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标题：Intimate Partner Violence and Cigarette Smoking: Association Between Smoking Risk and Psychological Abuse With and Without Co-Occurrence of Physical and Sexual Abuse
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作者：Hee-Jin Jun ; Janet W. Rich-Edwards ; Renée Boynton-Jarrett 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2008
卷号：98
期号：3
页码：527-535
DOI：10.2105/AJPH.2003.037663
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined the association between psychological abuse in a current relationship and current cigarette smoking among women, with and without the co-occurrence of physical or sexual abuse. Methods. Women’s experience of psychological abuse, experience of physical or sexual abuse, and smoking status were ascertained through a survey of female nurses. A score of 20 or more on the Women’s Experience With Battering scale defined psychological abuse. We used logistic regression to predict current smoking, adjusting for demographic and social covariates. Analyses included women in a current relationship (n=54200). Results. Adjusted analyses demonstrated that women experiencing only psychological abuse alone were 33% (95% confidence interval [CI]=13%, 57%) more likely to smoke than nonabused women. Compared with nonabused women, psychologically abused women’s risk of smoking was greater if they reported a single co-occurrence of physical or sexual abuse (odds ratio [OR]=1.5; 95% CI=1.3, 1.8) or multiple co-occurrences (OR=1.9; 95% CI=1.7, 2.3). Conclusions. Psychological abuse in a current relationship was associated with an increased risk of smoking in this cohort of largely White, well-educated, and employed women. The co-occurrence of physical or sexual abuse enhanced that risk. Further research is needed to see if these associations hold for other groups. Epidemiological research has increasingly informed our understanding of the nature and scope of intimate partner violence (IPV) against women, especially physical and sexual abuse. 1 ^, 2 An estimated 33% to 54% of American women are at risk for domestic violence during their lifetime, and 7% to 23% report current IPV to their primary health care providers. 3 Following a recommendation from the National Research Council, 4 psychological abuse (also referred to as “emotional abuse”) is considered distinct from other forms of IPV. It may occur independently or co-occur with these other forms of violence. Qualitative studies demonstrate that psychological abuse in an intimate relationship is an enduring, traumatic, and multidimensional experience. Conceptually distinct from episodic physical or sexual assault, psychological abuse involves isolation from social supports, humiliation or degradation, demonstration of power and threats, ongoing threat of physical danger, and a chronic sense of fear and disempowerment. 5 ^, 6 It can occur with or without concurrent physical or sexual abuse. 6 ^– 8 There are many adverse physical and mental health consequences of violence against women. 6 ^, 9 ^– 12 Violence can affect health by increasing cigarette smoking, 13 a major preventable cause of morbidity and mortality among women. A relationship between IPV and smoking, hypothesized for some time, 14 ^– 17 is theoretically grounded in research on stress and coping. All forms of IPV can be conceptualized as a chronic psychological stressor. 18 Smoking is a means of reducing stress, especially among women. 19 Stress is associated with smokers’ desire for a cigarette, smoking more cigarettes, and less success in quitting smoking. 20 Population-based studies demonstrate an association between physical or sexual partner abuse and cigarette smoking, 5 ^, 21 but they have scarcely considered the influence of psychological abuse on smoking. 7 We extend the present literature by examining the association between psychological abuse (measured with the Women’s Experience With Battering [WEB] scale)—with and without the co-occurrence of physical or sexual abuse—and current cigarette smoking among women. This is an important public health issue for many reasons. Psychological abuse has been associated with an elevated risk for physical and mental health sequelae on a scale similar to or higher than that observed for physical or sexual violence. 22 Exposure to multiple forms of victimization may further increase the risk of adverse health outcomes or negative health behaviors. 23 ^– 26 The extent to which psychological abuse alone or in combination with physical or sexual abuse is associated with smoking has not been examined. We sought to describe the prevalence of physical or sexual abuse and psychological abuse, and their co-occurrence, and tested the following hypotheses among women in a current relationship: (1) women experiencing psychological abuse alone will be more likely to smoke cigarettes, and (2) women experiencing multiple types of abuse (i.e., the co-occurrence of psychological abuse and physical or sexual abuse) will be at an even higher risk of smoking than nonabused women.