Intimate Partner Violence and Child Health

描述(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至最低？尽管有社会或法律干预以制止暴力，IPV仍经常在家庭中继续存在。因此，儿童仍然容易受到不利健康后果的影响。这表明，为了保护儿童的健康，我们必须制定IPV干预措施，以降低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经验基础的理解，重点放在中介影响上。这项拟议研究的目标就是获得这样的理解。指导这项研究的总体框架是，IPV通过对母亲情绪健康和育儿方式的影响间接导致儿童健康状况不佳，进而影响儿童结果。两个相关的考虑包括IPV的模式(基于变量，如严重性、频率和方向性)的存在，以及这些模式可能以不同的方式影响儿童。这项提案概述了两项研究。第一个是对儿童从出生到童年中期的队列研究，其中将使用包括结构方程模型在内的先进分析方法：目标1：定义IPV的潜在结构，评估IPV的类型，并确定随着时间的推移IPV的模式；目标2：确定这些IPV结构与儿童健康和保健利用之间的关系；目标3：评估母亲情绪健康和父母教养作为IPV和儿童健康之间关系的中介因素的作用。第二项定性研究将涉及对有年幼子女的受虐妇女的半结构化访谈：目标4：描述受虐妇女对IPV、她们的情绪健康、她们的育儿方式和她们孩子的健康之间关系的看法。这些目标符合NICHD的使命，即“所有儿童都能实现他们健康和富有成效的生活的潜力。”这位候选人是一名拥有流行病学学位的儿科医生，其拟议的职业发展计划侧重于：1)了解IPV的病因和流行病学；2)从理论上了解家庭冲突对儿童健康的影响；3)学习更高水平的数据分析方法；以及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努力，促进暴露在IPV中的儿童的健康发展。在完成这项奖励后，她将提交一份R01申请，要求进行一项纵向队列研究，收集有关有和没有接触IPV的当地队列儿童健康的主要数据。从公共卫生的角度来看，童年是确立个人终身健康轨迹的关键时期；IPV有可能显著损害儿童的健康。更好地了解IPV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.