J Immigrant Minority Health DOI 10.1007/s10903-014-9988-8
ORIGINAL PAPER
Risk Factors for Intimate Partner Violence in a Migrant Farmworker Community in Baja California, Me´xico Marcella J. Lopez • Rachel A. Mintle • Sylvia Smith • Alicia Garcia • Vanessa N. Torres Allie Keough • Hugo Salgado
•
Ó Springer Science+Business Media New York 2014
Abstract Intimate partner violence (IPV) is one of the most common forms of violence against women worldwide. Among Mexican women, it is estimated that 15 to 71 % have experienced physical or sexual abuse by an intimate male partner in their lifetime. This study examined the prevalence of four leading risk factors associated with IPV (alcohol consumption, education, socioeconomic status (SES), and gender roles) in adult women (n = 68) in a migrant farmworker community in Me´xico. Alcohol consumption among women was higher than the national average, and partner consumption was lower. Education level and SES were low, and women identified with a feminist ideology more than a traditional gender role. Results also revealed that 86.4 % (n = 57) of participants identified violence against women as a common problem in the community, and the majority (94.0 %, n = 62) of participants believe that IPV specifically is a problem within the community.
M. J. Lopez R. A. Mintle (&) S. Smith A. Garcia V. N. Torres A. Keough Department of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, Hardy Tower 119, 5500 Campanile Dr., San Diego, CA 92182-4162, USA e-mail: [email protected] H. Salgado Joint Doctoral Program in Public Health (Global Health), San Diego State/University of California, Hardy Tower 119, 5500 Campanile Dr., San Diego, CA 92182-4162, USA e-mail: [email protected] H. Salgado Joint Doctoral Program in Public Health (Global Health), San Diego State/University of California, 9245 Sky Park Court, Ste. 110, San Diego, CA 92123, USA
Keywords Mexican Migrant farmworker Intimate partner violence Risk factors Gender roles
Background Violence against women is a global health problem, irrespective of culture, region, or country in the world [1]. The most common form of violence against women is intimate partner violence (IPV). IPV may occur between two people in an intimate relationship, resulting in physical violence, sexual violence, or psychological harm [1–3]. Physical health effects from IPV may include spinal injuries, decreased mobility, unintended pregnancies, and sexually transmitted infections, such as human immunodeficiency virus (HIV) [1]. Psychological effects of IPV may include depression, post-traumatic stress disorder, sleep difficulties, eating disorders, and suicidal thoughts [1]. Social and economic costs may include missed days of work, hospitalizations, social isolation, and financial dependency [1]. Research indicates that 10 to 69 % of women have experienced physical violence by an intimate male partner (e.g. spouse, former spouse, dating partner) over their lifetime [3]. In Me´xico, it is estimated that 15 to 71 % of women have experienced physical or sexual abuse by an intimate partner during their lifetime [5–7]. In 2006, 27.6 % of women in the state of Baja California had experienced IPV in their lifetime according to the National Survey of Violence Against Women [8]. However, women from rural areas such as the coastal town of San Quintı´n in Baja California were likely underrepresented in this national survey, a pattern echoed by the low amount of public health research examining IPV across Me´xico’s migrant farmworker communities.
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According to the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC) and empirical research done in Me´xico, the most prevalent risk factors associated with IPV have been found to be high alcohol use, strict gender roles, low income, and low education [1, 9, 10]. Given the lack of research on IPV in rural communities and our knowledge of these common and unique risk factors for IPV, the current study explored the following research question: What is the prevalence of leading IPV risk factors in the migrant farmworker community of San Quintı´n? The first hypothesis was that high alcohol consumption, strict gender roles, and low socioeconomic status (SES) would be prevalent in this migrant farmworker community. The second hypothesis was that alcohol consumption among women and their intimate partners in San Quintı´n would be higher than the prevalence in Me´xico and Baja California. Third, it was hypothesized that this population would hold strict gender role beliefs. Lastly, it was hypothesized that education and income levels in San Quintı´n would be lower than the averages in Baja California and Me´xico. Conceptual Framework A framework commonly used to examine human behavior is the Socio Ecological Model (SEM), which posits that behaviors are impacted by multiple factors that interact across multiple levels of influence [11]. The WHO and CDC utilize a four-level model (individual, interpersonal, community, society) of the SEM to both understand violence and identify potential intervention strategies across the globe [4, 12]. When applied to IPV in a global setting, the SEM can be valuable in understanding the interaction between the internal and external factors associated with IPV. The top four identified individual level risk factors for IPV are personal alcohol consumption, education level, annual income, and personal beliefs about gender roles [10]. Interpersonal level factors include intimate partner’s alcohol consumption, social relationships, and community support [10]. Societal level factors in this study include societal norms that influence gender role beliefs, such as ‘‘machismo’’, an ideal in Mexican culture that promotes male dominance over his partner [10]. Methods Participants This cross sectional study was reviewed and approved by the San Diego State University (SDSU) Institutional Review Board (IRB). The study was conducted with a sample of 68 adult women in Lomas San Ramon (LSR), a
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colonia1 within the rural, migrant farmworker community of San Quintı´n in Baja California, Me´xico. Data Collection Data were collected in April 2012, as part of a two-day medical clinic entitled Viaje Interinstitucional de Integracio´n Docente, Asistencial y de Investigacio´n (VIIDAI). Eligibility criteria were: (1) Resident of San Quintı´n; (2) Able to speak and understand Spanish or English; and (3) Female aged 18 and older. Participants were recruited in two ways: (1) All eligible VIIDAI clinic patients were asked to participate in the interviewer-administered survey after registering for their clinic appointment; and (2) Via door-to-door recruitment, inviting residents from randomly selected households to participate in the intervieweradministered survey outside of their place of residence. All interviewers were bilingual, female, graduate-level research assistants. All participants were given the option to complete the interview in a private setting. Measures For alcohol use, survey questions utilized by previous VIIDAI researchers were employed to evaluate alcohol use of both participants and their current partners [13]. Questions inquired about the frequency of alcohol use, with categorical response options (never, once per week, 2–3 times per week, 4–5 times per week, 6–7 times per week). Participants were also asked to report how many drinks of alcohol they consumed on a typical day using an openended response option. Education was assessed by a one-item question: ‘‘What is the highest level in school you have completed?’’ Response options included: none, some or completed elementary school, some or completed junior high, some or completed high school, and other. To assess SES, weekly household income during each season (harvest season and off-season) was asked. A range of monthly incomes were provided to aid participants in estimating their total household income. Two sets of measures were utilized to evaluate gender roles. A 12-item scale developed by Kulis et al. [14] was designed to measure both negative and positive masculine and feminine attributes in an individual. Assertive (positive) masculinity was characterized by traits such as self-confidence, competence, and leadership (a = .43). Aggressive (negative) masculinity encompasses traits such as dominance and controlling behavior (a = .35). Affective (positive) femininity is regarded as empathy, nurturance, and emotional expressiveness (a = .49). Lastly, submissive 1
A colonia is a term referring to a rural neighborhood in Me´xico.
