HEALTH DISPARITIES and VIOLENCE AGAINST WOMEN Why and How Cultural and Societal Influences Matter

Home , Diversity (politics), Violence and Victims

HEALTH DISPARITIES AND VIOLENCE AGAINST WOMEN Why and How Cultural and Societal Influences Matter

TRICIA B. BENT-GOODLEY Howard University School of Social Work

This article encourages readers to consider the cultural and societal influences that impact health and health disparities among women survivors of intimate partner violence (IPV). Health consequences caused by IPV are widely documented and broadly discussed. Connections between health disparities and IPV are also discussed as related to women of color. Cultural factors and societal influences are identified to provide the reader with greater awareness of how these issues intersect with and impact IPV. Finally, the implications for scientific research and practice are discussed to include considerations for stronger assessment tools, greater collaboration and community participation, determination of best practices, requirement of cultural competence, mandated accountability, encouragement of mentorship, increased funding for research, increased advocacy, and increased culturally competent media and health promotion campaigns.

Key words: culture; women of color; intimate partner violence; domestic violence; health; health disparities

THE RELEVANCE of culture when responding to develop evidence-based interventions that to intimate partner violence (IPV) continues to are responsive to the grassroots initiatives at the be discussed. Some contend that violence is forefront of this issue, we are called to respond there regardless of culture and to distinguish to cultural influences. The purpose of this article cultural matters might allude to the notion that is to encourage practitioners and scholars to survivors contribute to the violence, that per- consider the cultural and societal influences that petrators are somehow less accountable for impact health and health disparities among committing acts of violence, or that culture is at women survivors of IPV. the root of abusive behaviors. This dilemma is particularly troublesome as there are still lim- IPV AND HEALTH DISPARITIES IN CONTEXT ited evidence-based interventions in this area, regardless of culture. The challenge of adding The connection between health and IPV this seemingly evasive component to an already has been discussed. It is still important to high- complex issue can be staggering. As we continue light the importance of the connection between

90 Bent-Goodley / HEALTH DISPARITIES & VIOLENCE AGAINST WOMEN 91

KEY POINTS OF THE RESEARCH REVIEW experience IPV each year (National Center for Injury Prevention and Control, 2003). IPV is Barriers: Individual Domain listed as 1 of the 10 leading health objectives of Healthy People 2010 (U.S. Department of • Help-seeking behaviors: Women of color often Health and Human Services, 2007). It costs turn to informal service providers to receive health systems more than $44 million annually services before reaching out to formal providers. • Stigmatization: Women of color may feel shame and to address IPV (NCIPC, 2003). IPV is the lead- embarrassment with regards to experiencing IPV ing cause of injuries to women between the because of the lack of information of the prevalence ages of 15 and 44 and is more common than of IPV in their respective communities. muggings, auto accidents, and cancer deaths • Family secrecy: Women of color are encouraged to combined. Women experiencing IPV are twice keep the business of the family within the family. as likely to be in poor health as those who are not experiencing IPV. IPV results in 21,000 hos- Barriers: Institutional Domain pitalizations, 28,700 emergency department • Lack of physician training on IPV: There is a need visits, and 39,900 visits to physicians annually for increased training on IPV for physicians and (NCIPC, 2003). Thirty-seven percent of women health care professionals, particularly with a focus reporting to emergency rooms are there on addressing the impact of stereotyping on qual- because of IPV. IPV is connected to higher lev- ity of care. • els of hypertension, diabetes, pain syndromes, Screening tools are inadequate: Screening tools do miscarriage, abortion, insomnia, fatigue, uri- not provide an assessment that considers cultural and societal influences. nary tract infections, irritable bowel syndrome, • Stereotyping and labeling: Women of color experi- arthritis, chronic disability, migraines, stomach ence several stereotypes and labels that discourage ulcers, HIV/AIDS, and sexually transmitted them from receiving assistance to deal with IPV. diseases (D. W. Campbell et al., 2002; J. C. • Lack of cultural competence: Ignoring the chal- Campbell, 2002; Constantino, Kim, & Crane, lenges faced by different groups denies and invalidates their experiences. 2005; Fisher & Shelton, 2006; Lee, Thompson, & • Language barriers: It is not just the words that get Mechanic, 2002; Lichtenstein, 2006; Plichta, lost in the translation but also the context for the 2004; Sutherland, Bybee, & Sullivan, 2002; words and meaning behind the language. Wingood & DiClemente, 1997; Wyatt, Axelrod, Chin, Carmona, & Loeb, 2000). Perhaps the Barriers: Systemic Domain most illustrative form of the severity of physical violence is when women lose their lives to • Discriminatory treatment: Disparate treatment leads IPV. In the past 6 years, 1,200 to 1,324 women to a suspicion that the system is out to get them as have been killed because of IPV (Fisher & opposed to being interested in helping them. • Poverty: The high prevalence of poverty in com- Shelton, 2006). To put this number in context, munities of color has a significant impact on the 30% of women killed—compared to 3% of men ways in which IPV is experienced. killed—were murdered as a result of IPV. The • Immigration status: So many women are placed health and IPV connection is not limited to the at a greater risk for violence because of immigra- national landscape. In a study on the global tion status, whether they are documented or undocumented. health of women (World Health Organization [WHO], 2005), up to one half of women suf- fered physical injuries as a result of domestic IPV, health, and health disparities. IPV is violence, and at least 20% of those that defined as “a pattern of assaultive and coercive acknowledged abuse in the study stated that behaviors including physical, sexual, and psy- they never reported it to anyone or any agency. chological attacks, as well as economic coer- The high degree of gender-based violence cion that adults or adolescents use against their (GBV) has prompted lawmakers in this intimate partners” (Schechter & Ganley, 1995, country to propose legislation focusing on p. 10). It is estimated that 5 million women addressing GBV in the world arena. 92 TRAUMA, VIOLENCE, & ABUSE / April 2007

