Preventive Medicine 47 (2008) 559564

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Preventive Medicine
j o u r n a l h o m e p a g e : w w w. e l s e v i e r. c o m / l o c a t e / y p m e d

Proling risk of fear of an intimate partner among men and women

E. Carolyn Olson , Bonnie D. Kerker, Katharine H. McVeigh, Catherine Stayton,
Gretchen Van Wye, Lorna Thorpe
Division of Epidemiology, NYC Department of Health and Mental Hygiene, 125 Worth Street, Room 315, CN #6, New York, NY 10013, USA

a r t i c l e i n f o a b s t r a c t

Article history: Objective. Fear of a partner, a component of intimate partner violence (IPV), can be used in clinical IPV
Available online 23 August 2008 assessment. This study examines correlates of fear in a population-based, urban sample to inform a gender-
specic health care response to IPV.
Keywords: Methods. This study used pooled data on 9687 men and 13,903 women collected in 2002, 2004 and 2005
Domestic violence through three random-digit-dial surveys of New York City adults. Bivariate and multivariable analyses were
Risk assessment
used to examine associations between fear and sociodemographic and health-related factors.
Fear
Sexual behavior
Results. There was no signicant difference in age-adjusted prevalence of reported fear of a partner
Alcohol between women (2.7%) and men (2.2%). In multivariable analysis, fear was correlated with being female,
younger age, divorced or separated marital status, poor self-reported health status, and multiple sex partners.
The most striking gender difference was in the stronger association with multiple sex partners among
women (adjusted Odds Ratio [aOR] = 6.2; p b 0.01). Binge drinking was correlated with fear only among low-
income adults (aOR = 2.8; p b 0.01).
Conclusion. IPV is a health concern for both men and women, and a risk prole for fear can guide IPV
assessment in health care. Physicians should consider multiple sex partners in women and alcohol misuse in
low-income patients as potential markers for IPV.
2008 Elsevier Inc. All rights reserved.

Introduction
Intimate partner violence (IPV) is a public health problem that
clinicians can identify in their patients (AMA, 1992; Gerbert et al.,
1999). Research has documented the health impacts of IPV, including
injury, development of chronic disease, frequent mental distress and
poor overall health status (Coker et al., 2002; Vest et al., 2002). IPV also
has been linked to increased health risk behaviors, such as substance
use, current smoking and high-risk alcohol use (Coker et al., 2002;
Cunradi et al., 1999; Lemon et al., 2002).
Research to inform IPV identication in clinical settings has
historically focused on the abuser's physical, sexual and psychological
tactics. However, identication of abuse, particularly coercion and
control, also requires questions about a victim's own experience
(Saltzman et al., 2002). One empirically established domain of
women's IPV experiences, perceived threat (Smith et al., 1995),
includes fear of an intimate partner. Traditionally examined as a
component of psychological abuse, fear also often accompanies and
can be a precursor to physical violence in a relationship (Coker et al.,
2007; Hathaway et al., 2000; Thompson et al., 2006). Fear of a partner
was shown to be strongly associated with physical IPV among female
emergency department patients, making it an appropriate, potentially
Corresponding author. Fax: +1 212 788 4473.
E-mail address: colson@health.nyc.gov (E.C. Olson).
easy area of questioning with which to initiate clinical IPV assessment
(Dearwater et al., 1998). Researchers also have examined fear to
distinguish severe, systematic IPV from situational or common
couple violence, which is less severe, more episodic, and more likely
perpetrated by both partners (Hamberger and Guse, 2002; Johnson,
2005, 2006; Miller, 2006).
Prior research on self-reported fear has largely focused on women.
A representative study of Massachusetts women found that 3.7%
reported past-year fear of a partner, but the study did not provide data
on men (Hathaway et al., 2000). One population-based study that did
compare women and men found somewhat higher rates of lifetime
experience of abuse of power and control including fear of a
partner among women and demonstrated an association with
chronic health problems (Coker et al., 2002). Other studies based on
non-probability samples also have found higher rates of fear among
women (Cercone et al., 2005; Follingstad et al., 1991; Hamberger and
Guse, 2002; Holzworth-Monroe, 2005; Phelan et al., 2005). No
published studies have compared women and men on the character-
istics or behaviors that are associated with fear of a partner, despite
increasing calls to identify IPV victimization among men (FVPF, 2004;
Mechem et al., 1999; Willis and Porche, 2003). Such knowledge could
help clinicians better identify at-risk patients who should be assessed
for IPV, including fear (Gerber et al., 2005).
This study used a population-based, urban sample to examine
gender similarities and differences in the correlates of self-reported

