The CDC defines IPV as "physical, sexual, or psychological harm by a current or former partner or spouse." [3]

The CDC also separates IPV into four categories: [3]

• Physical violence: This is the intentional use of physical force with the potential for causing death, disability, injury, or harm. Physical violence includes, but is not limited to, scratching; pushing; shoving; throwing; grabbing; biting; choking; shaking; slapping; punching; burning; use of a weapon; and use of restraints or one's body, size, or strength against another person.


• Sexual violence is divided into three categories: 1) use of physical force to compel a person to engage in a sexual act against his or her will, whether or not the act is completed; 2) attempted or completed sex act involving a person who is unable to understand the nature or condition of the act, to decline participation, or to communicate unwillingness to engage in the sexual act, e.g., because of illness, disability, or the influence of alcohol or other drugs, or because of intimidation or pressure; and 3) abusive sexual contact.


• Threats of physical or sexual violence use words, gestures, or weapons to communicate the intent to cause death, disability, injury, or physical harm.


• Psychological/emotional violence involves trauma to the victim caused by acts, threats of acts, or coercive tactics. Psychological/emotional abuse can include, but is not limited to, humiliating the victim, controlling what the victim can and cannot do, withholding information from the victim, deliberately doing something to make the victim feel diminished or embarrassed, isolating the victim from friends and family, and denying the victim access to money or other basic resources. It is considered psychological/emotional violence when there has been prior physical or sexual violence or prior threat of physical or sexual violence. In addition, stalking is often included among the types of IPV. Stalking generally refers to "harassing or threatening behavior that an individual engages in repeatedly, such as following a person, appearing at a person's home or place of business, making harassing phone calls, leaving written messages or objects, or vandalizing a person's property"

From the Centers for Disease Control and Prevention [4], here are four categories of risk factors that increases the chances of an individual becoming a victim of IPV. Risk factors are not causes of IPV but can create an environment where IPV is likelier to develop.

Individual Risk Factors
• Low self-esteem
• Low income
• Low academic achievement
• Young age
• Aggressive or delinquent behavior as a youth
• Heavy alcohol and drug use
• Depression
• Anger and hostility
• Antisocial personality traits
• Borderline personality traits
• Prior history of being physically abusive
• Having few friends and being isolated from other people
• Unemployment
• Emotional dependence and insecurity
• Belief in strict gender roles (e.g., male dominance and aggression in relationships)
• Desire for power and control in relationships
• Perpetrating psychological aggression
• Being a victim of physical or psychological abuse (consistently one of the strongest predictors of perpetration)
• History of experiencing poor parenting as a child
• History of experiencing physical discipline as a child

Relationship Factors
• Marital conflict-fights, tension, and other struggles
• Marital instability-divorces or separations
• Dominance and control of the relationship by one partner over the other
• Economic stress
• Unhealthy family relationships and interactions

Community Factors
• Poverty and associated factors (e.g., overcrowding)
• Low social capital-lack of institutions, relationships, and norms that shape a community's social interactions
• Weak community sanctions against IPV (e.g., unwillingness of neighbors to intervene in situations where they witness violence)

Societal Factors
• Traditional gender norms (e.g., women should stay at home, not enter workforce, and be submissive; men support the family and make the decisions)

Risk Factors for Immigrant & Refugee Communities
In addition to the list by the CDC, these are additional or key risk factors identified for immigrant and refugee communities. [9]
• Both young and old are considered risk factors. The older the victim, the increased risk of lifetime IPV.
• Marital status
• Urban residence
• Low income or financial strain
• Partners' use of substances, especially heavy alcohol consumption

Additionally, the Lifetime Spiral of Gender Violence shows forms of violence against women during their lifetime that specifically ring true to APIs.

• Female victims of IPV report lower levels of health-related QOL than non-abused women.
• IPV victims with post-traumatic stress disorder (PTSD) report significantly more impairment in health-related QOL across various dimensions: physical functioning, role limitations due to emotional problems, vitality, social functioning, and mental health aspects of QOL.[12]

There are a many physical consequences of IPV victims. IPV increases 50 to 70 percent of problems women have with gynecological, central nervous system, and stress-related problems.[3]

Increased occurrences of headaches, back pain, STDs, vaginal bleeding, vaginal infections, pelvic pain, painful intercourse, UTIs, appetite loss, abdominal pain and digestive problems were seen in abused women. [3]

From the National Network to End Domestic Violence (NNEDV)[6], here are some facts on the cost of domestic violence.

