Prevalence of strangulation in survivors of sexual assault & domestic violence

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A Prospective Study of Intimate Partner Violence as a Risk Factor for Detectable Plasma Viral Load in HIV-Positive Women Engaged in Transactional Sex in Mombasa, Kenya

We conducted a prospective cohort study to evaluate intimate partner violence (IPV) as a risk factor for detectable plasma viral load in HIV-positive female sex workers (FSWs) on antiretroviral therapy (ART) in Kenya. 

IPV in the past year was defined as ≥1 act of physical, sexual, or emotional violence by the index partner (i.e. boyfriend/husband). The primary outcome was detectable viral load (≥180 copies/ml). In-depth interviews and focus groups were included to contextualize results. Analyses included 195 women (570 visits). 

Unexpectedly, IPV was associated with significantly lower risk of detectable viral load (adjusted relative risk 0.21, 95 % CI 0.05-0.84, p-value = 0.02). Qualitative findings revealed that women valued emotional and financial support from index partners, despite IPV. IPV was not a major barrier to ART adherence. 

The observed association between IPV and lower risk of detectable viral load in FSWs may be due to unmeasured personal and relationship factors, warranting further research.

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By:  Wilson KS1,2, Wanje G3, Yuhas K4, Simoni JM5, Masese L6, Vander Stoep A7, Jaoko W3, Hughes JP8, Richardson BA4,8, Scott McClelland R4,7,6,3.

• 1Department of Global Health, University of Washington, Seattle, 98104, USA. ksw@uw.edu.
• 2Department of Epidemiology, University of Washington, Seattle, USA. ksw@uw.edu.
• 3Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.
• 4Department of Global Health, University of Washington, Seattle, 98104, USA.
• 5Department of Psychology, University of Washington, Seattle, USA.
• 6Department of Medicine, University of Washington, Seattle, USA.
• 7Department of Epidemiology, University of Washington, Seattle, USA.
• 8Department of Biostatistics, University of Washington, Seattle, USA. 
• AIDS Behav. 2016 May 3. 

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Intimate partner violence and condom negotiation efficacy among gay and bisexual men in Atlanta

Background:

The experience of intimate partner violence (IPV) has been shown to decrease condom negotiation efficacy among women; however, studies of this association among gay and bisexual men (GBM) are lacking.

Methods:

A venue-recruited sample of 745 GBM was recruited in Atlanta, GA, USA in 2012-13. Participants self-completed a survey including questions on recent (previous 12 month) experience and perpetration of IPV using the IPV-GBM Scale. Multivariate regression analysis examined the association between reporting low condom negotiation efficacy with the respondent's most recent sex partner (19.2% of respondents) and recent experience of IPV with the same or another partner.

Results:

Nearly half the sample (49.1%) reported recent receipt of IPV, although prevalence varied considerably across the forms of IPV. GBM who reported recent IPV experience were significantly less likely to report having felt able to negotiate condom use.

Conclusions:

These findings suggest that IPV may be a significant risk factor for HIV acquisition and transmission among GBM.

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By:  Rob Stephenson A B D, Ryan Freeland B and Catherine Finneran C 

A Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI 48104, USA. B The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI 48104, USA. C Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA 30322, USA. D Corresponding author. Email: rbsteph@umich.edu 

Sex Health. 2016 Apr 28. doi: 10.1071/SH15212. 

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A Prospective Cohort Study of Intimate Partner Violence and Unprotected Sex in HIV-Positive Female Sex Workers in Mombasa, Kenya

We conducted a prospective cohort study to test the hypothesis that intimate partner violence (IPV) is associated with unprotected sex in HIV-positive female sex workers in Mombasa, Kenya. 

Women completed monthly visits and quarterly examinations. Any IPV in the past year was defined as ≥1 act of physical, sexual, or emotional violence by the current or most recent emotional partner ('index partner'). Unprotected sex with any partner was measured by self-report and prostate specific antigen (PSA) test. 

Recent IPV was associated with significantly higher risk of unprotected sex after adjusting for age, alcohol use, and sexual violence by someone besides the index partner. 

