their lifetime history
of physical health symptoms is more questionnable. Conceptually speaking, important
details about the nature of the sexual assault are absent. Respondents may have
experienced a lifetime of incest, a one-time rape (by a stranger or an acquaintance), or
mllltiple incidents of sexual violence fi'om an intimate partner(s). This lack of
information about the frequency, severity, and context of sexual assault may lead to

ex‘I’Oneons conclusions. For example, it is likely that some of the participants have

A

 

 

9
experienced non-sexual abuse from an intimate partner. Assuming this were true, it is
posfible that some of the health problems are a result of violence experienced in an
intimate relationship, or the combined experience of an abusive relationship and sexual
assault, and not solely the experience of sexual assault. Despite these limitations, this
study does indicate that experiences of sexual assault have numerous physical health
correlates.

In 1974 Burgess and Holmstrom identified "rape trauma syndrome". In the
first phase of the syndrome, women experience a multitude of somatic reactions in
addition to the initial physical trauma. These symptoms include: skeletal muscle
tension, tension headaches, fatigue, sleep disturbances, gastrointestinal irritability,
Changes in appetite, nausea, genitourinary disturbances including discharge, itching,
burning sensations, generalized pain, and vaginal infections. In the second phase, they
are at risk of developing phobias and nightmares related to the trauma. In addition to
the health problems described above, Burgess and Holmstrom (1974) reported that a
Serious concern for survivors of rape was the possibility that they had contracted a
venereal disease. This research also indicates that women who have experienced
Sexual assault experience a wide variety of physical health symptoms.

In another study, Campbell (1989b) examined the severity and number of
PhYSical health symptoms in women who had experienced non-sexual violence in their

relah'onships, who had experienced sexual and non-sexual violence in their
reliltionships, and who had not experienced violence but were having serious
relationship problems. Overall, women who had experienced violence in their

relationships (both sexual and non-sexual) had significantly more frequent and severe

A

 

 

10

physical symptoms of stress than the control group of women (Campbell, 1989b).
Further, women who had experienced sexual violence in their relationships also
experienced more severe physical violence than the women who reported non-sexual
violence only, corroborating the contention of Shields and Hanneke (1983) that sexual
abuse is characteristic of more severe battering situations (Campbell, 1989a). In
contrast, there was no significant difference between the two groups of abused women
in terms of their physical symptoms of stress and their perceived health status. That
is, women who were more severely abused and/or who experienced sexual abuse in
addition to physical abuse, did not demonstrate more stress-related physical health
Symmoms or have a lower perceived health status than the women who experienced
physical abuse alone from an intimate partner. This is in contrast with the finding of
Eby, Campbell, Sullivan, and Davidson (1995) that women who were sexually abused
(and also more severely physically abused) reported more frequent physical health
Symptoms than women who experienced non-sexual abuse from a partner.

While the aforementioned studies do link experiences of sexual violence with
Women’s health outcomes, not all of the studies focus on sexual violence within an
intimate relationship. Burgess and Holrnstrom’s rape trauma syndrome was created
afiel' interviewing rape survivors in a hospital emergency ward and Golding’s (1994)
8tlldy not discriminating among the context, frequency, or severity of the sexual
“saints This is an important distinction because the health sequellae, both physical or
psychological, associated with non-sexual battering, battering that includes sexual
Violence, experiences of sexual violence in childhood, and experiences of rape are not

l"ecessarily the same. When studies do not address the context of the violence

A

11

experienced and then report findings related to health outcomes, then that information

may unintentionally misrepresent the truth.

 

Clearly, there are a wide array of health symptoms associated with experiences
of violence and reported by women with abusive partners, whether they have
experienced physical violence, sexual violence, or some combination of the two.
Researchers have posited that there are relationships between women’s health
symptoms and their experiences of abuse, such that experiences of abuse lead to
physical injuries and stress, which lead to experiences of stress-related physical health
Symptoms. It has further been suggested that as the frequency and severity of abuse
increases, the physical injuries from the abuse and the level of stress increase, leading
t0 increased frequency and severity of stress-related physical health symptoms.
Unforttmately, scant research has been conducted that has investigated these
x‘elationships. One of the most obvious flaws in previous research studies is the
Omission of level of stress as a variable. While it certainly seems intuitive that
experiencing abuse increases one’s level of stress, none of the aforementioned studies
have included level of stress as a measured variable. Only one study was found that
examined level of stress as a variable (Jaffe, Wolfe, Wilson, & Zak, 1986). They did
n°ts however, examine how experiences of abuse affect level of stress. Jaffe et al.
(1986) found that negative life events and experiences of abuse both predicted
women’s experience of somatic complaints, although the predictive ability of negative
life events and experiences of abuse were not reported individually. Unfortunately,
their construct of physical health was reported as somatic complaints throughout the

al‘ficle, with no further description as to the participants’ physical health. It would

A

 

 

 

 

 

12
appear, therefore, that the relationship between women’s experiences of abuse and their
level of stress has been virtually ignored.

Research examining the relationships between women’s level of abuse and their
level of physical health symptomatology has been conducted. Carnpbell’s (1989a;
1989b) research demonstrated that battered women were found to have significantly
more frequent and severe stress related symptoms than a control group of women who
had not experienced abuse from a partner. However, as noted previously, there was no
increase in stress-related physical health symptoms for women who had experienced
sexual violence in addition to other experiences of violence from their intimate
partners, and this group of women experienced more severe physical violence as well.
While other research has likewise found that women who have experienced sexual
Violence have also experienced more frequent physical violence, results differed in that
a significant increase was observed in stress-related physical health symptoms for
Women who experienced both sexual and non-sexual partner violence when compared
to women who experienced non-sexual partner violence solely (Eby et al., 1995). In a
1991 study, Follingstad et al. found that the most severe type of physical force
tS’I’ically used against a respondent and the frequency of physical violence were
SiShificant predictors of experiencing more frequent physical and psychological health
syruptoms. The study further reported that women experiencing more severe forms of
phBVsJical force had more physical health symptoms than women experiencing moderate

fol‘ms of physical abuse (Follingstad et al., 1991). Therefore, two of the three studies
indicated that level of abuse, in terms of type of abuse, severity, and frequency, does

impact the level of physical health symptomatology experienced by women. Since the

A

 

 

 

 

 

13
results of research examining the nature of the relationship between frequency and/or
severity of abusive experiences and frequency of physical health symptoms are
contradictory, it appears that more research needs to be conducted in order to establish
the extent of this relationship.

In sum, with respect to physical health symptomatology, women who have
experienced abuse do seem to report more stress-related physical health symptoms than
women who have not experienced abuse. Certainly there is a body of literature that
has documented the relationship between stress and physical health. However, the
hypothesis that experiences of abuse leads to increased stress and therefore increased
physical health symptomatology has not been empirically tested. Nor is it clear that
more frequent and/or severe abuse leads to more frequent or severe health
sltmptomatology. In addition to health symptomatology, research has focused on other
physical health problems, including alcohol and drug use.

Alcohol and Drug Use

The literature on the use and abuse of alcohol and drugs by women with
abusive partners has shown that women with abusive partners report high rates of
a100hol and drug use, although the direction of this relationship has not been
unequivocably determined. Assessments of the impact of violence on women’s health
have revealed that victims of assault are more likely than nonvictims to be diagnosed
as alcohol or drug dependent, even when assessed years after the attack (Koss, 1990).
The relationship between domestic violence and substance abuse is such that 45
percent of the women in alcohol treatment programs were victims of domestic violence

Who subsequently became alcohol dependent (Randall, 1990).

 

A

 

 

 

14

Numerous researchers have given accounts of the reality that women who have
eiqierienced or are experiencing domestic violence are also misusing drugs and alcohol.
Bmd on an examination of the medical records of 481 women seeking aid for injuries
in an emergency room, Flitcraft (1978) reported that 15 percent of the identified
battered women abused alcohol and 9 percent of the identified battered women abused
drugs. Campbell, Poland, Waller, and Ager (1992) found that 28 percent of the
women who had experienced physical violence in their sample had used illicit street
drugs during pregnancy. Yet another study reported that women who experienced
violence during pregnancy were at greater risk than women who had not of being
heavy users of alcohol and illicit drugs, and that comparisons of frequency of use by
the two groups indicated that women who had experienced violence were heavier
substance users in all categories of use (Amaro, Fried, Cabral, & Zuckerman, 1990).
Appleton’s (1980) research suggested that women’s use of alcohol was related not only
to CXperiencing abuse, but also to the fiequency with which women experienced abuse.
Women who reported experiencing abuse more than three times admitted less
abStention from alcohol than women who reported one to three battering incidents and
a Comparison group of non-battered women. While the participants in this study did
“0t report high rates of illicit drug use, the most frequent drugs of choice were
marijuana and tranquilizers (Appleton, 1980). The use of alcohol, tranquilizers, and/or
anti-depressants by women with abusive partners has been reported in other research as
W811 (Gayford, 1975; Hilberman & Munson, 1977-78; Miller, Downs, & Gondoli,
1989).

 

A

15

Although the evidence suggests that women who have experienced abuse are
using alcohol and/or drugs, researchers have been unable to conclusively establish the
direction of this relationship. It has been postulated that abused women may
self-medicate with alcohol, illicit drugs, and prescription medication in order to cope
with the violence (Amaro et al., 1990; King, 1981; Stark & Flitcraft, 1988). In an
attempt to document the relationship between experiences of abuse and the use of
alcohol and drugs, comparisons of the medical records of non-battered women and
identified battered women pm to the onset of the battering and then again subsequent
to the battering were conducted. The results indicated no significant differences in
drug use between these groups initially, but that women who subsequently experienced
abuse had a higher incidence of drug abuse (F litcraft, 1978). While this finding was
not replicated for alcohol abuse (Flitcraft, 1978), a comparison between the recorded
Onset of alcoholism and of abusive injury among battered and nonbattered women
indicated that 74 percent of the alcohol cases emerged post-abuse (Stark & Flitcraft,
1988). This suggests that experiences of abuse preceded alcohol abuse for the majority
Of Women, and not the reverse.

Additional findings corresponding to the use of prescription drugs indicate that
exDefiances of abuse precede substance abuse. Unfortunately, the medical profession
has Shown a lack of proficiency in recognizing and acknowledging cases of woman
balfitting. One result of this lack of vision and subsequent misdiagnosis is that
bmered women are more likely than non-battered women to leave an emergency ward
With a prescription for pain medication or tranquilizers (F litcraft, 1978). Stark,

Flitcraft, and Frazier (1979) determined that one in four battered women leave an

 

 

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emergency ward with a prescription for sleeping medications, tranquilizers, or
anti-depressants, and a "label" indicating a psychiatric problem, as compared to one in
fifty non-battered women. Since victims of battering are often misdiagnosed and
over-medicated (King, 1981), and their ensuing drug dependency often involves an
addiction or abuse of a prescription given to them by a physician following an abusive
episode, preliminary support exists for the contention that abusive episodes generally
precede substance abuse problems.

Collectively, these studies contain methodological and conceptual flaws that
prevent a coherent understanding of the relationship between experiences of partner
abuse and substance abuse. It has been suggested that poverty may be a potential
confound in the interpretation of much of this research, due to the fact that the stresses
of living in poverty may lead to increased alcohol and drug use. In almost half of the
Studies cited above, poverty is a competing hypothesis. Gayford (1975) and Hilberman
and Munson (1977-78) both conducted descriptive research on exclusively poor,
battered samples. While Miller et a1. (1989) included a comparison group in the
design, there were significant differences between the alcoholic group, who were found
to have experienced more partner violence, and the non-alcoholic group, who were
found to have experienced less partner violence, with respect to annual personal
in<=Ome, annual household income from all sources, and entitlements or unemployment
“3 the major income source. That is, women who were alcoholic and experiencing
More partner violence also had significantly fewer economic resources.

Another problem with the aforementioned research is the lack of identifying

how or in what ways experiences of abuse affect use of alcohol or drugs. Prevalent in

 

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the literature has been the implicit assumption that experiences of abuse lead to

increased stress, and therefore increased use of alcohol and drugs. Of the studies cited

 

above, only one measured the concept of stress, finding that victims of violence had
experienced significantly greater numbers of negative life events than non-victims
(Amara et al., 1990). The potential relationship between experiences of negative life
events and alcohol and/or drug use was not examined. A significant drawback of this
study in terms of understanding the relationship between woman battering and

, substance abuse, however, was the failure to identify the context of abuse. Participants
were asked whether they had recently experienced any physical threats or abuse or
whether they had been involved in any fights or beatings. Not all of the participants
knew their assailant, nor does the fact that they knew their assailant indicate that their
assailant was a partner or ex-partner. While this study provided evidence that
violence, generally defined, was related to substance use, it did not necessarily provide
eVidence specific to the issue of woman battering. Acknowledging the context of

experiences of abuse in outcome research is needed because experiencing a one-time

 

Stranger assault, a rape from a stranger or acquaintance, or ongoing abuse from an
intinmte partner may not lead to similar outcomes.
Risk for STDs or the AIDS virus

The medical risks of substance abuse are substantial for women. Although the
medical risks and consequences will vary greatly depending upon the women’s drug of
chDice, two pertinent concerns include exposure to sexually transmitted diseases
(STDs) and the Acquired Immune Deficiency Syndrome (AIDS) virus. Tollett (1990)

amelted that the use of drugs, particularly crack cocaine, is associated with the current

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18
increase in sexually transmitted diseases. Congenital syphilis and penicillin-resistant
gonorrhea are two examples of STDs whose incidence are on the rise, in part due to
the grave reality that addicted women frequently exchange sex for drugs (Tollett,
1990). Moreover, the risk of contracting the AIDS virus is increased for the drug
abuser who shares needles with other intravenous drug users (Tollett, 1990). In an
examination of perceptions of battered women’s health needs, Rodriguez (1989) found
that women repeatedly cited exposure to the AIDS virus when asked about their
immediate health concerns. Therefore, it seems relevant to include assessments of risk
for STD’s and the AIDS virus in physical examinations of women with abusive
partners. Not only for the reasons mentioned above, but the potential for rape
increases women’s chances of exposure to an STD or the AIDS virus, most obviously
because the use of condoms is unlikely. STD’s have been estimated to occur in up to
30 percent of rape victims (Goodman et al., 1993a).

It is apparent that women with abusive partners suffer numerous physical health
Problems. It is less apparent what predicts the potential severity of experiences of
health symptoms and other health problems. Also unknown are the specific
mechanisms through which experiences of abuse affect physical health. For example,
d0 experiences of abuse have a direct negative effect on women’s physical health or
do they have an indirect effect on women’s physical health through some other
Variable, such as stress? Past research has both explicitly and implicitly stated that
experiences of abuse lead to increased levels of stress, thereby negatively impacting
WOmen’s health. While this hypothesis certainly seems plausible, it has yet to be

empirically tested in the literature.

A

 

 

19

Further, past research that has investigated the relationships between
experiences of abuse and health has not consistently controlled for other stressors that
may be contributing to women’s negative health outcomes, such as living in poverty.
Of all of the research studies cited thus far, only four of them did not rely on
primarily low-income participants. While there is a range of incomes represented
among the studies that recruited from emergency room departments and that used
medical records, participants in these studies were primarily poor and uninsured. Since
much of the research has been conducted with women with restricted incomes, it is
necessary to include comparison groups into our research so that the reported physical
health symptoms are not mistakely attributed to the abuse, when in fact poverty may
be a contributing factor. Well over half, approximately 62%, of the research on poor
Women has not included comparison groups in their designs.

Finally, previous research has not examined other reasons why women’s health
may be differentially affected, such as individual coping strategies or levels of social
Support. Clearly, additional research is needed to clarify our understanding of these
issues.

Mental Health Effects

A relationship between experiences of battering and women’s mental health is
eVidenced in two ways. First, a high incidence of psychological symptoms have been
I"morted by researchers investigating women who have been abused by an intimate
Partner. While two of the most frequently reported psychological symptoms are
d‘epl'ession and anxiety, the range of symptoms include memory loss, cognitive

diilsociations, somatic problems, reexperiencing the traumatic event when exposed to

‘

 

 

 

 

 

20

associated stimuli, and suicidal thoughts and attempts (Browne, 1987; Dutton, 1992;
Hilberman & Munson, 1977-78; Hoff, 1990; Jaffe, Wolfe, Wilson, & Zak, 1986; Stark
& Flitcrafi, 1988). Mitchell & Hodson (1983) and Follingstad et al. (1991) found
frequency and severity of the abuse were strongly related to number and severity of
stress-related physical and psychological symptoms.

Second, women in abusive relationships have a higher prevalence of mental
health symptoms than women who are not experiencing abuse. A survey of 6,002
randomly drawn households by Gelles and Harrop ( 1989) yielded a nationally
representative sample of battered and non-battered women. Women who had been
physically abused reported higher levels of moderate and severe psychological distress.
Koss (1990) also reported that battered women show identifiable degrees of mental
health difficulties when compared with non-battered women, even when assessed years
after the attack. Battered women were more likely to be diagnosed with depression,
alcohol & drug dependence or abuse, generalized anxiety, obsessive-compulsive
disorder, eating disorders, posttraurnatic stress disorder, and other psychological
diagnoses (Koss, 1990). This evidence has led researchers to the conclusion that a
history of victimization may be a risk factor for the development of lifetime mental
health problems (Kilpatrick, Saunders, Veronen, Best, & Von, 1987).

It is important to acknowledge the difficulty of attributing causality, despite the
association between a history of experiencing violence and various psychological
health problems. That previous research has not controlled for possible confounds has
been a criticism of prior work. The need to control for possible confounds is firrther

eVidenced by Gelles and Harrop’s (1989) results that indicated income was a

A

 

 

 

 

21
significant predictor of psychological distress. Moreover, the nature of the relationship
between experiences of abuse and mental health outcomes is still unclear. For
example, do experiences of abuse have a direct effect on women’s psychological
health, or do experiences of abuse increase women’s level of stress, which then has a
detrimental effect on women’s health? If the latter is true, then research is needed to
investigate how abuse impacts women’s experiences of stress. While experiencing
abuse is clearly the issue, how the abuse affects other aspects of women’s lives is
important to intervention efforts. The current study will focus on two important
mental health outcomes documented in the woman battering literature, depression and
suicide. A brief review of these specific mental health outcomes follows.
ssion
Multiple studies have documented the presence of depression in women who
have been abused by their partners. Sato and Heiby (1992) found that almost one half
(47%) of their sample of women involved in battered women’s groups or shelters
reported clinically significant levels of depressive symptoms, and concluded that
women who have experienced severe battering may be at particular risk for depression
and other forms of psychological distress. Cascardi and O’Leary (1992) found similar
rates of depression (52%) in their sample of women who had used a community
agency for women with abusive partners. Further, rates of depression for women with
abusive partners have been found to be higher when compared to both the general
p0pulation and women who are not experiencing abuse from an intimate partner
(American Psychiatric Association, 1987; Campbell, 1989a; Gleason, 1993; Jaffe et al.,

1986; Kessler, McGonagle, Zhao, Nelson, Hughes, Eshleman, Wittchen, & Kendler,

A

 

 

 

 

22

1994; Walker, 1984). Prevalence rates of depression for women in the general
population have been estimated to range from 7 to 13 percent during any given year,
and from 15 to 21 percent during one’s lifetime (American Psychiatric Association,
1987; Kessler et al., 1994).

Research studies investigating the prevalence of depression in women with

abusive partners report rates higher than those for women in the general population.

In research comparing women who received assistance from a battered women’s

agency with a comparison group of randomly sampled women from across the United

States, Gleason (1993) found that the prevalence of depression was higher in the

Women who had been battered. Other studies have documented high levels of

depressive symptoms in women who have experienced abuse from a partner as well
(Campbell, 1989a; Mitchell & Hodson, 1983; Rounsaville, 1978; Straus & Gelles,
1987; Walker, 1984).

One of the only longitudinal studies examining the relationship between women

With abusive partners and depression suggests that abusive experiences are directly
l'elated to depression. Campbell, Sullivan, and Davidson (1995) found that while 83
Percent of the women reported feelings of depression at the initial interview
(inimediately afier exit from a domestic violence shelter), reported rates of depression
dropped to 58 percent ten weeks later and 59 percent at the six—month follow up.
I"loreover, continued physical and emotional abuse from a partner was significantly
correlated with depression. Additional factors found to be related to depression were

quility of life, perceived social support, and fear and anxiety (Campbell et al., 1995).

‘

 

 

 

 

 

 

23
There is considerable evidence indicating that experiences of abuse signficantly

contributes to women’s experiences of depression. The results of research conducted
by Mitchell and Hodson (1983) and Walker (1984) demonstrate the need to control for
possible confounds, however. Although the participants in their studies were all
experiencing abuse, indicating that higher levels of depression may be expected, they
found that women who were unemployed, had lower incomes, and less education

experienced increased depression (Mitchell & Hodson, 1983; Walker, 1984). A

criticism of previous research has been that the nature of the relationship between

women’s experiences of abuse and psychological health outcomes has not been

Studied. It is easy to imagine how experiences of abuse might directly affect women’s
level of depression, in terms of women fearing for their safety and/or the safety of
their children or women feeling deceived by the abusive behavior of their partners.
Alternatively, women’s experiences of abuse may increase their level of stress, thereby
illcr'easing their level of depression. Of the aforementioned studies, only Mitchell &
HOdson (1983) proposed to examine the impact of stress on the psychological health of
WOmen with abusive partners. Their operationalization of stress, however, was level of
Violence. No study has examined how experiences of abuse specifically contribute to
Women’s level of stress and consequent psychological health outcomes, such as
depression.
m

A final grave health risk for women is suicide. Experiences of abuse are

thought to be one of the most important precipitating factors in women’s suicide

atliempts (Goodman et al., 1993a). It is estimated that 26 percent of the women who

 

 

 

 

 

 

 

 

 

 

 

 

24
attempt suicide are victims of domestic violence (Randall, 1990). In an examination
of 100 women in a battered women’s shelter, Gayford (1975) established that fully one
halfof the participants had tried to commit suicide at least once. Attempts to commit
suicide and suicidal thoughts are consistently reported among a substantial percentage
of this population (Amaro et al., 1990; Gleason, 1993; Hilberman & Munson, 1977-78;
King, 1981; Koss, 1990; Mills, Rieker, & Carmen, 1984; Stark & Flitcraft, 1982; Stark
& Flitcraft, 1988; Straus & Gelles, 1987).

While there appears to be evidence for the contention that women with abusive
partners experience negative physical and psychological health outcomes, the extent to
which abuse predicts these physical and psychological health outcomes is less clear.
Alternate explanations may explain part of the observed relationships between abuse
and health in past studies. Much of the previous research has not included comparison
groups of non-abused women, but has been conducted with women living with

l'esmicted incomes. For this reason, it is important to examine the potential effects of
Poverty on women’s health.
Effects of Poverty on Women’s Health

Research has demonstrated that persons undergoing stress or emotional
Problems are at greater risk for diseases (Greywolf, Ashley, & Reese, 1982; Holmes &
Masuda, 1974; Seyle, 1956). Women living in poverty who continually face a variety
of hardships would intuitively seem to be at greater risk for developing health
Problems. Indeed, the relationship between poverty and poor health outcomes has
been documented repeatedly in the literature (Adler, Boyce, Chesney, Cohen, Folkman,

I<Iflhn, &. Syme, 1994; Belle, 1982; Haan, Kaplan, & Syme, 1989). Illsley and Baker

 

25
(1991) reported that socioeconomic status differences are found for rates of mortality
and morbidity from almost every disease and condition. In research that specifically
examined mental health outcomes for women living in poverty, researchers found that
women frequently recounted experiences of health problems such as ulcers, alcoholism,
migraines, hypertension, and pneumonia as well (Greywolf et al., 1982).

Research examining the relationship between poverty and mental health has
intimated that poverty is related to poorer mental health outcomes. While one study
found no relationship between depression and education, income, or the number of
children the woman had (Sato & Heiby, 1992), it is important to note that their sample
was exclusively a shelter sample and likely lacked the variability (particularly for
income) to detect any differences that may have existed between their "depressed" and
"not depressed" groups. Prior research has suggested that women who use shelters are
Ofien unemployed or work in low income jobs (Hofeller, 1982; Okun, 1986). In

Contrast to the above findings, a study that examined the potential stresses leading to
high rates of depression among low-income mothers found that level of depression was
I'Clated to amount of stress (i.e. poverty) and support in one’s environment (Belle,
1982). Overall, the researchers concluded that low-income women have high rates of

depressive symptoms and other mental health problems compared to population base

rates (Belle, Dill, Feld, Greywolf, Reese, & Steele, 1982). Mirowsky and Ross’s
(1989) review of the literature indicated that employed persons and persons with
higher incomes are less depressed. Moreover, studies that have compared the
Dnevalence of depression and depressive symptoms between different levels of SES

Ms have found an inverse relationship between these variables (Adler et al., 1994;

 

 

 

 

 

   

26
Kaplan, Roberts, Camacho, & Coyne, 1987; Murphy, Olivier, Monson, Sobol,
Federman, & Leighton, 1991).
This brief review of the literature supports a relationship between SES and
health outcomes. Women living in poverty are likely to have poor physical and

mental health outcomes. While much of the past research with women with abusive

 

 

 

 

partners has recruited samples that are primarily composed of low SES women, many
1 of these studies have not included comparison groups in their design. Future research
that investigates the relationship between battering and women’s physical and mental
health must include comparison groups, holding poverty constant, so that competing
hypotheses can be eliminated.

Another conceptual flaw in past research examining the relationship between

Women’s experiences of abuse and health outcomes is the failure to fully incorporate

 

the constructs of stress and coping. While the concept of stress has been integrated to
the extent that studies have measured "stress-related" symptoms, the hypothesis
fl‘equently asserted in the literature that experiences of abuse lead to increased stress
has been virtually untested. Further, as mentioned previously, research in this field has

not yet addressed the notion that women may be differentially affected by their

AAA“

i ~ eXperiences of abuse. Perhaps the coping strategies employed by women or the level
of social support received influence the potential adverse consequences to physical and
DSychological health. Goodman et al. (1993a) stated that although women of diverse
circumstances experience physical and sexual assault, women who live under high
Stress and have few coping resources are at especially high risk for negative

Psychological health outcomes. While this certainly may be true, the literature on

 

   

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women with abusive partners has yet to empirically test this assertion. This next
section will discuss these issues in greater detail.
The Relationship Between Stress and Health

Women’s experiences of abuse has been linked to poor health outcomes.
However, the precise nature of this relationship is less understood. One of the most
popular, and reasonably intuitive, explanations for why this relationship exists uses
stress as a conceptual framework. Experiencing abuse is thought to place significant
stress on the individuals in that situation, causing higher rates of negative health
outcomes.

The relationship between stress and physical and mental health has been
Stablished in the stress literature (Caplan, 1964, 1981; Dohrenwend, 1978;
DOhrenwend & Dohrenwend, 1974; 1981; Felner, Farber, & Primavera, 1983; Selye,
1956, 1982). Selye (1956) was among the first prominent researchers to document a
link between stress and physical health. It was not until later that researchers
eI'Eperimented with the idea that stress may negatively affect mental health as well
(Caplan, 1964; Lazarus, 1966). Stress has been conceptualized as a state that occurs

When persons perceive that events in their environment have created emotional or task
demnds that exceed their ability to cope (Adler et al., 1994; Lazarus & Folkrnan,
1984). This has resulted in the operationalization of stressors as exposure to life
eVents that require adjustment or adaptation (Adler et al., 1994; Felner, Farber, &
l)l’imavera, 1983; Holmes & Rahe, 1967), as persistent life strains (Pearlin, Lieberman,

Memghan, & Mullan, 1981), and as daily hassles and difficult life circumstances that

   

 

 

28
are ongoing in a person’s life (Carver, Scheier, & Weintraub, 1989; Kanner, Coyne,
Schaefer, & Lazarus, 1981).
However, not all persons are similarly affected by experiencing the same
stressful event. Lazarus & F olkman’s (1984) model of stress suggests that the
interpretation of stressful events, the perception of potential threats and harms, and
one’s perceived ability to cope with them, all have an impact on subsequent physical
and psychological health. Likewise, other researchers have investigated the
psychological and situational factors that moderate the effects of stress on physical and
mental health. The following factors are those that have consistently been reported to
moderate or mediate the negative physical and psychological health effects of stress: 1)
the individual’s perceptions, needs, and values (Aneshensel & Gore, 1991; Turner,
Kessler, & House, 1991), 2) social support (Aneshensel & Frerichs, 1982; Aneshensel
& Gore, 1991; Billings & Moos, 1981; Bloom, 1992; Cobb, 1976; Cohen & Wills,
1985; Dohrenwend, 1978; Fiore, Coppel, Becker, & Cox, 1986; House, Umberson, &
Landis, 1988; Kessler, Price, & Wortman, 1985; Levine & Perkins, 1988; Pilisuk &
Minkler, 1985; Turner et al., 1991), 3) financial and material resources (Dohrenwend,
1978; Allen & Britt, 1983), and 4) other individual coping resources (Aneshensel &
Gore, 1991; Levine & Perkins, 1988; Turner et al., 1991).

In the case of women with abusive partners, the emotional toll of living in
cOlrstant fear of assault and physical harm certainly is a potential stressor that could
Wt in negative physical and psychological health symptoms. Battering may
represent a stressor with particularly negative consequences for additional reasons.

Felner et al. (1983) reported that two properties of life events found to be significantly

 

 

 

 

f—

29
related to their impact were the extent to which the event can be anticipated and the
individual’s perception of control over its occurrence. Women involved in battering
relationships often recount stories pertaining to the fact that they never knew when a
violent episode was coming. It is not uncommon to hear accounts of being woken
from sleep only to find themselves in the midst of an abusive situation. Further,
women often will relate the different ways in which they changed their behavior to try
and prevent another violent incident. For women who remain in the abusive
relationship, attempts to prevent future violence are overwhelmingly futile. Given that
abusive episodes typically cannot be anticipated or controlled, it may be likely that the
stress of abuse increases women’s risk for negative physical and mental health
outcomes.

Social support was one factor discussed above as moderating the relationship
between level of stress and experiences of negative psychological health sequelae.
Only one study has explicitly examined social support as moderating the relationship
between stress (i.e. abuse) and psychological health. Mitchell & Hodson (1983) did
not find that social support moderated the relationship between experiences of abuse
and negative psychological health sequelae. However, their measure of social support
was operationalized as number of persons in their network, contact with individuals in
their network, and type of response of persons in their network to their battering
situation (either avoidant or empathic). This is important to note because researchers
have determined that evidence for the buffering model of social support is most likely
to be found when the measure assesses the perceived availability of support in

response to nwds elicited by stressful events (Cohen & Wills, 1985). Thus, it may be

‘

 

 

 

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30
that the operationalization of social support in Mitchell & Hodson’s (1983) study
partly explains why they did not find social support to moderate the relationship
between abuse and psychological health. Clearly, future research that explores the
moderating effects of social support must attend to this measurement issue.

More generally speaking, findings from the few studies in the woman battering
literature that have examined the relationship between social support and psychological
health indicate that social support is positively related to better psychological health.
Mitchell & Hodson (1983) found that psychological adjustment in their sample of
battered women was positively impacted by increased support from informal sources.
Other studies have similarly found that perceived social support was significantly
related to feeling less depressed (Sato & Heiby, 1992; Campbell et al., 1995). Only
Follingstad et al.’s (1991) research indicated that social support did not significantly
predict the number of physical and psychological health symptoms women
experienced. Unfortunately, most research findings on the social support of women
involved with violent partners indicate that they are frequently socially isolated
(Dobash & Dobash, 1979; Dobash, Dobash, & Cavanaugh, 1985; Mitchell & Hodson,
1983; Walker, 1984), although one study revealed adequate levels of social support
among this group of women (Sato & Heiby, 1992). Overall, these findings suggest
that another reason the stress of battering may negatively impact women’s physical and
mental health is due to their reduced level of social support.

Again, however, income may explain part of this relationship. Low SES may
increase stress by increasing the likelihood of experiencing negative life events, and by

reducing the social, psychological, and material resources needed to successfully cope

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with stressful life events (Adler et al., 1994; Allen & Britt, 1983). Aneshensel & Gore
(1991) described that chronic stressful life conditions may increase a person’s
susceptibility to the negative impact of life stressors. Poverty easily qualifies as a
chronic stressful life condition. Persons living in poverty must deal with inadequate or
unaffordable housing, safety concerns for themselves and their loved ones, apathy from
formal institutions originally created to provide resources and support (such as the
education, medical, social service, and legal systems), and other concerns stemming
from a lack of financial stability. Indeed, McLeod & Kessler (1990) found that
persons of low SES are more likely to experience undesirable life events than their
economically advantaged counterparts.

The potential buffering effects of social support are unclear for women living
in poverty. Multiple researchers have posited that opportunities for forming,
maintaining, and accessing formal and/or informal supportive networks are lessened for
persons of low SES, decreasing the likelihood of buffering the stressors that emerge
(Adler et al., 1994; Cohen & Wills, 1985; House, Kessler, Herzog, Mero, Kinney, &
Breslow, 1991; McLeod & Kessler, 1990). One reason for this may be because the
informal social networks of poor women likely consist of others who are similarly
situated financially, diminishing their ability to rely on them for specific supportive
flmctions, such as providing material support (Belle, 1990). However, etlmographic
research has documented that members of lower-status groups may have more access
to supportive relationships than members of high-status groups, at least among the
Black community (Stack, 1974). In a study that examined the role of social support

on psychological consequences of economic stress Whelan (1993) found that social

A

 

 

32
support did buffer the effects of economic stress on emotional well-being. Whelan
(1993) did note, however, that even when instrumental and emotional support were
available chronic economic strain had a detrimental effect on emotional well-being.

In addition to social support, material and financial resources and individual
coping resources have been demonstrated to moderate the relationship between
experiences of abuse and poor physical and psychological health. Individual coping
strategies are thought to have a protective function with respect to psychological health
in three ways. First, through eliminating conditions giving rise to the problems;
second, through perceptually controlling the meaning of the stressful experience in a
manner that reduces the likelihood it will be interpreted as problematic; and third,
through keeping the emotional consequences of the stressful experience within
manageable limits.

In the case of experiencing violence from an intimate partner, however, it Xis
unclear whether or not women’s coping responses can effectively protect psychological
health. Due to the fact that male partners use violence as a means of gaining power
and control over their intimate partners, the only effective strategy in eliminating the
violence perpetrated against women has been physical separation from an abusive
partner. Even after separation, women are not guaranteed freedom from their abuse.
Time, financial resources, and legal intervention are all often needed to eliminate the
violence in women’s lives. While acts of separation or initiating legal intervention can
be conceptualized as active coping strategies, the investment of time, energy, and
resources may call into question the first described protective function of coping in this

situation. The second protective function described above seems equally questionnable

A

 

 

33
in this case. While women may interpret the first violent incident as an aberration, it
is likely that women who have experienced repeated abuse from an intimate partner
will find this problematic. The third protective function of coping, that of helping to
manage the emotional stress of the situation in such a way as to reduce the negative
impact on psychological health seems the most plausible.

It is important to investigate whether or not coping impacts the psychological
health of women with abusive partners because individuals who have poor
psychological health in the face of stressful life experiences are frequently blamed for
not possessing the coping resources necessary to deal with their problems. They are
viewed as having individual deficits. In the case of women with abusive partners,
however, it is possible that regardless of their use of coping strategies, the persistent
strain of existing in an abusive relationship and the stresses consequent to that
relationship result in poor psychological health. This would suggest that poor health
outcomes are a product of environmental factors, rather than individual deficits.
Pearlin & Schooler (1978) have acknowledged that coping effectiveness may vary as a
function of the stressful situation. If, on the other hand, coping resources are found to
moderate the relationship between stress and psychological health then that may help
to explain why women’s health is differentially affected by experiences of abuse.

Rationale for the Present Study

Although the body of literature investigating the effects of abusive experiences
on women’s health has grown rapidly, there are still wide gaps in our existing
knowledge, due to the conceptual and methodological flaws recently discussed.

Methodological and conceptual weaknesses of previous research include: 1) a lack of

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34
comparison groups, 2) discrepancies in the definitions of abuse, 3) a reliance on
women who had recently sought help for their abuse, usually women who have resided
at a battered women’s shelter, and 4) a failure to explicitly examine the hypothesis that
experiences of abuse lead to increased stress among women. Consequently, the
weaknesses of the previous research limit the causal inferences and conclusions that
can be drawn regarding the relationship between women’s experiences of abuse and
their health.

It is vital to include comparison groups in our research designs with women in
battering relationships. The vast majority of the research on women with abusive
partners has been descriptive in nature. While this has been an important component
of documenting woman battering as a critical social and public health problem, it is
necessary to strengthen the methods employed in this field of research to gain new and
useful knowledge. Many of the past studies have been conducted with predominantly
low SES women without including comparison groups in their designs. This severely
limits the ability to make causal inferences with respect to the relationship between
experiences of abuse and negative health outcomes.

Researchers must also be clear and specific about the definitions and types of
abuse they investigated, especially when reporting their results. Studies have varied in
terms of whether they define abuse as psychological, physical, sexual, or any
combination of the three. This is of particular importance when investigating the
physical and mental health effects of abusive experiences because symptoms vary
considerably across individuals, across social contexts, an_d across different types of

violence experienced (Goodman et al., 1993a). For example, the single largest group

A

 

35

of PTSD sufferers are rape victims (Goodman et al., 1993b). The fact that sexual
abuse is common in battering relationships has already been discussed. However, if
one only measures physical abuse and PTSD symptomatology, it may lead to an
erroneous conclusion about the strength of the relationship between physical violence
and PTSD. It could, in fact, be true that women who experienced sexual an_d physical
violence had increased PTSD symptomatology, while women who experienced
physical violence without sexual violence had lower rates of PTSD symptomatology.
The problem is that such information is unavailable in many studies. Problems such
as this, along with the prevalence rates of psychological, physical, and sexual abuse,
lead to the conclusion that investigators should include an assessment of each of these
types of abuse when purporting to examine the effects of "abuse" on health outcomes
for women.