0091-7435/$ see front matter 2008 Elsevier Inc. All rights reserved.
doi:10.1016/j.ypmed.2008.08.005
560 E.C. Olson et al. / Preventive Medicine 47 (2008) 559564
fear of a partner in the past year, including sociodemographic
characteristics, health status and risk-taking behaviors. We hypothe-
sized that women would be more likely to report fearing a partner
than men, and that correlates of fear would differ by gender. Based on
our ndings, we created a risk prole for fearing a partner to inform
gender-specic public health responses to IPV in health settings.
Methods
Data collection and sample
The New York City Community Health Survey (NYC CHS) is an
annual random-digit-dial, cross-sectional survey of approximately
10,000 non-institutionalized adults ages 18 and older administered by
the NYC Department of Health and Mental Hygiene. Data for this study
were collected through computer-assisted telephone interviews
conducted in 2002, 2004 and 2005. A stratied random sample
design was used with probability of selection based on neighborhood
of residence and number of adults in the household; neighborhoods
were dened by 33 zip-code aggregations in 2002 and 34 in 2004 and
2005. One adult was randomly selected as the respondent in each
eligible household. Surveys were conducted in 9 languages in 2002
and more than 40 languages in 2004 and 2005.
The three samples (N = 9764 in 2002; N = 9585 in 2004; N = 9818 in
2005) represented cooperation rates of 64% [percent of eligible
households contacted (AAPOR, 2000)] in 2002, 59% in 2004, and
71% in 2005. Records with incomplete data on fearing a partner were
excluded, and the sample was restricted to ages 1864. The nal
combined sample size was 23,590 (9687 men; 13,903 women).
Respondents with missing data for independent variables were not
included in bivariate analyses. The multivariable model was based on
the 18,346 respondents with complete data for all included variables.
Measures
CHS survey questions were adapted from the Behavioral Risk Factor
Surveillance System [BRFSS (CDC, 2002a)] and the National Health
Interview Survey (CDC, 2002b) and cover demographics, health status,
risk-taking behaviors, and health care access. To measure fear of a
partner, all respondents were asked: In the past 12 months, have you
been frightened for the safety of yourself, your children or friends
because of the anger or threats of an intimate partner? The denition
of intimate partner was not further specied. Other IPV research has
also used this question (Bonomi et al., 2006; Hathaway et al., 2000;
Lemon et al., 2002; Thompson et al., 2006).
Key independent variables
Demographic variables included gender, age, race/ethnicity, marital
status, interview language, and country of birth. Education, employ-
ment, health insurance, and household income (low:b200% of the
federal poverty level; middle: 200%399%; high: 400%) were used as
proxies for socioeconomic status. In 2002, household income was
categorized in dollar ranges, so federal poverty level groups were
imputed. Health status was measured as self-reported overall health.
Risk-taking behaviors included binge drinking in the past month (ve
or more drinks on one occasion), and number of sex partners in the
past year. Having at least one same-sex sex partner in the past year also
was examined.
Statistical analyses
Data from 2002, 2004, and 2005 were combined and weighted to
account for unequal selection probabilities and non-response. Primary
weights consisted of the number of adults in each household divided
by the number of residential phone lines. Post-stratication weights
were used to adjust the data to the age, sex, and racial/ethnic
composition of each neighborhood, according to the U.S. Census 2000
(US Census Bureau, 2000).
Bivariate analyses were conducted to examine the relationship
between fear of a partner and hypothesized correlates, and stratied
analyses were used to explore income interactions for possible
inclusion in the multivariable model. Results were age-adjusted to
the Year 2000 Standard Population. Student's t-tests were used to
assess differences in the age-adjusted prevalence of fear between
different subgroups.
A logistic regression model of reported fear of a partner was
constructed for the full sample. Independent variables were added in
forward stepwise modeling based on their signicance level in bivariate
Chi-square analyses (p b 0.10) and kept in the model according to the
Wald F test (p b 0.05). Variables dropped during model-building were
added back to the nal model to assess for possible confounding (odds-
ratio change 15%). Age was kept as a potential confounder. No evidence
of collinearity between independent variables was found using a
Kendall Tau correlation matrix. To test our hypothesis of gender
differences in the risk prole for fear, interactions with gender were
explored for all signicant correlates, after nalizing the main-effects
model. Interactions between income and both number of sex partners
and binge drinking were also tested, based on their signicance in
bivariate, stratied analyses. Interactions with signicant Wald F p-
values were retained. All analyses were conducted using SAS-callable
SUDAAN 9.0 (RTI International, Research Triangle Park, NC, 2005) to
correct standard errors for the complex sample design.
Results
Among NYC adults, 2.7% (95% condence interval [CI]: 2.4%, 3.1%)
of women and 2.2% (CI: 1.9%, 2.7%) of men reported fear of an intimate
partner in the past year. There was no signicant difference in
prevalence between women and men.
Bivariate analyses
Differences in fear were found across age, racial/ethnic, and
marital-status groups (Table 1). Both divorced and never-married
respondents had a higher prevalence of fear than partnered adults, but
a lower prevalence than separated adults (p b 0.01). Fearing a partner
was elevated among lower socioeconomic groups, including those
who did not complete high school, unemployed adults, uninsured
adults, and low- and middle-income adults. Reported fear also varied
by health status and risk-taking behaviors. Binge drinkers were more
likely to report fear than non-binge drinkers, and fear was more than
twice as high among those with three or more past-year sex partners
as those with two or fewer.
Patterns between fearing a partner and associated correlates were
relatively similar between men and women, with a few exceptions.
Among those with three or more sex partners, women were nearly
twice as likely as men to report fear (8.9% vs. 4.6%; Student's t-test
p = 0.01). Having a same-sex sex partner was associated with reported
fear among women only. Language of interview had opposite effects
on fearing a partner by gender: English-speaking women had a higher
prevalence than non-English-speaking women, while English-speak-
ing men had a lower prevalence than non-English-speaking men.
Country of birth (U.S.-born vs. foreign-born) was not signicantly
associated with fear among women or men (data not shown).
We used stratied, bivariate analyses to explore the effect of
income on the associations between fearing a partner and both
number of sex partners and binge drinking. Low-income adults with
multiple sex partners were more than four times as likely to report
fear as those with high incomes (10.6% vs. 2.5%, Student's t-test
p = 0.000). We found that income also modied binge drinking, with
low-income binge drinkers three times as likely to report fear as high-
income binge drinkers (6.6% vs. 1.6%, Student's t-test p = 0.000).
 E.C. Olson et al. / Preventive Medicine 47 (2008) 559564 561