Compounded with these physical health women (Kaiser, 2003). These issues are present issues are the mental health issues that often regardless of socioeconomic status but are, of occur simultaneously with physical pain. course, more pronounced among lower-income Increased feelings of fearfulness, depression, communities. anxiety, posttraumatic stress disorder (PTSD), These disparities in health are compounded suicidal ideation, loss of self-efficacy, and sub- when we consider IPV. Already at greater risk, stance abuse are all mental health issues that women of color who are experiencing IPV may compound and correspond to the pervasive- not be able to obtain the necessary medical care ness and insidiousness of the physical health for fear of revealing the violence (Lee et al., issues (Bogat et al., 2005; J. C. Campbell, 2002; 2002). The perpetrator may discourage or pre- Jordan, Nietzel, Walker, & Logan, 2004; Plichta, vent the survivor from obtaining medical treat- 2004; Walton-Moss, Manganello, Frye, & ment. Or the women may lack the necessary Campbell, 2005). control of their finances to put money toward medical services. The stress of the violence and Health Disparities and IPV impending abuse may exacerbate health issues. One clear example of the connection between These issues are compounded when race, eth- health disparities and IPV can be illustrated nicity, and culture are taken into consideration through the high rate of HIV/AIDS among (Banks-Wallace et al., 2002; Davis, 2003; Solis, African American women and Latinas. In 2002, 2003-2004). Crenshaw (1991) asserted that it is HIV was the number one cause of death for the intersectionality of abuse that women of African American women aged 25 to 34 (Kaiser, color experience by virtue of their gender and 2006a). African American women accounted for race or ethnicity that warrants greater atten- 67% of new AIDS cases in 2005, and Latinas tion. That is, one cannot fully understand IPV accounted for 16% of new AIDS cases. The most and health disparities without examining the common reason for infection is because of het- way in which they intersect with race and eth- erosexual transmission for both groups of nicity, gender, socioeconomic status, and other women. Women experiencing IPV are less considerations of social construction. An exam- likely to negotiate using condoms for fear of ination of one issue without consideration of greater abuse, placing them in a position of the patterns of oppression renders an incom- enhanced risk for contracting the virus (Wyatt plete analysis. et al., 2002). They are also less likely to adhere Although some debate whether health dis- to antiretroviral medication regimes (Mugavero parities are dissipating and health care is et al., 2006). Coupled with the rate of HIV infec- becoming more equitable, inequity in the tion, IPV exacerbates the disparities within the health care arena continues to be real HIV infection rates. The connection between (Cornelius & Ortiz, 2004; The Henry J. Kaiser health disparities and IPV has received little Family Foundation [hereafter, “Kaiser”], 2003; attention in the research but is clearly problem- Snowden, 2004). Women of color, particularly atic within oppressed populations. those of African ancestry, continue to experience higher infant mortality rates, cardiovascu- Cultural and Societal Influences Matter lar disease, diabetes, hypertension, HIV infection, STDs, cancer, obesity, lupus, and It seems that there is no sense of outrage about poor dental care (Kaiser, 2003; Keppel, Pearcy, discriminatory treatment and lack of culturally & Wagener, 2002; Thomas, 2006). Health dis- competent care. Cultural competence has been parities have been linked to the type and qual- defined as “an ongoing process in which one ity of care that women of color receive (Clark, continuously strives to achieve the ability to 2003). Women of color tend to receive substan- work effectively within the cultural context of dard care, lower quality of care, less follow-up, the individual or community” (J. C. Campbell & and fewer referrals, and they are less likely to Campbell, 1996, p. 457). What is less empha- possess health coverage compared to Caucasian sized is that culture shapes experiences, creates Bent-Goodley / HEALTH DISPARITIES & VIOLENCE AGAINST WOMEN 93 perceptions, and impacts how we think, feel, Diversity Still Remains Within Racial and absorb, refine, justify, and solidify information. Ethnic Groups It determines how we view ourselves and those around us and fundamentally deter- There is diversity within racial and ethnic mines who we are and where we see ourselves groups, so culture is experienced in different (Bent-Goodley, 2005a; Kanuha, 1994; Myers, ways (Bent-Goodley & Williams, 2005; Boyd- 1995). Although women of color may share Franklin, 2003; Dasgupta, 2000; Krane, Oxman- some experiences, ultimately the way culture is Martinez, & Ducey, 2000; Lee, 2000; Sullivan, experienced is unique to the individual Bhuyan, Senturia, Shiu-Thornton, & Ciske, (Gutierrez & Lewis, 1999; Hill, 1997; Sokoloff, 2005; Wyatt, 1994). No racial or ethnic group is 2005; Solomon, 1976). Having a clear under- monolithic. For example, although Latinos standing of the individual’s experiences and have experienced barriers to accessing health unique circumstances is needed to fully engage care services, there are differences between eth- in assessment and planning. No one can or nic groups within the Latino community. should diminish this experience. It is not sim- Mexican Americans are less likely to have ply about identifying a cultural practice, but it insurance and more likely to have language is also important to understand how culture— barriers compared with Cuban Americans as experienced by the person—influences all and Puerto Ricans (Cornelius & Ortiz, 2004). that they do, think, and understand (Lee et al., This discrepancy is largely explained because 2002). One can hire a person of the same culture of employment status and occupation. “The to provide a service or ask a research question, industries in which Mexican Americans are but if the program is not culturally relevant or employed tend to be seasonal, rely on day the intervention not developed within a cultural labor, and pay cash to avoid giving benefits, framework, then the outcome is still uncertain. paying taxes, or checking immigration docu- mentation” (Cornelius & Ortiz, 2004, p. 158). Culture Is Not a Predictor of IPV The implications for IPV are similar. There are differential impacts of IPV among Latinas In examining the role that culture plays in (Aldarondo, Kantor, & Jasinski, 2002), with IPV, it is important to acknowledge that having studies finding a higher prevalence of IPV a particular cultural orientation is not a predic- among Mexican American women (Firestone, tor that IPV will occur. However, understand- Lambert, & Vega, 1999; Lown & Vega, 2001). ing the cultural orientation provides an Lacking access to health care limits a Mexican attuned sense of direction, an expanded aware- American woman who is experiencing IPV ness of potential factors, and a keen lucidity of from obtaining preventive health services and latent barriers and strengths that can be used to limits her options when choosing a provider address the challenges of IPV. For example, it who makes her feel comfortable. When she has been stated that IPV is more prevalent in does reach out for help, she is likely to experi- the African American community (Rennison & ence language barriers among providers and a Welchans, 2000). Yet when socioeconomic lack of understanding of the unique experi- status is controlled for, the differences of preva- ences she brings as a Mexican American lence are contradicted and African Americans woman. Consequently, it is vital to acknowl- are no more likely to experience IPV than other edge the importance of ethnicity within the groups (Hampton, Carrillo, & Kim, 1998; racial and ethnic experience to provide a more Lockhart, 1985; Rennison & Welchans, 2000). substantive and targeted service. This examination points to the need, for example, to discern cultural influences from Cultural Strengths class considerations associated with living in poor and economically challenged communi- Finally, culture should not be viewed simply ties (Fernandez-Esquer & McCloskey, 1999; as a barrier. Having a sense of the cultural Michalski, 2004). strengths within groups allows for opportunities 94 TRAUMA, VIOLENCE, & ABUSE / April 2007 to engage women experiencing IPV (Bent- The Individual Domain: Barriers to Care Goodley, 2005b; Kanuha, 1994; Lown & Vega, 2001; Sokoloff & Dupont, 2005; Yoshioka, Help-Seeking Behaviors DiNoia, & Ullah, 2001). Another core cultural Women of color often turn to informal service value shared by women of color is the empha- providers to receive services before reaching sis and value placed on spirituality (Bent- out to formal service providers (Bent-Goodley, Goodley & Fowler, 2006; El-Khoury et al., 2004; 2004a; Bent-Goodley, 2006; El-Khoury et al., Fernandez-Esquer & McCloskey, 1999; Lown & 2004; Sokoloff, 2005; C. M. West, Kantor, & Vega, 2001; Wahab & Olsen, 2004). As a Jaskinski, 1998; T. C. West, 1999). Turning to strength, women of color have used their spir- friends and faith-based communities first (Bent- ituality as a form of resistance ethics (T. C. West, Goodley & Fowler, 2006; El-Khoury et al., 2004), 1999), a coping mechanism, and a method of women of color are less likely to reach out to retaining hope so that they can survive. It is true mental health, criminal justice, or health pro- that these same core cultural strengths can be fessionals as their first alternative. Typically used in a negative manner and have been used to women of color reach outside of their network manipulate and maintain women in abusive rela- to receive supports when the violence has tionships and submissive roles. As the impor- severely escalated, when they are afraid of tance of cultural and societal influences is hurting their partner or themselves, or when considered, it is equally important to acquire they are trying to stop an abusive incident from greater understanding of those cultural strengths occurring (Lipsky, Caetano, Field, & Larkin, that can be more effectively and efficiently used 2006; Yoshioka et al., 2001). They are often not to help women empower themselves and find looking to have their partner prosecuted nor solutions to end the violence in their lives. are they necessarily looking for counseling services, but instead they are seeking more of CULTURAL AND SOCIETAL INFLUENCES: an immediate resolution to the situation at BARRIERS TO CARE hand. It is important for health professionals and researchers to understand this trajectory, It is critical to examine cultural and societal as it may be challenging for the woman to influences within individual, institutional, and reveal what she is experiencing to someone she systemic domains (Moracco, Runyan, & Dulli, does not know and may not trust because of 2003; Pyles & Kim, 2006). The individual his or her association with a system that could domain denotes the internal barriers as experi- report the violence. enced by women, impacting their decision making and experience with IPV. The institu- The Stigma Associated With IPV tional domain examines the barriers on the organizational level that impact how women The stigma associated with having experi- experience services. The systemic level exam- enced abuse is profound. Women of color may ines those systemic barriers that occur on the be particularly stigmatized because they may larger societal level that impact the functioning have received messages that domestic violence and experiences of survivors. The individual does not take place in their respective racial or domain includes help-seeking behaviors, the ethnic community (Plough, 2000). This mes- stigma associated with IPV, and the need to sage is reinforced when public health messages maintain family secrecy. The institutional and institutions only feature Caucasian domain includes poor training on IPV, inade- women. Not seeing themselves in the message quate screening tools, stereotyping and label- and hearing that IPV is not common to the ing, lack of cultural competence, and language experiences of women of color fosters a per- barriers. The systemic domain includes dis- ception that it is either the woman’s fault or criminatory treatment across systems, the high that something is wrong with the woman. As a levels of poverty in communities of color, and result, the stigma associated with IPV is height- issues surrounding immigration. ened. It is important for health professionals Bent-Goodley / HEALTH DISPARITIES & VIOLENCE AGAINST WOMEN 95 and researchers to understand the power of respond to IPV among medical staff has even stigmatization, as the feeling of shame may been seen in a negative light among health propose an obstacle for the woman to discuss the fessionals (Moracco et al., 2003). Physicians violence she is experiencing. have been found to have serious stereotypical notions of IPV survivors and women of color Maintaining Family Secrecy (Plough, 2000). In a study of barriers impacting physicians’ ability to identify and address IPV, Keeping family business in the family is a the clear biases against women of color and message commonly received by women of survivors of IPV is evident. color (Abraham, 2000; Boyd-Franklin, 2003; Despite claims that services are not impacted Kanuha, 1994). The idea of “not airing your because of prejudicial attitudes, women of color dirty laundry” has been passed down from have been able to identify negative experiences generation to generation as a means of secur- with hospital staff and formal systems of care ing the family’s image and stability. It is not that leave an imprint in their mind when con- looked on kindly when someone betrays the fronted with formal service systems again (D. trust of the family by revealing problems within W. Campbell et al., 2002; Haywood, 2000; it. It is assumed that the parties involved can McNutt, van Ryn, Clark, & Fraiser, 2000; resolve the problems on their own without Plichta, 2004; Rodriguez, Bauer, Flores-Ortiz, & the intervention of other people, including Szkupinski-Quiroga, 1998). Accordingly, in extended family members. Particularly when a addition to training in IPV, it is important to woman marries, it is reinforced that she has to train health care professionals in cultural com- find ways of addressing marital problems and petence and to find creative ways to address issues within her smaller family system. and eliminate the prejudice that exists among Sometimes family members will even send the physicians with a very vulnerable population woman back home to resolve the problem, of women. regardless of the fact that she is experiencing abuse. In addition to these issues, sharing fam- Screening Tools and IPV ily issues is taboo and can be viewed as a form of betrayal of the larger family (Abraham, 2000; If we can agree that culture does matter and Lee, 2000). Thus, there can be great shame in that a one-size-fits-all approach in IPV research telling others about IPV. It is important for and service provision does not best serve women, health professionals and researchers to under- then new considerations and approaches truly stand the depth of this obligation to the family, rooted in abolishing these inequities and find- as it may hinder women of color from being ing solutions that work are warranted. Our willing to share information, even when they sense of science and rigor does not adequately individually acknowledge the danger and risk capture the essence of culture. Current mea- they are experiencing. sures do not assess the impact of race, ethnicity, gender, sexual orientation, religion, age, and Organizational Domain: Barriers to Care culture on IPV outcomes. Our screening tools and research designs are often not designed Limited Training in IPV with a full understanding of the complexity of these issues for the people we are serving Health professionals have received limited (A. L. Coker, Pope, Smith, Sanderson, & Hussey, training in IPV. Although not specific to cul- 2001; Wyatt, 1994). A cultural experience that ture, it is important to acknowledge that the might lie dormant, but comes back to create systematic training of health professionals serious issues for the individual, has to be con- regarding IPV is already lacking (Moracco, sidered despite its fluid nature. The field must Runyan, & Dulli, 2003; Rhodes & Levinson, also consider certain methods that best answer 2003; Stayton & Duncan, 2005; Virginia desired questions. There may be times when Department of Health, 2006). The desire to randomized controlled trials are not the best 96 TRAUMA, VIOLENCE, & ABUSE / April 2007 design to answer questions. In the quest to 2000; Hampton & Yung, 1996; Huang & Gunn, thrust evidence-based practice into the fore- 2001). Some service providers believe in using front, we must ask: Are there negative implica- a culture-blind approach, believing that every- tions related to culture that have yet to be fully one should be treated exactly the same and receive considered? This is a vital question to critically the exact same service (Gondolf & Williams, discuss as we move forward. 2001). Ignoring the challenges faced by different groups denies and invalidates their experi- Stereotyping and Labeling ences. Two results of ignoring the different needs presented by different cultures are (a) higher Women of color experience several stereo- levels of withdrawal from services and (b) less types and labels that discourage them from effective treatment experienced among vulner- receiving assistance to deal with IPV (Bent- able populations (Gondolf & Williams, 2001; Goodley & Williams, 2005; Richie, 1996; Sullivan Haywood, 2000; McNutt et al., 2000; T. C. et al., 2005; C. M. West, 2002; T. C. West, 1999). West, 1999; Williams & Becker, 1994). An addi- African American women are often stereotyped tional issue when there is a lack of cultural as being strong or big enough to respond to vio- competence is the inability to connect with the lence. This stereotype has led to African client (Bent-Goodley, 2004a, 2005b; Moracco American women being denied shelter services. et al., 2003). The service provider may not Latinas have actually been denied services understand how to develop a relationship with because they did not speak English and providers the client because of different cultural values. felt that they might feel isolated in an all- Other times, the client may feel uncomfortable English speaking shelter (Crenshaw, 1991). sharing her personal business with someone Another cultural stereotype is that lesbian from a different cultural background because women have been perceived as being less she feels that the person may not understand likely to experience IPV because they have a her situation or because she does not want to same-sex partner (Bent-Goodley & Williams, educate the person about her culture to 2005; McClennen, 2005). Some providers have receive services (Boyd-Franklin, 2003). The questioned the urgency or validity of the threat lack of cultural competence goes beyond a because it is coming from another woman. The practice approach and really speaks to pro- power of these stereotypes is critical to under- viding services that are ethical, competent, stand. The outcome of having experienced and effective. When such a significant element these types of stereotypical encounters may of the client’s or patient’s experience is create a sense that the formal provider system denied, everything within the helping transac- is either not interested or is incapable of tion is problematic—from the assessment of the responding to their unique circumstances. In individual’s situation to the selected method of addition, these negative events may be shared response. This phenomena is also true for with other women in the community. Once researchers. To study these issues without shared, other women may internalize what using a culturally competent approach does they experienced and perceive the formal little to really add to the science and promote service systems as being unresponsive and dis- scholarship that can be applied across groups. interested in helping them as well. Thus, in addition to the individual woman feeling iso- Language Barriers lated from formal providers, it can manifest into additional women being less likely to seek Language barriers are important considera- needed services. tions for all women of color (Bent-Goodley, 2005b; Kanuha, 1994; Loke, 1997). Even when Lack of Cultural Competence using the teleconference method or inter- preters to translate what women are saying, Lack of cultural competence can impact language barriers place women at tremendous services in several manners (Brach & Fraser, risk. Something could be lost in the translation Bent-Goodley / HEALTH DISPARITIES & VIOLENCE AGAINST WOMEN 97 or not fully understood, increasing the poten- responsible because of their citizenship. This is tial for further violence. Some formal providers a policy issue that warrants greater attention continue to use children as a means of inter- and advocacy. preting what a mother is saying. The woman When compared to all other groups of may not choose to say everything to the child, women, African American women have masking the violence or leaving out critical greater dual arrests when IPV is involved information because of her lack of willingness (Dennis, Key, Kirk, & Smith, 1995; Kupenda, to share the information with a child. Despite 1998; Melton, 1999; Mills, 1998). They are also our awareness of this major barrier, little has more likely to be prosecuted as a result of IPV. been done to ensure that language is no longer This type of discriminatory treatment leads to a barrier for women across diverse racial and African American women being unwilling to ethnic groups. reach out to the criminal justice system, despite It is not just the words that get lost in the the need for assistance. This disparate treat- translation but also the context for the words ment leads to a suspicion that the system is and the meaning behind the language that is “out to get them” as opposed to being inter- important (Bent-Goodley, 2005b). Some women ested in helping them. African American of color may become offended when referred to women have also experienced a higher degree as a “battered woman” or “victim” (Bent-Goodley, of child removals when IPV is involved in sim- 2001, 2004b). They may not define IPV the same ilar cases across ethnic groups (Bent-Goodley, way as the service provider (Bent-Goodley, 2004b; Bent-Goodley & Brade, in press). Many 2001; Plichta, 2004; Sokoloff & Dupont, 2005; African American women often choose not to Sullivan et al., 2005). As a result, the woman tell child welfare workers about IPV because may not even know that she is experiencing they know that once the information is IPV. And the service provider might not fully revealed, they are at greater risk of losing their understand the severity of the issue because children. These examples of discriminatory she does not understand the context of the ver- treatment are critical to help-seeking behav- nacular in the culture. Therefore, language bar- iors. These issues occur within a context of dis- riers must be a focal point for health care proportionate numbers of people of color in providers and researchers to avoid the possible the criminal justice system and children of miscommunication, disruption, and diffusion color in the child welfare system. This context in relationship building or confusion and frus- exacerbates the perception that these systems tration within the professional relationship. are less interested in helping people of color and poor women. Systemic Domain: Barriers to Care High Levels of Poverty Discriminatory Treatment Women of color are more likely than Caucasian Different cultural groups have experienced women to experience living in poverty (Kaiser, discriminatory treatment when attempting to 2006a). The high levels of poverty within com- get help for IPV. For example, a 1978 law titled munities of color must be acknowledged and Oliphant v. Suquamish Indian Tribe (435 U.S. addressed. Although poverty is not a cause of 191) is a legal statute that prohibits tribal courts violence, there are issues stemming from these from having criminal jurisdiction over factors that are relevant to how IPV is experi- American citizens. As a result of this statute, enced (D. W. Campbell et al., 2002; Sutherland American men who perpetrate IPV against et al., 2002; Williams & Mickelson, 2004). For Native American women cannot be prosecuted example, women who are poor are often more by tribal courts (Bent-Goodley, 2004a). Little reliant on public service systems than women has been done to document the numbers of who have greater financial means (Kaiser, perpetrators who have been abusive toward 2006a; Plichta, 2004). Public health systems Native American women without being held often do not cater to the individual or have the 98 TRAUMA, VIOLENCE, & ABUSE / April 2007 same time parameters to consider the needs of status can serve as a barrier to receiving each patient. Women often experience longer services and create feelings of distrust of for- waits for service, less cordial care, fragmented mal provider systems. services, transportation constraints related to having to travel to multiple places for services, IMPLICATIONS and less time to talk with the health provider (Schulz, Parker, Israel, & Fisher, 2001). In addi- There are a number of implications as we tion, resources in the community, housing and consider the next wave of research addressing shelter space, may be limited or have long wait- IPV and how it intersects with culture. The first ing lists, impacting the woman’s ability to follow step is to accept that culture matters and that up with issues identified by health personnel when we design programs and interventions (Plough, 2000). Taxed and overwhelmed, these to meet the needs of everyone, we do little for systems may not be responsive in addressing anyone. This problem requires conscious the complex needs of women living in poverty. emphasis and resolution to increase what we The outcome is that poor women have fewer know in this area and find solutions that are options, have less access to care, and experience diverse in thinking and rooted in a curiosity poorer services and more barriers to services that centers around finding resolutions that are than do women with economic resources. meaningful to people, not just one group of people, but representative of the changing Immigration Status needs of a growing demographic.