Addressing IPV in comprehensive HIV programs for HIV-positive women in this key population is important to improve wellbeing and reduce risk of sexual transmission of HIV.

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By:  Wilson KS^1,2, Deya R³, Yuhas K³, Simoni J⁴, Vander Stoep A⁵, Shafi J^6,7, Jaoko W⁶, Hughes JP⁸, Richardson BA^3,8, McClelland RS^3,5,9,6.

Author information

¹Department of Global Health, University of Washington, Box 359931, Seattle, 98104, USA. ksw@uw.edu.

²Department of Epidemiology, University of Washington, Seattle, USA. ksw@uw.edu.

³Department of Global Health, University of Washington, Box 359931, Seattle, 98104, USA.

⁴Department of Psychology, University of Washington, Seattle, USA.

⁵Department of Epidemiology, University of Washington, Seattle, USA.

⁶University of Nairobi, Nairobi, Kenya.

⁷Coast Province General Hospital, Mombasa, Kenya.

⁸Department of Biostatistics, University of Washington, Seattle, USA.

⁹Department of Medicine, University of Washington, Seattle, USA.

AIDS Behav. 2016 Apr 19. [Epub ahead of print]

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Homicide-suicide and the role of mental disorder: A national consecutive case series

PURPOSE:

There is a lack of robust empirical research examining mental disorder and homicide-suicide. Primary care medical records are seldom used in homicide-suicide research. The aims of this study were to describe the characteristics of offenders and victims; determine the prevalence of mental disorder and contact with mental health services and examine adverse events prior to the offence.

METHODS:

This was a mixed-methods study based on a consecutive case series of offences in England and Wales occurring between 2006 and 2008. 60 homicide-suicides were recorded. Data sources included coroner's records, police files, General Practice (GP) and specialist mental health records, and newspaper articles.

RESULTS:

The results show that most victims were spouse/partners and/or children. Most perpetrators were male (88 %) and most victims were female (77 %). The incidents were commonly preceded by relationship breakdown and separation. 62 % had mental health problems. A quarter visited a GP for emotional distress within a month of the incident. Few had been in recent contact with mental health services before the incident (12 %). Self-harm (26 %) and domestic violence (39 %) were common.

CONCLUSION:

In conclusion, GPs cannot be expected to prevent homicide-suicide directly, but they can reduce risk generally, via the treatment of depression and recognising the risks associated with domestic violence.

Full article at:   http://goo.gl/DwrChG

By:   Flynn S1, Gask L2, Appleby L3, Shaw J3.

• 1The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Institute of Brain Behaviour and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. sandra.m.flynn@manchester.ac.uk.
• 2Institute of Population Health, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
• 3The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Institute of Brain Behaviour and Mental Health, University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK. 
• Soc Psychiatry Psychiatr Epidemiol. 2016 Apr 16.

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Women Exiting Street-Based Sex Work: Correlations between Ethno-Racial Identity, Number of Children, and Violent Experiences

Through this article the authors examine data collected from 126 women seeking services at a transitional housing facility, primarily for women leaving street-based prostitution. Descriptive statistics on the women's ethno-racial identity, numbers of children, and experiences with violence are presented and analyzed to determine correlations and implications for social service providers working with this unique population of women. 

Nearly half of respondents are women of color, a majority have given birth to at least one child, and more than half are in a non-commercial intimate partnership, with a significant number reporting extensive experiences with violent trauma and abuse. 

Results indicate statistically significant differences in women's ethno-racial self-identification and their experiences of sex work and violence, as well as their marital status. Most notably, African-American and Hispanic women face the greatest and most diverse forms of intimate partner violence and negative sex industry experiences, with African-Americans more likely to engage in sex work as minors, be sexually abused as children, work for a pimp, and face physical assault and instances of sex trafficking. 

Results also support existing research showing correlations between traumatic childhood events and adult substance abuse, sexual assault, and other negative outcomes.

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By:  Hankel J1, Dewey S2, Martinez N3.

• 1 Independent scholar , Denver , Colorado , USA.
• 2 Gender & Women's Studies, University of Wyoming , Laramie , Wyoming , USA.
• 3 Street's Hope , Denver , Colorado , USA.
• J Evid Inf Soc Work. 2016 Apr 4:1-13. 