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(negative) femininity is characterized by dependence and inadequacy (a = .38). All response options utilized a Likert scale ranging from 1 (rarely) to 5 (always). Higher scores on each scale indicated a higher association with that particular trait. The second gender role scale used was the short form Sex-Role Ideology Scale (SRIS), which consists of 13 of the original 30 items [15]. This scale is designed to measure gender ideology, or beliefs about the behaviors and roles of men and women [15]. Participants responded with their level of agreement on a Likert scale of 1 (strongly disagree) to 7 (strongly agree). A lower score was representative of a traditional view of gender roles, while a higher score indicated a more feminist ideology (a = .52). Variables of Interest Other questions included in the survey battery aimed to assess participant views on violence in the community, migration history, and other demographic information. Due to the sensitive nature of the questions asked, particularly surrounding alcohol use and violence in the community, social desirability was assessed using Short Form A from the validated Marlowe-Crowne Social Desirability scale (MCSD) [16]. Higher scores on this scale indicate a subject’s tendency to present oneself in a socially favorable manner [17]. Analysis Statistical analyses were conducted using IBM SPSS Statistics (version 19.0). Descriptive statistics were obtained for demographic and sociocultural characteristics of the sample. Prevalence of each independent variable was determined to provide baseline estimates of risk factors. Pearson’s correlations were assessed to examine associations between the four identified IPV risk factors, as well as correlations between those risk factors and other variables (i.e. demographic information, gender roles, and social desirability). Cronbach’s alpha was used to examine internal consistency reliability between the two validated scales measuring gender roles, the SRIS short form, and the masculinity/femininity scale developed by Kulis et al. [14, 15].
Table 1 Demographic characteristics of study sample (n = 68) Characteristic
n (%) or M (± SD)
Mean age
30.02 (9.25)
Education None
10 (14.5)
Completed or some elementary school
42 (60.8)
Completed or some junior high school
8 (11.5)
Completed or some high school
6 (8.6)
Other
1 (1.4)
Employment None
2 (3.0)
Agricultural farm worker
32 (47.8)
Homemaker Other
37 (55.2) 6 (8.8)
First Language Spanish
40 (59.7)
Indigenous language
27 (39.1)
Marital status Single Married Separated Live with a partner
9 (13.0) 30 (43.5) 4 (5.8) 23 (33.3)
Living situation Single head of household
6 (8.7)
Live with mother or mother-in-law
11 (15.9)
Live with spouse or partner
53 (76.8)
Live with extended family members
9 (13.0)
Number in household B5 C6
32 (47.8) 35 (52.2)
Number of children in house 0
3 (4.5)
1
14 (20.9)
C2
40 (74.6)
Seguro popular No
22 (32.8)
Yes
42 (62.7)
Weekly harvest season income B2,500 pesos
43 (64.2)
2,501–3,800 pesos
14 (20.9)
3,801–5,100 pesos
8 (11.9)
C5,101 pesos
1 (1.5)
Mexican peso conversion to US dollars (USD): $2,500 pesos = $190 USD; $3,800 pesos = $289 USD; 5,100 pesos = $388 USD
Results Sample characteristics are summarized in Table 1. Sixtyeight individuals completed the survey, 61.7 % at the clinic and 38.3 % via door to door sampling (Table 2). The mean age was 30.02 (SD = 9.25); 43.5 % of participants were married and 33.3 % lived with a partner. Most participants
Table 2 Response rate by recruitment site Recruitment site
n
%
Completed surveys at clinic site
42
61.7
Completed surveys via random sampling in community
26
38.3
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J Immigrant Minority Health Table 3 Prevalence of leading IPV risk factors Risk factor
Table 4 Views on violence n (%) or M ± SD
Personal alcohol use Does not drink alcohol
46 (69.7)
No alcohol in past 30 days Less than once per week
a
Once per weeka
Question
n (%)
Believe violence is a problem in community
61 (92.4)
Most common types
14 (21.5)
Youth violence
1 (1.4)
Gang violence
58 (87.9)
3 (4.6)
Elder abuse
38 (57.6)
Number of drinks consumesb
58 (87.9)
Self-directed violence
30 (45.5)
1–2
11 (17.0)
Armed violence
41 (62.1)
3–4
4 (6.2)
Child maltreatment
49 (74.2)
C5
2 (3.0)
Workplace violence
42 (63.6)
Violence against women
57 (86.4)
Education None Completed or some elementary school
10 (14.5) 42 (60.8)
Completed or some junior high school
8 (11.5)
Completed or some high school
6 (8.6)
Other
1 (1.4)
Partner’s alcohol use Does not drink alcohol
34 (51.5)
No alcohol in past 30 days
2 (3.0)
Less than once per weeka
5 (7.6)
Once per week
a
2–3 times per weeka
14 (21.2) 2 (3.0)
Number of drinks partner consumesb 1–2
4 (6.3)
3–4
4 6.3)
C5
9 (17.3)
Kulis et al. [14] gender roles Affective femininity Submissive femininity
4.17 ± .89 2.70 ± .83
Assertive masculinity
3.31 ± 1.12
Aggressive masculinity
1.89 ± .83
SRIS score
4.34 ± .79
SRIS Sex Role Inventory Scale a
In the past 30 days. bNumber of drinks consumed in a typical day when person consumes alcohol
(60.8 %) had completed or attended elementary school, and over half (55.2 %) served as a household homemaker. Approximately two-thirds of participants (64.2 %) reported a weekly household income of less than $190 USD (approximate). Prevalence of IPV risk factors are presented in Table 3. Regarding alcohol use, 69.7 % reported never having used alcohol; 22 % had consumed alcohol in their lifetime, but not in the past 30 days. Just over half (51.5 %) reported that their partner did not drink alcohol. Of those participants that had a partner who drank alcohol, the majority (21.2 %) reported that their partner used alcohol once per week.
