ORIGINAL ARTICLE

ORIGINAL ARTICLE Domestic Violence Against Women: Systematic Review of Prevalence Studies Samia Alhabib & Ula Nur & Roger Jones Published online: 15 December 2009 # Springer Science+Business Media, LLC 2009 Abstract To systematically review the worldwide evidence on the prevalence of domestic violence against women, to evaluate the quality of studies, and to account for variation in prevalence between studies, using consistent definitions and explicit, rigorous methods. Systematic review of prevalence studies on domestic violence against women. Literature searches of 6 databases were undertaken for the period 1995 to 2006. Medline, Embase, Cinahl, ASSIA, ISI, and International Bibliography of the Social Sciences were searched, supplemented by hand searching of the reference lists from studies retrieved and specialized interdisciplinary journals on violence. A total of 134 studies in English on the prevalence of domestic violence against women, including women aged 18 to 65 years, but excluding women with specific disabilities or diseases, containing primary, empirical research data, were included in the systematic review. Studies were scored on eight predetermined criteria and stratified according to the total quality score. The majority of the sudies were conducted in North America (41%), followed by Europe (20%). 56% of studies were population-based, and 17% were carried out either in primary or community health care settings. There was considerable heterogeneity both between and within geographical locations, health care settings, and study quality The prevalence of lifetime domestic violence varies from 1.9% in Washington, US, to 70% in Hispanic Latinas in Southeast US. Only 12% scored a maximum of 8 on our quality criteria, with 27% studies scored 7, and 17% scored 6. The mean lifetime prevalence of all types of violence was found to be highest in studies conducted in psychiatric and obstetric/gynecology clinics. Results of this review emphasize that violence against women has reached epidemic proportions in many societies. Accurate measurement of the prevalence of domestic violence remains problematic and further culturally sensitive research is required to develop more effective preventive policies and programs. Keywords Domestic violence .Women . Prevalence . Review Introduction Violence against women includes all verbal, physical, and sexual assaults which violate a woman’s physical body, sense of self and sense of trust, regardless of age, race, ethinicity, or country (Campbell 1995). Violence against women has been identified as a major public health and human rights issue (Joachim 2000), and has been estimated by the World Health Organization (WHO) to account for between 5–20% of healthy years of life lost in women aged 15 to 44 (WHO 1997). Twenty years ago, violence against women was not considered an issue worthy of international attention or concern. This began to change in the 1980s, as women’s groups were organized locally and internationally to S. Alhabib (*) Academic Unit of Primary Health Care, University of Bristol, 25 Belgrave Road, Bristol BS8 2AA, UK e-mail: samia.alhabib@bristol.ac.uk U. Nur Cancer Statistics-Cancer Research UK, London School of Hygiene and Tropical Medicine, London, UK R. Jones Department of General Practice & Primary Care, King’s College London, London, UK J Fam Viol (2010) 25:369–382 DOI 10.1007/s10896-009-9298-4 demand attention to the physical, psychological, and economic abuse of women. Gradually, violence against women has come to be recognized as a legitimate human rights issue and a significant threat to women’s health and well being (Ellsberg and Heise 2005). The process began in Europe and North America, but even in the United States, where this trend was most apparent, it took 20 years for rising awareness to lead to legislation and to potentially effective preventive measures. Only in the early 1990s were comprehensive laws enforced and effective resources allocated to deal with gender violence (Gelles 1997). Worldwide, domestic violence is as serious a cause of death and incapacity among women aged 15–49 years as cancer, and a greater cause of ill health than traffic accidents and malaria combined (The World Bank 1993). In addition to causing injury, violence increases women’s long-term risks of a number of other health problems, including chronic pain, physical disability, drug and alcohol abuse, and depression (Heise et al. 1999). Secondary to the biopsychosocial effects of battering are the high costs of such violence. Abused women have more than double the number of medical visits, an 8-fold greater mental healthcare usage, and an increased hospitalization rate compared to non-abused women (Wisner et al. 1999). The WHO multi-country study on women’s health and domestic violence has recently confirmed significant associations between lifetime experiences of partner violence and self reported poor health (Ellsberg et al. 2008). Prevalence studies of violence against women report wide variations in levels of violence within and between health care settings. The reported lifetime prevalence of physical or sexual violence, or both, varied from 15% to 71% among the countries studied in the WHO multi-country study (Garcia-Moreno et al. 2006). Few studies have used standard methods to derive comparative prevalence figures. The World-Safe initiative represents a successful model that has been used in five countries (Brazil, Chile, Egypt, Philippines, and India) to study intimate partner violence against women and children (Sadowski et al. 2004). The WHO multi-country study uses another model, which has been applied in 10 different countries. While confirming that physical and sexual partner violence against women is widespread, the variation in prevalence within and between study settings emphasizes that this violence is not inevitable, and needs to be addressed. Over the last 10 years, a number of prevalence surveys on intimate partner violence has been published from around the world. However, despite a number of initiatives, such