Intimate partner violence and initiation of smoking and drinking: A population-based study of women in Yokohama, Japan
Introduction
Intimate partner violence (IPV) is prevalent in the lives of women around the globe. A multi-country study coordinated by the World Health Organization (WHO) documented prevalence estimates from 15 to 71% in participating countries (Garcia-Moreno, Jansen, Ellsberg, & Heise, 2005). IPV has wide-ranging negative effects on women’s physical, mental, sexual and reproductive health and substance (ab)use (Campbell, 2002, Clark and Foy, 2000, Golding, 1999, Watts and Zimmerman, 2002). This paper focuses on the two most commonly used substances, alcohol and tobacco, among women in Yokohama, the second largest city in Japan.
At least three lines of research have investigated the relationship between IPV and alcohol use: 1) alcohol use as a risk factor for IPV perpetration; 2) incident-specific use (whether the perpetrator and/or victim was drinking at the time of IPV incidence); and 3) alcohol use as a consequence of IPV victimization. The first line of research has been probably most extensively investigated and has found that alcohol use is associated with increased risk of IPV perpetration in both clinical and community samples (Foran and O’Leary, 2008, Kyriacou et al., 1999, Leonard and Senchak, 1996, Lipsky et al., 2005). The second line of research has found a strong association between substance use and IPV perpetration but a weaker, less consistent relationship between substance use and victimization (Kantor and Asdigian, 1994, Thompson and Kingree, 2006). The present study represents the third line of research. This line of research, particularly in early studies, has tended to rely on clinical samples and has documented high rates of alcohol use and smoking among battered women and/or high rates of IPV victimization among women with substance abuse problems (Clark and Foy, 2000, McCauley et al., 1995, Miller et al., 1989, Ratner, 1993, Roberts et al., 1997).
Compared to studies of IPV and drinking, research on the relationship between IPV and smoking is limited in number and scope (Weaver & Etzel, 2003). Recently, several large-scale, population-based health studies have assessed use of both alcohol and tobacco and documented a significant association between IPV and current smoking, current heavy or binge drinking, or problem drinking among women in the U.S. (Black and Breiding, 2008, Lemon et al., 2002, Weinbaum et al., 2001). For example, Black and Breiding reported an adjusted odds ratio of 1.7 for current heavy or binge drinking and 2.3 for current smoking among those who have reported IPV. A recent population-based study in India also found an association between women’s experience of IPV and smoking (Ackerson, Kawachi, Barbeau, & Subramanian, 2007).
There are several plausible pathways linking IPV and substance abuse. One pathway is that abused women self-medicate to cope with stress. It is also possible that mental health difficulties associated with IPV may lead to health risk behaviors. For example, experience of IPV is likely to lead to a sense of helplessness and worthlessness, depressive symptoms, and posttraumatic stress symptoms, which may, in turn, lead to self-destructive behaviors such as smoking, heavy drinking, or suicide (Acierno et al., 1996, Chilcoat and Breslau, 1998, Weaver and Etzel, 2003). Another plausible pathway is increased exposure by association with partners who engage in heavy substance use. Given a significant association between IPV perpetration and heavy and/or problem drinking among men (O’Leary and Schumacher, 2003, White and Chen, 2002), abused women are more likely to have partners who drink heavily (Barnett and Fagan, 1993, White and Chen, 2002), which may result in increased opportunity to consume alcohol, and/or a partner’s encouragement (or coercion) to do so.
The Global Burden of Disease report identifies both tobacco use and alcohol use among the leading risk factors for both mortality and burden of disease among high-income countries, East Asia, and the Pacific regions (Ezzati et al., 2006). Moreover, studies have found an association between the use of these two substances: early initiation of smoking is associated with heavier and longer smoking, as well as alcohol abuse and dependence in adulthood; and early initiation of drinking is associated with current smoking and current drinking, as well as heavy smoking and drinking (Breslau et al., 1993, Grant and Dawson, 1997, Taioli and Wynder, 1991).
