Violence is a major public health concern and social problem. Possible effects on men’s health have not been well studied. To address this gap, we examined the link between violence and health for men who have had multiple experiences of violence over their lifetime.

To capture men’s experiences of cumulative lifetime violence, we defined violence broadly as physical, emotional and sexual abuse that may have occurred anytime from child through to adulthood in family, dating and partner relationships, schools, communities and workplaces. We developed and tested a new measure of cumulative lifetime violence. Men living in eastern Canada were invited to take part in an online survey that included measures of violence and health.

A total of 658 men completed an online survey. Of these, 244 completed a “health check” for blood pressure, cholesterol, blood sugar, height and weight and 32 took part in a one-on-one interview about their experiences with violence.

See a detailed overview of the study and findings.

See one-page summaries of findings and peer reviewed papers:

• Cumulative Lifetime Violence, Gender Role Conflict, and Cardiovascular Disease in Eastern Canadian Men
• Cumulative Lifetime Violence Severity: Does it Make a Difference to the Health of Canadian Men?

• Cumulative Lifetime Violence Severity Scale: Development and Initial Testing Among Men

• CLVS & Chronic Pain in a Community Sample of Canadian Men

• Patterns and Correlates of Cannabis Use by CLVS as a Target/Perpetrator in a Community Sample of Eastern Canadian Men

• The Mental Health Effects of Cumulative Lifetime Violence in Men: Disruptions in the Capacity to Connect With Others And Finding Ways to Reengage

• Cumulative Lifetime Violence, Gender, Social Determinants of Health and Mental Health in Canadian Men: A Latent Class Analysis
• Masculinity and violence interconnectedness: Defining and reconciling the gender paradox among men with cumulative lifetime violence histories

Research team

• Kelly Scott-Storey RN, PhD
• Sue O’Donnell RN, PhD
• Judith Wuest RN, PhD
• Judith Macintosh RN, PhD
• Marilyn Merritt-Gray RN, MN
• Jeannie Malcolm BA, MA
• Petrea Taylor, RN, PhD
• Charlene Vincent, RN, MN

Contact the research team at 1-888-457-6600 or health@unb.ca.

Funded by the Canadian Institutes of Health Research, Operating Grant 2014-2022.

Intimate partner violence (IPV) is a serious public health problem with significant social and economic costs. To accurately determine current prevalence rates and impacts of IPV over time, measurement and collection of data must be valid, timely, adequately descriptive, and nationally representative.

Of particular concern has been the misalignment between theoretical understanding and measurement of IPV within population surveys including the tendency to use measures framed around either conflict or experiences of physical and sexual violence as defined by the Criminal Code of Canada. To address these concerns, a short form version of the Composite Abuse Scale (CASR-SF) was developed for use in national and population surveys and recently tested among a large Canadian sample of diverse women (Ford-Gilboe et al., 2016).

The CASR-SF addresses many of the identified limitations by not only measuring a broad range of types of IPV (physical, sexual, psychological) but also assessing the severity and intensity of the experiences. While this is an important advancement in the measurement of IPV, the extent to which the CASR-SF is robust in other samples, including men, requires testing.

Purpose: To assess the relevance of the CASR-SF among Canadian men, and the applicability and fit of the items across men’s diverse contexts and social location.

Objectives: 1) To conduct a literature review on men’s experiences of intimate partner violence; 2) To consult experts working in the field of IPV; and 3) produce a research report on the applicability and fit of the CASR-SF for men, including recommendations for future work.

Results

Objective 1: Scott-Storey, K., O’Donnell, S., Ford-Gilboe, M., Varcoe, C., Wathen, N., Malcolm, J. & Vincent, C. (2022). What about men? A critical review of men’s experiences with intimate partner violence. Trauma Violence Abuse.

Objective 3: Scott-Storey, K., O’Donnell, S., Ford-Gilboe, M., Varcoe, C., & Malcolm, J. (2017). Expert Consultation: Applicability and Fit of CASRSF for Men. Final Report submitted to the Public Health Agency of Canada.

Project team

• Kelly Scott-Storey, PhD, RN, Faculty of Nursing, UNB
• Sue O’Donnell, PhD, RN, Faculty of Nursing, UNB
• Marilyn Ford-Gilboe, PhD, RN, FAAN; Arthur Labatt Family School of Nursing, Western University
• Colleen Varcoe, PhD, RN, School of Nursing, University of British Columbia
• Jeannie Malcolm, BA, MA, Faculty of Nursing, UNB

Funded by the Public Health Agency of Canada 2017.