• The cost of intimate partner violence annually exceeds $5.8 billion, including $4.1 billion in direct health care expenses.
• Between one-quarter and one-half of domestic violence victims report that they lost a job, at least in part, due to domestic violence.
• Women who experienced domestic violence were more likely to experience spells of unemployment, have health problems, and be welfare recipients.
• Domestic violence has been estimated to cost employers in the U.S. up to $13 billion each year.
• In the U.S., rape is the most costly crime to its victims, totaling $127 billion a year including medical costs, lost earnings, pain, suffering and lost quality of life.
• New research shows that intimate partner violence costs a health plan $19.3 million each year for every 100,000 women between the age of 18 and 64 enrolled.

According to our lecture by Susan M. Hadley MPH* on domestic violence, it mandatory to report child and elder abuse. All health care providers can report if they suspect a person is being abused. They are protected under the law if they "report in good faith & exercise due care."

Ms. Hadley also stated that reporting requirements for IPV vary by jurisdiction and states and should be checked with the state attorney general.

*Hadley MPH, Susan M. "Domestic Violence: The Health Provider's Response." PubH 6123. University of Minnesota, Minneapolis. 22 Mar. 2010. Lecture.

According to the Hmong Cultural Center, the Hmong originated in China and migrated to southeast Asian in the 18th century and settling in Laos, Northern Vietnam and Thailand. During the Vietnam War, they were recruited by the CIA to fight in the US Secret Army. They saved downed US pilots in the jungles of Laos and fought against the Vietnamese and the Pathet Lao. The US withdrew from the SE Asia in 1975, and left the Hmong vulnerable for persecution by the communist Pathet Lao. The Hmong fled for refuge in neighboring Thailand and eventually were sponsored by Lutheran missionaries to France, Australia, and the US. In 2003, the US State Department allowed 15,000 Hmong refugees from the Wat Tham Krabok refugee camp in Thailand into the US. [13]

While the magnitude is of IPV in the Hmong community has not been documented, we know that nationally, one in four women are victims of IPV. [17] We also know that IPV occurs regardless of race, ethnicity, socio-economic status, age, religion, and all other characteristics. [10] With the population of the Hmong in 2000 at 94,439 and 49 percent female, we can calculate that about 11,000 Hmong women are victims of IPV. [9]

Like with mainstream America, many cases of IPV do not go reported. Problems are dealt within the clan system and when all else has failed, the women reaches out to the mainstream resources. [14] When they do contact local resources, with 1 out of 3 Hmong families linguistically isolated [2], the organizations may not have the ability to provide help to these women if they do not have access to an interpreter or are unfamiliar with the cultural dynamics.

Additional barriers the Hmong face when tackling IPV is its patriarchal culture where women are not valued as much as men. [18] Hmong men still practice polygamy, though not as common nowadays, and is condoned by the community. [13] Clans are led by men and women do not hold as many important decision-making roles in the community. [18]

Although there is limited data available on prevalence of IPV in the Hmong community, there have been many cases in the past years illustrating that the Hmong community is not immune from IPV.

Feb. 5, 2010 - LoNeng Kiatoukaysy was charged with causing bodily harm to his wife.

March 25, 2009 - Husband charged after wife says she was sold into marriage at age 12.

November 11, 2007 - Women killed during domestic dispute

August 21, 2007 - May Yang murdered by her estranged husband.

September 14, 2006 - Chor Xiong kills his estranged wife and her boyfriend.

April 26, 2006 - Leng Moua stabbed his wife during a heated argument.

April 5, 2006 - Man kills himself after 11-hour standoff with SWAT teams.

February 16, 2006 - Murder-Suicide of Hmong couple with long history of domestic violence.

November 11, 1998 - Murder-suicide of Hmong couple in Iowa

September 4, 1998 - Mother kills her 6 children and attempts suicide.

Portraits of Hmong Women contains five stories of Hmong women and their experiences of IPV.

Hmong in Minnesota

• The Hmong are the largest API community in Minnesota at 27.3% [2]


• St. Paul is home to 40,707 Hmong people, the largest concentration in a metropolitan area.[8]


• The Hmong make up only 2% of the national API population.[2]


• The Hmong had one of the fastest growth rate from 1990 to 2000. [2]


• 1/3 of Hmong live below the federal poverty line. [2]


• 51% of Hmong are under 18 years old. [9]


• There are 6.51 persons in an average Hmong family. [9]


• A majority of Hmong live in overcrowded housing. [2]


• 55% of Hmong have less than a high school education. [2]


• The Hmong per capita income of $7,147 is the lowest in the Twin Cities. [2]


• 55.6% of Hmong are foreign-born.[9]


• 31.4% of foreign-born are US citizens. [9]


• The Hmong is one of the four API groups whose majority are limited English proficient. [2]


• More than 1 out of 3 Hmong households are linguistically isolated. [2]

Immigrants & IPV

• 51% of IPV homicides victims in NYC were foreign-born. [15]


