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Background: There is a need for effective interventions that enable women in current or past violent relationships to reduce their risk of revictimization. One approach that can be taken is safety planning, where advocates and women talk about strategies that theoretically increase the women's safety. Although this process is common, there is little empirical research focusing on the effectiveness of the safety strategies., Methods: This systematic review examines the frequency with which women report using safety strategies and their effectiveness at reducing risk of revictimization., Results: Nine studies reviewed confirm prior research, namely, that women in intimate partner violence situations are using a variety of safety strategies at varying frequencies to protect themselves. Results from two studies looking at whether use of safety strategies reduces a woman's risk of future violence provide modest support for a greater risk of revictimization among women who used resistance strategies. Seven studies examined the perceived helpfulness of the strategies. Women who involved other individuals reported that interaction as helpful. There are several limitations to this review, including the focus on perceived helpfulness. What is reported here is not an objective assessment of safety strategy effectiveness. We were also not able to determine whether strategies women reported using were actually discussed during safety planning., Conclusion: There is a dearth of literature focusing on the effectiveness of safety strategies. Women and advocates talk about safety strategies we know very little about. Additional research examining the consequences of using safety strategies is needed because what is known now is preliminary and limited., (Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.)

Intimate partner violence (IPV), substance use, and HIV are often co-occuring health problems affecting low-income urban women, and have been described as connected epidemics making up a "syndemic." Research suggests that each issue separately is associated with depressive symptoms, but no studies have examined the combined effect of IPV, substance use and HIV on women's depression. Interviews were conducted with 96 women recruited from community health clinics serving low-income women in an urban U.S. city. All women were over 17, not pregnant, English-speaking, without private insurance and had experienced physical IPV in the past year. Women were primarily African American (82%) and 82% were receiving income assistance. Twenty seven percent were HIV-positive, and 27% had used heroin or cocaine in the past 6 months. Based on the Centers for Epidemiological Studies Depression Scale (CES-D ), 73% were depressed. Women who experienced severe IPV in the past 6 months were compared to women who experienced no IPV or psychological IPV only in the past 6 months; those who experienced severe IPV were 5.3 times more likely to be depressed, controlling for HIV status, drug use, age, and relationship status. Women who experienced severe IPV, were HIV-positive, and used drugs (7.3% of sample) were 7.98 times as likely to be depressed as women without these characteristics. These findings confirm that severe IPV is significantly associated with depression among urban abused women. Furthermore, this research suggests that the syndemic effect of IPV, substance use, and HIV could be even more detrimental to women's mental health. Health practitioners and researchers should be aware of the combined impact of the IPV, substance use, and HIV syndemic and consider how they can address the mental health needs of urban women.

Background: Numerous studies have demonstrated an association between characteristics of the school environment and the likelihood of school violence. However, little is known about the relative importance of various characteristics of the school environment or their differential impact on multiple violence outcomes., Methods: Primarily African-American students (n = 27) from Baltimore City high schools participated in concept mapping sessions, which produced interpretable maps of the school environment's contribution to school violence. Participants generated statements about their school environment's influence on school violence and, with the assistance of quantitative methods, grouped these statements according to their similarity. Participants provided information about the importance of each of these statements for the initiation, cessation, and severity of the violence that occurs at school., Results: More than half of the 132 statements generated by students were rated as school environment characteristics highly important for the initiation, cessation, and/or severity of school violence. Participants identified students' own actions, expectations for disruptive behavior, and the environment outside the school as the characteristics most important for the initiation and increased severity of violence that occurs in school. Participants had a more difficult time identifying school environment characteristics important for the cessation of school violence., Conclusion: This study provides support from students for the role of the school environment in school violence prevention, particularly in preventing the initiation and reducing the severity of school violence. Schools can utilize the information presented in this article to begin discussions with students and staff about prioritizing school environment changes to reduce school violence., (© 2011, American School Health Association.)

Objective: Despite widespread prevention efforts, youth violence persists in many urban communities. This investigation explores the unique perspectives and local capacities to address urban youth violence., Method: Qualitative in-depth interviews were conducted with prominent neighborhood individuals (PNIs) from low-wealth neighborhoods that varied by risk for youth violence., Findings: Findings reveal examples of increased levels of social action in the designated low risk for youth violence neighborhoods. Similar activities were also present, but to a lesser extent, within the high-risk neighborhoods. Results illustrate how PNIs formally and informally share information and take action to address youth violence., Conclusion: PNIs are an often-overlooked resource in gaining local insight for addressing health issues, such as youth violence. The efforts identified exhibit expertise and culturally sensitive opportunities for working together to address youth violence. Understanding such dynamics is essential for informing the development of locally endorsed violence-prevention interventions.