Immigration status is an additional reason Developing Stronger Tools to Assess the why so many women of color are placed at a Impact of Culture greater risk for violence (Bent-Goodley, 2004a; Dasgupta, 2000; Loke, 1997; Orloff, 1999; Raj & As we explore solutions for women experi- Silverman, 2002). Whether the woman is docu- encing IPV, it is important for us to develop mented or undocumented, she may feel tools that better assess the impact of culture uncomfortable reaching out for services. If she (D. W. Campbell et al., 2002). Many surveys comes from a country where formal systems have participants check blocks to identify their (such as law enforcement) cannot be trusted, racial background, but that does not necessar- then she may choose not to reach out to formal ily identify the impact of culture for that providers as a means of protecting herself person. As we evolve as scientists, it is critical from further perceived tyranny. Services for that we develop tools and measures that ascer- immigrant women who are experiencing IPV tain the meaning of culture for the patient or are limited in many communities, and even participant. when they are available, the waiting lists for receiving such supports are often prohibitive Encouraging Greater Collaboration and because they are so long (Raj & Silverman, Community Participation 2003). Long waiting lists to address IPV can lead to greater risk for violence. The woman Researchers and providers should be may also experience threats and mixed mes- expected to engage in greater collaboration sages from her family of origin (Abraham, across disciplines and systems to best serve the 2000; Bent-Goodley, 2004a). Violence against needs of those experiencing and perpetrating women may be accepted in her country of ori- IPV. The solution to IPV cannot be found with gin, so she may face further stigmatization any one profession. Acknowledging the neces- from her family or from her husband’s family sity of interdisciplinary collaboration is critical for reaching out for assistance. Understanding to finding solutions to address the complexity how immigration status impacts the choices of of IPV. women is important for health care profes- Participation from the community is key in sionals and researchers because immigration finding enduring solutions to IPV that can be Bent-Goodley / HEALTH DISPARITIES & VIOLENCE AGAINST WOMEN 99 sustained beyond a particular research study receive public funds should be able to provide or program. Although coordinated community evidence of culturally competent procedures responses are promulgated, they are often a and practices that demonstrate an understand- collaborative effort of formal service providers ing and respect for diverse populations. systems as opposed to community and grass- Clearly, cultural competence should be evident roots organizations. It is critical to find ways to in practice, but it should also be evident within incorporate diverse professional perspectives administrative structure, policy and procedure, and increased community participation to find staffing, board membership, evaluative mea- viable solutions for IPV in diverse communi- sures and tools, and research design (Pyles & ties. Using these partnerships to discuss the Kim, 2006). If we continue to encourage the use implications of culture can create stronger, of cultural competence without having conse- more effective interventions. quences for not using a culturally competent approach, then many providers and researchers Engaging in More Intervention Research will continue to dismiss using a culturally com- and Determining Best Practices petent approach.

