Drinking, Diversity, and Discrimination: Campus-Level Factors that Influence Students' Risk of Experiencing Sexual Assault.

College students' individual-level risk factors for sexual assault victimization have been studied for decades, but fewer studies have looked at whether and how campus-level factors, such as campus-level rates of discrimination and campus diversity, might also influence student victimization risk. Identifying these broader factors can inform efforts to develop more effective campus-level sexual assault preventive interventions. We conducted a secondary analysis of data from a large, multi-campus health and well-being survey (N = 309,171 students across 474 US campuses) to explore how campus-level factors shape students' risk of experiencing sexual assault after accounting for students' individual-level risk factors. Using mixed-effects logistic regression, we examined the influence of campus-level factors (e.g., campus sexual orientation demographics and gender diversity) on students' odds of experiencing sexual assault, after accounting for individual risk factors (e.g., sexual and gender minority status). Although some campus characteristics, such as enrollment size, had small significant effects on students' odds of experiencing sexual assault, we found larger significant effects from aggregated campus-level rates of binge drinking, campus diversity (particularly regarding sexual orientation and gender), and discrimination. These findings suggest that comprehensive campus sexual violence prevention would benefit from strategies that promote safe and inclusive campuses, especially for students with marginalized sexual and gender identities.

Can This Provider Be Trusted? A Review of the Role of Trustworthiness in the Provision of Community-Based Services for Intimate Partner Violence Survivors.

While there is a growing literature on intimate partner violence (IPV) survivors and service providers, it is limited by its largely atheoretical and descriptive nature, and its emphasis on individual-level survivors' help-seeking. We seek to broaden our understanding by shifting the focus onto organizations and service systems and introducing the concept of these providers' trustworthiness toward survivors. Provider trustworthiness in delivering services includes benevolence (locally available and caring), fairness (accessible to all and non-discriminatory), and competence (acceptable and effective in meeting survivors' needs). Guided by this conceptualization, we conducted an integrative review drawing on four databases: PsycINFO, PubMed, Web of Science, and Westlaw. We identified studies for inclusion that were published between January 2005 and March 2022, and we examined the trustworthiness of community-based providers serving adult IPV survivors in the United States, including domestic violence services, health and mental health care, the legal system, and economic support services (N = 114). Major findings include (1) many survivors live in communities with no shelter beds, mental health care, or affordable housing; (2) many services are inaccessible because they lack, for example, bilingual staff, sliding fees, or telehealth options; (3) too many providers are harmful or discriminatory toward survivors, especially those who are, for example, sexual or gender minorities, immigrants or non-English-speaking, poor, or Native, Black, or Latinx; (4) many providers appear to be incompetent, lack evidence-based training, and are ineffective in meeting survivors' needs. We call on researchers, advocates, and providers to examine provider trustworthiness, and we offer an introduction to measuring it.

The Effects of Social Location and Situational Factors on Young Women's Disclosure of Intimate Partner Violence Across Relationships.

The goal of the study was to examine disclosure of physical and sexual intimate partner violence (IPV) victimization across abusive relationships within a sociodemographically diverse sample of young women. We recruited 283 participants, ages 18 to 24, from a university, a 2-year college, and community sites serving low-income young women, and assessed physical and sexual IPV victimization, and related disclosure, across each of their abusive relationships (415 total). We used multilevel modeling to examine the effects of social location and situational factors on the odds of any disclosure of abuse during first relationships and across relationships. The rate of physical IPV disclosure was 50%, vs. 29% for sexual IPV. Multilevel model results indicated setting, IPV type, high frequency sexual IPV, and fear were significantly related to any disclosure.

Predictors of Sexual Violence Across Young Women's Relationship Histories.

The goal of the current study was to identify risk factors that predict sexual intimate partner violence (IPV) victimization across young women's relationship histories, within a socioeconomically diverse sample recruited from a university, a 2-year college, and community organizations serving low-income young women. We interviewed 148 young women aged 18 to 24 years about partner victimization (physical IPV, coercive control, and sexual IPV) within each of their relationships (up to four relationships, beginning with their first; 388 in total). We used the life history calendar to structure the interviews and obtain detailed information about each relationship, including age difference between participants and their partners, and relationship length. We used multilevel modeling to examine primary caregiver highest grade completed (an indicator of socioeconomic status [SES]), participant age, age difference, relationship length, setting, and physical IPV/coercive control as predictors of sexual IPV during their first relationship and across Relationships 1 to 4. Sexual IPV during participants' first relationship was inversely associated with SES and age, and positively associated with physical IPV/coercive control; 2-year college and community participants reported lower rates of sexual IPV during the first relationship, compared with university participants. The trajectory of sexual IPV across Relationships 1 to 4 declined among university participants and increased among 2-year college participants; age difference and physical IPV/coercive control positively covaried with sexual IPV across Relationships 1 to 4. Low SES, young age, large age difference, and the presence of physical IPV and coercive control may be risk factors for sexual IPV victimization within adolescent relationships. Sexual violence prevention and intervention approaches should incorporate these risk factors, and be designed to reach an increasingly socioeconomically diverse population across a variety of settings, to be effective.