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Believe IPV is a problem for women in community Knowledge of resources
62 (93.9) 62 (95.4)
Table 3 also displays mean scores and standard deviations for both gender role scales. Results from Kulis et al.’s [14] scale yielded the following means, with a range of 1–5: mean affective femininity score was 4.17 (SD = .89), mean submissive femininity score was 2.70 (SD = .83), mean assertive masculinity score was 3.31 (SD = 1.12), and mean aggressive masculinity score was 1.89 (SD = .83). Higher scores indicate higher association with that particular trait. The mean score for the SRIS short form was 4.36 (SD = .79), with a range of 1–7. For this scale, a higher score indicates a higher identification with a feminist ideology, as opposed to a traditionalist view of gender roles. Table 4 reflects participant views on violence. Most participants (92.4 %) believed that violence is a problem in the community of LSR. Further, 86.4 % of participants identified violence against women as a problem in the community. Over 90 % of participants believe that IPV in particular is a problem for women in the community. When asked if they would be able to help a friend, or find help for a friend in the community that had experienced domestic or partner violence, 95.4 % responded ‘yes’. Pearson’s correlations were conducted between the key IPV risk factors, displayed in Table 5. Education showed an inverse association with age (r = -.23, p = .060), indicating older women received less education. An inverse correlation was also seen between education and aggressive masculinity (r = -.27, p = .037) and submissive femininity (r = -.31, p = .013), showing that as education level increases, association with negative gender role traits decreases. Submissive femininity and aggressive masculinity were positively correlated (r = .28, p = .030), indicating that identification with one trait is associated with identification of the other trait as well. Affective femininity and SRIS mean score were positively correlated (r = .37, p = .008), as anticipated since both scales
-.004 (.973)
-.09 (.507)
-.07 (.621)
Submissive femininity
SRIS
Marlowe Crowne
-.24 (.067)*
.07 (.639)
.05 (.724)
.01 (.911)
.06 (.642)
.05 (.705)
-.19 (1.79)
-.31 (.013)**
-.18 (.157)
-.27 (.037)**
-.05 (.683)
-.23 (.060)*
.15 (.237)
_
.18 (.145)
.15 (.244)
Education
* Significant at p \ .100; ** Significant at p \ .05
Weekly income during harvest season
-.12 (.354)
Positive femininity
a
.07 (.598)
Aggressive masculinity
.11 (.401)
-.12 (.337)
-.07 (.561)
-.07 (.582)
Age
Assertive masculinity
.18 (.145)
.04 (.762)
.15 (.244)
_
.19 (.138)
-.05 (.695)
Partner alcohol use
-.05 (.695)
Education
_
Personal Alcohol Use
Partner alcohol
Weekly income
Personal alcohol
Risk factor
Pearson correlation (significance)
Table 5 Leading risk factor correlations
.11 (.398)
.06 (.649)
.15 (.237)
-.17 (.201)
-.11 (.439)
-.02 (.903)
-.07 (.597)
-.16 (.229)
_
.04 (.762)
.19 (.138)
Weekly incomea
.02 (.877)
-.09 (.507)
.08 (.565)
-.13 (.327)
-.03 (.829)
.13 (.333)
_
.06 (.649)
-.23 (.060)*
-.12 (.337)
-.07 (.561)
Age
-.32 (.017)**
.14 (.338)
-.07 (.578)
.28 (.030)**
.17 (.184)
_
.13 (.333)
.11 (.398)
-.05 (.683)
.11 (.401)
-.07 (.582)
Assertive masculinity
-.10 (.431)
.21 (.137)
.32 (.011)**
-.03 (.804)
_
.17 (.184)
-.03 (.829)
-.16 (.229)
-.27 (.037)**
.06 (.642)
.07 (.598)
Aggressive masculinity
.008 (.953)
.37 (.008)**
-.13 (.330)
–
-.03 (.804)
.28 (.030)
-.13 (.327)
-.07 (.597)
-.18 (.157)
.01 (.911)
-.12 (.354)
Positive femininity
.14 (.315) -.35 (.007)**
_
-.13 (.330)
.32 (.011)**
-.07 (.578)
.08 (.565)
-.02 (.903)
-.31 (.013)**
.05 (.724)
-.004 (.973)
Submissive femininity
-.17 (.223)
_
.14 (.315)
.37 (.008)**
.21 (.137)
.14 (.338)
-.09 (.507)
-.11 (.439)
-.19 (.179)
.07 (.639)
.09 (.507)
SRIS
_
-.17 (.223)
-.35 (.007)**
.008 (.953)
-.10 (.431)
-.32 (.017)**
.02 (.877)
-.19 (.147)
.05 (.705)
-.24 (.067)*
-.07 (.621)
Marlowe Crowne
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measure positive gender role traits with higher scores indicating a more feminist ideology. Significant correlations were found between the MCSD and partner alcohol use (r = -.24, p = .067), assertive masculinity (r = -.32, p = .017), and submissive femininity (r = -.35, p = .007). Comparisons were made to examine internal consistency reliability between both gender role scales. Assertive masculinity and affective femininity, measuring positive gender role traits, had similar reliabilities (a = .43 and a = .49, respectively). The two subscales measuring negative gender role traits, aggressive masculinity and submissive femininity, also had similar reliabilities (a = .35 and a = .38, respectively). Affective femininity’s internal consistency is also comparable to the SRIS scale (a = .52). While the individual scale reliabilities were not particularly high, they were comparable to their corresponding scales.
