Int. J. Environ. Res. Public Health 2009, 6 3161 From an ecological vantage, there are four levels of analysis: (1) personal history factors the individual brings into the relationship, (2) the immediate context in which the abuse takes place (i.e., microsystem; e.g., family, intimate partner), (3) institutions and social structures that comprise the microsystem (e.g., work, neighborhood, social networks), and 4) macrosystem; the general views and attitudes that permeate the culture at large [70]. In addition to these four areas, Edleson and Tolman [71] also consider a fifth factor, the mesosystem, which includes the interrelationship among the various factors identified above (e.g., link between person’s family and employment, relationships with legal institutions, social groups). Ecological theories have been used to explain how youth who experience parental alcohol abuse and IPV may be more likely to live in high-crime neighborhoods which may adversely impact the quality of schools and increase exposure to neighborhood violence. These parents may not be able to protect their children from neighborhood influences by moving to a safer area. The developmental ecological approach emphasizes both the social ecology in which the child develops, particularly for youth and families in high-risk settings (e.g., [72]), and risk factors that vary depending on child age [73]. 2.5. Family-Couple Theories Viewed from a family-couple vantage, witnessing paternal alcoholism and intimate partner violence has been linked to children’s fears [37] and internalizing symptoms [38-41]. The combined verbal/physical dyadic violence has also been related to greater likelihood of aggression and emotional maladjustment in children [74]. Moreover, growing empirical evidence shows that childhood exposure to the trauma of others can compromise adolescent and adult mental health outcomes [75]. Because dyads in which married or cohabiting patients entering treatment for alcoholism and other drugs of abuse are 4–6 times more likely to engage in acts of intimate partner violence than couples in the general population, children in these homes may be exposed to comparatively high levels of partner violence [14,15]. 2.6. Spillover Theories In recent years, researchers have recognized that interparental conflict is intrinsically and empirically linked to family processes and parenting [60-62]. Although there are different forms of interparental conflict [62], the overt hostile style [76], which involves frictional conflict in which couples display verbal aggression and physical violence [77], depicts many couples in which a partner abuses alcohol or drugs [78]. In these couples, poor communication is hypothesized as the mode by which partners communicate and work through everyday disagreements that ‘spill over’ into parent-child interactions and parenting behaviors [79]. In a meta-analytic review of the association between marital quality and parenting, Krishnakumar and Buehler [62] found an average effect size of d = −0.62 between overt interparental conflict and negative parenting. It is possible that parents who engage in intimate partner violence may exhibit an overall style of interaction toward their children that is characterized by coerciveness and negative verbalizations [80].