The third problem with previous research is that the majority of research that
examined physical and mental health outcomes was conducted with convenience
samples found at battered women’s shelters, hospital emergency departments, and
public health clinics. The reliance on women who have sought help for the abuse they
have experienced, or consequences of the abuse they have experienced, is problematic
because there is no guarantee that women who seek help for their abuse are
representative of women who are experiencing abuse. Moreover, the reliance on
convenient samples such as those mentioned above is problematic because it has been
widely recognized that although battering crosses all socioeconomic levels, the women

who access the services listed above are women with fewer resources, i.e. women with

restricted incomes (Okun, 1986).

36

It seems obvious that experiencing abuse from an intimate partner is a major
stressor. Given the association between level of stress and physical and mental health
outcomes, previous research that has posited a relationship between the high
prevalence of negative health outcomes and experiences of abuse is credible.

However, the relationship between experiences of abuse and level of stress has been
virtually unexamined in prior research. It may be that experiences of abuse directly
contribute to poor physical and psychological health outcomes for women a_n_d that
experiences of abuse indirectly affects women’s health through increasing her level of
stress. Experiences of abuse can lead to other stressors that may also contribute to
poor health such as losing employment, conflicts with friends or family members,
moving, financial strains, dealing with the legal system, and threats to have children
removed from the home. Therefore, it is critical that future research address the
relationship between experiences of abuse and level of stress.

The Present Study

Research Obiectives

Previous research findings indicate that there are significant health problems for
women who have been battered by an intimate partner. Physical health problems
reported by women with abusive partners include: frequent health symptoms such as
sleep problems, headaches, stomach pain, chest pains, etc.; the use of alcohol and/or
drugs to relieve stress, increasing women’s overall use of alcohol or drugs; risk for
STD’s and AIDS; and increased utilization of health services. Mental health problems
include high levels of depression and frequent suicidal thoughts. Since the majority of

research has been conducted with women who have been abused and are also poor, the

37

extent to which these physical and mental health problems are a result of the abuse or
living with a restricted income has not been determined.

This research study had two main goals. First, to provide a detailed description
of experiences of abuse, level of stress, and physical and psychological health
outcomes for the participants in this study. Second, to elucidate the effects of abuse
on women’s health while holding poverty constant. Specifically, this study examined
the joint effects of experiences of abuse and level of stress in physical and
psychological health outcomes for women living in poverty through path analysis using
Lisrel VIII. The integration of previously studied variables into a comprehensive path
model lends further support to this study’s contribution to existing literature.

Figure l is a diagram of the path model. This path model demonstrates the
predicted relationship between experiences of abuse and level of stress. In this model,
experiences of abuse were conceptualized in three ways: 1) in terms of the presence or
absence of abuse, 2) in terms of recent psychological abuse experienced, and 3) in
terms of the overall abuse experienced. The first conceptualization was simply a
dichotomous variable of whether or not women had experienced abuse in the past year.
The second and third conceptualizations both measured abuse as a continuous variable,
but one examined solely psychological abuse and the other was a more holistic
conceptualization that included psychological, physical, and sexual abuse.

As Figure 1 indicates, level of stress was conceptualized as a combination of
the occurrence and stressfulness of life events as well as how many ongoing difficult
life circumstances were present. Both experiences of abuse and level of stress were

thought to directly impact women’s psychological and physical health, as indicated in

38

the model. Experiences of abuse were further thought to indirectly affect women’s
psychological and physical health. Also represented in the model are the predicted
buffering effects of social support and coping. Recall that previous research suggested
social support and coping are moderators of the relationship between level of stress
and psychological health, when the manner in which social support is operationalized
is attended to. Since abuse has so frequently been conceptualized as equivalent to
stress in prior research, social support and coping was predicted to moderate this
relationship as well.
Hypotheses

Experiences of abuse have been associated with negative health outcomes in the
literature. It was expected that women who are experiencing abuse would report
poorer health outcomes than women not experiencing abuse. Not only is experiencing
abuse a major life stressor by itself, but experiencing abuse from an intimate partner
potentially precipitates other life stressors as well, such as moving, separation or
divorce, concern for the safety of one’s children, financial difficulties, and legal
difficulties, to name a few. Given this assumption, the following hypotheses were

tested:

1. It was hypothesized that experiences of abuse would have a direct negative
effect on psychological health, such that experiences of higher levels of abuse

would be associated with lower levels of psychological health.

39

It was hypothesized that experiences of abuse would have a direct negative
effect on physical health, such that experiences of higher levels of abuse would

be associated with lower levels of physical health.

It was hypothesized that experiences of abuse would have a direct positive
effect on women’s experiences of stress, such that experiences of higher levels

of abuse would be associated with higher levels of stress.

It was hypothesized that stress would predict psychological health, such that
higher levels of stress in women’s lives would be associated with lower levels

of psychological health.

It was hypothesized that stress would predict physical health, such that higher
levels of stress in women’s lives would be associated with lower levels of

physical health.

It was hypothesized that stress would mediate the relationship between

women’s experiences of abuse and women’s psychological health.

It was hypothesized that stress would mediate the relationship between

women’s experiences of abuse and women’s physical health.

 

40

It was hypothesized that both social support and coping would moderate the
relationship between experiences of abuse and psychological health. That is,
there would be a significant interaction effect of social support and coping with
experiences of abuse on women’s psychological health. Specifically, the
relationship between abuse and psychological health would be strong and
positive when social support and coping are low. However, under conditions of
high social support or high coping the relationship between abuse and

psychological health would diminish.

It was hypothesized that both social support and coping would moderate the
relationship between stress and psychological health. That is, there would be a
significant interaction effect of social support and coping with level of stress on
women’s psychological health. Specifically, the relationship between stress and
psychological health would be strong and positive when social support and
coping are low. However, under conditions of high social support or high

coping the relationship between stress and psychological health would diminish.

41

 

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CHAPTER 2

METHOD

Research Design

This research study employed a cross-sectional multivariate design. This design
allowed for a description of the physical and psychological health profiles for women
living in poverty who have been abused and not abused, as well as an investigation of
the joint effects of abuse and stress on women’s psychological and physical health
Within the model, it was possible to determine the extent to which abuse affects
women’s health when women are concurrently taxed with the stress of living in
poverty.

Research Participants

Recruitment

One hundred and seven interviews were successfully completed for this study.
A minimum sample size of one hundred was selected because there were ten paths
specified in the original model. Using the general rule of thumb of ten participants
per path, this sample size was presumed to provide adequate power to conduct the
appropriate data analyses (Miller, 1986; Nunnelly, 1978). (For a more thorough
discussion of power, please see the limitations section of the discussion chapter.) A

major concern with respect to sampling for this study, given its goals, was the actual

42

43

operationalization of the independent variable of abuse, that is, the definition of
"abused" versus "non-abused" women. Although there are no longitudinal data to date
that have examined the long-term health outcomes for women with abusive partners,
research on rape survivors has suggested that negative health consequences related to
the sexual assault cease within the first year after the attack for 80 percent of survivors
(Hanson, 1990). Negative health consequences for a smaller percentage of rape
survivors may persist for years after their assault. Therefore, the category of "abused"
women consisted of women who had experienced more than one incident of physical
harm in the past six months, g women who had experienced more than one incident
of physical harm in the past year and who also had experienced continued threats in
the past six months. For women to be placed into the "non-abused" category, women
must not have experienced any threats, physical harm, or sexual violence within the
past year. (See Appendix A for a copy of the Eligibility Screening Tool).

Using these definitions there were several groups of women who were excluded
from participation in the research. Women who experienced severe psychological
abuse or threats without concurrent physical abuse and women who experienced only
one incident of physical abuse in the past year without recent threats (i.e. within the
past six months) were excluded from the sample. This was because they did not meet
the criteria for inclusion in the "abused" category, but were probably experiencing
more negative health outcomes resulting from these incidents than "non-battered"
women. Women who experienced sexual abuse from anyone who was not a partner or
ex-partner were also excluded from the sample due to the unique nature of the

negative health outcomes sometimes associated with rapes and sexual assaults. The

44

operationalizations of abuse described above were created by the researcher in
collaboration with other researchers and service providers in the field of woman abuse,
as well as by talking with women who are survivors of battering relationships.
Women in each of the two groups were defined by their status as "abused" or "non-
abused", and living with restricted incomes. Women who had incomes equal to or less
than 125% of the federally-set poverty guidelines met the income eligibility
requirement for the study. This figure, 125% of the federally-set poverty guidelines, is
the income cut-off for indigent persons to receive a variety of local community
resources. (See Appendix B for a copy of the Income Eligibility Chart).

This research project was conducted in the Greater Lansing Area of Ingham
County, Michigan and involved the cooperation of numerous institutions.
Relationships were forged with a variety of community support systems for indigent
women. The community support systems were accessed to recruit "abused" and "not
abused" women who were living with restricted incomes. Women were recruited from
the following sources: 1) Ingham County Department of Social Services, 2) Capital
Area Community Services, 3) Cristo Rey Community Center, 4) Housing Resource
Center, and 5) Economic Crisis Center. What follows is a description of the
recruitment procedures that were implemented and an explanation of how each of the
community sites mentioned above were involved. Written administrative agreements
for each of these sites were secured in order to ensure that everyone understood their
role within the research process. (See Appendix C for copies of the Administrative

Agreements).

45

Phase One: Recruiting participants who were "Med" ad "not w.
Several recruitment procedures were implemented in Phase One, the phase of
recruiting both "abused" and "non-abused" women for participation in the project.
Recruitment efforts at Phase One were targeted within the Ingham County Department
of Social Services (D.S.S.). During the pilot phase of the project, project flyers were
mailed to 250 participants (See Appendix D for a copy of the initial recruitment flyer).
Based on this mailing, the project received 16 phone calls from women who were
interested in participating. Of those 16 phone calls, 10 women met the eligibility
guidelines and completed interviews with the project. Due to the high cost of
conducting this mailing and the time and effort involved in locating women to conduct
the eligibility screen, an alternate strategy that recruited women in-person was
implemented.

One morning each week a table was set up in the lobby of the Ingham County
D.S.S. to recruit women face-to-face for several hours. Small incentives, such as
perfumed soaps, bath salts, and earrings, were offered to women who consented to
having the study explained to them and who participated in the screening. Women
were screened to meet the criteria of poverty and abuse. Poverty was defined as
mentioned above, an income equal to or less than 125% of the federally-set poverty
guidelines. The "abused" and "not abused" groups were defined according to the
criteria outlined above. Interviews were scheduled with interested, eligible women at
their earliest convenience. Business cards with the project name and phone number,

the interviewer’s name and phone number, and the date and time of the interview were

46

provided to each woman. Women were paid $10.00 for their participation in the
project at the completion of their interview.

During Phase One of the recruitment process, the interviewer assigned to
complete the actual interview was a different person than the interviewer who
conducted the eligibility screen. In this way, interviewers were blind to whether or not
the woman was "abused" when approaching the interview. All of the questions that
asked about participants’ experiences of abuse, or that would be likely to elicit a
response related to participants’ experiences of abuse, were placed at the end of
interview. These strategies were implemented to reduce the bias that interviewers may
unknowingly introduce when asking about the participants’ physical and psychological
health. Weekly records were kept that tracked the number of completed interviews for
women in each of the two categories, "abused" and "not abused". Due to the fact that
the project was able to recruit and interview "not abused" women more quickly than
the "abused" women, Phase One of the recruitment process continued until all of the
spaces available for the "not abused" participants had been filled.

Phase Two: Recruiting participants who were "M. At the beginning of
Phase Two, the project had recruited all of the "not abused" women and two-fifths of
the "abused" women. Therefore, efforts to increase the recruitment of "abused"
women were initiated. Three strategies were implemented to perform this task. First,
the in-person recruitment at D.S.S. was intensified through setting up the table in the
lobby two mornings each week, instead of just one. Since the in-person recruitment at
D.S.S. had been quite successful, it was expected that doubling the project’s

recruitment efforts there would prove fruitful.

 

 

47

Second, the cooperation of the three other cooperating community resource
agencies that serve indigent women was enlisted. These community resources included
Capital Area Community Services, Cristo Rey Community Center, and the Economic
Crisis Center. Flyers that briefly described the project had been submitted to the
respective directors of each of the community agencies for feedback prior to their
distribution. They announced that the project was interested in talking with women
who were being or who had been hurt by someone they love to participate in an
interview about their health. Interested women were requested to call the project
number to receive more information (See Appendix E for a copy of the revised
recruitment flyer). The eligibility screening for the project was either conducted by
phone or in-person if the women did not have a phone. At that juncture, interested,
eligible women were scheduled to be interviewed at their earliest convenience.

It is important to note at this point that 50 flyers were given to each of the
three agencies, and the agencies were responsible for posting and/or otherwise making
the study known to their clients. The extent to which the agencies cooperated in
distributing and/or posting the flyers is unknown, which influences the true response
rate for the study. It was estimated that only 2 of the total participants in the study
were recruited from these three sources combined: one woman from Capital Area
Community Services and one woman from Cristo Rey. It was estimated that none of
the participants were recruited from Economic Crisis Center. Given this, the flyers
may have been widely distributed and the low percentage of participants from these
sites reflects a low response rate. Alternatively, there may have been low cooperation

on the part of the staff or directors of these agencies that resulted in a small percentage

 

48

of the flyers having been distributed, indicating a high response rate. Therefore, the
following discussions related to eligibility and retention rates of women refer only to
women who were recruited in—person or who called the project number. The overall
response rate for recruitment efforts is unknown.

The third recruitment strategy that was implemented to increase recruitment of
"abused" women was a mailing. This was possible with the cooperation of the fiflh
community resource agency that participated in the study, the Housing Resource
Center (H.R.C.). The same flyer that was described above was used in a mailing to
women clients who had received emergency housing assistance for rent and/or security
deposits in the past year from the Housing Resource Center. The director of the
H.R.C. provided project staff with a room for stuffing and labeling envelopes, as well
as the names and addresses of their past clients. Women who responded to the study
announcement were screened by phone or in—person if they did not have a phone, and
were interviewed at their earliest convenience, if eligible. Only one mailing was
conducted in cooperation with the Housing Resource Center. Of the 126 flyers sent,
the project received 13 phone calls from interested women, 7 of whom were eligible.
In Phase Two, use of the three aforementioned intensified recruitment strategies was
successful in recruiting the remaining "abuse " participants. Obviously, interviewers
throughout Phase Two were not able to conduct these interviews blind to group, i.e.
"abused" or "not abused".

To summarize, at the end of both Phase One and Phase Two of recruitment,
221 women had been screened for potential participation in the study. In terms of

apparent effectiveness of the different recruitment strategies, recruiting women in

49

person through D.S.S. was by far the most effective approach in terms of cost, time,
and establishing a rapport with potential participants. While the exact figure is
unknown, it was estimated that at approximately 91.5 percent of the women who
participated in the study were recruited through D.S.S. It is important to acknowledge
that not all women who were approached agreed to participate in the screening
procedures. It is estimated that approximately one-third of the women approached
declined to be screened, although this figure was not specifically tracked. The
majority of the remaining participants, approximately 6.5 percent, were recruited
through the mailing conducted in cooperation with the Housing Resource Center. The
results of this mailing were previously mentioned. A very small number of
participants, estimated to be two, were recruited from Capital Area Community
Services and Cristo Rey Community Center. As was mentioned earlier, it is believed
that none of the participants were recruited from Economic Crisis Center. Since flyers
were handed out by the staff of these agencies, it is unknown how many flyers were
distributed, and impossible to determine how many of the flyers that were distributed
actually resulted in a response. Clearly, however, the results of this recruitment effort
suggest that more active recruitment strategies result in greater success. Recruiting in-
person was by far the most effective approach. Targeted mailings to individuals
resulted in a poor response rate, but not as poor as simply providing flyers to agencies.
The extent to which this lack of response can be attributed to the agencies’ failure to
deliver the flyers, lack of investment in whether or not their clients participated, or
general mistrust and/or disinterest in the study is unclear. See Table 1 for a summary

of the recruitment process for each of the five sites.

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50
Table 1

Summary of Recruitment Proces_s for Resegch Sites

 

Dgpartment of Social Services (D.S.S.)
Mailing (during pilot phase)

Flyers mailed:

Responses (via phone calls):

Number screened:

Number eligible:

Number interviewed:
In-person Recruitment

Number of women screened:

Number eligible:

Number interviewed:

Housing Resource Center (H.RC.)
F lyers mailed:

Responses (via phone calls):
Number screened:

Number eligible:

Number interviewed:

Capital Area Community Services (C.A.C.S.)

Number of flyers given to agency:
Responses (via phone calls):
Number screened:

Number eligible:

Number interviewed:

Cristo Rey Communig Center

Number of flyers given to agency:
Responses (via phone calls):
Number screened:

Number eligible:

Number interviewed:

Economic Crisis Center (E.C.C.)

Number of flyers given to agency:
Responses (via phone calls):

250
16
13
10
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193

106
88

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With respect to eligibility, of the 221 women screened for participation in the
project, 125 were eligible. Of the 96 women not eligible for participation, 57% were
ineligible because they were "not abused" and the project was recruiting "abused"
women only, 13% were ineligible due to being over the income eligibility cutoff point,
and 30% were ineligible because they had either experienced severe psychological
abuse or threats without concurrent physical abuse, they had experienced only one
incident of physical abuse in the past year without recent threats, and/or because they
had experienced a sexual assault from a stranger in the past year. It was expected that
a subset of the women who were initially screened in-person or by phone and were
targeted as not having experienced abuse would disclose during the course of their
interview that they were being abused or had experienced recent abuse. In practice,
this was not a barrier. All but one woman who reported not having experienced recent
abuse during the initial screen similarly reported not having experienced recent abuse
during their interview.

Of the 125 women eligible for the project, 108 women were actually
interviewed, resulting in a retention rate of 86% from the time of the screen to the
completion of the interview. The vast majority of women who did not follow through
with participation in the study were located (82%), but were simply not interested in
participating any longer at the time of the scheduled interview. Reasons given for not
wanting to participate included being too busy or overwhelmed, being worried about
the actual interview process itself, and/or being endangered by participation in the
interview. Only three women were not able to be located for their interviews. One

woman was dropped from the study after the interview was completed because she had

52

experienced ritual satanic and cult abuse and incest as a child, and was still
experiencing severe physical and psychological health problems as a result of her prior
experiences of abuse. Therefore, the final sample included 107 participants, n=50 who
were "abused" and n=57 who were "not abused".

Demographic Characteristics

The participants in this study were a racially diverse group of women. (See
Table 2 for a presentation of the relevant demographic information). Approximately
one-half (49%) of the women were non-Hispanic White, slightly less than that were
African-American (38%), and a smaller percentage of the women were Latina (9%).
There was only one participant from each of the following racial backgrounds: Native
American; Afiican-American/Latina; non-Hispanic White/Latina; and Mulatto/Native
American/African. Ages ranged from 17 to 62 years of age, with a mean age of 31
years. The vast majority of the participants had children (86%).

Much of the demographic information reflects the fact that these women were
living with restricted incomes. Over three quarters of the sample were receiving
governmental assistance (79%), which could be in the form of Aid to Families with
Dependent Children (A.F.D.C.), food stamps (F.S.), and/or Social Security Income
(S.S.I.). The majority of the sample received either Medicaid or Medicare (69%), a
small percentage had private insurance (9%), and nearly one-fourth of the sample was
without any health insurance coverage (22%). While over half of the participants had
been employed for some part of the past six months (57%), just over a third were
employed at the time of their interview (3 7%). The mean monthly income for

participants was only $766.34, and this income supported an average of three people.

Table 2

Demoggaphics of Research Participants

53

 

 

N %
RACE
Afi'ican-American 41 38
White, Non-Hispanic 52 49
Latina 10 9
Native American 1 1
White, Non-Hispanic/Latina 1 1
African-American/Latina 1 1
Mulatto/Native American/African 1 1
AGE
17-20 years 15 14
21-25 years 21 19
26-30 years 20 19
31-35 years 18 17
36-40 years 14 13
Over 40 years 19 18
RECEIVING GOVERNMENT ASSISTANCE 84 79
HEALTH INSURANCE TYPE
Private Insurance 10 9
Medicaid/Medicare 74 69
Uninsured 23 22
BEEN EMPLOYED IN PAST SIX MONTHS 61 57
EMPLOYED CURRENTLY 40 37
TYPE OF EMPLOYMENT
Sales/ Waitress 21 34
Domestic/Childcare/Janitorial 13 21
Human Services 10 16
Clerical 6 10
Factory 3 5
Managerial 1 2
Self-Employed 1 2
Other 6 10
ACCESS TO CAR 55 51

54
Table 2 (cont’d)

 

 

 

N %
NUMBER OF CHILDREN LIVING WITH HER
None 29 27
One 32 30
Two 23 21
Three 14 13
Four 5 5
Five 2 2
Six 2 2
CURRENTLY A STUDENT 20 19
EDUCATION LEVEL COMPLETED
Less than High School 39 36
High School Diploma/ G.E.D. 26 24
Some College 38 36
College Degree 1 1
Trade School Degree 2 2
Professional Degree 1 1
"ABUSED" WOMEN 50 47
"NOT ABUSED" WOMEN 57 53
WOMEN WHO HAD EVER EXPERIENCED ABUSE 77 77
(p=100)
MEAN MONTHLY INCOME $766.00
MEAN # OF PEOPLE MONEY SUPPORTS 3

 

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55

Approximately half of the women reported having access to a car (51%), meaning that
if she needed to visit the doctor, go grocery shopping, to do laundry, or some other
necessary task, that she could easily get access to a car.

The demographic information also reflects the relationship between economic
resources and education level. Nearly one-fifth of the participants were currently
enrolled in school (19%), and their educational levels varied. Close to two-thirds of
the sample had a high school diploma/equivalency degree or less, with 36% of the
participants having not yet completed high school and 24% of the participants having
completed their high school diploma or General Education Diploma (G.E.D.). Just

over a third of the women had some college coursework, but had been unable to
complete their college education (36%). Only four of the 107 participants had a
college degree, a trade school degree, or a professional degree.

The sample was split relatively evenly between women who had experienced
recent abuse (47%), the "abused" group, and women who had not experienced recent
abuse. (53%), the "not abused" group. Past research has indicated that the baseline rate
0f abuse for women involved in intimate relationships with men is one in three (Straus
& Gelles, 1987; 1988). This means that one in every three women in the US. will
experience abuse from one of her male partners at least once during her lifetime. Due
to this, women in the "not abused" group were asked if they had e_ve__r experienced
abuse from an intimate partner. One-half of the women in the "not abused" group had

experienced abuse from an intimate partner (54%), SD=.5. The average length of time
Since they had experienced this abuse was 113 months, or over nine years ago, with a

range from just over a year prior to the interview (13 months) to twenty-three years

56

ago (275 months). The average length of time that women had experienced abuse
from this partner was 1.9 years, with a mode of one day, and a range from one day to
twenty-three years.

For women in the "abused" group, seventy-six percent reported that they had
ended or were ending their relationship with their assailant. The average length of
time that women had experienced abuse from this partner was 4.4 years, with a range
from nine days to eighteen years. The average length of their relationship with their
assailant was 5.5 years, and the average number of previous separations from their
assailant was 3.5. Of the women who had been pregnant since their involvement with
their assailant, fifty-one percent of them had been physically harmed at least once
during their pregnancy.

In order to ensure that the "abused" women and the "not abused" women were
not different with respect to their demographic data, correlations were computed
between the group membership variable (i.e. abused vs. non-abused) and age, race,
education levels, whether or not women were receiving government assistance,
employment status over the past six months, status as a student over the past six
months, and number of children living with her. All of these correlations were non-
Sigtlificant (range .00 - .18), indicating that the two groups were not significantly

different with respect to important demographic variables that have been confounds in

past research.

57

Procedure

Interviewer Training

Extensive face to face interviews were conducted by the author and trained
interviewers. Undergraduate students at the university were recruited and trained as
project interviewers. Interviewers committed to working two consecutive semesters, as
part of an independent study in community psychology research methods. Interviewer
training consisted of weekly readings, thought papers, and discussions about the nature
and dynamics of woman battering, poverty, and women’s health issues. (See
Appendix F for a copy of the PSY 490 syllabus and course curriculum). Students also
gained in-depth familiarity with the interviews through learning the material in the
Interviewer’s Training Manual (see Appendix G), role playing practice interviews, and
learning proper coding techniques. These skills were mastered before they were
allowed to conduct actual interviews. At the end of training, interrater agreement on
the interview items (via percent agreement) was calculated by having each interviewer
independently code the same interview. Each interview was reviewed and a ratio was
calculated of the total number of items coded correctly to the total number of
interview items. Individual scores ranged from 99.15% to 99.79%, with a mean
percent agreement of 99.45%. Midway through data collection, percent agreement
was calculated at 99.36%. This was done to ensure continued reliability and to
monitor the quality of the data.

Additional steps were taken and incorporated into weekly case supervision to
monitor the quality of the data and to ensure consistency among interviewers. Each

week all the interviewers met to review the progress of their case(s). If an interviewer

58
was having difficulties contacting a particular woman, then the group brainstormed

strategies together and mapped out a plan for the following week. If the interview had
been completed, then each interviewer was instructed to bring coding questions or
concerns to the attention of the group. Decision rules were made within the group and
implemented so that interviews were coded similarly across interviewers. Any time
there were unanswered questions, or an item or items may have been missed,
interviewers tracked the participants again to ensure accurate responses. While this
was a rare occurrence, happening only a total of four times, it did contribute to the
overall quality of the data. Finally, every tape-recorded interview conducted by the
trained interviewers was reviewed for errors. Trained interviewers were graded on
each interview they conducted and were given weekly written feedback pertaining to
their interview coding, style, and tone.
Data Collection

All of the interviews were conducted by the trained interviewers and the author
of this study. During the eligibility screen administered at recruitment, the
interviewers explained that the purpose of the interview was to investigate women’ 3
health, and to explore potential factors that may have adverse effects on women’s
health. All of the interviews were tape recorded for verification purposes with the
participant’s consent. Women were paid $10.00 each for their participation in the
interview. (See Appendix H for a copy of the consent form).

Measures
The interview was developed based on information gathered through the

literature, suggestions and input from women who have experienced abuse in the past,

59

input and suggestions from persons with an extended background in the field of
woman battering, and previous research with women with abusive partners living in
poverty. (See Appendix I for a copy of the interview). A listing and description of
the measures that were used will follow. Prior to that discussion, however, a brief
summary of the scaling decision rules will be presented.

For each construct proposed in the model, summaries of the relevant
psychometric properties are presented, along with the rationale for either deleting
specific items within the scale or for deciding against using the construct in the model
altogether. In general, reliability analyses were conducted for all items within each
scale. Items that were identified as having low variability were then dropped from
subsequent analyses. The corrected item-total correlations generated from the
reliability analyses were examined and items with particularly low corrected item-total
correlations as compared to other scale items were dropped. In general, unless there
were conceptually compelling reasons to include an item(s), the difference between the
largest and the smallest correlations for a given scale was not greater than r=.35. This
was done to facilitate the creation of an internally consistent scale.

After these analyses had been performed on each scale, the scales and
constructs were then tested for unidirnensionality through factor analyses. Each scale
was tested through a series of factor analyses requesting the single factor solution as
well as multiple factor solutions that were theoretically determined based on the
individual scale. Factor solutions were then compared to ascertain whether it was
reasonable to use the unidimensional solution in the model or whether the data

indicated multidimensionality within the scale. In general, the three issues that were

60

part of the decision rule process included: 1) examining the factor loadings to insure
that an item loaded at least .30 on any given factor, 2) examining the eigenvalues and
the percent of variance accounted for by the factors, and 3) examining the scree plot to
visually determine whether or not the scale warranted a single factor versus a multiple
factor solution. For the scales that appeared to be multidimensional, the items making
up the various factors were examined in an attempt to assess whether or not the factors
were theoretically meaningful. After this process was completed for each of the
scales, the identical procedure was conducted on each of the constructs that were
measured by multiple scales. Changes based on these scaling procedures were then
incorporated into the revised conceptual model.
Ab_us_e

Within the model, abuse was conceptualized and tested in three different ways.
First, abuse was conceptualized as whether or not the women were screened into the
"abused" or the "not abused" group. The operationalization of each of these groups
has already been discussed. While this conceptualization of abuse provided one test of
the conceptual model, it was a single dichotomous item, and therefore no scaling
information was possible. The other two ways in which abuse was conceptualized
involved a measure of psychological abuse and a measure of overall abuse that
included psychological abuse, physical abuse, and sexual violence. The psychological
abuse measure was given to every participant who was currently involved in or had
been involved in an intimate relationship in the past six months. The overall abuse
measure was created in an attempt to capture the true nature of abuse. Women in

abusive relationships as defined by this research don’t simply experience psychological

61

abuse, or physical abuse, or sexual abuse, but instead experience a range of abusive
acts along a continuum for each of these three domains of abuse. Scaling information
for each of these two scales is presented below.

Pachological Abuse. Psychological abuse was measured using the Index of
Psychological Abuse (Sullivan, Tan, Basta, Rumptz, & Davidson, 1992), a 33-item
measure of the frequency of ridicule, harassment, and criticism experienced. Women
were asked to rate how often their partner or ex-partner engaged in hurtful behaviors
in the past six months, such as "lied to them or deliberately misled them" and
"controlled their money or activities". This 4-point scale ranged from "never" to
"often". Another item from the interview, how often they had been threatened by a
partner or ex-partner in any way was also included in this scale. The reliability
analysis led to the deletion of 3 items whose corrected item-total correlations were
substantially lower than those of the remaining 31 items. The three items that were
dropped were: 1) threatened to commit suicide when angry with her, 2) abused or
threatened to abuse pets, and 3) punished or deprived the kids when angry with her.
An internal consistency of .97 was established for this 31-item scale and the corrected
item-total correlations ranged from .55 to .88. Table 3 lists the items comprising the
psychological abuse scale, the internal consistency estimate, and the corrected item-
total correlations.

A factor analysis was then conducted to test for unidimensionality of the
psychological abuse scale. When a single factor solution was requested, factor
loadings ranged from .58 to .90. The first factor had an eigenvalue of 17.9,

accounting for nearly 58% of the variance, and there was a sharp drop in the

62
Table 3

Pachometric Promrties of the Psychological Abuse Scale

 

Scale Items Corrected Item-Total
Correlations

 

How often did her partner or ex-partner:

1. try to humiliate her .88
2. make contradictory demands or requests of her .87
3. ridicule or insult her most valued beliefs .87
4. threaten her in any way .84
5. call her names .84
6. ignore or make light of her feelings .82
7. ridicule or criticize her in public .82
8. criticize her strengths, or parts of herself she’s proud of .82
9. criticize her intelligence .81
10. withhold approval or affection as a punishment for her .81
11. ignore or make light of her anger .80
12. criticize her physical appearance or sexual attractiveness .80
13. try to control her activities .79
14. lie or deliberately mislead her .77
15. insult women as a group .77
16. criticize her family or fiiends to her .7 7
17. discourage her contact with family or friends .77
18. break or destroy something important to her .72
19. criticize her religion, race, heritage, or class .72
20. forbid her to go out without him .72
21. refuse to do things with her .68
22. try to force her to leave her home .68
23. accuse her of having/wanting other sexual relationships .64
24. threaten to end the relationship if she didn’t do what he wanted .64
25. try to control her money .63
26. tell her about other relationships he was having to hurt her .62
27. harass her family or friends in some way .62
28. leave her somewhere with no way to get home .59
29. refuse to talk with her .59
30. threaten to hurt her family or friends .57
31. threaten to take the children away from her .55

Alpha = .97

 

63

eigenvalue for the second factor. The scree plot confirmed this single factor solution,
and it was concluded that the data suggested that the psychological abuse scale was
unidimensional.

Overall Abuse. Overall abuse was measured using a composite of items from
the Index of Psychological Abuse (discussed above), a modified l6-item version of
Straus’ Conflict-Tactics Scale [CTS] (1979), and two items that assessed the presence
of sexual violence. In the modified version of the CTS, women were asked to rate
how often their assailant engaged in different acts of violence, such as pushing,
choking, and threatening them with a gun or knife, on a 6-point scale ranging from
"never" to "more than four times a week". The two items measuring sexual violence,
"being forced into sexual activity" and "whether or not their partner(s) had used threats
to have sex with them" have been used in previous research assessing sexual violence
(Hanneke et al., 1986). A reliability analysis was conducted for this 18-item physical
and sexual violence scale. Four items were dropped due to their low corrected item-
total correlations. These items included: 1) tied her up or physically restrained her, 2)
drove recklessly, 3) burned her, and 4) used a gun or knife against her. The final 14-
item subscale had corrected item-total correlations ranging from .60 to .86, and the
internal consistency estimate was .96.

A factor analysis was then conducted to test for unidimensionality of the
physical and sexual abuse scale. When a single factor solution was requested, factor
loadings ranged from .65 to .89. The first factor had an eigenvalue of 9.0, accounting
for 64.5% of the variance, and there was a sharp drop in the eigenvalue and percent of

variance accounted for with the second factor. The scree plot confirmed this single

64

factor solution, and it was concluded that the data suggested that the physical and
sexual abuse subscale was unidimensional.

Since each of the subscales in the overall abuse construct had demonstrated
unidimensionality, the overall abuse construct was then tested for unidimensionality as
well. First, factor analyses were run on all 45 items in the overall abuse construct
requesting two and three factor solutions. This was done to examine how the items
would load onto their respective factors. Specifically, the factor analyses indicated that
the sexual abuse items did load onto the physical abuse factor, rather than as a
conceptually separate subscale, and that both physical and psychological abuse did, to
some extent, load onto two separate factors, as expected.

Second, a single factor solution on the 45 item overall abuse scale was
requested. Factor loadings for the single factor solution ranged from .50 to .89. The
first factor had an eigenvalue of 24.1, accounting for 52.4% of the variance, and there
was a sharp drop in the eigenvalue and percent of variance accounted for with the
second factor. The scree plot confirmed that the overall abuse scale demonstrated
sufficient unidimensionality and that the construct of overall abuse could be used in
subsequent analyses. A reliability analysis was conducted on the overall abuse scale.
As Table 4 indicates, the internal consistency estimate for this 45-item scale was .98,
with a range of corrected item-total correlations from .50 to .88. The results of these
analyses on the overall abuse scale indicated that the conceptual grouping of
psychological, physical, and sexual abuse items into a composite score was justified in
terms of measurement-related issues. Therefore, the model was run using the three

conceptualizations of abuse mentioned earlier, the presence or absence of abuse,

65
Table 4

Psychometric Progrties of the Overall Abuse Scale

 

Scale Items Corrected Item-Total
Correlations

 

How often did her partner or ex-partner:

1. threaten her in any way .88
2. try to humiliate her .85
3. make contradictory demands or requests of her .84
4. grab her .83
5. ridicule or insult her most valued beliefs .82
6. ridicule or criticize her in public .81
7. push or shove her .80
8. criticize her strengths, or parts of herself she’s proud of .80
9. criticize her physical appearance or sexual attractiveness .80
10. call her names .80
11. criticize her intelligence .79
12. try to control her activities .77
13. break or destroy something important to her .77
14. discourage her contact with family or friends .76
15. slap her .76
16. insult women as a group .75
17. forbid her to go out without him .75
18. withhold approval or affection as a punishment for her .75
19. try to force her to leave her home .74
20. ignore or make light of her anger .74
21. ignore or make light of her feelings .74
22. lie or deliberately mislead her .73
23. criticize her family or friends to her .73
24. use threats to try and have sex with her .72
25. hit her with a fist .71
26. throw something at her .71
27 . beat her up .70
28. criticize her religion, race, heritage, or class .70
29. attempt to hit her with an object .69
30. break her glasses or tear her clothing .67
31. harass her family or friends in some way .65
32. choke her .65
33. refuse to do things with her .65
34. accuse her of having/wanting other sexual relationships .64
35. threaten to end the relationship if she didn’t do what he wanted .64
36. kick her .63

66
Table 4 (cont’d)

 

Scale Items Corrected Item-Total
Correlations

 

How often did her partner or ex-partner:

37. try to control her money .63
38. leave her somewhere with no way to get home .61
39. threaten to hurt her family or friends .59
40. force any unwanted sexual activity .59
41. threaten her with a gun or knife .57
42. tell her about other relationships he was having to hurt her .55
43. refuse to talk with her .52
44. threaten to take the children away from her .51
45. hit her with an object .50

Alpha = .98

 

67

experiences of psychological abuse, and experiences of overall abuse, which included
psychological, physical, and sexual abuse items.
Physical Health

Within the model, physical health was conceptualized as a composite of three
separate measures. These measures included physical health symptoms, alcohol and
drug use, and risk for contracting HIV/STD. Scaling information for each of these
three individual measures is presented below. Following that is a summary of the
results of the test for unidimensionality of the physical health construct.

Physical Health Symptoms. Physical health symptoms were measured using an
adaptation of the Cohen-Hoberman Inventory of Physical Symptoms [CHIPS] (1983).
The original scale was modified to include the physical symptoms that have been
predominant in populations of women with abusive partners, such as choking
sensations, ulcers, and pelvic pain (Campbell, 1989a, 1989b; Rodriguez, 1989).
Participants were asked to provide two ratings for each of the physical health
symptoms. First, women were asked to rate on a 6-point scale, ranging from "never"
to "more than four times per week", how often they had been bothered by each of the
physical health symptoms. Second, for women who had experienced abuse and had
endorsed an item on the health symptom scale, women were asked to indicate whether
or not they felt a specific health symptom was a result of their abuse. This second
rating was be used for descriptive purposes only.

