1. Population-Based Study of Magnitude and Risks for Educators
School Violence:
Population-Based Study of Magnitude and Risks for Educators

2. RESEARCH TEAM MINNESOTA EDUCATORS’ STUDY Susan Goodwin Gerberich, PhD
Nancy M. Nachreiner, PhD
Andrew D. Ryan, MS
Steven J. Mongin, MS
Timothy R. Church, PhD
Patricia M. McGovern, PhD
Mindy S. Geisser, MS
Denise Feda, MS, PhD Candidate
Starr Kelley Sage, MPH, PhD Candidate
Evette Pinder, MPH, PhD Candidate
Gavin D. Watt, BA

3. MINNESOTA EDUCATORS’ STUDY BACKGROUND AND SIGNIFICANCE

4. Work-Related Violence
900 work-related homicides annually ( ) (Duhart, 2001) 516 in 2006 (Bureau of Labor Statistics, Fourth major cause of all occupational fatality
1.7 million non-fatal work-related acts of violence ( ); 12.5/1,000 persons (Duhart, 2001; Bureau of Labor Statistics,
Estimated cost: 4.2 billion dollars per year, $250,000/episode lost work time (Albrecht, 1997)

5. Minnesota United States Rocori High School September 2003 2 fatalities
Red Lake High School
March 2005
10 fatalities, including 1 teacher
and numerous non-fatalities
United States
• , 60 events identified by media
• , 32 events
html

6. MINNESOTA EDUCATORS’ STUDY PURPOSE OF THE STUDY
• Identify the magnitude and related consequences of physical and non-physical work-related violence against educators
• Identify specific risk factors for work-related physical violence against educators

7. MINNESOTA EDUCATORS’ STUDY
METHODS

8. MINNESOTA EDUCATORS’ STUDY STUDY COHORT
Kindergarten-12th grade licensed teachers (n = 116,661) identified in the Minnesota licensing databases, as of January 01, 2003
PILOT STUDY
300 teachers randomly sampled to test all study phases
SCREENING SURVEY
26,000 teachers randomly sampled from population
ELIGIBLE COHORT
Cohort of 6,469 eligible teachers, based on screening survey

9. MINNESOTA EDUCATORS’ STUDY PHASE 1: INITIAL COMPREHENSIVE STUDY
STUDY DESIGN
PHASE 1: INITIAL COMPREHENSIVE STUDY
6,469 Educators
Determine the magnitude and consequences of work-related violence for a one-year period of time

10. MINNESOTA EDUCATORS’ STUDY PHASE 2: CASE-CONTROL STUDY
STUDY DESIGN
PHASE 2: CASE-CONTROL STUDY
Cases (n=372): Persons who reported being physically assaulted and worked as educators in Minnesota during a 12-month study period
Controls (n=1,116): Persons who did not report being physically assaulted and worked as educators in Minnesota during a 12-month study period
Identify specific risk factors for work-related physical assault, based on exposures one-month prior to the assault for cases and a randomly assigned period for controls

11. MINNESOTA EDUCATORS’ STUDY CONTACT PROCEDURES AND DATA COLLECTION
STUDY DESIGN
CONTACT PROCEDURES AND DATA COLLECTION
• Comprehensive and Case-Control mailed surveys:
(cover letter, including informed consent information, specially designed surveys, and stamped, return envelopes)
• Up to four follow-up mailings to optimize response rates
• Validation of injury and exposure information

12. MINNESOTA EDUCATORS’ STUDY
STUDY DEFINITIONS
Work-related violence: intentional use of physical force or emotional abuse, against an employee, that results in physical or emotional injury and consequences
Physical Assault: occurs when you are hit, slapped, kicked, pushed, choked, grabbed, sexually assaulted, or otherwise subjected to physical contact intended to injure or harm
Non-Physical Violence: threat; sexual harassment; verbal abuse; and bullying

13. MINNESOTA NURSES’ STUDY
STUDY DEFINITIONS
NON-PHYSICAL VIOLENCE includes: threat; sexual harassment; verbal abuse; and bullying.
Threat: occurs when someone uses words, gestures, or actions with the intent of intimidating, frightening or harming you
Sexual Harassment: occurs when you experience any type of unwelcome sexual behavior (words or actions) that creates a hostile work environment
Verbal Abuse: occurs when another person yells or swears at you, calls you names, or uses other words intended to control or hurt you
Bullying: is defined as repeated acts of intimidation or coercion

14. MINNESOTA EDUCATORS’ STUDY ANALYSES
Descriptive analyses to estimate incidence and identify consequences of work-related violence
Multivariate analyses to estimate the effect of specific exposures on violence, i.e., to identify “risk and protective factors”
Analyses controlled for numerous factors to minimize bias and adjustments were made for non-response in the presence of unknown eligibility.

