552442 research-article2014
JIVXXX10.1177/0886260514552442Journal of Interpersonal ViolenceZhang et al.
Article
Intimate Partner Violence Among Hong Kong Young Adults: Prevalence, Risk Factors, and Associated Health Problems
Journal of Interpersonal Violence 2015, Vol. 30(13) 2258–2277 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0886260514552442 jiv.sagepub.com
Huiping Zhang, PhD,1 William C. W. Wong, MD,2 Patrick Ip, FRCPCH,2 Susan Fan, MBBS,3 and Paul S. F. Yip, PhD2
Abstract Intimate partner violence is a serious social problem and public health issue affecting the well-being of the young adults. However, there is very little epidemiological evidence on the incidence and associated health problems in contemporary Chinese society. Using a representative community sample of 1,223 young adults aged 18 to 27 years conducted by Hong Kong Family Planning Association in 2011, this study aimed to estimate the prevalence, risk factors, and possible health consequences of intimate partner violence among young adults in Hong Kong. It is found that the prevalence of lifetime and preceding 1-year intimate partner violence by former or current partners was 8.6% and 4.9% respectively. Male youths who were older were less likely to experience past-year intimate partner violence (odds ratio [OR] = 0.21, p < .05) and those who had a university degree or were unemployed 1Renmin
University of China, Beijing University of Hong Kong, Pokfulam 3Family Planning Association of Hong Kong, Wan Chai 2The
Corresponding Author: Paul S. F. Yip, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong. Email: [email protected]
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were more likely to experience past-year intimate partner violence (OR = 8.48, p < .01 and OR = 8.14, p < .05 respectively). Female youths who had a full-time job were less likely to experience the lifetime violence (OR = 0.15, p < .05) and those who were ever pregnant with current partner were more likely to experience both lifetime intimate partner violence (OR = 5.00, p < .05) and past-year violence (OR = 5.63, p < .05). Both female and male victims were more likely to be subjected to mental health problems and only female victims felt fear for the violent partner. Keywords intimate partner violence, young adults, Hong Kong, health
Introduction Intimate partner violence is characterized by any behavior within an intimate relationship that causes physical, psychological, or sexual harm to those in the relationship (Krug, Dahlberg, Mercy, & Zwi, 2002). Such behaviors range from physical aggression, psychological abuse, forced sexual intercourse, and other forms of sexual coercion, to various controlling behaviors. Surveys in the United States showed that the populationbased prevalence of intimate partner violence by a spouse, boyfriend/ girlfriend, or ex-partner was 8% to 12% occurring in the previous year (Plichta, 1996; Schulman, 1979; Straus & Gelles, 1986; Teske & Parker, 1983), and 18% to 35% in the lifetime (Center for Disease Control and Prevention [CDCP], 1998, 2000a, 2000b; Klein, Campbell, Soler, & Chez, 1997; Schafer, Caetano, & Cook, 1998). A recent population-based household survey on women in 10 countries by World Health organization (WHO) showed that lifetime prevalence of physical or sexual partner violence or both varied from 15% to 71%, and the preceding 1-year prevalence of that ranged from 4% to 54% (Garcia-Moreno, Jansen, Ellsber, Heise, & Watts, 2006). Hospital-based studies in China reported a 26% prevalence of preceding 1-year violence, with a 43% prevalence of lifetime violence against women (Xu et al., 2005). Regarding the young adults, most studies have been conducted among the college dating students, and the prevalence of preceding 1-year physical violence ranged from 20% to 40% in Canada and U.S. universities (Sugarman & Hotalling, 1989). A recent survey of 31 universities in multicountries indicated that 17% to 45% of the college students in dating relationship reported a physical assault from a partner in the previous 12 months and Hong Kong college students in this study reported a 28.6% prevalence of physical violence from the dating partner (Straus,
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2004). It is quite common to find that the prevalence rate of intimate partner violence is high when measured by Conflict Tactics Scale and Abuse Assessment Screen (Tiwari et al., 2007). Multiple factors including demographic, socioeconomic, behavioral, and cultural factors have been identified to be associated with intimate partner violence. For example, younger age, lower education level, and unemployment have been associated with an increased risk of intimate partner violence across studies (Aldarondo & Sugarman, 1996; Martin, Tsui, Maitra, & Marinshaw, 1999; McCauley et al., 1995). Marital status is also associated with intimate partner violence. One previous study showed that intimate partner violence was more severe in cohabiting than dating or married couples (Stets & Straus, 1989), attributing the reason to being that cohabiting couples may be more likely to be isolated from their network of kin than dating and married couples, and thus lack surveillance and monitoring of violent behaviors from family members. Such cohabiting relationships may also lack some features of marriage which serve to constrain the conflict from escalating into the violence such as material, social, and psychological investment in the relationship. Poor body image satisfaction was found to be related to increased risk for physical aggression (Shelton & Liljequist, 2002) and one qualitative study on women with physical impairment found that low body esteem increased vulnerability to intimate partner violence (Hassouneh-Phillips & McNeff, 2005), because they thought they were less worthy and had no alternatives to the current relationship. Recent studies found that the pregnancy-related violence was not uncommon in both Western countries and Hong Kong (Gazmararian et al., 1996; Leung et al., 2002). Young adults who smoked and drank frequently were more likely to experience intimate partner violence (Roberts, Lawrence, Williams, & Raphael, 1998; Vest, Catlin, Chen, & Brownson, 2002; Xu et al., 2005). In addition, drug use has also been a strong predictor of intimate partner violence (McCauley et al., 1995). Meanwhile, previous studies have also indicated that intimate partner violence has serious health consequences. Abused women have reported increased physical health problems, mental health problems, as well as fear of the violent partner (Campbell, 2002; Cascardi, O’Leary, & Schlee, 1999; Golding, 1999; Tollestrup et al., 1999; Wisner, Gilmer, Saltzman, & Zink, 1999). Gender difference in intimate partner violence has been intensively debated among researchers and practitioners in recent years. The focus of mainstream studies has been to support a gender asymmetry dynamic (Kimmel, 2002; Melton & Belknap, 2003; Tjaden & Thoennes, 2000). To be specific, men are more likely to be the perpetrator and women are the victims of intimate partner violence, especially in the form of control-motivated
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violence. This argument is consistent with the higher proportion of medical care for domestic violence injuries required by women than do men (Stets & Straus, 1990). However, more than 200 studies have found that women and men are equally likely to report that they had been victimized by domestic violence in previous 12 months (Archer, 2000; Fiebert, 2004), especially among young and unmarried couples. For instance, 4.2% of men and women reported that they have experienced physical violence by partners during the previous 12 months in Great Britain (Tendler, 1999), and activists for men’s right argued that men are the victims of intimate partner violence at least as often as women (Brott, 1994). What is unknown is how these features may play out in the Hong Kong Chinese context. Despite an increasing literature capturing some of the recent complexity of intimate partner violence in developed countries, there are few populationbased studies on this topic in the Chinese context. Based on a representative household survey of young adults aged 18 to 27 years residing in Hong Kong, the current study has threefold purposes: first, to estimate the prevalence of intimate partner violence among young adults in Hong Kong; second, to examine the risk factors for intimate partner violence; third, to investigate the associations between intimate partner violence and physical and mental health problems.
Methods Design and Participants This study was based on the data from the Youth Sexuality Study (YSS) conducted by the Family Planning Association of Hong Kong (FPAHK) from September to December in 2011. YSS is the longest-running, communitybased household survey of youth sexuality in Hong Kong, which has been carried out every 5 years since 1981. It assesses youth’s sexuality, intimate partner violence, and physical and mental health. The Hong Kong Census and Statistic Department (HKCSD) provided a systemically selected, random sample of 11,518 living quarters. A total of 9,654 households were successfully contacted, with 13.7% with youths aged 18 to 27 years. If the household had youths in the required age group, the fieldworker would ask whether the youths were available or not to undertake the survey. If the household had youths but were not present then they revisited. If only one youth was present, then they asked the youth to participate in the interview. If more than one youth was present, then they used the nearest birthday method to recruit the respondent. Finally, 1,223 participants (625 males and 598 females) completed the survey, yielding a response rate of 80%.