• Married immigrant women experience higher levels of physical and sexual abuse than unmarried immigrant women. [8]

API & IPV

• 81.1% of Asian women reported experiencing at least one form of IPV [11]


• 28.5% of the survey participants knew of a woman who was being abused by her in-laws. [11]

IPV Nation-wide

• A woman is battered every 9 seconds in the United States.[17]


• 1 out of every 4 U.S. women has been assaulted by an intimate partner. [17]


• More than 800 Minnesotans, or 16 of every 100,000 people, were treated in hospitals for injuries caused by an intimate partner in 2001. [17]


• A child's exposure to the father abusing the mother is the strongest risk factor for transmitting violent behavior from one generation to the next. [7]


• In 2009, 12 women were killed due to familial and domestic violence. [7]

Here is Haddon's matrix applied to IPV in the Hmong community.

Phases	Human	Vehicles & Equipment	Physical Environment	Socio-Economic Environment
Pre-Injury Phase	Provide education about signs of unhealthy relationships.	Screen individuals to identify high risk for perpetrating IPV and provide education	Remove item from residence that may be used a weapon (firearm, bats, tools, etc...)	Foster social norms that do not condone IPV. Train health and social services in cultural sensitivity and diversity. Develop culturally-appropriate prevention programs with collaboration of the community. Train community/clan leaders in IPV prevention.
Injury Phase	Teach populations how to react if they experience IPV to lessen/prevent injury. Also, provide available resources for help.	Teach perpetrators calming methods or resources where they can go for help.	Have victims have a safe plan in place if they need to escape their residence.	Promote ways for individuals to intervene an IPV situation in a safe manner (i.e., call authorities).
Post-Injury Phase	Have community/clan leaders available for the victim to speak to about the situation and the options available. Provide local resources where the victim can receive proper assistance to her/his needs.	Have community/clan leaders who have been trained in IPV counsel the perpetrator. Send perpetrator to rehabilitation where s/he can obtain culturally-appropriate education on IPV.	Provide a safe location (shelter) where the victim can stay.	Lobby for fund to provide social services for victims and perpetrators. Have community leaders debrief with community about incident.
Total Losses/Costs	Damage to People	Damage to Vehicles & Equipment	Damage to Physical Environment	Damage to Society

Using Haddon's ten strategies [14] to prevent IPV in the Hmong community.

1. Prevent the creation of the hazard.
Change cultural attitude about gender roles and domestic violence.

2. Reduce the amount of hazard.
Teach community about signs of domestic violence and resources available.

3. Prevent the release of hazards that already exists.
Provide anger/stress management to high risk offenders.

4. Modify the rate or spatial distribution of the hazard from its source.
Train clan leaders and have them promote healthy relationships among their clan members.

5. Separate by time or space the hazard from that which can be protected.
Provide adequate shelters available for victims.

6. Separate the hazard and what is to be protected by a material barrier.
Send perpetrators to rehabilitation facility or prison.

7. Modify relevant basic qualities of the hazard.
Provide education and counseling for the perpetrators.

8. Make what is to be protected more resistant to damage from the hazard.
Train victims in self-defense, create a safe plan, and/or resources.

9. Move rapidly to detect and evaluate the damage that has occurred and counter its continuation and extension.
Train emergency response team to recognize a domestic violence situation and develop protocol to prevent the perpetrator repeat.

10. Stabilize, repair and rehabilitate the damage or injured person.
Provide medical care, shaman, counseling, social services for victims.

Recommendations and strategies for immigrant and refugee communities to reduce IPV.

• Improve educational attainment and the high school graduation rate among the Hmong, Laotian, Cambodian, and Vietnamese communities [2]. This will improve families' economic situation by opening up opportunities to find jobs.


• Improve mainstream services. [10] Training cultural sensitivity and having interpreters available to help women who are limited English proficient.


• Train and develop community leaders to change attitude about IPV [10]. Community leaders have strong ties to both the mainstream community and their community. They will be the forces behind creating or improving local cultural organizations to develop prevention programs.


• Lobby for at local, state, and federal levels for policy-makers to fund and social and health services in languages and culturally-appropriate ways for IPV victims.[10]


• Continue to research the topic for specific communities, especially for the API communities where much of the data is aggregated for all API ethnicities. [10]

Recommendation for the Hmong community
These are some suggestions by the Hmong Violence Prevention Project [18] to reduce IPV.

• Support Hmong women's leadership.


• Include both genders in change efforts.


• Address IPV without blaming or shaming.


• Open up a dialogue about gender equity.


• Teach both sexes about traditions and rituals.

Based on the literature review completed on IPV, some recommendations for reducing disparities on this topic are:

Consistent definition - IPV is also called domestic violence, domestic abuse, violence against women and battery. Having such different names and different definitions will make it difficult to collect and report accurate numbers.