Multivariable analyses
Table 2 presents two multivariable logistic regression models of
fear of an intimate partner: a main-effects model and a nal model
with interaction terms. The main-effects model shows that women
were 60% more likely to report fear of a partner than men (adjusted
odds ratio [aOR] = 1.6; CI: 1.2, 2.1). Separated and divorced adults
were more than twice as likely to report fear as those with partners,
and widowed adults were less likely. Both adults of lower house-
hold income and those without a high school diploma were more
likely to report fear than high-income adults and college graduates,
respectively. Adults who reported poor overall health had more
than twice the odds of fearing a partner of those with very good/
excellent health (aOR = 2.5; CI: 1.6, 4.1). Both risk-taking behaviors,
binge drinking and having multiple sex partners, were indepen-
dently associated with fear of a partner. Adults with multiple sex
partners had the highest odds of reporting fear (aOR = 2.8; CI:
1.9, 4.1).
Two interactions were observed in the nal model. Women with
multiple sex partners were more than twice as likely to report fear as

Table 1
Age-adjusted prevalence of fear of a partner by independent variables, New York City 200220042005

Total population Women only Men only

na % reporting fear 95% condence na % reporting fear 95% condence na % reporting fear 95% condence
interval interval interval
Total 579 2.5 (2.2, 2.8) 374 2.7 (2.4, 3.1) 205 2.2 (1.9, 2.7)
Age (not age-adjusted)
1824 (ref) 89 3.9 (3.0, 5.1) 48 3.8 (2.6, 5.5) 41 4.0 (2.8, 5.8)
2544 332 2.7 (2.3, 3.1) 225 3.0 (2.6, 3.6) 107 2.3 (1.8, 2.9)
4564 158 1.6 (1.3, 1.9) 101 1.8 (1.4, 2.3) 57 1.4 (1.0, 1.9)
Race/ethnicity
Non-Hispanic White (ref) 132 1.4 (1.2, 1.8) 76 1.6 (1.2, 2.2) 56 1.2 (0.9, 1.6)
Non-Hispanic Black 166 2.7 (2.3, 3.3) 121 2.9 (2.4, 3.6) 45 2.4 (1.7, 3.4)
Hispanic 227 3.7 (3.1, 4.4) 140 3.7 (3.0, 4.7) 87 3.7 (2.8, 4.8)
Other 54 2.0 (1.4, 2.8) 37 2.6 (1.7, 4.0) 17 1.5b (0.8, 2.7)
Marital status
Partnered [married; member 164 1.8 (1.5, 2.3) 102 2.1 (1.6, 2.7) 62 1.7 (1.1, 2.7)
of unmarried couple] (ref)
Never married 229 2.5 (2.1, 2.9) 139 2.6 (2.2, 3.2) 90 2.3 (1.8, 3.0)