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Participants were identified and invited to participate in the survey by the experienced fieldworkers. A pilot survey (N = 40) was conducted in September 2011 to test the flow of the questionnaire. The questionnaire was then revised before fieldwork adoption. If there were eligible respondents, face-to-face interviews were conducted unless the respondents requested to do the questionnaires by themselves. The questionnaires were anonymous and confidentiality was emphasized. The fieldworkers recorded contact results to assess response rate. If the respondents could not be contacted, a maximum of five revisits were attempted before being classified as unsuccessful. The fieldwork was completed in December 2011.
Measures The standardized questionnaire collected information on participant’s age, gender, education, employment status (student, unemployment or housewife, full-time job); marital status (single, cohabited, married, or others); and total number of sexual partners in the past 6 months (coded as zero, one, or more than one). Prevalence of violence by current or former intimate partner was assessed by timing (lifetime and past 12 months) and type (physical, psychological, and sexual abuse), as operationalized in the well-validated Chinese Abuse Assessment Screen (Tiwari et al., 2007). Physical abuse was operationalized in the questionnaire as the following 10 items: throwing things, pushing, slapping, dragging, hitting, threatening with a weapon, beating, kicking, choking, and burning. Psychological abuse was assessed with 10 items: insults or make one feel bad, belittling or humiliating in front of other people, insulting your appearance and/or behavior, watching you, doing things to scare the respondent on purpose, threatening to hurt the respondent, threatening to hurt someone she or he cares about, criticizing you, and destroying your belongings. Sexual abuse was assessed with 3 items: using physical force to have sexual intercourse when the respondent did not want to, ignoring contraceptive use when this had been requested by the respondent, and insisting on oral or anal sex against the respondents’ wishes. Physical appearance satisfaction was measured with one global item on the subjective evaluation of physical appearance with responses ranging from (1) very dissatisfied, (2) dissatisfied, (3) fair, (4) satisfied, (5) very satisfied, (6) don’t care. Those who reported “1,” “2,” and “3” were classified as “dissatisfied group,” and “4” and “5” as “satisfied group.” Due to the small number of response “6,” it was deleted in the analysis.
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Smoking. The respondents were asked to choose one of eight statements to indicate their smoking status: (1) I have never smoked, (2) I have smoked once but don’t smoke now, (3) I smoked everyday once but have quit, (4) I smoke occasionally now, (5) I smoke 1 to 5 cigarettes per day, (6) I smoke 6 to 15 cigarettes per day, (7) I smoke 16 to 25 cigarettes per day, (8) I smoke 26 cigarettes or more per day. Those who reported “1” were classified as “never smokers,” “2” and “3” as “experimental smokers,” and “4” to “8” as “current smokers.” Alcohol use. The respondents were asked to indicate the frequency of alcohol use: (1) never use, (2) used, less than 1 day per week, (3) used, 1 to 2 days per week, (4) used, 3 to 6 days per week, (5) used, every day per week. Those who reported “1” were classified as “never drinking,” “2” and “3” as “occasional drinking,” and “4” to “5” as “frequent drinking”. Drug use. The respondents were asked to indicate whether they had used the following psychotropic substances and inhalants: (1) ketamine, (2) MDMA, (3) methamphetamine, (4) midazolam, (5) marijuana, (6) organic solvent, (7) cough medicine, (8) cocaine, (9) heroin, and (10) others, excluding drugs prescribed by doctors. Those who reported “yes” to any of these drugs were classified as “having used drugs” and those who reported “no” to all were classified as “never having used drugs.” Physical and mental health was measured by the Physical and Mental Component Summary of the standard Short Form 12 Health Survey (SF-12), which has been validated in the Hong Kong Chinese population (Lam, Tse, & Gandek, 2005). Higher scores on the SF-12 reflected better physical and mental health. Fear for the partner. The respondents were asked to indicate whether they felt afraid of the intimate partner who abused them physically, psychologically, or sexually with responses “1 = yes” and “0 = no.”
Data Analysis The analysis was conducted in two parts using SPSS 16.0 software (Chicago, IL: SPSS Inc.). First, descriptive statistics were conducted to provide profiles of the participants, lifetime and preceding 1-year violence. Next, gender differences of these variables were tested using chi-square tests for categorical variables. Second, two multivariate logistic regressions were performed on the sample to identify factors associated with the lifetime and preceding 1-year
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Table 1. Prevalence of the Lifetime and Preceding 1-Year Intimate Partner Violence by Gender. Time
Types
Total Male Female (N = 1,223) (n = 625) (n = 598)
Lifetime violence Physical or mental 105 (8.6%) 58 (9.2%) 47 (7.9%) violence Preceding 1-year Physical violence 11 (0.9%) 5 (0.8%) 6 (1.0%) violence Mental violence 47 (3.8%) 22 (3.5%) 25 (4.1%) Sexual violence 2 (0.2%) 1 (0.1%) 1 (0.1%) Total 60 (4.9%) 28 (4.5%) 32 (5.3%)
F
p
2.21 .33 0.16 0.50 0.00 0.25
.68 .47 .83 .61
violence. These high-risk factors included demographic variables (e.g., age, gender, education, employment status, and marital status), physical appearance satisfaction, multiple sex partners, pregnancy history, smoking, drinking, and drug use. Both odds ratio (OR) and its 95% confidence level interval (CI) were provided, and an alpha level of .05 was set for bivariate comparisons and multivariate analyses.
Results Prevalence As shown in Table 1, the lifetime prevalence of intimate partner violence including physical and mental violence was 8.6% in total, being 9.2% and 7.9% for males and females respectively. The preceding 1-year prevalence of intimate partner violence from the current or former partner was 4.9% in total, and that was 4.5% and 5.3% for males and females respectively. And the prevalence of physical, psychological, and sexual violence by intimate partners was 0.9%, 3.8%, and 0.2% respectively in the past year. However, gender differences were not found for the lifetime intimate partner violence as well as for the preceding 1-year intimate partner violence.
Risk Factors Table 2 and 3 presents the descriptive statistics as well as the logistic regression results of demographic, socioeconomic, and behavioral factors for males and females separately. Older Hong Kong male youths were less likely to be the victims of the preceding 1-year violence (OR = 0.21, p < .01) than those males who were
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Age group 18-22 23-27 Education Secondary or below Vocational training or equivalent University or above Employment Student Unemployment Full-time job Marital status Single Cohabited Married Physical appearance satisfaction Dissatisfied Satisfied
Variables
0.91 [0.27, 3.07]
0.97 [0.15, 6.10] 3.34 [0.92, 12.12]
3.92 [0.68, 22.63] 0.49 [0.11, 2.09]
1.98 [0.34, 11.46] 0.40 [0.04, 3.99]
0.49 [0.18, 1.34]
53.2 20.6 26.2 42.0 7.4 50.6 90.0 4.6 5.4 48.3 51.7
OR (95% CI)
48.1 51.9
Descriptive Statistics (%)
0.16
0.44 0.43
0.12 0.34
0.97 0.06
0.88
Significance
Lifetime Violence
0.99 [0.33, 2.98]
4.65 [0.94, 22.85] 1.56 [0.13, 18.22]
8.14 [1.14, 57.93]* 1.27 [0.25, 6.42]
3.43 [0.57, 20.43] 8.48 [1.82, 39.47]**
0.21 [0.05, 0.84]*
OR (95% CI)
(continued)
0.98
0.05 0.72
0.03 0.76
0.17 0.006
0.02
Significance
Preceding 1-Year Violence
Table 2. Demographic and Socioeconomic Characteristics and Risk Factors for the Lifetime and Preceding 1-Year Violence for Males (n = 628).
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Note. OR = odds ratio. *p < .05. **p < .01.
