# Presentation: 162342

## 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**

## 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

## 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 )

## Rural disadvantage (2003 NSCH data)

**Poverty**

**Public or no health insurance**

**Parental educ ****≤ HS**

## Factors of interest

- Residence
- Race/Ethnicity
- Parental Stress

## 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

## 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 75th percentile

**Notes:**
Parenting stress: Never, sometimes, usually, always were the responses

## Nationally, 1 in 10 children experience violent disagreements (10.3%)

**Nationally, 1 in 10 children experience violent disagreements (10.3%)**

**Notes:**
An additional 31.5% experienced heated disagreement

## Residence

- p=0.0001

**Notes:**
----------------------------------------------------------------------
RURAL4                 Sample      Weighted    Row          SE Row
   HISPCODE            Size        Size        Percent      Percent
----------------------------------------------------------------------
Total
   Total                   99660    70508338       100.00         0.00
   HISPANIC                13045    12255125        17.38         0.23
   NH WHITE                69363    42956436        60.92         0.28
   NH BLACK                 9453    10126727        14.36         0.21
   NH OTHER                 7799     5170051         7.33         0.18
1
   Total                    4332     1780545       100.00         0.00
   HISPANIC                  219       84587         4.75         0.61
   NH WHITE                 3560     1380073        77.51         1.21
   NH BLACK                  216      224052        12.58         1.08
   NH OTHER                  337       91833         5.16         0.50
2
   Total                   17012     8208773       100.00         0.00
   HISPANIC                 1358      692318         8.43         0.42
   NH WHITE                13500     6301789        76.77         0.58
   NH BLACK                 1022      845995        10.31         0.44
   NH OTHER                 1132      368670         4.49         0.21
3
   Total                   10118     4467701       100.00         0.00
   HISPANIC                 1071      471927        10.56         0.62
   NH WHITE                 7497     3178795        71.15         0.83
   NH BLACK                  546      458245        10.26         0.57
   NH OTHER                 1004      358733         8.03         0.47
4
   Total                   68198    56051320       100.00         0.00
   HISPANIC                10397    11006293        19.64         0.28
   NH WHITE                44806    32095778        57.26         0.33
   NH BLACK                 7669     8598435        15.34         0.25
   NH OTHER                 5326     4350814         7.76         0.22
----------------------------------------------------------------------

## Race/Ethnicity

- p<0.0001

**Notes:**
----------------------------------------------------------------------
RURAL4                 Sample      Weighted    Row          SE Row
   HISPCODE            Size        Size        Percent      Percent
----------------------------------------------------------------------
Total
   Total                   99660    70508338       100.00         0.00
   HISPANIC                13045    12255125        17.38         0.23
   NH WHITE                69363    42956436        60.92         0.28
   NH BLACK                 9453    10126727        14.36         0.21
   NH OTHER                 7799     5170051         7.33         0.18
1
   Total                    4332     1780545       100.00         0.00
   HISPANIC                  219       84587         4.75         0.61
   NH WHITE                 3560     1380073        77.51         1.21
   NH BLACK                  216      224052        12.58         1.08
   NH OTHER                  337       91833         5.16         0.50
2
   Total                   17012     8208773       100.00         0.00
   HISPANIC                 1358      692318         8.43         0.42
   NH WHITE                13500     6301789        76.77         0.58
   NH BLACK                 1022      845995        10.31         0.44
   NH OTHER                 1132      368670         4.49         0.21
3
   Total                   10118     4467701       100.00         0.00
   HISPANIC                 1071      471927        10.56         0.62
   NH WHITE                 7497     3178795        71.15         0.83
   NH BLACK                  546      458245        10.26         0.57
   NH OTHER                 1004      358733         8.03         0.47
4
   Total                   68198    56051320       100.00         0.00
   HISPANIC                10397    11006293        19.64         0.28
   NH WHITE                44806    32095778        57.26         0.33
   NH BLACK                 7669     8598435        15.34         0.25
   NH OTHER                 5326     4350814         7.76         0.22
----------------------------------------------------------------------

## Parental Stress

- p<0.0001

**Notes:**
----------------------------------------------------------------------
RURAL4                 Sample      Weighted    Row          SE Row
   HISPCODE            Size        Size        Percent      Percent
----------------------------------------------------------------------
Total
   Total                   99660    70508338       100.00         0.00
   HISPANIC                13045    12255125        17.38         0.23
   NH WHITE                69363    42956436        60.92         0.28
   NH BLACK                 9453    10126727        14.36         0.21
   NH OTHER                 7799     5170051         7.33         0.18
1
   Total                    4332     1780545       100.00         0.00
   HISPANIC                  219       84587         4.75         0.61
   NH WHITE                 3560     1380073        77.51         1.21
   NH BLACK                  216      224052        12.58         1.08
   NH OTHER                  337       91833         5.16         0.50
2
   Total                   17012     8208773       100.00         0.00
   HISPANIC                 1358      692318         8.43         0.42
   NH WHITE                13500     6301789        76.77         0.58
   NH BLACK                 1022      845995        10.31         0.44
   NH OTHER                 1132      368670         4.49         0.21
3
   Total                   10118     4467701       100.00         0.00
   HISPANIC                 1071      471927        10.56         0.62
   NH WHITE                 7497     3178795        71.15         0.83
   NH BLACK                  546      458245        10.26         0.57
   NH OTHER                 1004      358733         8.03         0.47
4
   Total                   68198    56051320       100.00         0.00
   HISPANIC                10397    11006293        19.64         0.28
   NH WHITE                44806    32095778        57.26         0.33
   NH BLACK                 7669     8598435        15.34         0.25
   NH OTHER                 5326     4350814         7.76         0.22
----------------------------------------------------------------------

## Examining parental stress

- 	Minority parents slightly more likely to report high stress (%)

- 	No difference across residence

## Violent disagreements: Final Results

|  | Hit, throw |  |  | Argue, shout |  |  |
| --- | --- | --- | --- | --- | --- | --- |
|  | OR | 95% CI |  | OR | 95% CI |  |
| Residence (reference: urban) |  |  |  |  |  |  |
| Rural | 0.86 | 0.77 | 0.95 | 0.98 | 0.92 | 1.05 |
| Race/Ethnicity (reference: white) |  |  |  |  |  |  |
|      Hispanic     | 1.03 | 0.87 | 1.21 | 1.07 | 0.95 | 1.20 |
|      African-American    | 1.73 | 1.51 | 1.98 | 1.41 | 1.29 | 1.54 |
|      Other  | 1.38 | 1.14 | 1.67 | 1.17 | 1.04 | 1.33 |
| Parenting stress 
(reference:  low) |  |  |  |  |  |  |
|      High Stress  | 3.17 | 2.91 | 3.47 | 1.99 | 1.87 | 2.12 |

- 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.

## 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

## Questions or Comments? 

- Charity G. Moore: _[cgmoore@med.unc.edu](mailto:cgmoore@med.unc.edu)_
- Janice C. Probst: _[jprobst@gwm.sc.edu](mailto:jprobst@gwm.sc.edu)_