Divorced 87 3.8 (2.7, 5.2) 66 4.4 (2.9, 6.6) 21 2.7 (1.6, 4.6)
Separated 86 9.5 (6.4, 14.0) 58 9.3 (5.4, 15.5) 28 10.0 (5.8, 16.6)
Widowed 11 2.5b (0.8, 7.7) 9 1.5b (0.7, 3.4) 2 4.8b (0.8, 24.6)
Education
Did not complete high school 148 4.5 (3.6, 5.6) 97 4.8 (3.6, 6.3) 51 4.1 (2.8, 6.1)
High school graduate 136 2.5 (2.0, 3.1) 82 2.4 (1.8, 3.2) 54 2.5 (1.8, 3.5)
Some college or technical school 132 2.2 (1.8, 2.8) 86 2.4 (1.8, 3.2) 46 2.1 (1.5, 2.9)
College graduate (ref) 161 1.9 (1.4, 2.4) 108 2.2 (1.7, 2.9) 53 1.5 (0.9, 2.4)
Employment
Employed (ref) 358 2.3 (2.0, 2.7) 219 2.5 (2.1, 3.0) 139 2.2 (1.7, 2.7)
Unemployed 85 3.5 (2.7, 4.6) 54 4.0 (2.8, 5.6) 31 3.0 (2.0, 4.5)
Not part of labor force 131 2.6 (2.0, 3.2) 101 2.8 (2.1, 3.6) 30 2.0b (1.1, 3.7)
Household income
(% of federal poverty level)
Low:b 200% 263 3.3 (2.8, 3.8) 174 3.2 (2.7, 3.9) 89 3.3 (2.5, 4.3)
Middle: 200399% 127 2.6 (2.1, 3.3) 90 3.2 (2.4, 4.2) 37 2.0 (1.3, 3.0)
High: 400% or higher (ref) 127 1.5 (1.2, 2.0) 73 1.9 (1.4, 2.7) 54 1.2 (0.8, 1.6)
Health insurance
Yes (ref) 440 2.2 (2.0, 2.5) 297 2.4 (2.1, 2.8) 143 2.0 (1.6, 2.5)
No 130 3.5 (2.8, 4.4) 69 3.8 (2.8, 5.1) 61 3.3 (2.3, 4.5)
Binge drank (past month)
Yes 112 3.7 (2.9, 4.6) 50 4.7 (3.4, 6.4) 62 3.2 (2.3, 4.4)
No (ref) 451 2.2 (2.0, 2.5) 317 2.4 (2.1, 2.8) 134 1.9 (1.6, 2.4)
Number of sex partners (past year)
02 (ref) 455 2.2 (2.0, 2.3) 320 2.5 (2.2, 2.9) 135 1.9 (1.5, 2.4)
3 or more 92 5.6 (4.3, 7.1) 37 8.9 (6.3, 12.6) 55 4.6 (3.3, 6.3)
At least 1 same-sex sex partner
(among adults sexually active in past year)
Yes 56 5.7 (4.1, 7.8) 33 8.8 (5.9, 12.8) 23 4.0 (2.4, 6.4)
No (ref) 370 2.3 (2.0, 2.6) 233 2.3 (2.0, 2.7) 137 2.2 (1.8, 2.8)
Self-reported health status
Excellent/Very good (ref) 225 1.8 (1.6, 2.2) 137 2.0 (1.6, 2.5) 88 1.7 (1.3, 2.2)
Good 186 2.6 (2.2, 3.2) 122 2.9 (2.3, 3.7) 64 2.3 (1.7, 3.0)
Fair 105 4.0 (3.0, 5.3) 71 3.9 (2.9, 5.3) 34 4.0 (2.5, 6.5)
Poor 59 4.7 (3.2, 6.8) 43 5.6 (3.6, 8.8) 16 3.7b (1.9, 6.9)
Language of interview
English (ref) 504 2.4 (2.2, 2.7) 334 2.8 (2.4, 3.3) 170 2.0 (1.7, 2.4)
Other than English 75 2.8 (2.0, 3.9) 40 1.8 (1.2, 2.7) 35 3.7 (2.4, 5.8)