as the European Network on Conflict, Gender, and Violence, the launching of a European Society of Criminology and efforts to develop an international survey on violence against women (Hagemann-White 2001), information from these studies has not been systematically collated and analyzed. The aim of this systematic review is to systematically summarize the worldwide evidence on the prevalence of domestic violence against women, to evaluate the quality of studies, and to try to account for variation in prevalence rates between studies. Methods Literature Searches Parallel literature searches of 6 databases (Medline, Embase, Cinahl, ASSIA, ISI, and International Bibliography of the Social sciences) were undertaken for the period1995–2006. The reference lists from retrieved studies and specilaized interdisciplinary journals in violence (Violence Against Women, Journal of Interpersonal Violence) were hand searched to look for further studies that might not have been retrieved by the database searches. Authors of unpublished studies, e.g., PhD theses, were contacted to obtain copies of their studies. We contacted experts in the field before and during the process to obtain feedback and advice with regard to methodology and analysis. All citations were exported into Reference Manager software (version 11). Searches included MeSH and text words terms, with combinations AND OR Boolean operator (Box 1). Box 1: words used in the search 1. Domestic violence. 13. Frequency. 2. Spouse abuse. 14. Prevalenc$.tw. 3. Battered women. 15. Incidenc$.tw. 4. Partner abuse. 16. Propotion$.tw. 5. Domestic violence.tw. 17. Frequenc$.tw. 6. Spouse abuse.tw. 18. 10 or 11 or 12 or 13 or 14 or 15 or 16 or17. 7. Battered women.tw. 19. Women. 8. Partner abuse.tw. 20. Wom#n.tw. 9. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8. 21. 19 or 20. 10. Prevalence. 22. 9 and 18 and 21. 11. Incidence. 23. Limit 22 to “all adult (19 plus years)” 12. Proportion. 24. Limit 23 to female. We included studies on the prevalence of domestic violence against women conducted between 1995 and 2006, published in English and including women aged between 18 and 65 years. We excluded studies on women with special disabilities or certain complicated diseases e.g., HIV, women in places of refuge, case reports, reviews, and non-English studies. We also excluded studies conducted on women aged >65 years and on violence against pregnant 370 J Fam Viol (2010) 25:369–382 women, where a large number of studies was found, which possibly merit a separate review. Our searches identified 1,653 primary studies, which were reduced to 356 after screening the titles and abstracts to assess whether the contents were likely to be within the scope of the review. We also checked for duplicates between databases, accounting for 180 (10.9%) of the total studies. A further 176 studies were excluded because they were largely naratives about domestic violence cases, studies of risk factors rather than prevalence or were predominately review articles. A final total of 134 studies was selected for further analysis (see Fig. 1). Quality Assessment These studies was assessed using structured guidelines (Loney et al. 2000), and were scored on eight quality criteria as follows: (1) specification of the target population, (2) use of an adequate sampling method (e.g., random, cluster), (3) adequate sample size (>300 subjects), (4) adequate response rate (>66%), (5) valid, repeatable case definition, (6) measurment with valid instrument, (7) reporting of confidence intervals or standard errors, and (8) attempts to reduce observer bias. We recorded the date of the study, the prevalence (and/or incidence) estimates of domestic violence (including life-time and/or current estimates), and the type of violence reported. These variables were coded from each study as categorical or continuous. After quality assessment was completed, studies were stratified according to the total score from 1–8. Data Synthesis The study data were coded and analyzed using SPSS Version 11. Meta-analyses were conducted in STATA version 10. Continuous & categorical variables were expressed as frequencies and percentages, and are summarized statistically in tables and are presented in graphic form. Prevalence estimates in the figures represent the simple weighted mean prevalence for all the studies done in each continent. A number of the studies we have included are described in more than one publication. In some cases, additional analysis conducted after completion of a study was reported in additional publications. In these cases, we used both reports to inform the data extraction. Conflict in quality scoring of the included studies was resolved by consensus between the authors (SA & RJ) Forest plots were produced to give a graphical representation of the studies and to convey the extent of heterogeneity between prevalence estimates. Heterogeneity between prevalence estimates was tested using a chi-squared test. Sensitivity analyses were used to determine whether any heterogeneity found could be due to differing study methodologies, study quality or geographical differences. Potentially relevant prevalence studies identified for retrieval (n=1653) Papers excluded on the basis of title & abstract (n=1297) Papers retrieved for more detailed evaluation (n=356) Papers excluded with reasons (n=180), duplicates between databases. Potentially appropriate prevalence studies to be included in the review (n=176) Prevalence studies excluded from review with reasons (n=134), studies of risk factors, narratives of domestic violence cases, or review articles. Prevalence studies included in the review with usable information (n=134) Fig. 1 Flow chart summarising literature review J Fam Viol (2010) 25:369–382 371 Results Most of the studies (41%) were conducted in North America, followed by 20% in Europe, 16% in Asia, 11% in Africa, and 5% in the Middle East (Table 1). Eighty three studies (56%) were population-based, twenty five (17%) were conducted in primary care, 12% in emergency care settings and others in