This paper presents a cross-sectional study examining the influence of neighborhood violence on multiple aspects of mothers' health. While the influence of neighborhood violence on health is important to understand for all populations, mothers are especially important as they play a key role in protecting their children from the consequences of violence. Three hundred and ninety-two Baltimore City mothers of children 5 years and younger completed a self-administered survey that included questions about perceptions of their safety as well as their personal experiences with neighborhood violence. Separate models were run to compare the relationship between each measurement of neighborhood violence and five diverse health-related determinants and outcomes: self-reported health status, smoking, exercise, average hours of sleep a night, and sleep interruption. Controlling for mother's age, child's age, maternal education, and marital status, mothers with high exposure to neighborhood violence were twice as likely to report poorer health, smoking, never exercising, and poor sleep habits. Maternal perception of neighborhood safety was not related to any of the assessed health-related determinants and outcomes. This study emphasizes the importance of measuring exposure to neighborhood violence rather than solely assessing perceived safety. Neighborhood violence was a common experience for mothers in this urban sample, and should be considered by health professionals in trying to understand and intervene to improve the health of mothers and their children.

Youth violence is a significant public health problem. Although the relationship between neighborhood-level factors and urban youth violence is recognized, the specific mechanisms of this relationship are often unclear. Prominent neighborhood individuals were identified within four select low-income urban neighborhoods in Baltimore City. In-depth interviews were conducted to explore these individuals' perceptions of the relationship between social and structural neighborhood-level factors and urban youth violence. Employment opportunities, local businesses, trash management, vacant housing, and street lighting were perceived as important neighborhood factors influencing young people's experiences. The relationship between these neighborhood characteristics and the local illicit drug market and youth violence is highlighted. Results provide an enhanced understanding of the importance of using a participatory-based research approach and the mechanisms of the relationship between neighborhood-level factors and youth violence. Both are critical components in designing and implementing multilevel youth violence prevention efforts.

This study was a secondary analysis of the relationships among lifetime experiences of violence, depressive symptoms, substance use, safer sex behaviors use, and past-year sexually transmitted infection (STI) treatment among a sample of 445 low income, primarily African American women (257 HIV-, 188 HIV+) reporting a male intimate partner within the past year. Twenty-one percent of HIV- and 33% of HIV+ women reported past-year STI treatment. Violence victimization increased women's odds of past-year STI treatment, controlling for HIV status and age. Depressive symptoms increased, and use of safer sex behaviors decreased, women's odds of past-year STI treatment. Results suggest that positive assessment for violence and/or depression indicates need for STI screening.

This study explored how young boys and girls living in low income urban neighborhoods defined and described reasons associated with youth violence. Five focus groups were conducted with 29 youth between the ages of 8 and 12 recruited from four selected study neighborhoods. Participants were asked to describe youth violence. Appropriate probes were used to explore similarities and differences by gender with regard to the reasons for violence. Definitions of youth violence were consistent across participants and included verbal threats, physical contact, and often the use of a weapon. Several common reasons for violence were found among both boys and girls; romantic relationships, respect, idle time, gangs/cliques, and witnessing violence. Reasons for violence unique to boys include fighting about issues related to money and illicit drugs. Gossip was identified as a reason specific to why girls engage in violence. Youth violence was perceived as a common problem impacting the lives of the boys and girls in this study. Although many of the reasons identified for violence are similar among boys and girls, select gender differences do exist. Future research and prevention efforts to address youth violence should engage young people in efforts to understand and address this important public health topic.

Unintentional and intentional injuries cause a great deal of human suffering throughout the world. They exact a huge toll on societies in terms of mortality, years of potential life lost, disability, and health care costs. The good news is that great strides have been made in understanding the causes of injuries and how to prevent them. Using seat belts and car seats, installing air bags in cars, replacing dangerous playground equipment, enforcing drinking and driving laws are but a few examples of modifying behavior, products, and environments to reduce injury risk. This paper provides an overview of the science of injury control and selected examples of how professionals in the field of patient education and counseling can contribute to enhancing the safety of the public.

Objectives: This research addresses four questions: (1) What role do health care providers play in women's disclosure to others of their HIV-positive status? (2) What are women's concerns and experiences with disclosure? (3) What violence do women living with HIV experience? (4) How is the violence related to their diagnosis and disclosures?, Methods: Participants were 310 HIV-positive women enrolled in an HIV primary care clinic in an urban teaching hospital. Women were interviewed once using both quantitative and qualitative methods., Results: Women had known they were HIV-positive for an average of 5.8 years; 22% had an HIV-positive partner; 58% had disclosed their status to more than 10 people; and 68% had experienced physical abuse and 32% sexual abuse as an adult. Fifty-seven percent of the sample reported that a health care provider had told them to disclose to their sex partners. Women who were afraid of disclosure-related violence (29%) were significantly more likely than those who were not to report that a health care provider helped them with disclosure (21% vs. 10%). Although 4% reported physical abuse following a disclosure event, 45% reported experiencing emotional, physical, or sexual abuse at some time after their diagnosis. Risk factors for experiencing abuse after diagnosis were a prior history of abuse, drug use, less income, younger age, length of time since diagnosis, and having a partner whose HIV status was negative or unknown., Conclusions: Identifying women at risk for abuse after an HIV-positive diagnosis is important for those who provide HIV testing and care. Routine screening for interpersonal violence should be incorporated into HIV posttest counseling and continuing primary care services.