A reliability analysis was performed on the 35-item frequency of health
symptoms scale. Four items were deleted due to their low corrected item-total

correlations when compared to the correlations for the remaining scale items. The

68

deleted items were constipation, diarrhea, migraine headaches, and ulcers. The six
additional items that had low corrected item total correlations were the gynecological
symptoms. Due to the fact that these items were part of a conceptual grouping, a
separate gynecological symptoms scale was created. The final health symptom scale
was composed of 25 items. Table 5 provides a summary of the scale’s psychometric
properties. As shown in the table, the internal consistency estimate for this scale was
.94 and the corrected item-total correlations ranged from .47 to .76.

A factor analysis was then conducted to test for unidimensionality of the
physical health symptoms scale. When a single factor solution was requested, factor
loadings ranged fi'om .50 to .79. The first factor had an eigenvalue of 10.3,
accounting for 41.4% of the variance, and there was a sharp drop in the eigenvalue
and percent of variance accounted for with the second factor. The scree plot
confirmed this single factor solution, and it was concluded that the data suggested that
the physical health symptom scale was unidimensional.

Gynecological Symptoms. As was discussed previously, a 6-item gynecological
scale was created due to the results of previous scaling analyses. The six items
comprising this scale included pelvic pain, abnormal vaginal bleeding or discharge,
painful intercourse, rectal bleeding, bladder infections, and painful urination. The
reliability analysis for this scale estimated the internal consistency to be .66, with item-
total correlations ranging from .27 to .56. See Table 6 for a summary of the
psychometric properties of the gynecological symptoms scale.

Similar to the other scales, a factor analysis was conducted to test for

unidimensionality of the gynecological symptoms scale. When a single factor solution

69
Table 5

Pachometric Promrties of the Physical Health Symptoms Scale

 

 

Scale Items Corrected Item-Total
Correlations

How often was she bothered by:

1. Feeling weak all over .76
2. Constant fatigue .71
3. Numbness or tingling in parts of her body .67
4. Heart pounding or racing .66
5. Muscle cramps .66
6. Severe aches and pains .66
7. Pains in her heart or chest .65
8. Blurred vision .64
9. Sleep problems, waking up in the night or early in the morning .62
10. Dizziness .61
11. Hot or cold spells .61
12. Hands trembling .61
13. Back pain .60
14. Acid stomach or indigestion .59
15. Shortness of breath when not exercising or working hard .59
16. Muscle tension or soreness .57
17. Faintness .57
18. Stomach pains .56
19. Poor appetite .56
20. Feeling low in energy .56
21 . Nightmares .55
22. Nausea and/or vomiting .53
23. Ringing in her ears .52
24. Choking sensations .51
25. Headaches .47

Alpha = .94

 

70
Table 6

Pachometric Properties of th_e Gynecological Symptoms Scale

 

Scale Items Corrected Item-Total
Correlations

 

How ofien was she bothered by:

1. Pelvic pain .56
2. Painful urination .54
3. Bladder infections .40
4. Rectal bleeding .39
5. Painful intercourse .34
6. Abnormal vaginal bleeding or discharge .27

Alpha = .66

 

71
was requested, factor loadings ranged from .39 to .83. The first factor had an

eigenvalue of 2.5, accounting for 40.8% of the variance, and there was a sharp drop in
the eigenvalue for the second factor. The scree plot confirmed this single factor
solution, and it was reasonably concluded that the gynecological symptoms scale was
sufficiently unidimensional. Since the scale was found to be unidimensional, it is
reasonable to assume that the relatively low internal consistency estimate was largely
due to random measurement error (Cortina, 1993). Due to the fact that random error
in a dependent variable does not bias parameter estimates, but serves only to decrease
power (Pedhazur, 1982), it was concluded that an alpha value of .66 was acceptable
for inclusion of the gynecological symptoms scale in the study.

Alcohol and Drug Use. Several different items were used to measure women’s
alcohol and drug use. First, women were asked to indicate on a 6-point scale, ranging
from "never" to "more than four times per week", how often they used alcohol,
marijuana, non-prescribed drugs (such as cocaine, crack, speed, heroin, etc.), sedatives
or tranquilizers, and anti-depressants. If endorsed, women were then asked to provide
a second rating indicating whether or not they have used any of those substances to
relieve stress in the past six months. Finally, participants were asked whether or not
they thought they had a problem with alcohol or drugs. The combination of these
items resulted in a 12-item alcohol and drug use scale. A reliability analysis led to the
deletion of 2 items whose corrected item-total correlations were substantially lower
than those for the remaining 10 items. Frequency of anti-depressant use and use of
anti-depressants to relieve stress were the two items that were dropped. An internal

consistency of .85 was established for this scale and the corrected item-total

72

correlations ranged from .40 to .70. Table 7 lists the items comprising the alcohol and
drug use scale and provides the internal consistency estimate and the corrected item-
total correlations.

A factor analysis was then conducted to test for unidimensionality of the
alcohol and drug use scale. Factor loadings ranged from .48 to .79 with a single factor
solution. The first factor in this solution had an eigenvalue of 4.3, accounting for
43.4% of the variance, and there was a sharp drop in the eigenvalue and percent of
variance accounted for with the second factor. The scree plot confirmed that it was
reasonable to use a single factor solution and that the alcohol and drug use scale
satisfied the condition of unidimensionality.

Risk for HIV/STD_s_. These variables were assessed using a modified version of

 

the Risk Assessment Questionnaire used by the Ingham County Health Department.
This questionnaire is used as an assessment tool by the county when a person comes in
for either a STD or HIV screen. The questionnaire included items relating to the
number of sex partners in the past six months, use of alcohol or drugs during sex, and
use of condoms and foam during sexual activity. Respondents were also asked about
their knowledge of their partners’ drug use. Individual items were designed to assess
the frequency that a person is engaging in behaviors that would put them "at-risk" for
contracting a STD or HIV.

It was anticipated that this scale would be comprised of 10 items. Two items,
whether or not she had shared needles to shoot up and whether or not she had used
dirty needles, were dropped due to lack of variance. None of the participants in this

sample reported engaging in either of these behaviors. A reliability analysis led to the

73

Table 7

Psychometric Promrties of the Alcohol and DruLUse Scale

 

 

 

Scale Items Corrected Item-Total
Correlations

1. Frequency of non-prescribed drug use,

such as cocaine, crack, speed, heroin, etc. .70
2. Use of non-prescribed drugs to relieve stress .65
3. Frequency of alcohol use .62
4. Self-perception of having a problem with drugs .60
5. Self-perception of having an alcohol problem .55
6. Use of marijuana to relieve stress .54
7. Use of alcohol to relieve stress .52
8. Frequency of marijuana use .51
9. Frequency of sedative or tranquilizer use .46
1 . Use of sedatives or tranquilizers to relieve stress .40

Alpha = .85

 

74

deletion of four additional items due to their low variance and therefore low corrected
item-total correlations. These items included exchanging sex for something she
needed, having partners who shot up with drugs, having partners who lived in a big
city, and engaging in high-risk behaviors with a person who was HIV positive.
Therefore, a 4-item scale remained. Two of the remaining items, her use of alcohol
and drugs during sex and her partner’s use of alcohol and drugs during sex, loaded
more strongly on the alcohol and drugs scale than the HIV/STDs scale in subsequent
factor analyses. Further, 93.5% of the sample reported either having no sexual
partners in the past six months or having only one or two sexual partners in the past
six months. Due to the fact that only one item remained that assessed her risk for
contracting HIV/STD, "her frequency of condom and spermicide use", the HIV/STD
scale was omitted from the conceptual model.

It was unexpected that the HIV/STD scale would be an ineffective measure for
this population. However, as previously mentioned, six of the ten items were omitted
due to no or low variance. That the two alcohol-related questions loaded more highly
on the alcohol and drug use scale than they did on the HIV/STD scale may be
explained in part by the fact that all of the drug-related risky behavior items had been
dropped. Given that more than nine out of ten participants reported zero to two sexual
partners in the past six months, it was decided that the item related to number of
partners in the past six months was insufficient in differentiating high-risk vs. low-risk
women. At this juncture, only one item remained, frequency of condom use, and it
was thought that this would be inadequate to represent the construct "Risk for

HIV/STDs". While using condoms certainly can prevent exposure to both HIV and

75

STDs, most of the women in this sample reported that they were involved in long-term
relationships. Therefore, lack of condom use in this sample appeared to be as much a
reflection of the nature of their relationships as it was a reflection of their actual risk
for contracting HIV or STDs. It is believed that future research interested in
investigating this construct needs to investigate women’s partners’ behaviors in
addition to women’s behaviors in order to adequately assess risk. Descriptive
information about this. construct is presented in the results section.

Physical Health Construct. The conceptual model had originally proposed a
physical health construct composed of physical health symptoms, alcohol and drug use,
and risk for HIV/STDs. The aforementioned scaling analyses resulted in a final
physical health construct that included physical health symptoms, gynecological
symptoms, and alcohol and drug use. Since each of the subscales in the final physical
health construct had demonstrated unidimensionality, the final physical health construct
was tested for unidimensionality. First, factor analyses were run on all items in the
physical health construct requesting a three factor solution. This was done to examine
how the items would load onto each factor. Results from the factor analyses indicated
that the physical health symptom items, the gynecological symptom items, and the
alcohol and drug use items loaded onto three separate factors. Specifically, factor
loadings, eigenvalues for each factor, percent of variance accounted for, and the scree
plot were examined and revealed that the data suggested a three factor solution. Table
8 presents the factor loadings for items on each of the three factors. The eigenvalue
for Factor 1 was 12.0, accounting for 28.6 percent of the variance, the eigenvalue for

Factor 2 was 4.0, accounting for 9.5 percent of the variance, and the eigenvalue for

76

 

 

 

Table 8

Factor Loadings for the Physical Health Symptom Scalp

(N=107)

Item Factor 1 Factor 2 Factor 3
Frequency of alcohol use .07 .72 .25
Frequency of marijuana use -.05 .66 .01
Frequency of drug use .21 .75 -.24
Frequency of tranquilizer use .47 .38 -.09
Self-rating of alcohol problem .16 .65 .23
Self-rating of drug problem .18 .68 -.10
Used alcohol to relieve stress .08 .63 .30
Used pot to relieve stress .05 .68 .04
Used drugs to relieve stress .13 .73 -.24
Used tranquilizers to relieve stress .35 .35 -.05
Sleep problems .64 .11 .12
Nightmares .44 .20 .41
Back pain .68 .08 .00
Dizziness .58 -.08 .34
Faintness .49 .OO .44
Constant fatigue .78 -.02 .10
Migraine headaches .44 .14 -.09
Headaches .48 .22 . 12
Nausea or vomiting .50 .05 .26
Acid stomach/ indigestion .61 .06 .15
Stomach pain .52 -.05 .39
Hot or cold spells .60 .02 .21
Hands trembling .57 .18 .23
Heart pounding or racing .54 -.04 .57
Poor appetite .49 .33 .23
Shortness of breath .59 .17 .13
Numbness or tingling .72 .11 .07
Choking sensations .50 .31 .15
Feeling weak all over .75 .27 .13
Pains in the heart or chest .50 .10 .55
Feeling low in energy .64 -.08 .10
Blurred vision .69 .06 .08
Muscle tension or soreness .58 .19 .12
Muscle cramps .58 .16 .36
Aches and pains .74 .13 .00
Ringing in ears .45 .22 .33

Table 8 (cont’d)

77

 

 

Item Factor 1 Factor 2 Factor 3
Pelvic pain .28 .14 .66
Vaginal bleeding or discharge .14 -.13 .30
Painful intercourse .01 .12 .58
Rectal bleeding .29 -.14 .27
Bladder infections -.11 .03 .57
Painful urination .11 -.05 .65

 

78

Factor 3 was 2.4, accounting for 5.6 percent of the variance. Since unidimensionality
for the physical health construct could not be reasonably established, each of the three
components of the physical health construct were treated as separate dependent
variables in the conceptual model.

Psychological Health

Within the model, psychological health was conceptualized as a composite of
three separate measures. These measures included suicide, depression, and quality of
life. Scaling information for each of these three individual measures is presented
below. Following that is a summary of the results of the test for unidimensionality of
the psychological health construct.

Sm. Risk for suicide was assessed through three items. Women were
asked how often they had thought about committing suicide in the past six months,
whether or not they had told anyone they wanted to commit suicide, and whether or
not they had ever attempted suicide. A reliability analysis of this 3-item scale
established an internal consistency estimate of .69, with corrected item-total
correlations ranging from .38 to .61. Table 9 lists the psychometric properties of the
suicide scale.

A factor analysis was then conducted to test for unidimensionality of the
suicide scale. Factor loadings ranged from .66 to .87 with a single factor solution.
The first factor in this solution had an eigenvalue of 1.9, accounting for 61.8% of the
variance, and there was a sharp drop in the eigenvalue and percent of variance

accounted for with the second factor. The scree plot confirmed that it was reasonable

fillu Al. m \\In

79
Table 9

Psychometric Promrties of the Suicide Scale

 

 

Scale Items Corrected Item-Total
Correlations
1. Frequency of suicidal thoughts .61
2. Whether or not she’s disclosed suicidal thoughts .52
3. Whether or not she’s attempted suicide .38

Alpha = .69

 

80

to use a single factor solution and that the suicide scale satisfied the condition of
unidimensionality.

Depression. Risk for depression was measured by a revised version of
Radloff’s (1977) CES-D. This 20-item scale is a self-report checklist of psychological
distress within the general population. A reliability analysis led to the deletion of 4
items whose corrected item-total correlations were substantially lower than those for
the remaining 16 items. The four items that were dropped include: 1) she felt that she
was just as good as other people, 2) she felt that everything she did was an effort, 3)
she thought that people were unfriendly, and 4) she could not ’get going’. An internal
consistency of .93 was established for this 16-item scale and the corrected item-total
correlations ranged from .52 to .80. Table 10 lists the items comprising the depression
scale and their corrected item-total correlations.

A factor analysis was then conducted to test for unidimensionality of the
depression scale. When a single factor solution was requested, factor loadings ranged
from .57 to .84. The first factor had an eigenvalue of 7.4, accounting for 48.4% of
the variance, and there was a sharp drop in the eigenvalue and percent of variance
accounted for with the second factor. The scree plot confirmed this single factor
solution, and it was concluded that the data suggested that the depression scale was
unidimensional.

Qualifl of Life. Overall psychological well-being was measured using a
revised version of Andrews & Withey’s (1976) Quality of Life measure. This 9-item
measure asked participants to rate on a 7-point scale, ranging from "extremely pleased"

to "terrible", how they felt about various aspects of themselves. One of the items, how

81

Table 10

Psychometric Promrties of the Depression Sea_le_

 

 

Scale Items Corrected Item-Total
Correlations

How often she:

1. Couldn’t shake off the blues .80
2. Felt depressed .79
3. Felt sad .77
4. Felt lonely .71
5. Thought that her life had been a failure .67
6. Had crying spells .65
7. Felt her sleep was restless .64
8. Was happy (item reverse coded) .63
9. Had trouble keeping her mind on what she was doing .62
10. Didn’t feel like eating .60
11. Enjoyed life (item reverse coded) .60
12. Talked less than usual .60
13. Was bothered by things that don’t usually bother her .57
14. Felt hopeful about the future (item reverse coded) .56
15. Felt fearful .53
16. Felt that people disliked her .52

Alpha = .93

 

82

she felt about the responsibilities she had for members of her family, was dropped
because of a low item-total correlation when it was compared to the correlations of the
remaining scale items. Table 11 presents the corrected item-total correlations and the
internal consistency estimate for the remaining 8 items. As indicated in the table, the
alpha for the 8-item scale was .89 and the corrected item-total correlations ranged from
.57 to .80.

A factor analysis was then conducted to test for unidimensionality of the
quality of life scale. Factor loadings ranged from .66 to .87 with a single factor
solution. The first factor in this solution had an eigenvalue of 4.6, accounting for
57.0% of the variance, and there was a sharp drop in the eigenvalue and percent of
variance accounted for with the second factor. The scree plot confirmed that it was
reasonable to use a single factor solution and that the quality of life scale satisfied the
condition of unidimensionality.

Psychological Health Construct. Since each of the scales in the psychological
health construct demonstrated unidimensionality, the psychological health construct
was then tested for unidimensionality as well. First, factor analyses were run on all 27
items in the psychological health construct requesting a three factor solution. This was
done to examine how the items would load onto each factor. Specifically, the factor
analyses indicated that the suicide items, the depression items, and the quality of life
items appeared to cluster together onto the three factors, as expected.

Second, a single factor solution on the 27 item psychological health scale was
requested. Factor loadings for the single factor solution ranged from .38 to .83. The

first factor had an eigenvalue of 11.7, accounting for 43.2% of the variance, and there

83
Table 11

flwchometric Pronerties of the Quality of Life Scafi

 

Scale Items Corrected Item-Total
Correlations

 

How she feels about:

1. Her life overall .80
2. Her emotional and psychological well-being .70
3. The amount of fun and enjoyment she has .70
4. Her independence or freedom .69
5. Herself .67
6. The way she spends her free time .60
7. What she’s accomplishing in her life .59
8. Her personal safety .57

Alpha = .89

 

84

was a sharp drop in the eigenvalue and percent of variance accounted for with the
second factor. The scree plot confirmed that the psychological health scale
demonstrated sufficient unidimensionality and that the construct of psychological
health could be used in subsequent analyses. Therefore, a reliabilities analysis was
conducted on the psychological health scale. As Table 12 indicates, the internal
consistency estimate for this 27-item scale was .95, with a range of corrected item-total
correlations from .36 to .80.

To further establish that the psychological health construct should be included
in the path model as one construct, instead of the three individual scales, the external
parallelism for this scale was examined. This involved correlating all of the individual
items in the physical health construct with the other major scales in the model, that is,
those that are external to that construct. To establish external parallelism, all of the
individual items should correlate in a similar manner with the other scales in the path
model. As is evidenced in Table 13, with few exceptions, the items on the
psychological health construct showed similar patterns of correlation with the other
scales in the path model. The four items that stood out in terms of not showing
similar patterns of correlation were QL2: "how she feels about herself", QLS: "how
she feels about what she’s accomplishing in her life", H2: "whether or not she’s talked
about feeling suicidal with someone else", and H1: "whether or not she’s attempted to
commit suicide". However, conceptually speaking, these items were thought to be
meaningful contributions to the conceptualization of psychological health and were

therefore included in the final scale.

85
Table 12

Psychometric Promrties of the Psychological Health Scale

 

 

Scale Items Corrected Item-Total
Correlations
1. She couldn’t shake off the blues .80
2. She felt depressed .80
3. How she feels about her emotional and psychological well-being .80
4. She felt sad .72
5. How she feels about her life overall .70
6. She felt lonely .69
7. She thought her life had been a failure .68
8. She was happy (item reverse coded) .67
9. She enjoyed life (item reverse coded) .66
10. She felt hopeful about the future (item reverse coded) .64
11. How she feels about the amount of fun and enjoyment she has .64
12. Frequency of suicidal thoughts .64
13. How she feels about her independence or freedom .62
14. She felt her sleep was restless .62
15. She had trouble keeping her mind on what she was doing .62
16. How she feels about the way she spends her free time .61
17 . How she feels about herself .60
18. She had crying spells .60
19. She didn’t feel like eating .54
20. She talked less than usual .54
21. How she feels about what she’s accomplishing in her life .54
22. How she feels about her personal safety .53
23. She felt fearful .53
24. She felt that people disliked her .52
25. She was bothered by things that don’t usually bother her .50
26. Whether or not she’s disclosed suicidal thoughts .47
27. Whether or not she’s attempted suicide .36

Alpha = .95

 

86
Table 13

Correlations between Psvchologigal Health Items and Major Scales in the Path Model

 

Daily Life Hlth Psych Adapt Malad Soc Overall

 

 

Item Hassle Event Sympt Abuse Cope Cope Supp Abuse
QLl .29 .32 .43 .30 -.07 .35 .42 .29
QL2 .14 .25 .26 .10 -.13 .19 .32 .11
QL3 .32 .23 .37 .27 .14 .33 .34 .27
QL4 .33 .27 .38 .21 -.11 .30 .40 .20
QL5 .19 .14 .33 .11 -.08 .30 .36 .10
QL6 .34 .28 .40 .20 .00 .36 .36 .17
QL7 .46 .39 .52 .37 -.09 .49 .42 .35
QL8 .28 .41 .35 .30 -.02 .29 .42 .28
D1 .36 .28 .29 .27 -.21 .32 .31 .26
D2 .36 .43 .39 .34 —.07 .37 .49 .31
D3 .34 .41 .32 .35 -.15 .30 .30 .32
D4 .40 .48 .31 .32 .06 .37 .27 .30
D5 .45 .42 .48 .33 .16 .37 .36 .31
D6 .45 .46 .52 .34 -.05 .51 .50 .33
D7 .51 .59 .43 .36 .02 .44 .48 .35
D8 .53 .48 .51 .37 -.05 .46 .42 .35
D9 .40 .34 .41 .37 -.05 .34 .40 .38
D10 .43 .49 .43 .37 .17 .35 .29 .36
D11 .38 .39 .62 .27 .03 .36 .34 .24
D12 .37 .32 .39 .37 .08 .20 .37 .36
D13 .43 .47 .53 .39 .01 .38 .40 .37
D14 .45 .47 .54 .37 .01 .46 .40 .37
D15 .41 .40 .44 .32 .16 .46 .51 .29
D16 .41 .39 .46 .46 .16 .45 .28 .45
H1 .17 .31 .17 .22 -.11 .23 .17 .22
H2 .18 .30 .45 .26 .12 .26 .20 .24
H3 .33 .29 .53 .30 .01 .37 .22 .31
Daily Hassle: Daily Hassles Scale Life Event: Stressful Life Events Scale

Hlth Sympt: Physical Health Symptom Scale Psych Abuse: Psychological Abuse Scale
Adapt Cope: Adaptive Coping Scale Malad Cope: Maladaptive Coping Scale

Soc Supp: Social Support Scale Overall Abuse: Overall Abuse Scale

 

87
Social Supmrt
Nine items, based on Bogat, Chin, Sabbath, & Schwartz’s (1983) social support

scale, were used to assess participants’ social support. Participants were asked to
report on a 7-point scale, ranging from "extremely pleased" to "terrible", how they
perceived both the quantity and the quality of the social support they receive with
respect to four specific domains of support: companionship, advice and information,
practical assistance, and emotional support. The final item on the social support scale
was an overall rating of the quantity and quality of the social support they received.
This operationalization of social support, assessing the satisfaction with the amount and
quality of interpersonal resources that are responsive to the different domains of social
support needs elicited by stressful life events, has been shown to provide the greatest
likelihood of detecting buffering effects (Cohen & Wills, 1985). The internal
consistency estimate for this scale was .91 and the corrected item-total correlations
ranged from .50 to .81. Table 14 presents the corrected item-total correlations for this
scale that were derived from the reliabilities analysis.

Similar to the other scales, a factor analysis was conducted to test for
unidimensionality of the social support scale. When a single factor solution was
requested, factor loadings ranged from .58 to .87. The first factor had an eigenvalue
of 5.4, accounting for 59.6% of the variance, and there was a sharp drop in the
eigenvalue for the second factor. The scree plot confirmed this single factor solution,

and it was concluded that the social support scale was sufficiently unidimensional.

88
Table 14

Paychometric Promrties of the Social Support Scale

 

 

 

Scale Items Corrected Item-Total
Correlations

How she feels about the:

1. Amount and quality of support she gets from others .81
2. Amount of emotional support she receives .78
3. Quality of emotional support she receives .76
4. Quality of practical assistance she receives .75
5. Amount of advice and information she receives .72
6. Amount of practical assistance she receives .72
7. Quality of companionship she receives .67
8. Quality of advice and information she receives .57
9. Amount of companionship she receives .50

Alpha = .91

 

89

_S_tLe_s_§

Two scales were used to measure level of stress in the present study. First, a
24-item scale, the Difficult Life Circumstances [DLC] scale (Barnard, 1988), was used
to assess a variety of potential problems, targeted toward a low-income sample, that
may be stressful for participants. Examples of items on this scale are "Do you have
trouble finding a place to live that is suitable and that you can afford?", "Do you have
problems with your credit rating?", "Do you get hassled pretty often by bill collectors
or collection agencies?", and "Has one of your children been having serious emotional
or behavioral problems at home?". This scale was dichotomously scored 0/1 and a
count of the number of bothersome problems participants experienced was tallied. No
reliability analyses were performed.

The second measure of stress used was a Life Event Checklist (Reischl, Eby, &
Rarnanathan, 1992). This checklist included subscales related to school, work, love
relationships, family, health, finances, and legal status. Participants were asked to
indicate if the event took place and how stressful the event was for them on a 5-point
scale, ranging from "not at all stressful" to "extremely stressful". For this scale, mean
ratings of stress were obtained by dividing the sum of all of the stressfulness ratings
by the total number of potential stressors. Stressors that did not take place for
respondents in the past six months were coded as "not at all stressful". Again,
reliability analyses were not performed on this scale because it was not expected that
this scale would be internally consistent. That is, the occurrence of one stressor was

not believed to affect the occurrence of another stressor across all the dimensions of

90

the scale. Factor analyses were not performed either due to the fact that there was no
need to establish unidimensionality.

The construct of interest in this study was the overall amount of stress in each
participants’ life. Therefore, for the overall measure of stress, the two scales were
standardized and added together for an overall stress score for each participant. This
overall stress score was the measure of stress used in subsequent analyses of the
model.

922212

The scale that was used to measure coping in this study was modified from
Carver et al.’s (1989) COPE Scale. Women were asked to rate on a 4-point scale
ranging from "never" to "often", how often they used each of the coping strategies to
deal with a specified situation. Specifically, women were asked to think about their
use of each of the coping strategies in response to having arguments or conflicts with
friends or family members, not including a partner or ex-partner. A reliability analysis
of this 30-item scale was performed. The results of this analysis indicated the use of
two separate coping scales, which have been named the "adaptive" coping scale and
the "maladaptive" coping scale. This was concluded after an examination of the
corrected item-total correlations indicated that the items with the lower correlations
were generally items that represented negative coping strategies.

Adaptive Coping. The adaptive coping scale was comprised of 21 items and
represented a subset of coping strategies the literature suggests have some adaptive
value (Carver et al., 1989). Types of adaptive coping strategies included active coping

and planning, positive reinterpretation and growth, and seeking out of social support.

91

A reliability analysis led to the deletion of 4 items. These items included: 1) accepting
that the situation had happened and that it couldn’t be changed, 2) deciding to learn to
live with the situation, 3) avoiding making matters worse by acting too soon, and 4)
getting away from everyone and everything so she could deal with it alone. As Table
15 indicates, the final internal consistency estimate for the 17—item adaptive coping
scale was .84 and the item-total correlations ranged from .32 to .66.

A factor analysis was then conducted to test for unidimensionality of the
adaptive coping scale. Factor loadings ranged from .41 to .82 with a single factor
solution. The first factor in this solution had an eigenvalue of 5.0, accounting for
29.4% of the variance, and there was a sharp drop in the eigenvalue and percent of
variance accounted for with the second factor. The scree plot confirmed that it was
reasonable to use a single factor solution and that the adaptive coping scale satisfied
the condition of unidimensionality.

Maladaptive Coping. The maladaptive coping scale was comprised of 9 items
and represented coping strategies that are theoretically of questionable value, such as
denial, focusing on and venting of emotions, behavioral or mental disengagement, and
using alcohol or drugs (Carver et al., 1989). Two items were deleted based on the
results of a reliability analysis that indicated low corrected item-total correlations.
These items included: 1) being alone for a period of time and 2) taking her mind off
the situation by doing other things. The range of corrected item-total correlations for
this 7-item maladaptive coping scale was .31 to .62, and the alpha was .75. Table 16
provides a summary of the psychometric properties of the maladaptive coping scale.

Since maladaptive coping seemed likely to be related to alcohol and drug use, a path

92
Table 15

Psychometric Promrties of the Adaptive Coping Scale

 

Scale Items Corrected Item-Total
Correlations

 

When she’s had arguments with family or friends, did she:

I. Think about the situation as a chance to learn or grow .66
2. Get rid of the problems she think may have caused the situation .56
3. Find something funny about the situation .55
4. Make a plan to deal with the situation .53
5. Make jokes about the situation .52
6. Get some advice from someone about what to do .50
7. Tell someone her feelings to get some support .45
8. Seek spiritual comfort by praying or meditating .44
9. Thought about the situation in a more positive way .43
10. Seek God’s help or put her trust in God .43
11. Get some understanding or sympathy from someone .40
12. Put aside other activities so she could deal with it .40
13. Focus on the situation and let other things slide a little .39
14. Talk to someone who could do something to help you .39
15. Take direct action to get around the situation .36
16. Think hard to come up with a strategy for the situation .33
17. Restrain herself until the time is right to do something .32

Alpha = .84

 

93
Table 16

Psychometric Promrties of the Maladaptive Coping Scale

 

Scale Items Corrected Item-Total
Correlations

 

When she’s had arguments with family or friends, did she:

I. Think about the situation less by drinking or using drugs .62
2. Help herself feel better by using drugs or alcohol .60
3. Give up trying to reach her goals in the situation .51
4. Express her emotions by destroying something/ hurting someone .44
5. Think about other things so she could forget about it .41
6. Let her feelings out by crying or yelling .41
7. Stop her attempts to deal with the situation .31

Alpha = .75

 

94
from maladaptive coping to alcohol and drug use was added to the path model, in

addition to the hypothesized moderator effects.

A factor analysis was then conducted to test for unidimensionality of the
maladaptive coping scale. When a single factor solution was requested, factor loadings
ranged from .37 to .74. The first factor had an eigenvalue of 2.9, accounting for
41.3% of the variance, and there was a sharp drop in the eigenvalue and percent of
variance accounted for with the second factor. The scree plot confirmed this single
factor solution, and it was concluded that the data reasonably indicated that the
maladaptive coping scale was unidimensional. See Table 17 for a summary of the

measurement model. See Figure 2 for a revised version of the path model.

Table 17

Measurement Model

95

 

Construct

Description of Construct

Measure

 

Presence vs. Absence
of Abuse

Overall Abuse

Psychological
Abuse

Physical
Health Symptoms

Alcohol &
Drug Use

Psychological Health

whether or not a woman
had experienced abuse from
a partner in the past year

frequency & severity

of threats, of being

pushed, punched, out,

kicked, restrained,

burned, shot; frequency of
forced sex, frequency of

use of threats to have sex;
frequency of ridicule, criticism,
and harassment

frequency of ridicule, criticism,
and harassment

frequency of health
symptoms; gynecological
symptoms

frequency of alcohol
and drug use; use of
alcohol or drugs to
relieve stress; self-
rated assessment of
alcohol or drug
problems

frequency & number of
times disclosed suicidal
thoughts, number of attempts;
depression; perceived

quality of life

Study screening tool

Straus’ (1979)
Conflict-Tactics
Scale; Hanneke,
Shields, & McCall’s
(1986) items for
assessing sexual
violence; Index of
Psychological Abuse
(Sullivan et al., 1992)

Index of
Psychological Abuse
(Sullivan et al., 1992)

Modified Cohen &
Hoberrnan’s (1983)
Inventory of

Physical Symptoms

Index of Alcohol &
Drug Use

Interview items;
Radloff’s (1977)
CBS-D; Andrew &
Withey’s (1976)
Quality of Life
Measure

Table 17 (continued)

96

 

Construct

Description of Construct

Measure

 

Social Isolation/
Social Support

Stress

Coping

quantity & quality

of emotional support,
practical assistance,
advice & information,
companionship, and
overall social support

dichotomous rating of

of problems or difficult

life circumstances;
occurrence and ranking of
stressful life events in the
areas of school, work,
family, relationships, health,
finances, and legal status

rating of the frequency of
use of various coping strategies

Bogat et al.’s (1983)
Social Support Scale

Barnard’s (1988)
Difficult Life
Circumstances;
Reischl, Eby, &
Rarnanathan’s (1992)
Life Event Checklist

Carver et al.’s (1989)
COPE Scale

97

 

 

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CHAPTER 3

RESULTS

Descriptive Information
Appsg

Physical and sexual abuse. Due to the screening procedure, only the women in
the "abused" category (11 = 50) reported experiencing incidents of physical and sexual
violence. Of the fifty women in the "abused" group, forty-five of them (90%) had
experienced at least one incident of physical harm in the past six months. Five of the
women, or 10% of the participants, had experienced threats in the past six months but
no physical or sexual violence. These women met the criteria for inclusion in the
"abused" group because they had experienced more than one incident of physical
violence in the past year ml they were experiencing ongoing threats from their
assailants, i.e. in the past six months.

Acts of violence ranged from grabbing her (86.0%) to threatening her with a
gun or knife (24.0%) and kicking her (20.0%). Table 18 lists the percentages of
women who experienced physical and sexual violence for women in the "abused"
group. The two items that assessed sexual violence indicated that fully one-half of the

"abused" participants had experienced their assailants using threats to try and have sex

98

Table 18

Percentages of Women Who Experienced Plysica_l_and Sexial Violence

 

 

 

(N = 50)

Type of Violence N Pm
Grabbed her 43 86.0
Pushed or shoved her 40 80.0
Slapped her 28 56.0
Threw something at her 28 56.0
Choked her 25 50.0
Used threats to try and have sex with her 25 50.0
Beat her up 24 48.0
Tried to hit her with an object 24 48.0
Broke her glasses or tore her clothing 23 46.0
Hit her with a fist 22 44.0
Forced any unwanted sexual activity 19 38.0
Hit her with an object 18 36.0
Threatened her with a gun or knife 12 24.0
Kicked her 10 20.0

 

100

with them, while 38.0% of these participants had experienced forced sexual activity.
Table 19 provides the percentages of women who experienced injuries as a result of
their abuse, as well as the status of their involvement with their assailant at the time
that these injuries were inflicted.

Psychological abuse. All respondents who had been involved in a relationship
with an intimate partner within the past six months, 86.9% of the sample, were asked
questions related to psychological abuse. The three most commonly reported forms of
psychological abuse were ignoring or making light of her feelings, ignoring or making
light of her anger, and criticizing her family or friends to her, with nearly two-thirds
of the sample having experienced these forms of hurtful behaviors. Table 20 reports
the percentages of women who experienced the different forms of psychological abuse
in the past six months. In sum, over the past six months, nine out of ten women in
the abused group experienced at least one act of physical violence, one-half of the
women in the abused group experienced some type of sexual violence, and nearly two-
thirds of the total sample experienced some form of psychological abuse at the hands
of a partner or ex-partner.

Physical Health Constructs

Physical health symptoms. Most of the respondents reported that they were
bothered by multiple physical health symptoms. Physical health symptoms reported
most frequently were feeling low in energy (89.7%), back pain (88.8%), and headaches
(86.0%). Of the physical health symptoms included on the final scale, choking
sensations was reported the least frequently (24.3%). Women did experience

additional physical health symptoms that were not included in the final scale. For

101
Table 19

Percentages of Women Who Experienced Injuries as a Result of Abuse

 

 

 

 

 

 

(N = 50)

Tm of Injgy N Ee_rc_eat
Soreness without bruises 40 80.0
Cuts, scrapes, or bruises 37 74.0
Strains or sprains 14 28.0
Burns, including rug burns 13 26.0
Any permanent scarring 9 18.0
Dislocated joints 6 12.0
Broken bones or fractures 5 10.0
Internal injuries 2 4.0
Pregnancy complications or a miscarriage 2 4.0
Loose or broken teeth 1 2.0
Knife or grmshot wound 1 2.0
Status of Involvement with Assailant at the time Iniuries Occurred

Involved with assailant 31 62.0
Only involved for part of the time 9 18.0
Not involved with assailant 5 10.0
Not applicable (i.e. woman experienced threats, 5 10.0

but not physical abuse in past 6 months)

 

1 02
Table 20

Percentages of Women Who Experienced Psychological Abuse
(N = 107)

 

 

 

Tm of Psychological Abuse N m
Ignored or made light of her feelings 71 66.4
Ignored or made light of her anger 70 65.4
Criticized her family or friends to her 68 63.6
Called her names 64 59.8
Accused her of having or wanting other sexual relationships 60 56.1
Refused to talk with her 58 54.2
Lied to her or deliberately misled her 57 53.3
Refused to do things with her she wanted to do 56 52.3
Made contradictory demands or requests of her 53 49.5
Tried to control her activities 53 49.5
Ridiculed or insulted women as a group 52 48.6
Criticized her strengths 52 48.6
Tried to humiliate her 50 46.7
Threatened her in any way 50 46.7
Criticized her intelligence 50 46.7
Discouraged her contact with family or friends 47 43.9
Criticized her physical appearance or sexual attractiveness 46 43 .0
Ridiculed or insulted her most valued beliefs 46 43.0

1 03
Table 20 (cont’d)

 

 

Typg of Psychological Abuse N M
Withheld affection or approval as a punishment 42 39.3
Ridiculed or criticized her in public 40 37.4
Forbid her to go out without him 38 35.5
Threatened to end the relationship if she didn’t

do what he wanted 35 32.7
Told her about other sexual relationships he wanted or was

having in order to hurt her 34 31.8
Tried to control her money 34 31.8
Broke or destroyed something important to her 32 29.9
Ridiculed or insulted her religion, race, heritage, or class 31 29.0
Tried to force her to leave her home 27 25.2
Threatened to take the children away from her 25 23 .4
Harassed her family or friends in some way 24 22.4
Left her somewhere with no way to get home 20 18.7
Threatened to hurt her family or friends 18 16.8

 

104
instance, almost two-thirds of the participants reported experiencing migraine
headaches (60.7%), and just over half the sample reported being bothered by
constipation (53.5%) and/or diarrhea (52.3%). Nearly one-fifth (17.8%) of the women
reported ulcers, and this figure is likely an underestimate because in many of the
interviews women reported that they thought that they had ulcers, but they had not yet
been to the doctor for a diagnostic test. Table 21 presents the percentages of women
who experienced physical health symptoms, in addition to the percentages of women in
the "abused" group who rated that a particular symptom was a result of their abuse.