15. MINNESOTA EDUCATORS’ STUDY CONCEPTUAL MODEL FOR WORK-RELATED VIOLENCE
TEACHERS
Personal Characteristics:
Demographics (gender;
age; race; marital status; socioeconomic status)
Body Mass
Stress
Education, including
specialty training
Illness/injury history,
including assaults
Violence
management/conflict
resolution training
Work-related Characteristics
Work experience
Job type
Workload; hours
worked/week
Student contact/week
(hours; numbers)
OTHERS
Co-workers:
Demographics (age;
gender; race)
Number/types of staff
Interaction/support
Students
Number/types
Mental
status/impairment
History of assaultive
behavior
• Other relevant
behaviors/activities
ENVIRONMENT
Facility:
Type/Level/Size of School
• Area socioeconomic
status
Location
• Physical design/attributes
(openness; visibility;
crowding; lighting;
barriers; room
configurations)
Security (systems;
personnel; access
controls; parking;
responsiveness)
Administration/
Management
Administration attitude
Tolerance of violence
Support for employees
Employee
assistance/resources
Support/resources for
students
Policies/protocols
PHYSICAL ASSAULT

16. MINNESOTA EDUCATORS’ STUDY COMPREHENSIVE STUDY RESULTS

17. MINNESOTA EDUCATORS’ STUDY COMPREHENSIVE STUDY RESPONSE RATES
TOTAL
OVERALL 84%
Full survey 78%
One page survey %

18. Physical Assault Rates*
MINNESOTA EDUCATORS’ STUDY WORK-RELATED VIOLENCE RATES PER 100 EDUCATORS/YEAR
Physical Assault Rates*
Persons with at least
one event/Participants Rates (95% C.I.)
TOTAL (425/5107) (7.6, 9.1)
Male (83/1222) (6.0, 8.9)
Female (342/3885) (7.8, 9.6)
*Adjusted for non-response

19. Non-Physical Violence Rates*
MINNESOTA EDUCATORS’ STUDY WORK-RELATED VIOLENCE RATES PER 100 EDUCATORS/YEAR
Non-Physical Violence Rates*
Persons with at least
one event/Participants Rates (95% C.I.)
TOTAL (1970/5103) (37.1, 39.8)
Male (438/1222) (33.6, 39.0)
Female (1532/3881) (37.8, 40.9)
*Adjusted for non-response

20. Non-Physical Violence Rates* Persons with at least one event
MINNESOTA EDUCATORS’ STUDY WORK-RELATED VIOLENCE RATES PER 100 EDUCATORS/YEAR
Non-Physical Violence Rates*
Classification
Persons with at least one event
Rates (95% C.I.)
Threat
957
20.6 (19.5, 21.8)
Sexual Harassment
212
4.5 (3.9, 5.1)
Verbal Abuse
1,576
32.9 (31.6, 34.3)
Bullying
550
11.6 (10.7, 12.6)
*Total Exposed = 4,731 Responders to Full Survey
Rates adjusted for non-response

21. Relationship to Victim: Student 560 (95) 61 (100) Employee 9 (2) 3 (5)
MINNESOTA EDUCATORS’ STUDY PERPETRATOR CHARACTERISTICS: PHYSICAL ASSAULT
Characteristics
(Multiple responses possible)
Specific
Assault
587 events
Number (%)
Ongoing
61 events
Relationship to Victim:
Student
560 (95)
61 (100)
Employee
9 (2)
3 (5)
Parent, Visitor, etc.
5 (1)
0 (-)
Gender: Male
453 (77)
54 (89)
Impaired: Yes
463 (79)
56 (92)
Impairment-Specific Assault: 77% due to disability/developmental delay; Injury/illness and alcohol/drugs both <1%
Majority of events involved single perpetrators

22. Relationship to Victim: Student 82 79 65 54 Employee 14 10 34 31
MINNESOTA EDUCATORS’ STUDY PERPETRATOR CHARACTERISTICS NON-PHYSICAL VIOLENCE
Characteristics
(Multiple responses possible)
Verbal Abuse
1576 events %
Threat
957 events
Sexual Harassment
212 events
Bullying
550 events
Relationship to Victim:
Student 82 79 65 54
Employee 14 10 34 31
Parent, Visitor, etc. 23 17 2
Gender: Male 86 67
Impaired: Yes 39 41 29
Note that for the non-physical violence, much greater proportions of parents, visitors, trespassers, and others are more likely to be involved than in physical assault cases
IMPAIRMENT: Like the physical assaults, the non-physical impairment is associated with disability/developmental delay.

