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Domestic Violence: Fighting Back

by Robin Roenker

"He attacked me with a pair of scissors and held me in the apartment all weekend, physically and verbally abusing me the whole time. On Sunday, I told him I was taking out the garbage; instead, I went to the hospital."

"He was drunk. He tried to break my leg, tried to stab me with a knife, slapped me, pushed me up against the wall. When he pushed me off the porch, I ran away and went to the police station."

"He'd call me all the time when he was drunk, at all hours of the day or night. He threatened to kill me and burn the house down, and this escalated over time."

These scary and sad stories all end with a common line: "Then I got a protective order."

"It's women's stories of pain and courage that motivate me to do the work that I do," says TK Logan, an associate professor in the Department of Behavioral Science. "I see remarkable strength in these women who face the fear of what the men in their lives might do to them, especially after the women leave and get a protective order. I really admire the courage of these women."

Photo of Karen Medley, Amy Wells, Kelli Frakes, Candice Burnette, TK Logan, Lisa Shannon, Janet Price, and Jennifer ColePart of the research team (from left and around): Karen Medley, Amy Wells, Kelli Frakes, Candice Burnette, TK Logan, Lisa Shannon, Janet Price, and Jennifer Cole

In a project titled "Alcohol, Violence, and Health Services in Rural Women," Logan and her research team are taking a close look at women's experiences of domestic violence, the contextual factors involved, and how women cope with this adversity on a day-to-day basis.

The study is examining a broad range of health and mental health issues associated with domestic violence and is one of more than 20 projects under way at the University of Kentucky Center on Drug and Alcohol Research (CDAR). Co-investigators in this study are Robert Walker, who joined the center as an assistant professor in 1999, and Carl Leukefeld, who established the center in 1990 and serves as CDAR director and chairman of the Department of Behavioral Science. The project began in September 2000 and is funded through 2005 by a $2.2 million grant from the NIH National Institute on Alcohol Abuse and Alcoholism.

Women's stories are the heart of this time-intensive and ambitious study. At the outset, project staff planned to interview 750 female victims of domestic violence, asking them to share important aspects of their lives including their health, mental health and use of substances in coping with stress.

One of the unique features of this study is that each participant has obtained a protective order in a Kentucky court in hopes of putting an end to the violence she faces at home. Previous studies of domestic violence victims have focused on women who have spent time in abuse shelters or who are in mental health or other medical treatment settings. "Using a protective order sample allows the research team to learn about the experiences of a broader range of women—both those who do and do not seek formal health or mental health services after victimization," says Logan. "It also gives us the opportunity to talk to women with a wide range of victimization experiences."

This study is also unique in that it includes rural and urban women. "This is one of the most important aspects of the project. We want to see if there are differences in the ways the two groups experience domestic violence," says Leukefeld.

Do Protective Orders Work?

One central question the team hopes to answer is a basic yet crucial one: Are protective orders doing their job?

"The overwhelming majority of states have protective orders," says Walker, a Berea, Kentucky, native who has worked in Lexington for 27 years as a mental health center director. "Legislators passed these laws with the assumption that the orders would provide some protection for victims of violence. Protective orders might work. No one really knows the answer to that question. We'll be the first group to look at this issue in rural and urban settings to see what happens to women after they get a protective order."

The team's findings regarding the effectiveness of protective orders will be very important for policy makers, says Walker, who adds that his years of front-line exposure to the negative physical and mental outcomes of abuse motivate his efforts to better understand domestic violence and develop ways to counter it. "We hope we find in this study that a substantial percentage of women who get the protective order report less violence afterward—that would be wonderful," he says.

All too often, though, the opposite is the case. Many times violence continues after the order is issued, at least for a while. In addition, many women face a multitude of barriers in trying to stop the violence and in trying to leave their abuser. Sometimes children are a consideration; other times, the women simply feel they have nowhere else to go. "And obstacles to stopping the violence and leaving an abusive relationship may be even more overwhelming for domestic violence victims in rural areas than for those in urban areas," Logan says. "There are victims living in isolated rural settings where the economy is in terrible shape."

"Some of these women are so tied to their partner or their spouse economically and in terms of social pressures that it is difficult to break away from that," says Leukefeld. "It's a reality. And it's a reality that's different in a rural area versus urban settings. This difference is what we're trying to understand."

Photo of Robert Walker"Protective orders might work," says Robert Walker, who has worked in Lexington for 27 years as a mental health center director. "We'll be the first group to look at this issue in rural and urban settings to see what happens to women after they get a protective order."

Getting Personal

Participants in the study take part in a three- to four-hour baseline interview as well as a two- to three-hour follow-up interview 12 months later. The interviewers ask specific questions about the types and amount of physical and emotional abuse the women experience. For example, rather than asking merely if the women had been threatened by an intimate partner, the interviewer asks them to describe how the threat occurred. Was it verbal? Were weapons involved?