Multiple sexual partners No Yes Impregnate the current partner No Yes Smoking status Never smoking Occasional smoking Current smoking Drinking status Never drinking Occasional drinking Frequent drinking Drug use No Yes
Variables
Table 2. (continued)
1.19 [0.35, 4.01]
2.77 [0.75, 10.17]
— 1.40 [0.45, 4.32]
3.63 [0.69, 19.05] 9.08 [0.44, 185.41]
1.26 [0.21, 7.47]
93.1 6.9 68.2 7.7 24.2 31.5 66.4 2.1 96.9 3.1
OR (95% CI)
80.3 19.7
Descriptive Statistics (%)
0.80
0.13 0.15
— 0.56
0.12
0.77
Significance
Lifetime Violence
2.12 [0.34, 12.96]
2.19 [0.39, 12.28] 8.67 [0.61, 125.34]
0.36 [0.03, 4.51] 1.26 [0.35, 4.47]
1.23 [0.24, 6.20]
3.20 [0.89, 11.49]
OR (95% CI)
0.41
0.37 0.06
0.43 0.72
0.80
0.07
Significance
Preceding 1-Year Violence
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Age group 18-22 23-27 Education Secondary or below Vocational training or equivalent University or above Employment Student Unemployment or housewife Full-time job Marital status Single Cohabited Married Physical appearance satisfaction Dissatisfied Satisfied
Variables
5.25 [0.96, 28.71]
0.56 [0.10, 3.01] 0.70 [0.18, 2.77]
0.10 [0.01, 1.02] 0.15 [0.02, 0.85]*
1.08 [0.24, 4.84] 0.44 [0.07, 2.63]
0.48 [0.17, 1.34]
48.8 24.8 26.4 42.2 10.5 47.3 83.2 6.2 10.6 52.9 47.1
OR (95% CI)
49.6 50.4
Descriptive Statistics (%)
0.16
0.92 0.37
0.05 0.03
0.50 0.61
0.05
Significance
Lifetime Violence
0.37 [0.13, 1.05]
1.45 [0.31, 6.75] 0.24 [0.03, 1.96]
1.45 [0.17, 12.43] 0.67 [0.14, 3.31]
0.83 [0.19, 3.56] 0.86 [0.22, 3.39]
0.57 [0.14, 2.36]
OR (95% CI)
(continued)
0.06
0.63 0.18
0.73 0.62
0.81 0.83
0.44
Significance
Preceding 1-Year Violence
Table 3. Demographic and Socioeconomic Characteristics and Risk Factors for the Lifetime and Preceding 1-Year Violence for Females (n = 595).
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Descriptive Statistics (%)
Note. OR = odds ratio. *p < .05.
Multiple sexual partners No 94.8 Yes 5.2 Pregnancy history with the current partner No 89.7 Yes 10.3 Smoking status Never smoking 83.4 Occasional smoking 7.6 Current smoking 9.0 Drinking status Never drinking 43.6 55.5 Occasional drinking Frequent drinking 0.8 Drug use No 97.6 Yes 2.4
Variables
Table 3. (continued)
0.72
0.03
0.27 0.19
0.76 0.06
0.62
5.00 [1.10, 22.60]*
0.30 [0.03, 2.62] 0.26 [0.03, 1.95]
0.84 [0.29, 2.42] 23.91 [0.92, 618.93]
1.78 [0.17, 18.29]
Significance
1.47 [0.16, 13.32]
OR (95% CI)
Lifetime Violence
4.59 [0.48, 43.97]
1.80 [0.59, 5.46] 3.28 [0.08, 132.40]
0.28 [0.03, 2.44] 0.24 [0.04, 1.46]
5.63 [1.20, 26.41]*
1.55 [0.18, 13.12]
OR (95% CI)
0.18
0.30 0.53
0.25 0.12
0.02
0.68
Significance
Preceding 1-Year Violence
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younger. Male youths who had a university degree were more likely to be the victims of the preceding 1-year intimate partner violence (OR = 8.48, p < .01) than those receiving a secondary or lower education. And it was also found that male youths who were unemployed were more likely to be the victims of past-year intimate partner violence (OR = 8.14, p < .05) than those who were students. However, similar demographic protective factors were not found for the lifetime intimate partner violence. Male youths who drank frequently were more likely to experience the past-year violence than those who never drank (OR = 8.67); however, this association was marginally significant. Female youths who had a full-time job were less likely to be the victims of lifetime violence than those who were students (OR = 0.15, p < .05). And female youths who had ever been pregnant to current partner were more likely to experience the lifetime and preceding 1-year violence than those who had never pregnant (OR = 5.00 and 5.63 respectively, p < .05). Female youths who were satisfied with their physical appearance were less likely to be the victims of preceding 1-year intimate partner violence than those who were dissatisfied (OR = 0.37); however, this association was only marginally significant.
Associations With Health Problems Table 4 presents the associations between lifetime violence and preceding 1-year violence and health problems, such as physical health, mental health, and fear of the partner. Hong Kong male youths’ victimization of lifetime and preceding 1-year violence was negatively associated with their mental health (β1 = −0.22, p < .001 and β2 = −0.10, p < .05); however, the associations were not found between lifetime violence and physical health and fear of the intimate partner, as well as for the preceding 1-year violence. Hong Kong female youths’ victimization of lifetime and preceding 1-year violence was negatively associated with their mental health (β3 = −0.20 and β4 = −0.15 respectively, p < .001). In addition, female youths who reported lifetime and preceding 1-year violence were more likely to report the fear of the partner (OR = 2.91 and 3.17 respectively, p < .05).
Discussion Using a representative community sample of young adults in Hong Kong, this study reports the most updated prevalence of lifetime and preceding 1-year violence to date. It was found that 8.6% of Hong Kong youths experienced the
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Table 4. The Associations Between Intimate Partner Violence and Health by Gender.
Lifetime violence (M) Preceding 1-year violence (M) Lifetime violence (F) Preceding 1-year violence (F)
Physical Health β
Mental Health β
Fear for the Violent Partner OR (95% CI)
−0.02 0.03
−0.22*** −0.10*
2.07 [0.82, 5.22] 2.25 [0.64, 7.89]
−0.04 −0.06
−0.20*** −0.15***
2.91 [1.20, 7.06]* 3.17 [1.14, 8.82]*
Note. Age has been controlled. OR = odds ratio; M = male; F = female. *p < .05. ***p < .001.