Data source: NYC Community Health Survey 200220042005; adults ages 1864. Data analyzed by the New York City Department of Health and Mental Hygiene, Bureau of
Epidemiology Services, in 2007.
a
Unweighted N (number of respondents) and weighted, age-adjusted percentages (prevalence) reported.
b
Relative standard error (RSE)N0.30; estimate should be interpreted with caution.
p-value b 0.05.
p-value b 0.01.
562 E.C. Olson et al. / Preventive Medicine 47 (2008) 559564

Table 2
Multivariable logistic regression models of fear of a partner, New York City 200220042005

Main-effects model Final model with interactions

Adjusted odds ratioa 95% condence interval p-valueb Adjusted odds ratioa 95% condence interval p-valueb
Sex 0.002
Male 1.0
Female 1.6 (1.2, 2.1)
Age 0.000 0.000
1824 1.0 1.0
2544 1.0 (0.7, 1.4) 1.0 (0.7, 1.5)
4564 0.5 (0.3, 0.8) 0.5 (0.3, 0.8)
Marital status 0.000 0.000
Partnered 1.0 1.0
Never married 1.3 (0.9, 1.7) 1.3 (1.0, 1.8)
Divorced 2.0 (1.4, 3.0) 2.1 (1.4, 3.0)
Separated 2.5 (1.6, 3.8) 2.5 (1.7, 3.9)
Widowed 0.7 (0.2, 2.1) 0.7 (0.2, 2.2)
Household income 0.028
Low 1.5 (1.1, 2.2)
Middle 1.5 (1.1, 2.1)
High 1.0
Education 0.030 0.026
Did not complete high school 1.7 (1.1, 2.5) 1.7 (1.2, 2.6)
High school graduate 1.2 (0.8, 1.7) 1.2 (0.8, 1.7)
Some college or technical school 1.0 (0.7, 1.3) 1.0 (0.7, 1.4)
College graduate 1.0 1.0
Self-reported health status 0.000 0.000
Excellent/Very good 1.0 1.0
Good 1.5 (1.1, 2.0) 1.5 (1.1, 2.0)
Fair 2.0 (1.3, 2.9) 2.0 (1.4, 2.9)
Poor 2.5 (1.6, 4.1) 2.6 (1.6, 4.2)
Binge drank (past month) 0.003
Yes 1.7 (1.2, 2.4)
No 1.0
Number of sex partners (past year) 0.000
02 1.0
3 or more 2.8 (1.9, 4.1)
Sex # of sex partners 0.027
Male, 02 partners 1.0
Male, 3 + partners 2.2 (1.3, 3.5)
Female, 02 partners 1.4 (1.0, 1.9)
Female, 3+ partners 6.2 (3.7, 10.3)
Binge drank household income 0.009
Binge drank, low income 2.8 (1.7, 4.8)
Binge drank, middle income 1.7 (0.9, 3.2)
Binge drank, high income 0.9 (0.5, 1.5)
No binge drinking, low income 1.1 (0.8, 1.7)
No binge drinking, middle income 1.3 (0.9, 2.0)
No binge drinking, high income 1.0

