Violence Prevention

Violence is a serious public health problem in the United States. From infants to the elderly, it affects people in all stages of life. In the United States, violence accounts for approximately 51,000 deaths annually. In 2007, more than 18,000 people were victims of homicide and more than 34,000 took their own life.

Estimating the size of this economic burden is helpful in understanding the resources that could be saved if cost-effective violence prevention efforts were applied. The cost of these deaths totaled to $47.2 billion ($47 billion in work loss costs and $215 million in medical treatment).

The number of violent deaths tells only part of the story. Many more survive violence and are left with permanent physical and emotional scars. Violence also erodes communities by reducing productivity, decreasing property values, and disrupting social services.Violence is a serious public health problem in the United States. From infants to the elderly, it affects people in all stages of life. In 2007, more than 18,000 people were victims of homicide and more than 34,000 took their own life.

Understanding Violence

Interpersonal violence is defined as the actual or threatened intentional use of force—physical, sexual, or emotional—against another person, group, or community. It may result in physical injury, psychological harm, or even death. Violence also includes suicide and nonfatal acts of self-harm.

Unfortunately, violence is a part of our daily life. It exists in all corners of our nation. It affects us all regardless of our age, gender, race, ethnicity, or socio-economic status. More than 50,000 violent deaths occur each year in the United States. The deaths only tell part of the story. Millions of others are left with debilitating physical and emotional injuries. These injuries negatively affect the health of victims for the rest of their lives.

Violence also erodes the fabric of our communities. It can threaten productivity in the workplace, decrease the value of our homes and businesses, and disrupt essential public and social services. The economic cost of violence is staggering. In 2000, the medical costs and productivity losses associated with nonfatal violence-related injuries and deaths were estimated at more than $70 billion each year. The total burden to society is far greater.

The good news is that violence is a problem with a solution. It can be prevented by using a thoughtful and systematic approach. While the field of violence prevention is still developing, our knowledge of “what works” increases every day.

Types of Violence

• Child Maltreatment (e.g., child abuse and neglect)
• Intimate Partner Violence (e.g., violence by a current or former spouse, boy/girlfriend)
• Sexual Violence (e.g., rape, sexual assault, sexual harassment)
• Suicide (e.g., fatal and nonfatal suicide behavior)
• Youth Violence (e.g., bullying, gang violence, peer violence)

Sexual Violence

Sexual Violence (SV) refers to sexual activity where consent is not obtained or freely given. Anyone can experience SV, but most victims are female. The person responsible for the violence is typically male and is usually someone known to the victim. The person can be, but is not limited to, a friend, coworker, neighbor, or family member.

There are many types of SV. Not all include physical contact between the victim and the perpetrator (person who harms someone else)—for example, sexual harassment, threats, and peeping. Other SV, including unwanted touching and rape, includes physical contact.

SV can impact health in many ways. Some ways are serious and can lead to long-term health problems. These include chronic pain, headaches, stomach problems, and sexually transmitted diseases.

SV can have an emotional impact as well. Victims often are fearful and anxious. They may replay the attack over and over in their minds. They may have problems with trust and be wary of becoming involved with others. The anger and stress that victims feel may lead to eating disorders and depression. Some even think about or attempt suicide.

SV is also linked to negative health behaviors. For example, victims are more likely to smoke, abuse alcohol, use drugs, and engage in risky sexual activity.

Why is sexual violence a public health problem?

SV is a significant problem in the United States:

• Among high school students surveyed nationwide, about 8% reported having been forced to have sex. The percentage of those having been forced to ever have sex was higher among female (11%) than male (5%) students.
• An estimated 20% to 25% of college women in the United States have experienced an attempted or complete rape during their college career
• Nearly 1 in 5 women and 1 in 71 men in the United States have been raped at some time in their lives.

These numbers underestimate the problem. Many cases are not reported because victims are afraid to tell the police, friends, or family about the abuse.Victims also think that their stories of abuse will not be believed and that police cannot help them.They may be ashamed or embarrassed. Victims may also keep quiet because they have been threatened with further harm if they tell anyone.