Discussion To our knowledge, this was the first study to quantitatively assess the prevalence of leading risk factors (high alcohol use, strict gender beliefs, low education, and low SES) for IPV in the colonia of LSR in San Quintı´n. Results revealed that the majority of participants believe that IPV is a problem within the community, and baseline measures of each risk factor were obtained. Results partially supported the second hypothesis that high alcohol use is prevalent in the colonia of LSR. Overall alcohol consumption was relatively low, however compared to the results from a Mexican national study [8], the current study found alcohol use among women to be higher among this sample, while male partner alcohol consumption was lower. This may be attributed to the self-report measurement or social desirability. Contrary to the third hypothesis, results from the current study indicate that participants had a higher association with feminist ideology, rather than traditional gender roles. This may be due to the differing social and cultural norms of this population. For example, in this migrant community where extra income is essential, it becomes more common for males and females alike to work in the fields, outside the home. The questions that suggest a difference between male working roles and female working roles may not apply since both genders work outside of the home, and likely in similar work environments. This could explain the perceived lack of traditional gender roles in this community. In congruence with the fourth hypothesis, low SES and low education levels were highly prevalent in this community. More than half of the participants reported weekly earnings of less than $190 USD during the regular
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strawberry harvest season of March, April, and May. Regarding education, the majority of participants reported no education, or only having completed or attended some elementary school. Further, many residents in the colonia LSR are living in extreme poverty. With high levels of poverty, individuals begin working at very young ages to lessen the financial burden, which leads to low levels of education in the colonia LSR. Limitations The analysis of IPV was limited by the cross-sectional design of the study, as causal inference cannot be made between IPV and identified risk factors. Further, the external validity may be low, as sampling was from a small migrant agricultural town in Baja California, Me´xico. In addition, the initial recruitment goal of this research study was N = 100. With the variability of attendees at the twoday clinic, the final sample size was N = 68. In review of the results, this small sample size may further limit the external validity of the study. As with any self-report survey, self-report bias is also a limitation to the validity of this study. Limitations may also include the psychometric properties of the risk factors studied. The measurement of alcohol use in the community may not have accurately assessed alcohol consumption, as the wording of the question may have evoked social desirability in responses. Given the sensitive nature of some of these questions, participants may have been influenced by social desirability. They may have been reluctant to answer truthfully for fear of being overheard by partners, family members, and/or friends during the interview. To account for this, the inclusion of the social desirability scale showed the degree of influence this bias had on the study results. Analysis of the social desirability scale suggests social desirability was a factor in responses to questions assessing these risk factors. This was anticipated given the sensitive nature of the questions on this survey. Since this research team was not adequately equipped to counsel and address IPV in this community, direct questions about IPV prevalence were not asked. Rather, questions investigated prevalence of key IPV risk factors, as well as proxy questions regarding violence in the community. While these risk factors are established in the literature as correlates to IPV, it cannot be assumed that the presence of these factors equates to IPV prevalence. Further, almost all participants stated that they would be able to help a friend if they had experienced IPV. Selection bias may have influenced the results of this study, as people who voluntarily seek help at a community medical clinic may be more likely to know of available resources in the community.
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Future studies should attain or create more accurate and culturally appropriate measures of leading IPV risk factors. To assess alcohol use, we recommend distinction of alcohol type, as well as inquire about religious beliefs and practices regarding alcohol. Considering the high levels of poverty in the community, we recommend that future studies assess SES via open-ended questions, and/or provide income categories that accurately reflect the population. Also, evaluating the partner’s education level would be beneficial, as an uneven education level in a relationship may contribute to a conflict in gender roles. Further, it is recommended that future studies evaluate financial control of household finances since IPV also includes economic abuse [18]. While both spouses may contribute to household income, it is unknown whether financial control is shared or dominated by a partner. New Contribution to the Literature Previous research suggests that many women experiencing IPV in Me´xico do not seek help due to shame, or more importantly because they do not trust the state or the health sector [19]. It is now known that resources are available to women and children in need of, or seeking help for, IPV in the colonia LSR. It is apparent that IPV is highly prevalent in the community, thus future research and interventions should consider providing educational opportunities for women and children. Focus groups may be beneficial to learn about coping strategies within the community, the prevalence of mental health stressors, and determining support strategies for women in the community. This study contributes to the limited body of research that discusses IPV risk factors specific to rural Mexican communities. These results may be used as baseline measures for future research studies on violence in San Quintı´n, Baja California, and may inform on various projects related to IPV in global public health projects.
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3. World Health Organization: World report on violence and health. 2002. http://whqlibdoc.who.int/hq/2002/9241545615.pdf. 4. World Health Organization: Preventing intimate partner and sexual violence against women: taking action and generating evidence. 2010. http://whqlibdoc.who.int/publications/2010/9789 241564007_eng.pdf. 5. Castro R, Peek-Asa C, Ruiz A. Violence against women in Me´xico: a study of abuse before and during pregnancy. Am J Public Health. 2003;93:1110–6. 6. Olaiz G, et al. Disen˜o metodolo´gico de la Encuesta Nacional sobre Violencia contra las Mujeres en Me´xico. Salud Publica Me´xico. 2006;48:328–35. 7. Ramirez-Rodriguez J. La violencia de varones contra sus parejas heterosexuales: realidades y desafı´os. Un recuento de la produccio´n mexicana. Salud Pu´blica de Me´xico. 2006;48(2):315–27. 8. Instituto Nacional de salud Pu´blica en Me´xico, INSP: Encuesta Nacional sobre Violencia contra las Mujeres, ENVIM. 2006. http:// cedoc.inmujeres.gob.mx/documentos_download/ENVIM_2006.pdf. 9. Avila-Burgos L, Valdez-Santiago R, Hijar M, et al. Factors associated with severity of intimate partner abuse in Me´xico: results of the first national survey of violence against women. Can J Public Health. 2009;100(6):436–41. 10. Centers for Disease Control and Prevention: Intimate partner violence: risk and protective factors. 2010. http://www.cdc.gov/ ViolencePrevention/intimatepartnerviolence/riskprotectivefactors. html. 11. Sallis JF, Owen N, Fisher EB. Ecological models of health behavior. In: Glanz K, Rimer B, Viswanath K, editors. Health behavior and health education: theory, research, and practice. California: Jossey-Bass; 2008. p. 465–85. 12. Centers for Disease Control and Prevention: Injury center: violence prevention. 2009. http://www.cdc.gov/ViolencePrevention/ overview/social-ecologicalmodel.html. 13. Volkmann T, et al. Drug scene familiarity and exposure to gang violence among residents in a rural farming community in Baja California, Mexico. Glob Public Health Int J Res Policy Pract. 2013;8(1):65–78. 14. Kulis S, Marsiglia FF, Nagoshi JL. Gender roles, externalizing behaviors, and substance use among Mexican-American adolescents. J Soc Work Pract Addict. 2010;10(3):283–307. 15. Cota AA, Xinaris S. Factor structure of the sex-role ideology scale: introducing a short form. Sex Roles. 1993;29:5–6. 16. Reynolds WM. Development of reliable and valid short forms of the Marlowe-Crowne social desirability scale. J Clin Psychol. 1982;38(1):119–25. 17. Fisher RJ, Tellis GJ. Removing social desirability bias with indirect questioning: is the cure worse than the disease? Adv Consum Res. 1998;25:563–7. 18. Instituto Nacional de las Mujeres, INMUJERES: Violencia en las relaciones de pareja: resultados de la Encuesta Nacional Sobre la Dina´mica de las Relaciones en los Hogares, 2006. http://cedoc. inmujeres.gob.mx/documentos_download/100924.pdf, 2008. 19. Agoff C, Rajsbaum A, Herrera C. Perspectivas de las mujeres maltratadas sobre la violencia. Salud Pu´blica de Me´xico. 2006; 48(2):307–14.