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Risk Assessments & Recidivism among a Population-Based Group of Swedish Offenders Sentenced to Life in Prison

BACKGROUND:

In Sweden, the number of people serving life sentences has steadily increased. To date, few studies have examined the recidivism rate or the predictive validity of different risk assessment instruments in this group.

AIMS:

Our aim was to test the predictive validity among inmates serving life sentences of two different instruments used for assessing risk-the Historical, Clinical and Risk Management-20 (HCR-20), most widely used in clinical populations, and the Psychopathy Checklist-Revised (PCL-R), commonly applied in both penal and clinical settings.

METHOD:

Ninety-eight life-sentenced prisoners were included, 26 of whom were released during the study period. Data on risk assessments and dates for release were collected from administrative records, while recidivism data were retrieved from a national database on criminal convictions.

RESULTS:

Sex offenders obtained the highest scores and inmates charged with domestic violent offences obtained the lowest scores on both instruments. The released prisoners were followed for a mean period of 33 months. During this time five prisoners (19%) reoffended, four of them violently, with an average time to recidivism of 10 months. Only PCL-R Facet 4, which reflects antisocial features, was significantly associated with recidivism.

CONCLUSIONS:

This small, but population-based, study demonstrates that antisocial behaviour shows incremental predictive validity for reoffending among life-sentenced offenders, but other measures have little to add for this specific task. The fact that those life sentenced prisoners who reoffended did so so soon after release should prompt allocation of earlier interventions towards preventing this.

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By:  Sturup J1, Karlberg D2, Fredriksson B3, Lihoff T3, Kristiansson M2.

• 1National Board of Forensic Medicine, Karolinska Institutet and Stockholm University, Sweden.
• 2National Board of Forensic Medicine and Karolinska Institutet, Sweden.
• 3National Board of Forensic Medicine, Sweden. 
• Crim Behav Ment Health. 2016 Apr;26(2):124-35. doi: 10.1002/cbm.1941. Epub 2015 Jan 30.

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Factors associated with Consistent Condom Use among Internally Displaced Women in Leogane, Haiti

OBJECTIVES:

Scant research has examined factors associated with condom use among internally displaced women in postdisaster settings, such as in postearthquake Haiti. The study objective was to examine social ecological factors associated with consistent condom use among internally displaced women in postearthquake Haiti.

METHODS:

A cross-sectional survey was conducted in 2012 with a peer-driven recruitment sample of internally displaced women in Leogane, Haiti. Peer health workers administered tablet-based structured interviews to a convenience sample of 175 internally displaced women.

RESULTS:

The 128 participants who reported being sexually active in the last 4 weeks were included in the analyses. Two-thirds (65.2%) reported consistent condom use in the last month. In multivariate logistic regression analyses controlled for age and income, participants that reported sex work, depression, higher number of sex partners and shorter relationship duration had lower odds of consistent condom use in the past month. Participants who reported no experiences of intimate partner violence, lower self-rated health, higher sexual relationship power and more meals per day, had a higher likelihood of reporting consistent condom use.

CONCLUSIONS:

This research provides the first assessment of contextual factors associated with consistent condom use among women displaced from a natural disaster such as Haiti's 2010 earthquake. Findings demonstrate the importance of social ecological approaches to understand intrapersonal (eg, sex work and depression), interpersonal (eg, relationship power, intimate partner violence and relationship duration) and structural (eg, food insecurity) factors associated with internally displaced women's condom use. Results can inform future sexual health research and interventions in international disaster contexts.

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By:  Logie CH1, Daniel C2, Wang Y3.

• 1Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
• 2Faculty of Social Work, Adelphi University, Garden City, New York, USA.
• 3Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada. 
• Sex Transm Infect. 2016 Mar 31. pii: sextrans-2015-052400. doi: 10.1136/sextrans-2015-052400.

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Interpersonal Violence & Traumatic Brain Injuries among Native Americans & Women

OBJECTIVES:

This study aimed to assess the odds of experiencing a traumatic brain injury (TBI) as a result of interpersonal violence (IPV) among Native Americans compared to other races controlling for gender, age, socioeconomic status, rurality and intoxication at the time of the injury.