obstetrics and gynaecology, paediatric, psychiatric and other hospital clinics. The sample size was over 300 in 84% of studies. Approximately 60% used a form of randomisation in their sampling (Table 2). In 41% of studies a measurement instrument was developed by the researchers using focus groups or by reference to other validated measuring instruments, although a few did not report about the instrument used. The most commonly used instrument was the Conflict Tactic Scale (16.9%), followed by the Abuse Assessment Screen (14%) and the WHO instrument (13%). The most frequently used method of collecting the data was face-to-face interviews (55%), followed by selfadministered questionnaires (30%), and telephone interviews (13%). Only eighteen studies (12%) scored a maximum of 8 on our quality criteria, with 33 (27%) studies scoring 7, 25 (17%) scoring 6 (Table 3). The mean lifetime prevalence for physical, sexual and emotional violence by country is shown in Fig. 2. The highest levels of physical violence were seen in Japanese immigrants to North America (about 47%), who also had high levels of emotional violence (about 78%) along with respondents studied in South America, Europe, and Asia (37–50%). The mean lifetime prevalence of physical violence was found to be highest (30–50%) in studies conducted in psychiatric and obstetric/gynecology clinics (Fig. 3). The highest rates of sexual violence were found in studies conducted in psychiatric, obstetric, and gynecology clinics (30–35%) and, for emotional violence, the highest rates Table 1 Summary of frequencies of settings and continents Frequency % Geographical setting 60 studies in North America 40.5 29 studies in Europe 19.6 23 studies in Asia 15.5 16 studies in Africa 10.8 8 studies in Middle East 5.4 5 studies in Australia 3.4 4 studies in South America 2.7 Healthcare setting 83 Population studies 56.1 25 studies primary care 16.9 18 studies in emergency care 12.2 8 studies in Obst/Gyn clinic 5.4 5 studies in hospital setting 3.4 3 studies in pediatric clinic 2 2 studies in psychiatric clinic 1.4 2 studies in college students 1.4 One study in surgical clinic 0.7 One study in HMO 0.7 Methods 80 population cross-sectional studies 54.1 57 clinical cross-sectional studies 38.5 5 clinical cohort studies 3.4 4 population cohort studies 2.7 Table 2 Summary of frequencies of sampling, methods, and instruments used Frequency % Sampling 124 studies >300 sample size 83.8 24 studies <300 sample size 16.2 88 studies used randomization 59.5 54 studies used other methods 36.5 Instruments 60 studies used their own instrument 40.5 25 studies used CTS 16.9 21 studies used AAS 14.2 19 studies used WHO instrument 12.8 6 studies used PVS 4.1 4 studies used ISA 2.7 3 studies used NorAQ 2 2 studies used women’s health questionnaire 1.4 One study used DVI 0.7 One study used SVAWS 0.7 One study used BRFSS 0.7 One study used WorldSAFE 0.7 Contact with subjects 82 studies used face-to-face interview 55.4 44 studies used self-administered 29.7 19 studies used telephone interview 12.8 Frequency % 18 studies scored 8 12.2 33 studies scored 7 22.3 25 studies scored 6 16.9 34 studies scored 5 23 27 studies scored 4 18.2 8 studies scored 3 5.4 One study scored 2 0.7 2 studies scored 1 1.4 Table 3 Summary of frequencies of qulaity score 372 J Fam Viol (2010) 25:369–382 were found in accident and emergency and psychiatric departments (65–87%). Forest plots of prevalence estimates and their confidence intervals indicate that there is a large amount of heterogeneity between studies. Heterogeneity was formally tested and confirmed by using the chi-squared test. This test showed strong evidence of heterogeneity (p<0.001). Sensitivity analyses found that even in studies that: used a standardized methodology (WHO), scored high in their quality criteria, were population-based (Fig. 3, 4, 5, and 6), and in studies that were done in the same continents (Dickers 2002), heterogeneity was a constant finding. Pooled estimates across geographical locations and settings were not calculated due to the extreme heterogeneity and the difficulty in interpreting them. Discussion The results of this review emphasize that violence against women has reached epidemic proportions in many societies and suggests that no racial, ethnic, or socio-economic group is immune. However, we have also highlighted substantial differences in methodologies, sample sizes, sampling periods, study populations, and the types of violence studied. For all types of violence there was a consistent and a significant heterogeneity between studies, even in studies that appeared to use standardized methods (e.g., WHO multi-country study), population studies, and studies that scored high on our quality criteria. Age, ethnicity, and socioeconomic status were not consistently documented, making comparisons and evaluations of generalizability difficult. However, the WHO Multi-country study was an important attempt to collect internationally comparable statistics through the use of standardized survey methods. Prevalence of violence has been assumed to be higher in clinical settings than in population samples (Campbell 2002), because it is assumed that health care utilization is higher among victims of abuse (Plichta 1992). For example, high prevalence rates have been measured in specific patient groups, for example at gynecology clinics in patients with severe premenstrual syndrome (PMS) or pelvic pain (Golding et al. 2000, Walling et al. 1994). This observation is consistent with the findings in our review, where the highest figures for violence were found in psychiatric, obstetrics and gynecology, and emergency clinic settings. Our review highlights several important factors involved in the epidemiology of domestic violence against women. 1) Surveys may not measure the actual number of women who have been abused, but rather, the number of women who are willing to disclose abuse. As with all self-reported disclosure, it is possible that results are biased by either over-reporting or under-reporting. In most studies, however, little evidence of over-reporting has been found (Koss 1993). 