As we search for solutions, it is critical to not Mandating Accountability only further our understanding of these issues but also to engage in intervention research to Scientists should be held accountable for the determine best practices for working with research they conduct. Communities should diverse cultural groups. It is evident that there not be left without sustainable efforts follow- is no one approach that will work for everyone, ing the completion of research. Communities so it is vital to engage in research that tests should be able to see the collective benefits of programs, services, and practices that can aid their participation beyond publications and the in resolving IPV within diverse frameworks. advancement of the knowledge base from As opposed to focusing solely on evidence- which they receive no direct benefit. As part of based practices, it is important to also identify the research enterprise, participants should be those best practices that are used within the able to develop sustainable means of address- indigenous systems of care and have been ing IPV. Researchers should be held account- found to be helpful. It should not be assumed able for helping these systems to find that communities do not know how to develop appropriate long-term solutions for IPV within their own services. For example, Native American their diverse communities. Too many partici- communities have developed a range of pants never even know the results of studies. It indigenous methods of addressing domestic is imperative that there be some accountability violence, such as the Navajo Peacemaking to the community that goes beyond publica- Method, through tribal domestic violence laws tions and scholarly presentations. (D. Coker, 1999; Valencia-Weber & Zuni, 1995; Wahab & Olson, 2004). Communities of color Encouraging Mentorship have a long history of mutual aid, established long before formal systems would provide To add to the scholarship of scholars of color, them with services (Carlton-LaNey, 2001). mentorship must be viewed as a means of Scientists may need to find ways to support advancing diverse ideas and varying thinking indigenous responses. within science development. It is critical to support and guide scholars of color as to the Requiring Cultural Competence funding and publication process. Mentorship is key, as it is difficult to understand the Cultural competence should be required research and publication enterprises when within the research enterprise and within sys- unfamiliar or unaware of how they function. tems of care, particularly those that receive Having the support of experienced and sea- public funding. Researchers or providers who soned scientists who are willing to create 100 TRAUMA, VIOLENCE, & ABUSE / April 2007 opportunities and open doors for individuals policies. Advocacy without consideration of capable of conducting research that adds to the reality of persistent discrimination and diversity and advancing the science is neces- oppression is irresponsible and fuels the sary if we are to truly strengthen the practice oppression experienced by far too many and science in this area. women on the margins.