lifetime physical or mental violence from a current or former partner in their lives, and 4.9% of them had the experience of physical, mental, or sexual violence in the past year. Although there is no comparable data in the West or in the Chinese context based on a population survey on young adults, these prevalence figures seem lower than those from the household survey on Japanese ever-partnered women with an average age of 35 years. To be specific, the prevalence of lifetime and preceding 1-year physical violence was 12.9% and 3.1% respectively, and that of lifetime and preceding 1-year sexual violence was 6.2% and 1.3% respectively in Japan (Garcia-Moreno et al., 2006). This study has also shown that the past-year prevalence of physical, mental, and sexual violence from an intimate partner was 0.9%, 3.8%, and 0.2% respectively, which is much lower than the findings on Mainland Chinese young women with a prevalence of 4% to 16% physical violence and 1% to 12% sexual violence reported (Xu et al., 2005). It is possible that the lower prevalence of lifetime and past-year intimate partner violence in our sample may be attributable to the use of the household survey with inherent biases and not all young adults surveyed were in a dating relationship. Gender difference in lifetime intimate partner violence is not found as well as in preceding 1-year violence and its components, which supports the gender symmetry hypothesis from an Eastern perspective. One plausible explanation is that our survey targets on young adults, and the relatively small sample size of subject involved in intimate partner violence may exerts an effect on gender symmetry in intimate partner violence as in some previous studies (Archer, 2000; Fiebert, 2004). Another explanation is that men’s reporting of violence used against them may be actually the violence defended by women (Kimmel, 2002), which can further be echoed by the finding in
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this study that men do not fear the person who perpetrated violence on them as women do. In addition, the measurement of intimate partner violence in this study focuses on the violence itself, which fails to capture to the motivation and initiation of violence and desire to control, thus improving the frequency of men as victims. Our study indicates that being an older male was predictive of being less likely to experience preceding 1-year violence, which is consistent with previous findings that younger couples are most likely to have the highest rates of violence (O’Leary, 1999). Moreover, male youths with a university degree were more likely to be the victims of intimate partner violence. Some studies have shown that high educational attainment of men was associated with low level of perpetrating violence (Okun, 1986). With reference to our finding, it is speculated that better educated men may resort to problem solving in couple conflict; however, they may suffer from a higher incidence of mental violence from the partner or they may be more sensitized to violence. Being unemployed was a risk factor for male youths’ past-year intimate partner violence. Previous studies have found that low socioeconomic status were associated with increased intimate partner violence (Cunradi, Caetano, & Schafer, 2002; Field & Caetano, 2004). In traditional Chinese culture, men commonly expected to be the breadwinner in the family (Shek, 2006). When a man is employed, it means he has fulfilled the cultural aspirations ascribed to him, so he is less likely to experience the physical or mental violence from the partner. Our study finds that female youths with a full-time job were less likely to experience lifetime intimate partner violence, which is consistent with the previous findings (Martin et al., 1999). Hong Kong females with paid work may improve the couple’s financial well-being and independence of men, thus decreasing the economic burden and associated dyadic conflict on the partner. Pregnancy history with the current partner was a risk factor for both lifetime and preceding 1-year violence. One explanation is that the male partner perceived that the pregnancy of his female partner had occurred sooner than intended (Glander, Moore, Michielutte, & Parsons, 1998; Wiemann, Agurcia, Berenson, Volk, & Rickert, 2000) and violence was a reaction to this. Considering the majority of single youths in our sample, another explanation is that the male partner has little family or institutional support and this internalizes a high level of associated stress (Jasinski, 2004). However, the casual relationship between pregnancy history and intimate partner violence should be established cautiously because of the cross-sectional design in this study. Cohabiting with the partner, multiple sex partners, and frequent drinking on the part of male youths were all associated with increased risk of preceding 1-year violence. Furthermore, female youths’ satisfaction with their body image was associated with decreased risk of past year violence, although
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it did not reach the statistically significant level. In contrast to previous studies, smoking and drug use are not associated with any lifetime or preceding 1-year intimate partner violence for both male and female youths. Further investigation of this association in Hong Kong–based studies should be explored. Finally, our study has indicated that both lifetime and preceding 1-year intimate violence were negatively associated with female youths’ mental health and were positively associated with their fear of the intimate partner, rather than the physical health, which may be attributed to the small cases of physical violence victimization or less severe physical assault from the male partner. However, male youths were not affected by two types of violence except for the mental health, suggesting that female victims of intimate partner violence are more likely to be subjected to severe negative consequences than male youths. As described above, the possible reason is that male’s reports of intimate partner violence victimization may be the violence from women in self-defense and this fails to acknowledge who the actual perpetrator of violence was (Kimmel, 2002). Therefore, the male youths’ experience is not associated with physical health problems and fear for the partner. There are several limitations that should be noted in this study: First, the measurement of lifetime intimate partner violence does not differentiate physical and mental violence separately, and sexual violence is not included in the lifetime measurement. Furthermore, the frequency and level of severity of preceding 1-year violence are omitted, which should be added to the next round of household survey on young adults in Hong Kong. Second, the research design of this study is cross-sectional, which makes causality difficult to infer from the present findings and the vice versa is also possible. For example, females who ever suffered from sexual violence may feel dissatisfied with their body image, including physical appearance. And the victims of intimate partner violence are more likely to engage in risky behaviors, such as cigarette smoking, alcohol drinking, and drug use as previous studies show (Jun, Rich-Edwards, Boynton-Jarrett, & Wright, 2008). Finally, the reliability of self-reported data may be subjected to social desirability and recall biases, which might underestimate the prevalence of intimate partner violence. It is suggested that data from the intimate partner might verify the current findings in future studies.
Conclusion Based on a representative community sample of 1,223 young adults, this study has informed our understanding of intimate partner violence in Hong
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Kong in several ways: First, this study has provided the most updated epidemiological evidence of intimate partner violence among Hong Kong young adults. Second, multiple variables including higher education and being unemployed were risk factors of past-year intimate partner violence for male youths and being pregnant was a risk factor for female youths. Third, this study has also mental health implications for the victims of intimate partner violence. Mental health service professionals who assess and treat the victims of intimate partner violence may need to pay special attention to female youths, as these youths may face more severe mental health problems. Acknowledgments The authors are grateful to the members of the Research Subcommittee of the Family Planning Association for their advice on the survey and the funding from the Department of Health to conduct the survey. We also appreciate the useful suggestions from the reviewers.
Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) declared receipt of the following financial support for the research, authorship, and/or publication of this article: The research is supported by the Department of Health of the Hong Kong Special Administrative Region and the Family Planning Association of Hong Kong.
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Lam, C. L. K., Tse, E. Y. Y., & Gandek, B. (2005). Is the standard SF-12 health survey valid and equivalent for a Chinese population? Quality of Life Research, 14, 539-547. Leung, W. C., Tiwari, A. F. Y., Leung, T. W., & Ho, P. C. (2002). Should we routinely scree pregnant women for domestic violence in Hong Kong? Journal of Gynaecology, Obsterics and Midwifery, 2, 96-100. Martin, S. L., Tsui, A. O., Maitra, K., & Marinshaw, R. (1999). Domestic violence in northern India. American Journal of Epidemiology, 150, 417-426. Melton, H.C., & Belknap, J. (2003). He hits, She hits: Assessing gender differences and similarities in officially reported intimate partner violence. Criminal Justice & Behavior, 30, 328-348. McCauley, J., Kern, D. E., Kolodner, K., Schroeder, A. F., DeChant, H. K., Ryden, J., . . .Derogatis, L. R. (1995). The “Battering syndrome”: Prevalence and clinical symptoms of domestic violence in primary care internal medicine practices. Annals of Internal Medicine, 123, 737-746. Okun, L. W. (1986). Women abuse: Facts replacing myths. Albany: State University of New York. O’Leary, K. D. (1999). Developmental and affective issues in assessing and treating partner aggression. Clinical Psychology: Science and Practice, 6, 400-441. Plichta, S. B. (1996). Violence, health and use of health services. In M. M. Falik & K. S. Collins (Eds.), Women’s health and care seeking behavior: The commonwealth fund survey (pp. 237-270). Baltimore, MD: Johns Hopkins University Press. Roberts, G. L., Lawrence, J. M., Williams, G. M., & Raphael, B. (1998). The impact of domestic violence on women’s mental health. Australian and New Zealand Journal of Public Health, 22, 796-801. Schafer, J., Caetano, R., & Cook, C. L. (1998). Rates of intimate partner violence in the United States. American Journal of Public Health, 88, 1702-1704. Schulman, M. A. (1979). A survey of spouse violence against women in Kentucky. Washington, DC: US Department of Justice. Shek, D. T. L. (2006). Chinese family research: Puzzles, progress, paradigms, and policy implications. Journal of Family Issues, 27, 275-284. Shelton, S., & Liljequist, L. (2002). Characteristics and behaviors associated with body image in male domestic violence offenders. Eating Behavior, 3, 217-227. Stets, J. E., & Straus, M. A. (1989). The marriage license as a hitting license: A comparison of assaults in dating, cohabiting and married couples. Journal of Family Violence, 4, 161-180. Stets, J. E., & Straus, M. A. (1990). Gender differences in reporting marital violence and its medical and psychological consequences. In M. A. Straus & R. J. Gelles (Eds.), Physical violence in American families (pp. 151-165). New Brunswick, NJ: Transaction. Straus, M. A. (2004). Prevalence of violence against dating partners by male and female university students worldwide. Violence Against Women, 10, 790-811.