2) The meaning of violence varies from culture to culture, and sometimes within the same culture (Krauss 2006). Women from Asian cultures are brought up in a belief system that stresses the greater need of the family over the needs of individual members (Rydstrom 2003). Although women in the poorest of nations are probably most inclined to believe that men are justified in beating their wives, in all settings, in developed and developing countries, abused women tend to hold more beliefs which justify violence against them (Fagan and Browne 1994). Fagan and Browne point out that, in classifying respondents as victims, a particular interpretation is placed on these responses, which may ignore important differences in the interpretation of ‘assault’ and of behaviors which 0 20 40 60 80 Asia Africa Europe South America North America Australia Middle East Chinese American Japanese American American Indian mean of prevpl mean of prevsl mean of prevel Fig. 2 Mean of lifetime prevalence of physical, sexual, and emotional violence by continent or country. Note: prevpl=prevalence of life time physical violence, prevel=prevalence of life time emotional violence, prevsl=prevalence of life time sexual violence 0 20 40 60 80 100 population based primary/community health hospital ED OBST/GYN pediatric psychiatric HMO college students surgery clinic mean of prevPL mean of prevSL mean of prevEL Fig. 3 Mean of lifetime prevalence of physical, sexual, and emotional violence by setting. Note: prevpl=prevalence of life time physical violence, prevel=prevalence of life time emotional violence, prevsl= prevalence of life time sexual violence J Fam Viol (2010) 25:369–382 373 constitute violence. However, not all women who suffer abuse identify with the socially constructed image of a ‘battered woman (Mahoney 1991). It is not only important to learn whether respondents have experienced any of the particular behaviors that we define as violent or abusive, but also to understand to what degree they share these labels with us. Many important social, political, and economic factors affect women’s lives, other than the cultural practices that receive so much attention in relation to violence. These include poverty, inequalities, new articulations of patriarchies in specific regions, and the legacies of colonialism and racism (Sokoloff and Pratt 2005). In Arab and Islamic countries, domestic violence is not yet considered a major concern, despite its increasing frequency and serious consequences. Domestic violence may be seen as a private matter and a potentially justifiable response to misbehavior on the part of the wife. Selective excerpts from religious tracts have been inappropriately used to endorse violence against women, although abuse is more likely to be a result of culture than of religion (Douki et al. 2003). However, issues of power and gender (Caetano et al. 2000), rather than ethnicity and race (Anderson 1997), may be more important in creating and maintaining male dominance and the imbalance of power between husbands and wives (Harris et al. 2005). Indeed, definitions of race and ethnicity are themselves problematic in research of this kind. Diverse ethnic groups are often collapsed into a single category, such as Asians, or the patterns of a single group such as Mexican Americans are over generalized to all Hispanics (Campbell et al. 1997). Because of this, data on partner violence among minority populations are often incomplete, precluding meaningful generalizations. 3) The measurement of domestic violence, and the accuracy of its reporting, are both fraught with problems, and much further work is need in this area. The choice of Garcia-Moreno C et al Bangladish 2006 Garcia-Moreno C et al Brazil 2006 Garcia-Moreno C et al Ethiopia 2006 Garcia-Moreno C et al Japan 2006 Garcia-Moreno C et al Namibia 2006 Garcia-Moreno C et al Peru 2006 Garcia-Moreno C et al Samoa 2006 Garcia-Moreno C et al Serbia 2006 Garcia-Moreno C et al Thailand 2006 Garcia-Moreno C et al Tanzania 2006 Hicks MHR et al 2006 Yang MS et al 2006 McCloskey LA et al 2005 Romito P et al 2005 Serquina-Ramiro L 2004 Salena H 2004 Eisikovits Z et al 2004 Ghazizadeh A 2005 op-Sidibe N et al 2006 Jain D et al 2004 Naved R.T et al 2006 Khawaja.M & Barazi.R 2005 Ramiro.L.S et al 2004 (Egypt) Ramiro.L.S et al 2004 (Philippine) Ramiro.L.S et al 2004 (Chile) Ramiro.L.S et al 2004 (India) Jewkes.R et al 2002 Raj A & Silverman.J.G 2002 Jewkes.R et al 2001/a Jewkes.R et al 2001/b Jewkes.R et al 2001/c Ellsberg.M.C et al 1999 Deyessa.N et al 1998 CDC, Georgia 1998 Hakimi et al 2001 study_id ES (95% CI) 19.00 (17.08, 20.92) 8.30 (6.72, 9.88) 29.00 (27.38, 30.62) 3.10 (2.18, 4.02) 15.90 (14.05, 17.75) 16.90 (14.95, 18.85) 17.90 (16.04, 19.76) 3.20 (2.30, 4.10) 7.90 (6.55, 9.25) 14.80 (13.17, 16.43) 3.00 (0.51, 5.49) 10.10 (7.93, 12.27) 16.20 (14.30, 18.10) 19.00 (15.27, 22.73) 29.00 (26.19, 31.81) 70.00 (64.89, 75.11) 6.00 (4.78, 7.22) 15.00 (12.80, 17.20) 47.00 (45.79, 48.21) 24.00 (20.26, 27.74) 19.00 (17.52, 20.48) 17.40 (12.81, 21.99) 10.50 (8.11, 12.89) 6.20 (4.71, 7.69) 3.60 (1.82, 5.38) 25.30 (22.12, 28.48) 9.50 (7.91, 11.09) 26.60 (19.75, 33.45) 10.90 (7.83, 13.97) 11.90 (8.80, 15.00) 4.50 (2.61, 6.39) 27.00 (23.06, 30.94) 10.00 (7.73, 12.27) 6.00 (5.17, 6.83) 2.00 (1.01, 2.99) 0 10 20 30 40 50 60 70 80 90100 Fig. 4 Forest plot of current physical violence studies 374 J Fam Viol (2010) 25:369–382 measures and the methodology used to establish the prevalence of domestic violence have significant impacts on the prevalence rates there are reported (Waltermaurer 2005). In our study, face-to-face interview methods yielded more disclosures of violence than self-reported or telephone interviews, in accordance with previous research indicating that the use of multiple and openended questions increases accurate reporting (Hamby et al. 1996). Written screening alone probably underestimates the prevalence of intimate partner violence (McFarlane et al. 1991). Our results indicate that prevalence of all types of violence