Current Trends Family and Other Intimate Assaults -- Atlanta, 1984

Although violence between spouses is well documented as a serious problem (1-4), public health and safety agencies need improved characterization of violence in intimate relationships to develop prevention strategies. This report summarizes a recent study in Atlanta that examined the incidence of family and other intimate assaults (FIAs) (i.e., assaults in which victim and perpetrator(s) were emotionally intimate at the time of or before the incident). FIAs occurred in a range of emotionally intimate relationships (e.g., siblings, parent-child, other relatives (including in-laws), married and unmarried partnerships, and terminated partnerships) (5).

Incident reports for 1984 from the Bureau of Police Services for the City of Atlanta* were reviewed to identify fatal and nonfatal FIAs. To be included, an incident report must have been classified either as a homicide or a nonfatal incident, with the latter involving one or more of the following circumstances: physical contact between persons, use of a weapon, threat with a weapon, and/or explicit verbal threat of bodily harm. In addition, Atlanta must have been the location of both the incident and the victim's residence.

One hundred seventy-seven FIAs were selected, including 27 fatal and 150 nonfatal incidents.** Victims were predominantly female (52% of fatal FIAs and 73% of nonfatal FIAs). Perpetrators were predominantly male (74% fatal, 80% nonfatal). The estimated nonfatal FIA victimization rate for Atlanta was 837 per 100,000 population, compared with a fatal FIA victimization rate of seven per 100,000 population (Table 1). Women were 2.4 times more likely than men to be victims of nonfatal FIAs. For fatal incidents, the rate for women equaled the rate for men. Both the fatal and the estimated nonfatal FIA rates for blacks and other races were three times the respective rates for whites.

Of the 177 FIAs, 165 (23 fatal, 142 nonfatal) involved one perpetrator and one victim. Of these, more than half of both fatal and nonfatal FIAs occurred between spousal or nonspousal partners in relationships ongoing when the incident occurred (Figure 1). More than one fifth of both fatal and nonfatal incidents involved terminated or estranged relationships. When combined, current and former partnerships accounted for 74% of fatal FIAs and 77% of nonfatal FIAs.

Police incident reports indicated that most of the 165 victims suffered some type of physical injury. In fatal incidents, twice as many victims suffered gunshot wounds (61%) as cuts or stab wounds (30%). In nonfatal incidents, 4% of victims suffered gunshot wounds; 32%, cuts or stab wounds; and 30%, some other type of injury. For the other one third of victims in nonfatal incidents, police incident reports indicated no physical injuries.

At least 26% of the fatal and 34% of the nonfatal incident perpetrators and 30% and 37% of victims, respectively, had one or more prior police contacts involving FIA. Approximately one fourth of all participants had prior police contact for FIA involving the same coparticipant as in the 1984 incident. Reported by: WR Elsea, MD, Fulton County Health Dept; G Napper, PhD, Office of State and Federal Criminal Justice Grants, City of Atlanta; RK Sikes, DVM, State Epidemiologist, Georgia Dept of Human Resources. Intentional Injuries Section, Epidemiology Br, Div of Injury Control, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Injury is the leading cause of years of potential life lost in the United States and accounts for an estimated $180 billion dollars in direct and indirect costs each year (6). Violence between persons who are related, share a household, or are otherwise intimate with each other is a widespread public health problem and a substantial contributor to the public health impact of injuries (7,8). In particular, intimate violence is a leading cause of injuries to women; in one study, battering was responsible for more injuries to women than were motor vehicle crashes, rape, and mugging combined (9). Overall, however, additional data are needed to further characterize intimate violence.

This study of FIAs in Atlanta was initiated to better define the nature and pattern of these assaults, assess the use of data from a wide range of disciplines and service agencies, examine the prevention potential of interagency cooperation, and ultimately suggest new ways to prevent this important source of injuries.

In 1984, for each reported fatal FIA, 120 police incident reports involved nonfatal FIAs. Because FIAs are substantially underreported and/or improperly categorized, fatal and nonfatal victimization rates based on police reports provide an incomplete assessment of FIAs (2,4). Additionally, because comparable rates do not exist for other urban areas, the magnitude of the problem in Atlanta cannot be compared with that in similar jurisdictions. Collection of data on the characteristics of FIAs in different locations would permit comparisons of rates and assist efforts to determine the effectiveness of different prevention strategies.