Increasing Funded Research Examining Increasing Culturally Competent Media This Intersection and Health Promotion Campaigns

Although the funding opportunities to con- More attention needs to be given to creating duct research on IPV are highly competitive, it more culturally competent media and health is still important to strengthen and expand promotion campaigns. There are still many funded research that examines the intersection oppressed populations that do not believe that between IPV and culture. Without a funding IPV occurs in their respective communities, or imperative specific to the intersection, it may they do not know when they are in an abusive be difficult to obtain funding to conduct research relationship. It is critical that media and health that is specific to populations often understud- promotion campaigns continue to be devel- ied and misunderstood. A focus on the inter- oped specifically for these populations while section will allow for developing and testing ensuring that the methods and messages are relevant measures, creating interventions that culturally targeted to optimize the impact. In allow for the diversity within groups of color addition to developing targeted media and and determining approaches that are more health promotion campaigns, it is important to effective across diverse cultures. It is likely target family members and friends who may that, by increasing our understanding of how have the ability to support or assist with stop- culture intersects with IPV, we will also learn ping the violence. more about how to address IPV across all communities. CONCLUSION Increasing Advocacy The connection between health disparities to Address Systemic Discrimination and IPV is clearly documented. Despite the connection, little is being done to address the Advocacy is at the heart of eradicating IPV inherent inequity within treatment and regardless of culture, yet there is a particular research. Our commitment to finding solutions need for advocacy that addresses the systemic to stop violence should not be deflated by an discrimination often experienced by people of inability to acknowledge that culture is rele- color and other oppressed populations. Each vant to how women experience IPV. Rekindling opportunity, whether on an individual, famil- our sense of curiosity and affirming our com- ial, communal, or societal level, offers an mitment to saving lives, scientific inquiry and opportunity to use advocacy as a way to iden- practice within IPV should be centered on find- tify discriminatory treatment and create ing enduring solutions to eradicate this devas- responses that address these persistent forms tating problem. It is only through our own of oppression. Strategies to aid survivors of integrity that we are able to recognize that cul- IPV should also be examined to gauge how ture is not an elusive concept. Taking into they might differentially impact people of color account that IPV affects and is affected by the and other oppressed populations. It should be whole person, not confined to gender and its acknowledged that some policies perceived as social distinctions, we can find solutions that supporting survivors of IPV could potentially are holistic and capable of addressing the have a differential impact among people of needs and circumstances of diverse groups of color. Once acknowledged, strategies can be women and the communities to which they developed to ensure that there is equity within belong. Bent-Goodley / HEALTH DISPARITIES & VIOLENCE AGAINST WOMEN 101