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Straus, M. A., & Gelles, R. J. (1986). Societal change and change in family violence from 1975 to 1985 as revealed by two national surveys. Journal of Marriage and Family, 48, 465-479. Sugarman, D. B., & Hotalling, G. T. (1989). Dating violence: Prevalence, context, and risk markers. In A. A. Pirog-Good & J. E. Stets (Eds.), Violence in dating relationships: Emerging social issues (pp. 3-31). New York, NY: Praeger. Tendler, S. (1999, January 22). Men suffer equally from violence in the home. London Times, p. 23. Teske, R., & Parker, M. (1983). Spouse abuse in Texas: A study of women’s attitudes and experiences. Houston, TX: Criminal Justice Center, Sam Houston State University. Tiwari, A., Fong, D. Y. T., Chan, K. L., Leung, W. C., Parker, B., & Ho, P. C. (2007). Identifying intimate partner violence: Comparing the Chinese abuse assessment screen with the Chinese revised conflict tactics scales. BJOG: International Journal of Obstetrics and Gynaecology, 114, 1065-1071. Tjaden, P., & Thoennes, N. (2000). Prevalence and consequences of male to female and female to male intimate partner violence as measured by the National Violence Against Women Survey. Violence Against Women, 6, 142-161. Tollestrup, K., Sklar, D., Frost, F. J., Olson, L., Weybright, J., Sandvig, J., & Larson, M. (1999). Health indicators of a managed care organization. Preventive Medicine, 29, 431-440. Vest, J. R., Catlin, T. K., Chen, J. J., & Brownson, R. C. (2002). Multistate analysis of factors associated with intimate partner violence. American Journal of Preventive Medicine, 22, 156-164. Wiemann, C. M., Agurcia, C. A., Berenson, A. B., Volk, R. J., & Rickert, V. I. (2000). Pregnant adolescents: Experiences and behaviors associated with physically assault by an intimate partner. Maternal and Child Health Journal, 4(2), 93-101. Wisner, C. L., Gilmer, T. P., Saltzman, L. E., & Zink, T. M. (1999). Intimate partner violence against women: Do victims cost health plans more? Journal of Family Practice, 48, 439-443. Xu, X., Zhu, F., O’Campo, P., Koenig, M. A., Mock, V., & Campbell, H. (2005). Prevalence of and risk factors for intimate partner violence in China. American Journal of Public Health, 95, 78-85.
Author Biographies Huiping Zhang is an associate professor of family study at Renmin University. She received a PhD in family study at the University of Hong Kong. Her research focuses on women’s socioeconomic status and marital relationship. Her research interests include gender study and public health. William C. W. Wong is an associate professor of family medicine at the University of Hong Kong. He received a MD from University of Edinburgh. His research focuses on sexual and reproductive health including HIV, and health equity in marginalized groups such as sex workers and migrants.
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Patrick Ip is an associate professor of pediatrics and adolescent medicine at the University of Hong Kong. His research covers community pediatrics including the dimension of early brain development, child mental health, violence and adolescent health. Susan Fan is the executive director of the Family Planning Association of Hong Kong. She graduated from the Medical Faculty of the University of Hong Kong. She serves on numerous government advisory bodies and non-government organizations and also contributes to clinical teaching as honorary clinical associate professor in the University of Hong Kong. Paul S. F. Yip is a professor at the Department of Social Work and Social Administration of the University of Hong Kong. He received a PhD in statistics from La Trobe University. He is also the director of Center for Suicide Research and Prevention and the chair of the Research Committee of the Family Planning Association of Hong Kong. His research interest include population health, suicide prevention, demography, and mental health.
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JIVXXX10.1177/0886260514552442Journal of Interpersonal ViolenceZhang et al.
Article
Intimate Partner Violence Among Hong Kong Young Adults: Prevalence, Risk Factors, and Associated Health Problems
Journal of Interpersonal Violence 2015, Vol. 30(13) 2258–2277 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0886260514552442 jiv.sagepub.com
Huiping Zhang, PhD,1 William C. W. Wong, MD,2 Patrick Ip, FRCPCH,2 Susan Fan, MBBS,3 and Paul S. F. Yip, PhD2
Abstract Intimate partner violence is a serious social problem and public health issue affecting the well-being of the young adults. However, there is very little epidemiological evidence on the incidence and associated health problems in contemporary Chinese society. Using a representative community sample of 1,223 young adults aged 18 to 27 years conducted by Hong Kong Family Planning Association in 2011, this study aimed to estimate the prevalence, risk factors, and possible health consequences of intimate partner violence among young adults in Hong Kong. It is found that the prevalence of lifetime and preceding 1-year intimate partner violence by former or current partners was 8.6% and 4.9% respectively. Male youths who were older were less likely to experience past-year intimate partner violence (odds ratio [OR] = 0.21, p < .05) and those who had a university degree or were unemployed 1Renmin
University of China, Beijing University of Hong Kong, Pokfulam 3Family Planning Association of Hong Kong, Wan Chai 2The
Corresponding Author: Paul S. F. Yip, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong. Email: [email protected]
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were more likely to experience past-year intimate partner violence (OR = 8.48, p < .01 and OR = 8.14, p < .05 respectively). Female youths who had a full-time job were less likely to experience the lifetime violence (OR = 0.15, p < .05) and those who were ever pregnant with current partner were more likely to experience both lifetime intimate partner violence (OR = 5.00, p < .05) and past-year violence (OR = 5.63, p < .05). Both female and male victims were more likely to be subjected to mental health problems and only female victims felt fear for the violent partner. Keywords intimate partner violence, young adults, Hong Kong, health
Introduction Intimate partner violence is characterized by any behavior within an intimate relationship that causes physical, psychological, or sexual harm to those in the relationship (Krug, Dahlberg, Mercy, & Zwi, 2002). Such behaviors range from physical aggression, psychological abuse, forced sexual intercourse, and other forms of sexual coercion, to various controlling behaviors. Surveys in the United States showed that the populationbased prevalence of intimate partner violence by a spouse, boyfriend/ girlfriend, or ex-partner was 8% to 12% occurring in the previous year (Plichta, 1996; Schulman, 1979; Straus & Gelles, 1986; Teske & Parker, 1983), and 18% to 35% in the lifetime (Center for Disease Control and Prevention [CDCP], 1998, 2000a, 2000b; Klein, Campbell, Soler, & Chez, 1997; Schafer, Caetano, & Cook, 1998). A recent population-based household survey on women in 10 countries by World Health organization (WHO) showed that lifetime prevalence of physical or sexual partner violence or both varied from 15% to 71%, and the preceding 1-year prevalence of that ranged from 4% to 54% (Garcia-Moreno, Jansen, Ellsber, Heise, & Watts, 2006). Hospital-based studies in China reported a 26% prevalence of preceding 1-year violence, with a 43% prevalence of lifetime violence against women (Xu et al., 2005). Regarding the young adults, most studies have been conducted among the college dating students, and the prevalence of preceding 1-year physical violence ranged from 20% to 40% in Canada and U.S. universities (Sugarman & Hotalling, 1989). A recent survey of 31 universities in multicountries indicated that 17% to 45% of the college students in dating relationship reported a physical assault from a partner in the previous 12 months and Hong Kong college students in this study reported a 28.6% prevalence of physical violence from the dating partner (Straus,
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2004). It is quite common to find that the prevalence rate of intimate partner violence is high when measured by Conflict Tactics Scale and Abuse Assessment Screen (Tiwari et al., 2007). Multiple factors including demographic, socioeconomic, behavioral, and cultural factors have been identified to be associated with intimate partner violence. For example, younger age, lower education level, and unemployment have been associated with an increased risk of intimate partner violence across studies (Aldarondo & Sugarman, 1996; Martin, Tsui, Maitra, & Marinshaw, 1999; McCauley et al., 1995). Marital status is also associated with intimate partner violence. One previous study showed that intimate partner violence was more severe in cohabiting than dating or married couples (Stets & Straus, 1989), attributing the reason to being that cohabiting couples may be more likely to be isolated from their network of kin than dating and married couples, and thus lack surveillance and monitoring of violent behaviors from family members. Such cohabiting relationships may also lack some features of marriage which serve to constrain the conflict from escalating into the violence such as material, social, and psychological investment in the relationship. Poor body image satisfaction was found to be related to increased risk for physical aggression (Shelton & Liljequist, 2002) and one qualitative study on women with physical impairment found that low body esteem increased vulnerability to intimate partner violence (Hassouneh-Phillips & McNeff, 2005), because they thought they were less worthy and had no alternatives to the current relationship. Recent studies found that the pregnancy-related violence was not uncommon in both Western countries and Hong Kong (Gazmararian et al., 1996; Leung et al., 2002). Young adults who smoked and drank frequently were more likely to experience intimate partner violence (Roberts, Lawrence, Williams, & Raphael, 1998; Vest, Catlin, Chen, & Brownson, 2002; Xu et al., 2005). In addition, drug use has also been a strong predictor of intimate partner violence (McCauley et al., 1995). Meanwhile, previous studies have also indicated that intimate partner violence has serious health consequences. Abused women have reported increased physical health problems, mental health problems, as well as fear of the violent partner (Campbell, 2002; Cascardi, O’Leary, & Schlee, 1999; Golding, 1999; Tollestrup et al., 1999; Wisner, Gilmer, Saltzman, & Zink, 1999). Gender difference in intimate partner violence has been intensively debated among researchers and practitioners in recent years. The focus of mainstream studies has been to support a gender asymmetry dynamic (Kimmel, 2002; Melton & Belknap, 2003; Tjaden & Thoennes, 2000). To be specific, men are more likely to be the perpetrator and women are the victims of intimate partner violence, especially in the form of control-motivated
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violence. This argument is consistent with the higher proportion of medical care for domestic violence injuries required by women than do men (Stets & Straus, 1990). However, more than 200 studies have found that women and men are equally likely to report that they had been victimized by domestic violence in previous 12 months (Archer, 2000; Fiebert, 2004), especially among young and unmarried couples. For instance, 4.2% of men and women reported that they have experienced physical violence by partners during the previous 12 months in Great Britain (Tendler, 1999), and activists for men’s right argued that men are the victims of intimate partner violence at least as often as women (Brott, 1994). What is unknown is how these features may play out in the Hong Kong Chinese context. Despite an increasing literature capturing some of the recent complexity of intimate partner violence in developed countries, there are few populationbased studies on this topic in the Chinese context. Based on a representative household survey of young adults aged 18 to 27 years residing in Hong Kong, the current study has threefold purposes: first, to estimate the prevalence of intimate partner violence among young adults in Hong Kong; second, to examine the risk factors for intimate partner violence; third, to investigate the associations between intimate partner violence and physical and mental health problems.