Working to elicit the same degree of detail, interviewers pose other questions to get a sense of the women's overall physical and mental health. Participants are asked how many days in the past month they experienced emotional distress, how many times in the past year they sought health care, how often and when they used alcohol or other drugs.

History of victimization. Quality of sleep. Symptoms of chronic pain. Existence of support networks. Stressful life events. Relationships with others. Barriers to seeking health and legal services. It's all covered.

To help participants answer such a sweeping and specific battery of questions, the interviewer uses a "calendaring" technique. Respondents use anchor dates—birthdays, holidays, and so forth—as triggers to help them remember instances of health problems, periods of depression, incidents of violence, drug use, as well as trips to the doctor and other significant events.

"We can see whether doctors' visits increase or decrease over time. Does she tend to hide after periods of severe violence, or seek treatment? We get month-by-month pictures of the participant's victimization and her substance abuse," says Logan. "And based on this approach, we can ask other questions: When there's more severe violence, does substance abuse increase before or after that violence, or do patterns pretty much remain the same regardless of levels of violence?"

Also, drawing on the participants' experiences, the team hopes to determine to what degree alcohol and drug abuse is related to coping, if substance use is a risk factor itself, or if both of the above are true, Walker says.

Although the stories they tell focus on abuse, sometimes severe, for many of these women, the interview is a positive experience. "They tell us they appreciate that we respect them enough to want to hear their stories," says Logan.

Is Domestic Violence Different in Rural Areas?

Leukefeld returns to the central focus of the project: the differences between the experiences of rural and urban domestic violence victims. In fact, the impetus for the grant, he says, sprang from the team's belief that women's experiences of victimization were going to be very different in Eastern Kentucky. "One of our research goals," he says, "is to see if this belief is supported by the data." Half of the study participants are domestic violence victims from Fayette County, which includes Lexington, and half are from rural areas of Eastern Kentucky, predominantly Floyd, Letcher and Perry counties.

Though the team is still conducting interviews and only preliminary data are available, results so far have confirmed many of the researchers' expectations: Domestic violence appears to be different in rural and urban areas, and many times it's the rural women who face more severe circumstances.

"Women in rural areas are more likely to be married to their partner than women in an urban area," Logan says. "And rural women tend to have been with the perpetrator longer—on average 10 years versus five years among urban women."

To date, the study has uncovered no significant differences in the rate at which rural and urban domestic violence victims are accessing health services—one of the important findings so far, Logan says. Still, rural domestic violence victims tend to report poorer overall health. For example, preliminary findings show that while rural women experienced medical problems an average of 9.5 days in the month prior to the follow-up interview, urban women reported similar problems an average of 6.5 days. "What's the connection between this higher incidence of medical problems and domestic violence?" Logan says. "That's what we're working to find out."

Patterns of sleep are also different for the two groups. "Rural women get less sleep," Walker says. "Does this finding reflect a higher level of fear or guardedness in the home environment? Possibly. Does it represent fear related to the perception of less protection from law enforcement? Possibly. We're going to need more time to see. But there's something going on there."

In looking at the two groups' alcohol and drug use, the research team has noticed another difference. "More rural women are using prescription drugs than urban women are, while more urban women are using alcohol and illegal substances," Logan says.

There also seem to be notable differences in the kinds of violence that occurs in the two areas, Logan says. For example, one in four of the victims from rural areas report that her partner has tried to hit or run her over with a car. "Women are not reporting that as often in the urban area," Logan says, adding that more women in the rural areas report threats in general, and specifically threats with weapons, than women in the urban area.

Findings so far also suggest that rural women have more trouble getting a protective order. "You're not supposed to be charged a fee for protective orders, but they do that in some rural counties," Logan says. "And in some places they publish the women's names in the local papers, which may not only create more stigma for victims but also serve as a barrier to obtaining a protective order. You have to be very determined to get a protective order in some rural areas."

Working to Make Home a Safer Place

Though trying to probe so many issues involved in domestic violence might seem overwhelming, for Walker it's the complexity of this project that makes it so exciting.

"There's a huge wealth of variables being collected here. Mental health, physical health, substance use. Any one of those could have been the focus of a study, but this one's got them all," Walker says. "It has so many avenues for rethinking how we understand those problems for women."

"I've always been interested in rural life—its rewards and challenges," Leukefeld says. "I grew up in a small town north of Chicago and worked 23 years in the health service there, but I always wanted to get back to a rural setting." Part of the appeal of the University of Kentucky at that point in his life was Kentucky's large, rural population and the opportunity to interact with this group.

"As a researcher, I feel a great passion about this line of inquiry. There is so much about domestic violence that we do not know and this study gives us an opportunity to examine it in great detail with people who experience it every day," Logan says. "I hope that we can contribute to women's safety in the long run by doing this study. That's reason enough to do this work."

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: The University of Kentucky Center on Drug and Alcohol Research (CDAR)