IMPLICATIONS FOR PRACTICE, POLICY, AND RESEARCH

Implications for the Future • Mandating accountability: Communities should not be left without sustainable efforts following the completion of research. • Develop stronger tools: We need to develop tools that • Encouraging mentorship: We must support and guide better assess the impact of culture. scholars of color as it relates to funding and the publi- • Encourage greater collaboration and community par- cation process. ticipation: Researchers and providers should be • Increasing funded research on the intersection: It is impor- expected to engage in greater collaboration across dis- tant to have targeted funded research opportunities that ciplines and systems to best serve the needs of those examine the intersection between IPV and culture. experiencing and perpetrating IPV. • Increasing advocacy to address systemic discrimina- • Engaging in more intervention research: We need to tion: Advocacy is at the heart of eradicating IPV determine best practices for working with diverse cul- regardless of culture. tural groups. • Increasing culturally competent media and health pro- • Requiring cultural competence: Cultural competence motion campaigns: More attention needs to be given to should be required within the research enterprise and creating more culturally competent media and health within practice systems. promotion campaigns for diverse communities.

REFERENCES Bent-Goodley, T. B., & Williams, O. J. (2005). Community insights on domestic violence among African Americans: Abraham, M. (2000). Speaking the unspeakable: Marital vio- Conversations about domestic violence and other issues lence among South Asian immigrants in the United States. affecting their community, Seattle, Washington. St. Paul, New Brunswick, NJ: Rutgers University Press. MN: Institute on Domestic Violence in the African Aldarondo, E., Kantor, G. K., & Jasinski, J.L. (2002). A risk American Community. marker analysis of wife assault in Latino families. Bogat, G. A., Leahy, K., von Eye, A., Maxwell, C., Violence Against Women, 8, 429-454. Levendosky, A., & Davidson, W. S. (2005). The influ- Banks-Wallace, J., Enyart, J., Lewis, L., Lewis, S., Mitchell, ence of community violence on the functioning of S., Parks, L., et al. (2002). Development of scholars inter- women experiencing domestic violence. American ested in community-based health promotion research. Journal of Community Psychology, 36, 123-132. Western Journal of Nursing Research, 24, 326-345. Boyd-Franklin, N. (2003). Black families in therapy: A multi- Bent-Goodley, T. B. (2001). Eradicating domestic violence systems approach (2nd ed.). New York: Guilford. in the African American community: A literature Brach, C., & Fraser, I. (2000). Can cultural competency reduce review, analysis and action agenda. Trauma, Violence, & racial and ethnic health disparities? A review and concep- Abuse, 2, 316-330. tual model. Medical Care Research and Review, 57, 181-217. Bent-Goodley, T. B. (2004a). Policy implications of domes- Campbell, D. W., Sharps, P. W., Gary, F., Campbell, J. C., tic violence for people of color. In K. E. Davis & T. B. & Lopez, L. M. (2002). Intimate partner violence in Bent-Goodley (Eds.), The color of social policy (pp. 65- African American women. Issues in Nursing, 7(1). 80). Alexandria, VA: CSWE Press. Retrieved from http://www.nursingworld.org/ojin/ Bent-Goodley, T. B. (2004b). Perceptions of domestic vio- topic17/tpc17_4.htm lence: A dialogue with African American women. Campbell, J. C. (2002). Health consequences of intimate Health and Social Work, 29, 307-316. partner violence. The Lancet, 359, 1331-1336. Bent-Goodley, T. B. (2005a). Culture and domestic vio- Campbell, J. C., & Campbell, D. W. (1996). Cultural com- lence: Transforming knowledge development. Journal petence in the care of abused women. Journal of Nurse of Interpersonal Violence, 20, 195-203. Midwifery, 41, 457-462. Bent-Goodley, T. B. (2005b). An African centered Campbell, J., Jones, A. S., Dienemann, J., Kub, J., approach to domestic violence. Families in Society, 86, Schollenberger, J., O’Campo, P., et al. (2002). Intimate 197-206. partner violence and physical health consequences. Bent-Goodley, T. B. (2006). Domestic violence and the Archives of Internal Medicine, 162, 1157-1164. Black church: Challenging abuse one soul at a time. In Carlton-LaNey, I. B. (Ed.). (2001). African American leader- R. L. Hampton & T. P. Gullotta (Eds.), Interpersonal ship: An empowerment tradition in social welfare history. violence in the African American community (pp. 107- Washington, DC: NASW Press. 119). New York: Springer. Clark, S. L. (2003). African American women and health Bent-Goodley, T. B., & Brade, K. (in press). Domestic vio- disparities: Implications of race, class and gender. In lence and kinship care. Journal of Health and Social Policy. T. B. Bent-Goodley (Ed.), African American social work- Bent-Goodley, T. B., & Fowler, D. (2006). Spiritual and ers and social policy (pp. 123-136). New York: Haworth. religious abuse: Expanding what is known about Cohen, S., DeVos, E., & Newberger, E. (1997). Barriers to domestic violence. Affilia, 21, 282-295. physician identification and treatment of family violence: 102 TRAUMA, VIOLENCE, & ABUSE / April 2007