has increased over time, despite the provision of legal services for victims of violence. International law, particularly the Convention on the Elimination of All Forms of Discrimination against Women (Merry 2003) is a law without sanctions, so that its implementation can easily be avoided, and traditional interpersonal relationships within societies can continue to provide conditions which perpetuate the use of violence (Khawaja and Barazi 2005; Michalski 2004). While we have attempted to follow a rigorous protocol in the conduct of this review, it is still subject to a number of limitations. It may be prone to indexing bias, publication bias and reporting bias. Our ability to assess quality of the studies that we identified was limited by the methodological information provided in the published articles, some of which was incomplete. Conclusion The high prevalence rates of violence experienced by women suggests that doctors practicing in all areas of medicine need to recognize and explore the potential relevance of violence issues when considering women’s reasons for presenting with ill health. Sensitization to the problem of domestic violence should be incorporated not only in medical training, but into govermental, legal, and judicial organizations. Inconsistences in methodology identified in the study emphasize the importance of developing clearer definitions so that findings can be compared across settings, to allow more accurate comparasions of prevalence rates over time, and between different population groups. Future research should seek to recognize cultural differences in family functioning without necessarily viewing such differences as ‘deviant’ or ‘pathological’, and should recog- Garcia-Moreno C et al Bangladish 2006 Garcia-Moreno C et al Brazil 2006 Garcia-Moreno C et al Ethiopia 2006 Garcia-Moreno C et al Japan 2006 Garcia-Moreno C et al Namibia 2006 Garcia-Moreno C et al Peru 2006 Garcia-Moreno C et al Samoa 2006 Garcia-Moreno C et al Serbia 2006 Garcia-Moreno C et al Thailand 2006 Garcia-Moreno C et al Tanzania 2006 Hicks MHR et al 2006 Yang MS et al 2006 McCloskey LA et al 2005 Romito P et al 2005 Serquina-Ramiro L 2004 Salena H 2004 Eisikovits Z et al 2004 Ghazizadeh A 2005 op-Sidibe N et al 2006 Jain D et al 2004 Naved R.T et al 2006 Khawaja.M & Barazi.R 2005 Ramiro.L.S et al 2004 (Egypt) Ramiro.L.S et al 2004 (Philippine) Ramiro.L.S et al 2004 (Chile) Ramiro.L.S et al 2004 (India) Jewkes.R et al 2002 Raj A & Silverman.J.G 2002 Jewkes.R et al 2001/a Jewkes.R et al 2001/b Jewkes.R et al 2001/c Ellsberg.M.C et al 1999 Deyessa.N et al 1998 CDC, Georgia 1998 Hakimi et al 2001 study_id 19.00 (17.08, 20.92) 8.30 (6.72, 9.88) 29.00 (27.38, 30.62) 3.10 (2.18, 4.02) 15.90 (14.05, 17.75) 16.90 (14.95, 18.85) 17.90 (16.04, 19.76) 3.20 (2.30, 4.10) 7.90 (6.55, 9.25) 14.80 (13.17, 16.43) 3.00 (0.51, 5.49) 10.10 (7.93, 12.27) 16.20 (14.30, 18.10) 19.00 (15.27, 22.73) 29.00 (26.19, 31.81) 70.00 (64.89, 75.11) 6.00 (4.78, 7.22) 15.00 (12.80, 17.20) 47.00 (45.79, 48.21) 24.00 (20.26, 27.74) 19.00 (17.52, 20.48) 17.40 (12.81, 21.99) 10.50 (8.11, 12.89) 6.20 (4.71, 7.69) 3.60 (1.82, 5.38) 25.30 (22.12, 28.48) 9.50 (7.91, 11.09) 26.60 (19.75, 33.45) 10.90 (7.83, 13.97) 11.90 (8.80, 15.00) 4.50 (2.61, 6.39) 27.00 (23.06, 30.94) 10.00 (7.73, 12.27) 6.00 (5.17, 6.83) 2.00 (1.01, 2.99) ES (95% CI) 0 102030405060708090100 Fig. 5 Forest plot of prevalences of current physical violence from population studies J Fam Viol (2010) 25:369–382 375 nize the complex nature of differences between and within ethnic groups. More concentrated and culturally sensitive research can lead to a clearer understanding of the scope and causes of violence against women, which in turn may lead to more effective preventive and intervention efforts. What is already known on this topic: • Domestic violence is increasingly recognized as a global health issue. • In the past decade a number of prevalence surveys on intimate partner violence have been performed. • Widely different estimates of the prevalence of domestic violence have been reported in different settings, suggesting a need to standardize the methodology used in such research. What this study adds: • Violence against women has reached epidemic proportions in most societies. • This review identified major differences in methodology, instruments, sample size, period covered, the population surveyed and types and forms of violence studied. • In all types of violence our meta-analysis indicated significant heterogeneity between studies, even in studies employing standardized methods. • To accurately estimate the prevalence of violence in different settings, researchers need to develop clear and consistent definitions to allow comparisons between settings. • prevalence of lifetime domestic violence varies from 1.9% in Washington, US, to 70% in Hispanic Latinas in Southeast US. Acknowledgements We would like to acknowledge the advice given by Dr. Kalwant Sidhu, Director of the MSc Programme at King’s College London, Martin Hewitt, who provided advice on literature searching, Dr. Paul Seed, who provided statistical advice, Prof. Gene Feder and Prof. Tony Ades for commenting on the paper before submission for publication and to Jeremy Nagle in the British Library, who helped to track down references. Contributorship Samia Alhabib had the original idea for the study which was refined by Roger Jones. Data collection, critical appraisal of studies and general data analysis were undertaken by Samia Alhabib. Meta-analysis and sensitivity analysis were undertaken by Ula Nur. Samia Alhabib and Roger Jones drafted and finalized the manuscript. Potential Conflict of Interest None declared. Ethics Approval Not required. Funding None Kocacik F et al 2006 Garcia-Moreno C et al Bangladish 2006 Garcia-Moreno C et al Brazil 2006 Garcia-Moreno C et al Ethiopia 2006 Garcia-Moreno C et al Japan 2006 Garcia-Moreno C et al Namibia 2006 Garcia-Moreno C et al Peru 2006 Garcia-Moreno C et al Samoa 2006 Garcia-Moreno C et al Serbia 2006 Garcia-Moreno C et al Thailand 2006 Garcia-Moreno C et al