Certain factors can increase the risk for SV. However, the presence of these factors does not mean that SV will occur.

Risk factors for perpetration (harm to someone else):

• Being male
• Having friends that are sexually aggressive
• Witnessing or experiencing violence as a child
• Alcohol or drug use
• Being exposed to social norms, or shared beliefs, that support sexual violence.

Definitions

It is important to understand what factors protect people or put them at risk for experiencing or perpetrating violence. Why are risk and protective factors useful? They help identify where prevention efforts need to be focused.

Risk factors do not cause violence. The presence of a risk factor does not mean that a person will always experience violence. Victims are never responsible for the harm inflicted upon them.

• Risk Factor—Characteristic that increases the likelihood of a person becoming a victim or perpetrator of violence.
• Protective Factor—Characteristic that decreases the likelihood of a person becoming a victim or perpetrator of violence because it provides a buffer against risk.

How can we prevent sexual violence?

The ultimate goal is to stop SV before it begins. Efforts at many levels are needed to accomplish this. Some examples include:

• Engaging high school students in mentoring programs or other skill-based activities that address healthy sexuality and dating relationships.
• Helping parents identify and address violent attitudes and behaviors in their kids.
• Creating policies at work, at school, and in other places that address sexual harassment.
• Developing mass media (e.g., radio, TV, magazines, newspapers) messages that promote norms, or shared beliefs, about healthy sexual relationships.

For more examples, see Sexual Violence Prevention: Beginning the Dialogue.

Sexual Violence: Risk and Protective Factors

Risk factors are associated with a greater likelihood of sexual violence (SV) perpetration. They are contributing factors and may or may not be direct causes. Not everyone who is identified as “at risk” becomes a perpetrator of violence.

A combination of individual, relational, community, and societal factors contribute to the risk of becoming a perpetrator of SV. Understanding these multilevel factors can help identify various opportunities for prevention.

Risk Factors for Perpetration

Individual Risk Factors

• Alcohol and drug use
• Coercive sexual fantasies
• Impulsive and antisocial tendencies
• Preference for impersonal sex
• Hostility towards women
• Hypermasculinity
• Childhood history of sexual and physical abuse
• Witnessed family violence as a child

Relationship Factors

• Association with sexually aggressive and delinquent peers
• Family environment characterized by physical violence and few resources
• Strong patriarchal relationship or familial environment
• Emotionally unsupportive familial environment

Community Factors

• Lack of employment opportunities
• Lack of institutional support from police and judicial system
• General tolerance of sexual violence within the community
• Weak community sanctions against sexual violence perpetrators

Societal Factors

• Poverty
• Societal norms that support sexual violence
• Societal norms that support male superiority and sexual entitlement
• Societal norms that maintain women’s inferiority and sexual submissiveness
• Weak laws and policies related to gender equity
• High tolerance levels of crime and other forms of violence

Sexual Violence: Prevention Strategies

Sexual violence is a serious problem that can have lasting, harmful effects on victims and their family, friends, and communities. The goal of sexual violence prevention is simple—to stop it from happening in the first place. However, the solutions are just as complex as the problem.

Prevention efforts should ultimately decrease the number of individuals who perpetrate sexual violence and the number of individuals who are sexual violence victims. Many prevention approaches aim to reduce risk factors and promote protective factors for sexual violence. In addition, comprehensive prevention strategies should address factors at each of the levels that influence sexual violence—the individual, relationship, community, and society.

The most common prevention strategies currently focus on the victim, the perpetrator, or bystanders.

• Strategies that aim to equip the victim with knowledge, awareness, or self-defense skills are referred to as risk reduction techniques.
• Strategies targeting the perpetrator attempt to change risk and protective factors for sexual violence in order to reduce the likelihood that an individual will engage in sexually violent behavior.
• The goal of bystander prevention strategies is to change social norms supporting sexual violence and empower men and women to intervene with peers to prevent an assault from occurring.
• Other prevention strategies may target social norms, policies, or laws in communities to reduce the perpetration of sexual violence across the population.