Lessons from five communities. Academic Medicine, 72, Hampton, R., & Yung, B. R. (1996). Violence in communities 19-25. of color: Where we were, where we are, and where we Coker, D. (1999). Enhancing autonomy for battered women: need to be. In R. L. Hampton, P. Jenkins, & T. Gullotta Lessons from Navajo Peacemaking. UCLA Law Review, (Eds.), Preventing violence in America (pp. 53-86). 47, 1-111. Thousand Oaks, CA: Sage. Coker, A. L., Pope, B. W., Smith, P. H., Sanderson, M., & Haywood, Y. (2000). Health systems response to victims Hussey, J. R. (2001). Assessment of clinical partner of domestic violence. In Forum Proceedings: Health and violence screening tools. Journal of the American Medical mental health consequences of domestic violence in the Women’s Association (JAMWA), 56, 19-23. African American community (pp. 59-72). Minneapolis, Constantino, R., Kim, Y., & Crane, P. (2005). Effects of a MN: Institute on Domestic Violence in the African social support intervention on health outcomes in res- American Community. idents of a domestic violence shelter: A pilot study. Hill, R. B. (1997). The strengths of African American families: Issues in Mental Health Nursing, 26, 575-590. Twenty-five years later. Washington, DC: R & B Publishers. Cornelius, L. J., & Ortiz, L. A. (2004). What will ensure Huang, C., & Gunn, T. (2001). An examination of domes- Mexican Americans equal access to health care? In tic violence in an African American community in K. E. Davis & T. B. Bent-Goodley (Eds.), The color of social North Carolina: Causes and consequences. Journal of policy (pp. 155-168). Alexandria, VA: CSWE Press. Black Studies, 31, 790-811. Crenshaw, K. (1991). Mapping the margins: Intersection- Jordan, C. E., Nietzel, M. T., Walker, R., & Logan, T. K. ality, identity politics, and violence against women of (2004). Intimate partner violence: A clinical training guide color. Stanford Law Review, 43, 1241-1299. for mental health professionals. New York: Springer. Dasgupta, S. D. (2000). Charting the course: An overview The Henry J. Kaiser Family Foundation (Kaiser). (2003). of domestic violence in the South Asian community in Key facts: Race, ethnicity and medical care. Washington, the United States. Journal of Social Distress and the DC: Author. Homeless, 9, 173-195. Kaiser. (2006a, November). The HIV/AIDS epidemic in the Davis, K. E. (2003). The policy implications of the Surgeon United States. Washington, DC: Author. General’s Report on mental health, race, culture and Kaiser. (2006b, August). Who are the uninsured? A consistent ethnicity. In T. B. Bent-Goodley (Ed.), African American profile across national surveys. Washington, DC: Author. social workers and social policy (pp. 93-122). New York: Kanuha, V. (1994). Women of color in battering relation- Haworth. ships. In L. Comas-Diaz & B. Greene (Eds.), Women of Dennis, R. E., Key, L. J., Kirk, A. L., & Smith, A. (1995). color: Integrating ethnic and gender identities in psy- Addressing domestic violence in the African American chotherapy (pp. 428-454). New York: Guilford. community. Journal of Health Care for the Poor and Keppel, K. G., Pearcy, J. N., & Wagener, D. K. (2002, Underserved, 6, 284-293. January). Trends in racial and ethnic specific rates for the El-Khoury, M., Dutton, M. A., Goodman, L. A., Engel, L., health status indicators: United States, 1990-98. Belamaric, R. J., & Murphy, M. (2004). Ethnic differences Washington, DC: National Center for Health Statistics. in battered women’s formal help-seeking strategies: A Krane, J., Oxman-Martinez, J., & Ducey, K. (2000). focus on health, mental health and spirituality. Cultural Violence against women and ethnoracial minority Diversity and Ethnic Minority Psychology, 10, 383-393. women: Examining assumptions about ethnicity and Fernandez-Esquer, M. E., & McCloskey, L. A. (1999). race. Canadian Ethnic Studies, 32, 1-19. Coping with partner abuse among Mexican American Kupenda, A. M. (1998). Law, life, and literature: A critical and Anglo women: Ethnic and socioeconomic influ- reflection of life and literature to illuminate how laws ences. Violence and Victims, 14, 293-310. of domestic violence, race, and class bind Black women Firestone, J. M., Lambert, L. C., & Vega, W. A. (1999). based on Alice Walker’s book The Third Life of Grange Intimate violence among women of Mexican origin: Copeland. Howard University Law Journal, 42, 1-26. Correlates of abuse. Journal of Gender, Culture and Lee, M. Y. (2000). Understanding Chinese battered women Health, 4, 119-134. in North America: A review of the literature and prac- Fisher, J. W., & Shelton, A. (2006). Survivors of domestic tice implications. Journal of Multicultural Social Work, 8, violence: Demographics and disparities in visitors to 215-241. an interdisciplinary specialty clinic. Family & Lee, R. K., Thompson, V. L., & Mechanic, M. B. (2002). Community Health, 29, 118-130. Intimate partner violence and women of color: A call Gondolf, E. W., & Williams, O. J. (2001). Culturally for innovations. American Journal of Public Health, 92, focused batterer counseling for African American 530-534. men. Trauma, Violence, & Abuse, 2, 283-295. Lichtenstein, B. (2006). Domestic violence in barriers to Gutierrez, L. M., & Lewis, E. (1999). Empowering women of health care for HIV-positive women. AIDS Patient Care color. New York: Columbia University Press. and STDs, 20, 122-132. Hampton, R., Carrillo, R., & Kim, J. (1998). Violence in Lipsky, S., Caetano, R., Field, C. A., & Larkin, G. L. (2006). communities of color. In R. Carrillo & J. Tello (Eds.), The role of intimate partner violence, race, and ethnic- Family violence and men of color: Healing the wounded ity in help-seeking behaviors. Ethnicity and Health, 11, male spirit (pp. 1-30). New York: Springer. 81-100. Bent-Goodley / HEALTH DISPARITIES & VIOLENCE AGAINST WOMEN 103

Lockhart, L. L. (1985). Methodological issues in compara- Raj, A., & Silverman, J. (2002). Violence against immigrant tive racial analyses: The case of wife abuse. Research women: The roles of culture, context, and legal immi- and Abstracts, 13, 35-41. grant status on intimate partner violence. Violence Loke, T. (1997). Trapped in domestic violence: The impact Against Women, 8, 367-399. of United States immigration laws on battered immi- Raj, A., & Silverman, J. (2003). Immigrant South Asian grant women. Boston University Public Interest Law women at greater risk for injury from intimate partner Journal, 6, 589-628. violence. American Journal of Public Health, 93, 435-438. Lown, E. A., & Vega, W. A. (2001). Prevalence and predic- Rennison, C. M., & Welchans, S. (2000, May). Intimate tors of physical partner abuse among Mexican American partner violence. Washington, DC: U.S. Department of women. American Journal of Public Health, 91, 441-445. Justice, Bureau of Justice Statistics. McClennen, J. C. (2005). Domestic violence between Rhodes, K. V., & Levinson, W. (2003). Interventions for same-gender partners: Recent findings and future intimate partner violence against women. Journal of the research. Journal of Interpersonal Violence, 20, 149-154. American Medical Association, 289, 601-605. McNutt, L. A., van Ryn, M., Clark, C., & Fraiser, I. (2000). Richie, B. E. (1996). Compelled to crime: The gender entrap- Partner violence and medical encounters: African ment of battered Black women. New York: Routledge. American women’s perspectives. American Journal of Rodriguez, M. A., Bauer, H. M., Flores-Ortiz, Y., & Preventive Medicine, 19, 264-269. Szkupinski-Quiroga, S. (1998). Factors affecting Melton, H. C. (1999). Police response to domestic vio- patient-physician communication for abused Latina lence. Journal of Offender Rehabilitation, 29(1-2), 1-21. and Asian immigrant women. Journal of Family Practice, Michalski, J. H. (2004). Making sociological sense out of 47, 309-311. trends in intimate partner violence. Violence Against Schechter, S., & Ganley, A. L. (1995). Domestic violence: Women, 10, 652-675. A national curriculum for family preservation practition- Mills, L. G. (1998). Mandatory arrest and prosecution ers. San Francisco, CA: Family Violence Prevention policies for domestic violence: A critical literature Fund. review and the case for more research to test victim Schulz, A., Parker, E., Israel, B., & Fisher, T. (2001). Social empowerment approaches. Criminal Justice and context, stressors, and disparities in women’s health. Behavior, 25, 306-318. JAMWA, 56, 143-149. Moracco, K. E., Runyan, C. W., & Dulli, L. (2003, May). Snowden, L. (2004). Mental health policy and people of Violence against women: Synthesis of research for public color: The Surgeon General’s supplement on culture, health policymakers (NCJ 201567). Washington, DC: race, and ethnicity and beyond. In K. E. Davis & T. B. National Institute of Justice. Bent-Goodley (Eds.), The color of social policy (pp. 117- Mugavero, M., Ostermann, J., Whetten, K., Leserman, J., 130). Alexandria, VA: CSWE Press. Swartz, M., Stangl, D., et al. (2006). Barriers to anti- Sokoloff, N. J. (Ed.). (2005). Domestic violence at the mar- retroviral adherence: The importance of depression, gins: Readings on race, class, gender, and culture. New abuse, and other traumatic events. AIDS Patient Care Brunswick, NJ: Rutgers University Press. and STDs, 20, 418-428. Sokoloff, N. J., & Dupont, I. (2005). Domestic violence at Myers, L. J. (1995). Understanding of Afrocentric world view: the intersections of race, class and gender: Challenges Introduction to an optimal psychology. Dubuque, IA: and contributions to understanding violence against Kendall/Hunt. marginalized women in diverse communities. Violence National Center for Injury Prevention and Control Against Women, 11, 38-64. (NCIPC). (2003). Costs of intimate partner violence Solis, H. L. (2003-2004). Health disparities: A growing against women in the United States. Atlanta, GA: Centers challenge in the Latino community. Harvard Journal of for Disease Control and Prevention. Hispanic Policy, 16, 53-67. Orloff, L. E. (1999). Access to public benefits for battered Solomon, B. (1976). Black empowerment. New York: immigrant women and children. Journal of Poverty Law Columbia University Press. and Policy Clearinghouse Review, 33, 237-256. Stayton, C. D., & Duncan, M. M. (2005). Mutable influ- Plichta, S. B. (2004). Intimate partner violence and physi- ences on intimate partner abuse screening in health cal health consequences. Journal of Interpersonal care settings. Trauma, Violence, & Abuse, 6, 271-285. Violence, 19, 1296-1323. Sullivan, M., Bhuyan, R., Senturia, K., Shiu-Thornton, S., Plough, A. L. (2000). Domestic violence in the African & Ciske, S. (2005). Participatory action research in American community: A local public health perspective. practice: A case study in addressing domestic violence In Forum Proceedings: Health and mental health conse- in nine cultural communities. Journal of Interpersonal quences of domestic violence in the African American com- Violence, 20, 977-995. munity (pp. 17-31). Minneapolis, MN: Institute on Sutherland, C. A., Bybee, D. I., & Sullivan, C. M. (2002). Domestic Violence in the African American Community. Beyond bruises and broken bones: The joint effects of Pyles, L., & Kim, K. M. (2006). A multilevel approach to stress and injuries on battered women’s health. cultural competence: A study of the community American Journal of Community Psychology, 30, 609-635. response to underserved domestic violence victims. Thomas, S. B. (2006). Historical and current policy efforts to Families In Society, 87, 221-229. eliminate racial and ethnic health disparities in the 104 TRAUMA, VIOLENCE, & ABUSE / April 2007