Gynecological symptoms. Similar to Table 21, Table 22 presents the
percentages of women who experienced gynecological symptoms and the percentages
of women in the "abused" group who rated a particular gynecological symptom as a
result of their abuse. Within this sample, 16 out of the 107 women had been pregnant
in the past six months. Three of the women who had been pregnant in the past six
months had had a miscarriage. While all three of the women who had miscarriages
were in the "abused" group, only two of the three women reported that their
miscarriage was a result of their abuse.

Alcohol and drug use. While not included in the alcohol and drug use scale,
information regarding women’s cigarette smoking was also collected and presented in
Table 23. Over half of the women in this sample were smokers (57.0%). Also
illustrated in Table 23 are the percentages of women who used alcohol and drugs, the
percentages of women who used alcohol and drugs to relieve stress, and women’s self-

perceptions of whether or not they had a problem with alcohol or drugs.

105

 

Table 21
Percentages of Women Who Expgrienced Physical HeW = 107)

and the Percentages of Women Who Rated Them a_s Due to Abuse (N = 50)

 

 

Physical Health Symptom N m _R_esplt
of Abuse
Feeling low in energy 96 89.7 48.0
Back pain 95 88.8 34.0
Headaches 92 86.0 76.0
Sleep problems 85 79.4 72.0
Constant fatigue 82 76.6 44.0
Muscle tension or soreness 77 72.0 56.0
Acid stomach or indigestion 76 71.0 48.0
Stomach pain 68 63.6 44.0
Poor appetite 65 60.7 54.0
Heart pounding or racing 64 59.8 62.0
Nightmares 63 58.9 54.0
Muscle cramps 63 58.9 44.0
Dizziness 61 57.0 30.0
Feeling weak all over 61 57.0 42.0
Pains in her heart or chest 61 57.0 38.0
Nausea and/or vomiting 60 56.1 36.0
Hot or cold spells 60 56.1 22.0

Severe aches and pains 58 54.2 48.0

106
Table 21 (cont’d)

 

 

Physical Health Symptom N Egr_cept 333111!
of Abuse

Hands trembling 54 50.5 52.0
Numbness or tingling in parts of her body 54 50.5 32.0
Shortness of breath when not exercising

or working hard 52 48.6 22.0
Blurred vision 50 46.7 24.0
Ringing in her cars 50 46.7 22.0
Faintness 47 43.9 22.0
Choking sensations 26 24.3 16.0

 

1 07
Table 22

Percentages of Women Who Exparienced Gynecological Symptoms (N = 107)
and the Percentages of Women Who Rated Them as Due to Abu_s_e (N = 50)

 

 

Gmecological Syrpptom N Meat M
of Abuse

Pelvic pain 53 49.5 26.0
Bladder infections 29 27.1 4.0
Abnormal vaginal bleeding or discharge 27 25.2 8.0
Painful urination 22 20.6 6.0
Painful intercourse 21 19.6 18.0
Rectal bleeding 10 9.3 2.0

 

1 08
Table 23

Percentages of Women Who Used Alcohol and Drugs
(N = 107)

 

 

 

 

 

 

Alcohol / DELUse Item N M 139m
Relieve Stress

In the past six months has she:

Used alcohol 72 67.3 36.4

Used nicotine 61 57.0 48.6

Used marijuana 42 39.3 25.2

Used sedatives, hypnotics, or tranquilizers 21 19.6 13.1

Used anti-depressants 14 13.1 9.3

Used non-prescribed drugs,

such as cocaine, crack, speed, or heroine 12 11.2 6.5

Self-Rating Categopy

No problems with alcohol 83 77.6

Recovering alcoholic 14 13.1

Heavy or problem drinker 5 4.7

Alcoholic 5 4.7

No problems with drugs 92 86.0

Recovering addict 7 6.5

Heavy or problem drug user 4 3.7

Addict 4 3.7

 

109

Women in the "abused" group were also asked to indicate whether they felt
their use of a particular substance had increased, decreased, or stayed the same as of
result of their abuse. The percentages of women who felt that their substance use had
increased were: 22.4% for nicotine, 20.6% for alcohol, 10.3% for marijuana, 1.9% for
non-prescribed "street" drugs, 9.3% for tranquilizers and sedatives, and 1.9% for anti-
depressants. Interestingly, the percentages of women who felt that their substance use
had decreased was often greater than the percentages of women who felt that their use
of various substances had increased. This was true for alcohol (38.3%), marijuana
(26.2%), non-prescribed "street" drugs (7.5%), and tranquilizers and sedatives (14.0%).
None of the participants reported that their nicotine use or their anti-depressant use had
decreased as a result of the abuse.

Of interest was whether or not the sedatives and anti-depressants women were
taking were prescribed by a doctor. For the twenty-one women who had used
tranquilizers, nearly three-fourths of them were prescribed by a doctor (71.4%). Of
the sixteen women using anti-depressants, 93.8% of them had been prescribed by a
doctor. Two women had been prescribed anti-depressants, but decided against using
them after they had been prescribed. The mean number of tranquilizer prescriptions
written in the past six months was 2.57, and the mean number of prescriptions for
anti-depressants in the past six months was 4.69.

Very few of the women in the total sample had received treatment for their
alcohol or drug problem in the past six months. Two women had been treated in an
inpatient setting for alcohol abuse in the past six months, five women had been treated

in an outpatient setting for alcohol abuse in the past six months, and five women had

110

participated in an Alcoholics Anonymous (AA) program in the past six months. In
terms of participation in drug treatment programs within the past six months, only one
woman had received drug treatment in an inpatient setting, four women had received
treatment through an outpatient setting, and three women had participated in a
Narcotics Anonymous (NA) program. However, these figures can be misleading
because there is overlap among women who reported alcohol and drug problems and
because some women obtained multiple forms of treatment.

Refer back to Table 23. It is important to note that 24 of the participants
reported that they were a heavy or problem drinker, a recovering alcoholic, or an
alcoholic, and 15 of the participants reported that they were a heavy or problem drug
user, a recovering addict, or an addict. However, 8 women reported that they had both
an alcohol and drug problem. This means that 16 of the women reported an alcohol
problem only and 7 of the participants reported a drug problem only. Further, an
examination of who reported obtaining treatment within these groups revealed that
62.5% of the women who reported a multiple substance abuse problem, i.e. alcohol
and drugs, had received some type of treatment in the past six months, 12.5% of the
women who reported a problem with alcohol had received some type of treatment in
the past six months, and none of the women who reported a problem with drugs had
received any type of treatment in the past six months. Therefore, the results suggested
that the majority of women who had both alcohol and drug problems had received
some type of treatment in the past six months, but that very few women who had a

drug only or an alcohol only problem had received treatment.

111

M for HIV/STD§. While the measure for risk behaviors that may lead to
contracting HIV or a sexually transmitted disease was not included in the revised
model, Table 24 presents the descriptive information for these items. Specifically, the
percentages of women that engaged in behaviors that may increase risk for contracting
HIV/STDs are listed. While the most common risk behavior was using condoms
"seldom" or "never" (44.8%), it is important to point out that 93.5% of the women had
had zero, one, or two sexual partners in the past six months. For three-fourths of these
women (73.8%), this was an intimate partner. Furthermore, of the women who
reported that they had been tested for HIV (76.6%), half of them had been tested for
HIV in the past six months (38.3% of the total sample).

Women’s Use of Health Care Services

Table 25 presents an overview of women’s use of health care services. Visits
to their doctor for a routine check up for themselves was the most frequent type of
health care visit (69.2%), followed by emergency room visits (48.6%). Also presented
in Table 25 are the mean number of visits women made to each of these health care
services and the percentage of visits that were a result of abuse. For the women who
had been to a therapist, psychiatrist, or psychologist, women most frequently had
referred themselves (30.8%), with the next most frequent referral source being a
medical doctor (23.1%).

In conclusion, with respect to physical health, the vast majority of participants
reported experiencing multiple physical health symptoms in the past six months.
Ratings of whether or not participants believed a physical health symptom was

attributable to having experienced abuse varied among the different symptoms and

1 12
Table 24

Percentages of Women Engaging in Behaviors that Increase HIV/STD Rial;
(N = 107)

 

 

 

Risk Behavior N Percent
Used condoms "seldom" or "never" during sex 48 44.8
Engaged in sex with casual partners 18 16.8
Had partners who used alcohol or drugs during

sex most or all the time 17 15.9
Had partners who lived in a big city,

such as Detroit or Chicago 9 8.4

Used alcohol or drugs during sex most or all the time 8 7.5

Exchanged sex for something she needed,
such as food, money, shelter, etc. 6 5.6

Had partners who did or may have shot up with drugs 6 5.6
Engaged in sex with one-time anonymous partners 4 3 .7

Engaged in high-risk behaviors with a
person who was HIV positive or had the AIDS virus 1 .9

Shared needles to shoot up with drugs 0 0.0

Used dirty needles to shoot up with drugs 0 0.0

 

113

 

 

 

 

Table 25

Summary of Women’s Use of Varioua Health Care Services

(N = 107)

Type of Health Care Service N Percent Mean # Due to
of Visits Abuse

Visit for a routine check up 74 69.2 4.07 18.3%

Emergency room visit 52 48.6 2.00 15.4%

Emergency doctor visit, not

to the emergency room 32 29.9 2.03 13.9%

Psychologist, therapist, or psychiatrist

visit 26 24.3 6.35 47.3%

 

114

ranged from 16 to 76 percent. Overall, gynecological symptoms were reported with
less frequency, although approximately one-half of the participants had experienced
pelvic pain in the past six months. Alcohol was the most frequently used substance
among participants, followed by nicotine and marijuana. Nearly one-fourth of the
sample reported a problem with alcohol, while 14 percent reported a problem with
drugs. Of the women who reported a problem with drugs, approximately half of them
also believed they had a problem with alcohol. While nearly half of the participants
reported infrequent condom use, the vast majority of the women in the sample reported
few (i.e. zero to two) sexual partners in the past six months. In terms of health service
use, women reported relatively high rates of accessing health care services. For
example, approximately one-half of participants had been to an emergency room for
themselves in the past six months.
Pachological Health

The psychological health of women in this sample varied widely. As can be
seen from Table 26, women’s scores on the depression scale ranged from "rarely or
never" feeling depressed to feeling depressed "most or all of time". The two items on
the depression scale with the highest means were she felt depressed and she felt that
everything she did was an effort. Also included in Table 26 are the descriptive
statistics for the quality of life scale and item statistics for the three suicide items. The
quality of life construct also demonstrates the high variability of women’s
psychological health, with scale scores ranging from 1.13, or "extremely pleased" with
her quality of life, to 7.00, that she felt "terrible" about her quality of life. In terms of

the suicide construct, women ranged from never having had thoughts about ending her

1 15
Table 26

 

Descriptive Statistics for the Psychological Health Con_s_truct_s_:
Scale Summaries for Depresaion and Quality of Life and Item Stati§tics for Suicide

(N = 107)

 

 

 

 

 

Psychological Health Construct i S_D Range
Depression 2.12 .73 1.00 - 3.88
Range (1 - 4)

*Low scale score equal to low depression

Quality of Life 3.40 1.30 1.13 - 7.00
Range (1 - 7)

*Low scale score equal to high quality of life

Suicide Items N Percent

In the past six months:

Women who reported suicidal droughts 40 37.4
Women who disclosed suicidal thoughts to someone else 27 25.2

Women who attempted suicide 7 6.5

 

116

life in the past six months to one woman who had attempted to commit suicide twelve
times in the last six months.
Moderator variables: Social support, adaptive coping,_and maladaptive coping

Table 27 presents the descriptive statistics for the moderator variables.
Specifically, the means, standard deviations, and ranges for each of the three scales are
presented. As can be seen from the table, in general women were mostly satisfied
with the amount and quality of the social support that they received. Women also
reported using more adaptive coping strategies (X = 2.83) in response to conflicts and
arguments with family members and friends than maladaptive coping strategies
(X = 2.15). The three adaptive coping strategies with the highest means included:
seeking God’s help (X = 3.17), making a plan about the best way to deal with the
situation (X = 3.07), and accepting that it had happened and that it couldn’t be
changed (X = 3.06). Finally, the percentages of women who used each of the
maladaptive coping strategies are also presented in Table 27.
S_trgs_s

Difficult Life Circumstances. Not surprisingly, the daily hassles women
experienced the most frequently were related to living in poverty. The most often
cited daily hassles were having problems with her credit rating (67.3%), having long-
terrn debts (57.0%), and having trouble finding a place to live that was suitable and
that she could afford (39.3%). Moreover, the next most frequently reported difficult
life circumstance was having problems with a former partner or spouse (38.3%), which
is clearly a common problem for women with abusive partners and ex-partners. One

item on this scale, having a partner in jail, was not reported by any of the participants

1 17
Table 27

Descriptive Statistics for the Moderator Variables:

 

 

Scale Summaries for Social Support, Adaptive, and Maladaptive Coping and

Percentages of Women Using Maladaptive Coping Strategies
(N = 107)

 

 

 

 

 

Moderator Variable X S_D_ Range
Social Support 3.09 1.28 1.11 - 7.00
(Range 1 - 7)

*Low scale score equal to high satisfaction w/ social support

Adaptive Coping 2.83 .50 1.00 - 3.68
(Range 1 - 4)

*Low scale score indicates less adaptive coping

Maladaptive Coping 2.15 .63 1.00 - 3.71
(Range 1 - 4)

*Low scale score equal to less maladaptive coping

Maladaptive Coping Items N Percent
Think about other things so she could forget about it 101 94.4

Let her feelings out by crying or yelling 93 86.9

Stop her attempts to deal with the situation 76 71.0

Give up trying to reach her goals in the situation 59 55.1

Help herself feel better by using alcohol or drugs 46 43.0

Think about the situation less by drinking or using drugs 40 37.4
Express her emotions by trying to destroy something

or hurt someone 33 30.8

 

118

in this study. The two difficult life circumstances reported with the least frequency
included having someone in the house other than herself or her partner who had an
alcohol or drug problem (10.3%) and being abused by someone other than a partner or
ex-partner (10.3%). Table 28 presents the descriptive statistics for the difficult life
circumstances scale. In order to assess whether women who were abused reported
more difficult life circumstances than women who were not abused, the percentages of
women who reported each difficult life circumstance were compared for the two
groups and Chi-Square tests of significance were conducted. Table 29 presents the
results of these analyses.

Life event checm. The life events that were given the highest stressfulness
rating (i.e. "extremely stressful") by participants were examined. The life events most
frequently rated "extremely stressful" for women in this study were: 1) Been a victim
of a violent crime, such as assault (28.0%), 2) Had less money than usual (26.2%),

3) Had increased arguments with her partner (22.4%), 4) Had a serious illness or
injury happen to her (16.8%), 5) Separated or ended a long-term relationship (15.0%),
6) Had trouble with one of her family members (14.0%), 7) Been a victim of property
damage or theft (13.1%), and 8) moved to a new home (12.1%). Several of the life
events on the checklist had not happened in the past six months for any of the 107
women. These life events included: she retired, her partner retired, experienced the
death of a partner, and experienced the death of a child. Eight women had been
released from jail in the past six months, however, none of them reported this was at
all stressful. Descriptive statistics for the life event checklist are also presented in

Table 28.

1 19
Table 28

Descriptive Statistics for the Scales in the Stress Construct:
the Difficult Life Circumstances Scale and the Life Event Checklist

(N = 107)

 

 

 

Stress Measure 2 §_ Range
Difficult Life Circumstances 6.76 3.82 0 - 16

Total count (Range 0- 25)
*Low scale score indicates lower number of daily hassles

 

Life Event Checklist 1.42 .30 1.00 - 2.52
Range (1 - 5)
*Low scale score equal to low stress

 

120

 

 

Table 29
A Campap'spn pf thg Pergentagas pf Abpsed Ed Non-Abased megn

Ex ri Difli Lif ir m e
W _lzus_¢_¢(_.lA % N_Q__b_§ed(_9.ln-A 11 °/ 13

(n = 50) (n = 57)

Having problems with her credit rating 78 58 489*
Having a problem with a former spouse
or partner 66 14 30.43 *
Has long-term debts 58 56 .04
Feels that she doesn't have enough privacy 52 25 857*
One of her children is having serious
emotional and behavioral problems 52 16 15.87 *
Having trouble finding a suitable place
to live that is affordable 46 33 1.79
Had frequent illnesses in the past year 44 25 4.51 * ‘/
Partner has an alcohol or drug problem 42 7 1820*
One of her children is having learning or
other school problems 40 30 1.22
Is hassled by bill collectors often 40 25 2.93
Been hospitalized in past year 38 26 1.68
Been looking for a job and not
been able to find one 34 35 .01
Having problems with her neighbors 34 18 3 .82*
She or someone in the house has a
longterm illness 32 35 .11

Without a phone in the home 30 14 402*

Table 29 (cont'd)

121

 

 

WW9: MW 6 "/ N__bLed_télon-A 8 ° 13

(n = 50) (n = 57)
Having regular fights with her partner 28 23 .38
Has a problem with alcohol or drugs 26 5 9.01 *
Is experiencing physical abuse by
someone other than her current partner 20 2 9.61 *
Has people living with her that she
wishes weren't there 18 12 .69
Work or school interferes with family life 18 11 1.23
Partner's work/school interferes with
family life 16 11 .70
Partner is away fi'om home more than half
the time because of a job or other reason 16 23 .78
Someone in the house (not self or partner)
has an alcohol or drug problem 14 7 1.41
Having problems with landlord 8 14 .97

 

*p<.05

 

122

Similar to the difficult life circumstances scale, the percentages of women who
reported each life event they experienced as stressful were compared for the two
groups and Chi-Square tests of significance were conducted. This was done in order
to assess whether women who were abused experienced more life events that they
rated as stressful than women who were not abused. Table 30 presents the results of
these analyses.

In summary, women who had experienced abuse reported a wide range of
physically and sexually violent acts. The percentage of this sample that reported
experiencing sexual violence corroborates the prevalence rates found in other studies
(Campbell, 1989a; Campbell & Alford, 1989; Eby et al., 1995; Shields & Hanneke,
1983; Stark & Flitcrafi, 1982). Both abused and not-abused women were bothered by
multiple physical health symptoms and reported using alcohol and drugs, although the
percentage of women who reported a problem with alcohol or drugs was small.
Further, the majority of women were not engaging in behaviors that would increase
their risk for HIV or STDs. Participants reported moderate levels of psychological
health, with the average woman feeling depressed "some or a little" of the time and
feeling ambiguous to mostly satisfied with her life. Women reported that they were
mostly satisfied with their social support, used adaptive coping strategies frequently,
and maladaptive coping strategies less often.

These results point to the need for comparison groups in research with abused
women. Many of the participants reported physical health symptoms, regardless of
their status in the "abused" vs. "not abused" groups. These results also suggest that

participants, while experiencing daily hassles and stressful life events that appear to be

123

 

 

Table 30
01.2-1.010- "‘1’.“ 11‘, fA ‘1:-9N0 -A:.-'q o‘mn
E rien Lif Ev n Th r I
Stressfirllifefiycm Ahussit‘Zd Nan-.Ahusedi‘ztz) 13
(n = 50) (n = 57)
Been a victim of a violent crime 90.0 5.3 7732*
Had less money than usual 74.0 47.4 7 .86*
Had increased arguments with partner 64.0 17.5 2411*
Moved to a new home 46.0 21.0 753*
Separated or ended a long-term
committed relationship 46.0 5.2 2403*
Had a serious fight with a friend/neighbor 38.0 19.3 462*
Had a serious illness or injury 36.0 28.0 .77
Had trouble with one of her family 36.0 24.6 1.66
members
Learned that her partner was unfaithful 34.0 7.0 1229*
Started or in the process of receiving
government aid 32.0 15.8 3.91“
Been a victim of property damage or theft 32.0 12.3 614*
Had a serious illness or injury happen to
one of her family members 28.0 24.6 .16
Experienced the death of a family member 28.0 21.1 .70
Reconciled a serious relationship 26.0 7 .0 7.18“
Been involved in a lawsuit or legal action 26.0 19.3 .69

Had trouble with her partner's family 24.0 8.8 674*

124

 

 

Table 30 (cont'd)
W W Nsmfibusedlm 13

(n = 50) (n = 57)
Started a new job or experienced a big
change in her current job 24.0 12.2 2.50
Serious illness or injury to partner 22.0 7.0 496*
Serious illness or injury to kids 22.0 10.5 2.62
Quit herjob 20.0 8.7 2.79
Had new problems with boss or co-worker 18.0 8.8 2.00
Started a steady dating relationship 18.0 5.2 434*
Had sexual difficulties 18.0 0.0 1120*
Been fired or laid off 16.0 5.2 3.33
Partner was fired or laid off 16.0 8.7 1.30
Experienced a utility shut off 16.0 2.0 598*
Experienced the death of a close fiiend 14.0 15.8 .07
Been unfaithful to partner 14.0 0.0 854*
Ended a steady dating relationship 12.0 7 .0 .78
Partner started a new job or experienced
a big change in current job 10.0 1.8 3.42
Had a miscarriage, stillbom, or abortion 10.0 0.0 598*
Experienced the death of a pet 10.0 1.8 3 .42
Taken on a major purchase 10.0 7 .0 .31
Arrested or convicted of a serious crime 10.0 3.5 1.84

125

 

 

Table 30 (cont'd)
Strgssflil Lifa Eyant &u§ed 1%) Nan-Abused 1%) xi

(n = 50) (n = 57)
Had children taken away or been
threatened with having kids taken away 10.0 1.8 3 .42
Received a jail sentence or detention 8.0 0.0 474*
Started menopause 6.0 1.8 1.33
Married or started a long-term committed
relationship 6.0 3.5 .37
Divorced 6.0 0.0 3.52
Had a new person move into the home 6.0 5.3 .03
Had her driver's license taken away 4. O 1.8 .49
Started classes at school 4.0 15.8 4.01 *
Had a child 4.0 3.5 .02
Stopped attending school 2.0 7.0 1.51
Found out she's unable to have children 0.0 3.5 1.79

 

*p<.05

 

126

related to living in poverty and experiencing abuse, were not the depressed, desperate,
isolated women that previous research indicates. Instead, they were using a variety of
adaptive coping strategies to cope with their lives and they had some level of social
support with which they were mostly satisfied. While they were not necessarily
satisfied with the quality of their lives, their feelings of depression seemed to vary to
an extent that implies situational factors, and not necessarily immutable personality
traits, a popular misconception about battered women.
Intercorrelations Among Constructs in the Path Model

Intercorrelations among each of the constructs in the path model were examined
to assess the relationships among the nine different scales. Since abuse was
conceptualized in three different ways, the presence or absence of abuse, psychological
abuse, and overall abuse, each different conceptualization of abuse was included in the
intercorrelation matrix. This resulted in an 11 X 11 intercorrelation matrix. Table 31
presents the uncorrected correlation matrix of all the constructs. As is evident in this
table, the results indicate that nearly all of the constructs in the path model are
intercorrelated to some degree, with the exception of adaptive coping. Table 32
presents the intercorrelation matrix of the path constructs using correlations corrected
for attenuation.‘ Due to the fact that the two intercorrelation matrices yielded similar
results, only the correlations from the uncorrected correlation matrix are discussed.
While some of the relationships discussed below were related to the path model, other

relationships are discussed that were not part of the tested model.

 

lDue to the fact that reliability was not calculated for the stress construct, no corrections
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129

Abuse and Major Path Constructs

In the present study, abuse was conceptualized in three different ways and it
was proposed that the path model be tested for each of the different measures of
abuse. An examination of the correlations among the different conceptualizations of
abuse showed a strong degree of inter-relatedness among the abuse measures. The
presence or absence of abuse, the dichotomous item that divided participants into the
two groups of "abused" and "not abused", correlated .78 with both the psychological
abuse scale and the overall abuse scale. Due to the dichotomous scoring, these
correlations cannot be higher than .80. The correlation between the psychological
abuse scale and the overall abuse scale was .98, indicating a lack of independence
between these two constructs. While there was some overlap of items between these
two scales, the magnitude of this correlation was unexpected. All of the
aforementioned correlations were significant at the p < .05 level. Therefore, it would
appear that psychological abuse and overall abuse measured similar constructs and/or
that psychological, physical, and sexual abuse occurred together, such that within a
relationship that has a high level of psychological abuse, physical and/or sexual abuse
were present as well. It would further appear that for the purposes of testing the
model, the overall abuse measure and the dichotomous measure of abuse will yield
nearly identical results. Due to the near perfect correlations among the three
conceptualizations of abuse, the dichotomized abuse measure (presence vs. absence of
abuse) is the only conceptualization of abuse that is presented in the remaining text.

As is evident in Table 31, experiences of abuse were significantly related to

level of stress. The presence or absence of abuse was associated with higher levels of

130

stress (r = .60, p_ < .05). This finding was consistent with the hypothesis that
experiences of abuse lead to higher levels of stress in women’s lives. Experiences of
abuse, as measured by the presence or absence of abuse, were also significantly related
to poor psychological health (r = -.45, p_ < .05), a greater number and more frequent
physical health symptoms (r = .30, p < .05), a greater number and more frequent
gynecological symptoms (r = .25, p < .05), and higher levels of alcohol and drug use
(r = .38, p < .05).

Table 31 also demonstrates that the presence or absence of abuse was found to
be significantly related to social support (r = -.26), maladaptive coping (r = .43), and
adaptive coping (r = .19), although the relationships between experiences of abuse and
each of these three variables were not tested as part of the path model. All of these
correlations were significant at the p < .05 level. This means that when abuse was
present, women were less pleased with the amount and quality of social support they
received, and they were more likely to have used a variety of coping strategies, both
adaptive and maladaptive.

Stress and Major Path Constructs

The relationships between stress and experiences of abuse have already been
discussed. Next, the relationships between level of stress and each of the dependent
variables in the path model were examined. As Table 31 indicates, moderate
correlations were found between level of stress and psychological health (r = -.62),
physical health symptoms (r = .51), gynecological symptoms (r = .39), and use of
alcohol and drugs (r = .42). All of these correlations were significant at the p_ < .05

level. This means that when women had high levels of stress, women experienced

131

poorer psychological health, a greater number and more frequent physical health and
gynecological symptoms, and reported higher levels of alcohol and drug use. The
presence of significant relationships between level of stress and each of the dependent
variables was consistent with the hypothesized paths in the model.

While not part of the tested model, the level of stress in women’s lives was
found to be significantly related to lower levels of satisfaction with the amount and
quality of social support they received (r = -.47, p < .05) as well as to more frequent
use of maladaptive c0ping strategies (r = .54, p_ < .05). However, level of stress was

not significantly related to use of adaptive coping strategies, as Table 31 illustrates.

Pachological Health and Mai or Path Constructs

 

An examination of the intercorrelation matrix presented in Table 31
demonstrated significant relationships between psychological health and both
experiences of abuse and level of stress, as previously mentioned. The relationships
among psychological health and the physical health constructs, however, have not been
addressed. Psychological health was found to be significantly related to physical
health symptoms (r = -.64, p < .05), gynecological symptoms (r = -.37, p < .05), and
use of alcohol and drugs (I = -.37, p < .05). These results indicated that as women
reported lower levels of psychological health, they experienced higher levels of
physical health and gynecological symptoms and higher levels of alcohol and drug use.
Poor psychological health was also related to lower levels of satisfaction with the
amount and quality of social support received (r = .5 6) and more frequent use of

maladaptive coping strategies (r = -.55). These correlations were significant at the

132

p < .05 level. No relationship was found between poor psychological health and the
use of adaptive coping strategies.
Mal Health Scales and Major Path Con_structs

The significant relationships between the physical health scales and experiences
of abuse, stress, and psychological health have already been reviewed. As Table 31
demonstrates, the intercorrelations among the physical health constructs reveal that
higher levels of physical health symptoms were positively related to experiencing a
greater number and more frequent gynecological symptoms (r = .45, p_ < .05) and
higher levels of alcohol and drug use (r = .39, p < .05). Experiencing gynecological
symptoms, however, was not significantly related to women’s use of alcohol and
drugs.

Only one of the physical health constructs, the frequency of experiencing
physical health symptoms, was related to lower levels of satisfaction with the amount
and quality of social support received (r = -.36, p < .05). All three of the physical
health constructs, however, were significantly related to the use of maladaptive coping
strategies. The correlations between maladaptive coping and physical health
symptoms, gynecological symptoms, and use of alcohol and drugs were r = .48,
r = .23, and r = .63 respectively. These correlations were all significant at the p_ < .05
level. None of the relationships between the physical health constructs and the use of
adaptive coping strategies were significant.
Social Sum; Maladaptive Coping, and Adaptive Coping

Earlier in this section, the relationships between social support, maladaptive

coping, and adaptive coping and the major path model constructs were discussed. In

133

the final evaluation of the results of the intercorrelation matrix presented in Table 31,
the relationships among these constructs were reviewed. A moderate correlation was
found between social support and maladaptive coping (r = -.3 8, p < .05), indicating
that as women reported lower levels of satisfaction with their social support, women
used a greater number and more frequent maladaptive coping strategies. No
significant correlations were found between level of social support and use of adaptive
coping strategies, or between use of maladaptive coping strategies and use of adaptive
coping strategies.

Taken together, the results in Table 31 indicate that experiences of abuse were
significantly related to higher levels of stress, poorer psychological health, and higher
levels of physical health symptoms, gynecological symptoms, and alcohol and drug
use. The presence of abuse was also related to dissatisfaction with the amount and
quality of social support and more frequent use of coping strategies, both adaptive and
maladaptive. Similar to abuse, higher levels of stress were significantly related to
poorer psychological health and higher levels of physical health symptoms,
gynecological symptoms, and alcohol and drug use. Higher levels of stress were also
related to dissatisfaction with the amount and quality of social support and more
frequent use of maladaptive coping strategies. Higher levels of stress were not,
however, related to more frequent use of adaptive coping strategies. In terms of
psychological health, women who experienced poorer psychological health experienced
more frequent physical health and gynecological symptoms, higher levels of alcohol
and drug use, dissatisfaction with the social support they received, and more frequent

use of maladaptive coping strategies. When women experienced poorer physical

134

health, regardless of the measure of physical health, women used more frequent
maladaptive coping strategies. Furthermore, women who experienced higher levels of
physical health symptoms reported higher dissatisfaction with the social support they
received. Finally, women who were more satisfied with their social support reported
less frequent use of maladaptive coping strategies.

mof the Moderator Hypotheses

After the measurement-related issues had been addressed, the next step was to
test the moderator hypotheses. Please refer back to Figure 2 for the explanation of the
moderator hypotheses. First, it was hypothesized that social support and coping would
moderate the relationship between abuse and psychological health. That is, there
would be a significant interaction effect of social support ,and coping with experiences
of abuse and psychological health such that when social support and coping were low,
the relationship between experiences of abuse and psychological health would be
strong and positive. This means that in conditions of low social support and low
coping, experiences of abuse would have a detrimental effect on women’s
psychological health. Conversely, when social support and coping were high, the
relationship between abuse and psychological health would diminish.

The second moderator hypothesis, also illustrated in Figure 2, was that social
support and coping would moderate the relationship between stress and psychological
health. Similar to above, this means that a significant interaction effect of social
support and coping with level of stress on psychological health was hypothesized.
Specifically, it was expected that when social support and coping were low, the

relationship between stress and psychological health would be strong and positive, such

135

that increased stress would have a detrimental effect on women’s psychological health.
However, under conditions of high social support or high coping, the relationship
between stress and psychological health would lessen.

Two steps were undertaken before the tests for the moderators were conducted.
First, each of the scales involved in the moderator analyses were standardized. Dunlap
and Kemery (1988) showed that if the predictors are standardized prior to forming
product terms for interaction analyses, then the product terms will be correlated near
zero with their constituent parts. This reduces the chances of collinearity problems.
Second, product variables were computed from all the predictors that were
hypothesized to interact with one another. At this juncture, tests of the moderators
were conducted. A description of the tests for each of these moderator hypotheses
follows.

Tests of the Moderators between Abuse and Psychological Health

 

As mentioned earlier, each of the three conceptualizations of abuse were highly
intercorrelated. Therefore, only the dichotomous conceptualization of abuse, the
presence or absence of abuse, was employed in subsequent analyses. Further, because
both an adaptive and a maladaptive coping scale had been created, both adaptive
coping and maladaptive coping were tested as moderators of the relationship between
experiences of abuse and psychological health. This resulted in three total interaction
hypotheses: presence or absence of abuse X adaptive coping, presence or absence of
abuse X maladaptive coping, and presence or absence of abuse X social support. To
test each of these hypotheses, moderated multiple regression was employed.

Specifically, the main effect terms, including stress, were entered at Step One and the

136

product terms were entered at Step Two. For each of the three interaction terms
tested, none of the product terms contributed significantly to the prediction of
psychological health (2 > .25 for all three product terms). That is, social support,
adaptive coping, and maladaptive coping did not moderate the relationship between
abuse and psychological health. Therefore, these hypothesized moderator effects were
removed from the path model.
Tests of the Moderato_rs between Stress and Psychological Health

Similar to above, social support, adaptive coping, and maladaptive coping were
tested as moderators of the relationship between stress and psychological health. The
moderated multiple regression procedures used to test the moderators between abuse
and psychological health were replicated to test the moderators between stress and
psychological health. That is, the main effect terms were entered at Step One,
including abuse, and the product terms were entered at Step Two. For each of the
three interaction terms tested, none of the product terms contributed significantly to the
prediction of psychological health (p_ > .25 for all three product terms). That is, social
support, adaptive coping, and maladaptive coping did not moderate the relationship
between stress and psychological health. Therefore, these hypothesized moderator
effects were removed from the path model. Based on the results of both sets of tests
for moderator hypotheses, social support, adaptive coping, and maladaptive coping
were tested as main effects on psychological health. See Figure 3 for a revised

version of the path model.

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Test of the Path Model

The path model was tested using path analysis in Lisrel VIII. Path analyses
were conducted using variance/covariance matrices based on correlations that were
corrected for attenuation as well as on uncorrected correlations. Since the results of
these two approaches to analysis were very similar, only the analyses involving
uncorrected covariances will be discussed. Nevertheless, path coefficients and T
values for both approaches for the path model are presented in Figures 4 and 5. In
this section, results from the analyses based on uncorrected correlations are discussed
for the model, beginning with the direct effects specified in the model and followed by
a discussion of the indirect effects.
The Effect of Abuse on Stress

It was hypothesized that experiencing abuse would have a positive direct effect
on the amount of stress in participants’ lives. In other words, the participants who
experienced abuse would experience higher levels of stress as well. This is
represented on the left-hand side of Figure 4. As Figure 4 indicates, the results from
the path model supported this hypothesis, the standardized path coefficient was .60
(t = 7.49: p < .05).
The Effect of Abuse on Psychological Health

It was also hypothesized that experiencing abuse would have a negative direct
effect on women’s psychological health, such that women who experienced abuse
would experience lower levels of psychological health, i.e. poorer psychological health.

As is illustrated in Figure 4, a direct negative effect of abuse on psychological health

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141
was not supported for the path model. The standardized path coefficient was -.15 (t =
-1.53; p > .05).
The Effect of Abuse on the Physical Health Scales

Another hypothesized relationship was that abuse would have a direct negative
effect on women’s physical health. That is, women who experienced abuse would
experience poorer physical health. In the originally proposed model, physical health
was a unidimensional construct. Due to the fact that physical health was
multidimensional, this hypothesis was tested for each of the three physical health
scales, physical health symptoms, gynecological symptoms, and use of alcohol and
drugs. Please refer to Figure 4 for the discussion of the direct effects of abuse on each
of the three physical health constructs.

The Effect of Abuse on Physical Health Smptoms. It was hypothesized that
experiences of abuse would have a direct positive effect on physical health symptoms,
such that women who experienced abuse would experience a greater number and more
frequent physical health symptoms. This direct positive effect of experiences of abuse
on physical health symptoms was not supported for the path model. As the figure
illustrates, the standardized path coefficient was .00 (t = .02; p > .05).

Effect of Abuse on Gynecological Symptoms. The second hypothesis
between abuse and the physical health scales was that experiences of abuse would have
a direct positive effect on women’s experiences of gynecological symptoms. In other
words, women who experienced abuse would experience a greater number and more

frequent gynecological symptoms. Similar to the physical health symptoms, this

142
hypothesis was not supported for the path model. The standardized path coefficient
was .02 (t = .18; p > .05).

The Effect of Abu_se on Alcohol and Drug Use. The final hypothesis that
examined the effect of abuse on a physical health construct stated that experiences of
abuse would have a positive direct effect on women’s use of alcohol and drugs. It was
expected that women who experienced abuse would have higher levels of alcohol and
drug use. This hypothesis was not supported. In the path model the standardized path
coefficient was .11 (t = 1.02; p > .05).

To review, it was hypothesized that experiences of abuse would have five direct
effects within the path model. As is evidenced in Figure 4, only one of the five paths
were significant in the model. Women who had experienced abuse did experience
higher levels of stress. However, the hypotheses that experiences of abuse would have
direct effects on psychological health, physical health symptoms, gynecological
symptoms, and alcohol and drug use were not confirmed.

The Effect of Stress on Psychological Health

Another hypothesized relationship was that women’s level of stress would have
a negative direct effect on women’s psychological health, such that as women
experienced a higher level of stress, they would experience poor psychological health.
An examination of Figure 4 reveals that a direct negative effect of level of stress on
psychological health was supported for the path model. The standardized path

coefficient was -.37 (t = -4.06; p < .05).