Data source: NYC Community Health Survey 200220042005; adults ages 1864. Data analyzed by the New York City Department of Health and Mental Hygiene, Bureau of
Epidemiology Services, in 2007.
a
Odds ratios adjusted for variables shown in each model.
b
Overall Wald F p-value for each categorical variable/interaction.

men with multiple partners (aOR = 6.2; CI: 3.7, 10.3 vs. aOR = 2.2; CI:
1.3, 3.5), and binge drinking was associated with fear only among low-
income adults (aOR = 2.8; CI: 1.7, 4.8).
Discussion
In this population-based study of New York City adults, the
prevalence of reported fear of an intimate partner was similar
between women and men. However, additional analyses suggested
important gender-dependent variation in behavioral risk factors for
IPV. No previous population-based research has compared the past-
year prevalence of fear among men and women. Our estimate of fear
among women was similar to that found in a representative sample
of Massachusetts women (Hathaway et al., 2000), but results of our
gender comparison differed from a national study that found
somewhat higher rates lifetime psychological IPV (including fear)
among women than men (Coker et al., 2002). Our risk prole of
fearing an intimate partner conrmed previous research on the
sociodemographic and health status correlates of IPV (Hathaway
et al., 2000; Coker et al., 2002; Rennison and Planty, 2003; Vest et al.,
2002). Our study also identied unique associations between fear
and risk-taking behaviors, highlighting the role of poverty. These
ndings may be informative in identifying markers for IPV assess-
ment in clinical settings.
We found that the magnitude of the association between number
of sex partners and fear differed by gender. While both men and
women with multiple partners were more likely to report fear, the
odds were three times higher among women. Prior studies have not
examined the connection between the number of sex partners and
fear among men or women, but associations have been found between
multiple partners and physical IPV among women (El-Bassel et al.,
1998; He et al., 1998; Sormanti et al., 2004; Wenzel et al., 2004; Wu
et al., 2003) and between multiple partners and dating violence
among male and female adolescents (Silverman et al., 2001, 2004;
Valois et al., 1999; Kreiter et al., 1999). More sex partners of either
gender may provide more opportunity for exposure to IPV. We found
that having at least one same-sex partner was associated with fear
among women but dropped from the multivariable model, suggesting
 E.C. Olson et al. / Preventive Medicine 47 (2008) 559564
that number of partners was more powerfully correlated with fear
than partner gender.
Income modied the association between binge drinking and
fear of a partner in our analysis. Among low-income adults, reported
fear was more than twice as high for binge drinkers as non-binge
drinkers; among high-income adults, there was no relationship
between alcohol and fear. While research has linked alcohol use to
IPV among both men and women (Coker et al., 2002; Cunradi et al.,
1999; Lemon et al.; 2002), no previous studies have identied a
stronger relationship between alcohol use and fear among low-
income adults. Our ndings may point to alcohol use as method to
deal with the compounded stress of IPV and economic hardship.
Prior research has shown hazardous drinking used as a coping
mechanism among adults with depression (Roeloffs et al., 2001).
Alternatively, the monetary and opportunity costs of binge drinking
may present personal challenges in households of limited means,
fueling interpersonal tensions. Regardless of direction, our ndings
demonstrate a strong correlation between binge drinking and
fearing a partner among poor adults. When alcohol misuse is
identied in health care settings, particularly those serving low-
income populations, providers should discuss IPV, including fear,
with patients.
We found evidence that both poverty and gender affect the
relationship between multiple sex partners and fear. Our stratied,
bivariate analyses suggest an association between multiple sex
partners and fear among low-income adults, but they cannot
illuminate the direction of this relationship. It may be that adults
with unstable incomes who report having multiple sex partners are
engaging in sex in exchange for security, drugs, or money, which has
been shown to increase IPV risk among women (Dunkle et al., 2004;
