Publication of results based on propensity score methods has increased dramatically, but there is little evidence that these methods yield substantially different estimates compared with conventional multivariable methods.
Strangulation is a unique and particularly pernicious form of intimate partner violence. To increase the relatively little that is known about strangulation survivors, focus groups and interviews were conducted as part of a practice-research engagement with a domestic violence shelter. All of the participants had been strangled and, among them, almost all were strangled multiple times. The loss of consciousness was common. Participants associated "choking" with use of body parts and "strangling" with use of objects. Although some minimized the assault, most considered strangulation to be serious and reported a variety of medical conditions following the assault. Few sought medical care. Of those who did, few disclosed the assault, or were asked about strangulation, which commonly resulted in misdirected treatment. Implications for improving detection and treatment are discussed.
Strangulation is a unique and particularly gendered form of nonfatal intimate partner violence, affecting 10 times as many women as men. Medical research documents multiple negative health outcomes of such victimization, and in the past decade nearly 30 U.S. states have enacted laws making nonfatal strangulation a felony. We extended prior work by using grounded theory in a qualitative study to explore women's experiences of, thoughts about, and reactions to being strangled. Each of the 17 mostly well-educated and African American domestic violence shelter residents had been strangled at least once by an intimate partner; most had survived multiple strangulations. Despite other severe abuse and a high level of fear, all were shocked that their partner strangled them. Participants reported an intense sense of vulnerability when they recognized during the assault how easily they could be killed by their partner. Nonetheless, they seemed to think of strangulation, not as a failed murder attempt, but as a way to exert power. Efforts to extricate themselves from a ''choking'' largely failed and resistance resulted in an escalation of the violence. Moreover, strangulation is difficult to detect which, as participants observed, makes it especially useful to the abuser. The aftereffects permeated the relationship such that strangulation need not be repeated in order for her to be compliant and submissive, thus creating a context of coercive control.
We reviewed the literature on the epidemiology of nonfatal strangulation (also, albeit incorrectly, called choking) by an intimate partner. We searched 6 electronic databases to identify cross-sectional, primary research studies from 1960 to 2014 that reported national prevalence estimates of nonfatal strangulation by an intimate partner among community-residing adults. Of 7260 identified references, 23 articles based on 11 self-reported surveys in 9 countries met the inclusion criteria. The percentage of women who reported ever having been strangled by an intimate partner ranged from 3.0% to 9.7%; past-year prevalence ranged from 0.4% to 2.4%, with 1.0% being typical. Although many epidemiological surveys inquire about strangulation, evidence regarding its prevalence is scarce. Modifying or adding a question to ongoing national surveys, particularly the Demographic and Health Surveys, would remedy the lack of data for low- and middle-income countries. In addition, when questions about strangulation are asked, findings should be reported rather than only combined with other questions to form broader categories (e.g., severe violence). Such action is merited because of the multiple negative short- and long-term sequelae of strangulation.
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