METHODS:

A secondary data analysis of the Arizona Trauma Database consisting of 18 944 cases of TBI between 2008-2010 throughout the state of Arizona was conducted. There were 312 patients who experienced injuries caused by IPV in the sample. Descriptive statistics, cross-tabulations, bivariate analyses and a logistic regression model were used for analyses.

RESULTS:

The logistic regression model found that Native Americans (OR = 1.15), patients from the other race category (OR = 1.18), females (OR = 1.35) and those who were insured (OR = 1.26) had higher odds of experiencing a TBI as a result of IPV. Rurality and intoxication were mediators of the correlation between Native American race and TBI as a result of IPV.

CONCLUSIONS:

Native Americans are more likely than Whites and females are more likely than males to experience TBIs as a result of IPV.

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By:  Linton KF1.

• 1School of Social Work, University of Hawaii at Manoa , Honolulu, HI , USA. 
• Brain Inj. 2015;29(5):639-43. doi: 10.3109/02699052.2014.989406. Epub 2014 Dec 17.

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The Roles of Family Factors and Relationship Dynamics on Dating Violence Victimization and Perpetration among College Men and Women in Emerging Adulthood

Using data from the International Dating Violence Study, this study examined the roles of early socialization, family social structure, and relationship dynamics factors on physical aggression in dating among U.S. college students in emerging adulthood. 

The interaction effects between these three domains of interest (early socialization, family social structure, and relationship dynamics) were explored to understand the underlying mechanisms that influenced victimization and perpetration in dating. 

In general, we found that family and relational variables associated with dating victimization and perpetration were fairly similar. Among the early socialization variables, experience of childhood neglect and having witnessed domestic violence were significantly related to victimization and perpetration. Living in a two-parent household appeared to exert a protective effect, although associations with parental education were not statistically significant. 

Furthermore, the participants were more likely to experience victimization or impose aggression in dating relationships which were characterized by conflicts, distress, dominance, or psychological aggression. Overall, for the participants who came from a two-parent household, dominance in dating was linked to less violence. 

When the participants faced higher levels of psychological aggression, adverse early socialization factors were associated with higher levels of dating violence victimization and perpetration. Research and practice implications were discussed.

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By:  Paat YF1, Markham C2.

• 1The University of Texas at El Paso, USA ypaat@utep.edu.
• 2University of Texas Health Science Center, Houston, USA. 
• J Interpers Violence. 2016 Mar 27. pii: 0886260516640544

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Risk Factors for Intimate Partner Violence: A Comparison of Antisocial and Family-Only Perpetrators

Subtyping male perpetrators of intimate partner violence (IPV) based on their generality of violence could facilitate the difficult task of matching perpetrator subtype with efficient risk management strategies. 

As such, the aim of the present study was to compare antisocial and family-only male perpetrators of interpersonal violence in terms of 

1. demographic and legal characteristics, 
2. risk factors for violence, and 
3. assessed risk and the importance of specific risk factors for violence. 

A quantitative design was used in this retrospective register study on data obtained from the Swedish police. Risk assessments performed with the Swedish version of the Brief Spousal Assault Form for the Evaluation of Risk (B-SAFER) and police registers were used. A sample of 657 male alleged IPV perpetrators were classified as antisocial (n= 341) or family-only (n= 316) based on their generality of violence. 

The results showed that the antisocial perpetrators were significantly younger, as well as more psychologically abusive. Antisocial perpetrators also had significantly more present risk factors for IPV, and were assessed with a significantly higher risk for acute and severe or deadly IPV, compared with the family-only perpetrators. The subtypes also evidenced unique risk factors with a significant impact on elevated risk for acute and severe or deadly such violence. Key findings in the present study concerned the subtypes evidencing unique risk factors increasing the risk for acute and severe or deadly IPV. 

Major implications of this study include the findings of such unique "red flag" risk factors for each subtype. To prevent future IPV, it is vital for the risk assessor to be aware of these red flags when making decisions about risk, as well as risk management strategies.