143

The Effect of Stress on the Physical Health Scales

It was also hypothesized that level of stress would have a direct negative effect
on women’s physical health. That is, as women experienced higher levels of stress,
they would experience poorer physical health. It was already discussed that the
physical health construct was multidimensional. For this reason, separate hypotheses
of the effect of stress on each of the physical health constructs were tested. Please
refer to Figure 4 for the discussion of the effects of stress on physical health. The
three physical health constructs included: physical health symptoms, gynecological
symptoms, and use of alcohol and drugs.

The Effect of Stress on Physigl Health Syr_nptoms. The first of the three
hypotheses between stress and physical health was that women’s level of stress would
have a direct positive effect on physical health symptoms, such that as women
experienced higher levels of stress, they would experience a greater number and more
frequent physical health symptoms. This direct positive effect of level of stress on
physical health symptoms was supported. As is indicated in Figure 4, the standardized
path coefficient for the path model was .51 (t = 4.77; p < .05).

The Effect of Stress on Gypecological Symptoms. The second hypothesis
between stress and the physical health scales was that level of stress would have a
direct positive effect on women’s experiences of gynecological symptoms. In other
words, as women experienced higher levels of stress, they would experience a greater
number and more frequent gynecological symptoms. Similar to the physical health
symptoms, this hypothesis was supported for the path model. The standardized path

coefficient was .38 (t = 3.35; p < .05).

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The Effect of Stress on Alcohol and Drug Use. The final hypothesis that

examined the effect of stress on a physical health construct stated that women’s levels
of stress would have a positive direct effect on women’s use of alcohol and drugs.
That is, as women experienced higher levels of stress, women would also indicate
more frequent use of alcohol and drugs. This hypothesis was not supported for the
path model, the standardized path coefficient was .08 (t = .85; p > .05).

In sum, stress was hypothesized to have direct effects on psychological health
and physical health, with four paths specified in all. Figure 4 demonstrates that all but
one of these paths, the path between level of stress and alcohol and drug use, were
significant. Therefore, women who experienced higher levels of stress experienced
poorer psychological health and a greater number and more frequent physical health
and gynecological symptoms. Women who experienced higher levels of stress did not
have higher levels of alcohol and drug use.

The Effect of Social Support on Psychological Health

As was discussed earlier, a test of the hypothesis that social support would
moderate the relationship between experiences of abuse and psychological health was
not supported. Therefore, social support was hypothesized to have a positive direct
effect on psychological health. That is, as women reported higher levels of social
support, they would report higher levels of psychological health, i.e. greater
psychological health. This is portrayed at the top of Figure 4. This hypothesis was
supported for the path model, the standardized path coefficient was .28 (t = 3.96;

9 < .05).

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The Effect of Adaptive Coping on Psychological Health

Similar to social support, it was originally hypothesized that coping would
moderate the relationship between experiences of abuse and psychological health.
Again, this moderator hypothesis was not supported for both adaptive and maladaptive
coping. Therefore, adaptive coping was hypothesized to have a positive direct effect
on women’s psychological health, such that as women used a greater number and more
frequent adaptive coping strategies, they would report greater psychological health. As
Figure 4 demonstrates, a direct positive effect of adaptive coping on psychological
health was supported in this model. The standardized path coefficient for the path
model was .13 (t = 1.88; p < .05).

The Effect of Maladaptive Coping on Psychological Health

Since the moderator hypothesis was not supported, it was hypothesized that
maladaptive coping would have a direct negative effect on psychological health. That
is, as women used a greater number and more frequent maladaptive coping strategies,
they would report lower levels of psychological health. Again, an examination of
Figure 4 shows that this direct negative effect of maladaptive coping on psychological
health was supported for the path model. The standardized path coefficient was -. 15
(t = -1.91;p < .05).

The Effect of Maladaptive Coping on Alcohol and Drug Use

 

The final path specified in the model was between maladaptive coping and
alcohol and drug use. It was hypothesized that maladaptive coping would have a
direct’positive effect on alcohol and drug use, such that as women used a greater

number and more frequent maladaptive coping strategies, women would report more

146
frequent use of alcohol and drugs. This hypothesis was supported for the path model,
the standardized path coefficient was .54 (t = 6.32; p < .05).

To clarify, with respect to the social support and coping constructs, four direct
effects were hypothesized and found to be significant. Three of these direct effects
were related to psychological health. It was found that women with higher levels of
social support had greater psychological health, that women who used a greater
number and more frequent adaptive coping strategies had greater psychological health,
and that women who used a greater number and more frequent maladaptive coping
strategies had poorer psychological health. Finally, women who had higher levels of
maladaptive coping strategies reported more frequent use of alcohol and drugs.
Indirect Effects of Abuse within the Path Model

Although there were no direct effects of abuse on the psychological health
construct or any of the physical health constructs, there were significant indirect effects
through stress. The significant indirect effects of abuse on psychological health,
physical health symptoms, and gynecological symptoms are discussed below. The
indirect effects of abuse on alcohol and drug use, while not significant, are also
presented. The indirect effects presented were based on analyses run using the
variance/covariance matrix based on uncorrected correlations. The results of the
significance of the indirect effects for the model run using the variance/covariance
matrix based on correlations corrected for attenuation yielded the same results as the

indirect effects discussed below.

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Indirect Effects of Abug on Psychological Health. The first significant
indirect effect was between abuse and psychological health. Within the path model,
the total effect of experiences of abuse on psychological health yielded a standardized
coefficient of -.37. Of this, -.22 was attributable to an indirect effect through stress.
This means that 59.5% of the effect of experiences of abuse on psychological health
was mediated by stress (t = 3.57; p < .05). Therefore, experiences of abuse did have
a negative impact on psychological health, albeit indirectly.

Indirect Effects of Abuse on Physical Health Symptoms. The second
significant indirect effect involved the construct of physical health symptoms. For the
model, the total effect of experiences of abuse on physical health symptoms yielded a
standardized coefficient of .30. Of this, .30 was attributable to an indirect effect
through stress. This means that fully 100.0% of the effect of experiences of abuse on
physical health symptoms was mediated by stress (t = 4.02; p < .05). Therefore,
experiences of abuse did have a negative impact on women’s experiences of physical
health symptoms through this indirect relationship.

Indirect Effects of Abu_se on Gynecological Symptoms. The third, and final,
significant indirect effect involved the gynecological symptoms scale. For the path
model, the total effect of experiences of abuse on gynecological symptoms yielded a
standardized coefficient of .25. Of this, .23 was attributable to an indirect effect
through stress. This means that 92.0% of the effect of experiences of abuse on
gynecological symptoms was mediated by stress (t = 3.05; p < .05). In sum, the
results indicated that women’s experiences of abuse did indirectly have a negative

impact on women’s experiences of gynecological symptoms.

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Indirect Effects of Abwn Alcohol and DruLUse. The last possible indirect
effect of abuse involved women’s use of alcohol and drugs. Results from the path
analysis indicated that there were no significant indirect effects of experiences of abuse
on women’s use of alcohol and drugs. The total effect of experiences of abuse on
alcohol and drug use yielded a standardized coefficient of .15. Of this, .05 was
attributable to an indirect effect through stress. This means that 33.3% of the effect of
experiences of abuse on alcohol and drug use was mediated by stress (t = 0.84;

p > .05). Overall, the results indicated that women’s experiences of abuse did not
have a negative impact on women’s alcohol or drug use, either directly or indirectly.

In summary, while experiences of abuse did not have a direct effect on
women’s psychological or physical health, there were significant indirect effects of
abuse on these constructs mediated by stress. Experiences of abuse had significant
indirect effects on women’s psychological health and their experiences of physical
health and gynecological symptoms. There was not, however, a significant indirect
effect of abuse on women’s use of alcohol or drugs. Table 33 summarizes the direct
and indirect effects of the path model.
filth Model Fit Inflss

There are numerous indices of overall model fit provided by Lisrel VIII. Only
those model fit indices that are typically reported in the literature are presented for the
path model. Descriptions of the individual indices are presented along with each of
the fit indices. The fit indices presented are based on analyses run using the
variance/covariance matrix based on uncorrected correlations. Fit indices for the

model run using the variance/covariance matrix based on correlations corrected for

149

 

 

Table 33

Summa_11 of the Direct and Indirect Effects for the Path Model

(N = 107)

Eifflt. PM! mama M
Experiences of Abuse on Psychological Health -.15 -.22* -.37*
Experiences of Abuse on Physical Health

Symptoms .00 .30* .30*
Experiences of Abuse on Gynecological

Symptoms .02 .23* .25*
Experiences of Abuse on Stress .60* n/a .60*
Stress on Psychological Health -.37* n/a -.37*
Stress on Physical Health Symptoms .51* n/a .51*
Stress on Gynecological Symptoms .38* n/a .38*
Social Support on Psychological Health .28* n/a .28*
Maladaptive Coping on Alcohol & Drug Use .54“ n/a .54“
Maladaptive Coping on Psychological Health -.15* n/a -.15*

 

*p<.05

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attenuation were nearly identical to the fit indices presented below, and do not suggest
any greater or lesser fit of the path model to the data.

The Chi-Square for goodness of fit with 11 degrees of freedom was equal to
46.61 (p < .05), indicating a significant discrepancy between the observed and
reproduced variance/covariance matrices. However, because the statistic is heavily
dependent on sample size, other indices of fit that are not dependent on sample size
were examined. The Goodness of Fit Index (GFI) was equal to .92, while the
Adjusted Goodness of Fit Index (AGFI) was equal to .69. The GFI value suggests
good model fit, while the AGF I value (which is the GF I adjusted for degrees of
freedom), is less than the traditionally accepted cutoff. Generally speaking, the GFI
and the AGFI values should be at least .90 to conclude that there is good model fit.
The standardized Root Mean Square Residual (RMR), which also measures the
discrepancy between the observed and reproduced variance/covariance matrices, was
.12. Finally, the Normed Fit Index (NF 1), which assesses the fit of the model relative
to an independence model, was .87. This value was slightly less than the accepted
cutoff value of .90. Taken together, these indices suggest a marginal fit of the overall
model to the data.

The above fit indices indicate that while there is a marginal fit of the overall
model to the data, revising the model through the addition or subtraction of parameters
might serve to increase its fit to the data. Lisrel VIII suggested four modifications.
All of the advised modifications revolved around the concept that just as level of stress
can affect the other variables in the model, so can the other variables impact a

person’s level of stress. The first modification suggested was a path from social

151

support to stress, indicating that a person’s satisfaction with the amount and quality of
social support received impacts the level of stress that a person experiences. That is, if
a person is very dissatisfied with the support and help they are receiving from other
people, then they may experience higher levels of stress. Also recommended was a
path from psychological health to stress, indicating that one’s psychological health can
impact the level of stress one experiences. Presumeably, this means that the poorer a
person’s psychological health, in terms of being dissatisfied with the quality of one’s
life, feeling depressed, and thinking about or attempting suicide, the higher levels of
stress that person may experience. A third path was recommended from alcohol and
drug use to stress, indicating that use of alcohol and drugs may influence the level of
stress a person experiences. This makes sense because excessive alcohol and drug use
can lead to negative outcomes, thereby resulting in higher levels of stress. A final
path was advised between maladaptive coping and stress, indicating that using
maladaptive coping strategies can influence the level of stress that a person
experiences. This may be because maladaptive coping strategies do not serve to
eliminate the stressor, or in the case where there is limited control over a stressor (i.e.
abuse, poverty), maladaptive coping strategies do not provide a person with the

perception that they are doing something to try and deal with their situation.

CHAPTER 4

DISCUSSION

Introduction

This study was designed to examine the effects of experiences of abuse and
stress on women’s physical and psychological health, for women living in poverty.
Although abuse was originally conceptualized in three different ways, high
intercorrelations among the different abuse constructs and identical findings across
models led to the presentation of a single path model. This model used a
dichotomized abuse variable, the presence or absence of abuse, that was determined by
a set of eligibility criteria that placed women into an "abused" or "not abused" group.

Three primary hypotheses were tested as part of this research study. First, it
was hypothesized that experiences of abuse would have direct effects on women’s
physical and psychological health outcomes. This hypothesis was not supported in the
path model. That is, experiences of abuse did not directly lead to poor psychological
or physical health outcomes. It was also hypothesized that abuse would have a direct
effect on women’s level of stressfulness, and that the level of stress in women’s lives
would have direct effects on their physical and psychological health. The results
indicated that experiences of abuse had a strong positive effect on level of stress. The

participants in the "abused" group had higher levels of stress than women in the "not

152

153

abused" group. Additionally, the hypothesis that stress would have direct effects on
women’s health outcomes was supported, such that women with higher levels of stress
experienced poorer psychological and physical health outcomes than women with
lower levels of stress. Finally, an examination of the indirect effects of experiences of
abuse on psychological and physical health outcomes demonstrated that abuse did have
an indirect effect on women’s health, mediated by stress.

In this section, the results of the study are examined and discussed. First is a
summary and discussion of the major descriptive findings. Next, a summary and
discussion of the correlational findings is provided. Following that is a summary of
the results of the path model, organized by hypotheses. Finally, in the last sections,
the methodological limitations of the research and the implications for firture research,
intervention, and policy are addressed.

Qiscpssion of Major Descriptive Firflipgs

Women in the "abused" group had experienced a wide range of physically and
sexually violent acts. The vast majority of the "abused" women had been grabbed,
pushed, or shoved. However, a smaller percentage of women experienced most of the
other acts of physical and sexual violence. This is not surprising given that grabbing,
pushing, and shoving are generally considered to be the most common types of
physical violence. Although the issue of severity of acts of violence is a highly
debated topic, these behaviors are also considered to be "less severe" acts of physical
abuse. In fact, many of the women who had experienced abuse had to be reminded
throughout their interviews that the project included acts of pushing and grabbing as

forms of physical violence. A small percentage of participants in the "abused" group

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did not think that they had experienced abuse from their partner or ex-partner for this
reason.

Still, acts of physical violence considered to be "severe" were reported by a
substantial percentage of the sample. Approximately one half of the abused women
reported that her assailant had choked her and beat her up in the past six months.
Sexual violence was also reported by a substantial percentage of the "abused" women.
The finding that thirty-eight percent of the women in the "abused" group experienced
forced sexual activity corroborates the results of other research that marital rape occurs
within approximately forty percent of all cases of battering (Campbell, 1989a;
Campbell & Alford, 1989; Eby et al., 1995; Shields & Hanneke, 1983; Stark &
Flitcraft, 1982).

Also interesting was the question of whether or not women in the "not abused"
group had ever experienced abuse. Just over one half of women in this group had
experienced abuse from an intimate partner in their lifetime. That is, in this study, one
in two of the control women had experienced abuse from an intimate male partner at
least once in her lifetime. This finding is somewhat higher than the rates reported in
previous research that indicated between 20% to 25% of the adult women in the
United States have been physically abused by a male partner (Stark & Flitcraft, 1988;
Straus & Gelles, 1988; Straus, Gelles, & Steinmetz, 1980).

All women who had been involved in an intimate relationship in the past six
months were asked the psychological abuse questions. The questions on this scale
ranged from things their partner might have done to annoy or hurt them to actual

threats to hurt them, their children, or their family and friends. An examination of the

155

percentages of women who had experienced each of these types of psychological abuse
indicated that there were women in the "not abused" category who had experienced
different forms of psychological abuse. Due to the fact that some of the psychological
abuse items, such as ignoring or making light of one’s feelings or criticizing a
partner’s family or friends, occur in many intimate relationships, this was not
surprising.

With respect to women’s physical health, practically all of the physical health
symptoms included on the final scale were reported by over half of the participants,
indicating that both "abused" and "not abused" women were bothered by multiple
physical health symptoms. This finding is in accordance with previous literature that
has documented the relationship between poverty and poor health outcomes (Adler et
al., 1994; Belle, 1982; Haan et al., 1989). Adler et al. (1994) suggest that low SES is
associated with increases in stressful events and stress perceptions, both of which may
operate to increase risk for illness.

In terms of women’s substance use, only one in ten women reported that they
had a current problem with alcohol or drugs. Note that women were asked whether or
not they felt that they had a problem with alcohol or drugs. More objective methods
of determining alcohol or drug abuse may have estimated higher rates of problems
with alcohol or drugs. Still, 9.4% of the women reported that they were a problem
drinker or alcoholic and 7.4% of the women reported that they were a problem drug
user or addict. Twelve month prevalence rates of alcohol dependence for women have
been estimated to be 3.7% and of drug dependence for women have been estimated to

be 1.9% (Kessler et al., 1994). Therefore, the women in this sample would appear to

156

demonstrate greater alcohol and drug dependence than women in the general
population, when measured by self-report. Due to the fact that a relatively general
frequency of substance use measure was employed, without corresponding measures of
the amount of consumption, the extent to which women who drink or use drugs more
frequently are actually abusing these substances is unclear.

One surprising finding was that for many of the substances women reported
using, women more frequently reported that their use of a particular substance had
decreased, rather than increased, as a result of the abuse they had experienced. This
contrasts with the hypothesis that abused women may self-medicate with alcohol and
drugs in order to cope with the abuse, as suggested by other researchers (Amaro et al.,
1990; Hilberman & Munson, 1977-78; King, 1981; Stark & Flitcraft, 1988). However,
in their interviews some women reported that their use of alcohol or drugs had
decreased as a result of their assailants’ alcohol or drug problems. In other words,
being involved with someone who had a problem with alcohol or drugs acted as a
deterrent against increased use of alcohol or drugs in response to their abuse for some
of the women in this sample. Seventy percent of the women in the "abused" group
had partners or ex-partners that they believed to have a current alcohol and/or drug
problem.

Overall, women in this study reported moderate psychological health. Scale
scores for depression scale indicated that the average woman in this sample felt
depressed "some or a little" of the time. According to Radlost (1977) cut-offs for
depression, fully one-half of this sample experienced no depression at all, less than

one-tenth of the sample experienced mild depression, nearly one-quarter of the sample

157

reported moderate depression, and one in six women experienced severe depression.
Rates of depression in this sample were similar to the rates of depression in Campbell
et al.’s (1995) study of women with abusive partners when depression was assessed ten
weeks after exiting shelter for battered women. Rates of depression were significantly
lower, however, than those reported by Gleason (1993). In Gleason’s (1993) study,
the six month prevalence of major depression for battered women at a shelter was 83
percent, and the six month prevalence for battered women in the community was 80
percent. One probable reason the rates in the present study are lower is that not all
women in the sample were being abused. However, even if one were to assume that
all the women in this sample who experienced severe depression were abused, the six
month prevalence rate would still only be 34 percent, which is significantly lower than
the rates reported in Gleason’s study. Rates of depression in the current study were
higher than one year prevalence rates of major depressive episodes in the general
population for women, which have been estimated at approximately 13 percent
(Kessler et al., 1994).

In terms of participants’ quality of life, the average score indicated that women
fell between the mostly satisfied rating and the equally satisfied and dissatisfied rating.
Quality of life and depression were strongly related in this sample (r = -.74),
corroborating past research that found as women reported higher satisfaction with their
overall quality of life and emotional well-being, they reported fewer symptoms of
depression (Campbell et al., 1995). Of concern is the fact that just over one-third of
the sample reported that they had thought about ending their life in the past six

months. While over half of those women stated that they had thought about this

158

relatively infrequently, i.e. once a month or less, this was still a substantial percentage
of the participants. This study did, however, find significantly lower rates of suicide
attempts than have been reported in previous research. Seven women in this study
(6.5%) reported that they had attempted suicide in the past six months. If one were to
assume that all of the women who reported a suicide attempt were in the abused
group, then fourteen percent of the battered women would have reported attempting
suicide. This figure is still well below past descriptive studies of battered women that
have reported suicide attempts in 35 to 40 percent of their samples (Gayford, 1975;
Walker, 1979). It is important to remember that the women in this sample were only
asked to report suicide attempts in the past six months. Further, this difference may
also be a reflection of the non-representative samples in the other studies.

On average, the participants in this study were mostly satisfied with the amount
and quality of the social support that they received, they used adaptive coping
strategies with relative frequency, and maladaptive coping strategies with less
frequency. An examination of the two stress scales provided preliminary support for
the study’s rationale. The stressful life events that were most frequently given the
highest stressfulness rating were all events that are easily construed as occurring in
conjunction with abuse. This is discussed in greater detail in the summary of the path
model findings. Further, it was thought that living in poverty would also increase
women’s level of stress. While this relationship cannot be tested due to the study’s
design, it is interesting to note that the most frequently reported difficult life
circumstances appeared to be related to living in poverty. Again, a more detailed

discussion of these issues follow in the summary of the path model findings.

159

Summafl of Intercorrela_t_i_<_)_n_s for Con_structs not Tested in the Path Model

Many of the significant scale intercorrelations were among the relationships
tested in the path model. Since a discussion of the path model ensues, this section will
only discuss the intercorrelations among constructs that were not part of the
hypothesized relationships. The presence or absence of abuse was significantly related
to social support. In other words, women who were in the "abused" group were more
likely to report displeasure with the amount and quality of the social support they
received than women in the "not abused" group. This finding is consistent with
previous literature that has suggested that women who have experienced abuse
typically experience a high degree of social isolation (Dobash & Dobash, 1979;
Dobash et al., 1985; Mitchell & Hodson, 1983; Walker, 1984).

Experiencing abuse was also significantly related to women’s use of coping
strategies. The presence or absence of abuse was significantly related to both
maladaptive and adaptive coping. These relationships indicated that women who were
abused used more frequent maladaptive and adaptive coping strategies. This makes
sense, given that experiencing abuse was related to higher levels of stress in women,
which perhaps resulted in more frequent use of coping strategies, both adaptive and
maladaptive. This relationship is important because it provides evidence that
contradicts Walker’s (1984) learned helplessness theory of women who have been
battered and provides support for the theory that women with abusive partners are
active help-seekers in their attempts to cope with the violence they have experienced,
and that they use a variety of strategies to deal with their situation (Gondolf, 1988).

There is a strong cultural myth that women involved in abusive relationships

160

could leave their assailants relatively easily if they so desired. Not only is it not that
easy to escape an abusive relationship, but most women want the abuse to end, n_ot
necessarily the relationship. To that end, women do actively seek help and employ a
variety of coping strategies to deal with their situation, as the results of this study have
indicated.

Level of stress was also significantly related to social support. This means that
women who experienced high stress levels were more likely to report dissatisfaction
with the amount and quality of their social support. One explanation for this finding
is that women who experience high levels of stress need more social support. While a
woman under high stress may have an identical support system to a woman under low
stress, the woman under high stress may still report greater dissatisfaction with the
amount and quality of social support she received because she needs a greater amount
of social support overall. Further, the women who had experienced abuse in this
sample frequently reported that their family and friends didn’t understand their
situation, and that they couldn’t talk to them about the abuse. Alternatively, it may be
that the direction of this relationship is reversed. That is, the failure of family and
friends to understand women’s situations may have contributed to their increased
stress. A weakness of past research has been the failure to conceptualize social
support as potentially contributing to stress (Thoits, 1982).

While a significant correlation was found between level of stress and
maladaptive coping, no significant relationship was found between level of stress and
adaptive coping. While women used adaptive coping strategies, on average, more

frequently than maladaptive coping strategies, women reported more frequent use of

161

maladaptive coping strategies with higher levels of stress. A possible explanation for
this finding is that women under high stress resort to maladaptive coping strategies
when they feel that nothing else is working. Conversely, it may be that using
maladaptive coping strategies increases the level of stress that women experience. It is
important to state that despite the fact that women were asked to respond to their use
of various coping strategies in a specific situation, when they’d had conflicts or
arguments with family members or friends, it often appeared that women reported their
use of coping strategies in response to stressful situations in general.

While adaptive coping was not significantly related to any of the physical
health constructs, use of maladaptive coping strategies was significantly related to a
greater number and more frequent physical health and gynecological symptoms and
more frequent alcohol and drug use. It is not surprising that using adaptive coping
strategies was unrelated to the physical health constructs. Using a variety of positive
strategies to cope with a stressful situation does not necessarily result in better physical
health, nor does it result in the elimination of a particular stressful situation that may
be adversely affecting one’s health. However, it is reasonable that using maladaptive
coping strategies to deal with a stressful situation would be related to physical health,
in terms of use of maladaptive coping strategies negatively impacting one’s physical
health. This is especially true since two of the seven items in the maladaptive coping
scale involved using alcohol or drugs to cope with a stressful situation.

Significant relationships were also found among the various dimensions of
health. Psychological health was significantly related to each of the physical health

constructs, such that as women reported poorer overall psychological health, they

162

reported experiencing a greater number and more frequent physical health and
gynecological symptoms and more frequent alcohol and drug use. This is consistent
with previous research that has documented the interrelatedness of physical and
psychological health. These correlations also indicated a relationship between alcohol
and drug use and physical health symptoms, such that as women used alcohol and
drugs more often, they reported higher levels of physical health symptoms. Again, this
corroborates past medical research that has suggested that alcohol and drug use can
lead to poor physical health.
Discussion of Path Model

Previous research had found that social support and individual coping resources
moderated the relationship between stress and psychological health (e. g. Aneshensel &
Frerichs, 1982; Aneshensel & Gore, 1991; Cohen & Wills, 1985; Levine & Perkins,
1988; Turner et al., 1991). For this reason, social support, adaptive coping, and
maladaptive coping were hypothesized to moderate the relationship between stress and
psychological health. Abuse was also thought to be a significant source of stress for
women. Therefore, social support, adaptive coping, and maladaptive coping were also
hypothesized to moderate the relationship between abuse and psychological health.
None of these moderator hypotheses were supported. One possible explanation for this
is that the stresses associated with living in poverty and experiencing abuse are more
constant, or stable, sources of stress. On the other hand, life events are typically one-
time happenings and daily hassles are generally considered to be less severe in nature.

Social support or use of coping strategies may lessen the effects of a one-time event or

163

of daily hassles on psychological health, but may not be able to impact this
relationship under a level of stress that remains high for a longer duration.

The fact that social support did not moderate the relationships between
experiences of abuse and psychological health and level of stress and psychological
health was surprising. Past research has demonstrated that one is more likely to find
evidence for moderating effects of social support when one measures the perceived
availability of supportive resources that are responsive to needs that are elicited by
stressful life events (Cohen & Wills, 1985). Given the operationalization of social
support in this study, essentially a satisfaction rating of the amount and quality of the
support received on a variety of domains of social support, one would have expected
an increased likelihood of finding moderating effects. The results of this study have
indicated support for the main-effect model of social support, which simply states that
social resources have a beneficial effect whether or not persons are undergoing stress.
This model of social support is more likely to be found when assessing degree of
integration into a larger social network (Cohen & Wills, 1985). One potential reason
for these findings may simply have been lack of statistical power to detect a
moderating effect. Yet another reason may be that social support increases one’s self-
esteem, lessens feelings of depression, and improves quality of life, whether or not one
is experiencing stress. Many of the women in this sample had experienced their share
of difficult times in the past, regardless of their current situation. In interviewing
women, there was a sense that they were thankful for all of the positive things in their
lives, and that they were determined not to take things for granted. It may be that

social support was perceived as something not to be taken for granted, regardless of

164

their current situation. The remainder of this section discusses the results of the test of
the path model.

Experiencing abuse was found to have a strong effect on the level of stress in
women’s lives. In other words, women who experienced abuse experienced higher
levels of stress as well. A descriptive look at the life event checklist indicated that the
life events most frequently rated extremely stressful can each be related to women’s
experiences of abuse. The item most frequently rated as extremely stressful was being
a victim of a violent crime, such as an assault. Clearly, this was a result of
involvement in an abusive relationship for many of these women. Another item,
having less money than usual, is often true for women after the termination of a
relationship. For women who are economically dependent on their partners, this
separation can be financially devastating. Further, if women have to move to a new
home, another item rated as extremely stressfirl and that is often the case for women
involved in battering relationships, their poor financial situation may be exacerbated.
Increased arguments with a partner or spouse, separation or ending a long term
relationship, and having experienced serious illnesses or injuries are all events that
make intuitive sense as likely to result from women’s experiences of abuse, and these
items were also among the most frequently rated extremely stressful. In sum,
experiences of abuse do lead to higher levels of stress for women.

In terms of the effects of experiencing abuse on women’s psychological and
physical health, no direct effects were established. That is, experiencing abuse does
not directly lead to negative health outcomes, such as poor psychological health, more

frequent physical and gynecological health symptoms, or more frequent alcohol or

165

drug use. However, there were significant indirect effects of experiences of abuse on
psychological health, physical health symptoms, and gynecological symptoms,
mediated through stress.

The finding that experiences of abuse indirectly affect women’s psychological
and physical health makes sense. There were some women in the "abused" group who
had been grabbed or pushed several times in the past year, but who did not perceive
their experiences of abuse to be problematic, at least when compared to other issues in
their lives they were facing. On the other hand, for other participants, the abuse was
one of the most significant sources of stress in their lives, either because they were
hurt that their partner or ex-partner would treat them this way, they were afraid of
having their children taken away, they felt it had taken a toll on their psychological
well-being, they had had to move, they had less money, they had to start receiving
governmental assistance, they had left all their belongings in exchange for personal
safety, and the list goes on. These results indicated that having experienced abuse had
significant detrimental effects on women’s health for women who perceived their
abuse to be a major stressor and for women whose experiences of abuse had created
other stressful situations. One explanation for this is that the frequency of abuse plays
a significant role. This is not to suggest that a single incident of physical violence is
not stressful, because even one assault can have significant detrimental effects, but that
more frequent abuse seems more likely to result in higher levels of stress for women.

A high level of stress was also found to have direct effects on women’s
psychological health and on women’s physical health, in terms of physical health

symptoms and gynecological symptoms. This means that, within this sample of

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women, high levels of stress led to poorer psychological health, increased frequency of
physical health symptoms, and more frequent gynecological symptoms. Given the
overwhelming evidence from past literature that stress affects physical and
psychological health (Caplan, 1964, 1981; Dohrenwend, 1978; Dohrenwend &
Dohrenwend, 1974, 1981; Felner et al., 1983; Selye, 1956; 1982), these effects were
not unexpected.

This direct effect was not supported for alcohol and drug use, however. In
other words, higher levels of stress in women did not lead to more frequent use of
alcohol or drugs. This is perhaps explained by the fact that it is not the actual level of
stress per se that may influence women’s use of alcohol and drugs, but the ways in
which women might cope with their stress that affects women’s alcohol and drug use.
In fact, these data supported this hypothesis. Use of maladaptive coping strategies in
response to stressful situations, such as focusing on and venting of emotions in
negative ways, behavioral and mental disengagement, and using alcohol or drugs, was
directly related to alcohol and drug use. That is, more frequent use of maladaptive
coping strategies led to higher levels of alcohol and drug use.

While social support did not moderate the relationship between experiencing
abuse and psychological health and stress and psychological health, there was a
significant direct effect of social support on psychological health. Therefore, higher
levels of satisfaction with the amount and quality of social support received did lead to
greater levels of psychological health for the women in this study. This finding

corroborates past research that linked social support to psychological well-being

167

(Aneshensel & Frerichs, 1982; Billings & Moos, 1981; Bloom, 1992; Cohen & Wills,
1985; Fiore et al., 1986; Turner, 1981; Wilcox, 1981).

Finally, due to the fact that adaptive coping and maladaptive coping were not
found to moderate the relationship between abuse and psychological health or stress
and psychological health, main effects of each of these coping strategies on
psychological health were tested. The results suggested that as women reported using
a greater number and more frequent adaptive coping strategies they also reported
greater psychological health. Therefore, it appeared that women used a variety of
coping strategies in response to the stress they experienced, subsequently leading to
greater psychological health. The stresses related to experiencing abuse and living in
poverty are often of signficant duration. Perhaps the use of adaptive coping strategies
gave women a sense of personal power, in that they were not allowing their situations
to control them, but rather they were doing what they could to take control of their
lives.

A significant main effect was also established for use of maladaptive coping
strategies on psychological health, such that women who used maladaptive coping
strategies in response to stressful situations reported lower psychological health. When
the maladaptive coping strategies were examined, this finding was not surprising.
Efforts to forget about a situation, giving up on one’s goals, halting attempts to deal
with a situation, or the use of alcohol or drugs are generally not effective means of
dealing with one’s stress. Further, one can easily envision how, when used over a
significant period of time, these strategies would lead to decreased psychological

health.

168

In conclusion, the results of this study indicated that experiences of abuse lead
to significantly higher levels of stress for women. While much of the past research
presumed this relationship, none had empirically tested it. Further, while experiencing
abuse did not directly lead to poor psychological or physical health among women, it
did indirectly lead to poorer psychological health and increased experiences of physical
health and gynecological symptoms through stress. Women’s level of stress not only
mediated the relationship between experiences of abuse and psychological and physical
health, but also directly impacted women’s psychological and physical health.
Specifically, higher levels of stress led to poorer psychological health and a greater
number and more frequent physical health and gynecological symptoms among
women. These relationships have been previously ignored in the literature. They are
important because they may help to explain the differences in women’s health
outcomes due to abuse. For example, women who have to move, enroll their children
in a new school, seek protection from the legal system, or deal with other abuse-
related stressors may experience more frequent, or a greater number of negative
physical and psychological health outcomes than women who experience fewer abuse-
related stressors. While not ascertainable from this study, the duration of the stressor,
such as having to move versus engaging in a legal battle lasting months or years, may
help to explain how experiences of abuse contribute to long-term versus short-term
detrimental health outcomes.

Furthermore, some of the negative health outcomes researchers have attributed
solely to experiences of abuse in the past may actually be in part due to other stressors

in women’s lives. This suggests the need for comprehensive, qualitative assessments

169

for women who have experienced abuse. Responding to women’s experiences of
abuse may not just include referrals for the abuse but also practical help dealing with
the stressful situations that the abuse has instigated. In other words, there are multiple
productive means of intervention.

The inclusion of a comparison group in this study was important as well. Due
to the fact that experiences of abuse did show significant indirect effects on
psychological and physical health, it can be said that abuse had detrimental effects on
women’s health. This was true even when the study included a comparison group of
women who were living in poverty and experiencing several similar stressors and
difficult life circumstances. However, this study allowed for a more realistic
interpretation of women’s lives through the inclusion of the stress construct. Thus, for
women who were not experiencing abuse, but who were dealing with other significant
stressors, health outcomes were similarly impacted in a negative way. Future research
needs to examine comparison groups of women who are not living in poverty in order
to assess how poverty and abuse may interact to affect women’s psychological and
physical health.

This study also defined the context of the abuse. That is, it specifically sought
to explore health outcomes for women who had experienced abuse from an intimate
partner. A lack of attention to the context of abuse was a criticism of some of the past
research on the effects of experiencing violence on women’s health. Clearly,
experiences of violence produced increased levels of stress. However, the nature of
the stressors, the number of stressors, and the duration of the stressors may all vary as

a function of the context in which the violence was experienced, consequently

170

producing a variety of detrimental health outcomes. It may, therefore, be inappropriate
to examine the health-related consequences of violence when the context of the abuse
has not been taken into account.
Methodological Limitations

There are several potential methodological limitations to this research. First,
this research was conducted with women who were living in poverty. This design was
selected in an attempt to improve on past research, in which poverty was a significant
confound in interpreting results due to a lack of comparison groups. A major research
question that remains unanswered, however, is what are the effects of living in poverty
on stress? While the most frequently reported difficult life circumstances were related
to financial issues, this does not provide sufficient evidence that poverty has a direct
effect on stress, although this may seem intuitive. Future research that includes a
range of income levels is needed to determine the extent of this relationship.

Representativeness of the sample was another concern for this study. Past
research had relied heavily on shelters for women with abusive partners and hospital
emergency rooms as recruitment sites. While this study avoided the convenience
samples above, women with restricted incomes were not randomly selected from the
community. Instead, women were approached at social service agencies,
predominantly the Department of Social Services. Hence, the representativeness of the
sample can still be called into question. There is no evidence that the women in this
study are representative of women living in poverty.

Another limitation, of course, was the exclusive use of self-report data This

elevated the potential for response bias, especially given the very sensitive nature of

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the interview items. For instance, women may have been embarassed to report their
true feelings, especially if they felt extremely bad about themselves or they were very
depressed and/or suicidal. Women may also have been embarrassed to report the real
extent of their abuse or their true use of alcohol or drugs. It is important to note,
however, that many women did report high levels of depression, suicidal thoughts,
alcohol and drug use, and abuse. For this reason it is impossible to evaluate the extent
to which this bias may have influenced the results.

Relatedly, another threat to validity stemming from the exclusive use of self-
report data was common-method bias. Collecting data from multiple sources would
help to lessen this bias in future research. Using hospital and other medical records to
verify visits to various health care services and physical health and gynecological
symptoms she reported experiencing, as well as interviewing family or friends to
verify items such as disclosure of suicidal thoughts, alcohol or drug use, and
significant life events are strategies that would reduce this potential bias.
Unfortunately, the practicality of actually incorporating these strategies into a research
study such as this is low. Many of the interview items requested information that is
difficult to verify. There were interviews in which women disclosed that they did not
talk to a medical doctor about the problems they were experiencing. Some women
reported that their family and friends were tired of hearing about their problems, or
that they did not want to burden members of their families or their fiiends with their
problems. Either way, the result was a lack of self-disclosure to other individuals who
would typically be able to corroborate self-report data. Additionally, assailants

typically engage in acts of violence behind closed doors. For much of the data

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involving women’s experiences of abuse, self-report is the only way to collect this
information.

Another limitation to this study was its cross-sectional nature. Cross-sectional
designs do limit the ability to make causal statements. Future research that examines a
similar model longitudinally, would greatly strengthen the findings of the present
research. In this way, changes in women’s physical and psychological health could be
examined as their experiences of abuse and level of stress increase or decrease.
Investigating how longitudinal changes in experiences of abuse and stress affect
women’s satisfaction with their social support and their use of adaptive and
maladaptive coping strategies would also be valuable.

