Slide 1

Prevalence of Violent Disagreements in US Families: Residence, Race or Ethnicity, and Parental Stress
Charity G Moore, PHD
University of North Carolina
Janice C Probst, PHD
Mark Tompkins, PHD
Steven Cuffe, MD
Amy B Martin, DRPH
University of South Carolina

Slide 2

NSCH and Violence
Looking for an Asthma in Children dataset
Discovered questions on disagreements in household
National data, large sample: more than 100,000
Study purpose: National estimates and estimates for rural minorities

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Factors of Interest
Residence, Rural; and Race or Ethnicity
Poverty
Shortage of health care providers
Lack of health insurance
Fewer economic resources
See Rural Health Response to Domestic Violence: Policy and Practice Issues: http://ruralhealth.hrsa.gov/pub/domviol.htm

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Rural Disadvantage: 2003 NSCH Data
On three bar graphs, the Y-axis gives percentages and the X-axis lists Small Rural, Medium Rural, Large Rural, and Urban. On the graph labeled Poverty, the bars marked Less than 100 Percent FPL show 25 percent for Small Rural, 21 percent for Medium Rural, and 17 percent each for Large Rural and Urban. On the same graph, the bars marked 100 to 199 Percent FPL show 31 percent for Small Rural, 30 percent for Medium Rural, 28 percent for Large Rural, and 21 percent for Urban. The graph labeled Public or No Health Insurance shows 48 percent for Small Rural, 43 percent for Medium Rural, 37 percent for Large Rural, and 34 percent for Urban. The graph labeled Parental Education Less than or Equal to High School shows 46 percent for Small Rural, 42 percent for Medium Rural, 36 percent for Large Rural, and 32 percent for Urban.

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Factors of Interest
Residence
Race or Ethnicity
Parental Stress

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Defining Key Variables: Violence
When you have a serious disagreement, do you:
1: Discuss calmly
2: Argue heatedly or shout, or
3: End up hitting or throwing things
Three levels of disagreement:
Violent: Any occurrence of hitting or throwing
Heated: Argue or shout sometimes, usually, or always
Calm: All others

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Definitions, continued
Residence: 
County level
Rural-Urban Continuum Codes 
Four levels: urban, large rural, med rural, small rural
Race or ethnicity: White, Black, Hispanic, and Other
Parental Stress:
Child was hard to care for
Child bothered parent
Felt angry with him or her
Split at the seventy-fifth percentile

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Nationally, 1 in 10 children experiences violent disagreements: 10.3 percent
A color-coded map of the United States is labeled Prevalence of Violent Disagreements, by State. Arkansas, Idaho, Indiana, Kansas, Kentucky, Maine, Nebraska, North Carolina, North Dakota, Oklahoma, Oregon, Tennessee, Vermont, Washington, and West Virginia have prevalences of 5.84 to 8.19. Alabama, Connecticut, Iowa, Massachusetts, Minnesota, Montana, New Hampshire, Rhode Island, and Wyoming have prevalences of more than 8.19 to 9.29. Arizona, California, Colorado, Florida Michigan, Missouri, New Mexico, Ohio, South Carolina, South Dakota, Texas, Virginia, and Wisconsin have prevalences of more than 9.29 to 11. Delaware, Illinois, Louisiana, Maryland, Nevada, New Jersey, New York, Pennsylvania, and Utah have prevalences of more than 11 to 12.72. Georgia and Mississippi have prevalences of more than 12.72 to 15.72.

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Residence
On a bar graph, the Y-axis gives percentages and the X-axis lists types of residence. The bars labeled Heated show 29 for Small Rural, 31 each for Medium Rural and Large Rural, and 32 for Urban. The bars labeled Hit or Throw show 10 for Small Rural, 8 for Medium Rural, 9 for Large Rural, and 11 for Urban. P is less than 0.0001.

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Race or Ethnicity
On a bar graph, the Y-axis gives percentages and the X-axis lists races and ethnicities. The bars labeled Heated show 32 for Hispanic, 30 for White, 37 for Black, and 32 for Other. The bars labeled Hit or Throw show 11 for Hispanic, 9 for White, 15 for Black, and 12 for Other. P is less than 0.0001.

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Parental Stress
On a bar graph, the Y-axis gives percentages and the X-axis lists stress levels. The bars labeled Heated show 29 for Low to Moderate Stress and 40 for High Stress. The bars labeled Hit or Throw show 8 for Low to Moderate Stress and 18 for High Stress. P is less than 0.0001.

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Examining Parental Stress
No difference across residence
On a bar graph, the Y-axis gives percentages and the X-axis lists types of residence. The bars show 24 for Small Rural, 23 each for Medium Rural and Large Rural, and 26 for Urban.
Minority parents slightly more likely to report high stress
On a bar graph, the Y-axis gives percentages and the X-axis lists races and ethnicities. The bars show 23 for Hispanic, 29 for White, 33 for Black, and 28 for Other.

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Violent Disagreements: Final Results
In a table, the main columns are Hit-Throw and Argue-Shout, each with the sub-columns OR and 95 Percent CI. The main rows are labeled Residence, reference urban; Race or Ethnicities, reference White; and Parenting Stress, reference low. The Hit-Throw OR’s are 0.86 for Rural, 1.03 for Hispanic, 1.73 for African-American, 1.38 for Other, and 3.17 for High Stress. The Hit-Throw 95 Percent CI’s are 0.77 and 0.95 for Rural, 0.87 and 1.21 for Hispanic, 1.51 and 1.98 for African-American, 1.14 and 1.67 for Other, and 2.91 and 3.47 for High Stress. The Argue-Shout OR’s are 0.98 for Rural, 1.07 for Hispanic, 1.41 for African-American, 1.17 for Other, and 1.99 for High Stress. The Argue-Shout 95 Percent CI’s are 0.95 and 1.05 for Rural, 0.95 and 1.20 for Hispanic, 1.29 and 1.54 for African-American, 1.04 and 1.33 for Other, and 1.87 and 2.12 for High Stress.

Included in the model but not shown: Child attributes including age, gender, health status, and health insurance; Parental characteristics including relationship to child, highest education in household, employment, parental health, perceived neighborhood support; and Family characteristics including poverty level, family structure, number of children, family mobility, primary language, and region.

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Conclusions
Violent and heated disagreements are not rare in US homes with children
No large differences across residence
Minority children are particularly at risk
Parenting stress may provide a clue for intervention

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Questions or Comments
Charity G Moore: cgmoore@med.unc.edu
Janice C Probst: jprobst@gwm.sc.edu