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ORIGINAL PAPER
Risk Factors for Intimate Partner Violence in a Migrant Farmworker Community in Baja California, Me´xico Marcella J. Lopez • Rachel A. Mintle • Sylvia Smith • Alicia Garcia • Vanessa N. Torres Allie Keough • Hugo Salgado
•
Ó Springer Science+Business Media New York 2014
Abstract Intimate partner violence (IPV) is one of the most common forms of violence against women worldwide. Among Mexican women, it is estimated that 15 to 71 % have experienced physical or sexual abuse by an intimate male partner in their lifetime. This study examined the prevalence of four leading risk factors associated with IPV (alcohol consumption, education, socioeconomic status (SES), and gender roles) in adult women (n = 68) in a migrant farmworker community in Me´xico. Alcohol consumption among women was higher than the national average, and partner consumption was lower. Education level and SES were low, and women identified with a feminist ideology more than a traditional gender role. Results also revealed that 86.4 % (n = 57) of participants identified violence against women as a common problem in the community, and the majority (94.0 %, n = 62) of participants believe that IPV specifically is a problem within the community.
M. J. Lopez R. A. Mintle (&) S. Smith A. Garcia V. N. Torres A. Keough Department of Health Promotion and Behavioral Science, Graduate School of Public Health, San Diego State University, Hardy Tower 119, 5500 Campanile Dr., San Diego, CA 92182-4162, USA e-mail: [email protected] H. Salgado Joint Doctoral Program in Public Health (Global Health), San Diego State/University of California, Hardy Tower 119, 5500 Campanile Dr., San Diego, CA 92182-4162, USA e-mail: [email protected] H. Salgado Joint Doctoral Program in Public Health (Global Health), San Diego State/University of California, 9245 Sky Park Court, Ste. 110, San Diego, CA 92123, USA
Keywords Mexican Migrant farmworker Intimate partner violence Risk factors Gender roles
Background Violence against women is a global health problem, irrespective of culture, region, or country in the world [1]. The most common form of violence against women is intimate partner violence (IPV). IPV may occur between two people in an intimate relationship, resulting in physical violence, sexual violence, or psychological harm [1–3]. Physical health effects from IPV may include spinal injuries, decreased mobility, unintended pregnancies, and sexually transmitted infections, such as human immunodeficiency virus (HIV) [1]. Psychological effects of IPV may include depression, post-traumatic stress disorder, sleep difficulties, eating disorders, and suicidal thoughts [1]. Social and economic costs may include missed days of work, hospitalizations, social isolation, and financial dependency [1]. Research indicates that 10 to 69 % of women have experienced physical violence by an intimate male partner (e.g. spouse, former spouse, dating partner) over their lifetime [3]. In Me´xico, it is estimated that 15 to 71 % of women have experienced physical or sexual abuse by an intimate partner during their lifetime [5–7]. In 2006, 27.6 % of women in the state of Baja California had experienced IPV in their lifetime according to the National Survey of Violence Against Women [8]. However, women from rural areas such as the coastal town of San Quintı´n in Baja California were likely underrepresented in this national survey, a pattern echoed by the low amount of public health research examining IPV across Me´xico’s migrant farmworker communities.
