1. S outh C arolina Rural Health Research Center Prevalence of Violent Disagreements in US Families: Residence, Race/Ethnicity, and Parental Stress Charity G. Moore, PhD University of North Carolina Janice C. Probst, PhD Mark Tompkins, PhD Steven Cuffe, MD Amy B. Martin, DrPH University of South Carolina

2. Rural Health Research Center S outh C arolina NSCH and violence  Looking for an “asthma in children” data set  Discovered questions on disagreements in household  National data, large sample (>100,000)  Study purpose: National estimates and estimates for rural minorities

3. Rural Health Research Center S outh C arolina Factors of interest Residence (Rural) and Race/Ethnicity  Poverty  Shortage of health care providers  Lack of health insurance  Fewer economic resources (see Rural Health Response to Domestic Violence: Policy and Practice Issues: http://ruralhealth.hrsa.gov/pub/domviol.htm )

4. Rural Health Research Center S outh C arolina Rural disadvantage (2003 NSCH data) Poverty Public or no health insurance Parental educ ≤ HS

5. Rural Health Research Center S outh C arolina Factors of interest  Residence  Race/Ethnicity  Parental Stress

6. Rural Health Research Center S outh C arolina Defining key variables: violence  “When you have a serious disagreement… do you….  (1) …discuss … calmly;  (2) …argue heatedly or shout;  (3) …end up hitting or throwing things.”  Three levels of disagreement:  Violent: ANY occurrence of hitting or throwing  Heated: Argue or shout “sometimes,” “usually,” or “always”  Calm: All others

7. Rural Health Research Center S outh C arolina Definitions, continued  Residence:  County level  Rural-Urban Continuum Codes  4 levels: urban, large rural, med rural, small rural  Race/ethnicity: White, Black, Hispanic and Other  Parental Stress:  Child was hard to care for  Child bothered parent  Felt angry with him/her  Split at the 75 th percentile

8. Rural Health Research Center S outh C arolina Nationally, 1 in 10 children experience violent disagreements (10.3%)

9. Rural Health Research Center S outh C arolina Residence p=0.0001

10. Rural Health Research Center S outh C arolina Race/Ethnicity p<0.0001

11. Rural Health Research Center S outh C arolina Parental Stress p<0.0001

12. Rural Health Research Center S outh C arolina Examining parental stress Minority parents slightly more likely to report high stress (%) No difference across residence

13. Rural Health Research Center S outh C arolina Violent disagreements: Final Results Hit, throwArgue, shout OR95% CIOR95% CI Residence (reference: urban) Rural0.860.770.950.980.921.05 Race/Ethnicity (reference: white) Hispanic1.030.871.211.070.951.20 African-American1.731.511.981.411.291.54 Other1.381.141.671.171.041.33 Parenting stress (reference: low) High Stress3.172.913.471.991.872.12 Included in the model but not shown: Child attributes including age, gender, health status, and health insurance; Parental characteristics including relationship to child, highest education in household, employment, parental health, perceived neighborhood support; and Family characteristics including poverty level, family structure, number of children, family mobility, primary language, and region.

14. Rural Health Research Center S outh C arolina Conclusions  Violent and heated disagreement are not rare in US homes with children  No large differences across residence  Minority children are particularly at risk  Parenting stress may provide a clue for intervention

15. Rural Health Research Center S outh C arolina Questions or Comments? Charity G. Moore: cgmoore@med.unc.educgmoore@med.unc.edu Janice C. Probst: jprobst@gwm.sc.edujprobst@gwm.sc.edu