Methods Design and Participants This study was based on the data from the Youth Sexuality Study (YSS) conducted by the Family Planning Association of Hong Kong (FPAHK) from September to December in 2011. YSS is the longest-running, communitybased household survey of youth sexuality in Hong Kong, which has been carried out every 5 years since 1981. It assesses youth’s sexuality, intimate partner violence, and physical and mental health. The Hong Kong Census and Statistic Department (HKCSD) provided a systemically selected, random sample of 11,518 living quarters. A total of 9,654 households were successfully contacted, with 13.7% with youths aged 18 to 27 years. If the household had youths in the required age group, the fieldworker would ask whether the youths were available or not to undertake the survey. If the household had youths but were not present then they revisited. If only one youth was present, then they asked the youth to participate in the interview. If more than one youth was present, then they used the nearest birthday method to recruit the respondent. Finally, 1,223 participants (625 males and 598 females) completed the survey, yielding a response rate of 80%.
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Participants were identified and invited to participate in the survey by the experienced fieldworkers. A pilot survey (N = 40) was conducted in September 2011 to test the flow of the questionnaire. The questionnaire was then revised before fieldwork adoption. If there were eligible respondents, face-to-face interviews were conducted unless the respondents requested to do the questionnaires by themselves. The questionnaires were anonymous and confidentiality was emphasized. The fieldworkers recorded contact results to assess response rate. If the respondents could not be contacted, a maximum of five revisits were attempted before being classified as unsuccessful. The fieldwork was completed in December 2011.
Measures The standardized questionnaire collected information on participant’s age, gender, education, employment status (student, unemployment or housewife, full-time job); marital status (single, cohabited, married, or others); and total number of sexual partners in the past 6 months (coded as zero, one, or more than one). Prevalence of violence by current or former intimate partner was assessed by timing (lifetime and past 12 months) and type (physical, psychological, and sexual abuse), as operationalized in the well-validated Chinese Abuse Assessment Screen (Tiwari et al., 2007). Physical abuse was operationalized in the questionnaire as the following 10 items: throwing things, pushing, slapping, dragging, hitting, threatening with a weapon, beating, kicking, choking, and burning. Psychological abuse was assessed with 10 items: insults or make one feel bad, belittling or humiliating in front of other people, insulting your appearance and/or behavior, watching you, doing things to scare the respondent on purpose, threatening to hurt the respondent, threatening to hurt someone she or he cares about, criticizing you, and destroying your belongings. Sexual abuse was assessed with 3 items: using physical force to have sexual intercourse when the respondent did not want to, ignoring contraceptive use when this had been requested by the respondent, and insisting on oral or anal sex against the respondents’ wishes. Physical appearance satisfaction was measured with one global item on the subjective evaluation of physical appearance with responses ranging from (1) very dissatisfied, (2) dissatisfied, (3) fair, (4) satisfied, (5) very satisfied, (6) don’t care. Those who reported “1,” “2,” and “3” were classified as “dissatisfied group,” and “4” and “5” as “satisfied group.” Due to the small number of response “6,” it was deleted in the analysis.
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Smoking. The respondents were asked to choose one of eight statements to indicate their smoking status: (1) I have never smoked, (2) I have smoked once but don’t smoke now, (3) I smoked everyday once but have quit, (4) I smoke occasionally now, (5) I smoke 1 to 5 cigarettes per day, (6) I smoke 6 to 15 cigarettes per day, (7) I smoke 16 to 25 cigarettes per day, (8) I smoke 26 cigarettes or more per day. Those who reported “1” were classified as “never smokers,” “2” and “3” as “experimental smokers,” and “4” to “8” as “current smokers.” Alcohol use. The respondents were asked to indicate the frequency of alcohol use: (1) never use, (2) used, less than 1 day per week, (3) used, 1 to 2 days per week, (4) used, 3 to 6 days per week, (5) used, every day per week. Those who reported “1” were classified as “never drinking,” “2” and “3” as “occasional drinking,” and “4” to “5” as “frequent drinking”. Drug use. The respondents were asked to indicate whether they had used the following psychotropic substances and inhalants: (1) ketamine, (2) MDMA, (3) methamphetamine, (4) midazolam, (5) marijuana, (6) organic solvent, (7) cough medicine, (8) cocaine, (9) heroin, and (10) others, excluding drugs prescribed by doctors. Those who reported “yes” to any of these drugs were classified as “having used drugs” and those who reported “no” to all were classified as “never having used drugs.” Physical and mental health was measured by the Physical and Mental Component Summary of the standard Short Form 12 Health Survey (SF-12), which has been validated in the Hong Kong Chinese population (Lam, Tse, & Gandek, 2005). Higher scores on the SF-12 reflected better physical and mental health. Fear for the partner. The respondents were asked to indicate whether they felt afraid of the intimate partner who abused them physically, psychologically, or sexually with responses “1 = yes” and “0 = no.”
Data Analysis The analysis was conducted in two parts using SPSS 16.0 software (Chicago, IL: SPSS Inc.). First, descriptive statistics were conducted to provide profiles of the participants, lifetime and preceding 1-year violence. Next, gender differences of these variables were tested using chi-square tests for categorical variables. Second, two multivariate logistic regressions were performed on the sample to identify factors associated with the lifetime and preceding 1-year
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Table 1. Prevalence of the Lifetime and Preceding 1-Year Intimate Partner Violence by Gender. Time
Types
Total Male Female (N = 1,223) (n = 625) (n = 598)
Lifetime violence Physical or mental 105 (8.6%) 58 (9.2%) 47 (7.9%) violence Preceding 1-year Physical violence 11 (0.9%) 5 (0.8%) 6 (1.0%) violence Mental violence 47 (3.8%) 22 (3.5%) 25 (4.1%) Sexual violence 2 (0.2%) 1 (0.1%) 1 (0.1%) Total 60 (4.9%) 28 (4.5%) 32 (5.3%)
F
p
2.21 .33 0.16 0.50 0.00 0.25
.68 .47 .83 .61
violence. These high-risk factors included demographic variables (e.g., age, gender, education, employment status, and marital status), physical appearance satisfaction, multiple sex partners, pregnancy history, smoking, drinking, and drug use. Both odds ratio (OR) and its 95% confidence level interval (CI) were provided, and an alpha level of .05 was set for bivariate comparisons and multivariate analyses.