At least one fifth of the incidents in this study involved nonspousal partnerships. An additional fifth involved partners who were estranged or whose relationships had previously ended; this finding indicates that violence occurs even after termination of an intimate relationship. Strategies for protecting women who have terminated abusive relationships but remain at risk for injury or death should be incorporated into existing efforts by police, health, and social service agencies to prevent FIAs.

Although most FIA victims suffer injuries and often seek medical attention for their injuries, medical records frequently do not provide information (e.g., the determination of whether an injury was intentional and the relationship of victim and perpetrator) necessary to estimate FIA incidence. In some states, laws require hospitals to report domestic violence (10); nonetheless, episodes of domestic violence involving adult female patients may be identified correctly by medical personnel as infrequently as 5% of the time (11)--possibly because most health-care providers are not trained to recognize interpersonal violence (12) and may not be aware of the health implications of repetitive violence. Physician training should promote not only recognition, treatment, and referral of victims but also primary prevention.

Since FIAs are often repeated, information about prior incidents can contribute to preventive efforts by identifying persons at high risk for being victims or perpetrators. Investigators have recently found that use of standardized protocols to screen trauma patients in a hospital emergency department substantially increased the ability of health-care providers to identify battered women (13). Once identified, victims can be referred to service providers (e.g., counselors and battered women's shelters). In addition to arrest, perpetrators can also be referred to counseling programs (e.g., programs for men who batter). Improved medical record data can also potentially complement and clarify estimates of FIA incidence derived from police incident reports by providing a more complete description of the health consequences of family and intimate violence. The productive interactions of public health, social service, and criminal justice agencies is necessary for the ultimate success of efforts to prevent interpersonal violence.

References

1. Mercy JA, Saltzman LE. Fatal violence among spouses in the

United States, 1976-85. Am J Public Health 1989;79:595-9.

2. Schulman MA. A survey of spousal violence against women in Kentucky. Washington, DC: US Department of Justice, 1979.

3. Straus MA, Gelles RJ. Physical violence in American families: risk factors and adaptations to violence in 8,145 families. New Brunswick, New Jersey: Transaction Publishers, 1990.

4. Teske RHC Jr, Parker ML. Spouse abuse in Texas: a study of women's attitudes and experiences. Huntsville, Texas: Survey Research Program, Criminal Justice Center, Sam Houston State University, 1983.

5. Saltzman LE, Mercy JA, Rosenberg ML, et al. Magnitude and patterns of family and intimate assault in Atlanta, Georgia, 1984. Violence and Victims 1990;5:3-17.

6. Rice DP, MacKenzie EJ, Jones AS, et al. The cost of injury in the United States: a report to Congress. San Francisco: University of California, Institute for Health and Aging; Johns Hopkins University, Injury Prevention Center, 1989.

7. Rosenberg ML, Gelles RJ, Holinger PC, et al. Violence: homicide, assault, and suicide. In: Amler RW, Dull HB, eds. Closing the gap: the burden of unnecessary illness. New York: Oxford University Press, 1987:164-78.

8. US Department of Health and Human Services/US Department of Justice. Surgeon General's Workshop on Violence and Public Health: report. Washington DC: US Department of Health and Human Services, Health Resources and Services Administration, 1986; publication no. HRS-D-MC 86-1.

9. Rosenberg ML, Stark E, Zahn MA. Interpersonal violence: homicide and spouse abuse. In: Last JM, ed. Public health and preventive medicine. 12th ed. Norwalk, Connecticut: Appleton-Century-Crofts, 1986:1399-426. 10. Lerman LG, Livingston F. State legislation on domestic violence. Response to Violence in the Family and Sexual Assault 1983;6:1-28. 11. Stark E, Flitcraft A, Zuckerman D, Grey A, Robison J, Frazier W. Wife abuse in the medical setting: an introduction for health personnel. Washington, DC: US Department of Health and Human Services, Administration for Children, Youth, and Families, Office on Domestic Violence, 1981. (Monograph no. 7). 12. CDC. Education about adult domestic violence in US and Canadian medical schools, 1987-88. MMWR 1989;38:17-9. 13. McLeer SV, Anwar R. A study of battered women presenting in an emergency department. Am J Public Health 1989;79:65-6.

• For this report, Atlanta is defined as that portion of the City of Atlanta located within Fulton County. Approximately 95% of the city's land mass and 91% (in 1984, 389,700 persons) of its population are within Fulton County.

** All 1984 homicides (n=27) meeting the inclusion criteria were selected. A stratified random sample (n=150) of nonfatal incidents was selected from incident reports stratified across seven crime categories (i.e., rape, robbery, assault, disorderly conduct, family and children offense, sex offense, and other).

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