Tanzania 2006 Xu X 2005 Sethi D 2004 Ruiz-Perez I 2006 Michelle Hynes et al 2004 XU X et al 2001 Fanslow.J and Robinson.E 2004 Hakimi et al 2001 study_id 38.25 (34.31, 42.20) 39.68 (37.28, 42.07) 27.13 (24.59, 29.68) 48.67 (46.89, 50.46) 12.84 (11.07, 14.61) 30.60 (28.27, 32.93) 48.59 (45.98, 51.19) 40.49 (38.11, 42.86) 22.80 (20.65, 24.96) 22.92 (20.81, 25.02) 32.86 (30.70, 35.02) 42.95 (39.02, 46.88) 34.85 (28.21, 41.49) 22.75 (18.64, 26.86) 24.91 (19.93, 29.90) 38.00 (34.12, 41.88) 16.98 (15.03, 18.94) 10.98 (8.76, 13.20) ES (95% CI) 0 10 20 30 40 50 60 70 80 90100 Fig. 6 Forest plot of high quality studies on life time prevalence of physical violence 376 J Fam Viol (2010) 25:369–382 Study ID Population % & Violence type sampling Sample size Response Case definition instrument CI ?Bias Score Hakim et al. 2001, population study Indonesia (Java) P (LT: 11%, C: 2%), S (LT: 22%, C: 13%), E (LT: 34%, C: 16%) ? 765 94% Yes WHO interview Yes Yes 7 Hynes et al. 2004, population study East Timor Current, P; 24.8% (19.9–29.8), E; 30.5% (22.2–38.8), S; 15.7% (8.6– 22.8) Random 288 74% Yes WHO interview Yes Yes 7 Haj-Yahia et al. 2000, population study Palestine Annual incidence; E; 52%,P; 52%, S; 37.6%, EC; 45% Random 2,800, 1,500 86.7%, 88.9% Yes CTS & ISA, Self-administered No No 6 Nikki et al. 2000, community clinic Latin Current overall prevalence; 19% Non-random 1,001 ? Yes ?AAS, interview No No 4 Naved et al. 2006, population study Bangladesh LT prevalence P; 39.7% (Urban), 41.7% (Rural), current P; 19% (Urban), 15.8% (Rural), Random 2,702 96% Yes CTS, interview No Yes 7 Mousavi et al. 2005, population study Iran LT overall; 36.8%, Incidence; 29.3%, P; 27.2%, E; 32.4% Random 386 87.5% No Others, interview No Yes 5 Fawole et al. 2005, population study Nigeria P; Current 31.3% Random 431 ? No Others, self-administered No Yes 4 Khawaja and Barazi 2005, population study Jordan LT P; 42.5%, C; 17.4% Random 262 (women) 95% Yes Others, interview No No 4 Seedat et al. 2005, population study U.S LT P; 16% Random 637 71% No Others, telephone interview No Yes 5 Amar and Gennaro 2005, college students U.S P; C; 48% Non-random 863 ? Yes AAS, self-reported No No 4 Koziol-McLain et al. 2004, ED New Zealand P; C; 21.3%, LT; 44.3% Random 174 60% Yes interview Yes Yes 6 Fanslow and Robinson 2004, population study New Zealand LT P, (Auckland); 15%, 17% (North Waikato) S: 9% in Auckland, 12% in North Waikato. Random 2,855 66.9% Yes WHO interview Yes Yes 8 Ramiro et al. 2004, population study Egypt, India, Philippine, Chile LT; (P): (Egypt); 11.1%, India= 34.6%, Philippines = 21.2%, Chile= 24.9% Random 422 (Chile), 631 (Egypt), L; 506, T; 700, V; 716, 1,000 (Philippines), Brazil=813 96.1%(Chile), 93.5%(Egypt), 88%(India), 100% (Philippine) Yes Developed by researchers using focus group, interview Yes Yes 7 C; (P): Chile= 3.6%, Egypt=10.5%, India=25.3%, Philippines= 6.2% LT; E; Chile= 50.7%, Egypt= 10.5%, India=24.9%, Philippines=19.3%. C; E; Chile=15.2%, Egypt=10.8%, India=16.2%, Philippines=4.8% Swahnberg K et al. 2004, Gyn. clinic Sweden LT E; 16.8, P; 32.1%, S; 15.9%, non-random 2,439 81% Yes NorAQ No Yes 6 Koenig et al. 2004, population study Uganda LT coercive sex; 24% ? 4,279 93% Yes Interview, other methods No Yes 5 ? Swahnberg I M et al. 2003, population study Sweden, validation study of NorAQ LT P; 36.4%, S; 16.9%, E; 21.4% random 1,168 61% Yes NorAQ Yes Yes 7 Grande et al. 2003, population study South Australia LT P; 16%, E; 19% random women=2,884 73.1% Yes Others, telephone survey Yes Yes 8 Harwell et al. 2003, population study American Indian C P; 5%, E; 18%, LT for both; 12% random women=588 94% Yes Others, telephone survey No Yes 6 Murty et al. 2003, population study Iowa C P; 2.9%, E; 46.7% random 689 67.1% Yes CTS, interview No Yes 7 ? Bensley et al. 2003, population study Washington C P; 1.9%, E; 5.1% random 3,527 57% Yes BRFSS Yes Yes 7 Maziak and Asfar 2003, primary care. Syria C P; 23% random 411 97% Yes Others, interview No Yes 6 El-Bassel et al. 2003, ED New York, American Latin C P, 15%, S; 6%, LT P; 43%, S; 20% Non-random 143 Not reported No Others, interview No No 1 Llika et al. 2002, primary care center Nigeria C overall; 40%, P; 15.8%, E; 20.1% random 300 100% Yes Others, interview No No 5 Okemgbo et al. 2002, population study Nigeria LT P; 78.7, %, S; 21.3%, Mutilation; 52.7% Random 308 Not reported Yes Others, interview No No 4 Basile 2002, population study U.S LT S; 34% Random 602 50% Yes Others, telephone survey No No 4 ? Coker et al. 2002, population study U.S LT P; 13.3%, S; 4.3%, E; 12.1%. Random 6,790 72.1% Yes CTS, telephone survey Yes No 7 Jewkes et al. 2002, population study South Africa LT P; 24.6%, Current; 9.5% Random 1,306 90.3% Yes Others, interview Yes Yes 7 Appendix Summary Table of the include studies: J Fam Viol (2010) 25:369–382 377 az-Olavarrieta et al. 2002, Hospital study Mexico P and/or S; C; 9%, LT; 26.3%. Non-random 1,780 71.9% Yes Self-administered,, AAS No No 5 Coker et al. 2002, family practice South Carolina LT P; 41.8%, S; 21.4%, E; 12.1%. ? 1,152 73% Yes Interview, ISA- to measure the severity of physical + AAS, web Scale for E, No Yes 6 Melnick et al. 2002, surgical trauma clinic U.S C P; 18% Not-reported 127 Not-reported Yes PVS, self-administered Yes Yes 5 Romito and Gerin 2002, ER +Community center Italy C P and/or S; 10.2% Non-random 510 76% Yes Others, interview No Yes 5 Raj and Silverman 2002, population study South Asian women in Boston C P; 26.6%, S; 15%, LTP;30.4%, S; 18.8% Snowball? 