Results Prevalence As shown in Table 1, the lifetime prevalence of intimate partner violence including physical and mental violence was 8.6% in total, being 9.2% and 7.9% for males and females respectively. The preceding 1-year prevalence of intimate partner violence from the current or former partner was 4.9% in total, and that was 4.5% and 5.3% for males and females respectively. And the prevalence of physical, psychological, and sexual violence by intimate partners was 0.9%, 3.8%, and 0.2% respectively in the past year. However, gender differences were not found for the lifetime intimate partner violence as well as for the preceding 1-year intimate partner violence.
Risk Factors Table 2 and 3 presents the descriptive statistics as well as the logistic regression results of demographic, socioeconomic, and behavioral factors for males and females separately. Older Hong Kong male youths were less likely to be the victims of the preceding 1-year violence (OR = 0.21, p < .01) than those males who were
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Age group 18-22 23-27 Education Secondary or below Vocational training or equivalent University or above Employment Student Unemployment Full-time job Marital status Single Cohabited Married Physical appearance satisfaction Dissatisfied Satisfied
Variables
0.91 [0.27, 3.07]
0.97 [0.15, 6.10] 3.34 [0.92, 12.12]
3.92 [0.68, 22.63] 0.49 [0.11, 2.09]
1.98 [0.34, 11.46] 0.40 [0.04, 3.99]
0.49 [0.18, 1.34]
53.2 20.6 26.2 42.0 7.4 50.6 90.0 4.6 5.4 48.3 51.7
OR (95% CI)
48.1 51.9
Descriptive Statistics (%)
0.16
0.44 0.43
0.12 0.34
0.97 0.06
0.88
Significance
Lifetime Violence
0.99 [0.33, 2.98]
4.65 [0.94, 22.85] 1.56 [0.13, 18.22]
8.14 [1.14, 57.93]* 1.27 [0.25, 6.42]
3.43 [0.57, 20.43] 8.48 [1.82, 39.47]**
0.21 [0.05, 0.84]*
OR (95% CI)
(continued)
0.98
0.05 0.72
0.03 0.76
0.17 0.006
0.02
Significance
Preceding 1-Year Violence
Table 2. Demographic and Socioeconomic Characteristics and Risk Factors for the Lifetime and Preceding 1-Year Violence for Males (n = 628).
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Note. OR = odds ratio. *p < .05. **p < .01.
Multiple sexual partners No Yes Impregnate the current partner No Yes Smoking status Never smoking Occasional smoking Current smoking Drinking status Never drinking Occasional drinking Frequent drinking Drug use No Yes
Variables
Table 2. (continued)
1.19 [0.35, 4.01]
2.77 [0.75, 10.17]
— 1.40 [0.45, 4.32]
3.63 [0.69, 19.05] 9.08 [0.44, 185.41]
1.26 [0.21, 7.47]
93.1 6.9 68.2 7.7 24.2 31.5 66.4 2.1 96.9 3.1
OR (95% CI)
80.3 19.7
Descriptive Statistics (%)
0.80
0.13 0.15
— 0.56
0.12
0.77
Significance
Lifetime Violence
2.12 [0.34, 12.96]
2.19 [0.39, 12.28] 8.67 [0.61, 125.34]
0.36 [0.03, 4.51] 1.26 [0.35, 4.47]
1.23 [0.24, 6.20]
3.20 [0.89, 11.49]
OR (95% CI)
0.41
0.37 0.06
0.43 0.72
0.80
0.07
Significance
Preceding 1-Year Violence
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Age group 18-22 23-27 Education Secondary or below Vocational training or equivalent University or above Employment Student Unemployment or housewife Full-time job Marital status Single Cohabited Married Physical appearance satisfaction Dissatisfied Satisfied
Variables
5.25 [0.96, 28.71]
0.56 [0.10, 3.01] 0.70 [0.18, 2.77]
0.10 [0.01, 1.02] 0.15 [0.02, 0.85]*
1.08 [0.24, 4.84] 0.44 [0.07, 2.63]
0.48 [0.17, 1.34]
48.8 24.8 26.4 42.2 10.5 47.3 83.2 6.2 10.6 52.9 47.1
OR (95% CI)
49.6 50.4
Descriptive Statistics (%)
0.16
0.92 0.37
0.05 0.03
0.50 0.61
0.05
Significance
Lifetime Violence
0.37 [0.13, 1.05]
1.45 [0.31, 6.75] 0.24 [0.03, 1.96]
1.45 [0.17, 12.43] 0.67 [0.14, 3.31]
0.83 [0.19, 3.56] 0.86 [0.22, 3.39]
0.57 [0.14, 2.36]
OR (95% CI)
(continued)
0.06
0.63 0.18
0.73 0.62
0.81 0.83
0.44
Significance
Preceding 1-Year Violence
Table 3. Demographic and Socioeconomic Characteristics and Risk Factors for the Lifetime and Preceding 1-Year Violence for Females (n = 595).
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Descriptive Statistics (%)
Note. OR = odds ratio. *p < .05.
Multiple sexual partners No 94.8 Yes 5.2 Pregnancy history with the current partner No 89.7 Yes 10.3 Smoking status Never smoking 83.4 Occasional smoking 7.6 Current smoking 9.0 Drinking status Never drinking 43.6 55.5 Occasional drinking Frequent drinking 0.8 Drug use No 97.6 Yes 2.4
Variables
Table 3. (continued)
0.72
0.03
0.27 0.19
0.76 0.06
0.62
5.00 [1.10, 22.60]*
0.30 [0.03, 2.62] 0.26 [0.03, 1.95]
0.84 [0.29, 2.42] 23.91 [0.92, 618.93]
1.78 [0.17, 18.29]
Significance
1.47 [0.16, 13.32]
OR (95% CI)
Lifetime Violence
4.59 [0.48, 43.97]
1.80 [0.59, 5.46] 3.28 [0.08, 132.40]
0.28 [0.03, 2.44] 0.24 [0.04, 1.46]
5.63 [1.20, 26.41]*
1.55 [0.18, 13.12]
OR (95% CI)
0.18
0.30 0.53
0.25 0.12
0.02
0.68
Significance
Preceding 1-Year Violence
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younger. Male youths who had a university degree were more likely to be the victims of the preceding 1-year intimate partner violence (OR = 8.48, p < .01) than those receiving a secondary or lower education. And it was also found that male youths who were unemployed were more likely to be the victims of past-year intimate partner violence (OR = 8.14, p < .05) than those who were students. However, similar demographic protective factors were not found for the lifetime intimate partner violence. Male youths who drank frequently were more likely to experience the past-year violence than those who never drank (OR = 8.67); however, this association was marginally significant. Female youths who had a full-time job were less likely to be the victims of lifetime violence than those who were students (OR = 0.15, p < .05). And female youths who had ever been pregnant to current partner were more likely to experience the lifetime and preceding 1-year violence than those who had never pregnant (OR = 5.00 and 5.63 respectively, p < .05). Female youths who were satisfied with their physical appearance were less likely to be the victims of preceding 1-year intimate partner violence than those who were dissatisfied (OR = 0.37); however, this association was only marginally significant.
Associations With Health Problems Table 4 presents the associations between lifetime violence and preceding 1-year violence and health problems, such as physical health, mental health, and fear of the partner. Hong Kong male youths’ victimization of lifetime and preceding 1-year violence was negatively associated with their mental health (β1 = −0.22, p < .001 and β2 = −0.10, p < .05); however, the associations were not found between lifetime violence and physical health and fear of the intimate partner, as well as for the preceding 1-year violence. Hong Kong female youths’ victimization of lifetime and preceding 1-year violence was negatively associated with their mental health (β3 = −0.20 and β4 = −0.15 respectively, p < .001). In addition, female youths who reported lifetime and preceding 1-year violence were more likely to report the fear of the partner (OR = 2.91 and 3.17 respectively, p < .05).
Discussion Using a representative community sample of young adults in Hong Kong, this study reports the most updated prevalence of lifetime and preceding 1-year violence to date. It was found that 8.6% of Hong Kong youths experienced the
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Table 4. The Associations Between Intimate Partner Violence and Health by Gender.