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By:  Petersson J1, Strand S2, Selenius H3.

• 1Mid Sweden University, Sundsvall, Sweden joakim.petersson@miun.se.
• 2Örebro University, Örebro, Sweden Swinburne University of Technology, Melbourne, Australia.
• 3Örebro University, Örebro, Sweden. 
• J Interpers Violence. 2016 Mar 27. pii: 0886260516640547. 

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Pathways to Romantic Relational Aggression Through Adolescent Peer Aggression & Heavy Episodic Drinking

Adolescent peer aggression is a well-established correlate of romantic relational aggression; however, the mechanisms underlying this association are unclear. Heavy episodic drinking (or "binge" alcohol use) was examined as both a prior and concurrent mediator of this link in a sample of 282 12-18 year old interviewed four times over 6 years. 

Path analyses indicated that early peer relational and physical aggression each uniquely predicted later romantic relational aggression. Concurrent heavy episodic drinking fully mediated this effect for peer physical aggression only. 

These findings highlight two important mechanisms by which peer aggression may increase the risk of later romantic relational aggression: a direct pathway from peer relational aggression to romantic relational aggression and an indirect pathway through peer physical aggression and concurrent heavy episodic drinking. 

Prevention programs targeting romantic relational aggression in adolescence and young adulthood may benefit from interventions that target multiple domains of risky behavior, including the heavy concurrent use of alcohol. 

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By:  Woodin EM1, Sukhawathanakul P1, Caldeira V1, Homel J1, Leadbeater B1.

• 1Department of Psychology, University of Victoria, Victoria, British Columbia, Canada.
• Aggress Behav. 2016 Mar 16. doi: 10.1002/ab.21651.  

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Mediators of the Relation Between Community Violence and Sexual Risk Behavior mong Adults Attending a Public Sexually Transmitted Infection Clinic

Prior research shows that violence is associated with sexual risk behavior, but little is known about the relation between community violence (i.e., violence that is witnessed or experienced in one's neighborhood) and sexual risk behavior. 

To better understand contextual influences on HIV risk behavior, we asked 508 adult patients attending a publicly funded STI clinic in the U.S. (54 % male, M _age = 27.93, 68 % African American) who were participating in a larger trial to complete a survey assessing exposure to community violence, sexual risk behavior, and potential mediators of the community violence-sexual risk behavior relation (i.e., mental health, substance use, and experiencing intimate partner violence). 

A separate sample of participants from the same trial completed measures of sexual behavior norms, which were aggregated to create measures of census tract sexual behavior norms. 

Data analyses controlling for socioeconomic status revealed that higher levels of community violence were associated with more sexual partners for men and with more episodes of unprotected sex with non-steady partners for women. 

For both men and women, substance use and mental health mediated the community violence-sexual risk behavior relation; in addition, for men only, experiencing intimate partner violence also mediated this relation. 

These results confirm that, for individuals living in communities with high levels of violence, sexual risk reduction interventions need to address intimate partner violence, substance use, and mental health to be optimally effective.

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By:  Senn TE1, Walsh JL2,3, Carey MP2.

• 1School of Nursing, University of Rochester, Box SON, 601 Elmwood Ave., Rochester, NY, 14642, USA. Theresa_Senn@urmc.rochester.edu.
• 2Centers for Behavioral and Preventive Medicine, The Miriam Hospital and Brown University, 164 Summit Ave., Providence, RI, 02906, USA.
• 3Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA. 
• Arch Sex Behav. 2016 Mar 21.

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Associations of Financial Stressors & Physical Intimate Partner Violence Perpetration

Background

Contextual factors, such as exposure to stressors, may be antecedents to IPV perpetration. These contextual factors may be amenable to modification through intervention and prevention. However, few studies have examined specific contextual factors. To begin to address this gap, we examined the associations between financial stressors and three types of physical IPV perpetration.

Methods

This analysis used data from Wave IV of The National Longitudinal Study of Adolescent to Adult Health. We used logistic regression to examine the associations of financial stressors and each type of IPV (minor, severe, causing injury), and multinomial logit regression to examine the associations of financial stressors and patterns of co-occurring types of IPV perpetration (only minor; only severe; minor and severe; minor, severe, and causing injury; compared with no perpetration).