23. MINNESOTA EDUCATORS’ STUDY SYMPTOMS AND FEELINGS POST-EVENT
Symptoms/Feelings
(Multiple responses possible)
None
Specific Assault
587 events % 24
Ongoing Assault
61 events 20
Anger 36 34
Fear, Anxiety, Stress 28 30
Stress-related physical symptoms 9 15
Difficulty concentrating 3
Difficulty sleeping 10 18
Withdrawal from contact with people 4 5

24. (Multiple responses possible) None % 9 12 4 Anger 59 58 71
MINNESOTA EDUCATORS’ STUDY SYMPTOMS AND FEELINGS POST-EVENT (Continued)
Symptoms/Feelings
(Multiple responses possible)
None
Verbal Abuse
N=1576 % 9
Threat
N=957
Sexual Harassment
N=212 12
Bullying
N=550 4
Anger 59 58 71
Fear, Anxiety, Stress 37 43 33 55
Stress-related physical symptoms 18 16 29
Difficulty concentrating 10 11 19
Difficulty sleeping 20 21 32
Withdrawal from contact with people 7 6 5

25. MINNESOTA EDUCATORS’ STUDY WORK-RELATED CONSEQUENCES OF VIOLENCE
(Multiple responses possible)
Single
Assault
587 events
Number (%)
Ongoing
61 events
Changes in Work - TOTAL
46 (7.8)
11 (16.4)
Restriction or modified work
25 (4.3)
10 (16.4)
Change for Student
14 (2.4)
2 (3.3)
Quit work
13 (2.2)
Transfer: Voluntary /involuntary
9 (1.5)
1 (1.6)
Leave of absence
1 (0.2)
Other
5 (0.9)

26. MINNESOTA EDUCATORS’ STUDY WORK-RELATED CONSEQUENCES OF VIOLENCE
(Multiple responses possible)
Verbal Abuse
1576 events
N (%)
Threat
957 events
Sexual Harassment
212
events
Bullying
550 events
Changes in Work - TOTAL
207 (13.1)
140
(14.6) 32
(15.1)
136 (24.7)
Restriction or modified work
63 (4.0)
46 (4.8)
11 (5.2)
44 (8.0)
Quit work
48 (3.1)
31 (3.2)
4 (1.9)
38 (6.9)
Transfer: Voluntary /involuntary
75 (4.8)
49 (5.1)
16 (7.6)
Leave of absence
16 (1.0)
15 (1.6)
1 (0.5)
8 (1.5)
Other
17 (1.1)
8 (0.8)
2 (0.9)
12 (2.2)

27. MINNESOTA EDUCATORS’ STUDY
CASE-CONTROL STUDY

28. MINNESOTA EDUCATORS’ STUDY CASE-CONTROL STUDY
372 Cases
Physical Assault
(at least one physical assault event)
1,116 Controls
No Physical Assault

29. MINNESOTA EDUCATORS’ STUDY CASE-CONTROL STUDY: RESPONSE RATES
OVERALL FULL LENGTH
SURVEYS ONLY
Percentage Percentage
TOTAL
Cases*
Controls
*Of the 299 case respondents, 290 were student-perpetrated

30. MINNESOTA EDUCATORS’ STUDY CASE-CONTROL STUDY: MULTIVARIATE ANALYSES*
SCHOOL EXPOSURES O.R. (95% C.I.)
School Location
Suburban (--)
Rural (0.8, 1.5)
Urban (1.4, 2.8)
School Size
<50 Students (1.7, 11.1)
50 to 200 Students (1.0, 3.5)
201 to 500 Students (0.8, 1.5)
501 to 1000 Students 1 (--)
>1000 Students (0.3, 0.8)
School Type (reference: public)
Public Magnet (1.1, 10.7)
*Adjustments for multiple factors, based on causal models, weighting for non-response

31. MINNESOTA EDUCATORS’ STUDY CASE-CONTROL STUDY: MULTIVARIATE ANALYSES*
EDUCATOR EXPOSURES O.R. (95% C.I.)
Years worked in this school
< 3 years (--)
3 to <7 years (1.0, 2.1)
7 to <14 years (0.5, 1.1)
14 or more years (0.5, 1.2)
Years as an educator
< 8 years (--)
8 to < 15 years (0.4, 0.9)
15 to < 25 years (0.4, 1.1)
25 or more years (0.2, 0.8)
*Adjustments for multiple factors, based on causal models, weighting for non-response