The purpose of this paper is to review the available literature on the intersections between HIV and violence and present an agenda for future research to guide policy and programs. This paper aims to answer four questions: (1) How does forced sex affect women's risk for HIV infection? (2) How do violence and threats of violence affect women's ability to negotiate condom use? (3) Is the risk of violence greater for women living with HIV infection than for noninfected women? (4) What are the implications of the existing evidence for the direction of future research and interventions? Together this collection of 29 studies from the US and from sub-Saharan Africa provides evidence for several different links between the epidemics of HIV and violence. However, there are a number of methodological limitations that can be overcome with future studies. First, additional prospective studies are needed to describe the ways which violence victimization may increase women's risk for HIV and how being HIV positive affects violence risk. Future studies need to describe men's perspective on both HIV risk and violence in order to develop effective interventions targeting men and women. The definitions and tools for measurement of concepts such as physical violence, forced sex, HIV risk, and serostatus disclosure need to be harmonized in the future. Finally, combining qualitative and quantitative research methods will help to describe the context and scope of the problem. The service implications of these studies are significant. HIV counseling and testing programs offer a unique opportunity to identify and assist women at risk for violence and to identify women who may be at high risk for HIV as a result of their history of assault. In addition, violence prevention programs, in settings where such programs exist, also offer opportunities to counsel women about their risks for sexually transmitted diseases and HIV.

Women represent an increasing proportion of AIDS cases and anecdotal reports suggest some face substantial risks when others learn they are HIV-positive. The purpose of this paper is to describe women's fears and experiences regarding disclosure of their HIV status. Fifty HIV-positive women, ages 16-45 from urban teaching hospital outpatient clinics, were interviewed using an in-depth, qualitative interview. Eighty-six percent of the women were African American and 56% were current or former IVDU. At the time of the interview, 88% of the women had known their HIV status for a year or more. All but one woman had disclosed her HIV status to at least one person and 82% had disclosed to multiple people. Although two-thirds of the women had been afraid to disclose to others because of concerns about rejection, discrimination or violence, three-quarters of the sample reported only supportive and understanding responses to their disclosure. One-quarter of the sample reported negative consequences of disclosure, including rejection, abandonment, verbal abuse and physical assault. Disclosure-related violence was discussed by nine women (18%): two who feared violence were relieved to find a supportive response; four chose not to disclose their status because they feared violence; and three women were verbally or physically assaulted. Fear of mistreatment figured prominently in decisions about disclosure among this sample. That many women found supportive and understanding responses is encouraging. However, there were sufficient examples of negative consequences, including violence, to suggest individualized approaches to post-test counseling, enhanced support services for HIV-positive women, and public education to destigmatize HIV-disease.

Reducing physical abuse directed at women by male partners is one of the nation's Year 2000 health objectives. An important target group for achieving this health objective is pregnant women. The present study examines the frequency, severity, perpetrators and psychosocial correlates of violence during the childbearing year. A panel of 275 women were interviewed 3 times during pregnancy and at 6 months postpartum. Moderate or severe violence was somewhat more common during the postpartum period than during the prenatal period--19% of women reported experiencing moderate or severe violence prenatally, compared to 25% in the postpartum period. For partner-perpetrated violence, being better educated was associated with increased risk of violence as was having had a sex partner who ever shot drugs; being older, having a confidant and having social support from friends were significant protective factors. For violence perpetrated by someone other than a male partner, having a confidant was a significant protective factor. Obstetric care providers who routinely come in contact with pregnant women, as well as emergency department staff, need to be systematically screening for violence against women. Efforts to enhance women's social support networks should be included in primary and secondary prevention programs.

We report on the occurrence of verbal abuse and physical violence during pregnancy for 358 low-income women. Overall, 65% of the women in our study experienced either verbal abuse or physical violence during their pregnancies. Twenty percent of the women in our sample experienced moderate or severe violence. Perpetrators, although primarily male partners, included family members and friends. These rates varied by age, with younger women experiencing significantly higher rates of verbal abuse and physical violence. There was no association between verbal abuse or physical violence and birth weight or gestational age. Prenatal care may be one of the only opportunities that women, and especially disadvantaged women, may have to get proper assistance with domestic violence. We conclude that enhanced screening, counseling, and referral by obstetricians and other health care providers are some of the immediate activities that could be implemented in prenatal care settings to address the compelling problems of violence during pregnancy.