Results of our review of the applicability and fit of the CASR-SF for men suggest that it shows promise in capturing men’s experiences of IPV. However, direct validation of the fit and relevance of the CASR-SF with a diverse sample of men who have experienced IPV is also needed. The inclusion of men with various gender and sexual identities, and different experiences of IPV is needed to gain an in-depth understanding of the broad relevance and fit of CASR-SF items and whether certain items function in similar or different ways among various groups of men.

Purpose: to further examine the applicability and fit of the CASR-SF by conducting cognitive testing with a diverse sample of men who have experienced IPV. Our primary aim was to examine whether the current 15 items are acceptable to and resonate with men based on their experiences of IPV. Based on findings from recent work examining and assessing the CASR-SF, which was supported by Status of Women Canada, we included and tested an additional item focused on sexual humiliation.

Results: O’Donnell, S., Scott-Storey, K., Ford-Gilboe, M., Varcoe, C., Wathen, N., MacMillan, H., & Malcolm, J. (2018). Cognitive Testing of the Composite Abuse Scale Revised-Short Form among Men. Final report submitted to Public Health Agency of Canada.

See a one-page summary of findings.

Project team

• Sue O’Donnell, PhD, RN, Faculty of Nursing, UNB
• Kelly Scott-Storey, PhD, RN, Faculty of Nursing, UNB
• Marilyn Ford-Gilboe, PhD, RN, FAAN; Arthur Labatt Family School of Nursing, Western University
• Colleen Varcoe, PhD, RN, School of Nursing, University of British Columbia
• Nadine Wathen, BA, MA, PhD, Faculty of Information and Media Studies, Western University
• Harriet MacMillan, MD, MSc, FRCPC, Department of Psychiatry and Behavioural Neurosciences, McMaster University
• Jeannie Malcolm, BA, MA, Faculty of Nursing, UNB

The focus of this bridging project was to strengthen evidence to support the feasibility of a national longitudinal study about variation in men’s health by cumulative lifetime violence severity (CLVS) and social determinants of health (SDOH).

Objective 1: To evaluate the effectiveness of Qualtrics© recruitment system. The successful acquisition of a target national sample of approximately 600 Canadian men with violence experience confirmed the usefulness and effectiveness of the Qualtrics© system for recruitment and management of an online survey, data quality, stratified data collection techniques, and for gathering contact information for subsequent waves.

Objective 2: To evaluate the structure, reliability, and validity of the new Cumulative Lifetime Violence Severity scale.

We successfully validated our CLVS scale as a new measure of lifetime violence for use in men’s health research using Principal Component Analysis. Specifically, structure of the 44-item scale (CLVS-44) developed previously with a sample of NB men was confirmed with data from the Canada-wide sample of 600 men, giving confidence to the new measure.

Objective 3: To document relationships among men’s CLVS measured with the CLVS-44; mental health, chronic pain and substance use; gender, and other SDOH overall, along with age. Descriptive and bivariate analyses along with regression analyses were used to explore relationships among variables of interest. Thus far, this study has largely confirmed our previous findings with a sample of NB men in New Brunswick that higher CLVS is associated with poorer mental health and physical health. Contrary to our previous research, where we had an unexpected finding that hazardous drinking was not related to CLVS severity, this research did demonstrate that relationship. Future inquiry is needed to better understand alcohol use among men in NB with a history of violence. A strength of this study was the successful measurement of SDOH that were not included in our previous work. Such determinants included food and housing security, and newcomers to Canada (in the past 5 years), which demonstrated bivariant differences by CLV severity. These measures permit analysis to understand which SDOH intersect with CLVS to increase men’s vulnerability to specific health outcomes.

See one-page summaries of findings and our peer reviewed publications to date related to analyses of these relationships:

• Cumulative lifetime violence severity, social determinants and anxiety in a national sample of Canadian men
• Attachment, mental health, and alcohol use by men: The mediating role of Cumulative Lifetime Violence Severity
• Cumulative lifetime violence, social determinants of health, and cannabis use disorder post cannabis legalization in a community sample of men: An intersectional approach

Project team

• Kelly Scott-Storey RN, PhD
• Sue O’Donnell RN, PhD
• David Busolo RN, PhD
• Enrico DiTommaso PhD
• Petrea Taylor RN, PhD
• Jeannie Malcolm BA, MA
• Charlene Vincent RN, MN

Funded by a New Brunswick Health Research Foundation Bridge Grant 2020-2022.

Our previous research with New Brunswick (NB) men showed that experiencing higher cumulative lifetime violence (CLV) severity as target and/or perpetrator is associated with poorer health outcomes. Unknown is how men with CLV histories manage their health in the context of broader social norms and structures.