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According to the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC) and empirical research done in Me´xico, the most prevalent risk factors associated with IPV have been found to be high alcohol use, strict gender roles, low income, and low education [1, 9, 10]. Given the lack of research on IPV in rural communities and our knowledge of these common and unique risk factors for IPV, the current study explored the following research question: What is the prevalence of leading IPV risk factors in the migrant farmworker community of San Quintı´n? The first hypothesis was that high alcohol consumption, strict gender roles, and low socioeconomic status (SES) would be prevalent in this migrant farmworker community. The second hypothesis was that alcohol consumption among women and their intimate partners in San Quintı´n would be higher than the prevalence in Me´xico and Baja California. Third, it was hypothesized that this population would hold strict gender role beliefs. Lastly, it was hypothesized that education and income levels in San Quintı´n would be lower than the averages in Baja California and Me´xico. Conceptual Framework A framework commonly used to examine human behavior is the Socio Ecological Model (SEM), which posits that behaviors are impacted by multiple factors that interact across multiple levels of influence [11]. The WHO and CDC utilize a four-level model (individual, interpersonal, community, society) of the SEM to both understand violence and identify potential intervention strategies across the globe [4, 12]. When applied to IPV in a global setting, the SEM can be valuable in understanding the interaction between the internal and external factors associated with IPV. The top four identified individual level risk factors for IPV are personal alcohol consumption, education level, annual income, and personal beliefs about gender roles [10]. Interpersonal level factors include intimate partner’s alcohol consumption, social relationships, and community support [10]. Societal level factors in this study include societal norms that influence gender role beliefs, such as ‘‘machismo’’, an ideal in Mexican culture that promotes male dominance over his partner [10]. Methods Participants This cross sectional study was reviewed and approved by the San Diego State University (SDSU) Institutional Review Board (IRB). The study was conducted with a sample of 68 adult women in Lomas San Ramon (LSR), a
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colonia1 within the rural, migrant farmworker community of San Quintı´n in Baja California, Me´xico. Data Collection Data were collected in April 2012, as part of a two-day medical clinic entitled Viaje Interinstitucional de Integracio´n Docente, Asistencial y de Investigacio´n (VIIDAI). Eligibility criteria were: (1) Resident of San Quintı´n; (2) Able to speak and understand Spanish or English; and (3) Female aged 18 and older. Participants were recruited in two ways: (1) All eligible VIIDAI clinic patients were asked to participate in the interviewer-administered survey after registering for their clinic appointment; and (2) Via door-to-door recruitment, inviting residents from randomly selected households to participate in the intervieweradministered survey outside of their place of residence. All interviewers were bilingual, female, graduate-level research assistants. All participants were given the option to complete the interview in a private setting. Measures For alcohol use, survey questions utilized by previous VIIDAI researchers were employed to evaluate alcohol use of both participants and their current partners [13]. Questions inquired about the frequency of alcohol use, with categorical response options (never, once per week, 2–3 times per week, 4–5 times per week, 6–7 times per week). Participants were also asked to report how many drinks of alcohol they consumed on a typical day using an openended response option. Education was assessed by a one-item question: ‘‘What is the highest level in school you have completed?’’ Response options included: none, some or completed elementary school, some or completed junior high, some or completed high school, and other. To assess SES, weekly household income during each season (harvest season and off-season) was asked. A range of monthly incomes were provided to aid participants in estimating their total household income. Two sets of measures were utilized to evaluate gender roles. A 12-item scale developed by Kulis et al. [14] was designed to measure both negative and positive masculine and feminine attributes in an individual. Assertive (positive) masculinity was characterized by traits such as self-confidence, competence, and leadership (a = .43). Aggressive (negative) masculinity encompasses traits such as dominance and controlling behavior (a = .35). Affective (positive) femininity is regarded as empathy, nurturance, and emotional expressiveness (a = .49). Lastly, submissive 1
A colonia is a term referring to a rural neighborhood in Me´xico.
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(negative) femininity is characterized by dependence and inadequacy (a = .38). All response options utilized a Likert scale ranging from 1 (rarely) to 5 (always). Higher scores on each scale indicated a higher association with that particular trait. The second gender role scale used was the short form Sex-Role Ideology Scale (SRIS), which consists of 13 of the original 30 items [15]. This scale is designed to measure gender ideology, or beliefs about the behaviors and roles of men and women [15]. Participants responded with their level of agreement on a Likert scale of 1 (strongly disagree) to 7 (strongly agree). A lower score was representative of a traditional view of gender roles, while a higher score indicated a more feminist ideology (a = .52). Variables of Interest Other questions included in the survey battery aimed to assess participant views on violence in the community, migration history, and other demographic information. Due to the sensitive nature of the questions asked, particularly surrounding alcohol use and violence in the community, social desirability was assessed using Short Form A from the validated Marlowe-Crowne Social Desirability scale (MCSD) [16]. Higher scores on this scale indicate a subject’s tendency to present oneself in a socially favorable manner [17]. Analysis Statistical analyses were conducted using IBM SPSS Statistics (version 19.0). Descriptive statistics were obtained for demographic and sociocultural characteristics of the sample. Prevalence of each independent variable was determined to provide baseline estimates of risk factors. Pearson’s correlations were assessed to examine associations between the four identified IPV risk factors, as well as correlations between those risk factors and other variables (i.e. demographic information, gender roles, and social desirability). Cronbach’s alpha was used to examine internal consistency reliability between the two validated scales measuring gender roles, the SRIS short form, and the masculinity/femininity scale developed by Kulis et al. [14, 15].
Table 1 Demographic characteristics of study sample (n = 68) Characteristic
n (%) or M (± SD)
Mean age
30.02 (9.25)
Education None
10 (14.5)
Completed or some elementary school
42 (60.8)
Completed or some junior high school
8 (11.5)
Completed or some high school
6 (8.6)
Other
1 (1.4)
Employment None
2 (3.0)
Agricultural farm worker
32 (47.8)
Homemaker Other
37 (55.2) 6 (8.8)
First Language Spanish
40 (59.7)
Indigenous language
27 (39.1)
Marital status Single Married Separated Live with a partner
9 (13.0) 30 (43.5) 4 (5.8) 23 (33.3)
Living situation Single head of household
6 (8.7)
Live with mother or mother-in-law
11 (15.9)
Live with spouse or partner
53 (76.8)
