How can the negative impact of intimate partner violence (IPV) on child health be minimized? IPV often continues in families despite social or legal interventions to stop the violence. Children therefore remain vulnerable to adverse health outcomes. This suggests that, to protect children's health, we must shape IPV interventions to reduce risks and to increase protective factors even if IPV continues. This requires a theoretically-guided, empirically-based understanding of the mechanisms by which IPV adversely influences child health, with a focus on the mediating influences. The goal of the proposed research is to gain such an understanding. The overarching framework guiding this research is that IPV leads to poor child health indirectly through its influence on maternal emotional health and parenting, which in turn affect child outcomes. Two related considerations include that patterns (based on variables such as severity, frequency and directionality) of IPV exist and that these patterns likely affect children differently. This proposal outlines two studies. The first is a cohort study of children followed from birth to middle childhood in which advanced analytical methods including structural equation modeling will be used to:
Aim 1 : Define the latent construct of IPV, assessing typologies of IPV and identifying patterns of IPV over time;
Aim 2 : Determine the relationship between these IPV constructs and children's health and health care use;
Aim 3 : Assess the role of maternal emotional health and parenting as mediators of the relationship between IPV and child health. A second qualitative study involving semi-structured interviews with abused women with young children will:
Aim 4 : Characterize abused women's perceptions of the relationship among IPV, their emotional health, their parenting and their child's health.
These aims fit with NICHD's mission of "all children achieving their potential for healthy and productive lives." The proposed career development program for this candidate, a pediatrician with a degree in epidemiology, focuses on: 1) understanding the etiology and epidemiology of IPV;2) obtaining a theoretical understanding of the impact of family conflict on children's health;3) learning higher level data analysis methods;and 4) acquiring qualitative research skills. The candidate's long-term career goal is to lead multidisciplinary efforts to facilitate the healthy development of children exposed to IPV. Upon completion of this award, she will submit an R01 application for a longitudinal cohort study collecting primary data on the health of a local cohort of children with and without IPV exposure. From a public health perspective, childhood is a critical time period in establishing an individual's lifetime health trajectory;IPV has the potential to significantly compromise children's health. A better understanding of the IPV-child health relationship will facilitate the design of effective, targeted interventions.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZHD1-DSR-M (HB))
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Maholmes, Valerie
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Johns Hopkins University
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Bair-Merritt, Megan H; Crowne, Sarah Shea; Thompson, Darcy A et al. (2010) Why do women use intimate partner violence? A systematic review of women's motivations. Trauma Violence Abuse 11:178-89
Bair-Merritt, Megan H; Jennings, Jacky M; Chen, Rusan et al. (2010) Reducing maternal intimate partner violence after the birth of a child: a randomized controlled trial of the Hawaii Healthy Start Home Visitation Program. Arch Pediatr Adolesc Med 164:16-23
Bair-Merritt, Megan H (2010) Intimate partner violence. Pediatr Rev 31:145-50; quiz 150
Rabin, Rebecca F; Jennings, Jacky M; Campbell, Jacquelyn C et al. (2009) Intimate partner violence screening tools: a systematic review. Am J Prev Med 36:439-445.e4