A final limitation of this study was power. The original sample size was
determined to be one hundred, given that there were ten paths in the model and the
general rule of thumb is to have ten participants per path. However, due to
measurement development based revisions, the final path model contained thirteen
paths. This means that one must consider the possibility that the sample size may
have been inadequate for detecting the relationships that were hypothesized in the
model. In order to address this issue, the sample size and T-values were used to
determine D-values, power was computed for each of the D-values, and then those D-
values were converted back to T-values to obtain the power for each of the paths
tested in the model (Dunlap, 1981). This procedure indicated that some of the
relationships in the path model were strong enough that a large sample size was not
required to have adequate power, while other relationships may have required a larger

sample size to have adequate power. For example, for this path model, T-values of

173

3.17 or more had 90 percent power. The T-values for the significant paths in this
model, with the exceptions of adaptive and maladaptive coping, ranged from 3.35 to
7.49, indicating that each of these paths had at least 90 percent power. However,
given the sample size, T-values that were less than 2.00 had less than 50 percent
power. The T-values for adaptive and maladaptive coping were -1.88 and 1.91
respectively, and according to the calculations for power had low power. The
remaining, nonsigrrificant paths in this model had T-values that ranged from .02 to
1.53, indicating that the power was inadequate to sufficiently test some of these
relationships.
Implications for Future Research. Intervention, and Policy

The present study was one of the first to test a path model that examined how
experiences of abuse affect women’s psychological and physical health. Further, while
past research has talked about experiences of abuse as stressful for women, no research
to date had examined the relationship between experiences of abuse and level of stress.
In order to remedy methodological flaws of past research, this study did not use
shelters for women with abusive partners or hospital emergency rooms, but recruited
participants from local social services agencies. Finally, this study included a
comparison group in its design in order to examine the joint effects of experiences of
abuse and level of stress on women’s psychological and physical health, for women
living in poverty.

The results of this study present a convincing case that experiences of abuse
lead to increased stress in women’s lives. While the issue of the potential effects of

poverty has been introduced repeatedly, it was impossible to assess these effects in this

174

sample, due to the lack of variability with respect to income. Future research needs to
include women of various socio-economic backgrounds to examine how poverty might
influence these relationships, and to examine whether abuse affects women’s physical
and psychological health similarly across women with various socio-economic
backgrounds. It may be that experiences of abuse have differential effects on low-
income versus middle-income women. This information is important in terms of
creating interventions and implementing policies on behalf of women with abusive
partners.

Future research also needs to include women with the full range of experiences
of abuse. In this study, women could not have experienced any threats, physical
violence, or sexual violence in the past year to be included in the "not abused" group.
The "abused" group of women, however, had to have experienced more than one
incident of physical harm in the past six months 9; more than one incident of physical
harm in the past year with ongoing threats (i.e. in the past six months). In other
words, physical harm had to have occurred more than once. If physical harm had
occurred only one time, there had to be ongoing threats. During the screening process,
there were two groups of women who did not qualify. One group included women
who had experienced only a single incident of physical harm and had no ongoing
threats of harm. The second group included women who had experienced threats from
a partner or ex-partner in the past year without concurrent physical abuse. Future
research needs to examine how less frequent experiences of physical abuse and how
experiencing threats without physical abuse affects women’s level of stress and

women’s psychological and physical health.

175

Finally, as mentioned previously, research that examines these relationships
over time is also needed. A critical direction for future longitudinal research is to
track changes in women’s physical and psychological health as their experiences of
abuse and level of stress increase or decrease. Also valuable would be to investigate
how longitudinal changes in experiences of abuse and stress affect women’s
satisfaction with their social support and their use of adaptive and maladaptive coping
strategies.

In terms of exploring areas for intervention strategies, the strong direct effect of
experiences of abuse on level of stress and the indirect effects of experiences of abuse
on psychological and physical health point toward implementing interventions aimed at
reducing and/or eliminating the violence that many women face from their intimate
partners. It is of primary importance to target our interventions to address the multiple
levels of causation in the elimination and prevention of woman battering. These
multiple factors include families and individuals who have been influenced by the
broader culture, community systems that are connected to and influenced by the
broader culture, as well as forces in the broader culture. Through preventive
interventions, women would experience lower levels of abuse and subsequently lower
levels of stress as well as fewer psychological and physical health concerns.

It is important not to ignore the needs of women who have experienced abuse,
however. Since experiences of abuse lead to increased stress, the primary goal is to
stop the violence in these women’s lives through providing referrals, support,
information, and advocacy services to women. The results of this study also suggested

that stressors triggered by the abuse are detrimental to women’s health. For this

176

reason, it is important to sit with women and listen to what they think are the primary
sources of stress in their lives. While interventionists and advocates on behalf of
women with abusive partners may believe that focusing on women’s experiences of
abuse is most helpful to women, it may be that for some women there are multiple
other stressors in women’s lives that need to be acknowledged and dealt with before
women can deal with their abuse. Once strategies to deal with the other potent
stressors have been negotiated or implemented, then perhaps these women can deal
with their abuse, whether that means preparing to leave an abusive partner or starting
the healing process once an abusive relationship has been terminated. For other
women, dealing with the abuse may be their first priority. In these cases it is vital to
remember that women need support and practical assistance not only in the short term,
but also over time. Depending on the stressors that women’s experiences of abuse
have instigated, programs that provide not only crisis intervention but also long-term
support and advocacy services need to be developed and funded.

In terms of interventions within our community systems, there is the need for
provision of resources and training for education about the nature, dynamics, and
consequences of woman battering. Since women with abusive partners have to deal
with multiple community systems, and are frequently blamed for their situation by
individuals within these systems, mental health professionals, health care professionals,
social service agents, members of the educational community, and professionals within
the criminal justice system would all benefit from educational seminars and training.

Women often reported dissatisfaction with health care professionals during their

interviews. Many of the women’s doctors had never identified them as having

177

experienced abuse. For the health care professionals who knew about the women’s
abuse history, not all of them appeared familiar with common health symptoms
associated with experiences of abuse. For example, one woman had been experiencing
choking sensations, a health symptom commonly reported in the literature. The doctor
she told about her symptom had never heard of anyone waking up with choking
sensations, had no possible explanations for her,,and offered no assistance in figuring
out how to resolve the problem. Indeed, it seemed as if some doctors were frustrated
at their patients for "not getting over it." One participant, whose doctor knew about
the abuse, reported that he told her she whined about her problems more than his 85 -
year-old geriatric patients and that he was tired of hearing about it. Clearly, there are
health care professionals who would benefit from education regarding the nature,
dynamics, and consequences of woman battering.

In fact, educating health care professionals is one of the policy implications of
this research. Instituting woman battering education in nursing and medical school
curriculums would serve to help medical professionals effectively identify and
intervene on behalf of women. Mandatory screening for violence is another policy
implication of the current study. There is a growing awareness that our medical
community could be doing more to intervene on behalf of women experiencing abuse.
The movement toward creating and implementing screening protocols for domestic
violence in hospitals needs to be supported in communities where this is occurring, and
demanded in communities who do not have programs in place. Finally, since these
results indicated that experiences of abuse increased the likelihood of moving, having

financial problems, legal problems, etc., policies need to be in place that provide

178

women with financial and legal assistance. This assistance is often critical to a woman
and her family successfully terminating an abusive relationship.

In conclusion, the results of this study imply that experiencing abuse from an
intimate partner may increase the stress that women experience, thereby negatively
impacting their psychological and physical health. To remedy this, interventions that
reduce violence, interventions that attend to all of the stresses women may be facing,
and policies aimed at educating health care professionals and implementing mandatory
screening protocols for violence need to be conducted. Through continued research
and a commitment to action, it is possible to help women lead lives that are free of

violence.

APPENDICES

APPENDIX A

APPENDIX A

ELIGIBILITY WORKSHEET FOR THE WOMEN’S HEALTH PROJECT

The Women’s Health Project is a research study that is interested in talking
with women who have restricted incomes about their health. We will be asking you
about the various health concerns that you have right now, in addition to asking you
about other aspects of your life that may be affecting your health. If you participate
in the interview, you will be paid $10.00 for your time, energy, and cooperation.

The interview will be scheduled at your convenience, at a location that you choose, as
long as it is a private place. Interviewers will not do the interview if there are other
adults around. Everything that you tell us will be held in the strictest confidence, so
that project staff are the only persons who know what you told us. The interview will
take about one and a half hours. Does this sound like something you might be
interested in, or might be willing to help us with?

YES ............................................................. 1
NO ............................................................. 2
DON’T KNOW .................................................. 7

(IF YES, GO ON WITH THE SCRIPT TO DETERMINE WHETHER OR NOT
THE WOMAN IS ELIGIBLE.)

(IF NO, ASK IF THERE IS ANY PARTICULAR REASON. PERHAPS WE CAN
CONVINCE HER WHY IT IS IMPORTANT TO US THAT SHE PARTICIPATE
AND/OR EASE HER CONCERNS REGARDING PARTICIPATION.)

(IF THE WOMAN DOESN’T KNOW, ASK HER IF YOU CAN EXPLAIN MORE
ABOUT THE PROJECT AND CONTINUE WITH THE SCRIPT.)

There are two issues we need to ask you to make sure you can be a part of
this research project. This should only take us about 10 minutes. First, since this
project is interested in health issues for low-income women, we just need to make
sure your income is not more than our cutoff point.

1. Are you currently receiving any governmental assistance (i.e. ADC, SSI, Food
Stamps)?

YES ............................................................. 1

NO ............................................................. 2

179

180

Can you please tell me how much money you get each month, including ADC,
food stamps, and rent money if you receive government assistance? (MAKE
SURE THIS INCLUDES ANY GOVERNMENT ASSISTANCE, FOOD
STAMPS, CHILD SUPPORT, JOB EARNINGS, AND THE INCOME OF
HER PARTNER - IF THEY ARE STILL LIVING TOGETHER)

 

 

 

 

 

 

Government assistance? IMONTH
Food stamps? IMONTH
Child support? /MONTH
Job earnings? IMONTH
Partner income? /MONTH
( Only if she is currently living with her partner)

Anything else? IMONTH
TOTAL = /MONTH

 

How many people does this money support each month?

 

(WRITE EXACT NUMBER)

(USING THE INCOME CHART, CHECK TO MAKE SURE HER MONTHLY
INCOME IS NOT MORE THAN IS SPECIFIED GIVEN HER FAMILY SIZE. IF
SHE IS WITHIN THE INCOME GUIDELINES, CONTINUE THE SCRIPT. IF
NOT, THANK HER FOR HER TIME AND INTEREST AND EXPLAIN YOU’RE
SORRY SHE IS NOT ELIGIBLE.)

Now, the second issue we need to ask you about has to do with any physical

harm you may have experienced in the past year. We want you to be a part of this
project, and the reason we are asking these questions is to understand all the aspects
of your life that may be affecting your health.

4.

In the past year, or since about . have you been
threatened by a partner or ex-partner in any way? By that I mean any time
your partner or ex-partner said or did things that made you feel scared or in
danger, whether in person, over the phone, through the mail, or through other

people.

(GO TO #421) YES ............................................................. 1
(GO TO #5) NO ............................................................. 2

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4a. In the past six months, or since about , have you been
threatened by a partner or ex-partner in any way? By that I mean any
time your partner or ex-partner said or did things that made you feel
scared or in danger, whether in person, over the phone, through the
mail, or through other people.

YES ............................................................. 1
NO ............................................................. 2
not applicable ..................................................... 8

In the past year, were you ever physically banned by your partner? This
includes any time when you might have been grabbed, pushed or shoved,
slapped, kicked, physically restrained, or any other physical act that could
have harmed you? This can also be any time when sexual activity may have
been forced, that is, any sexual activity that you did not want to happen, but
did.

(GO TO #Sa) YES ............................................................. 1
(GO TO # 7) NO ............................................................. 2

5a. How many times has this happened in the past year?

 

In the past six months, were you ever physically harmed by your partner?
This includes any time when you might have been grabbed, pushed or shoved,
slapped, kicked, physically restrained, or any other physical act that could
have banned you? This can also be any time when sexual activity may have
been forced, that is, any sexual activity that you did not want to happen, but
did.

(GO TO #6a) YES ............................................................. 1
(GO TO #7) NO ............................................................. 2
not applicable ..................................................... 8

6a. How many times has this happened in the past six months?

 

In the past year, have you experienced arsy forced sexual activity from
someone you didn’t know? Again, this can be anything that you did not want
to happen, but did.

182
A WOMAN IS ELIGIBLE ONLY IF:

1) SHE HAS EXPERIENCED PHYSICAL HARM MORE THAN ONE
TIME IN THE PAST SIX MONTHS.

2) SHE HAS EXPERIENCED PHYSICAL THREATS OR PHYSICAL
HARM IN THE PAST SIX MONTHS, AND HAS EXPERIENCED
PHYSICAL HARM MORE THAN ONE TIME IN THE PAST YEAR.

3) SHE HAS EXPERIENCED N2 PHYSICAL THREATS IN THE PAST
YEAR, HQ PHYSICAL HARM IN THE PAST YEAR, AND N_O SEXUAL
VIOLENCE IN THE PAST YEAR.

Okay, based on what you’ve told me just now, you are / are not (CIRCLE
ONE) eligible to participate in the interview for the Women’s Health Project.

IF A WOMAN IS NOT ELIGIBLE, THEN THANK HER FOR HER TIME AND
INTEREST AND EXPLAIN YOU’RE SORRY THAT SHE’S NOT ELIGIBLE AND
EXPLAIN THE REASON WHY. YOU CAN SAY SOMETHING LIKE,
"UNFORTUNATELY, WE DON’T HAVE THE RESOURCES TO INTERVIEW
EVERYONE WE’D LIKE TO. BECAUSE OF THIS, THE WOMEN WE
INTERVIEW MUST NOT HAVE EXPERIENCED ANY VIOLENCE IN THE
PAST YEAR AT ALL, OR MUST HAVE EXPERIENCED VIOLENCE
RECENTLY, WHICH FOR US MEANS THE PAST SIX MONTHS. I’M SORRY
WE WON’T BE ABLE TO DO THE FULL INTERVIEW WITH YOU. "

(**IF SHE HAS EXPERIENCED ANY FORCED SEXUAL ACTIVITY, OR
HAS EXPERIENCED EARLIER ABUSE, MAKE SURE THAT YOU TELL
HER ABOUT AND GIVE HER PHONE NUMBERS FOR THE
APPROPRIATE COMMUNITY RESOURCES, SUCH AS CADA, THE
LISTENING EAR, OR THE SEXUAL ASSAULT CENTER)

IF A WOMAN IS ELIGIBLE, THEN PLEASE CONTINUE WITH THE SCRIPT

Now that we know that you can be a part of our project, I just have a couple
of additional questions to ask you before we schedule your interview.

9. Does this still sound like something you’d like to help us with by participating
in an interview? Please remember that everything you tell us is kept
completely confidential.

(GO ON TO #10) YES ............................................................. 1

10.

11.

12.

183

(IF NO, THEN SEE IF YOU CAN ANSWER ANY CONCERNS SHE
MIGHT HAVE ABOUT PARTICIPATING. IF NOT, THEN FOLLOW THE
PROCEDURE OUTLINED ABOVE FOR WOMEN WHO ARE NOT
ELIGIBLE)

Name

 

Address City Zip

 

Phone

 

If you were to be difficult to reach, who would be most likely to know how
we could contact you? (GET AS MANY CONTACTS AS POSSIBLE. USE
THE BACK IF NECESSARY).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11a. Name (relationship)
Address
City State___ Zip
Phone

11b. Name (relationship)
Address
City State__ Zip
Phone

11c. Name (relationship)
Address
City State Zip
Phone

 

If we schedule the interview, but I have a hard time reaching you because
something comes up for you, could we contact the people you just mentioned
to find out where you are and reschedule?

13.

14.

15.

16.

184

Are you currently involved with or dating someone?

(GO TO #14) YES ............................................................. 1
(GO TO #18) NO ............................................................. 2

Does this person live with you?

YES ............................................................. 1
NO ............................................................. 2
not applicable ..................................................... 8

Can you please tell me their first name so that I can call them that?

 

Do you plan to let know that you are going to be
interviewed by a project called The Women’s Health Project?
YES ............................................................. l
N O ............................................................. 2

not applicable ..................................................... 8

APPENDIX B

APPENDIX B

INCOME ELIGIBILITY CHART
1994 Figures

125% of the Federally Set Poverty Level

Family Size Monthly Income
1 $708.00
2 $948.00
3 $1184.00
4 $1424.00
5 $1660.00
6 $1900.00
7 $2140.00
8 $2376.00
9 $2616.00
10 $2852.00

** For households that are supporting more than 10 people, add
$240.00 for each additional person.

185

APPENDIX C

APPENDD( C

MICHIGAN STATE UNIVERSITY

 

DEPARTMENTOF PSYCHOLOGY EAST LANSING ° MICHIGAN 0 48824-lll‘
PSYCHOLOGY RESEARCH BUILDING

Administrative Agreement
between The Women’s Health Project
and Cristo Rey Community Center

The Women’s Health Project director agrees to:

1. assume full responsibility for the design, implementation, analyses, and publication of
this research project.

2. follow University procedures for insuring the confidentiality of information from
participants in this study.

3. make available to Cristo Rey Community Center the results of this research when the
project is completed.

The Cristo Rey Community Center staff agree to:

1. post flyers announcing The Women’s Health Project in the Direct Assistance area
lobby and any other visible area that the staff sees fit to display them.

2. provide space for project staff one or two afternoons a week, for the duration of the
project, in which to explain the project to potential participants.

.4 “i ,r‘ "
TW/ )7? War/V3»— ‘Wifcu re ’Wztijkw-m
Tomasa Velasquez Sylvia .‘Holguin

‘ Direct Assistance CoordinatorI

Cristo Rey u n :

William 8. Davidson 11, Ph.D.
Women’s th Project Women’s Health Project

    
     

 

 

 

MSU 1': an Affmtivc Action/Equal Opportunity Institution

186

187

MICHIGAN STATE UNIVERSITY

 

DEPARTMENT OF PSYCHOLOGY EAST LANSING 0 MICHIGAN 0 4882-14117
PSYCHOLOGY RESEARCH BUILDING

Administrative Agreement
between The Women's Health Project
and Capital Area Community Services

The Women’s Health Project director agrees to:

I. assume full responsibility for the design, implementation, analyses, and publication of
this research project.

2. follow University procedures for insuring the confidentiality of information from
participants in this study.

3. make available to CACS the results of this research when the project is completed.

The Capital Area Community Services staff agree to:

1. post flyers announcing The Women’s Health Project in their lobby and any other
visible area that the staff sees fit to display them.

2. provide space for extra flyers to be displayed in order that interested women may take
one home with them.

MW

Barb Sluka, iate Director of Programs
CapitalAreaCOu-mt ' ' s

       

 

 

William 8. Davidson II, Ph.D.
Women’s Health Project

"80 B an Affirmative Action/Equal Opportunity [Institution

188

MICHIGAN STATE UNIVERSITY

 

DEPARTMENT OF PSYCHOLOGY EAST LANSING 0 MICHIGAN 0 48824-1117
PSYCHOLOGY RESEARCH BUILDING

Administrative Agreement
between The Women’s Health Project
and The HousingResource Center

The Women’s Health Project director agrees to:

I.

assume full responsibility for the design, implementation, analyses, and publication of
this research project.

follow University procedures for insuring the confidentiality of information from
participants in this study.

provide all the labor, staff, and materials for the mail recruitment, with the exception
of the actual mailing labels or addresses. The project will pay postage costs.
Further, the project agrees that no information whatsoever concerning past clients of
the Housing Resource Center will be recorded.

make available to The Housing Resource Center the results of this research when the
project is completed.

The Housing Resource Center staff agree to:

l.

 

provide mailing labels or addresses of women who have received services from the
Housing Resource Center in the past year, and a room in which project staff can stuff
and label envelopes for a mailing. This mailing will provide a brief description of the
project, along with information on how to become more involved, if interested.

   

 

 

 

/
W‘ iam 8. Davidson 11, Ph.D.
Women’s Health Project

mu 8 an Affirmative Action/w Opportunity Institution

189

MICHIGAN STATE UNIVERSITY

 

DEPARTMENT OF PSYCHOLOGY EAST LANSING 0 MICHIGAN 0 48824-1117
PSYCHOLOGY RESEARCH BUILDING

Administrative Agreement
between The Women’s Health Project
and The Economic Crisis Center

The Women’s Health Project director agrees to:

I. assume full responsibility for the design, implementation, analyses, and publication of
this research project.

2. follow University procedures for insuring the confidentiality of information from
participants in this study.

3. make available to The Economic Crisis Center the results of this research when the
project is completed.

The Economic Crisis Center staff agree to:

1. post flyers announcing The Women’s Health Project on the downstairs bulletin board
and any other visible area that the staff sees fit to display them.

2. provide flyers so that interested women may take one home with them.

3. have staff informed about the project to discuss potential participation with women
residing at the shelter. This could happen at house meetings, or during the planning
sessions that take place separately with each woman.

4. provide a private room for the interview to take place, for women who have indicated
interest in participating. Interviews will only take place at E.C.C. if adequate child
care arrangements have been made at the time the interview was scheduled. The
director shall be informed of scheduled interviews and child care arrangements in

 

advance.
.I /
«415.141 r ~22"
Beverly Wie: " irector

We *4

r'. 7
/ -’ /

I

. -.. ’-rly° William ST Davidson n, Ph.D.
Women’ eel Project Women’s Health Project

 

 

MSU It on 4”?th Action/Equal Opportunity Institution

190

MICHIGAN STATE UNIVERSITY

 

DEPARIMINI (II I’\Y(.Ht)l.(')()\' I‘AS'I' LANSING 0 MICHIGAN ‘ 48824-1117
PSYCIIOltXiY RISEARCH Bllll DING

Administrative Agreement
between The Women’s Health Project
and The Department of Social Services

The Women’s Health Project director agrees to:

I. assume full responsibility for the design, implementation, analyses, and publication of
this research project.

2. follow University procedures for insuring the confidentiality of information from
participants in this study.

3. provide all the labor, staff, and materials for any and all mail recruitment, with the
exception of the actual mailing labels. The project will pay postage costs.

4. make available to The Department of Social Services the results of this research when
the project is completed.

The Department of Social Services staff agree to:

1. post flyers announcing The Women’s Health Project in the main lobby and any other
visible area that the staff sees fit to display them.

2. provide space for extra flyers to be displayed in order that interested women may take
one home with them.

3. provide space in the main lobby for project staff several afternoons or mornings a
week, for the duration of the project, in which to explain the project to potential
participants.

4. provide mailing labels of current AFDC recipients within Ingham County, and a room
in which project staff can stuff and label envelopes for a mailing. This mailing will
provide a brief description of the project, along with information on how to become
more involved, if interested. If necessary, additional mailings will be pursued.

% %I%W .
J . Strope, Diré’tor ‘__/,.. >

Ingham County De 3» ial Services

 

      

 

Wil ram S. Davidson II, Ph.D.
Women’s Health Project

MSU is an Affinnatiw Action/Equal Opportunity Institution

APPENDIX D

APPENDIX D

 

 

ATTENTION ALL WOMENII

Your help may be needed!

The Women’s Health Project is looking for women who
have restricted incomes to take part in an interview about
numerous aspects of their health. There are many issues
in your lives that may be affecting your health, and we
need to know more!!

Women who qualify will be paid $10.00 for their time
and cooperation.

If interested,

Call 393-8633
for more information
and to make sure you’re eligible.

Participation is completely confidential.

 

 

191

APPENDIX E

APPENDIX E

 

 

HAVE YOU BEEN HURT BY
SOMEONE YOU LOVE?
Your help may be needed!

The Women’s Health Project is looking for women who

1) have been recently abused by a lover or spouse an_d
2) have restricted incomes

We are interested in women who would be willing
to take part in a confidential interview about numerous
aspects of their health. This is one of many issues in
your lives that may be affecting your health, and we need
to know more!!

Eligible women will be paid $10.00 for their time
and help.

If interested, call 393-8633
for more information
and to make sure you ’re eligible.
Participation is completely confidential.

 

 

192

APPENDIX F

APPENDIX F

Syllabus: Fall 1&4

PSY 490: Independent Study with The Women’s Health Project
Tuesdays: 5:30 - 7:30 p.m.

SUPERVISORS:

Kim Eby Kelly Bennett
402 Baker Hall 402 Baker Hall
355-9519(w); 355-7440(w); 393-8633(h) 339-9771(h)

Office Hours: by appointment

COURSE PURPOSE:

This course is the first in a two semester sequence of conducting field
research. The overall course sequence was designed to broadened your knowledge in
the areas of woman abuse, women’s health, and poverty; to provide you with the
necessary skills in recruitment and interviewing techniques, data collection, data
coding, and computer data entry; and to give you general experience in conducting
research in community settings.

The first semester of the course sequence is an introduction to the Women’s
Health Project, presentation of the relevant issues involved - such as woman abuse,
poverty, and women’s health, training in interviewing skills, and assignment of
interviewing cases. The second semester of the sequence will focus on completion of
interviews along with further discussion of woman abuse, poverty, women’s health,
and issues in conducting community research.

FORMAT:

This course will involve several components. These components include:
weekly training, readings, and discussion of relevant concepts; homework; interview
case responsibility; and weekly supervision of interview progress. We will meet once
a week for 2 hours throughout the first semester. We will continue to meet once a
week throughout the second semester as well. There will be no midterm or final for
this course, however, we will meet both registration and finals weeks.

Weekly training, readings, and discussion. Readings have been assigned for
the first seven weeks of training. Students are expected to do the readings each week
pm); to class and come to class prepared to ask questions and discuss what they’ve
read. Part of your grade will be based on your class participation. Because we will
soon be out in the community interviewing women, it is important that we know you
have prepared each week. Please feel free to ask any and all questions that you may
have, no question is too silly or too small to be discussed.

193

194

Case responsibilig. Your cases are the women you are interviewing each
week. These will be assigned on an as needed basis approximately halfway through
the first semester. Efforts will be made to equalize the workload and number of cases
that each student will have, although obviously students who have signed up for more
credits will be conducting more interviews. It is hoped that you will receive an
average of two interviews per week. No student will receive a case until the
supervisors have determined that you are ready to begin interviewing. Case
responsibility will constitute the most significant part of your grade after training has
ended. Several components of case responsibility will be evaluated. These include:

1) Maintaining confidentiality

2) Contacting the interviewee and screening for her eligibility for the study

3) Conducting the interviews correctly and on time

4) Coding the interviews correctly and on time

5) Reporting your case to your supervisory group and handing in all materials op
time

 

Homework. There will be weekly homework assignments for this class.
During training, homework assignments will include weekly readings, thought papers,
practice interviews and screening procedures, and current events. After training,
homework assignments will simply be your case responsibility and current events.
Your homework is important because it was designed to better help you master the
material. You must complete your homework assignments on time and in full.
Assignments not turned in on time or complete will not be given full credit.

Weekly supprvision. Once you have been assigned a case, class will consist of
current events and weekly supervision. Attendance is mandatog and participation a
must. All interview materials should be brought to class completely coded, with any
questions you may have had clearly documented. In this way, your supervisory group
will be able to help you in the most efficient way. Supervision may include any or all
of the following components: listening to and coding other students’ interviews,
discussing issues surrounding interviewing and woman battering, brainstorming
additional recruitment strategies and efforts, making decisions about coding rules, and
reviewing and role-playing various scenarios. Our group is designed so that everyone
can give each other feedback and suggestions, we would like it to be interesting and
fun, as well as instructive.

GRADING CRITERIA:

Due to the unique nature of this two semester course, the grading criteria may
be different from those of other classes you have taken. Please be sure that you fully
understand the grading criteria as outlined, as no exceptions will be made.

195

Attendance and Class participation. During training, 50% of your grade will
be based on your attendance in class and your class participation. Attendance is
critical in a class such as this because we only meet once a week, and each week we
will discuss a new topic and learn another aspect of the interviewing process.
Therefore, attendance is mandatory. If you miss more than one class, you will fail
the course. If you must miss class, it is imperative that you contact your supervisors
within one day of class so that we can meet with you to make up what you missed.
Failing to do so will earn you zero credit for that week. It is also imperative that you
come to class on time and do not make plans to leave class early. Tardiness will also
result in a grade reduction for that week. Class participation will be expected every
week and includes sharing current events, asking questions, discussing the readings,
discussing other issues or concepts, and actively listening and providing feedback to
your colleagues. After training is completed, 30% of your grade will be based on
your attendance and your class participation.

 

Homework. During training, the other 50% of your grade will be based on
your homework assignments. This includes doing the weekly readings, your thought
papers, bringing in current events articles to share, and turning in practice interviews
on time and in full.

Case resmnsibilig. After training is over, 70% of your grade will be based
on your case responsibility for each of the cases to which you are assigned. Please
see Criteria for Calculating Case Responsibility. This includes completion of
interviews by the agreed upon date and promptness of banding in data. Case
responsibility further includes correctly coding the interviews before coming to class.
In addition, interviewers must demonstrate a reasonable amount of diligence and
flexibility in attempting to contact interviewees and setting up interviews. Grades will
be reduced if the entire interview packet is not turned in at the designated class
meeting.

All interviewers are expected to conduct themselves in a professional manner
with all women. This includes keeping scheduled appointments, being on time to
appointments, conducting quality interviews, and treating all women with respect and
courtesy.

 

“Please Note: Random checks will be done with the women to verify that they
received their money, that you were on time for your appointment, and that you
conducted the interview in an appropriate manner.

If circumstances arise that prevent the accomplishment of any of the above-
mentioned criteria, it is the interviswer’s responsibility to keep her supervisors
informed and up-to-date on any problems that may exist. This should be done as
soon as the problem arises, and pp; when the interview is past due.

196

EXCEPTIONS TO THE GRADING CRITERIA:

1) Anyone violating confidentialig during the course of the semesters will
automatically be terminated as an interviewer and will receive a 0.0 for each term of
participation. This means not discussing your case with anyone, including family,
roommates, and partners. Even if you share information without revealing the
woman’s name, this is still considered a violation of confidentiality. This also means
not having anyone accompany you to the woman’s house, even if it is to drop you
off. Please be sure to keep your interview folders out of sight of everyone. Also
please conduct phone conversations with women from a private location. The silly
people you can discuss cases with are those in your supervisory group.

2) Your grade for the first semester will be recorded as "incomplete" on your
report card. You will receive separate grades at the end of your second semester, n_ot
one averaged grade. Should you drop out or be terminated before your commitment
date, you will receive a 0.0 for each semester of participation. If you need
documentation of your grade for a job, graduate school, or financial aid, just ask and
we will provide this to you.

3) We reserve the right to not assign cases to interviewers whom we feel have
not demonstrated an adequate grasp of the interviewing techniques or the interviewing
process. Should this occur, you will be terminated from the project and will receive a
0.0 for each semester of participation. We will not take such action without making
every effort on our part to resolve the problem(s) first.

CRITERIA FOR CALCULATIN CASE RESPONSIBILITY

As indicated earlier, a percentage of your weekly grade is comprised of case
responsibility. This encompasses the following components: 1) making a diligent
effort to complete your interview on time; 2) filling out your tape, progress report,
and interview correctly and completely; and 3) following project guidelines when
conducting and completing your interviews. Case responsibility grades will be
calculated in the following way:

4.0: Interview is completed on time or the most diligent effort was made to do so.
Cassette tape, progress report, and interviews are filled out with no errors.
Interview was completed with no errors. (If you have coding questions that
you ask in class, your grade will not be reduced)

3.0: Interview is completed on time or a diligent effort was made to do so.
Cassette tape, progress report, and interviews are filled out with less than 3
minor errors. Interview was completed with fewer than 2 errors.

2.0: Interview is either not completed on time due to a lack of diligent effort on the
part of the interviewer, and/or cassette tape, progress report, and interviews
are filled out with 3-6 minor errors, and/or interview was completed with 2-5
errors.

1.0:

0.0:

197

Interview is either not completed on time due to negligence on the part of the
interviewer, and/or cassette tape, progress report, and interviews are filled out
with 7-8 minor errors, and/or interview was completed with 6-7 errors.

Interview is either not completed on time due to lack of any effort on the part
of the interviewer, and/or cassette tape, progress report, and interviews are
filled out with 9 or more minor errors, and/or interview was completed with 8
or more errors.

l 98
Syllabus; Spring 1995

PSY 490: Independent Study with The Women’s Health Project
Tuesdays: 5:00 - 7:00 p.m.

INSTRUCTOR: Kim Eby
402 Baker Hall
355-9519(w); 393-8633(h)
Office Hours: by appointment

COURSE PURPOSE:

This course is the second in a two semester sequence of conducting field
research. The overall course sequence was designed to broadened your knowledge in
the areas of woman abuse, women’s health, and poverty; to provide you with the
necessary skills in recruitment and interviewing techniques, data collection, data
coding, and computer data entry; and to give you general experience in conducting
research in community settings.

The second semester of the course sequence is designed to allow students
experience in actual data collection for a research project, data coding, and computer
data entry. The second semester of the sequence will also focus on further discussion
of woman abuse, poverty, women’s health, and issues in conducting community
research.

F RMAT:

This course will involve several components. These components include:
recruiting participants; interview case responsibility; and weekly supervision of
interview progress. We will meet once a week for 2 hours throughout this second
semester. As before, there will be no midterm or final for this course, however, we
will meet both registration and finals weeks.

Case resp_onsibility. Your cases are the women you are interviewing each
week. These will be assigned at about 2-3 per week throughout the second semester.
Efforts will be made to equalize the workload and number of cases that each student
will have, although obviously students who have signed up for more credits will be
conducting more interviews. Case responsibility will constitute the most significant
part of your grade this semester, although grades may be issued for additional
activities, such as recruitment and data entry. Several components of case
responsibility will be evaluated. These include:

1) Maintaining confidentiality

2) Conducting the interviews correctly and on time

3) Coding the interviews correctly and on time

4) Reporting your case to your supervisory group and handing in all materials as
{are

 

199

Weekly sumrvision. Class will mainly consist of weekly supervision.
Age;ndance is mandatosy and participation a must. All interview materials should be
brought to class completely coded, with any questions you may have had clearly
documented. In this way, your supervisory group will be able to help you in the most
efficient way. Supervision may include any or all of the following components:
listening to and coding other students’ interviews, discussing issues surrounding
interviewing and woman battering, brainstorming additional recruitment strategies and
efforts, making decisions about coding rules, and reviewing and role-playing various
scenarios. The group is designed so that everyone can give each other feedback and
suggestions, I would like it to be interesting and fun, as well as instructive.

GRADING CRITERIA:

Due to the unique nature of this two semester course, the grading criteria may
be different from those of other classes you have taken. Please be sure that you fully
understand the grading criteria as outlined, as no exceptions will be made.

Attendance and Class participation. Attendance is critical in a class such as
this because we only meet once a week, and each week we will need to discuss the
recruitment and interview progress. Therefore, attendance is mandatory. If you miss
more than one class, you will fail the course. If you w miss class, it is imperative
that you contact me within one day of class so that I can meet with you to make up
what you missed. Failing to do so will earn you zero credit for that week. It is also
imperative that you come to class on time and do not make plans to leave class early.
Tardiness will also result in a grade reduction for that week. Class participation will
be expected every week and includes asking questions, discussing your case
responsibility, discussing other issues or concepts, and actively listening and
providing feedback to your colleagues. Thirty percent of your grade will be based on
your attendance and your class participation.

 

Case resppnsibiligl. Now that training is over, 70% of your grade will be
based on your case responsibility for each of the cases to which you are assigned.
This encompasses the following components: 1) making a diligent effort to complete
your interview on time; 2) coding your tape, progress report, and interview correctly
and completely; 3) completing your interview correctly and completely; and 4)
following project guidelines when conducting and completing your interviews.
Grades will be reduced if the entire interview packet is not turned in at the designated
class meeting.

All interviewers are expected to conduct themselves in a professional manner
with all women. This includes keeping scheduled appointments, being on time to
appointments, conducting quality interviews, and treating all women with respect and
courtesy.

If circumstances arise that prevent the accomplishment of any of the above-
mentioned criteria, it is your responsibility to keep me up-to-date on any problems
that may exist. This should be done as soon as the problem arises, so; when the
interview is past due.

200
EXCEPTION TO THE GRADING CRITERIA:

Anyone violating confidentially during the course of the semester will
automatically be terminated as an interviewer and will receive a 0.0 for that term of
participation. This means not discussing your case with anyone, including family,
roommates, and partners. Even if you share information without revealing the
woman’s name, this is still considered a violation of confidentiality. This also means
not having anyone accompany you to the woman’s house, even if it is to drop you
off. Please be sure to keep your interview folders out of sight of everyone. Also
please conduct phone conversations with women from a private location. The an_ly
people you can discuss cases with are those in your supervisory group.

201

THE WOMEN’S HEALTH PROJECT
Psychology 490 Training Schedule - Fall 1994

 

Weekl - Tuesday, Augast 30

 

Introductions

Overview of the Women’s Health Project and the role of the interviewer
Review Syllabus and Training schedule

Agreement to Interview for the Project

Fill out independently and discuss
* Feelings about battering
* Beliefs about abuse in close relationships
* Facts about woman abuse and battering

Review homework for next week
READINGS FOR NEXT WEEK (V iolenee Against Women):

Okun, L. (1986). History. In Woman Abuse: Fapts Replacing Mytl_l_s, pp. 1-10.

Browne, A. (1993). Violence against women by male partners: Prevalence,
outcomes, & policy implications. American Psychologist, £00), 1077-1087.

Finkelhor, D. & Yllo, K. (1985). The myth and reality of marital rape. In License

to Raps: The Sexual Abuse of Wives, pp. 13-36.
Gondolf, E. (1988). The survivor theory. In Battered Women as Survivors, 11-25.

Heise, L. (1993). Violence against women: The missing agenda. In M. Koblinsky,
J. Tirnyan, & J. Gay (Eds), Ih‘e Health of Women: A Global Persxctive, pp.
171-187.