Live with extended family members
9 (13.0)
Number in household B5 C6
32 (47.8) 35 (52.2)
Number of children in house 0
3 (4.5)
1
14 (20.9)
C2
40 (74.6)
Seguro popular No
22 (32.8)
Yes
42 (62.7)
Weekly harvest season income B2,500 pesos
43 (64.2)
2,501–3,800 pesos
14 (20.9)
3,801–5,100 pesos
8 (11.9)
C5,101 pesos
1 (1.5)
Mexican peso conversion to US dollars (USD): $2,500 pesos = $190 USD; $3,800 pesos = $289 USD; 5,100 pesos = $388 USD
Results Sample characteristics are summarized in Table 1. Sixtyeight individuals completed the survey, 61.7 % at the clinic and 38.3 % via door to door sampling (Table 2). The mean age was 30.02 (SD = 9.25); 43.5 % of participants were married and 33.3 % lived with a partner. Most participants
Table 2 Response rate by recruitment site Recruitment site
n
%
Completed surveys at clinic site
42
61.7
Completed surveys via random sampling in community
26
38.3
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J Immigrant Minority Health Table 3 Prevalence of leading IPV risk factors Risk factor
Table 4 Views on violence n (%) or M ± SD
Personal alcohol use Does not drink alcohol
46 (69.7)
No alcohol in past 30 days Less than once per week
a
Once per weeka
Question
n (%)
Believe violence is a problem in community
61 (92.4)
Most common types
14 (21.5)
Youth violence
1 (1.4)
Gang violence
58 (87.9)
3 (4.6)
Elder abuse
38 (57.6)
Number of drinks consumesb
58 (87.9)
Self-directed violence
30 (45.5)
1–2
11 (17.0)
Armed violence
41 (62.1)
3–4
4 (6.2)
Child maltreatment
49 (74.2)
C5
2 (3.0)
Workplace violence
42 (63.6)
Violence against women
57 (86.4)
Education None Completed or some elementary school
10 (14.5) 42 (60.8)
Completed or some junior high school
8 (11.5)
Completed or some high school
6 (8.6)
Other
1 (1.4)
Partner’s alcohol use Does not drink alcohol
34 (51.5)
No alcohol in past 30 days
2 (3.0)
Less than once per weeka
5 (7.6)
Once per week
a
2–3 times per weeka
14 (21.2) 2 (3.0)
Number of drinks partner consumesb 1–2
4 (6.3)
3–4
4 6.3)
C5
9 (17.3)
Kulis et al. [14] gender roles Affective femininity Submissive femininity
4.17 ± .89 2.70 ± .83
Assertive masculinity
3.31 ± 1.12
Aggressive masculinity
1.89 ± .83
SRIS score
4.34 ± .79
SRIS Sex Role Inventory Scale a
In the past 30 days. bNumber of drinks consumed in a typical day when person consumes alcohol
(60.8 %) had completed or attended elementary school, and over half (55.2 %) served as a household homemaker. Approximately two-thirds of participants (64.2 %) reported a weekly household income of less than $190 USD (approximate). Prevalence of IPV risk factors are presented in Table 3. Regarding alcohol use, 69.7 % reported never having used alcohol; 22 % had consumed alcohol in their lifetime, but not in the past 30 days. Just over half (51.5 %) reported that their partner did not drink alcohol. Of those participants that had a partner who drank alcohol, the majority (21.2 %) reported that their partner used alcohol once per week.
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Believe IPV is a problem for women in community Knowledge of resources
62 (93.9) 62 (95.4)
Table 3 also displays mean scores and standard deviations for both gender role scales. Results from Kulis et al.’s [14] scale yielded the following means, with a range of 1–5: mean affective femininity score was 4.17 (SD = .89), mean submissive femininity score was 2.70 (SD = .83), mean assertive masculinity score was 3.31 (SD = 1.12), and mean aggressive masculinity score was 1.89 (SD = .83). Higher scores indicate higher association with that particular trait. The mean score for the SRIS short form was 4.36 (SD = .79), with a range of 1–7. For this scale, a higher score indicates a higher identification with a feminist ideology, as opposed to a traditionalist view of gender roles. Table 4 reflects participant views on violence. Most participants (92.4 %) believed that violence is a problem in the community of LSR. Further, 86.4 % of participants identified violence against women as a problem in the community. Over 90 % of participants believe that IPV in particular is a problem for women in the community. When asked if they would be able to help a friend, or find help for a friend in the community that had experienced domestic or partner violence, 95.4 % responded ‘yes’. Pearson’s correlations were conducted between the key IPV risk factors, displayed in Table 5. Education showed an inverse association with age (r = -.23, p = .060), indicating older women received less education. An inverse correlation was also seen between education and aggressive masculinity (r = -.27, p = .037) and submissive femininity (r = -.31, p = .013), showing that as education level increases, association with negative gender role traits decreases. Submissive femininity and aggressive masculinity were positively correlated (r = .28, p = .030), indicating that identification with one trait is associated with identification of the other trait as well. Affective femininity and SRIS mean score were positively correlated (r = .37, p = .008), as anticipated since both scales
-.004 (.973)
-.09 (.507)
-.07 (.621)
Submissive femininity
SRIS
Marlowe Crowne
-.24 (.067)*
.07 (.639)
.05 (.724)
.01 (.911)
.06 (.642)
.05 (.705)
-.19 (1.79)
-.31 (.013)**
-.18 (.157)
-.27 (.037)**
-.05 (.683)
-.23 (.060)*
.15 (.237)
_
.18 (.145)
.15 (.244)
Education
* Significant at p \ .100; ** Significant at p \ .05
Weekly income during harvest season
-.12 (.354)
Positive femininity
a
.07 (.598)
Aggressive masculinity
.11 (.401)
-.12 (.337)
-.07 (.561)
-.07 (.582)
Age
Assertive masculinity
.18 (.145)
.04 (.762)
.15 (.244)
_
.19 (.138)
-.05 (.695)
Partner alcohol use
-.05 (.695)
Education
_
Personal Alcohol Use
Partner alcohol
Weekly income
Personal alcohol
Risk factor
Pearson correlation (significance)
Table 5 Leading risk factor correlations
.11 (.398)
.06 (.649)
.15 (.237)
-.17 (.201)
-.11 (.439)
-.02 (.903)
-.07 (.597)
-.16 (.229)
_
.04 (.762)
.19 (.138)
Weekly incomea
.02 (.877)
-.09 (.507)
.08 (.565)
-.13 (.327)
-.03 (.829)
.13 (.333)
_
.06 (.649)
-.23 (.060)*
-.12 (.337)
-.07 (.561)
Age
-.32 (.017)**
.14 (.338)
-.07 (.578)
.28 (.030)**
.17 (.184)
_
.13 (.333)
.11 (.398)
-.05 (.683)
.11 (.401)
-.07 (.582)
Assertive masculinity
-.10 (.431)
.21 (.137)
.32 (.011)**
-.03 (.804)
_
.17 (.184)
-.03 (.829)
-.16 (.229)
-.27 (.037)**
.06 (.642)
.07 (.598)
Aggressive masculinity
.008 (.953)
.37 (.008)**
-.13 (.330)
–
-.03 (.804)
.28 (.030)
-.13 (.327)
-.07 (.597)
-.18 (.157)
.01 (.911)
-.12 (.354)
Positive femininity
.14 (.315) -.35 (.007)**
_
-.13 (.330)
.32 (.011)**
-.07 (.578)
.08 (.565)
-.02 (.903)
-.31 (.013)**
.05 (.724)
-.004 (.973)
Submissive femininity
-.17 (.223)
_
.14 (.315)
.37 (.008)**
.21 (.137)
.14 (.338)
-.09 (.507)
-.11 (.439)
-.19 (.179)
.07 (.639)
.09 (.507)
SRIS
_
-.17 (.223)
-.35 (.007)**
.008 (.953)
-.10 (.431)
-.32 (.017)**
.02 (.877)
-.19 (.147)
.05 (.705)
-.24 (.067)*
-.07 (.621)
Marlowe Crowne
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measure positive gender role traits with higher scores indicating a more feminist ideology. Significant correlations were found between the MCSD and partner alcohol use (r = -.24, p = .067), assertive masculinity (r = -.32, p = .017), and submissive femininity (r = -.35, p = .007). Comparisons were made to examine internal consistency reliability between both gender role scales. Assertive masculinity and affective femininity, measuring positive gender role traits, had similar reliabilities (a = .43 and a = .49, respectively). The two subscales measuring negative gender role traits, aggressive masculinity and submissive femininity, also had similar reliabilities (a = .35 and a = .38, respectively). Affective femininity’s internal consistency is also comparable to the SRIS scale (a = .52). While the individual scale reliabilities were not particularly high, they were comparable to their corresponding scales.