Goal: To gain a contextual understanding of how men with CLV manage and promote their health.

Methods: Using a qualitative grounded theory (GT) photovoice (PV) approach we are examining the processes, strengths and challenges associated with efforts to manage and increase control over health among men who have experienced CLV. Eight NB men who have lifetime experiences of CLV have been interviewed individually. Four also took part in a 5-session photovoice group, taking and discussing photos that depict their health promotion experiences. The GT PV approach allowed for both one-on-one and collective discussion of individual, social, and structural factors that strengthen, support, and/or limit men’s health promotion. This participatory process provided opportunities for men to increase their awareness of their own needs, actions and strengths in promoting their health.

Analysis of interviews and group discussions is underway using constant comparative analysis. Men described a range of CLV experiences that resulted in significant health and social consequences. They defined health broadly and discussed both formal and informal approaches to managing and promoting physical, emotional and social well-being with results that were variously beneficial and harmful. Some identified fears and challenges accessing violence-related help and a lack of overall acknowledgement of men’s violence that limited men’s ability to engage in health promoting behaviors. The outcome of analysis will be a foundational theory that will contribute to new knowledge and provide important direction for future trauma- and violence-informed health interventions and/or policies that are sensitive to the unique needs of men with CLV histories.

Project team

• Sue O’Donnell RN, PhD
• Kelly Scott-Storey RN, PhD
• David Busolo RN, PhD
• Petrea Taylor RN, PhD
• Jeannie Malcolm BA, MA
• Charlene Vincent RN, MN

Funded by the New Brunswick Health Research Foundation Bridge Grant 2019-2022.

Study of men’s health and violence is flawed by narrow definitions of violence and designs that neglect the confounding impacts of other experiences of lifetime cumulative violence as target and perpetrator. We addressed this shortcoming by developing and initially testing the Cumulative Lifetime Violence Severity (CLVS) scale for health research with men (Scott-Storey et al., 2020).

Using this scale, a sample of eastern Canadian men, and variable-oriented research approaches in a cross-sectional inquiry, we found that CLVS is negatively associated with men’s health (e.g., chronic pain, cannabis use, mental health) overall. However, variable-oriented methods neglect the heterogeneity of experiences and outcomes among men. Person-oriented methods are needed to identify distinct sub-groups within the sample and the meaningful characteristics that distinguish sub-groups from one another.

Men’s health stems from the accumulation of experiences over time but longitudinal studies of violence and health are rare. Knowledge from such analyses is critical to understanding which men are most at risk for violence-related health issues and for design of trauma- and violence-informed interventions to support them.

Goal: To explore how CLVS is associated with change in violence-affected men’s health over time, both overall and by sub-groups that reflect the diversity in violence exposure and the intersectional influences of social determinants of health (SDOH) including gender.

Aims: 1) To revise, evaluate and confirm the structure, validity and reliability of the CLVS scale; 2) To identify mutually exclusive sub-groups of men according to patterns of CLVS and SDOH such as gender, immigration status, age, financial stability, social connection, and mastery at baseline, and explore differences within and among sub-groups in mental health, cannabis use, and chronic pain by subgroup over time; and 3) examine change in CLVS scores over time and the association between these changes and specified health outcomes as mediated or moderated by salient SDOH.

Methods: A longitudinal, prospective online survey of a national sample of 1400 Canadian men in 3 waves 12 months apart. We will use both variable-oriented and person-oriented methods: for example, exploratory and confirmatory factor analysis (Aim 1); latent class analysis (Aim 2); and structural equation modelling with latent growth curve analysis (Aim 3).

Expected outcomes: 1) knowledge of sub-groups of violence-affected men most at-risk for negative health outcomes will inform programs and policies aimed at promoting and managing men’s health; 2) validation of a new measure of CLVS for men’s health research; 3) insight into variation in men’s health over time according to CLVS and SDOH; and 4) evidence of ways in which different patterns of violence are associated with health outcomes.

Progress to date: The team has developed and refined the online survey, established a study protocol for recruitment and survey administration at baseline, 12 months and 24 months. Approval has been received from the UNB Research Ethics Board and data collection is ongoing.

Project team

• Kelly Scott-Storey RN, PhD
• Sue O’Donnell RN, PhD
• Judith Wuest RN, PhD
• David Busolo RN, PhD
• Enrico DiTommaso PhD
• Petrea Taylor RN, PhD
• Jeannie Malcolm BA, MA
• Charlene Vincent RN, MN

Funded by a Canadian Institutes of Health Research Project Grant 2021-2026.