Intimate Partner Violence and Child Health

描述（由申请人提供）：如何将亲密伴侣暴力（IPV）对儿童健康的负面影响降到最低？尽管社会或法律干预制止暴力，IPV往往在家庭中继续发生。因此，儿童仍然容易受到不利健康结果的影响。这表明，为了保护儿童健康，我们必须制定IPV干预措施，以减少风险并增加保护因素，即使IPV继续存在。这需要对IPV对儿童健康产生不利影响的机制有理论指导和基于经验的理解，重点是中介影响。所提出的研究的目标就是获得这样一种理解。指导这项研究的总体框架是，IPV通过对母亲情绪健康和养育子女的影响间接导致儿童健康状况不佳，而母亲情绪健康和养育子女又反过来影响儿童的结局。两个相关的考虑因素包括：IPV的模式（基于严重程度、频率和方向性等变量）是存在的，这些模式可能对儿童产生不同的影响。该提案概述了两项研究。第一个是对从出生到童年中期的儿童进行队列研究，其中包括结构方程模型在内的先进分析方法将用于：目标1：定义IPV的潜在结构，评估IPV的类型和识别IPV随时间的模式；目的2：确定这些IPV构式与儿童健康和保健使用之间的关系；目标3：评估母亲情绪健康和养育子女作为IPV与儿童健康之间关系的中介的作用。第二项定性研究涉及对有年幼子女的受虐待妇女进行半结构化访谈，将：目标4：描述受虐待妇女对IPV、她们的情绪健康、养育子女和子女健康之间关系的看法。这些目标符合联合国儿童发展中心的使命，即“所有儿童都能实现其潜力，过上健康和有益的生活”。该候选人是一名拥有流行病学学位的儿科医生，其职业发展计划侧重于：1)了解IPV的病因学和流行病学；2)从理论上了解家庭冲突对儿童健康的影响；3)学习更高层次的数据分析方法；4)获得定性研究技能。候选人的长期职业目标是领导多学科工作，以促进暴露于IPV的儿童的健康发展。在完成该奖项后，她将提交一份R01申请，用于纵向队列研究，收集当地有和没有暴露于IPV的儿童队列的主要健康数据。从公共卫生的角度来看，童年是建立个人一生健康轨迹的关键时期；IPV有可能严重损害儿童健康。更好地了解ipv6与儿童健康的关系将有助于设计有效的、有针对性的干预措施。

DESCRIPTION (provided by applicant): How can the negative impact of intimate partner violence (IPV) on child health be minimized? IPV often continues in families despite social or legal interventions to stop the violence. Children therefore remain vulnerable to adverse health outcomes. This suggests that, to protect children's health, we must shape IPV interventions to reduce risks and to increase protective factors even if IPV continues. This requires a theoretically-guided, empirically-based understanding of the mechanisms by which IPV adversely influences child health, with a focus on the mediating influences. The goal of the proposed research is to gain such an understanding. The overarching framework guiding this research is that IPV leads to poor child health indirectly through its influence on maternal emotional health and parenting, which in turn affect child outcomes. Two related considerations include that patterns (based on variables such as severity, frequency and directionality) of IPV exist and that these patterns likely affect children differently. This proposal outlines two studies. The first is a cohort study of children followed from birth to middle childhood in which advanced analytical methods including structural equation modeling will be used to: Aim 1: Define the latent construct of IPV, assessing typologies of IPV and identifying patterns of IPV over time; Aim 2: Determine the relationship between these IPV constructs and children's health and health care use; Aim 3: Assess the role of maternal emotional health and parenting as mediators of the relationship between IPV and child health. A second qualitative study involving semi-structured interviews with abused women with young children will: Aim 4: Characterize abused women's perceptions of the relationship among IPV, their emotional health, their parenting and their child's health. These aims fit with NICHD's mission of "all children achieving their potential for healthy and productive lives." The proposed career development program for this candidate, a pediatrician with a degree in epidemiology, focuses on: 1) understanding the etiology and epidemiology of IPV; 2) obtaining a theoretical understanding of the impact of family conflict on children's health; 3) learning higher level data analysis methods; and 4) acquiring qualitative research skills. The candidate's long-term career goal is to lead multidisciplinary efforts to facilitate the healthy development of children exposed to IPV. Upon completion of this award, she will submit an R01 application for a longitudinal cohort study collecting primary data on the health of a local cohort of children with and without IPV exposure. From a public health perspective, childhood is a critical time period in establishing an individual's lifetime health trajectory; IPV has the potential to significantly compromise children's health. A better understanding of the IPV-child health relationship will facilitate the design of effective, targeted interventions.