Discussion To our knowledge, this was the first study to quantitatively assess the prevalence of leading risk factors (high alcohol use, strict gender beliefs, low education, and low SES) for IPV in the colonia of LSR in San Quintı´n. Results revealed that the majority of participants believe that IPV is a problem within the community, and baseline measures of each risk factor were obtained. Results partially supported the second hypothesis that high alcohol use is prevalent in the colonia of LSR. Overall alcohol consumption was relatively low, however compared to the results from a Mexican national study [8], the current study found alcohol use among women to be higher among this sample, while male partner alcohol consumption was lower. This may be attributed to the self-report measurement or social desirability. Contrary to the third hypothesis, results from the current study indicate that participants had a higher association with feminist ideology, rather than traditional gender roles. This may be due to the differing social and cultural norms of this population. For example, in this migrant community where extra income is essential, it becomes more common for males and females alike to work in the fields, outside the home. The questions that suggest a difference between male working roles and female working roles may not apply since both genders work outside of the home, and likely in similar work environments. This could explain the perceived lack of traditional gender roles in this community. In congruence with the fourth hypothesis, low SES and low education levels were highly prevalent in this community. More than half of the participants reported weekly earnings of less than $190 USD during the regular
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strawberry harvest season of March, April, and May. Regarding education, the majority of participants reported no education, or only having completed or attended some elementary school. Further, many residents in the colonia LSR are living in extreme poverty. With high levels of poverty, individuals begin working at very young ages to lessen the financial burden, which leads to low levels of education in the colonia LSR. Limitations The analysis of IPV was limited by the cross-sectional design of the study, as causal inference cannot be made between IPV and identified risk factors. Further, the external validity may be low, as sampling was from a small migrant agricultural town in Baja California, Me´xico. In addition, the initial recruitment goal of this research study was N = 100. With the variability of attendees at the twoday clinic, the final sample size was N = 68. In review of the results, this small sample size may further limit the external validity of the study. As with any self-report survey, self-report bias is also a limitation to the validity of this study. Limitations may also include the psychometric properties of the risk factors studied. The measurement of alcohol use in the community may not have accurately assessed alcohol consumption, as the wording of the question may have evoked social desirability in responses. Given the sensitive nature of some of these questions, participants may have been influenced by social desirability. They may have been reluctant to answer truthfully for fear of being overheard by partners, family members, and/or friends during the interview. To account for this, the inclusion of the social desirability scale showed the degree of influence this bias had on the study results. Analysis of the social desirability scale suggests social desirability was a factor in responses to questions assessing these risk factors. This was anticipated given the sensitive nature of the questions on this survey. Since this research team was not adequately equipped to counsel and address IPV in this community, direct questions about IPV prevalence were not asked. Rather, questions investigated prevalence of key IPV risk factors, as well as proxy questions regarding violence in the community. While these risk factors are established in the literature as correlates to IPV, it cannot be assumed that the presence of these factors equates to IPV prevalence. Further, almost all participants stated that they would be able to help a friend if they had experienced IPV. Selection bias may have influenced the results of this study, as people who voluntarily seek help at a community medical clinic may be more likely to know of available resources in the community.
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Future studies should attain or create more accurate and culturally appropriate measures of leading IPV risk factors. To assess alcohol use, we recommend distinction of alcohol type, as well as inquire about religious beliefs and practices regarding alcohol. Considering the high levels of poverty in the community, we recommend that future studies assess SES via open-ended questions, and/or provide income categories that accurately reflect the population. Also, evaluating the partner’s education level would be beneficial, as an uneven education level in a relationship may contribute to a conflict in gender roles. Further, it is recommended that future studies evaluate financial control of household finances since IPV also includes economic abuse [18]. While both spouses may contribute to household income, it is unknown whether financial control is shared or dominated by a partner. New Contribution to the Literature Previous research suggests that many women experiencing IPV in Me´xico do not seek help due to shame, or more importantly because they do not trust the state or the health sector [19]. It is now known that resources are available to women and children in need of, or seeking help for, IPV in the colonia LSR. It is apparent that IPV is highly prevalent in the community, thus future research and interventions should consider providing educational opportunities for women and children. Focus groups may be beneficial to learn about coping strategies within the community, the prevalence of mental health stressors, and determining support strategies for women in the community. This study contributes to the limited body of research that discusses IPV risk factors specific to rural Mexican communities. These results may be used as baseline measures for future research studies on violence in San Quintı´n, Baja California, and may inform on various projects related to IPV in global public health projects.
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