Until the early 1990s, IPV in Japan was considered a personal matter rather than a social problem or crime (Yoshihama, 2002). A nationwide study in 1992 uncovered the serious and widespread nature of IPV (Yoshihama, 2002, Yoshihama and Sorenson, 1994). Recent population-based studies found that between 16.1 and 24.9% of adult women experience physical IPV, and 8.1–15.8% are subject to sexual IPV (Naikakufu Danjokyodosankakukyoku, 2009, Yoshihama et al., 2007, Yoshihama et al., 2009). Over the years, social action has increased to address this previously neglected problem, and the country’s first law on IPV was enacted in 2001.
The proportion of Japanese who drink is high; 43.1–46.2% of women aged 20–49 are current drinkers, with 5.8–12.0% classified as “heavy” drinkers according to criteria used by the Ministry of Health, Labour and Welfare1 (those who drink three times or more per week and one gou (equivalent to one large bottle of beer or 2 glasses of wine) or more on the days they drink) (Koseirodosho, 2006). Over the last decade, the prevalence of smoking among women in Japan has remained virtually unchanged (10.9% in 1998, 11.3% in 2003 and 10.0% in 2006), in contrast to the prevalence of smoking in men, which has declined steadily (from 50.8% in 1998 to 46.8% in 2003 to 39.9% in 2006) (Koseirodosho). As in studies of other western countries, heavy drinking and smoking have been found to be associated with higher morbidity of various chronic illnesses and associated mortalities, as well as higher health care costs in Japan (Izumi, Tsuji, Ohkubo, Kuwahara, & Nishino, 2001). Studies of substance use among adults in Japan, however, tend to focus on men and examine risk factors that are primarily job-related stress. Few studies have examined the relationship between IPV and substance use, and these studies used small convenience samples of women (Morita and Nobuta, 2005, Sekii et al., 2005). One of the few population-based studies in Japan found that, relative to the frequency of alcohol use, the amount of alcohol consumption was more strongly associated with IPV experiences (Shimizu, Kim, & Hirota, 2005).
This study examines the relationship between experience of IPV and alcohol and tobacco use among women in Yokohama, Japan, a previously under-studied population group. This study addresses two methodological issues. First, most studies have been cross-sectional with a number of notable exceptions (Magdol et al., 1998, Quigley and Leonard, 2000, Temple et al., 2008). Second, most studies use dichotomous grouping of those with a history of IPV versus those without such a history at the time of the interview. These studies do not take into account the temporal sequence of onset of drinking or smoking and the experience of IPV. Methodologically, this study differs from most previous studies. We collected retrospective data, which enabled us to employ methods of survival analysis (also known as event history analysis) to examine the probability of initiating drinking and smoking relative to the timing of experiencing IPV.
Section snippets
Methods
We used data from the WHO Multi-Country Study of Women’s Health and Domestic Violence conducted in 2000–2001 in the city of Yokohama, Japan.
Respondents’ characteristics
As shown in Table 1, the mean age of the respondents was 35.21 years (sd = 11.47). At the time of the interview, the majority (63.25%) had some post-secondary education, were married and/or cohabiting (72.04%), had one or more children (64.95%), and were working (57.88%); 30.22% indicated experiencing extreme or some difficulties in making ends meet. Based on available population-based statistics, the distributions of the respondents’ characteristics were comparable to those of female residents
Discussion
This study of women aged 18–49 in Yokohama, Japan found a significant association between IPV and current smoking and early initiation of smoking. In addition, compared to those who had not, women who had ever experienced IPV tended to drink heavily, though the two groups of women did not vary in their frequency of drinking. This finding is consistent with studies in the United States and Japan in which the amount of alcohol consumption, but not the frequency, is a strong correlate of IPV among
Acknowledgments
The authors wish to thank the study participants and dedicated interviewers. Special thanks to the Japan project team members: Hiroko Akiyama, Tamie Kaino, Saori Kamano, Fumi Hayashi, and Tomoko Yunomae. This study was funded in part by grants from the World Health Organization; the Toyota Foundation; the Japan Ministry of Health and Welfare; the University of Michigan Center for the Japanese Studies, Institute for Research on Women and Gender, and School of Social Work; and the Japan National
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