Results

Fewer men perpetrated threats/minor physical IPV (6.7 %) or severe physical IPV (3.4 %) compared with women (11.4 % and 8.8 %, respectively). However, among physical IPV perpetrators, a higher percentage of men (32.0 %) than women (21.0 %) reported their partner was injured as a result of the IPV. In logistic regression models of each type of IPV perpetration, both the number of stressors experienced and several types of financial stressors were associated with perpetrating each type of IPV. Utilities nonpayment, housing nonpayment, food insecurity, and no phone service were associated with increased odds of perpetrating each form of IPV in adjusted analysis. Eviction was associated with perpetrating severe physical IPV but not threats/minor IPV or IPV causing injury. In multinomial logit regression comparing patterns of IPV perpetration to perpetrating no physical IPV, the relationships of financial stressors were less consistent. Food insecurity was associated with perpetrating only minor physical IPV. Comparatively, overall number of financial stressors and four types of financial stressors (utilities nonpayment, housing nonpayment, food insecurity, and disconnected phone service) were associated with perpetrating all three forms of physical IPV.

Conclusions

Combined with prior research, our results suggested interventions to improve financial well-being may be a novel way to reduce physical IPV perpetration.

Estimated proportion and 95 % confidence estimates of exposure to financial stressors and perpetration of three forms of physical IPV

	Men	Women	Difference
	Percent (95 % CI)		P-valuea
Financial stressors
Number of financial stressors			<.0001
None	77.2 (75.4–79.1)	72.3 (70.2–74.5)
1–2	16.3 (14.2–18.4)	18.8 (16.8–20.8)
3–4	5.2 (4.1–6.2)	7.3 (6.0–8.6)
5–6	1.4 (0.9–1.8)	1.5 (1.0–2.0)
Utilities nonpayment
Yes	12.7 (11.5–14.0)	17.6 (15.7–19.4)	<.0001
No	87.3 (86.0–88.5)	82.4 (80.6–84.3)
Housing nonpayment
Yes	9.4 (8.4–10.4)	10.2 (9.0–11.3)	.26
No	90.6 (89.6–91.6)	89.8 (88.7–91.0)
Food insecurity
Yes	9.9 (8.7–11.1)	14.0 (12.6–15.3)	<.0001
No	90.1 (88.9–91.3)	86.0 (84.7–87.4)
No phone service
Yes	7.8 (6.8–8.8)	10.4 (9.3–11.5)	<.0001
No	92.2 (91.2–93.2)	89.6 (88.5–90.7)
Utilities turned off
Yes	5.4 (4.6–6.3)	5.4 (4.6–6.1)	.82
No	94.6 (93.7–95.4)	94.7 (93.9–95.4)
Evicted
Yes	1.0 (0.7–1.4)	1.0 (0.7–1.4)	.93
No	99.0 (95.6–99.3)	98.9 (98.6–99.3)
Intimate partner violence perpetration
Threats/Minor physical
Yes	6.7 (5.7–7.5)	11.4 (10.1–12.7)	<.0001
No	93.4 (92.5–94.3)	88.6 (87.3–89.9)
Severe physical
Yes	3.4 (2.9–4.0)	8.8 (7.8–9.9)	<.0001
No	96.6 (96.0–97.2)	91.2 (90.1–92.2)
If Yes to physical, caused injury
Yes	32.0 (25.6–38.5)	21.0 (17.7–24.4)	.003
No	68.0 (61.5–74.4)	79.0 (75.6–82.3)

aChi-square test

Full article at:   http://goo.gl/HVAfAe

By:  Laura M. Schwab-Reese, Corinne Peek-Asa, and Edith Parker

Department of Community & Behavioral Health, University of Iowa College of Public Health, Iowa City, IA 52240 USA

Department of Occupational & Environmental Health, University of Iowa College of Public Health, Iowa City, IA 52240 USA

Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado, Anschutz Medical Campus, 13123 E 16th Ave, B390, Aurora, CO 80045 USA

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