HONIEWORK:

1) Bring in at least one article/current events on woman battering.
2) Thought paper: 2 pages typed (no more or less please) on the readings

Week 2 - Tuesday, September 6
Current Events

Talk about Readings and thought papers
Review Interviewer’s Handbook

Review homework for next week

202
READINGS F OR NEXT WEEK (Women’s Health Issues):

Corea, G. (1985). The Hidden Malpractice: How American Medicine Mistreats
Women. Chapter 4: Patient-doctor relationship & Chapter 13: Treatment of

common female health problems.

Muller, C. F. (1990). Medicaid: The lower tier of health care for women. In
Health Care and Gender, pp.l47-167.

Smyke, P. (1991). Factors influencing women’s health. In Women and Health, pp.
25-58.

Women’s Task Force (MDMH) (1982). Women and their physicians. In For Better

or For Worse?; Women and the Mental Health System, pp. 21-25.
Using the Questionnaire (1976). In University of Michigan _I_r_r_terviewer’s Manual.

HOMEWORK:
1) Bring in at least one article/current events on a women’s health issue.
2) Thought paper: 2 pages typed on the readings

Week 3 - Tuesday, September 13

Current Events

Talk about Readings and thought papers

Review "Using the Questionnaire" article specifically

Explain procedures for phone calls and in-person visits; determining eligibility for the
study and worksheets; please take detailed notes

Review homework for next week
READINGS FOR NEXT WEEK (Women and Poverty):

Corcoran, M., Duncan, G. J., & Hill, M. S. (1984). The economic fortunes of
women and children: Lessons from the panel study of income dynamics.
$83—53 Journal of Women in Culture and Sociegy, _1_Q(2), 232-248.

Welfare Information, pp. 1-3.

Wilson, J. B. (1987). Women and poverty: A demographic overview. Women and
Health, 3, 21-40.

Zambrana, R. E. (1987). A research agenda on issues affecting poor and minority
women: A model for understanding their health needs. Women and Health,
1;, 137-160.

 

203

HOMEWORK:
1) Bring in at least one article/current events on women and poverty.
2) Thought paper: 2 pages typed on the readings
3) Practice with someone from class and turn in the eligibility form and tape
next week. Bring a list of questions to class.

Week 4 - Tuesday, September 20
Current Events

Talk about Readings and thought papers
Review recruitment procedures and eligibility worksheet for the project

Go through the first half of the Women’s Health Project Interview: please take
detailed notes

Review homework for next week
READINGS FOR NEXT WEEK (Abuse & Poverty: Effects on Women’s Health):

Belle, D., Dill, D., Feld, E., Greywolf, E., Reese, M. F., & Steele, E. (1984).
Mental health problems and their treatment. In D. Belle (Ed.), Lives in
Stress: Women and Depression, pp. 197-210. Greywolf, E., Ashley, P., &
Reese, M. F. (1984). Physical health issues, pp.211-221.

Goodman, L. A., Koss, M. P., & Russo, N. F. (1993). Violence against women:
Physical and mental health effects. Part I: Research findings. Applied and
Preventive Psychology, 2, 79-89.

Goodman, L. A., Koss, M. P., & Russo, N. F. (1993). Violence against women:
Mental health effects. Part II: Conceptualizations of posttraumatic stress.

Applied and Preventive Psychology, 2, 123-130.

 

HOMEWORK:
1) Thought paper on the readings
2) Practice with someone from class and turn in the interview and tape next
week. Bring a list of questions to class.

Week 5 - Tuesday, September 27
Talk about Readings and thought papers
Discuss homework assignment

Go through the second half of the Women’s Health Project Interview - please take
detailed notes

204

Review homework for next week
READINGS FOR NEXT WEEK (Women of Color):

Gordon-Bradshaw, R. H. (1987). A social essay on special issues facing women of
color. Women and Health, 1_2, 243-259.

Helms, J. E. (1992). Various selections from A Race is a Nice Thing to Have.

Lockhart, L. & White, B. W. (1989). Understanding marital violence in the black
community. Journal of Integpprsonal Violence, _4_(4), 421-436.

McIntosh, P. (1989). White priviledge: Unpacking the invisible knapsack. Peace
and Freedom, 10-12.

Ehrenreich, B. (1991). Two, three, many husbands. In G. Kaufman (Ed.), I_r_r
Stitches: A Patchwork of Feminist Humor and Satire, pp. 27-31.

 

HOMEWORK:
1) Thought paper (same as always) on the readings.
2) Practice with someone different from class and turn in interviews and tape
next week. Write down any and all questions and bring to class.

 

Week 6 - Tuesday, October 4
Talk about Readings and thought papers

Class discussion and exercises: cultural diversity, developing race and ethnicity
awareness

Discuss how practicing the full interview went

Review additional paperwork to be filled out: consent form, reimbursement voucher,
etc.

Review homework for next week
READINGS FOR NEXT WEEK (Empathy and Values):

(LAST WEEK OF READINGS! !) Values, empathy, effective communication skills
packet

HOMEWORK:
1) This time entire interview will be practiced from beginning to end,
meaning the interview and all additional paperwork. Turn in tape, interview,
and additional forms next class period, with any questions that may have come
up.
2) 1-2 page summary about your thoughts on the course so far

205

Week 7 - Tuesday, October 11

Talk about Readings and thought papers

Class exercises and discussion: values, empathy, effective communication skills
Discuss mock project interview homework

Schedule 30 minute conferences with your supervisors to review progress, strengths,
and weaknesses before class the next week.

HOMEWORK:
1) Bring in current events articles related to the project
2) Meet with your supervisors
WeeL8 - Tuesday. October 18
Current Events
Discuss and review major issues for mock-interviews
Review general issues of interviewer’s responsibilities, What To Do It? . ..
Review tracking techniques
HOMEWORK:

1) Bring in article for current events
2) First interviews or tasks related to recruitment

Week 9 - Tuesday, October 25 through Week 16 - Tuesday, December 13
(meeting at new and improved location)

 

Current Events
Case supervision
HOMEWORK:

** Bring in article for current events
** Interviews and recruitment as needed

APPENDIX G

APPENDIX G

IN TERVIEWING
REFERENCE
HANDBOOK

Field Research and Data Gathering

for the Women’s Health Project

206

207
INTERVIEWING DO’S AND DON’TS

2.0.

*Be prepared for the interview (have all necessary questions ready--make sure tapes
and tape recorder are functioning properly).

*Identify yourself properly.

*Explain why the information is necessary (Make it clear that there’s a constructive
purpose behind the presented questions).

*Emphasize that all information is confidential.

*Interview each woman alone (the only exception to this is small children that may be
present; however, never interview a woman around another adult or older children
who may listen or interfere).

*Have interviews done in time to code and turn in on the due date.

*Treat all women with consideration (what the woman thinks about you and your
conduct can greatly influence her conduct).

*Be friendly; don’t frighten or intimidate the woman.
*Try to gain the woman’s confidence and respect.
*Dress appropriately.

*Be a good listener. . .concentrate on the interview so that the woman being
interviewed feels that there is some concern.

*Let all women know that you are simply present to gather information and cannot
give assistance. You can, however, give her referrals or refer her to CADA.

*Tape record the entire interview, including paying interviewees.

*Have a map of the Greater Lansing Area available to you at all times.

208
DON’T

 

*Don’t set up interviews and then fail to show up, and don’t arrive at interviews late.

*Don’t rush through the interview or act impatient with a woman who is taking a long
time to be interviewed.

*Don’t let the woman refer to happenings longer ago than the referent time period of
the interview.

*Don’t use obscene language.
*Don’t violate confidentiality.
*Don’t offer advice of any kind, no matter how tempting this may be.

*Don’t drink alcohol or do drugs with your woman. If they do, please ask them to
wait until the interview is over.

*Don’t drink any alcohol or be under the influence of any drugs prior to an interview.

BASIC RULES FOR INTERVIEWING

Rule

The interviewer must
read the questions exactly
as they are worded in the
questionnaire.

The interviewer must
ask every question that
applies to the respondent.

The interviewer must
use prompt cards where
required.

The interviewer must
only probe nondirectly.

The interviewer must
make sure that she has
correctly understood an
answer and that it is
adequate.

The interviewer must
not answer for the
respondent.

The interviewer must
not seek or give unrelated
information.

@son for Rule

To avoid changing the stimulus
conditions intended by the
researcher.

To avoid missing data.

To obtain answers which are of
the form or kind desired by
the researcher.

To avoid suggesting or
implying a particular answer
or range of answers.

To avoid misrepresentation
arising from selective
comprehension of the
respondent’s answer.

To avoid bias which might
arise from the interviewer’s
inference.

To avoid distracting the
respondent from answering
the question.

210

When the respondent
asks for clarification the
interviewer must clarify
nondirectively and in
accordance with the
question objectives.

As the respondent indicates
problems in understanding what
is meant by a question or

probe or instruction, the
interviewer must clarify; this
must be done without implying

or suggesting a particular
answer or range of answers so
that an alteration of the
stimulus conditions is avoided.

9. When the respondent
gives an inadequate answer
the interviewer must probe,
repeat the question, or clarify
the question in order to
obtain an adequate answer.

To avoid inadequate answers
being accepted.

1. Read each question slowly and clearly. A slow and deliberate pace gives the
respondent time to understand the full scope of the question and to formulate a
carefully reply. Although you will become very familiar with the measures during
the course of the study, you must remember that it is all new to each respondent, and
each should be given an equal chance to understand and respond to all of the
questions.

2. Do use the questionnaire carefully, but informally. Speak in a natural,
conversational tone. This requires that you be very familiar with the wording of the

interview questions and with the transitions between sections. Being informal,
however, does not mean that you may be careless in your techniques.

3. Ask the questions in the order in which they are presented in the
questionnaire. Earlier questions can sometimes affect the answers to subsequent

questions. Question order needs to be standardized from respondent to respondent if
the interviews are to be comparable.

 

4. Ask evepy question sp_ecified in the questionnaire. In answering one question,
a respondent will sometimes also answer another question which appears later in the

interview. Do not skip question, even if you think that you already know the answer.
It is your responsibility to make certain, wherever possible, that the respondent is
fully exposed to each question specified in the questionnaire.

If the respondent gives you information which answers a subsequent question,
when you get to that question you may preface it with a remark which shows that you
have not forgotten aware of the earlier response, and ask (if appropriate) the
respondent’s cooperation in answering again.

211

Even if a respondent tells you to provide a certain answer for a series of
similar questions (e.g. " just put ’very effective’ down for all of those") you must still
ask each question. You may say, "We’re asking people about each one of these, so
I’d like to know how you feel about each one separately. "

5. Rep_eat questions which are misunderstood or misinterpreted. Occasionally, a
respondent may misunderstand or misinterpret what is asked. When this happens, the

best technique is to repeat the question just as it is written in the measure. If you
suspect that the respondent merely needs time to think it over, simply wait for the
woman to respond.

6. Keep track of changes you make in the questionnaire. Any changes, even
inadvertent ones, that you make in the wording, phrasing, or order of questions must

be noted in the margin of the questionnaire.

(Adapted from: Interview’s Manual. (1976). Ann Arbor: Institute for Social
Research. Special thanks to Andrea Solarz for her assistance).

212
PROBING FOR INFORMATION

One of the most challenging and important parts of the interviewer’s work is
getting the respondent to answer the question which was asked. If the respondent
gives you an incomplete or irrelevant answer, nrisunderstands the questions, if you do
not understand her answer, or if she loses track of the question and gets off on
another topic, it is y_opr_ responsibility to get her back on the track through careful,
neutral techniques. The quality of the interview depends a great deal on the
interviewer’s ability to probe and use these techniques successfully.

Probing has two major functions:

a. It motivates the respondent to communicate more fully so that she expands
on, clarifies, or explains the reasons behind what she has said.

b. It helps the respondent focus on the specific content of the interview so that
irrelevant and unnecessary information can be avoid.

Probes must perform these two functions without introducing bias.

An answer may be inadequate because it is only a partial answer and therefore
incomplete; it may also be irrelevant, about something other than the subject of the
question, or it may be unclear.

In order to be an effective prober, you must understand the purposes of each
item, and the type of response that is required. In addition, there are several different
neutral techniques that can be used to stimulate a fuller, clearer response.

1. Remating the questions. When the respondent does not seem to
understand the question or misinterprets it, when she seems unable to make up her
mind or when she strays from the subject, the most useful technique is to repeat the
question just as it was written on the questionnaire. Many respondents, hearing it for
a second time, realize what kind of answer is needed. They may not have heard the
question fully the first time, or they might have missed the question’s emphasisd the

2. An emtant pause. The simplest way to convey to a respondent that you
know she has begun to answer the question, but that you feel she has more to say, is
to be silent. The pause (sometimes accompanied by an expectant look or a nod of the
head) gives the respondent time to gather her thoughts.

Pauses are often useful in encouraging communication, and they should
become a natural part of your interviewing technique. Be sensitive, however, to each
individual respondent in using pauses. Some respondents may actually be out of ideas
or have expressed all their thoughts on the subject.

213

3. Remating the resmndent’s reply. Simply repeating what the respondent
has said as soon as she has stopped talking is often an excellent probe. This should

be done as you are writing or recording the response, so that you are actually
repeating the respondent’s reply and recording it at the same time.

4. Neutral questions or comments. Neutral questions or comments are
frequently used to obtain clearer and fuller responses. Verbal encouragement is
usually effective when an answer has been given but is incomplete relative to the
purposes of the item. Such probes would include comments such as "Uh huh," "I
see," "Yes, " or "Mm. " Following are examples of several commonly used probes:

How do you mean?

Could you tell me more about your thinking on that?
Will you tell me what you have in mind?

I’m not sure I understand what you have in mind.
Which answer do you think comes closest?

Anything else?

Any others?

Which would be closer to the way you feel?

These probes indicate that the interviewer is interested and they make a direct
request for more information. Successful probing requires that you recognize
immediately just how the respondent’s answer has failed to meet the objective of the
question and then be able to formulate a neutral probe to elicit the information
needed. You know the question objectives--the respondent does not.

5. In some instances, it may be necessary for you to not only ask for more
information but to specify the kind of information desired. Clarification probes are
indicated when responses appear to be inconsistent, contradictory, or ambiguous. The
following are examples of clarification probes.

a) I’m not sure I understand. Did you just say that (repeat the problematic
response).
b) I’m sorry, but I’m not clear about what you meant by that--could you tell

me a little more?

c) If a respondent gives an "I don’t know" response to an attitude/opinion
question, you can say things like:

(1) There are no right or wrong answers to these questions.

e) We are just interested in finding out how Lop feel about this.

(Adapted from: Interviewer’s Manual, (1972). Ann Arbor: Institute for Social

Research. And Reagles, K. (1979). A Handbook for Follow-up Studies in the Human
Services. NY: 1CD Rehabilitation and Research Center. Thanks to Andrea Solarz

for her assistance.)

 

214
PREPARING FOR THE INTERVIEW

It is vital that you be adequately prepared BEFORE conducting an interview.
Therefore make sure that you have covered all of the following steps before meeting
with a woman to be interviewed.

1. Look over all important information from the data sheet, such as number of
children living with her and the name of her partner/assailant. That way, during the
interview you can say "When we talked with you the other day you said that 3
children were living with you. Is that correct?" This lets women know that what
they say is paid attention to and helps personalize the interviewing process.

2. Make sure the tapes and tape recorder are functioning properly before going on an
interview. Make sure the tape recorder has batteries in case you need to go
somewhere without an outlet to conduct the interview (like a park).

3. Three pieces of information must be included on each tape that is turned in. They
are:

(1) Woman’s ID# - the identification number assigned to the woman
(2) Date of Interview - this is the date the interview is completed (mm/dd/yr)
(3) m1terview’s ID# - your ID#

Example:

1212001345 10/28/94 04

“Never put the woman’s name on the tape. Use only her ID#.

215
INITIAL PHONE CONTACT

1. If a woman or child answers the phone, ask for the interviewee by name. Do not
identify yourself as being from MSU to anyone except the woman herself. If a man
answers, ask for a phony name ( ) and act as though you
have a wrong number (or hang up). BE POLITE.

2. Once you have the woman on the phone, introduce yourself. Ask her if she
knows who you are, and ASK HER IF IT IS SAFE AND/OR CONVENIENT FOR
HER TO TALK. Remind her you’ve called to set up her interview and that she will
be paid $10.00. ("Hi, I’m and I’m an interviewer with the Women’s Health
Project. I’m calling to set up your interview. ")

3. Set up a time that is convenient for both of you that week. ( "I have Thursday and
Sunday available. Do either of those days work for you? Sunday? Okay, all
morning is open for me. When is convenient for you? This interview will take about
11/2 hours. ") IT IS EXPECTED THAT INTERVIEWS WILL BE COMPLETED
AND CODED THE WEEK THAT THEY ARE ASSIGNED. IF THIS WILL NOT
BE POSSIBLE, CONTACT ONE OF US.

4. Explain confidentiality briefly. ("Since everything that you tell me is private--just
between us--it is very important that we have a quiet place to talk where no one can
overhear us. Is there a place like that where we can talk on Sunday?")

5. Make sure you set up a time and place that will be SAFE for the woman. You

will want to pick her up and go to a park, uncrowded restaurant, or other private
location if there is ANY chance of her being in danger.

6. Get clear directions to your meeting place. Asking for landmarks and a brief
description of where she’s living in case of a wrong address is always a good idea.
("Could you please tell me an easy way to get to your place? ") This seems like such
an obvious thing to get, but many an interviewer has hung up the phone and has no
sooner begun to congratulate herself on a job well done, when the realization hits that
she has to call back for directions. Also, confirm your directions with your Lansing
map and carry it with you in case you get lost.

7. Make sure that you refit the day, time and place of your scheduled meeting! ! I!
("I’m looking forward to seeing you on this Sunday at 10:00 AM. at your home.")
If you set up an interview more than 3 days in advance, you should call and confirm
the day before the interview. If the woman doesn’t have a phone, let her know that
you will drop by the day before her interview to remind her of your appointment.
WE KNOW THIS SOUNDS LIKE A PAIN, BUT IT IS CONSIDERABLY LESS
WORK THAN GOING TO AN INTERVIEW, BEING BLOWN OFF, FINDING
HER AGAIN, AND SETTING UP A SECOND INTERVIEW TIME.

216
IF THE WOMAN HAS NO PHONE

1. Go to the house; if a woman or child answers, ask for the woman. If a man
answers, ask for a phony name ( ).

2. If you talk to an alternate contact or a neighbor as a strategy to find the woman,
do not mention the Women’s Health Project. It is none of their business, so protect
the woman’s privacy at all times. You are a student at MSU who is looking for

(use her real name). In the past she helped us out with a project, and
you wanted to see if she wanted to help us again. This is true, but does not reveal
any more information than they need to know. If someone refuses to give you an
additional information unless you tell them more, thank them, leave the project phone
number and your name, and leave to call a supervisor.

 

Procedure for Tracking Down Sources:

Phone the home phone

Visit the woman’s home

Visit neighbors of woman

Phone any alternate contacts on referral sheet
Visit any alternate contacts on referral sheet
Contact supervisors

P‘F‘PP’PT‘

If an initial phone call doesn’t pan out (disconnected, etc.), be sure to check
both the phone book apd information. The number for information is: 1-555-1212.

After you’ve gone through the steps outlined above, contact a supervisor. We
may have another resource available to you.

APPENDIX H

APPENDIX H

Consent Form
PARTICIPANT AGREEMENT
MSU WOMEN’S HEALTH PROJECT

The Women’s Health Project is a research study conducted through Michigan
State University designed to better understand the different aspects of women’s
physical and emotional health. You will be interviewed one time, for which you will
be paid $10.00. It is expected that the interview will take one to one and a half
hours. We feel it is important to know exactly what you are agreeing to, so it is
outlined below:

1. My involvement in this research study has been fully explained to me and I am
volunteering to participate. I realize that I may discontinue my participation at
any time without penalty.

2. I agree to be interviewed by the Women’s Health Project. I understand that I
will be paid $10.00 for completing the interview. I understand that I will be
asked questions about the social support I receive, abuse experienced (if
applicable), and my physical health, including questions about drug and
alcohol use and at-risk sexual behavior. I understand I may choose not to
answers certain questions without penalty.

3. I understand that any information I provide to anyone involved with The
Women’s Health Project will be held in the strictest confidence and that my
anonymity will be protected. I understand this to mean that anyone involved
with the project may not disclose my participation in the project in any way.

4. I understand that I may receive results of this project, if I desire, after its
completion by calling or writing the Women’s Health Project (whose business
card I’ve received).

OPTIONAL:

5. I agree to have the interview tape recorded to ensure accuracy of information.
I understand that I can request that the tape recording be stopped at any time. '
I also understand that this cassette tape will be held in the strictest of
confidence, that my name or any identifying information will not be recorded
or marked on the tape, and that it will be destroyed after the completion of the
research study. YES_ NO_.

 

 

 

Participant Signature Project Staff Date

217

APPENDIX I

APPENDIX I

Respondent ID

Women's Health Project
Interview

Name

Okay, we're almost ready to start. I just want you to know
that all of the information that you have given me that has any
identifying information on it, such as your name, address, and
alternate contacts, will be filed in a separate folder with only
your identification number on it. This top page of the interview
will also be filed in that folder. The actual interview; that
has all of the information that you are about: to tell me, has no
identifying information on it: at all. The only thing on the
interview is your identificaticmlnumber. So, there is no way
that if someone were to look at this interview; that they would
be able to tell who you were from the information here. Okay?

The Women's Health Project is a research study that is
interested in talking with women with restricted incomes about
their health. We will be asking you about various health
concerns that you have right: now, in addition to asking you about
other aspects of your life that may be affecting your health.

Do you have any questions before we get: started?

218

219

Respondent ID

Interviewer'ID#
Time Interview Started

First, I'd just like to ask you some general questions about
yourself.

 

 

1. What is your race or ethnic background?
BLACK/AFRICAN AMERICAN ......... 1
WHITE / CAUCAS IAN ................ 2
HISPANIC/LATINA ................ 3
ASIAN-PACIFIC .................. 4
NATIVE AMERICAN ................ 5
OTHER ( ) ............. 6

2. What is your date of birth? / /

3. How many children.do you have?

 

(IF NO CHILDREN, GO TO #4)

3a. What are their names and ages? (INDICAfliiNUMBER IN
EACH AGE RANGE: NO CHILDREN=88)

UNDER FIVE YEARS OLD

 

5 TO 12 YEARS OLD

 

13 TO 18 YEARS OLD

 

OVER 18 YEARS OLD

 

3b. What type of custody do you currently'have of your

children?
FULL ........................... 1
(IN COURT PROCESS) TEMPORARY ...................... 2
(DIVORCED; EQUAL CUSTODY) JOINT .......................... 3
(NO CUSTODY) NONE ........................... 4
(CHILDREN ARE GROWN) ........... 5
OTHER( ) ........... 6

 

(No children) .................. 8

220

Respondent ID
3

3c. How many of your children are currently living with
you?
(She has no children) ......... 88

(IF LESS THAN ALL CHILDREN) What are their ages?
(PUT 88 IN EACH ONLY IF SHE HAS NO CHILDREN)

UNDER FIVE YEARS OLD

 

5 TO 12 YEARS OLD

 

13 TO 18 YEARS OLD

 

OVER 18 YEARS OLD

 

Are you receiving any governmental.assistance, such as ADC,
$81, or food stamps?
YES ............................ 1
NO ............................. 2
In the last six months, have you been employed?
(GO TO #Sa) YES ............................ 1
(GO TO #6) NO ............................. 2

5a. (IF YES) Are you employed right now?

YES ............................ 1
NO ............................. 2
not applicable ................. 8

5b. What type of work do/did.you do? (IF EMPLOYED IN PAST 6
MONTHS)

CLERICAL ....................... 1
DOMESTIC/CHILDCARE ............. 2
SALES/WAITRESS ................. 3
MANAGERIAL ..................... 4
FACTORY ........................ 5
HUMAN SERVICES ................. 6
SELF EMPLOYED .................. 7
OTHER ( ) ......... O

 

(not applicable) ............... 8

7.

221

Respondent ID
4

5c. Do/did you work part-time, full-time, or sporadically
(off and on, temporary)? (FULLTIME = 35 HOURS PER WEEK OR
MORE)

PART-TIME ...................... 1
FULL-TIME ...................... 2
SPORADICALLY ................... 3
(not applicable) ............... 8
Are you currently a student?
(GO TO #6a) YES ............................ 1
(GO TO #7) NO ............................. 2

6a. Part-time or full-time?

PART TIME ...................... 1
FULL TIME ...................... 2
(not applicable) ............... 8

What's your current educational level?

LESS THAN HIGH SCHOOL .......... 1
HIGH SCHOOL GRAD/ GED .......... 2
SOME COLLEGE ................... 3
COLLEGE GRADUATE ............... 4
TRADE SCHOOL ................... 5

PROFESSIONAL DEGREE ............ 6

222

Respondent ID
5

8. How much.money'have you lived on each month for the past six
months, including ADC, food stamps, and rent money if you
receive government.assistance? (MAKE SURE THIS INCLUDES ANY
GOVERNMENTHASSISTANCE, FOOD STAMPS, CHILD SUPPORT, JOB
EARNINGS, AND INCOME OF HER PARTNER - IF THEY WERE LIVING

 

 

 

 

 

 

TOGETHER)

GOVERNMENTNASSISTANCE? /MONTH
FOOD STAMPS? /MONTH
CHILD SUPPORT? /MONTH
JOB EARNINGS? /MONTH
PARTNER INCOME? /MONTH
(only if she was living with her partner)

ANYTHING'ELSE? /MONTH
AVERAGE MONTHLY INCOME = /MONTH

 

8a. How many people did this income support?

 

9. .How much of this income did you directly'bring into the home
rather than another adult? This includes ADC or any other
government.aid you may get.

NONE OF THE INCOME ............. l

 

PROBE TO ENSURE I 1/2 OF THE INCOME OR LESS ...... 2
ACCURACY OF RESPONSE |
' OVER 1/2 BUT NOT ALL

 

 

OF THE INCOME .................. 3
ALL OF THE INCOME .............. 4
10. lHow much of this income did your (husband/boyfriend/partner)

contribute? (IF SHE BROUGHT IN ALL OF THE INCOME, MARK "1")

NONE OF THE INCOME ............. 1
1/2 OF THE INCOME OR LESS ...... 2
OVER 1/2 BUT NOT ALL INCOME....3
ALL OF THE INCOME .............. 4
not applicable ................. 8
(NO PARTNER)
11. Do you have regular access to a car?
YES ............................ 1

NO ............................. 2

223

Respondent ID

 

 

6
12. As far as where you're living right now, are you:
RENTING APT. OR HOME ........... 1
RENTING A ROOM ................. 2
BUYING YOUR HOME ............... 3
STAYING W/FRIENDS/RELATIVES . . . . 4
OTHER( ) ............. 5
13. How many other adults are in the same home you're in?
(HOMELESS .................... 88)
L4. How many children.are in the same home you're in?
(HOMELESS .................... 88)

Quality of Life Questionnarire

In this section of the interview, I want to find out how you feel
about various parts of your life. Please tell me the feelings
you have now, taking into account what has happened in the past
six months, and what you expect in the near future.

(HAND PARTICIPANT GREEN CARD #1)

On this card are the answers that I'd like you to give me. I'll
be asking you about a list of things. After I ask you each
question” please tell me what answer on this card gives the best
summary of how you feel: either "EXTREMELY’PLEASED", "PLEASED",
"MOSTLY SATISFIED", "EQUALLY SATISFIED AND DISSATISFIED", "MOSTLY
DISSATISFIED", "UNHAPPY", or "TERRIBLE", depending on how you
feel about that part of your life. If you feel that a question
doesn't apply to you, just let me know.

EXTREMELY PLEASED

PLEASED

MOSTLY SATISFIED

EQUALLY SATISFIED AND DISSATISFIED
MOSTLY DISSATISFIED

UNHAPPY

TERRIBLE

refused to answer

1

\oqmmpww

15. First, a very general question” How do you feel about
your life overall? .....................................

16. In general, how do you feel about yourself? ............

17. How do you feel about your personal safety? ............

224

Respondent ID

 

 

 

.7
l = EXTREMELY PLEASED
2 = PLEASED
3 = MOSTLY SATISFIED
4 = EQUALLY SATISFIED AND DISSATISFIED
5 = MOSTLY DISSATISFIED
6 = UNHAPPY
7 = TERRIBLE
9 = refused to answer
18. How do you feel about the amount of fun and
enjoyment you have? ....................................
19. How do you feel about the responsibilities you have for
members of your family? ................................
20. How do you feel about what you're accomplishing in
your life? .............................................
21. How do you feel about your independence or freedom, how

free you feel to live the kind of life you want? .......

 

22. How do you feel about your emotional and psychological
well-being? ............................................

23. How do you feel about the way you spend your spare
time? .................................................

Social Support Section

Now I'm going to ask you some questions about how you feel about
the kind of support and how you feel about the amount of support
that you get from others.

(MAKE SURE PARTICIPANT STILL HAS GREEN CARD #1)

 

Again, for each of the questions in the following section I'd
like you to use the GREEN CARD #1. If you feel like a question
doesn't apply, just let me know.

EXTREMELY PLEASED

PLEASED

MOSTLY SATISFIED

EQUALLY SATISFIED AND DISSATISFIED
MOSTLY DISSATISFIED

UNHAPPY

TERRIBLE

refused to answer

\OQONU'IDbb-DNH

The first couple of questions have to do with companionship.

24. In general, how do you feel about the amount of
companionship that you have? ...........................

25. In general, how do you feel about the quality of
companionship that you have? ...........................

225

Respondent ID

EXTREMELY'PLEASED

PLEASED

MOSTLY SATISFIED

EQUALLY SATISFIED AND DISSATISFIED
MOSTLY DISSATISFIED

UNHAPPY

TERRIBLE

refused to answer

mummpwmw
II II II II II II II II

Okay, thanks. Now I'm going to ask you about a different kind of
help that you may receive from others called "advice and
information". This means being able to count on folks to provide
you with advice and information about personal matters, such as
problems with your children, spouse, or dealing with a personal
situation. It can also be getting advice or information about
resources, such as finding a job or a place to stay, where to
find furniture or other material goods, and things like that.

26. In general, how do you feel about the amount of

advice and information that you receive? ...............
27. In general, how do you feel about the gpality of

advice and information that you receive? ...............
The next couple of questions have to do with another type of
support called "practical assistance, " for example, people you
can count on to help you get things or do things. These are
folks that you can count on to be dependable when you need help,
or that you can count on to do a favor for you, like take you
someplace you need to go, watch your kids, loan or give you money
or something you need.

28. In general, how do you feel about the amount of
practical assistance that you receive? .................

29. In general, how do you feel about the quality of
practical assistance that you receive? .................

Now I'd like to ask you about the "emotional support" that you
receive. This can mean being able to count on someone to listen
to you when you want to talk about something personal, or feeling
that there are people in your life who really care about you.

30. In general, how do you feel about the amount of
emotional support that you receive? ....................

31. In general, how do you feel about the quality of
emotional support that you receive? ....................

32. In all, about how many close friends would you say you have?
That is, friends or relatives you feel at ease with and can
talk to about what's on your mind?

 

CLOSE FRIENDS (WRITE EXACT NUMBER)

 

226

Respondent ID

33. INow, for the last question.about social support, how
do you feel overall about the amount and quality of the
support and help you receive from others? ..............

 

Health.Questionnaire

These next questions are meant to find out more about your
physical health“ Again, if you don't feel that a question
applies to you, just let me know.

34“ .Now, I have a list of symptoms and would like you to answer
how much you've been bothered in the last six months by the
following:

(USE PINK CARD #3 AND MARK ALL RESPONSES IN COLUMN A)

1 = NEVER

2 = ONCE A MONTH OR LESS

3 = 2 OR 3 TIMES A MONTH

4 = ONCE OR TWICE A WEEK

5 = 3 OR 4 TIMES A WEEK

6 = MORE THAN 4 TIMES A WEEK

9 = no answer (explainuwhy)

A E

Sleep problems (can't fall asleep,
wake up in the middle of the night or
early in the morning ................................. /
Nightmares ........................................... /
Back pain ............................................ /
Constipation ......................................... /
Dizziness ............................................ /
Diarrhea ............................................. /
Faintness ............................................ /
Constant fatigue ..................................... /
Migraine headache .................................... /
Headache ............................................. /
Nausea and/or vomiting ............................... /
Acid stomach.or indigestion .......................... /
Stomach pain ......................................... /
Ulcers ............................................... /
Hot or cold spells ................................... /

227

Respondent ID

A
Hands trembling .................................... .._
Heart pounding or racing ............................ _.__
Poor appetite ...................................... .._

Shortness of breath when not

exercising or working hard .......................... _.__
Numbness/tingling in parts of your body ............. .__
Choking sensations.................................=.__
Felt weak all over ................................. _.__
Pains in your heart or chest ........................ _.___
Feeling low in energy ............................... .__
Blurredvision.....................................;__
Muscle tension or soreness .......................... _.__
Muscle cramps ...................................... h
Severe aches and pains .............................. #—
Ringing in your ears ................................ _.___
Pelvic pain ........................................ ._p__
Vaginal bleeding or discharge

(other than your period) ............................ _.___
Painful intercourse................................._:_
Rectal bleeding .................................... ._.__
Bladder infections.................................._.__
Painful urination (passing water) ................... _._

\\\\\

10

Ian

228

Respondent ID
11

In this next set of questions I will ask you about your use of
alcohol and drugs, includinggprescriptituxdrggs. It is not
uncommon.for people to use alcohol or drugs as a way of coping
when situations become very stressful or as a form of recreation.
Please remember that all of your answers will be kept strictly
confidential.and answer as truthfully'as possible.

35. First, I have a list of substances.and would like you to
answer about how often you have used each of the following
substances in the last six months, or since about

 

(USE PINK CARD #3, AND MARK ALL RESPONSES IN COLUMN’A)

 

 

 

 

 

1 = NEVER
2 = ONCE A MONTH OR LESS
3 = 2 OR 3 TIMES A MONTH
4 = ONCE OR TWICE A WEEK
5 = 3 OR 4 TIMES A WEEK
6 = MORE THAN 4 TIMES A WEEK
9 = refused to answer

A £3 E
Nicotine (i.e. cigarettes) ....................... / /
Alcohol (any use at all) ......................... / /
Marijuana ........................................ / /
Non-prescribed drugs (includes cocaine,
crack, speed, uppers, heroin, LSD) ............... / /
Sedatives, hypnotics, or tranquilizers ........... / /
Anti-depressants ................................. / /

 

36. (IF SHE HAS USED SEDATIVES, HYPNOTICS, OR TRANQUILIZERS)
Were the sedatives, hypnotics, or tranquilizers prescribed
by a doctor?

YES .............. 1—--> HOW MANY PRESCRIPTIONS?
NO ............... 2 (888 IF NO OR not applicable)
not applicable...8

37. (IF'SHE HAS USED ANTI-DEPRESSANTS) were the anti-
depressants prescribed by a doctor?

YES .............. 1---> HOW MANY PRESCRIPTIONS?
NO ............... 2 (888 IF NO OR not applicable)
not applicable...8

229

Respondent ID
12

38. Next I'd like to ask you a question.that is a little
different. Some people turn to different types of
substanceS‘when situations become very stressful for them.
Have you used any of the following substances to relieve
stress in the past six months?

1=YES
2=NO
8 = not applicable (COLUMN A = 1)

(GO BACK TO THE BEGINNING OF THE LIST. FOR EACH ITEM THAT SHE
REPORTED USING, ANY USE AT ALL, ASK HER IF SHE HAS USED THAT
SUBSTANCE TO RELIEVE STRESS IN THE PAST SIX MONTHS. MARK ALL OF
THESE ANSWERS IN COLUMN _B_. IF SHE HAS NOT USED A PARTICULAR
SUBSTANCE IN THE PAST SIX MONTHS, MARK "8" IN COLUMN _B.)

 

 

 

 

39. WOuld.you consider yourself to be an:
ALCOHOLIC .................... 4
ASK EACH HEAVY/ PROBLEM DRINKER ....... 3
RECOVERING ALCOHOLIC ......... 2
NO PROBLEMS WITH ALCOHOL ..... 1 (GO TO £43)
40. iHave you been treated in an inpatient setting for alcohol

abuse in the past six months?

YES .............. 1 ---> HOW MANY TIMES?
NO ............... 2 (88 IF NO OR not applicable)
not applicable...8

41” Have you been treated.in an outpatient setting (not
including AA) for alcohol abuse in the past six months?

YES .............. 1 ---> HOW MANY TIMES?
NO ............... 2 (88 IF NO OR not applicable)
not applicable...8

42 . Have you participated in an Alcoholics Anonymous [AA]
program in the past six months?

 

YES .............. 1 —--> HOW MANY TIMES?
NO ............... 2 (INDICATE # OF STARTS)
not applicable...8 (88 IF NO OR not applicable)
43. WOuld.you consider yourself to be an:
ADDICT ....................... 4
ASK EACH HEAVY/ PROBLEM DRUG USER ..... 3
RECOVERING ADDICT ............ 2

 

 

 

NO PROBLEMS WITH DRUGS ....... 1 (GO TO #47)

44.

45.

46.

47.

230

Respondent ID
13

Have you been treated.in an inpatient setting for drug abuse
in the past six months?

YES .............. 1--—> HOW MANY TIMES?
NO ............... 2 (88 IF NO OR not applicable)
not applicable...8

Have you been treated.in an outpatient setting (not
includingfiNA) for drug abuse in the past six months?

YES .............. 1--—> HOW MANY TIMES?
NO ............... 2 (88 IF NO OR not applicable)
not applicable...8

Have you participated in a Narcotics Anonymous [AA] program
in the past six months?