"I Still Feel Like I Am Not Normal": A Review of the Role of Stigma and Stigmatization Among Female Survivors of Child Sexual Abuse, Sexual Assault, and Intimate Partner Violence.

Child sexual abuse (CSA), sexual assault (SA), and intimate partner violence (IPV) occur within social contexts that shape how survivors judge themselves and are evaluated by others. Because these are gendered sexual and intimate crimes that violate social norms about what is appropriate and acceptable, survivors may experience stigma that includes victim-blaming messages from the broader society as well as specific stigmatizing reactions from others in response to disclosure; this stigmatization can be internalized among survivors as self-blame, shame, and anticipatory stigma. Stigma and stigmatization play an important role in shaping survivors' thoughts, feelings, and behaviors as they recover; their risk of revictimization; and their help-seeking and attainment process. In this review, we synthesize recent CSA, SA, and IPV research ( N = 123) that examines female survivors' self-blame, shame, internalized stigma, and anticipatory stigma as well as negative social reactions in response to survivors' disclosure. We highlight critical findings as well as implications for research, practice, and policy, and we note gaps in our current knowledge.

Beta Testing a Novel Smartphone Application to Improve Medication Adherence.

BACKGROUND: We developed and beta-tested a patient-centered medication management application, PresRx optical character recognition (OCR), a mobile health (m-health) tool that auto-populates drug name and dosing instructions directly from patients' medication labels by OCR. MATERIALS AND METHODS: We employed a single-subject design study to evaluate PresRx OCR for three outcomes: (1) accuracy of auto-populated medication dosing instructions, (2) acceptability of the user interface, and (3) patients' adherence to chronic medications. RESULTS: Eight patients beta-tested PresRx OCR. Five patients used the software for ≥6 months, and four completed exit interviews (n = 4 completers). At baseline, patients used 3.4 chronic prescription medications and exhibited moderate-to-high adherence rates. Accuracy of auto-populated information by OCR was 95% for drug name, 98% for dose, and 96% for frequency. Study completers rated PresRx OCR 74 on the System Usability Scale, where scores ≥70 indicate an acceptable user interface (scale 0-100). Adherence rates measured by PresRx OCR were high during the first month of app use (93%), but waned midway through the 6-month testing period (78%). Compared with pharmacy fill rates, PresRx OCR underestimated adherence among completers by 3%, while it overestimated adherence among noncompleters by 8%. DISCUSSION: Results suggest smartphone applications supporting medication management are feasible and accurately assess adherence compared with objective measures. Future efforts to improve medication-taking behavior using m-health tools should target specific patient populations and leverage common application programming interfaces to promote generalizability. CONCLUSIONS: Our medication management application PresRx OCR is innovative, acceptable for patient use, and accurately tracks medication adherence.

The Effects of Cumulative Violence Clusters on Young Mothers' School Participation: Examining Attention and Behavior Problems as Mediators.

Using a cluster analysis approach with a sample of 205 young mothers recruited from community sites in an urban Midwestern setting, we examined the effects of cumulative violence exposure (community violence exposure, witnessing intimate partner violence, physical abuse by a caregiver, and sexual victimization, all with onset prior to age 13) on school participation, as mediated by attention and behavior problems in school. We identified five clusters of cumulative exposure, and found that the HiAll cluster (high levels of exposure to all four types) consistently fared the worst, with significantly higher attention and behavior problems, and lower school participation, in comparison with the LoAll cluster (low levels of exposure to all types). Behavior problems were a significant mediator of the effects of cumulative violence exposure on school participation, but attention problems were not.

Pathways to help: adolescent sexual assault victims' disclosure and help-seeking experiences.

In this study, we conducted semistructured interviews with N = 20 adolescent sexual assault victims who sought postassault help from the medical and legal system to understand young survivors' disclosure and help-seeking processes. Results revealed three distinct disclosure patterns and pathways to help-seeking. First, in the voluntary disclosure group, victims told their friends, who encouraged them to tell an adult, who then encouraged--and assisted--the survivors in seeking help. Throughout this process, the survivors' disclosures at each step were within their control and reflected their choices for how to proceed. Second, in the involuntary disclosure pattern, victims also first disclosed to friends, but then those friends told adults about the assault, against the survivors' wishes; the adults made the victims seek help, which was also against the survivors' preferences. Third, in situational disclosures, the survivors were unconscious at the time of the assault, and their friends disclosed and sought help on their behalf. We also examined how these initial disclosure patterns related to victims' continued engagement with these systems.