United States: Future opportunities for public health Wyatt, G. E., Axelrod, J., Chin, D., Carmona, J. V., & Loeb, education research. Health Promotion Practice, 7, 324-330. T. B. (2000). Examining patterns of vulnerability to U.S. Department of Health and Human Services. (2007, domestic violence among African American women. March 13). Healthy people 2010. Retrieved from Violence Against Women, 6, 495-514. http://www.healthypeople.gov/ Wyatt, G. E., Myers, H. F., Williams, J. K., Kitchen, C. R., Valencia-Weber, G., & Zuni, C. P. (1995). Domestic vio- Loeb, T., Carmona, J. V., et al. (2002). Does a history of lence and tribal protection of indigenous women in the trauma contribute to HIV risk for women of color? United States. Saint John’s Law Review, 69. Retrieved Implications for prevention and policy. American from http://www.vawnet.org/DomesticViolence/ Journal of Public Health, 92, 660-665. PublicPolicy/TribalProtection.pdf Yoshioka, M. R., DiNoia, J., & Ullah, K. (2001). Attitudes Virginia Department of Health. (2006). Intimate Partner toward marital violence: An examination of four Violence Health Care Provider Survey: Virginia 2006. Asian communities. Violence Against Women, 7, Richmond, VA: Author. 900-926. Wahab, S., & Olson, L. (2004). Intimate partner violence and sexual assault in Native American communities. Trauma, Violence, & Abuse, 5, 353-366. SUGGESTED FUTURE READINGS Walton-Moss, B., Manganello, J., Frye, V., & Campbell, J. C. (2005). Risk factors for intimate partner violence and Bent-Goodley, T. B. (2001). Eradicating domestic violence associated injury among urban women. Journal of in the African American community: A literature Community Health, 30, 377-389. review, analysis and action agenda. Trauma, Violence, & West, C. M. (Ed.). (2002). Violence in the lives of Black Abuse, 2, 316-330. women: Battered, black and blue. New York: Haworth. Bent-Goodley, T. B. (2004a). Policy implications of domes- West, C. M., Kantor, G. K., & Jaskinski, J. L. (1998). tic violence for people of color. In K. E. Davis & T. B. Sociodemographic predictors and cultural barriers to Bent-Goodley (Eds.), The color of social policy (pp. 65- help-seeking behavior by Latina and Anglo American 80). Alexandria, VA: CSWE Press. battered women. Violence and Victims, 13, 361-375. Campbell, J. C. (2002). Health consequences of intimate West, T. C. (1999). Wounds of the spirit: Black women, vio- partner violence. The Lancet, 359, 1331-1336. lence, and resistance ethics. New York: New York Richie, B. E. (1996). Compelled to crime: The gender entrap- University Press. ment of battered Black women. New York: Routledge. White, E. (1994). Chain, chain, change: For Black women in Sokoloff, N. J., & Dupont, I. (2005). Domestic violence at abusive relationships. Washington, DC: Seal Press. the intersections of race, class and gender: Challenges Williams, O. J., & Becker, R. L. (1994). Domestic partner and contributions to understanding violence against abuse: The results of a national survey. Violence and marginalized women in diverse communities. Violence Victims, 9, 287-296. Against Women, 11, 38-64. Williams, S. L., & Mickelson, K. D. (2004). The nexus of West, T. C. (1999). Wounds of the spirit: Black women, vio- domestic violence and poverty: Resilience in women’s lence, and resistance ethics. New York: New York anxiety. Violence Against Women, 10, 283-293. University Press. Wingood, G., & DiClemente, R. (1997). The effects of an abusive primary partner on the condom use and sexual Tricia B. Bent-Goodley, PhD, MSW, is an associate negotiation practices of African American women. professor at Howard University School of Social Work. American Journal of Public Health, 87, 1016-1018. She has published in a number of areas, including social World Health Organization (WHO). (2005). WHO multi- policy, domestic violence, child welfare, social work country study on women’s health and domestic violence against women: Initial results on prevalence, health conse- entrepreneurship, and African American social welfare quences, and women’s responses. Geneva, Switzerland: history. Her research has largely focused on the intersec- Author. tion of violence against women with cultural compe- Wyatt, G. E. (1994). Sociocultural and epidemiological tence, child welfare, probation and parole, adolescent issues in the assessment of domestic violence. Journal violence, health and mental health, and faith- and com- of Social Distress and the Homeless, 3, 7-21. munity-based interventions.