160 Not-reported Yes CTS, self-administered No No 3 Brokaw et al. 2002, ED New Mexico LT P; 47.3% Random 421 67.1% No Others, interview No Yes 5 Krishnan et al. 2001, ED U.S LT P; 72%, S; 20%, E; 92% Non-random 87 70% No Others, interview No No 2 Grynbaum et al. 2001, primary care Israel C P; 21.7%, Incidence; 10% Non-random 133 95.7% No PVS, self-administered No No 3 Barnes et al. 2001, University students African American LT P; 15.6%, E; 11.7% random 179 47% Yes ISA, self-administered No No 4 Weinbaum et al. 2001, population study California C P; 6% random 3,408 70% Yes CTS, telephone survey Yes No 7 Parkinson et al. 2001, Paediatric clinic Massachusetts C P; 2.5%, LT; 16.5%. Non-random 553 71.2% No Others, self-administered Yes No 4 Coid et al. 2001, primary care London LT P; 41%, S; 9% Non-random 1,207 55% Yes Others, self-administered No No 3 Subramaniam and Sivayogan 2001, community health center Sri Lanka LT P; 30%, C; 22% random 417 55% Yes Others, interview No Yes 5 Jewkes et al. 2001, population study South Africa 1) Eastern Cape (n=396): LT P; 26.8%, C P; 10.9%, LT S; 4.5%, C E; 51.4%. random 1,306 90.3% Yes Others, interview Yes Yes 7 2) Mpumalanga: (n=419), LT P; 28.4%, C; 11.9%, LT S; 7.2%, C E; 50%. 3) Northern Province: (n=464); LT P; 19.1%, C; 4.5%, C E; 39.6% Plichta and Falik 2001, population study U.S LT P; 19.1%, S; 20.4% ? 1,821 ? Yes CTS Yes No 5 Bauer et al. 2000, primary care California 1) C P; 10%, S;3%, E; 10%, random 734 74% Yes AAS, telephone survey No No 6 2) LT P; 45%, S; 17%, E; 34% Harwell and Spence 2000, population study Montana C P; 3% random 1,017 90% Yes Others, telephone interview Yes Yes 7 Coker et al. 2000, population study south Carolina LT P; 10.6%, S; 7.8%, E; 7.4% random women=314 69.4% Yes ASS, telephone survey Yes Yes 8 Caetano et al. 2000, population study U.S couples C P black; 23%, Hispanic; 17%, whites; 12% random White=555, Black=358, Hispanic=527 85% Yes CTS, interview No No 6 ? CDC 2000, population study. South Carolina LT P; 10.6%, E; 7.4%, S; 7.8% random 313 women 69.4% Yes AAS, telephone survey Yes No 7 ? CDC 2000, population study. Washington LT P; 23.6% random 2,012 women 61.4% Yes CTS, telephone survey Yes No 6 Coker et al. 2000, family practice South Carolina LT P; 40%, E; 13.6%, C P; 8.9%, E; 7.5% Non-random 1,152 73% Yes Interview, ISA to measure current abuse, WEB to assess battering, AAS to measure life-time abuse No Yes 6 Coker et al. 2000, family practice Columbia LT P; 32%, S;17.3%, E; 12.5%, C P; 18.9%, S; 14.4%, ? 1,401 89% Yes Interview, ISA; for current S &P, WEBS; for battering, ASS; for life-time No No 5 Ernst et al. 2000, ED U.S C P; 5%, LT; 38.6% ? Random 57 78% Yes Self-reported, ISA No Yes 5 Ellsberg et al. 1999, population study Nicaragua LT P; 40%, C; 27% ? 488 100% Yes CTS, Interview Yes Yes 7 Tollestrup et al. 1999, population study Mexico C P; 6.7%, E; 13.5 Random 2,415 75 Yes CTS, telephone survey No Yes 7 Deyessa et al. 1998, population study Ethiopia LT P; 45% (n=303), C; 10% Random 673 ? Yes Others, interview No Yes 5 Kershner et al. 1998, community clinic Minnesota LT P; 37%, C P; 6.6%, E; 21.1%, S; 2.1%, Non-random 1,693 82.4% Yes Others, self-administered No Yes 5 ? CDC 1998, population study Georgia C P; 6%, LT; 30% Random 3,130 78% Yes Others, telephone survey Yes No 6 Pakieser et al. 1998, ED Texas LT P; 37%, C; 10%. Non-random 4,448 40% Yes Others, self-administered No No No 378 J Fam Viol (2010) 25:369–382 Sachs et al., ED California LT P; 14.7%, C; 3.9% Non-random 480 women 66.2% Yes Others, self-administered Yes No 5 Magdol et al. 1997, population study New Zealand C P; 27.1%, E; 83.8% Schei et al. 2006, population study Australia LT P/E/S; 27.5% Random 356 90% Yes CTS, interview No No 6 Yuan et al. 2006, population study Native American LT P;45%,S; 14% Random 793 98% Yes Others, interview No No 5 Avdibegovic et al. 2006, psychiatric clinic Bosnia and Herzegovina LT,P; 75.9%, P & S; 43.5%, E; 85.6% Random 283 89.5% Not reported DVI, interview No No 4 Kocacik et al. 2006, population study Turkey LTE; 53.8%, P 38.3%, S;7.9% random 583 100% Not reported WHO, interview No No 5 WHO, Garcia-Moreno et al. 2006, population study Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa (National), Serbia, Thailand, Tanzania, Bangladesh: LT (P:39.7%, S:37.4%), C (P19%,S:20.2%) random 24,097 Japan (60.2%), other countries range; 85– 97.8% Yes Interview, built on CTS Yes Yes 8, in Japan=7 2-Brazil: LT (P27.2%,S 10.2%), C (P8.3%,S 2.8%). 3. Ethiopia: LT (P48.7%, S 58.6%), C (P29%, S 44.4%). 4. Japan; LT (P12.9%, S 6.2%), C (P3.1%, S 1.3%). 5. Namibia: LT (P30.6%,S 16.5%), C(P15.9%,S9.1%). 6. Peru: LT (P48.6%,S 22.5%), C (P16.9%, S 7.1% ). 7. Samoa: LT (P40.5%, S 19.5%), C (P17.9%, S 11.5%). 8. Serbia: LT (P22.8%, S 6.3%), C (P3.2%, S 1.1%). 9. Thailand: LT (P22.9%, S 29.9%), C(P7.9%, S 17.1%). 10. Tanzania: LT (P32.9%, S 23%), C (P14.8%, S 12.8%). Hicks et al. 2006, population study Chinese American LT P;13%, C; 3%, random 323 56% Yes CTS, interview Yes Yes 7 Yang et al. 2006, population study Taiwanese aboriginal tribes LT prevalence P; 15%, C; 10.1%, S: 4% random 876 84.7% No ASS, interview Yes No 6 Thompson et al. 2006, population study Washington LT prevalence (P; 44%, S: 30.3%, E: 35.1%) random 3,568 56.4% Yes WEB, telephone survey No No 5 Ruiz-Perez et al. 2006, general practice Spain LT prevalence; P: 14.3%, E: 30.8%, S: 8.9% Random 1,402 88.35% Yes WHO, self-administrated No No 6 Ergin et al. 2005, primary care Turkey (Bursa) LT P; 34.1%, E; 15.8%, economic; 8.2%, all-type violence; 29.5% Not reported 1,427 71% Yes AAS, interview No Yes 6 McCloskey et al. 2005, population study Mohsi (Tanzania sub-Saharan Africa) LT P: 19.7%, S: 3.4%, C: P; 16.2%, S: 1.4%. Random 1,444 71% Yes One item from CTS, and 2 items from AAS, one item from SES, interview Yes No 7 Overall prevalence: 26% Bengtsson-Tops 2005, psychiatric clinic Sweden LT P; 28%, S; 19%, Economic; 16%; E; 46%. Non-Random 1,382 79% Yes Others, interview No No 4 C; P; 6%, S;3%, Economic; 6%, E; 22% Kyu and Kana 2005, population study Myanmar (South-East Asia), C; P; 27%, E; 69% Random 286 82% Yes CTS, self-administered No No 5 Burazeri et al. 2005, population study Albania C; P; 37% Random 1,196 87% No Others, interview Yes No 5 Mayda and Akkus 2004, population study Turkey LT P; 41.4%, E; 25.98%, S; 8.6%, E; 77.6% Non-Random 116 100% Yes Others, interview No Yes 4 McFarlane et al. 2005, primary care U.S C P&S; 8.9% in White, 6% in African American, 5.3% in Hispanic. Non random 7,443 Not reported Yes Others? No No 4 Romito et al. 2005, family practice Italy Overall P, S, E, LT: 27.4%, C: 19.9% Non random 444 78.6% Yes