Continued efforts on researching underrepresented groups - During the literature search, it was difficult to find baseline IPV data on Hmong, outside of general API information. The API category is filled with many different and diverse groups so it is important not to clump them together.

Program evaluation - Evaluating programs to see its effectiveness and ways to improve it for future uses is always important.

Community involvement - It is important to involve the communities in creating programs and interventions because they are the ones who will be utilizing them. If an outsider creates the program and do not understand the culture of the community, it may not be as effective although it may have worked in other different communities.

Battered Women's Legal Advocacy Project: 1-800-313-2666 or 612-343-9842
BWLAP is a state-wide program that serves battered women, their advocates, attorneys and the general public in Minnesota.

Domestic Abuse Project: 1-800-793-5975 or 612-874-7063
DAP provide counseling, education and advocacy to families affected by domestic abuse to give them the tools to transform their lives.

Asian Women United of Minnesota: 651-724-0756

SEWA-Aifw: 952-912-9100
SEWA-AIFW originated from a desire to meet the unrecognized and unmet needs of the Asian-Indian community in Minnesota.

1. 2009 FEMICIDE REPORT. Publication. Minnesota Coalition for Battered Women. Web. 9 Apr. 2010. .

2. A Community of Contrasts: Asian Americans and Pacific Islanders in the United States. Publication. Asian American Justice Center, 2006. Web. 8 Apr. 2010. .

3. Campbell, PhD, RN, Jacquelyn, Alison Snow Jones, PhD, Jacqueline Dienemann, PhD, RN, and Joan Kub, PhD, RN. "Intimate Partner Violence and Physical Health Consequences." Archives of Internal Medicine 162.10 (2002): 1157-163.

4. "CDC - Injury - Intimate Partner Violence: Definitions." Centers for Disease Control and Prevention. Web. 26 Apr. 2010. .

5. "CDC - Intimate Partner Violence: Risk and Protective Factors." Centers for Disease Control and Prevention. Web. 1 Apr. 2010. .

6. Dabby, Firoza C. Gender Violence In Asian & Pacific Islander Communities. Publication. Asian & Pacific Islander Institute on Domestic Violence APIA Health Forum, Oct. 2007. Web. 9 Apr. 2010. .

7. DOMESTIC VIOLENCE AND SEXUAL ASSAULT FACT SHEET. Rep. National Network to End Domestic Violence. Web. 3 Apr. 2010. .

8. Dutton et al., Mary. Characteristics of Help-Seeking Behaviors, Resources, and Services Needs of Battered Immigrant Latinas: Legal and Policy Implications, 7 Geo. J. on Poverty L. and Pol'y 245 (2000).

9. Hmong 2000 Census Publication: Data and Analysis. Publication. Hmong National Development and Hmong Cultural Center, Mar. 2009. Web. 8 Apr. 2010. .

10. Intimate Partner Violence in Immigrant and Refugee Communities: Challenges, Promising Practices and Recommendations. Publication. Robert Wood Johnson Foundation and Family Violence Prevention Fund, Mar. 2009. Web. 3 Apr. 2010. .

11. Karen A. McDonnell & Shamira E. Abdulla, Project AWARE, Asian/Pacific Islander Resource Project (2001).

12. Laffaye, Charlene, Collen Kennedy, and Murray B. Stein. Post-Traumatic Stress Disorder and Health-Related Quality of Life in Female Victims of Intimate Partner Violence. Rep. Apr. 2003. Web. 4 Apr. 2010. .

13. Lee, Txong Pao and Pfeifer, Mark E. "Building Bridges: Teaching about the Hmong in our Communities." Powerpoint presentation for the Hmong Cultural Center, St. Paul, MN. 2009

14. MENJÍVAR, CECILIA, and OLIVIA SALCIDO. "Immigrant Women and Domestic Violence: Common Experiences in Different Countries." GENDER & SOCIETY 16.6 (2002): 898-920.

15. New York City Department of Health and Mental Hygiene, Femicide in New York City: 1995-2002 (2004), available at http://www.nyc.gov/html/doh/downloads/pdf/ip/femicide1995-2002_report.pdf

16. Runyan, Carol W. "Introduction: Back to the Future--Revisiting Haddon's Conceptualization of Injury Epidemiology and Prevention." Epidemiologic Reviews 25 (2003): 60-64. Print.

17. STATISTICS on Domestic Violence. Publication. Domestic Abuse Project. Web. 5 Apr. 2010. .

18. Thao, Bo. Hmong Women's Dialogues Project Our Voices Create Our Future. Rep. Hmong Women Action Team, Aug. 2006. Web. 4 Apr. 2010. .