Effective and Promising Programs

Unfortunately, little is known about what works to prevent sexual violence. To date, only one prevention program, Safe Dates, has been shown in a randomized controlled trial to prevent or interrupt sexual violence perpetration. Other programs are accumulating evidence for effectiveness and are moving towards or are currently conducting rigorous evaluations. Until more is known about what works and for whom, program planners can use prevention principles to strengthen their approach and evaluation to determine the effectiveness of new or existing programs.

Understanding Intimate Partner Violence

Intimate partner violence (IPV) occurs between two people in a close relationship. The term “intimate partner” includes current and former spouses and dating partners. IPV exists along a continuum from a single episode of violence to ongoing battering.IPV includes four types of behavior:

• Physical violence is when a person hurts or tries to hurt a partner by hitting, kicking, or other type of physical force.
• Sexual violence is forcing a partner to take part in a sex act when the partner does not consent.
• Threats of physical or sexual violence include the use of words, gestures, weapons, or other means to communicate the intent to cause harm.
• Emotional abuse is threatening a partner or his or her possessions or loved ones, or harming a partner’s sense of self-worth. Examples are stalking, name-calling, intimidation, or not letting a partner see friends and family.

Often, IPV starts with emotional abuse. This behavior can progress to physical or sexual assault. Several types of IPV may occur together.

Why is IPV a public health problem?

• Nearly 3 in 10 women and 1 in 10 men in the US have experienced rape, physical violence, and/or stalking by a partner with IPV-related impact.
• IPV resulted in 2,340 deaths in 2007. Of these deaths, 70% were females and 30% were males.
• The medical care, mental health services, and lost productivity (e.g., time away from work) cost of IPV was an estimated $5.8 billion in 1995. Updated to 2003 dollars, that’s more than $8.3 billion.

These numbers underestimate the problem. Many victims do not report IPV to police, friends, or family. Victims may think others will not believe them or that the police cannot help.

How does IPV affect health?

IPV can affect health in many ways. The longer the violence goes on, the more serious the effects.

Many victims suffer physical injuries. Some are minor like cuts, scratches, bruises, and welts. Others are more serious and can cause death or disabilities. These include broken bones, internal bleeding, and head trauma.

Not all injuries are physical. IPV can also cause emotional harm. Victims may have trauma symptoms. This includes flashbacks, panic attacks, and trouble sleeping. Victims often have low self-esteem. They may have a hard time trusting others and being in relationships. The anger and stress that victims feel may lead to eating disorders and depression. Some victims even think about or commit suicide.

Who is at risk for IPV?

Several factors can increase the risk that someone will hurt his or her partner. However, having these risk factors does not always mean that IPV will occur.

• Being violent or aggressive in the past
• Seeing or being a victim of violence as a child
• Using drugs or alcohol, especially drinking heavily
• Not having a job or other life events that cause stress

Healthy vs. Unhealthy Relationships

Sometimes a relationship might not be abusive, but it might have some serious problems that make it unhealthy. If you think you might be in an unhealthy relationship, you should be able to talk to your partner about your concerns. If you feel like you can’t talk to your partner, try talking to a trusted friend, family member, or counselor. Consider calling a confidential hotline to get the support you need and to explore next steps. If you’re afraid to end the relationship, call a hotline for help.

Signs of an unhealthy relationship include:

• Focusing all your energy on your partner
• Dropping friends and family or activities you enjoy
• Feeling pressured or controlled a lot
• Having more bad times in the relationship than good
• Feeling sad or scared when with your partner

Signs of a healthy relationship include:

• Having more good times in the relationship than bad
• Having a life outside the relationship, with your own friends and activities
• Making decisions together, with each partner compromising at times
• Dealing with conflicts by talking honestly
• Feeling comfortable and able to be yourself
• Feeling able to take care of yourself
• Feeling like your partner supports you

If you feel confused about your relationship, a mental health professional can help. Remember, you deserve to be treated with respect.