Examining cumulative victimization, community violence exposure, and stigma as contributors to PTSD symptoms among high-risk young women.

This study examines patterns of lifetime victimization within the family, community violence exposure, and stigma as contributors to posttraumatic stress disorder (PTSD) symptoms within a sample of 198 high-risk young women who are pregnant or parenting. We used cluster analysis to identify 5 profiles of cumulative victimization, based on participants' levels of witnessing intimate partner violence (IPV), physical abuse by an adult caregiver, and sexual victimization, all beginning by age 12. Hierarchical regression was used to examine these 5 clusters (ranging from a High All Victimization cluster characterized by high levels of all 3 forms of violence, to a Low All Victimization cluster characterized by low levels of all 3 forms), along with community violence exposure and stigma, as predictors of PTSD symptoms. We found that 3 of the cumulative victimization clusters, in comparison with Low All Victimization, were significant predictors of PTSD symptoms, as was stigma, while community violence exposure was not a significant predictor.

Beyond deficits: intimate partner violence, maternal parenting, and child behavior over time.

Exposure to intimate partner violence (IPV) has negative consequences for children's well-being and behavior. Much of the research on parenting in the context of IPV has focused on whether and how IPV victimization may negatively shape maternal parenting, and how parenting may in turn negatively influence child behavior, resulting in a deficit model of mothering in the context of IPV. However, extant research has yet to untangle the interrelationships among the constructs and test whether the negative effects of IPV on child behavior are indeed attributable to IPV affecting mothers' parenting. The current study employed path analysis to examine the relationships among IPV, mothers' parenting practices, and their children's externalizing behaviors over three waves of data collection among a sample of 160 women with physically abusive partners. Findings indicate that women who reported higher levels of IPV also reported higher levels of behavior problems in their children at the next time point. When parenting practices were examined individually as mediators of the relationship between IPV and child behavior over time, one type of parenting was significant, such that higher IPV led to higher authoritative parenting and lower child behavior problems [corrected]. On the other hand, there was no evidence that higher levels of IPV contributed to more child behavior problems due to maternal parenting. Instead, IPV had a significant cumulative indirect effect on child behavior via the stability of both IPV and behavior over time. Implications for promoting women's and children's well-being in the context of IPV are discussed.

Does job stability mediate the relationship between intimate partner violence and mental health among low-income women?

Intimate partner violence (IPV) has detrimental consequences for women's mental health. To effectively intervene, it is essential to understand the process through which IPV influences women's mental health. The current study used data from 5 waves of the Women's Employment Study, a prospective study of single mothers receiving Temporary Assistance for Needy Families (TANF), to empirically investigate the extent to which job stability mediates the relationship between IPV and adverse mental health outcomes. The findings indicate that IPV significantly negatively affects women's job stability and mental health. Further, job stability is at least partly responsible for the damaging mental health consequences of abuse, and the effects can last up to 3 years after the IPV ends. This study demonstrates the need for interventions that effectively address barriers to employment as a means of enhancing the mental health of low-income women with abusive partners.

The effects of adolescent intimate partner violence on women's educational attainment and earnings.

Intimate partner violence (IPV) is a serious, widespread problem that negatively affects women's lives, including their economic status. The current study explored whether the financial harm associated with IPV begins as early as adolescence. With longitudinal data from a sample of 498 women currently or formerly receiving welfare, we used latent growth curve modeling to examine the relationships between adolescent IPV, educational attainment, and women's earnings. We found that women who had been victimized by a partner during adolescence obtained less education compared with nonvictimized women, with victimization indirectly influencing women's earnings via educational attainment. The findings support the need for intervention strategies aimed at preventing IPV and promoting women's educational and career development over the life course.

A model of sexually and physically victimized women's process of attaining effective formal help over time: the role of social location, context, and intervention.

As empirical evidence has demonstrated the pervasiveness of sexual assault and intimate partner violence in the lives of women, and the links to poor mental health outcomes, attention has turned to examining how women seek and access formal help. We present a conceptual model that addresses prior limitations and makes three key contributions: It foregrounds the influence of social location and multiple contextual factors; emphasizes the importance of the attainment of effective formal help that meets women's needs and leads to positive mental health outcomes; and highlights the role of interventions in facilitating help attainment. We conclude with research and practice implications.

The impact of intimate partner violence on low-income women's economic well-being: the mediating role of job stability.