32. MINNESOTA EDUCATORS’ STUDY CASE-CONTROL STUDY: MULTIVARIATE ANALYSES*
EDUCATOR EXPOSURES O.R. (95% C.I.)
Job Type
Full-time contract 1 (--)
Part-time contract (0.2, 0.7)
Substitute (0.2, 1.0)
Primary Professional Activity (reference: classroom teacher)
School social worker (2.8, 19.2)
Special Education (4.2, 8.8)
Topic Taught (reference: not taught)
Special Education (2.5, 5.4)
Speech Pathology (1.1, 5.1)
*Adjustments for multiple factors, based on causal models, weighting for non-response

33. MINNESOTA EDUCATORS’ STUDY CASE-CONTROL STUDY: MULTIVARIATE ANALYSES*
STUDENT CHARACTERISTICS O.R. (95% C.I.)
Student Gender
Primarily Male (--)
Primarily Female (0.1, 0.8)
Appeared Equal (0.4, 0.9)
Student race compared to educator
Same race (--)
Different race (1.6, 3.9)
Unsure of race (1.4, 11.9)
Student impairment (reference: not impaired)
Impaired due to disability or (1.2, 5.7)
developmental delay
Student age (reference: less than 10 years)
10 years or older (0.4, 0.8)
*Adjustments for multiple factors, based on causal models, weighting for non-response

34. MINNESOTA EDUCATORS’ STUDY CASE-CONTROL STUDY: MULTIVARIATE ANALYSES*
EXPOSURES O.R. (95% C.I.)
Parent/Family/Guardian Involvement
Outstanding (0.1, 1.0)
Very Good (0.2, 0.7)
Good 1 (--)
Fair (0.9, 2.1)
Poor (1.7, 4.6)
*Adjustments for multiple factors, based on causal models, weighting for non-response

35. MINNESOTA EDUCATORS’ STUDY CASE-CONTROL STUDY: MULTIVARIATE ANALYSES*
SCHOOL EXPOSURES O.R. (95% C.I.)
Sufficient resources (no versus yes)
Lack of up-to-date technology 1.4 (1.0, 1.9)
Lack of sports equipment/facilities 1.9 (1.3, 2.7)
Lack of musical equipment/facilities 1.9 (1.3, 2.8)
*Adjustments for multiple factors, based on causal models, weighting for non-response

36. MINNESOTA EDUCATORS’ STUDY CASE-CONTROL STUDY: MULTIVARIATE ANALYSES*
ENVIRONMENTAL EXPOSURES O.R. (95% C.I.)
Easily accessible exits
Yes (0.2, 0.7)
No (--)
Physical barriers
Yes (1.1, 2.2)
No (--)
Lighting Level
Soft light (1.0, 2.0)
Bright as Daylight 1 (--)
*Adjustments for multiple factors, based on causal models, weighting for non-response

37. MINNESOTA EDUCATORS’ STUDY
LIMITATIONS
Potential for bias is inherent in any study.
However, many strategies have been incorporated to minimize the potential biases, including:
• rigorous development and testing of data collection
instruments and validation sub-studies
• limited recall periods
• extensive follow-up to optimize response
• adjustment for non-response and control for potentially
confounding factors in analyses

38. MINNESOTA EDUCATORS’ STUDY SUMMARY
One of the first comprehensive efforts, using various techniques, to:
Identify the magnitude, and consequences of work-related violence against teachers
Identify specific risk factors that can serve as the basis for development of relevant prevention and control efforts

39. MINNESOTA EDUCATORS’ STUDY SUMMARY
Violence, both physical and non-physical, is a significant problem among Minnesota educators.
Some environmental exposures and other characteristics appear to increase the risk of physical violence:
Working in:
Urban schools
Schools with less than 200 students
Public magnet schools
Working with:
Special education or speech pathology students
Students of a different race than the educator
Students with disabilities or developmental delays

40. MINNESOTA EDUCATORS’ STUDY SUMMARY
Some environmental exposures and other characteristics appear to increase the risk of physical violence (continued)
Having less than 3 to 6 years experience at the school and
Working in environments with:
Physical barriers
Soft versus bright lighting
Lack of current technology and sports and music equipment/facilities
Fair/poor parent/family/guardian involvement

41. MINNESOTA EDUCATORS’ STUDY SUMMARY
Some environmental exposures and other characteristics appear to decrease the risk of physical violence:
Working in schools with >1000 students
Working in a school 7 years or longer
Working as an educator 8 years or longer
Having easily accessible exits
Working primarily with female students, or an equal number of male/female students
Working with students aged 10 or older
Having very good/outstanding parent/family/guardian involvement

42. MINNESOTA EDUCATORS’ STUDY ACKNOWLEDGMENTS
Support for this effort is provided, in part, by the: National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Department of Health and Human Services (R01 OH007816); Center for Violence Prevention and Control, University of Minnesota; Regional Injury Prevention Research Center, University of Minnesota; Zayas Graphics