Others, self-administered No No 4 Newman et al. 2005, paediatric ED Chicago C P & S; 11% Non random 461 Not reported Not reported AAS, self-administered No No 3 Hegarty and Bush 2002, general practice Australia LT, P: 23.3%, E: 33.9%, S; 10.6% random 2,338 78.5% Yes AAS, self-administered Yes No 6 J Fam Viol (2010) 25:369–382 379 Dal Grande et al. 2003, population study Australia LT P; 16%, E; 19%. random 6,004 73.1% Yes Others, telephone interview Yes Yes 7 Xu X et al. 2005, gynecology clinic China (Fuzhou) Overall LT P, S, E; 43%, C; 26% random 685 89% Yes WHO Q, interview Yes No 7 Parish et al. 2004, population study China LT P; 34% random 1,665 women 76% No Others, interview No No 4 John et al. 2004, gynecology clinic North England LT P; 21%, C: 4% Non random 920 90% Yes AAS, self-administered No No 5 Romito et al. 2004, primary care Italy LT P; 14.1%, S; 17.6%, E; 16.4% Non random 542 8.6% Yes Others, Self-administered Yes No 5 C: P; 5.2%, S: 5.2%, E: 19% Serquina-Ramiro et al. 2004, population study Manila LT P; 47.2%, C; 29% Random 1,000 90% Yes WorldSAFE, interview No Yes 7 Rivera- Rivera et al. 2004, population study Mexico LT P; 35.8% random 1,641 93.5% Yes CTS, interview Yes Yes 8 Keeling and Birch 2004, Hospital Warral, UK LT ?P: 34.9%, C; 14% Non random 294 99.3% No AAS, self administered Yes No 4 Cox et al. 2004, ED Northern Canada Overall life-time P & E: 51%, C: 26%, random 1,223 80% Yes Others, interview Yes Yes 8 Incidence: 18% Kramer et al. 2004, primary care U.S LT: P; 49.5%, S; 265, E; 72%. Non random 1,268 9% in each cell Yes AAS, self administered Yes No 6 C; P; 11.7%, S; 4.2%, E; 27.9%. Sethi et al. 2004, ER UK Life-time P.; 34.8%, C; 6.1% Non random 228 86.8% Yes WHO Q, interview Yes No 5 Peralta and Fleming 2003, family medicine Madison, Wisconsin C; P: 10.3%, E; 43.5% Non random 399 Not reported Yes CTS, self reported No No 4 Ruiz-Perez et al. 2006, primary care Spain LT of any violence; 22.8% Non random 449 89.08% Yes WHO Q, self administered No No 5 Lown et al. 2006, population study California C P; 27.4%, S; 6.7% Non random 1,786 85% Yes CTS, interview Yes Yes 7 Ghazizadeh et al. 2005, population study Iran LT P; 38%, C; 15% random 1,040 97% No Others, interview No No Faramarzi et al. 2005, obstetric/ gynecology clinic Iran C P; 15%, S; 42.4%, E; 81.5% Non random 2,400 Not clear Yes AAS, interview No No 5 Ahmed and Elmradi 2005, medical center Sudan C P & E; 41.6% Non random 492 86.8% Yes Others, self-administered No No 4 Evans-Campbell et al. 2006, population study New York LT P; 40% random 112 women 83% No Others, interview No Yes 4 op-Sidibe et al. 2006, population study Egypt LT P; 34.3%, C; 47% random 6,566 99% Yes Others, interview No No 5 Apler et al. 2005, primary care Turkey LT P; 58.7%, C P; 41.1%%, E; 33.6% Non random 506 Not reported Yes AAS, interview No No 4 Coid et al. 2003, general practice Hackney, east London LT S; 24% Non random 1,206 54% Yes Others, self administered Yes No 4 Siegel et al. 2003, pediatric setting U.S Incidence; 6%, LT P; 22%, C: 16% Non random 435 Not reported No Others, self administered No Yes 3 Boyle and Todd 2003, ED Cambridge LT P; 21.3%, C; 6.1%, incidence: 1.2% random 307 84.8% Yes Others, interview Yes No 5 Shaikh et al. 2003, obstetric/ gynecology clinic Pakistan LT P; 55.9%, E; 75.9%, S; 46.9% Non random 307 70.4% Yes Others, interview No No 3 Richardson et al. 2002, general practice East London LT P:;41%, C; 17%, E; 74% Non random 2,192 64% Yes Others, self administered Yes Yes 6 Bradley et al. 2002, general practice Ireland LT P; 39%, E; 54% Non random 2,615 72% Yes Others, self administered Yes No 5 Mazza et al. 2001, population study Australia Overall LT prevalence; 28.5%, E; 17%, S; 40.8%, Non random 395 90% Yes CTS, self-administered Yes No 6 Zachary et al. 2001, ED New York C P; 7.9%, LT; 38% Non random 795 76.8% Yes CTS, interview No Yes 6 Az- Olavarrieta et al. 2001, hospital study Mexico LT P; 14%, E; overall; 40%, S; 9.3% Non random 1,255 83% Yes Others, elf-administered Yes No 5 Augenbraun et al. 2001, hospital study Brooklyn, NY LT P; 37.6%, E; 32.8%, C P; 15.5%, E; 19.1% Non random 375 96% Yes Others, elf-administered No Yes 5 Lown and Vega 2001, population study Fresno County, California C P; 10.7% Random 1,155 90% Yes AAS, self-administered Yes Yes 8 Hedin et al. 2000, gynecology clinic Sweden C; P; 6%, S; 3%, E; 12.5% Non random 207 64% Yes SVAW, self-administered No No 3 Jones et al. 1999, HMO survey Washington DC LT P, S, E; 36.9%, C; 4% Non random 10, 599 14% Yes AAS, self-administered No No 4 Duffy et al. 1999, pediatric ED New England city LT P; 52%, S; 21%, Non random 157 Not reported Yes AAS, interview No Yes 4 Fikree and Bhatti 1999, primary care Pakistan, Karachi LT P; 34% Non random 150 Not reported No Others, interview No No 1 Dearwater et al. 1998, ED Pennsylvania & California LT P/E; 36.9%, C P/S; 14.4% Non random 4,641 74% Yes AAS, self-administered Yes Yes 7 Ernst et al. 1997, ED New Orleans LT non P; 22%, P; 33%, C non-Pl; 15%, current P; 19% random 283 women 94% Yes ISA, self-administered No No 5 380 J Fam Viol (2010) 25:369–382 References Anderson, K. 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APA Module Assignment For this assignment, you will review materials in the DeVry library to help gain a better understanding of APA citations. a.    Click https://hub2.devry.edu/node/272 b.    Listen to the tutorial or download and review the transcript on APA and answer the questions below After reviewing the presentation, compose a 2-paragraph response in which you address each of the following points: 1.    Why is APA style used to document ideas in writing? What is the purpose of the in-text citation? Demonstrate your understanding of the in-text citation by providing an in-text citation for the article you summarized for the week 2 assignments. (15 points) 2.    In the article that you summarized in week 2, you may have found some information that you want to quote directly. To demonstrate the process for citing a direct quote, provide an example of properly quoted material. (20 points)