Lifetime violence (M) Preceding 1-year violence (M) Lifetime violence (F) Preceding 1-year violence (F)
Physical Health β
Mental Health β
Fear for the Violent Partner OR (95% CI)
−0.02 0.03
−0.22*** −0.10*
2.07 [0.82, 5.22] 2.25 [0.64, 7.89]
−0.04 −0.06
−0.20*** −0.15***
2.91 [1.20, 7.06]* 3.17 [1.14, 8.82]*
Note. Age has been controlled. OR = odds ratio; M = male; F = female. *p < .05. ***p < .001.
lifetime physical or mental violence from a current or former partner in their lives, and 4.9% of them had the experience of physical, mental, or sexual violence in the past year. Although there is no comparable data in the West or in the Chinese context based on a population survey on young adults, these prevalence figures seem lower than those from the household survey on Japanese ever-partnered women with an average age of 35 years. To be specific, the prevalence of lifetime and preceding 1-year physical violence was 12.9% and 3.1% respectively, and that of lifetime and preceding 1-year sexual violence was 6.2% and 1.3% respectively in Japan (Garcia-Moreno et al., 2006). This study has also shown that the past-year prevalence of physical, mental, and sexual violence from an intimate partner was 0.9%, 3.8%, and 0.2% respectively, which is much lower than the findings on Mainland Chinese young women with a prevalence of 4% to 16% physical violence and 1% to 12% sexual violence reported (Xu et al., 2005). It is possible that the lower prevalence of lifetime and past-year intimate partner violence in our sample may be attributable to the use of the household survey with inherent biases and not all young adults surveyed were in a dating relationship. Gender difference in lifetime intimate partner violence is not found as well as in preceding 1-year violence and its components, which supports the gender symmetry hypothesis from an Eastern perspective. One plausible explanation is that our survey targets on young adults, and the relatively small sample size of subject involved in intimate partner violence may exerts an effect on gender symmetry in intimate partner violence as in some previous studies (Archer, 2000; Fiebert, 2004). Another explanation is that men’s reporting of violence used against them may be actually the violence defended by women (Kimmel, 2002), which can further be echoed by the finding in
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this study that men do not fear the person who perpetrated violence on them as women do. In addition, the measurement of intimate partner violence in this study focuses on the violence itself, which fails to capture to the motivation and initiation of violence and desire to control, thus improving the frequency of men as victims. Our study indicates that being an older male was predictive of being less likely to experience preceding 1-year violence, which is consistent with previous findings that younger couples are most likely to have the highest rates of violence (O’Leary, 1999). Moreover, male youths with a university degree were more likely to be the victims of intimate partner violence. Some studies have shown that high educational attainment of men was associated with low level of perpetrating violence (Okun, 1986). With reference to our finding, it is speculated that better educated men may resort to problem solving in couple conflict; however, they may suffer from a higher incidence of mental violence from the partner or they may be more sensitized to violence. Being unemployed was a risk factor for male youths’ past-year intimate partner violence. Previous studies have found that low socioeconomic status were associated with increased intimate partner violence (Cunradi, Caetano, & Schafer, 2002; Field & Caetano, 2004). In traditional Chinese culture, men commonly expected to be the breadwinner in the family (Shek, 2006). When a man is employed, it means he has fulfilled the cultural aspirations ascribed to him, so he is less likely to experience the physical or mental violence from the partner. Our study finds that female youths with a full-time job were less likely to experience lifetime intimate partner violence, which is consistent with the previous findings (Martin et al., 1999). Hong Kong females with paid work may improve the couple’s financial well-being and independence of men, thus decreasing the economic burden and associated dyadic conflict on the partner. Pregnancy history with the current partner was a risk factor for both lifetime and preceding 1-year violence. One explanation is that the male partner perceived that the pregnancy of his female partner had occurred sooner than intended (Glander, Moore, Michielutte, & Parsons, 1998; Wiemann, Agurcia, Berenson, Volk, & Rickert, 2000) and violence was a reaction to this. Considering the majority of single youths in our sample, another explanation is that the male partner has little family or institutional support and this internalizes a high level of associated stress (Jasinski, 2004). However, the casual relationship between pregnancy history and intimate partner violence should be established cautiously because of the cross-sectional design in this study. Cohabiting with the partner, multiple sex partners, and frequent drinking on the part of male youths were all associated with increased risk of preceding 1-year violence. Furthermore, female youths’ satisfaction with their body image was associated with decreased risk of past year violence, although
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it did not reach the statistically significant level. In contrast to previous studies, smoking and drug use are not associated with any lifetime or preceding 1-year intimate partner violence for both male and female youths. Further investigation of this association in Hong Kong–based studies should be explored. Finally, our study has indicated that both lifetime and preceding 1-year intimate violence were negatively associated with female youths’ mental health and were positively associated with their fear of the intimate partner, rather than the physical health, which may be attributed to the small cases of physical violence victimization or less severe physical assault from the male partner. However, male youths were not affected by two types of violence except for the mental health, suggesting that female victims of intimate partner violence are more likely to be subjected to severe negative consequences than male youths. As described above, the possible reason is that male’s reports of intimate partner violence victimization may be the violence from women in self-defense and this fails to acknowledge who the actual perpetrator of violence was (Kimmel, 2002). Therefore, the male youths’ experience is not associated with physical health problems and fear for the partner. There are several limitations that should be noted in this study: First, the measurement of lifetime intimate partner violence does not differentiate physical and mental violence separately, and sexual violence is not included in the lifetime measurement. Furthermore, the frequency and level of severity of preceding 1-year violence are omitted, which should be added to the next round of household survey on young adults in Hong Kong. Second, the research design of this study is cross-sectional, which makes causality difficult to infer from the present findings and the vice versa is also possible. For example, females who ever suffered from sexual violence may feel dissatisfied with their body image, including physical appearance. And the victims of intimate partner violence are more likely to engage in risky behaviors, such as cigarette smoking, alcohol drinking, and drug use as previous studies show (Jun, Rich-Edwards, Boynton-Jarrett, & Wright, 2008). Finally, the reliability of self-reported data may be subjected to social desirability and recall biases, which might underestimate the prevalence of intimate partner violence. It is suggested that data from the intimate partner might verify the current findings in future studies.
Conclusion Based on a representative community sample of 1,223 young adults, this study has informed our understanding of intimate partner violence in Hong
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Kong in several ways: First, this study has provided the most updated epidemiological evidence of intimate partner violence among Hong Kong young adults. Second, multiple variables including higher education and being unemployed were risk factors of past-year intimate partner violence for male youths and being pregnant was a risk factor for female youths. Third, this study has also mental health implications for the victims of intimate partner violence. Mental health service professionals who assess and treat the victims of intimate partner violence may need to pay special attention to female youths, as these youths may face more severe mental health problems. Acknowledgments The authors are grateful to the members of the Research Subcommittee of the Family Planning Association for their advice on the survey and the funding from the Department of Health to conduct the survey. We also appreciate the useful suggestions from the reviewers.
Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) declared receipt of the following financial support for the research, authorship, and/or publication of this article: The research is supported by the Department of Health of the Hong Kong Special Administrative Region and the Family Planning Association of Hong Kong.
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Author Biographies Huiping Zhang is an associate professor of family study at Renmin University. She received a PhD in family study at the University of Hong Kong. Her research focuses on women’s socioeconomic status and marital relationship. Her research interests include gender study and public health. William C. W. Wong is an associate professor of family medicine at the University of Hong Kong. He received a MD from University of Edinburgh. His research focuses on sexual and reproductive health including HIV, and health equity in marginalized groups such as sex workers and migrants.
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Patrick Ip is an associate professor of pediatrics and adolescent medicine at the University of Hong Kong. His research covers community pediatrics including the dimension of early brain development, child mental health, violence and adolescent health. Susan Fan is the executive director of the Family Planning Association of Hong Kong. She graduated from the Medical Faculty of the University of Hong Kong. She serves on numerous government advisory bodies and non-government organizations and also contributes to clinical teaching as honorary clinical associate professor in the University of Hong Kong. Paul S. F. Yip is a professor at the Department of Social Work and Social Administration of the University of Hong Kong. He received a PhD in statistics from La Trobe University. He is also the director of Center for Suicide Research and Prevention and the chair of the Research Committee of the Family Planning Association of Hong Kong. His research interest include population health, suicide prevention, demography, and mental health.
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