Wechsberg et al., 2005; Wenzel et al., 2004). Conversely, research
also has demonstrated that women who experienced childhood
abuse (Hillis et al., 2001) or lifetime sexual assault (Brener et al.,
1999) were subsequently more likely to engage in sexual risk
behaviors. While the causal pathway between fear and multiple
partners remains unclear, our results indicate that sexual risk-taking
behavior is strongly correlated with fearing a partner, and this may
be particularly true among low-income patients. Standard sexual
risk factor screening in reproductive and sexual health care settings
should be expanded to include discussion of IPV when risk factors
are identied.
Our ndings shed new light on the inuence of poverty on health
and violence, suggesting that risky behaviors are more closely linked
to IPV among poor adults. This may be due to lack of support or
resources to deal with either the violence experienced or negative
consequences of risk-taking behaviors. These results invite research-
ers to further examine the pathways through which poverty not only
elevates the risk of IPV and risk-taking behaviors, but also increases
the concurrence of violence and such behaviors. Our results suggest
that the identication of certain behaviors should raise clinicians'
awareness about possible IPV and guide IPV assessment.
Study limitations and strengths
While the strengths of this study lie in its diverse, population-
based sample, the cross-sectional design does not allow for the
determination of causality. Adults without a landline telephone were
not included in the sampling frame, introducing possible selection
bias. Self-report data may lead to underestimates of fear prevalence if
respondents are not comfortable disclosing IPV. Multi-question scales
of fear and disempowerment related to IPV have been shown to
capture a higher prevalence of abused women than our single
question (Bonomi et al., 2006). Moreover, it has been hypothesized
that men experience more stigma than women about reporting IPV
victimization (Mechem et al., 1999; Willis and Porche, 2003), although
we found no evidence to suggest differential underreporting by
563
gender. Men and women also may have different perceptions (Hankin
and Abramson, 2001) about what constitutes fear and therefore be
referring to different phenomenon when responding to the question.
Further research should explore gender differences in experiences
that result in fearing a partner and their connections to violence.
We cannot examine the extent to which men and women
responded positively to the fear question because of threats to the
safety of children, rather than to themselves. The lower prevalence of
fear among non-English-speaking women may indicate that the
concept of fearing a partner was not effectively communicated to this
group and identication of IPV in non-English-speaking populations
may require specialized, culturally-appropriate assessment tools.
Finally, our study could not examine the co-occurrence of specic
physical, sexual or psychological abuse tactics with fear. However,
other studies have found that psychological abuse, including fear of a
partner, is linked to multiple forms of IPV (Coker et al., 2007;
Dearwater et al., 1998).
Conclusions
Our nding of gender parity in reported fear and correlated risk
factors suggests that health care professionals should address IPV and
its consequences with both women and men. Fearing a partner has
strong associations with risk-taking behaviors, particularly in low-
income populations. Sexual risk behavior may signal the need for IPV
assessment, particularly among low-income and female patients.
Among low-income adults, identication of alcohol misuse indicates a
need for discussion about IPV. Clinicians may nd it easier to address
IPV by rst asking patients with identied risk characteristics about
fear of an intimate partner before asking about specic abusive tactics.
Such targeted assessment could lead to more identication and
effective referral of IPV in health settings.
Conict of Interest
The authors have no conict of interest to declare.
Acknowledgments
This research was funded by the New York City Department of
Health and Mental Hygiene. We would like to thank Donna
Eisenhower, director of the NYC Community Health Survey (CHS);
Chitra Ramaswamy for CHS data management; Shannon Farley for
data checking; and Debbie Prior for her research assistance.
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