This study sought to extend our understanding of the mechanisms by which intimate partner violence (IPV) harms women economically. We examined the mediating role of job instability on the IPV-economic well-being relationship among 503 welfare recipients. IPV had significant negative effects on women's job stability and economic well-being. Job stability was at least partly responsible for the deleterious economic consequences of IPV, and the effects lasted up to three years after the IPV ended. This study demonstrates the need for services and policies that address barriers to employment as a means of improving the economic well-being of low-income women with abusive partners.

Sexual victimization and family violence among urban African American adolescent women: do violence cluster profiles predict partner violence victimization and sex trade exposure?

Guided by an intersectional feminist perspective, we examined sexual victimization, witnessing intimate partner violence (IPV) in the family, and familial physical abuse among a sample of 180 urban African American adolescent women. We used cluster analysis to better understand the profiles of cumulative victimization, and the relationships between profiles and IPV victimization and personal exposure to the sex trade. Just under one third of the sample reported sexual victimization, with cooccurrence with both forms of family violence common. The cluster profile with high levels of severe family violence was associated with the highest rate of IPV victimization and sex trade exposure.

The impact of family and community violence on children's depression trajectories: examining the interactions of violence exposure, family social support, and gender.

This longitudinal study used multilevel modeling to examine the relationships between witnessing intimate partner violence (IPV), community and school violence exposure (CSVE), family social support, gender, and depression over 2 years within a sample of 100 school-aged children. We found significant between-child differences in both the initial levels of depression and the trajectories of depression; depression over time was positively associated with change in witnessing IPV and CSVE and negatively associated with change in support. Two significant 3-way interactions were found: Gender and initial support, as well as gender and initial witnessing IPV, both significantly moderated the effect of change in witnessing IPV on the children's depression over time.

The effects of community and family violence exposure on anxiety trajectories during middle childhood: the role of family social support as a moderator.

This 2-year longitudinal study investigated the relations between community and school violence exposure, witnessing intimate partner violence (IPV), family social support, and anxiety, within a sample of 100 school-age children (39% female, M age = 9.90 years). Using multilevel modeling, we found heterogeneity across children in terms of their initial levels of anxiety and their trajectories of anxiety over time. Initial community and school violence exposure and witnessing IPV were both positively associated with initial levels of anxiety. Over time, change in both community and school violence exposure and witnessing IPV positively covaried with anxiety. Further, gender, initial family social support, and change in family social support significantly moderated the effect of change in community and school violence exposure on anxiety.

Urban adolescent mothers exposed to community, family, and partner violence: is cumulative violence exposure a barrier to school performance and participation?

Using a risk and resilience perspective, the authors assessed urban adolescent mothers' exposure to community, family, and partner violence and analyzed the relationships between cumulative violence exposure and multiple school outcomes, within the context of welfare reforms. Positive attitude toward school and social support were examined as moderators of violence exposure on school outcomes. The authors pilot tested the questionnaire with 10 participants, then surveyed 120 adolescent mothers regarding their violence exposure, school performance and participation, positive attitude toward school, and social support. Results indicate very high rates of lifetime exposure to violence; intercorrelations and regression analyses indicate that as violence exposure increases, school outcomes tend to worsen, with positive attitude toward school found to be a significant moderator of the effects of exposure to community violence on behavior problems in school. Implications for researchers, practitioners, school policies and programs, and welfare policies and programs conclude the article.

Urban adolescent mothers exposed to community, family, and partner violence: prevalence, outcomes, and welfare policy implications.

The federal welfare reforms of 1996 mandated that all minor adolescent mothers receiving cash assistance must attend school and live at home to receive their cash grant. Though this law has been in place for over 8 years, little research has been done that explores the barriers facing adolescent mothers who try to attend school and live at home. Anecdotal and qualitative evidence from welfare reform evaluation studies suggests that violence may be just such a barrier. This article reviews the recent empirical literature on urban adolescent mothers' exposure to multiple forms of violence. The author delineates and critiques the existing research on the prevalence of and outcomes linked with exposure to community violence, witnessed parental violence, physical abuse within the family, and partner violence among this population. The article concludes with recommendations for researchers, practitioners, and policy makers in light of the reviewed findings.

Resilience among urban adolescent mothers living with violence: listening to their stories.

Using a risk and resilience approach grounded in a multicultural feminist perspective, this qualitative study explores 10 urban adolescent mothers' experiences with multiple forms of violence, the relationships between violence and school, and their resilience, all within the context of welfare reforms. The findings suggest lives rife with simultaneous, often severe violence, the impacts of witnessing parental violence, linkages between family and partner violence, and cumulative violence exposure as a barrier to positive school outcomes. Several young women emerge as resilient, with five distinct factors conceptualized as contributing to resilience. In conclusion, the implications for welfare policies and programs are discussed.