YES .............. 1--—> HOW MANY TIMES?
NO ............... 2 (INDICATE # OF STARTS)
not applicable...8 (88 IF NO OR not applicable)

These next few questions have to do with thoughts and
feelings about ending your life you may have experienced hi
the last six months. It is not unusual for some people to
think about suicide when life becomes very difficult for
them. How often have you thought about ending your life in
the past six months? (USE PINK.CARD #3)

NEVER ................... 1(IF "NEVER", GO TO #48)
ONCE A MONTH OR LESS....
2 OR 3 TIMES A MONTH....
ONCE OR TWICE A WEEK....
3 OR 4 TIMES A WEEK .....
MORE THAN 4 TIMES/WK....

mmmww

47a. Have you told someone else you wanted to kill yourself
in the past six months?

YES .............. 1---> HOW MANY TIMES?
NO ............... 2 (888 if NO or not applicable)
not applicable...8

47b. Have you tried to kill yourself in the past six
months?

YES .............. 1—--> HOW MANY TIMES?
NO ............... 2 (888 if NO or not applicable)
not applicable...8

231

Respondent ID
14

In this section.we'd like to find out some information that
may be more difficult to answer. These questions will help us
better'understandnwhether'you may be at-risk for getting a
sexually transmitted<iisease or the AIDS virus. We know that
some of the questions may not be easy to answer, but in order to
understanduall of the health risks that women may face, please
try to answer them as truthfully'as possible.

48. Which of the following sexual partner experiences best
describeS‘you?
SEX WITH MEN ONLY ....................... 1
SEX WITH WOMEN ONLY ..................... 2
SEX WITH BOTH MEN AND WOMEN ............. 3
(GO TO #57) NEVER ENGAGED IN SEX .................... 8
49. How many sexual partners have you had in the last six
months?
(GO TO #57) O ....................................... 1
1 TO 2 .................................. 2
3 TO 5 .................................. 3
6 OR MORE ............................... 4
not applicable .......................... 8

EH). Who is included in your list of sexual partners in the past
six months? (Please circle all that apply.)

YES NO N/A

SEX WITH MY LOVER/SPOUSE .......... 1....2....8
CASUAL SEX PARTNERS ............... 1....2....8
ONE TIME ANONYMOUS SEX PARTNERS...1....2....8

51. In the past six months, have you exchanged sex for something
you needed, such as money, shelter, food, or something else
you felt you needed?

YES ..................................... 1
NO ...................................... 2
not applicable .......................... 8
52. How often did you use condoms and spermicides when you were

 

having sex in the past six months?

ALL OF THE TIME ......................... 1
MOST OF THE TIME ........................ 2
OCCASIONALLY ............................ 3
SELDOM .................................. 4
NEVER ................................... 5

not applicable .......................... 8

S3.

54.

55.

56.

57.

232

Respondent ID
15

Have you used alcohol or drugs during sex in the past six
months?

ALL OF THE TIME ......................... 1
MOST OF THE TIME ........................ 2
OCCASIONALLY ............................ 3
SELDOM .................................. 4
NEVER ................................... 5
not applicable .......................... 8

Have any of your partner(s) in the past six months used
alcohol or drugs when you were having sex?

ALL OF THE TIME ......................... 1
MOST OF THE TIME ........................ 2
OCCASIONALLY ............................ 3
SELDOM .................................. 4
NEVER ................................... 5
DON'T KNOW .............................. 7
not applicable .......................... 8

Have any of your sexual partners shot up with drugs in the
past six months?

YES ..................................... 1
NO ...................................... 2
DON'T KNOW .............................. 7
not applicable .......................... 8

Have any of your sexual partners in the past six months
lived in a big city, such as Detroit or Chicago?

YES ..................................... 1
NO ...................................... 2
not applicable .......................... 8

Have you shared.needles to shoot drugs in theppast six
months?

YES ..................................... 1
NO ...................................... 2
57a. (IF YES)Have you used dirty needles in the past six
months?
YES ..................................... 1
NO ...................................... 2

not applicable .......................... 8

233

Respondent ID
16

58. IHave you engaged.in high-risk behaviors (such as sexual
intercourseu oral sex, and/or sharing needles) with person
who is HIV-positive or has the AIDS virus in the past six

 

 

months?
YES ..................................... 1
NO ...................................... 2
DON'T KNOW .............................. 7
59. Have you ever been tested for the HIV-virus?
YES ..................................... 1
NO ...................................... 2

59a” (IF YES) Have you been tested for the HIV-virus.ip
the past six months?

YES ..................................... 1
NO ...................................... 2
not applicable .......................... 8
60. ‘Thank you for answering all of those questions and sharing

that informaticm1with.me. I know it's not easy to discuss some
of these concerns. Now I have a list of the ways you might have
felt or behaved.in the last week. We would like to know how
often you have felt any of these ways in the past week. Please
tell me the answer that best describes how often.you felt this
way. (USE BLUE CARD #4)

RARELY OR NEVER (LESS THAN ONE DAY)
SOME OR A LITTLE (1-2 DAYS)
OCCASIONALLY (3-4 DAYS)

MOST OR ALL THE TIME (5-7 DAYS)

htkoH

During phe pas; week:

A. You were bothered by things that usually don't bother you..

B. You did not feel like eating; your appetite was poor .......

C. You felt that you could not Shake off the blues even with
help from your family or friends ..............................

D. You felt that you were just as good as other people ........
You had trouble keeping your mind on what you were doing...
You felt depressed .........................................

E
F
G. You felt that everything you did was an effort .............
H You felt hopeful about the future ......................... .p___

I. You thought your life had been a failure ...................

234

Respondent ID
17

RARELY OR NEVER (LESS THAN ONE DAY)
SOME OR A LITTLE (1-2 DAYS)
OCCASIONALLY’ (3-4 DAYS)

MOST OR ALL THE TIME (5-7 DAYS)

huNH
II II II II

During the past week:

0 Z 2 b N Q

"U

w )0

U)

H

61.

You felt fearful ...........................................

Your sleep was restless ....................................

You were happy .............................................

You talked less than usual .................................

You felt lonely ............................................

People were unfriendly .....................................

You enjoyed life ...........................................

You had crying spells ......................................

You felt sad ...............................................

You felt that people dislike you ...........................

You could.not "get going" ..................................

Now I'd like to ask you about a list of problems that can be

common for some women. These are difficult situations‘or
circumstances that may make your life more troublesome. For each
question I ask, you must decide if it is a problem for you. You
can simply tell me "YES" or "NO". If any of these questions make
you uncomfortable, or don't apply to you, just let me know.

A.

YES NO
Are you having regular arguments or conflicts
with your present partner or steady boyfriend?....1....2
Are you having some sort of problemwwith any
one of your former spouses or partners? ........... 1....2
Is your partner in jail? .......................... 1....2
Is your partner away from the home more than
half of the time because of a job or other
reason? ........................................... 1....2
Do you have long-terntdebts, i.e. more
than 2 years? ..................................... 1....2

Do you have problems'with your credit rating? ..... 1....2

235

Respondent ID
1 8

Do you get hassled pretty often by bill
collectors or collection agencies? ................ 1 . . . . 2

Have you been looking for a job and have
not been able to find one? ........................ 1. . . .2

Does your work or school interfere with your
family life? ...................................... 1. . . .2

Does your partner's work or school interfere
with your family life? ............................ 1. . . .2

Do you have trouble with your landlord? ........... 1. . . .2

Do you have trouble finding a place to live
that is suitable and you can afford? .............. 1. . . .2

Do you feel you do not have enough privacy? ....... 1. . . .2

Do you have people living with you, relatives
or friends, that you wish weren't there? .......... 1. . . .2

Do you have neighbors who are unfriendly
or are giving you problems? ....................... 1. . . .2

Do you or someone in your household have a
longterm illness? ................................. 1. . . .2

Have you had frequent illnesses this past year? . . . 1 . . . .2
Do you have a problem with alcohol or drugs? ...... 1. . . .2

Does your partner have a problem with alcohol
or drugs? ......................................... 1....2

Does someone in your household other than you
or your partner have a problem with alcohol
or drugs? ......................................... 1....2

Is someone other than your current partner
abusing you in any way? ........................... 1 . . . . 2

Have you been hospitalized in the past year
for any reason -- accident or illness? ............ 1. . . .2

Are you without a phone at your present home? ..... 1. . . .2

Is one of your children experiencing learning
problems or other school problems that require
you to consult with teachers or school officials. .1. . . .2

Has one of your children been having serious
emotional or behavioral problems at home, such
as repeated nightmares, tantrums, or outbursts? . . . 1 . . . . 2

236

Respondent ID
19

62. Next, I'd like to ask you about different events that have
happened to you in the last six months. I'd like you to first
tell me when the event occurred. Then I'd like you to tell me
how upsetting or stressful the event was for you. (HAND
PARTICIPANT ORANGE CARD #5) These are the answers I'd like you
to use.

IF THERE WAS MORE THAN ONE OCCURRANCE OF AN EVENT, RECORD THE
MOST RECENT ONE. IF THE PARTICIPANT DID NOT EXPERIENCE AN EVENT,
LEAVE THE DATE COLUMN BLANK AND MARK "8".

NOT AT ALL STRESSFUL
A LITTLE STRESSFUL
MODERATELY STRESSFUL
VERY STRESSFUL
EXTREMELY STRESSFUL
not applicable

(DU'IIAUJNH

DATE STRESS
RATING?
First, let's talk about your home. In the last
six months have you:

1. Moved to a new town or neighborhood? _/_/_
2. Had a serious argument with a friend
or neighbor? _/_/_

Okay, let's talk about school. In the last
six months have you:

3. Started classes at school? This
can include GED, LCC, or MSU _/_/_
4 . Stopped attending school? _/_/_

Next, let's talk about your work. In the
last six months have you:

5. Started a new job or experienced a

big change in your current job? _/_/_
6. Had your partner or spouse start a new

job or experience a big change in

their current job? _/_/_
7. Been fired or laid off? _/_/_
8. Had your partner or spouse fired, laid

off or quit their job? _/_/_
9. Had new troubles with your boss or

other people at work? _/_/_

10. Retired? _/_/_

11. Had your partner or spouse retire?

12. Quit your job?

Now I'd like to talk about your serious

relationships. In the last six months have

13. Started.a steady dating relationship?

14. Ended a steady dating relationship?

15. Married or started.a long-term
committed.relationship?

16. Separated or ended a long—term
committed relationship?

17. Divorced?

18. Reconciled a marital or romantic
relationship?

19. IHad increased arguments with your
spouse or partner?

20. Been unfaithful?

21. Learned that your partner or spouse

237

NOT AT ALL STRESSFUL
A LITTLE STRESSFUL
MODERATELY STRES S FUL
VERY STRESS FUL
EXTREMELY STRES S FUL
not applicable

(DU'lhh-JNH

was unfaithful to you?

Okay, let's talk a bit about your family.
the last six months have you:

22.

23.

24.

25.

Had or adopted a child?

Had trouble with your partner's
or spouse's family'members?

Had trouble with one of your family
members? (not your partner or spouse)

Had a new person move into your home?

Respondent ID

20
DATE STRESS
RATING?
_/_/_
_/_/_
you:
_/_/_
_/_/_
_/_/_
_/_/_
__/_/__
_/_/_
_/_/_
_/_/_
_/_/_
_/_/_
_/_/_
_/__/_
_/_/_

238

NOT AT ALL STRESSFUL
A LITTLE STRESSFUL
MODERATELY STRESSFUL
VERY STRESSFUL
EXTREMELY'STRESSFUL
not applicable

(DU'IIhUNH

Respondent ID

DATE

Next, I'd like to talk to you about your health.
In the last six months have you:

26.

27.

28.

29.

30.

31.

32.
33.
34.

35.

36.

37.

38.

Now let's talk about your finances.

Had any serious illness or injuries?

Had any serious illness or injuries
happen to your partner or spouse?

Had any serious illness or injuries
happen to one of your children?

Had any serious illness or injuries
happen to any other family'members?

Had a miscarriageq stillborn, or
abortion?

Found out that you're unable to
have children?

Started menopause?
Had any sexual difficulties?
Experienced the death of a child?

Experienced the death of a partner
or spouse?

Experienced the death of an other
close family member?

Experienced the death of a close
friend?

Experienced the death of a pet?

last six months have you:

39.

40.

41.

Had less money than usual?

Taken on a major purchase?

Started receiving public assistance?

In the

_/_/_
_/_/_
_/_/__
_/__/_
_/_/_
_/_/_
_/_/_
_/__/_
_/_/_
_/_/_
_/_/_
_/_/_
_/_/_
_/_/_
_/_/_
_/_/_

21

STRESS
RATING?

42.

239

Respondent ID
22

NOT AT ALL STRESSFUL
A LITTLE STRESSFUL
MODERATELY STRESSFUL
VERY STRESSFUL
EXTREMELY'STRESSFUL
not applicable

mU'lnbbJNl-J
II II II II II II

DATE STRESS
RATING?

Had your utilities shut off? _/_/_

Finally, let's talk about your legal status.
In the past six months have you:

43.

44.

45.

46.

47.

48.

49.

50.

Been involved in a law suit or any
legal action _/__/_

Had your driver's license taken away
by the police or court? _/_/__

Been arrested or convicted of a
serious crime? _/_/_

Received a jail sentence or detention?__/_/__
Been released from jail? _/_/_

Been a victim of property damage
or theft? _/_/_

Been a victim of violent crime, such
as rape or assault? _/ /

Had your children taken away from you
or been threatened with having your
children removed from your home? _/_/_

240

Respondent ID
23

63. Okay, now I'd like to know what types of strategies you use
to deal with certain stressful situations when they happen to
you. Specifically, I'd like you to think about times when you've
had conflicts with friends or family members in the past six
months. These can be any type of fights or arguments you may
have had with a friend or family member other than a partner, ex-
partner, or the person who may have abused or is abusing you.

So, in the past six months, when you've had a fight or argument
with a friend or family member, please tell me how often you
tried any of the strategies below to deal with these conflicts.
HAND PARTICIPANT YELLOW CARD #2. I'd like you to use the
following answers .

1 = NEVER

2 = RARELY

3 = SOMETIMES
4 = OFTEN

When you've had fights with friends or family members have you:

A. Let your feelings out by crying or yelling? ............
B. Think about the situation in a more positive
way, like telling yourself it could be worse? ..........

C. Accept that it happened and that it can't be changed?. ._
D. Find something funny about the situation? ............. :__
E. Give up trying to reach your goals in the situation?. . ._
F. Hold back or restrain yourself until the time

was right to do something? .............................

(3. Make a plan about the best way to deal with
the situation? .........................................

I4. Put aside other activities so you could deal
with the situation? ....................................

I. Take action to get rid of the problems you
think may have caused the situation? ...................

 

J. Seek spiritual comfort by praying or meditating? .......
K. Take your mind off the situation by doing other things?
L. Tell someone your feelings about the situation

to get some support? ...................................

M. Get some advice from someone about what to do? .........

N. Be alone for a period of time? .........................

241

Respondent ID

24
1 = NEVER
2 = RARELY
3 = SOMETIMES
4 = OFTEN

When you've had fights with friends or family members have you:

O.

P.

U)

2 <2 C'. P]

X

BB.

CC.

DD.

Help yourself feel better by using drugs or alcohol?...

Express your emotions by trying to destroy
something or hurt someone? .............................

Think about the situation as a chance to learn
or grow as a person? ...................................

Decide to learn to live with the situation? ............
Make jokes about the situation? ........................
Stop your attempts to deal with the situation? .........
Avoid making matters worse by acting too soon? .........

Think hard to come up with strategies for the situation?

Focus on the situation.and let other things slide
a little? ..............................................

Take direct action to get around the situation? ........
Seek God's help or put your trust in God? ..............

Think about other things so that you could forget
about the situation? ...................................

Get some understanding or sympathy from someone? .......
Talk to someone who could do something to help you?....

Get away from everythingmand everyone so you could
deal with this alone? ..................................

Think about the situation less by drinking
alcohol or taking drugs? ...............................

242

Respondent ID
25

In this next section, I would like to ask you some questions
about how often you receive medical care.

64. Have you visited an emergencwaard in a hospital for
yourself in the past six months?

(GO TO #65) YES .............. 1 --—> HOW MANY TIMES?
(GO TO #65) NO ............... 2 (88 IF NO)

64a. (IF YES AND WOMAN HAS BEEN ABUSED) How many of these
visits would you say were related.to any abuse you may have

 

experienced?
(INDICATE EXACT AMOUNT ..............
(not applicable) ................... ="888"
65. Have you visited a medical doctor for an emergency'for
yourself in the past six months?
(GO TO #66) YES .............. 1 ---> HOW MANY TIMES?
(GO TO #66) NO ............... 2 (88 IF NO)

65a. (IF YES AND WOMAN HAS BEEN ABUSED) How many of these
visits would.you say were related to any abuse you may have

 

experienced?
(INDICATE EXACT AMOUNT ..............
(not applicable) ................... ="888"
66. Have you visited.a medical doctor for a routine check-up«or
appointment for yourself in the past six months?
(GO TO #67) YES .............. 1---> HOW MANY TIMES?
(GO TO #67) NO ............... 2 (88 IF NO)

66a. (IF YES AND WOMAN HAS BEEN ABUSED) How many of these
visits would you say were related to any abuse you may have

 

experienced? '
(INDICATE EXACT AMOUNT ..............
(not applicable) ................... ="888"
67. IHave you visited.a psychologist, therapist, or psychiatrist
in the past six months?
(GO TO #67a) YES .............. 1 ---> HOW MANY TIMES?
(GO TO #68) NO ............... 2 (88 IF NO)

243

Respondent ID

 

26
67a. (IF YES) Who referred you to this person?
YOURSELF ........................... l
FRIEND/FAMILY ...................... 2
SHELTER WORKER ..................... 3
MEDICAL DOCTOR ..................... 4
EMERGENCY WARD DOCTOR .............. 5
COURT ORDER (JUDGE) ................ 6
OTHER( ) ............ 7
not applicable ..................... 8

(**INTERVIEWERS: FOR ALL WOMEN Go TO #68)

67b. (IF YES AND WOMAN HAS BEEN ABUSED) How many of these
visits would you say were related to any abuse you may have

experienced?
( INDICATE EXACT AMOUNT ..............
(not applicable) ................... ="888"

68. What type of medical insurance do you currently have?

PRIVATE INSURANCE .................. 1
MEDICAID/MEDICARE .................. 2
NONE ............................... 3

In this next section of the interview, I'd like to ask you
some questions about your relationship(s) in the past six months.
If you don't want to answer any of these questions or if you want
to stop at any time, just let me know.

69. In the past six months, or since about , have
you been threatened by a partner or ex-partner in any way?
By that I mean any time your partner or ex-partner may have
said or did things that made you feel scared or in danger,
whether in person, over the phone, through the mail, or

through other people.

(GO TO #698.) YES ............................ 1
(GO TO #70) NO ............................. 2

69a. Have you been threatened by more than one person in
.the past six months?

(GO TO #69b) YES ............................ 1
(GO TO #70) NO ............................. 2
not applicable ................. 8

69b. How many people have threatened you in the past six
months?

(ACTUAL NUMBER) ............

70.

71.

244

Respondent ID
2 7

In the past six months, have you ever been physically harmed
by a partner or ex-partner? This includes any time when you
might have been grabbed, pushed or shoved, slapped, kicked,
physically restrained, or any other physical act that could
have harmed you. This can also be any time when sexual
activity may have been forced, that is, any sexual activity
you did not want to happen, but did.

(GO TO #7061) YES ............................ 1
(GO TO #71) NO ............................. 2

70a. Have you been harmed by more than one person in the
past six months?

(GO TO #70b) YES ............................ 1
(GO TO #70d) NO ............................. 2
not applicable ................. 8

70b. How many people have harmed you in the past six
months?
(ACTUAL NUMBER) ............

70c. (IF MORE THAN ONE PERSON) With who would you say the
violence you have experienced has been more severe?

(GO TO #72) (NAME OF ASSAILANT/PARTNER)

70d. (IF ONLY ONE PERSON) Would you mind telling me this
person's first name so I can refer to them by that?

(GO TO #72) (NAME OF ASSAILANT/PARTNER)

(IF NO THREATS AND NO HARM) Have you ever been physically
harmed by a partner or ex-partner? This includes any time
when you might have been grabbed, pushed or shoved, slapped,
kicked, physical-1y restrained, or any other physical act
that could have harmed you. This can also be any time when
sexual activity may have been forced, that is, any sexual
activity that you did not want to happen, but did.

(GO TO #71a) YES ............................ 1
(GO TO #710) NO ............................. 2

71a. (IF YES) When did this happen? (IF SHE HAS
EXPERIENCED ANY HARM FROM A PARTNER MORE THAN ONE TIME IN
HER LIFE, THEN RECORD THE MOST RECENT TIME)

DATE OF MOST RECENT ABUSE (IF APPLICABLE) . . .
71b. (IF YES) How long did the abuse last? By that I
mean, did you experience this harm for months, years, or was

it one time?

LENGTH OF ABUSE (IF APPLICABLE) .............
(ACTUAL NUMBER OF DAYS: "00000" IF NO PREVIOUS ABUSE)

71.

72.

73.

74.

245

Respondent ID
2 8

71C. Are you currently in a relationship with or have you
been in a relationship with anyone in the past six months?

(GO TO #71d) YES ............................ 1
(GO TO #92) NO ............................. 2
not applicable ................. 8

71d. Would you mind telling me the first name of the person
you are currently in a relationship with or have been
most recently involved in a relationship with so I can
refer to them by that?

(GO TO #75) (NAME OF (EX-)PARTNER) .....

(IF THREATS, BUT NO HARM IN PAST SIX MONTHS) Would you mind
telling me the name of the person who has been threatening
you? (IF SHE WAS THREATENED BY MORE THAN ONE PERSON,
REMEMBER THAT WE'RE LOOKING FOR THE PERSON WHO ALSO
PHYSICALLY HARMED HER IN THE PAST YEAR)

(GO TO #72) (NAME OF ASSAILANT/PARTNER)

How long after you became involved with did
he first physically assault you?
(ACTUAL NUMBER OF DAYS) . . . .
(not applicable = "8888")

72a. (IF YES) How long did the abuse last? By that I
mean, did you or have you experienced this harm for months,
years, or was it one time?

LENGTH OF ABUSE (IF APPLICABLE) .............
(ACTUAL NUMBER OF DAYS: "00000" IF NO PREVIOUS ABUSE)

 

Have you ever become pregnant since knowing ?
(GO TO #73a) YES ............................ 1

(GO TO #74) NO ............................. 2

not applicable ................. 8

73a. (IF YES) Did he ever physically assault you when you
were pregnant?

 

YES ............................ 1

NO ............................. 2

not applicable ................. 8

Is in any kind of program to deal with his
violence?

(GO TO #74a) YES ............................ 1

(GO TO #75) NO ............................. 2

(SKIP 74a, AND MARK "7") (DON'T KNOW) ................... 7

(not applicable) ............... 8

246

Respondent ID
2 9

74a. (IF YES) What type of treatment is he in?

INDIVIDUAL THERAPY (VOLUNTARY) . 1
INDIVIDUAL THERAPY (MANDATED) . . 2

 

 

GROUP THERAPY (VOLUNTARY) ...... 3

GROUP THERAPY (MANDATED) ....... 4

OTHER ( ) ........ 5

(DON'T KNOW) ................... 7

(not applicable) ............... 8

75. What is your current relationship with ?

MARRIED, LIVING TOGETHER ............. 1

MARRIED, SEPARATED ................... 2

DIVORCED ............................. 3

GIRL/BOYFRIEND, LIVING TOGETHER ...... 4

GIRL/BOYFRIEND, NOT LIVING TOGETHER. . 5

 

EX-GIRLFRIEND & BOYFRIEND ............ 6

DATING, BUT NOT GIRL/BOYFRIEND ....... 7

OTHER( ) .................. 9

not applicable ....................... 8
76 . How long have you known ?

 

(WRITE EXACT NUMBER OF MONTHS)
(not applicable = "888")

 

77. How long were you/have you been in a relationship with ?

(WRITE EXACT NUMBER OF MONTHS)
(not applicable = "888")

 

78. How many previous separations, if any, have you had from
(ACTUAL NUMBER) ................

(not applicable = "888")
(IF NO PREVIOUS SEPARATIONS, GO TO #79)

78a. How long did your most recent separation last?

(ACTUAL NUMBER OF BAY—S) ........
(NO PREVIOUS SEPARATIONS = "00000")
(not applicable = "88888")

247

Respondent ID

 

3O
79. Would you say that has or used to have an
alcohol or drug problem?
(GO TO #80) NO PROBLEM ..................... 0
ALCOHOL ONLY ................... 1
DRUG ONLY ...................... 2
ALCOHOL & DRUG PROBLEM ......... 3
RECOVERING ALCOHOLIC (SOBER) . . .4
RECOVERING ADDICT (CLEAN) ...... 5
RECOVERING ALCOHOLIC/ADDICT. . . . 6
(DON 'T KNOW) ................... 7
not applicable ................. 8

79a. (IF SHE THINKS HE HAS AN ALCOHOL AND/OR DRUG PROBLEM,
INCLUDING "RECOVERING") Is he currently receiving any type
of treatment for this problem?

(GO TO #79b) YES ............................ 1

(GO TO #80) NO ............................. 2

(SKIP 79b, AND MARK "7") (DON'T KNOW) ................... 7
(not applicable) ............... 8

79b. (IF YES) What type of treatment is he in?

 

OUTPATIENT TREATMENT ........... 1
INPATIENT TREATMENT ............ 2
OTHER( ) . . . 3
(DON'T KNOW) ................... 7

(not applicable) ............... 8

248

Respondent ID
3 1

Now I have a list of some things some men do to annoy or
hurt their partners and ex-partners. These are emotional
kinds of things that can happen in any relationship. Using
this card (SHOW YELLOW CARD #2), could you tell me how often
in the last 6 months did any of these things
to annoy or hurt you?

NEVER

RARELY

SOMETIMES

OFTEN

not applicable
(refused to answer)

\DmvwaH
II II II II II II

How often has he refused to talk with you ..............
How often has he accused you of having or

wanting other sexual relationships .....................
Told you about other sexual relationships he

wanted or was having in order to hurt you ..............

Refused to do things with you that you wanted to do. . . .

Forbid you to go out without him .......................

Tried to control your money ............................

Tried to control your activities .......................
Withheld approval, appreciation, or affection
as punishment for you ..................................

Lied to you or deliberately misled you .................

Made contradictory demands or requests of you ..........

Cal led you names .......................................

Tried to humiliate you .................................

Ignored or made light of your anger ....................

Ignored or made light of your other feelings ...........

Ridiculed or criticized you in public ..................

Ridiculed or insulted your most valued beliefs .........
Ridiculed or insulted your religion, race,
heritage, or class .....................................

Ridiculed or insulted women as a group .................

249

Respondent ID

NEVER

RARELY

SOMETIMES

OFTEN

not applicable
(refused to answer)

KOQIAUJNH

Used threats to try and have sex with you .............
Criticized your

that you are or

strengths, or those parts of yourself
once were proud of ....................

Criticized your

Criticized your physical appearance or
sexual attractiveness ................................

Criticized your family or friends to you ..............
Harassed your family or friends in some way ...........
Discouraged your contact with family or friends .......
Threatened to hurt your family or friends .............
Broken or destroyed something important to you ........

Abused or threatened to abuse pets to hurt you ........
(NO PETS = "8")

Punished or deprived the children when he was
angry with you .......................................
(NO CHILDREN = "8")

Threatened to take the children away from you .........
(NO CHILDREN = "8")

Left you somewhere with no way to get home ............

Threatened to end the relationship if you didn't
do what he wanted ....................................

Tried to force you to leave your home .................

Threatened to commit suicide when he was
angry with you .......................................

intelligence ..........................

32

O
_

FOR WOMEN WHO HAVE EXPERIENCED NO THREATS AND NO ABUSE, GO TO

#92 .

FOR WOMEN WHO HAVE BEEN THREATENED ANDZOR PHYSICALLY HARMED,

CONTINUE WITH #81.

81.

82.

250

Respondent ID
33

(SHOW PINK.CARD #3) How many times in the last six months
has

threatened you in any way? Using the
definition I read earlier, that means said or did things
that made you feel scared or in danger, whether in person,
over the phone, through the mail, or through other people.

 

NEVER

ONCE A MONTH OR LESS

2 OR 3 TIMES A MONTH
ONCE OR TWICE A.WEEK

3 OR 4 TIMES A WEEK
MORE THAN 4 TIMES A WEEK
(not applicable)
(refused.to answer)

\DmmU'lukaNl-J
II II II II II II II II

Now I have list of different types of violence women have
experienced from their partners and ex-partners. I wonder
if you could tell me, as best as you can remember; how many
times in the last six months did any of the
following things to you: (USING PINK CARD #3)

NEVER

ONCE A MONTH OR LESS

2 OR 3 TIMES A MONTH
ONCE OR TWICE A WEEK

3 OR 4 TIMES A WEEK
MORE THAN 4 TIMES A WEEK
(not applicable)
(refused to answer)

\OCDONU'IrPAWNH
II II II II II II II II

How often did he break your glasses or tear
your clothing ..........................................

Pushed or shoved you ...................................

Grabbed you ............................................

Slapped you with an open hand ..........................

Hit you with a fist ....................................

Kicked you .............................................

Threw something at you .................................

Aside from throwing; how often did he hit
you with an object .....................................

Tried to hit you with an object ........................

Drove recklessly; so that you felt scared
or endangered ..........................................

251

Respondent ID
34

NEVER

ONCE A MONTH OR LESS

2 OR 3 TIMES A MONTH
ONCE OR TWICE A WEEK

3 OR 4 TIMES A WEEK
MORE THAN 4 TIMES A WEEK
(not applicable)
(refused to answer)

mmmmprI-I
II II II II II II II II

Choked you .............................................

Burned you .............................................

Tied you up or physically restrained you in some way. . .

Beat you up ............................................

Forced.any sexual activity'you didn't want to happen...

Threatened you with a gun or knife .....................

Used a gun or knife against you ........................

(IF SHE HAS NOT BEEN HARMED AT ALL, GO TO #87)

83. (IF SHE HAS BEEN HARMED.AT ALL) Now I'm going to go through
a list of injuries and ask you "yes" or "no" if you've had
any of these injuries in the last 6 months. Did you have:

YES NO N/A

Cuts, scrapes, or bruises .............. 1....2 ..... 8
Soreness without bruises ............... 1....2 ..... 8
Burns, including rug burns ............. 1....2 ..... 8
Loose or broken teeth .................. 1....2 ..... 8
Broken bones or fractures .............. 1....2 ..... 8
Internal injuries ...................... 1....2 ..... 8
Strains or sprains ..................... 1....2 ..... 8
Dislocated joints ...................... 1 . . . .2 ..... 8
Pregnancy'complications/miscarriage....1....2 ..... 8
Knife or gunshot wound ................. 1....2 ..... 8
Permanent scarring ..................... 1....2 ..... 8

Any other injuries not
mentioned ( )....1....2 ..... 8

84.

85.

86.

87.

88.

252

Respondent ID
35

(IF SHE HAS BEEN HARMED AT ALL) Were you involved.in a
relationship with him at the time this violence occurred?

 

YES ............................ 1
NO ............................. 2
ONLY FOR SOME OF THE

VIOLENCE (explain) 3
(not applicable) ............... 8

(IF SHE HAS BEEN HARMED.AT ALL) How many times in the past
six months did you seek medical treatment.because of
injuries from ?
(INDICATE EXACT NUMBER)....
(not applicable) ............ 888)

 

(IF SHE HAS BEEN HARMED AT ALL) How many times in that time
period do you think.you required medical attention because
of such injuries but didn't receive it?
(INDICATE EXACT NUMBER) . . . .
(not applicable) ............ 888)

 

(ASK EVERYONE) How many times in the last six months did
physically'harm.you or attempt to harm you? (USE
PINK.CARD #3)

(MAKE SURE THIS ANSWER IS CONSISTENT“WITH HER RESPONSE'TO
#47)

NEVER

ONCE A MONTH OR LESS

2 OR 3 TIMES A MONTH

ONCE OR TWICE A WEEK

3 OR 4 TIMES A WEEK

MORE THAN 4 TIMES A WEEK
(not applicable)

oommpwton-s
II II II II II II II

In general, how typical was the violence in the past six
months compared to the violence throughout.your
relationship? Would you say it was:

MUCH LESS SEVERE

LESS SEVERE

ABOUT THE SAME

MORE SEVERE

MUCH MORE SEVERE
(RELATIONSHIP< SIX MONTHS)

ODU'IubUJNH
II II II II II II

89.

90.

253

Respondent ID
3 6

Now I'd like to ask you how you think the abuse you've
experienced has affected your health. This is still
something that we don't know very much about, and you can
help us by telling us how you think your health has been
affected. I'm going to go back to the physical health
symptoms I asked you about earlier. I simply want to know
which physical health problems you think are a result of
your abuse. You can say "YES" or "NO".

(GO BACK TO PAGE 9, WHICH IS THE BEGINNING OF THE HEALTH
QUESTIONS. FOR EACH ITEM SHE REPORTED IN COLUMN A, ASK HER
IF SHE FEELS IT WAS A RESULT OF THE ABUSE SHE EXPERIENCED.
IF SHE REPORTS "YES", MARK "1" IN COLUMN B, IF SHE SAYS
"NO", MARK "2" IN COLUMN _B_. IF SHE HAS NOT BEEN BOTHERED AI
A_L_I_.a BY A SYMPTOM, MARK "8" IN COLUMN B FOR N/A.)

FOR WOMEN WHO REPORTED NO ABUSE, THEN MARK AN "8" FOR EACH
SYMPTOM IN COLUMN B.

Now I'd like to ask you how you think the abuse you've
experienced has affected your use of the substances you
mentioned earlier. For example, you may feel that the abuse
you've experienced has caused you to smoke more. Or, you
may feel that the amount you smoke has not changed as a
result of the abuse you've experienced. Please remember
that there are no right or wrong answers, we are just
interested in what you think. For this next question, I
would like you to tell me whether you think your use of each
of the above substances has increased, decreased, or stayed
about the same as a result of the abuse you've experienced.

l = INCREASED

2 = STAYED ABOUT THE SAME

3 = DECREASED

8 = not applicable (COLUMN A = 1)

(GO TO PAGE 11, WHICH IS THE BEGINNING OF THE ALCOHOL/DRUG LIST.
FOR EACH ITEM THAT SHE REPORTED USING, ANY USE AT ALL, ASK HER IF
SHE FEELS HER USE OF THAT SUBSTANCE HAS INCREASED, DECREASED, OR
STAYED ABOUT THE SAME AS A RESULT OF THE ABUSE THAT SHE HAS
EXPERIENCED. MARK ALL OF THESE ANSWERS IN COLUMN 9. IF SHE HAS
NOT USED A PARTICULAR SUBSTANCE IN THE PAST SIX MONTHS, MARK "8"
IN COLUMN 9.)

FOR WOMEN WHO REPORTED NO ABUSE, THEN MARK AN "8" FOR EACH OF THE
SUBSTANCES IN COLUMN Q.

254

Respondent ID
3 7

91. Now I'd like to ask you how you think the abuse you've
experienced has affected your use of various medical
services. We're going to go back to that section. For the
services you said you visited in the past six months, I want
you to tell me how many of the visits were due to any abuse
that you have experienced.

(GO TO PAGE 25, WHICH IS THE BEGINNING OF THE HEALTH SERVICE
UTILIZATION SECTION. FOR EACH OF THE DIFFERENT HEALTH SERVICES
SHE HAS USED IN THE PAST SIX MONTHS, ASK HER HOW MANY OF THE
VISITS WERE RELATED TO ANY ABUSE SHE MAY HAVE EXPERIENCED. THESE
ARE ITEMS 64a, 65a, 66a, AND 67b.)

FOR WOMEN WHO REPORTED NO ABUSE, THEN MARK AN "888" FOR EACH OF
THESE ITEMS.

92. (ASK EVERYONE) There's just one more health-related issue I
want to ask you about before we move on. Have you been
pregnant in the past six months?

(GO TO #92a) YES ................... 1
(GO TO #93) NO .................... 2
92a. (IF YES) Many women experience gynecological

problems, including miscarriages. Can you tell me whether
or not you have had a miscarriage in the past six months?

(GO TO #92b) YES ................... 1---> HOW MANY?
(GO TO #93) NO .................... 2 (88 if NO or N/A)
(GO TO #93) not applicable ........ 8

92b. (IF YES AND ABUSED) Would you say that your
miscarriage was a result of the abuse you experienced?

YES ............................ 1
NO ............................. 2
not applicable ................. 8

255

Respondent ID
3 8

93. Okay, we're almost done now. In this part of the interview,
I want to talk with you about a situation that may have been
upsetting or stressful for you. Please think about a situation
that has happened in the past month, or since about ,
that was very upsetting for you. This could have been an
argument with your partner or other family member, problems
dealing with the kids, or anything else that may have happened.
This situation could have been very upsetting or only a little
bit bothersome, but it should be the worst thing that has
happened in the last month.

Can you think of a specific situation like this? I would
also like to know where and when this happened, who was involved,
and why this situation actually happened.

(USE THE BOTTOM OF THIS PAGE AND THE BACK TO RECORD HER
RESPONSE . )

Event :

 

 

 

 

 

 

 

 

 

 

 

Checklist: When? What? Where? Who? Why?

Thank you so much for taking the time to answer all of these
questions. We appreciate all of your input. Is there anything
in the interview that you had questions about or would like to
ask me about?

MAKE SURE THAT YOU HAVE THOROUGHLY ADDRESSED ALL OF HER CONCERNS.
AT THIS TIME, PAY HER AND MAKE SURE SHE SIGNS THE VOUCHER.

Time interviewed ended
Length of interview

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